[Caries prevention in historical perspective. Oral hygiene]. / Serie: Cariëspreventie in historisch perspectief. Mondhygiëne.

Since the beginning of the twentieth century, the ability to prevent caries has greatly improved. This is due to both increased knowledge about the origin of dental caries, and to the availability of effective aids to oral hygiene, such as fluoride toothpaste. The effect of oral hygiene on the general population has also risen because more and more people brush their teeth.

[Caries prevention in historical perspective. Social factors]. / Serie: Cariëspreventie in historisch perspectief. Maatschappelijke factoren.

At the beginning of the twentieth century, children from poor families had less caries than children from affluent families. Later this changed: as the socio-economic status of the parents was higher, the children had less dental caries. The same relationship between socio-economic status and caries prevalence was later evident in adults. Throughout the twentieth century, in individuals with a low socio-economic status more teeth were extracted than in individuals with a high socio-economic status. At the end of the twentieth century, oral health in general was much better than at the beginning. That change is partly due to increased prosperity, increasing attention to oral hygiene, the introduction of fluoride toothpaste and the strong increase in the number of professionals in oral care. Increased knowledge of the causes and prevention of caries also played a role, if a less prominent one.

[Series: Caries prevention in historical perspective. Fluoride]. / Serie: Cariëspreventie in historisch perspectief. Fluoride.

Shortly after the Second World War it became known in the Netherlands that fluoride can contribute to the prevention of dental caries. As to how this effect was achieved, opinions differed. Initially, the dominant the view was that fluoride had to be absorbed into the enamel and dentine during tooth formation to make the teeth resistant to caries. Later it was discovered that decalcification of the enamel is inhibited if fluoride is present in the dental plaque. While in the beginning water fluoridation was considered to be the most effective measure to prevent caries, the current position is that tooth brushing with fluoride toothpaste plays the most important role in caries prevention.

[Series: Caries prevention in historical perspective. Early treatment of carious lesions]. / Serie: Cariëspreventie in historisch perspectief. Vroegtijdige behandeling cariëslaesies.

In the Dutch Journal of Dentistry the opinion is often expressed that treatment of carious deciduous teeth is necessary to reduce the risk of dental caries in the permanent teeth. It is clear that early restorative treatment of caries lesions can contribute to the preservation of teeth. The question is whether such a treatment also has a primary preventive impact on other not yet affected teeth. Results of epidemiological research carried out in the period 1960-1980 do not support the view that it does. To combat the 'disease' caries in children restoration of carious teeth alone will not suffice. Professional oral care in young children should be focused primarily on removing the causes of dental caries by insisting on improvements in hygiene and diet.

[Series: Caries prevention in historical perspective. Education]. / Serie: Cariëspreventie in historisch perspectief. Voorlichting.

In the Netherlands, since the end of the nineteenth century, information has been given to the public about possible ways to prevent dental caries. This happened in the dental offices, in health centres where the parents of young children received advice, and in schools. From 1968 until the mid-1980s, large-scale information campaigns were organised in various municipalities and regions. The Ivory Cross, a Dutch society for oral health education, has been providing information on oral health and supporting the provision of information for, among others, dentists and dental hygienists by offering educational material. The understanding of the phenomenon 'information' has changed during the past century. By applying new insights, there is an increased chance to prevent caries by providing information.

[Series: Caries prevention in a historical perspective. Food]. / Serie: Cariëspreventie in historisch perspectief. Voeding.

Different ideas on the impact of diet on the occurrence of dental caries that have been of influence during the last 125 years are discussed. The initial premise was that deficits in calcium and vitamins during the formation phase of the teeth were the cause of their high caries susceptibility. That idea has been abandoned. The frequency with which someone eats or drinks after the eruption of the teeth and the avoidance of quickly degradable carbohydrates in the diet now appear to be the most important factors for the development of caries lesions. The question whether nutrition education is still needed now that caries can be prevented by cleaning teeth with fluoride toothpaste, is discussed.

[Research for sale. Risks of contract research]. / Onderzoek tegen betaling. Risico's van contractonderzoek.

In recent years it has become more and more apparent that contract research not only has obvious advantages, but risks also. It has been found that occasionally investigators are pressed to modify the conclusions of their work if the conclusions conflict with the interests of the funding organisation. In other cases, the publication of results is obstructed or retarded. Not only commercial companies, but also governmental and other non-profit institutions are guilty of these practices. If research findings are not presented or are presented in an altered form, not only will science be obstructed, but also the entire society will suffer. The responsibility for preventing these practices not only falls with the investigators, but also with their research institutions and the funding organisations.

[Oral health care in nursing and old people's homes and institutions for the mentally handicapped]. / Mondzorg in verpleeg- en verzorgingshuizen en instellingen voor verstandelijk gehandicapten.

Staff members and residents of nursing homes and old people's homes were interviewed about the facilities and provision of oral health care. Clinical examinations were performed to obtain data about the oral health status of the institutionalised elderly. Results show that in most cases the oral health care facilities were insufficient to give care to persons with natural teeth. Of the edentulous elderly 43% reported that the retention of the lower denture was insufficient.

Dental caries prevalence and the use of fluorides in different European countries.

Data in a WHO report relating caries prevalence and the use of fluorides in different European countries were compared with data obtained directly from investigators in the field of oral epidemiology. The reliability of DMFT indices of 12-year-old children, mentioned in the WHO report, appeared sufficient to make comparisons between countries on the basis of these data. The WHO data files on the different applications of fluoride were incomplete. When figures were present, they were not always in agreement with those from the investigators. A decrease of the DMFT indices could be shown in a large number of countries. In further comparative studies between European countries, cultural differences (in dietary habits, for instance) should be taken into account.

Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder.

A nationwide survey of oral conditions, treatment needs, and attitudes toward dental health care in Dutch adults was carried out in 1986. One of the aims of the study was to assess the prevalence of signs and symptoms of temporomandibular disorder (TMD). A sample of 6577 persons (from 15 to 74 yr of age), stratified for gender, age, region, and socio-economic status, was contacted. Of this sample, 4496 persons participated in the behavioral part of the study, of whom 3526 were examined clinically. The TMD prevalence was based on (1) perceived signs and symptoms of TMD and (2) clinical examination of joint sounds, deviation, and pain on mandibular movements. A total of 21.5% of the Dutch adult population perceived some dysfunction, and 44.4% showed clinically assessed signs and symptoms of TMD. In nearly all age groups, the signs and symptoms of TMD appeared more in women than in men. Agreement between the results of the clinical examination and the anamnestic dysfunction index was significant (p < 0.0001); however, the Pearson's correlation coefficient was low (r = 0.29). The odds-value (risk-ratio) that subjects who perceived signs and symptoms of TMD would present with clinically assessed signs and symptoms of TMD was 2.3. The results of the survey were compared with results of a meta-analysis performed on 51 TMD prevalence studies. The analysis revealed (1) a perceived dysfunction rate of 30% and (2) a clinically assessed dysfunction of 44%, both based on compound samples of, respectively, over 15,000 (23 studies) and over 16,000 (22 studies) randomly selected subjects.

Leukocyte adhesion deficiency in a Dutch Holstein calf: a case with a clear-cut family history.

A leukocyte adhesion deficiency characterized by recurrent (predominantly bacterial) infections, lack of extravascular polymorphonuclear leukocyte (PMN) and pus formation has been described first in humans and then in dogs, and recently also in cattle. Because of important clinical similarities, a unitary explanation for the leukocyte adhesion deficiency (LAD) syndrome in mammals is proposed, inasmuch that an intrinsic leukocyte defect (i.e. mutations in genes encoding the common CD18 subunit), is thought to cause the disease. However, thus far, the hallmark of such intrinsic leukocyte defects, notably their heritability (or familial incidence), has not (yet) been unequivocally demonstrated. This is the first report to describe the occurrence of four Dutch bovine LAD (BLAD) cases with the clearest familial clustering observed to date. The diagnosis was based on the clinical features of very poor thriving, in general, of the calves, hyperneutrocytosis without appreciable left shift, and the absence of PMN CD11a, or CD11b, or CD11c using monoclonal antibodies (mAb) and/or Concanavalin A binding activity of PMN lysates in immunoblots. Interestingly, a familial clustering was observed also for below-normal PMN CD11c expression. Thus, a cow with low CD11c expression (50.4%) and delivering three of the study BLAD calves, also had a healthy descendant with low (44.9%) PMN CD11c expression. These findings suggested the possibility that both subnormal expression and lack of PMN CD11 expression are inheritable factors in cattle. Furthermore, a large prospective study using the present mAb for selecting relatives expressing the complete spectrum (0 to > or = 90%) of PMN CD11/CD18 expression would create a comprehensive study population for understanding both the role of genetic factors and of survival strategies in BLAD.

Ethnicity and maternal education as risk indicators for dental caries, and the role of dental behavior.

The aim of this study was to assess differences in dental health between socioeconomic and ethnic groups in a cohort of 5-yr-old children born in 1982 and in a cohort of 11-yr-old children born in 1976. A further aim was to evaluate the putative role of dental behaviors as intervening factors between ethnicity and maternal education on the one hand and caries experience on the other. A secondary analysis was performed on data collected in a study monitoring the oral health of youths covered by public health insurance (Ziekenfonds) in the Netherlands. The results showed both ethnicity and maternal education to be indicators of caries risk in the primary dentition. For caries in the permanent dentition, only maternal education could be identified as a risk indicator. Dental behaviors were related to caries experience as well as to ethnicity and maternal education, though the evidence for the role of these dental behaviors as intervening factors was weak. It is concluded that the validity and reliability of the behavioral measurements might be questionable and that the mechanism underlying the differences in caries experience between the various groups is still little understood.

Underestimation of the prevalence of approximal caries and inadequate restorations in a clinical epidemiological study.

UNLABELLED: The prevalence of clinically diagnosed approximal caries and inadequate approximal restorations is usually underestimated, when compared with radiographic assessment as a 'gold standard'. OBJECTIVE: The aim of this study was to determine the degree of this underestimation in a clinical epidemiological project. METHODS: Clinical data (n = 951) of 17- and 23-year-olds were collected by calibrated examiners and bitewing radiographs were taken after obtaining the participant's consent. The radiographic examination of the approximal surfaces on the radiographs of 621 participants was based on criteria derived from the clinical protocol. A second examiner judged 20% of the radiographic material to determine the interobserver agreement, using Cohen's kappa. The agreement proved to be good (kappa = 0.66) for dentine caries diagnosis, and fair (kappa = 0.44) for restoration assessment. RESULTS: Of the total number of recorded decayed or inadequately restored surfaces only 10.8% and 13.8% respectively were found clinically. Of the total number of clinically sound surfaces, 10.1% had dentine caries on the bitewing radiograph. The percentage of clinically adequate restorations needing replacement was 25.7%. CONCLUSION: It was concluded that the prevalence of approximal caries and inadequate restorations in this clinical epidemiological study was highly underestimated. At least for these age groups the results contain a serious warning for epidemiologists and general dental practitioners with respect to the outcome of clinical caries diagnosis.

Use of fluoride tablets and effect on prevalence of dental caries and dental fluorosis.

A study was executed to investigate the relation between the use of fluoride tablets by children in the age period 1.5-6 yr on the one hand and the caries experience at the age of 6 and 15 yr and the prevalence of fluorosis at the age of 15 yr on the other hand. The year of birth of the child, the motivation of the mother to engage in preventive dental behavior, the level of her school education and her place of birth were taken into account as possible confounding factors. A significant relation was found between the use of fluoride tablets and the prevalence of fluorosis. The most important predicting factor for the caries experience of the child was the mother's motivation to engage in preventive dental behavior. An effect of fluoride tablets on the caries experience could not be demonstrated.

Tooth loss and dental caries in Dutch adults.

As part of a nationwide dental survey in 1986 a caries study was executed in 3526 adults, aged 15-74 yr, living in 40 residential areas in The Netherlands. Marked differences were found between the social classes distinguished (more edentates in the lower classes) and between the different regions. It is supposed that these differences reflect the lack of dental manpower in the past.

Secular trends of caries prevalence in 6- and 12-year-old Dutch children.

Recently two papers have been published dealing with possible changes in the downward trend of caries experience among Dutch schoolchildren in the late 1980s. To answer the question if the decline of caries has come to an end, a meta-analysis was carried out on epidemiological data collected in 5-6 and 11-12-yr-old children between 1980 and 1990. From results of the present analysis it appears that after 1983 a halt in the decline of caries prevalence among 6-yr-olds occurred, whereas among 12-yr-olds, the earlier decrease in mean DMFS scores continued in the period 1980-89.

The problem of participation in the Dutch National Dental Survey.

In 1986 a nationwide dental survey was carried out in the Netherlands. The aims of the study were to assess the prevalence of oral diseases, need and demand for dental care and oral selfcare in the Dutch population aged 15-74 yr. This paper describes the general sampling and analysis procedures to detect selectivity in the participation. Irregular dental attenders seemed to be underrepresented in the final sample. Poststratification was used to overcome this problem of selectivity.

Objective and subjective need for cosmetic dentistry in the Dutch adult population.

In order to assess the objective and subjective need for cosmetic dentistry in the Dutch adult population in 1986 a stratified sample of 2784 dentate persons, aged 15-74 yr, participated in the study. The aesthetics of anterior teeth and first premolars in the maxillary mandibular arch were determined by dental examiners as well as by the examinees. According to the dental examiners 16-63% of the people in the age range from 15 to 74 yr were in need of cosmetic dental care. Based on the patient's opinion (subjective need) these percentages varied between 18 and 40% in the different age groups. The discrepancy between the objective and subjective assessment in the percentage of people in need of cosmetic dental care increased with age.

Malocclusion and orthodontic treatment need of 15-74-year-old Dutch adults.

In 1986 a nationwide dental survey was performed in the Netherlands. This article describes the prevalence of dentofacial anomalies in the age group 15-74 yr, as well as the subjective and objective need for orthodontic treatment. The main findings were: severe crowding in the mandible was found in approximately 15%; an Angle Class II situation was seen in 28%; a maxillary overjet of greater than 5 mm was found in 23%; orthodontic treatment had or was being performed in approximately 25%; 45% of orthodontic treatment was carried out by a general practitioner; using professionally defined need, 39% of the population required treatment whereas only 14% of the people felt that this treatment was necessary.

Risk indicators and potential risk factors for caries in 5-year-olds of different ethnic groups in Amsterdam.

The aim of this study was threefold: first, to assess the oral health of Turkish, Moroccan, Surinamese, Dutch and "other" 5-yr-old children living in Amsterdam; second, to identify risk indicators for caries, in addition to ethnicity; and third, to identify potential risk factors related to differences in caries experience in these children. Results showed the mean dmfs scores of Turkish and Moroccan children to be much higher than that of the Dutch and Surinamese children; 8.1 and 8.2 versus 3.6 and 3.4, respectively. The educational level of the parents and the gender of the children were important risk indicators, in addition to ethnicity. The age of the child at which the parents had started to brush their child's teeth, the use of fluoride tablets and the regularity of the brushing behavior in the past could be identified as potential risk factors.