The influence of examination of the assessment of the intra-examiner error by using the plaque and gingival index systems.

The plaque situation on 48 surfaces in 31 children 13 years of age was assessed. A re-examination within 2 hours indicated a significant increase in the number of O Plaque Index scores. Following paired comparison of each of the 48 areas, 22 % of the surfaces were found to have changed score. Significantly more scores indicating improvement of the plaque situation were found at the second examination. A re-examination of plaque on consecutive days in a similar group of children showed no significant changes. Re-examination of the gingival conditions within 2 hours indicated a significant increase in the number of scores of 2 and this was confirmed by the paired comparison on the 48 surfaces. The findings indicate systematic errors rather than intra-examiner inconsistency.

Effect of mouth rinsing and toothbrushing with fluoride solutions on caries among Norwegian schoolchildren.

The caries experience and the plaque and gingival conditions of 14-year-old children participating in fortnightly fluoride (0.2 % NaF) mouth rinsing (88 subjects) were compared with observations in children performing supervised toothbrushing with a fluoride (0.5 % NaF) solution 4-5 times per year (n = 90). Most of the children, 84 and 90% respectively, had participated in these programs for the previous 6 years. Caries was assessed only on radiographs. The mean number of decayed surfaces was 5.8 (s.d. = 4.1, n = 88) and 5.4 (s.d. = 4.1, n = 90). The mean numbers of decayed and filled surfaces were 19.3 +/- 9.2 and 27.9 +/- 10.2 for subjects with rinsing or brushing. This significant difference could not be ascribed to sex, social class, years of residence in the towns, number of dentists performing the previous treatments, toothbrushing habits, use of fluorides at home, or amount of plaque. All children had gingivitis. There were no differences in the mean number of Plaque Index score 2 or the number of Gingival Index score 2 between the children with the different preventive programs. The girls' oral hygiene was better than the boys', but the gingival conditions were the same. Sex, social class, and toothbrushing techniques tended to have a slight influence on the amount of plaque.

Alveolar bone loss in the permanent first molars of Norwegian schoolchildren receiving systematic dental care.

A distance exceeding 2 mm from the cementoenamel junction (CEJ) to the alveolar bone was observed on the proximal surfaces of the first molars of proportionally more 15-year-olds (101 subjects) than 13-year-olds (99 subjects). The measurements were performed on bitewing radiographs, and the methodologic error amounted to 3%. Recordings in excess of 2 mm were most frequent (0.27 and 0.23) for the distal surfaces of the maxillary molars.

An approach to objective assessment of caries prophylactic measures in a dental health program.

In a retrospective survey the mean number of intact proximal surfaces on the first molars of 13-year-old children was found to increase from 2.6 to 4.8 following 7 years of a preventive program with fortnightly fluoride mouthrinsings (0.2% NaF). This improvement was significant and corresponded to a reduction of the totally filled surfaces from 30.0 to 16.6. Caries on the proximal surfaces on the first molars was assessed from bite-wing radiographs. Judged from interexaminer comparisons, the number of filled surfaces was a reliable parameter of the caries prevalence in 13-year-old children. In a group of 54 children aged 13 who participated in the preventive program, the caries experience on the proximal surfaces of the first molars was significantly associated with the total DMFS.

Caries experience as predictor for caries incidence.

The caries increment (filled surfaces) from the ages 7 to 15 years were compared in children with three or fewer (low prevalence group) or eight or more filled surfaces (high prevalence group) at the age of 8. The children participated in a fortnightly fluoride mouthrinsing program (10 ml of 0.2% NaF). Following 8 years of dental treatment and caries prophylaxis, the caries increments were 11.4 (s.d. = 7.7, n = 23 subjects) and 17.1 (s.d. = 9.6, n = 39 subjects) surfaces, i.e. significantly different (t = 2.376). Significantly (t = 4.034) more fillings had been required in the high than in the low prevalence group (31.1 +/- 17.1 vs. 15.5 +/- 9.6). The "risk group" could be identified at the ages of 7 to 8 by high caries prevalence and high ratio fillings/caries increment. Social class and number of teeth accounted more for the initial caries prevalence than for the caries increment. Correlation analyses revealed a significant, but not strong (r = 0.50), association between caries prevalence at the age of 7 and increment of fillings.

Comparison of 1% and 2% lidocaine hydrochloride used as single local anesthetic: effect on postoperative pain course after oral soft tissue surgery.

It is known that some local anesthetics may cause pain when the initial local anesthetic effect disappears. The aim of this trial was to compare the postoperative pain intensities after infiltration of plain lidocaine 1% and 2% used in gingivectomies. The trial was done as a controlled, randomized, double-blind, parallel group study involving 117 patients with mean age 48 years (range 29-71 years) allocated to two treatment groups. There was no statistically significant difference between the mean postoperative pain courses of lidocaine 1% and 2% after gingivectomies during an 11-h observation period. A numerical difference was seen from 7 to 11 h in favor of lidocaine 1%. There were more patients experiencing no pain, but more patients reporting higher pain scores in the lidocaine 2% group than in the lidocaine 1% group. These differences were not statistically significant. It can be concluded that there is apparently no difference between lidocaine 1% and 2% with respect to postoperative pain experience when using gingivectomy as a pain model.

Increase in volume of lignocaine/adrenaline-containing local anaesthetic solution causes increase in acute postoperative pain after gingivectomy.

A randomized, single-blind, within-patient, crossover study was done in 44 patients (27 women and 17 men mean age 47 years, range 29-63) who had bilateral 'identical' gingivectomies. On one occasion a standard volume of local anaesthetic containing lignocaine 2% and adrenaline (1/80 000) was infiltrated into the mucosal tissue before operation. On the other occasion double the standard volume was infiltrated. The intensity of pain postoperatively was recorded by the patients on 100 mm visual analogue scale every hour for an 11-hour observation period. The intensity of pain when double volume had been given was significantly higher than that after the standard volume from 2 to 8 hours postoperatively (P < 0.04), the median (range) being 52.0 mm (0.0-434.0) compared with 30.5 mm (0.0-359.0) after the standard volume (P < 0.005). Doubling the volume of local anaesthetic containing adrenaline that was infiltrated increased the intensity of acute pain after gingivectomy.

Infiltrated lidocaine 2% with epinephrine 1:80,000 causes more postoperative pain than lidocaine 2% after oral soft tissue surgery.

A controlled, randomized, double-blind, within-patient, crossover study was made with 50 patients (28 women and 22 men) of mean age 47 years (range, 32-69 years) who were subjected to identical bilateral gingivectomies. On one occasion, lidocaine 2% was infiltrated as the local anesthetic. On the other occasion, lidocaine 2% with epinephrine 1:80,000 was given. Postoperative pain intensity was recorded by the patients on a 100-mm visual analogue scale every hour during an 11-hour observation period. The mean pain intensity was numerically higher after lidocaine 2% at 0 hours and 1 hour postoperatively. Then the mean pain intensity after lidocaine 2% was lower than that after lidocaine 2% with epinephrine 1:80,000 throughout the remaining observation period. The difference in pain intensity was statistically significant (P < .05) at 2, 4, 5, 6, and 7 hours after surgery. Mean sum (SEM) pain intensity over the 11-hour observation period was lower (P = .03) after lidocaine 2%, 66.5 (13.4) mm than after lidocaine 2% with epinephrine 1:80,000, 92.6 (15.4) mm. The study shows that high epinephrine concentration (1:80,000) increases the postoperative pain after dental soft tissue surgery with mild pain.

Increase in volume of dental local anaesthetic solution while maintaining the tissue lidocaine and adrenaline concentration does not increase acute postoperative pain after gingivectomy.

A randomised, single-blind, within-patient, crossover study was done in 45 patients (29 women and 16 men, mean age 49 years, range 37-71) who had bilateral "identical" gingivectomies. On one occasion a standard volume of local anaesthetic containing 2% lidocaine and 1/80,000 adrenaline was infiltrated into the mucosal tissue before operation. On the other, double the standard volume with 1% lidocaine and 1/160,000 adrenaline was infiltrated. The intensity of postoperative pain was recorded by the patients on a 100 mm visual analogue scale every hour for an 11-hour observation period. The time courses and the sum of pain intensity after injection of the double and standard volumes did not differ significantly. Doubling the volume of local anaesthetic while maintaining the total lidocaine and adrenaline concentration that was infiltrated does not influence the intensity of acute pain after gingivectomy.

[Occurence of dental plaque among Norwegian children with systematic school dental care. A method for identification of patients with special need for dental plaque control]. / Plaqueforekomst blant en gruppe norske barn med systematisk skoletannpleie. En metode for identifikasjon av pasientgrupper med saerlig behov for plaquereduserende tiltak

The prevalence of dental plaque was assessed in 1534 school children 7-12 years old in Porsgrunn, Norway. Only the first molars and the incisors were examined. In each child 48 scorings were carried out by the Plaque Index (Pl I) (Silness & Löe 1964). The frequencies of Pl I score 0, 1 and 2 were calculated per individual, school class and school. Score 0 expresses an optimal situation whereas score 2 is assumed to indicate the need for treatment. These features have been visualized, and the distribution pattern seems to be suitable for dental public health workers. Mean Pl I was 1.50. Score 3 was not observed. 55% of the tooth surfaces was covered with dental plaque corresponding to score 2, whereas score 1 was observed in 40%. Children with score 0 on all tooth surfaces were not registered. Great variation in plaque prevalence was found between the school classes. The 6. grade (aged 12 years) children showed the best condition.

Serum antibodies and loss of periodontal bone in patients with rheumatoid arthritis.

The number of teeth, % of alveolar bone loss, serum IgG, and serum antibodies to Bacteroides gingivalis, Capnocytophaga ochracea and Eubacterium saburreum were recorded in 37 patients diagnosed with rheumatoid arthritis (RA) and in an age- and sex-matched control group of 37 individuals free from RA. The RA group had a significantly increased loss of teeth and loss of alveolar bone compared to the control group. The RA patients also had a significantly increased level of serum IgG. In the total material, 26% of the variation in loss of alveolar bone was accounted for by age, diagnosis of rheumatoid arthritis, and levels of antibodies against B. gingivalis and E. saburreum. In the RA group, 48% of this variation was accounted for by age, total serum IgG and IgG antibodies to B. gingivalis and E. saburreum.

Postoperative pain experience after gingivectomies using different combinations of local anaesthetic agents and periodontal dressings.

The present study examines postoperative pain experience following 243 gingivectomies in Norwegian patients using possible combinations of 3 local anaesthetics (lidocaine-adrenalin, prilocaine-felypressin or mepivacaine) and 3 periodontal dressings (Coe-pak, Wondrpak or Nobetec). When Coe-pak was used, the mean pain score was higher (P less than 0.05) in the group treated with lidocaine-adrenalin 4 to 6 h after gingivectomy than the groups treated with prilocaine-felypressin or mepivacaine. There was no significant difference between the groups treated with prilocaine-felypressin or mepivacaine. When Wondrpak or Nobetec were used, there was no significant difference between any of the local anaesthetics used. The present finding shows that the local anaesthetic combination of lidocaine-adrenalin (1:80,000) gives rise to a higher mean postoperative pain experience after gingivectomy than prilocaine-felypressin or mepivacaine. However, the relative difference in pain experience seen after gingivectomy when using the present local anaesthetic agents is masked when using an eugenol-containing periodontal dressing. Thus, the higher pain experience reported after lidocaine-adrenalin may only be clinically important when using periodontal dressings without local anaesthetic components such as eugenol.

Effect of non-eugenol- and eugenol-containing periodontal dressings on the incidence and severity of pain after periodontal soft tissue surgery.

This study examines the incidence and severity of postoperative pain after gingivectomy using one non-eugenol-containing periodontal dressing, Coe-pak (n = 76) and 2 eugenol-containing periodontal dressings, Wondrpak (n = 64) and Nobetec (n = 86). All patients were subjected to gingivectomy using 1 type of local anaesthesia (lidocaine + adrenalin) only and covering the surgical areas with either of the 3 different dressings in a randomized study. Postoperative pain was assessed on 100 mm visual analogue scales over 5 days starting immediately after surgery. No pain was reported by 22.0% of the patients after Coe-pak, 23.4% after Wondrpak and 30.2% after Nobetec. 13.2% of the patients took analgesics after Coe-pak treatment, 3.1% after Wondrpak and 1.2% after Nobetec. Mean pain score after Coe-pak was higher (P less than 0.05) than after Nobetec 2 h after operation until the morning on the 3rd postoperative day. Mean pain score after Coe-pak was higher (P less than 0.05) than after Wondrpak 3 h to 9 h after operation. No statistically significant difference was found between Wondrpak and Nobetec regarding mean pain score.

A dose-response study of adrenaline combined with lignocaine 2%: effect on acute postoperative pain after oral soft tissue surgery.

AIMS: The combination of lignocaine and adrenaline may cause more postoperative pain than other types of local anaesthetic agents with comparable clinical efficacy. This study investigates the dose-response effect of adrenaline added to lignocaine on postoperative pain, when used as local anaesthetic for oral soft tissue surgery. METHODS: A controlled, randomized, double-blind, parallel group study included 195 patients (108 females/87 males) with mean age 49 years (range 26-75 years). The patients were allocated to one of three treatment groups receiving lignocaine 2% (n = 66), lignocaine 2% with adrenaline 1 : 160 000 (n = 63) or lignocaine 2% with adrenaline 1 : 80 000 (n = 66). RESULTS: Lignocaine 2% with adrenaline 1 : 80 000 gave significantly more pain intensity than lignocaine 2% or lignocaine 2% with adrenaline 1 : 160 000. The postoperative pain intensity courses after lignocaine 2% and lignocaine 2% with adrenaline 1 : 160 000 showed a similar pattern except for the time period just after completion of surgery when lignocaine 2% with adrenaline 1 : 80 000 caused less pain. CONCLUSIONS: High adrenaline concentrations (1 : 80 000) combined with lignocaine local anaesthetic solution offers no advantage with respect to pain alleviation during the immediate postoperative pain period. High exogenous adrenaline concentrations may play a significant role in enhancing acute postoperative intensity.

[Autotransplantation of teeth]. / Autotransplantasjon av tenner. En oversikt og et behandlet kasus.

This article gives a review of autotransplantation of teeth. From being a method of rather poor prognosis, autotransplantation has developed to be a safe treatment procedure. Scientific criteria for selecting patients, donor teeth, surgical procedures and postoperative care has contributed to this. The surgical procedure and the endodontic treatment are discussed. The degree of root development is of importance. Complications may be extern root resorption and ankylosis because of damage to the periodontium.

Benefits and prognoses following 10 years of a fluoride mouthrinsing program.

This paper is based upon the mean annual amounts of fillings (filled surfaces) and the DMFS among 6/7- to 15/16-year-old children. Each age group comprised about 450 children. Cross-sectional recordings were available prior to the start of a caries-preventive program based on 2-weekly fluoride rinses. Cross-sectional and longitudinal DMFS recordings were different during the 10 years of observation. This indicates benefits exceeding the present 70% reduction in need for fillings and 50% improved caries prevalence. The ratio fillings needed for giving the DMFS score among 13- to 14-year-old children was found to improve from 1.60 to 1.16. Based on the cumulative amounts of fillings and the ratio of fillings/DMFS, a DMFS of 15 may be expected in 4 years among children 15-16 years old. This caries prevalence is not markedly different from DMFS recordings among Scandinavian children living in fluoride areas.

Periodontitis, caries and salivary factors in Sjögren's syndrome patients compared to sex- and age-matched controls.

The aims of this investigation were: (i) to study a group of dry mouth Sjögren's syndrome (SS) patients comprising individuals with pathological and non-pathological amounts of rest saliva and (ii) to compare these two categories of SS patients with a sex- and age-matched control group with respect to their periodontal and dental status. Thirty-three dry mouth patients and 33 sex- and age-matched patients, referred to the same private dental clinic in southern Norway, were examined for rest and stimulated saliva, as well as their dental and periodontal status. All patients were referred to the local hospital for blood and urine examinations. The dry mouth SS patients were all of the secondary type. Volumes of rest and stimulated saliva were significantly lower in the low saliva SS group compared with the high saliva SS group; the values for immunoglobulin G (IgG) and IgA were similarly lower for the low saliva group, but not for IgM which was significantly higher. The two SS subgroups and their controls were compared for the volume of rest and stimulated saliva, which showed a statistically significant lower volumes for the low saliva SS group compared with the control group. None of the subgroups and their controls differed concerning filled or missing teeth, but the total SS group revealed significantly higher number of missing teeth. The periodontal and dental status did not show any statistically significant differences except for a few scattered higher periodontal level losses of attachment in the SS subgroups. The blood and urine analyses showed statistically significant higher values for sedimentation rate, white blood cell count and haemoglobin in the SS low saliva group compared with the control group while anti-streptolysin was lower. In the high saliva SS group only sedimentation rate and white cell count were higher compared with the control. The conclusions is SS patients do not have an increased risk for developing periodontitis.