Use of professionally administered topical fluorides in Asia.

Professionally applied topical fluoride varnish, gel, and solution have been shown to be effective in preventing and in arresting dental caries. Their use in different countries in Asia varies greatly and may not correlate with the dental caries situation of the populations in the countries. In the higher-income countries, use of fluoride varnish and gel is common among dental professionals. In contrast, the use of professionally administered topical fluorides is not common in the lower-income countries. Fluoride varnish, being easy to apply and safe, has been the preferred agent for the prevention of early childhood caries, which is prevalent in many developing countries in Asia. The relatively high cost of professionally administered fluoride agents and the shortage of a dental workforce, especially in lower income countries, have hampered the widespread adoption of these effective caries prevention methods in the private and public dental services. Government health policies should be pursued to lower the cost of treatment, either through incentives for local production and/or elimination of taxes and tariffs on imported fluoride products.

Trends in oral health from childhood to early adulthood: a life course approach.

OBJECTIVES: The aims of this study were to investigate trends in oral health in a cohort from late childhood through adolescence to early adulthood and to describe how the oral health of young adults was affected by their family sociodemographic characteristics, oral health status, and utilization of dental services during adolescence using life course approach. METHODS: A cohort of 638 students was followed from late childhood (12 years old) through adolescence (15 years old) to early adulthood (18 years old) in Hong Kong. Dental examinations included the assessment of caries experience (DMFT score) and periodontal conditions (Community Periodontal Index, CPI) according to WHO criteria. Information on utilization of dental services, parental education attainment, and monthly household income was collected. Path analyses were performed to investigate oral health trends and the relationships between oral health (DMFT scores and highest CPI values) at age 18 years and the sociodemographic characteristics at age 12 years, oral health, and utilization of dental services during adolescence. RESULTS: In 2004 and 2007, 395 (62%) and 324 (51%) subjects of the original sample were followed up when they reached the age of 15 and 18 years, respectively. The mean DMFT score gradually increased from 0.62 at age 12 to 1.52 at age 18 (P < 0.001). The proportion of subjects with calculus or shallow periodontal pockets (highest CPI score 2 or 3) also increased with age, from 58% at age 12 to 96% at age 18 (P < 0.001). The oral health trend path models showed that DMFT score and highest CPI value at age 18 years were positively associated with DMFT score and highest CPI value at younger ages (P < 0.05). Results of the two extended path models showed that household income had positive effect on the utilization of dental services (ß > 0.29, P < 0.05) and the utilization of dental services had positive effect on DMFT score (ß > 0.12, P < 0.05) but not for highest CPI value (P > 0.05). However, parental education attainment had no significant effect on either DMFT score or highest CPI value (P > 0.05). CONCLUSIONS: Oral health status had become worse from childhood to early adulthood in the study cohort. Economic circumstance of the subjects was found to be positively related to their utilization of dental services and through this contributed to the subjects' caries experience. Oral health at younger ages was positively associated with succeeding oral health conditions.

Risk indicators for early childhood caries in 2-year-old children in southern China.

BACKGROUND: The aim of this study was to explore the relationship between early childhood caries (ECC) and relevant socio-economic, behavioural and biological experiences in the life course of children. METHODS: A cross-sectional study of 2-year-old children was analysed. A questionnaire collected socio-economic and behavioural data during the first two years of the participants' life. Caries experience was recorded at the level of cavitation and oral hygiene was assessed using the Visible Plaque Index (VPI). Microbiological investigation collected information on colony-forming units (CFU) of Streptococcus mutans (S. mutans). The outcome was ECC. Bivariate and multiple logistic regression analyses were performed. RESULTS: The study included 394 children, with 109 having ECC and 285 being caries-free. The mean decayed, missing and filled primary teeth (dmft) score of the ECC group was 3.65 ± 3.12, with decayed teeth making up 100% of the score. The results of the final logistic regression analysis showed that ECC was significantly associated with the mother's schooling at child's birth [<12 years vs. ≥12 years, OR = 1.80], VPI score [>60% vs. 0-20%, OR = 5.71], and S. mutans [≥10(5) CFU/ml vs. 0 CFU/ml, OR = 3.80]. CONCLUSIONS: Social, behavioural and biological factors during the life course of 2-year-old children in southern China are associated with the development of ECC.

Caries assessment by clinical examination with or without radiographs of young Chinese adults.

OBJECTIVE: To compare caries status assessment of posterior teeth of young Chinese adults by using clinical examination alone and with the supplemental use of bitewing radiographs. METHODS: Two calibrated dentists examined the posterior teeth of 200 Chinese university students (aged 18-24 years) using dental mirrors and probes under optimal lighting. Caries was diagnosed by visual detection of carious cavities. Duplicate examinations were performed to monitor intra- and inter-examiner variations. Bitewing radiographs were taken and examined by an independent dentist. Caries was recorded when a lesion extended into dentine. RESULTS: Among the 3,162 posterior teeth examined, 113 were detected with caries. More than one third (35.4%) of the caries found in the posterior teeth was not detected from reading the radiographs but was detected by clinical examination. About half (51.4%) of the caries was found on the bitewing radiographs only, leaving 13.2% being detected by using either method. With the supplement of bitewing radiographs, there was a 105% increase in the number of carious lesions detected. This leads to a correction factor of 1.13 for adjustment of the mean DMFT score obtained from conducting clinical examinations alone. CONCLUSION: Due to the significant number of clinically undetected carious cavities in these young Chinese adults who live in a community with water fluoridation, it may be advisable to use a correction factor to adjust the caries experience obtained from epidemiological surveys when bitewing radiographs are not available.

Bayesian analysis of clustered interval-censored data.

The recording of multiple interval-censored failure times is common in dental research. Modeling multilevel data has been a difficult task. This paper aims to use the Bayesian approach to analyze a set of multilevel clustered interval-censored data from a clinical study to investigate the effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting active dentin caries in Chinese pre-school children. The time to arrest dentin caries on a surface was measured. A three-level random-effects Weibull regression model was used. Analysis was performed with WinBUGS. Results revealed a strong positive correlation (0.596) among the caries lesions' arrest times on different surfaces from the same child. The software WinBUGS made the above complicated estimation simple. In conclusion, the annual application of silver diamine fluoride on caries lesions, and caries removal before the application, were found to shorten the arrest time.

[The cost-effectiveness of ART and resin sealant on caries prevention].

OBJECTIVE: Pit and fissure sealants have been widely used to caries prevention. More often, ART is used in caries treatment. ART was used to prevent caries in recent years. However,the cost-effectiveness of ART that is used to caries prevention still remains unclear. The aim of the present research was to compare the cost-effectiveness of ART with that of resin sealant in caries prevention for primary school children. METHODS: Two hundred and twelve children aged 7 to 9 years old took part in this research. The molar of every child on one side of the mouth was sealed by light-cure resin sealant(Concise,3M) and by chemically firmed glass ionomer (Ketac-molar, ESPE) on the opposite side. The routine methods were used to seal teeth and the cotton rolls and suction were used to keep dry. The time for manipulation,amount of materials and times for repetition in the program were recorded. The retained rate of sealed material on the teeth was checked month after treatment. RESULTS: The results indicated the time for manipulation,cotton rolls and times for repetition in sealant was respectively 3.54 (min.), 2.52 and 0.04 (times) in sealant and 3.18 (min.),1.13 and 0.03 (times) in ART. The material of ART was more expensive than of resin sealant. Respectively,the costs of glass ionomer and resin sealant were 3.77 and 0.93(Yuan). However, the cost of equipment used in sealant were much more expensive than that used in ART. Furthermore, there was no significantly difference between sealant and ART in the remaining rate. CONCLUSION: The results suggest that ART is more cost-effective than sealant on caries prevention.