A comparison of two methods for the evaluation of the daily urinary fluoride excretion in Romanian pre-school children.

OBJECTIVE: To compare two different methods of estimating daily fluoride urinary excretion in pre-school children under stable fluoride intake conditions. DESIGN: Thirty-five healthy kindergarten children, permanent residents of Targu-Mures, Romania, where the average drinking water fluoride concentration is 0.12 mg F/L, participated on two separate occasions, when they were aged 4-6 and 5-7 years, respectively in the collection of a) a mid-morning spot urine sample and b) a 16-h time-controlled urine sampling. In case a), the ratio of concentrations of fluoride and creatinine were measured, while in case b) the rates of fluoride excretion in two separate 8-hour periods were used to estimate the 24-hour fluoride urinary excretion. RESULTS: The estimated average daily fluoride urinary excretion values (S.D.) were 0.318 (0.182) mg F/day for method a) and 0.341 (0.193) mg F/day for method b). These values were not significantly different (Mann-Whitney U test; p = 0.49). The estimated daily fluoride doses were 0.040 (0.021) and 0.043 (0.022) mg F/kg body weight/day, respectively. The latter values were not significantly different (Mann Whitney U test; p = 0.38). CONCLUSIONS: Results obtained suggest that under stable F-intake conditions the estimation of the daily fluoride urinary excretion by means of a mid-morning spot urine sample yields comparable results to those obtained with the more involved method of separate, two 8 h (16 h) time-controlled urine sampling recommended by the WHO. Use of spot urine sampling appears to be particularly useful for epidemiological studies.

Effect of after-meal sucrose-free gum-chewing on clinical caries.

Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings to the clinical setting, we conducted a two-year study on 547 schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after meals, three times daily. The "Control" group was not provided with chewing gum. After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries, excluding white spots, compared with the "Control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a moderate caries population practicing normal oral hygiene, including the use of fluoride dentifrices, an after-meal gum-chewing regimen can significantly reduce the rate of caries development.

Effect of after-meal sucrose-free gum-chewing on clinical caries.

Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings to the clinical setting, we conducted a two-year study on 547 schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after meals, three times daily. The "Control" group was not provided with chewing gum. After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries, excluding white spots, compared with the "Control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a moderate caries population practicing normal oral hygiene, including the use of fluoride dentifrices, an after-meal gum-chewing regimen can significantly reduce the rate of caries development.

Prevalence study of oral precancerous lesions within a complex screening system in Hungary.

Previous epidemiological studies, performed in conjunction with compulsory lung screening examinations, showed good results in detecting oral lesions in Hungary, where the mortality rate of oropharyngeal cancer has increased by more than 30% in the past decade. Oral examinations were performed on a district population sample in Budapest, called regularly for X-ray lung examinations. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. Oral examinations of 7820 individuals were performed: 42.9% in men and 57.1% in women; 42% of all examined subjects were over 60 yr of age. Oral leukoplakia was diagnosed in 104 cases (1.3%). Histologic examination revealed squamous cell carcinoma in one case. About 70% of oral leukoplakias occurred in men and 30% in women. Oral lichen was diagnosed in six cases (0.08%). The prevalence of smokers was 86.5% in the leukoplakia group as compared with with 29% in the non-lesion group. The new organizational screening model seems to function well in the "risk group" of elderly persons, especially in the early diagnosis of oral cancer and precancerous lesions.

Progressive and regressive changes in Hungarian oral leukoplakias in the course of longitudinal studies.

Follow-up studies of 520 patients with leukoplakia during a 25-year period showed changes in the clinical type in 66 cases, i.e. 12.7%. Regressive changes occurred in 9%, progressive changes in 3.7%. The highest frequency of change in the clinical type was found in the group of erosive leukoplakias. The most frequent changing sites were the labial mucosa, commissures and buccal mucosa. Of the etiologic factors, smoking and Candida infection seemed to be correlated with the change of type. Oral leukoplakia should be considered a dynamic changing lesion of the oral mucosa.

Dental and oral symptoms of diabetes mellitus.

Dental and oral examinations of 1360 patients with diabetes mellitus showed higher DMFT mean values with fewer carious teeth and more filled and extracted teeth than the controls. PI mean values were higher in diabetics than in the controls, the difference being statistically significant, and showed a positive correlation with age, but no correlation with the length of time since the disease was established. No correlation was found between the severity of gingivitis and changes in blood glucose levels. The sucrose-free diet of diabetics does not seem to reduce caries prevalence. The increased DMFT index is explained by the fact that, due to periodontitis, diabetics lose more teeth sooner than do healthy people.

Prevalence study of tongue lesions in a Hungarian population.

The aim of the study was to assess the prevalence of tongue lesions in a district population, in Budapest, called regularly for X-ray lung examinations. Oral examinations of 7820 individuals were performed, 42% were over 60 yr of age, 42.9% were men and 57.1% women. Tongue alterations were found in 18.52% of the examined individuals, more frequently in women than in men. Lingua fissurata has been diagnosed in 8.8%, geographic tongue in 3.0% of the examined subjects. Atrophic lesions of the tongue were found in 6.37%, among them 5.42% central papillary atrophy (median rhomboid glossitis): 0.35% of the total sample. Manifest clinical symptoms of oral Candidiasis were found in 2.15% of the total sample, and in 4.28% of patients with tongue lesions. The occurrence of oral leukoplakia and lichen in patients with tongue lesions was respectively 0.47 and 0.07%. The prevalence of tongue alterations was consistent with the literary data, the oral screening attached to the X-ray lung examinations proved to be useful in detecting changes of the oral mucosa.

Effect of fluoridated milk on caries: 3-year results.

The effect of fluoridated milk consumption has been investigated in a follow-up study of 269 children aged 3-9 years. Children consumed 200 ml of milk daily, fluoridated in the groups 3-5 years with 0.4 mg F-, and in those aged 6-9 years with 0.75 mg F-, for 300 days yearly. The caries data were analyzed with special regard to changes in the DMF values of the permanent first molars, the yearly examination data of the corresponding age groups compared and correlated with the length of fluoridated milk consumption. Statistical analysis of the permanent first molar data showed significant negative correlation between DMF means and length of fluoridated milk consumption in children 5-6 years old at the time of evaluation. The caries reduction after 3 years was 74% and statistically significant (P less than 0.001). In children 7-9 years old the caries reduction of the permanent first molars was less, and statistically not significant. A slight reduction of DMFS mean values in the front teeth of this group could be observed.

Prevalence of oral leukoplakia in Havana City, Cuba.

A survey related to the detection of precancerous lesions of the oral cavity has been done in Cuba for the first time. The sample comprised 749 randomly selected workers from Havana City Province, taking into account the census records of the Cuban population up to 1979. Prevalence of lesions and their relation to age, sex and predisposing factors, such as smoking, alcohol habits and mechanical trauma were studied. 4.4% of leukoplakia and preleukoplakia considered together and 2.1% leukoplakia alone, and two cases of oral lichen planus and leukokeratosis nicotina palati (0.1% of each) were found. The former lesions were more frequently encountered in people above 50 years old, specially in males and specifically among those who had smoked for more than 10 years. Sites of location most frequently encountered were the buccal mucosa and the labial commissures.

Caries prevalence of preschool children in Baja, Hungary, in 1975 and 1982: effect of a supervised monthly NaF mouthrinsing program.

The aim of the study was 1) to compare the caries prevalence of preschoolchildren in Baja with data from 1975 and 2) to evaluate the effect of 0.2% sodium-fluoride mouthrinsings practiced during the last 4 yr. In 20 kindergartens of Baja 1462 children between 3 and 6 yr of age were investigated. All the children were participants in an oral hygiene motivation program and fluoride rinsings, performed generally monthly, but at least 10 times in a year. The dental investigations of the primary teeth were carried out by the same team as in 1975. The frequency of caries-free children increased from 18.8% in 1975 to 24.8% in 1982. The dmft mean values decreased only in the 5- and 6-yr-old children.

Risk group assessment of oral precancer attached to X-ray lung-screening examinations.

The mortality rate of oral tumours in Hungary, as in some other countries, is increasing. In order to assess risk groups for oral cancer and precancer, oral examinations were carried out as part of the X-ray screenings for lung cancer in the 3rd district of Budapest, Hungary. There were 5,034 adults who participated voluntarily in these investigations. After completing a questionnaire with 23 questions, a short oral examination was performed. Males comprised 57.7% of the group, and the age-distribution among men and women was similar. Oral precancerous lesions were found in 3.7% of the whole group, in 3.3% of those with leukoplakia, and in 0.4% of those with oral lichen planus. The prevalence of leukoplakia in men was 5.8%, and in women 1.5%, with significantly higher prevalences in men and women over 40. Among the examined persons there were 31% who were smokers, and 6% reported that they were regular consumers of alcohol. Fifty-four percent of those examined reported that they did not visit the dentist regularly. Oral complaints came mostly from those with lichen planus. The described model, where the oral screening examinations are done in conjunction with other examinations, in a so-called multiphasic screening system, seems to be a worthwhile approach for early diagnosis of oral cancer and precancer.

Caries prevalence of preschoolchildren in Baja, Hungary in 1955 and 1975.

In 1975 caries epidemiologic investigations were performed in 1,017 preschoolchildren of Baja, aged 3--6 years. The data were analyzed and compared with those of 620 preschoolchildren of the same city in 1955. A mean increase of 10.9% of the caries frequency (percentage of examinees with caries), and a mean increase of 43.5% of the caries intensity(dmft count per examinee) could be observed in spite of a better vitamin D prophylaxis. The possible cariogenic role of the increased surgar consumption (37.5 kg from 24.4 kg per individual during 20 years) is discussed.

Comparative cytologic and histologic studies in oral leukoplakia.

Comparative analysis of cytologic and histologic results and clinical types of 201 oral leukoplakias has shown: 1) an agreement between cytologic and histologic results in 76.6% of all cases; 2) an occurrence of carcinoma in 32.9% of the erosive leukoplakias in 3.2% of the verrucous leukoplakias, and none in the leukoplakia simplex group; 3) a higher efficacy of cytology in detecting malignancy in the erosive leukoplakia group.

Harmonization of dental education and curricula in Europe.

The need to harmonize undergraduate dental education and the recognition of dental degrees throughout the member countries of the European Union was recognised early on and was subject of EEC Directives in 1978. Growth of the EEC into the EU with the addition of more member nations has lead to continuing debate about the appropriate standards and measures for dental education. Attention has been given to defining both the 'input' measures of stipulating curricula and the 'output' measures of testing the competency of graduating dentists.

Exfoliative cytologic examinations in the early diagnosis of oral cancer.

Oral cytology-in spite of the wide extension of the use of cytologic diagnostic methods in various branches of medicine was and is the subject of many controversies. Opinions concerning the reliability of oral exfoliative cytology differ but all agree upon one point, oral cytology is not a substitute for biopsy. The main value of oral exfoliative cytology seems to lie in the diagnosis of malignant tumours, but differs according to the stages of progression of the disease. Comparison of cytological and histological results in oral carcinomas according to various authors gave a false negative rate of between 0 and 31 per cent. Advanced oral carcinomas already arouse suspicion at clinical examination and indicate the need for a biopsy. Therefore, in spite of the frequent ulceration increasing the effectiveness of cytodiagnostics, the importance of exfoliative cytology in advanced tumours is diminished. Exfoliative cytology may act as an important diagnostic aid in early oral carcinomas with ulcerated surfaces, even in some clinically unsuspected cases malignancy can be detected. In multiple or extensive lesions the selection of the most suitable site for the biopsy is possible. In leukoplakia the effectiveness of cytology is still more subject to dispute, the rate of false negatives is reported as high as to 63-9 per cent. However, when taking the clinical type of leukoplakia into consideration, the erosive leukoplakias which are known to be more inclined to become malignant showed a 76-6 per cent reliability of cytodiagnosis.

Xylitol and caries: the collaborative WHO oral disease preventive programme in Hungary.

The aim of this study was to assess the practical value of peroral xylitol at low to moderate dosage as a caries preventive measure. The trial was planned as a field study to test the feasibility of partial sucrose substitution in the relatively uniform conditions expected to occur in institutionalized children. The caries increment in the experimental group (X-group) was compared with the increments in other groups following the systemic administration of fluoride in milk or drinking water (F-group), and conventional dental treatment procedures alone (C-group). Conventional treatment was also provided for children in the X- and F-groups who used in an unsupervised manner a fluoride-containing dentifrice. The dentifrice used by the X-group also contained 10 per cent xylitol. The C-group used predominantly fluoride-free dentifrices. At baseline there were 990 children in the study. At the end of the 3-year study period there were 689 subjects. The caries scoring into four main categories was carried out yearly according to WHO criteria. The analysis of the data showed highly significant differences between the X-, F- and C-groups when measuring caries activity as the increment of DMF teeth and tooth surfaces, and also as the increment rate assessing the true caries incidence in a biostatistical sense. These results were obtained in conditions where caries prevalence and incidence continued to be high. The observations indicate that peroral xylitol has a cariostatic effect.

Anticalculus efficacy of three dentifrices.

PURPOSE: To evaluate the anticalculus effect of three commercial dentifrices. MATERIALS AND METHODS: A 12-week independent and double-blind clinical study was conducted on a population of calculus-forming adult male and female subjects in Budapest, Hungary to directly compare the anticalculus efficacy of three commercially-available dentifrices, as compared to a placebo dentifrice. The three commercially-available anticalculus dentifrices compared in this clinical study to a 0.243% sodium fluoride/silica placebo dentifrice were as follows: (1) A dentifrice containing 1.3% soluble pyrophosphate and 1.5% of a PVM/MA copolymer in a 0.243% sodium fluoride/silica base. (2) A dentifrice containing 0.3% triclosan and 2% of a PVM/MA copolymer in a 0.243% sodium fluoride/silica base. (3) A dentifrice containing 0.3% triclosan and 0.75% zinc citrate in a 1.14% sodium monofluorophosphate/silica base. RESULTS: All three anticalculus dentifrices provided statistically significant reductions in supragingival calculus formation, as compared to a placebo dentifrice, after 12 weeks of use. The reductions in supragingival calculus formation ranged from 39% to 55%, as compared to a placebo dentifrice, for the three commercially-available anticalculus dentifrices. There was no statistically significant difference among the three commercially-available dentifrices with regard to anticalculus efficacy.

Tobacco use and oral leukoplakia.

The increase in cancer mortality throughout the world justifies the study of its causes and development. Hungary has the highest mortality rate from oropharyngeal cancer out of forty-six countries. Tobacco use is implicated in the development of oral cancer, and oral leukoplakia as well. The aim of the study was to give an overview of the connection between tobacco use and oral leukoplakia, considering the epidemiologic patterns of tobacco habits, the prevalence of smoking in oral leukoplakia, and the effect of smoking on clinically healthy oral mucosa with special respect to central Europe and Hungary. In the data, strong evidence has been found for the role of smoking in the development of both oral cancer and oral leukoplakia. Epidemiologic patterns of cigarette smoking show a steep increase in central European countries. Cross-sectional studies show a higher prevalence rate of leukoplakia among smokers, with a dose-response relationship between tobacco use and oral leukoplakia, and intervention studies show a regression of the lesion after stopping the smoking habit.

Clinical study on the effect of amine fluoride/stannous fluoride on exposed root surfaces.

The aim of this study was to assess the remineralizing effect of an amine fluoride (AmF)- and stannous fluoride (SnF2)-containing toothpaste and mouthrinse on exposed root surfaces. A total of 44 adults participated in the 20-week, double-blind study and were grouped as follows: (1) 20 participants (mean age 45.7 years) used an AmF/SnF2 experimental toothpaste plus AmF/SnF2 (Meridol) mouthwash, and (2) 24 participants (mean age 48.8 years) used an NaF-containing toothpaste and mouthrinse. Root caries index (RCI) and root surface scores were determined by a modified method of Katz (J Dent Res, 1984). RCI mean values showed decreases of approximately 47% in the AmF/SnF2 group, and 10% in the NaF group. With respect to root caries scores, the number of persons with decreased softened (non-carious) surfaces between the baseline and control examinations was statistically significant (p less than 0.05) in the AmF/SnF2 group but not significant in the NaF group. A statistically significant difference (p less than 0.05) in the results of the groups favored the AmF/SnF2 subgroup. Thus, the data point to a possible remineralizing effect of topically applied AmF/SnF2 on softened root caries surfaces.

Effect of an antibacterial varnish and amine-fluoride/stannous fluoride (AmF/SnF2) toothpaste on Streptococcus mutans counts in saliva and dental plaque of children.

The purpose of this study was to evaluate the effect of the simultaneous application of a chlorhexidine and thymol-containing varnish (Cervitec) and an amine fluoride/stannous fluoride containing toothpaste (Meridol) on Streptococcus mutans counts in saliva and dental plaque of school children 12-14 years of age, during a six-week period. The children were separated into group 1 (Cervitec varnish + fluoride-containing toothpaste), group 2 (Cervitec varnish + Meridol toothpaste), and group 3 (Meridol toothpaste alone). Over the six weeks the greatest improvement in salivary Streptococcus mutans count occurred in group 2. Overall, a statistically significant decrease in total microbiological count, and Streptococcus mutans was found in all three groups.