The implementation of field trials.

Even though a preventive agent has been shown to be powerful in reducing the incidence of, for example, dental caries when tested in a longitudinal clinical trial, it might not be as powerful when tested under more realistic environmental conditions. Field trials or field demonstration programs will provide the final evidence for determining if the agent or procedure is of such practical importance as to be included as a component in a dental care delivery system. The methodology developed for health services research provides the possibility of testing the effectiveness of a single or combined components in a dental care delivery system seen in relation to the environment and conditions under which it operates. The World Health Organization is at present involved in the implementation of a long range of field demonstration programs in various parts of the world especially in developing countries in order to establish the potential of known preventive procedures in population groups with different levels and different progression patterns of oral diseases.

Dental mutilations among villagers in Central Java and Bali.

In Central Java and on the island of Bali 779 and 437 villagers respectively were examined for dental mutilations. In Java 81.1% of the males and 99.2% of the females showed dental mutilations in the form of grinding the incisal and vestibular surfaces of the maxillary incisors and canines. In Bali, the figure for males was 91.3% and for females 96.6%. In Java as well as on the island of Bali most of the mutilations had been subjected to artificial staining. The authors have found a relief in the temple of Borobudur, built about 800 A.D., possibly depicting the performance of a dental mutiliation.

Forecasting progress in preventive dentistry.

Technological forecasting is a new discipline with research methodologies of its own. One of the methods is the delphi-experiment. Predictive experiments have been conducted in both medicine and pharmacology, but not yet in the field of dentistry and dental research. The first round of the present dental delphi-experiment was conducted in 1975 with the participation of an international panel consisting of 91 experts. The experts were requested to respond to six questions related to dental caries and six questions related to periodontal disease. Numerous forecasts concerning future developments or breakthroughs were given by the international panel. This report discusses the preliminary findings.

Anti-caries effect of a 2% Na2PO3F-dentifrice in a Danish fluoride area.

A 3-year experimental toothbrushing study was conducted in a natural fluoride area in Denmark to evaluate the anti-caries effect of a 2% sodium monofluorophosphate dentifrice. In a previous report the results for the total population of 1,407 schoolchildren, representing a broad age-span (7-12 years), at the commencement of the study in 1970 were given. In the present report results are presented for two subpopulations of "8-year-olds" and "11-year-olds" at the commencement of the study. Differential analysis of the effect of the test dentifrice on defined types of surfaces for the two subpopulations is given. The evaluation was performed using both the conventional DMF-indices and the recently published ECSI-Index6. The evaluation showed that the test dentifrice had a valuable anti-caries effect in both age groups, above and beyond the effect of the waterborne fluoride. Proximal surfaces were affected most baneficially by the active agent both in relative and absolute terms. However, an appreciable caries-preventive effect was also found on the "pit and fissure" surfaces.

Dental caries-reducing effects of a milk fluoridation project in Bulgaria.

OBJECTIVES: The aim of the present study was to investigate the effects of a community-based milk fluoridation project on dental caries. METHODS: Fluoridated milk was provided to about one-half of kindergarten and other schoolchildren in Asenovgrad, a town in the southern part of Bulgaria. The estimated daily milk consumption was 200 ml containing 1 mg of fluoride (approximately 5 ppm F). Cross-sectional samples of 6 1/2-year-olds in Asenovgrad and Panaguriche (a nearby town selected as the reference community) were examined at the start of the study in 1988 and after three years. Additional cross-sectional samples of 7 1/2-year-olds in Asenovgrad who were and were not drinking fluoridated milk were examined at baseline and at three years to provided an internal control group. Samples of 6 1/2 and 8 1/2-year-olds from Asenovgrad and Karlovo were examined in 1993 to provide for five-year follow-up comparisons. RESULTS: In 6 1/2-year-old children who had consumed fluoridated milk for three years, there was a decrease in the mean dmft per child of 40 percent and in the mean DMFT of 89 percent compared to children examined at baseline. Children in Asenovgrad who were 4 1/2 years old at the start of the study and had been drinking fluoridated milk for three years had on average 44 percent fewer dmft and 83 percent fewer DMFT at 7 1/2 years of age than those not drinking fluoridated milk. After five years the dmft index was 40 percent less and the DMFT index 79 percent less in those children who had participated in the full five years of the program compared to the control group. CONCLUSIONS: Results seem to confirm the caries-reducing effects of milk fluoridation found in previous studies. Unexpected large caries reductions obtained in this nonexperimental study, however, probably cannot be attributed to the fluoridation of milk alone. The mere introduction of the project might have led to other changes affecting dental caries, such as improved oral hygiene and better dietary habits.

Effect of an amine fluoride dentifrice on dental caries used in a community-based oral health education program.

OBJECTIVES: The purpose of this study was to investigate the caries-reducing effect of an amine fluoride toothpaste when used under real-life conditions in a community preventive program. METHODS: Approximately 12,500 children 3-12 years of age were provided with toothpaste (four tubes or 360 grams annually during three years) to be used in kindergartens or schools and once a day at home. The teachers supervised daily toothbrushing sessions. Random samples of children in each of the ages 3, 6, 9, and 12 years were selected from the intervention and the reference communities at both the start of the study and after three years, and examined for dental caries experience. RESULTS: Amine fluoride dentifrice seemed to provide a reduction in dental caries prevalence compatible to the most commonly used fluoride dentifrice compounds. CONCLUSIONS: The implemented fluoride toothpaste program is a feasible and practical method of improving the oral health status of children.

Preventive responses to various national problems.

The prevalence of dental disease appears to be increasing, especially in developing countries. The adoption of traditional Western-style oral health care delivery systems, which may be entirely inappropriate to the local circumstances, has resulted in the establishment of expensive and inefficient services in many parts of the world. In planning a realistic oral health service, administrators must first identify the problem, estimate available manpower in terms of number, type and distribution and identify the economic resources which can reasonably be allocated to oral health. Five categories of oral health status have been identified in various countries ranging from a situation characterized by very low, stable or increasing oral health problems with an acute shortage of manpower and almost non-existent dental care delivery system to the situation found in the most advanced countries where the oral health problem, though very high, may be already decreasing and where there is adequate manpower and delivery systems are highly developed. A preventive strategy for each of these five categories is presented which it is hoped would lead to an improvement of the oral status of the world's population as fast and as cheaply as possible.

Fluorides and dental fluorosis.

This paper attempts to review present knowledge on the ingestion and metabolism of fluoride in relation to the occurrence of endemic dental fluorosis, a condition caused by an excessive intake of fluoride during tooth formation. The clinical appearance of dental fluorosis is characterized by lustreless opaque white patches in the enamel which may become striated, mottled and/or pitted. The opaque areas may become stained yellow to dark brown. The affected teeth may show a pronounced accentuation of the perikymata and, in more severe cases, multiple pits and larger areas of hypoplasia of the enamel appear so that the normal morphology of the tooth is lost. Due to the universal presence of fluoride in water, soil and the atmosphere it is not surprising that humans are exposed to various levels of fluoride intake , not only through food and water, but in industrial and pharmaceutical products and other sources. Water-borne fluoride, however, has been said to represent the largest single component of this element's daily intake, except where unusual dietary patterns exist. The daily amount of fluoride intake through water varies with climate (maximum daily temperature) and age. It has been postulated that significant changes in patterns of food and beverage ingestion, because of changes in available products and the ways in which they are marketed as well as many foods and beverages being processed in fluoridated communities, may have caused a change in the prevalence and severity of dental fluorosis over the past 30 years. Since fluoride remains pre-eminent among the measures available for increasing the resistance of teeth to caries attack, continued and renewed research on the ingestion and metabolism still has high priority.

Transactions of an international conference. Worldwide concern: better dental care for more people. An international collaborative study. How oral surveys were conducted.

A special form and field manuals defining examination criteria were prepared for recording the following: 1. Number of teeth present both primary and permanent 2. Periodontal disease (a) Oral hygiene using the simplified oral hygiene index. (b) Periodontal condition using a modified P.I. index. (c) Periodontal treatment requirements. 3. Dental caries The DMF index was used with separate coding for filled or crowned teeth having additional primary or secondary decay. 4. Dento facial anomalies Both treatment need and treatment status were recorded. 5. Prosthetic status Possession and requirements for partial or full dentures and bridges were recorded for the age groups 13-14 and 35-44. 6. Oral pathology Pathological conditions of the gingiva and oral mucosa. 7. Need for immediate attention Conditions causing or likely to cause pain or danger to general health unless immediate treatment was given. The recording was carried out using fibre optic illumination, disposable mirrors and sickle probes. X-rays were not utilized. Two roving epidemiologists first established reproducible criteria and then calibrated the local examiners. Re-calibration took place at intervals and repeat examinations of a small sample population ensured reproducibility of recordings. The completed charts were sent to the WHO Oral Health Unit where they were edited and the data transferred to computer tape for analysis. For the present reports three variables--number of carious teeth, caries treatment/need ratio and number of teeth with gingivitis were selected for special study.

The community care model of the Intercountry Centre for Oral Health at Chiangmai, Thailand.

The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

Continuous improvement of oral health in Europe.

The oral health action programmes of the WHO Regional Office for Europe (WHO/EURO) comply with the overall European Health Policy and targets for the improvement of health in Europe by the year 2000 (HFA2000) and focus on promotive and preventive care approaches primarily at the community level. Various activities, including the development of guidelines for local action projects, have been established to support WHO/EURO's Member States in initiating preventive oral health care system and introducing the concept of continuous quality development in oral health care. The main focus for Countries of Central and Eastern Europe (CCEE) is to formulate national goals for oral health and to further develop oral health services in the region. Collection of national data using agreed European quality indicators for oral health will form the basis of appropriate monitoring and development of technologies to improve oral health care services and the oral health status at large. The WHO/EURO action programmes aim to implement oral disease prevention and health promotion activities. Guidelines have been established to support individual Member States who intend to establish community-based programmes in accordance with scientifically sound principles and methods. The ORATEL Project (Telematic System for Quality Assurance in Oral Health Care) is part of the Commission of European Communities (CEC) strategy for harmonization and standardization in health care (CEC) Programme for advanced informatics in medicine--AIM/CEC) and ORATEL is the only AIM/CEC project related to oral health. The ORATEL Project aims to improve the oral health status in the European Region through use of appropriate computerized information systems. The Project will support management and administration of dental clinics and will be an integral part of a quality assurance system to promote a standardized level of quality in the field. Its advanced educational and decision-support tools can be used by professionals at all levels of the system. ORATEL possesses tools for aggregating and transmitting data upwards for monitoring and evaluation purposes at local, national and supranational administrative levels.