Validity and reproducibility of ICDAS II in primary teeth.

The aim of this in vitro study was to assess the validity and reproducibility of the ICDAS II (International Caries Detection and Assessment System) criteria in primary teeth. Three trained examiners independently examined 112 extracted primary molars, ranging from clinically sound to cavitated, set up in groups of 4 to mimic their anatomical positions. The most advanced caries on the occlusal and approximal surfaces was recorded. Subsequently the teeth were serially sectioned and histological validation was undertaken using the Downer and Ekstrand-Ricketts-Kidd (ERK) scoring systems. For occlusal surfaces at the D(1)/ERK(1) threshold, the mean specificity was 90.0%, with a sensitivity of 75.4%. For approximal surfaces, the specificity and sensitivity were 85.4 and 66.4%, respectively. For occlusal surfaces at ICDAS code > or =3 (ERK(3) threshold), the mean specificity and sensitivity were 87.0 and 78.1%, respectively. For approximal surfaces, the equivalent values were 90.6 and 75.3%. At the D(3) threshold for occlusal surfaces, the mean specificity and sensitivity were 92.8 and 63.1%, and for approximal surfaces 94.2 and 58.3%, respectively. Mean intraexaminer reproducibility (Cohen's kappa) ranged from 0.78 to 0.81 at the ICDAS code > or =1 cut-off and at the ICDAS code > or =3 cut-off from 0.74 to 0.76. Interexaminer reproducibility was lower, ranging from 0.68 to 0.70 at the ICDAS code > or =1 cut-off and from 0.66 to 0.73 at the ICDAS code > or =3 cut-off. In conclusion, the validity and reproducibility of the ICDAS II criteria were acceptable when applied to primary molar teeth.

Dietary patterns, toothbrushing habits and caries experience of schoolchildren in West Yorkshire, England.

OBJECTIVE AND METHOD: The present study followed a group of 608 children, aged 7-11 years from six primary schools, for whom detailed dietary information was available. These children were traced four years later when they were in secondary school. The aim of the study was to investigate the relationship between the original dietary pattern, current dietary pattern, toothbrushing habit and oral health. Of the original children, 500 were traced to 32 secondary schools over a wide geographic area. For logistical reasons those in 18 schools were selected and positive consent and full data was obtained for 315 together with an additional group of 122 of their classmates. Three-day, self-reported dietary data was obtained, together with information on toothbrushing habits. A dental examination was carried out using BASCD survey methodology. RESULTS: The children in this study had a lower DMFT (0.82) than found in the most recent survey for the area (1.39). No significant relationship was found between sugar-sweetened foods or drinks at age 7-11 and caries in the first permanent molar teeth at age 11-15 years, however a significant relationship was found between current sugar-sweetened drinks consumption and caries. Significantly less caries was associated with the reported moderate consumption of dairy products by the children when aged 11-15 years. The bedtime consumption of NMES drinks at 7-11 was significantly associated with an increase in caries as was the bedtime consumption of non-milk extrinsic sugars (NMES) foods at 11-15 years. A significant inverse relationship was found between claimed toothbrushing frequency and caries. Of those children aged 11-15 years claiming to brush at least once a day, 69% were caries-free with a mean DMFT of 0.69. Of the children who claimed to brush only occasionally or never, 52% were caries-free and they had a mean DMFT of 1.05. CONCLUSION: The reported consumption of sugar-sweetened drinks and the lack of regular toothbrushing were found to be the factors most strongly linked to caries and this finding is consistent with other recent studies.

The dental caries experience of 5-year-old children in Great Britain (2005/6). Surveys co-ordinated by the British Association for the study of community dentistry.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 5-year-old children from across England, Wales and Scotland in 2005/6. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs) and health boards (HBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: 239,389 five and six year-old children from across England, Wales, Scotland and the Isle of Man were examined in 2005/2006. The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean d3mft across England was 1.47 (d3t = 1.10, mt = 0.20, ft = 0.16), across Wales the corresponding values were 2.38 (d3t = 1.70, mt = 0.43, ft = 0.25) and in Scotland 2.16 (d3t = 1.45, mt = 0.51, ft = 0.20). Overall, 39.4% of children in Great Britain had evidence of caries experience in dentine (d3mft > 0, including visual dentine caries). The distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay was 3.99, as opposed to the overall mean of 1.57. Trends over time demonstrate a small change in mean d3mft since 2003/4 when the mean was 1.62, although the mean value for those with dentine decay experience remained constant (4.00 vs 3.99). The care index has also fallen marginally from 12% to 11%. The BASCD co-ordinated NHS Epidemiology Programme will evolve in coming years as differing priorities in the frequency of inspecting particular age groups is being seen as well as a desire to measure other aspects of oral health in addition. CONCLUSION: Overall, there has been only a small overall improvement in the dental health of 5-year-old children over the last 2 years and no diminution of the level of disease in those affected for some time, although in Scotland a pattern of continuing steady progress from previously high levels is seen. While many children enjoy good oral health, sizable groups remain within the population of 5-year-old children who have a clinically significant burden of preventable dental disease.

The dental caries experience of 11-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 2004 / 2005.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 11-year-old children from across England and Wales, Scotland, Isle of Man, and Jersey in 2004/5. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs), health boards (HBs), and local health boards (LHBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean values for D3MFT within the current English strategic health authorities ranged from 0.19 in Harlow to 1.32 in North Manchester and in Salford; in Wales mean values ranged from 0.69 in Vale of Glamorgan to 2.09 in Blaenau Gwent; while in Scotland they ranged from 0.59 in Orkney to 1.77 in Western Isles. Mean D3MFT across England was 0.64 (D3T = 0.32, MT = 0.06, FT = 0.25), across Wales it was 1.09 (D3T = 0.48, MT 0.11, FT = 0.50), and across Scotland values were 1.29 (D3T = 0.52, MT = 0.17, FT = 0.60). Overall, 31.3% of children in England & Wales and 47.1% of children inspected in Scotland had evidence of caries experience in dentine (D3MFT > 0, including visual dentine caries). As in previous surveys, the distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay in England and Wales was 2.12, as opposed to the overall mean of 0.66; in Scotland the corresponding values were 2.74 and 1.29. Trends over time demonstrate an improvement in overall mean D3MFT for England and Wales since the 2000/2001 of 12-year-olds, although part of this difference is accountable to the younger age, at examination, in this survey. The mean value for those with dentine decay experience was also marginally less at 2.12 compared with 2.35 in the previous survey. (Figures for Scotland were not included in the 2000/2001 survey.) The care index was also found to be marginally lower than previously at 41% compared with 48% but again the younger age of the children would influence this value. CONCLUSION: Dental health of 11-year-old children has been surveyed in Great Britain, Jersey, and the Isle of Man: being a slightly younger mean age than in previous BASCD surveys. Geographic variation in oral health is marked at both the local and national levels. Overall, the provision of operative care for those with dentinal decay is around 42%. While many children enjoy good oral health, sizable groups remain within the population of 11-year-old children who have a clinically significant burden of preventable dental disease.

The dental caries experience of 5-year-old children in England and Wales (2003/4) and in Scotland (2002/3). Surveys co-ordinated by the British Association for the Study of Community Dentistry.

OBJECTIVE: This paper reports the results of standardized clinical caries examinations of 5 year old children from across England and Wales in 2003/4 and Scotland in 2002/3. These co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating strategic health authorities (SHAs), primary care trusts (PCTs) and health boards (HBs). Caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. Data for Jersey and the Isle of Man are also included. RESULTS: The results again demonstrated a wide variation in disease prevalence and care strategies across Great Britain. Mean values for d3mft within the current English Strategic Health Authorities ranged from 0.47 in Maidstone Weald (South) to 3.69 in North Kirklees (North); in Wales mean values ranged from 1.48 in Flintshire (NW) to 3.73 in Merthyr (SE); while in Scotland they ranged from 1.29 in Borders to 3.67 in Argyll & Clyde. Mean d3mft across England was 1.49 (d3t = 1.12, mt = 0.19, ft = 0.18), across Wales it was 2.42 (d3t = 1.70, mt = 0.43, ft = 0.29) and across Scotland values were 2.76 (d3t = 1.87, mt = 0.65, ft = 0.24). Overall, 39.6% of children in England & Wales and 55.4% of children inspected in Scotland had evidence of caries experience in dentine (d3mft > 0, including visual dentine caries). The distribution of caries was highly skewed. Thus the mean caries experience for those with dentinal decay in England and Wales was 3.90, as opposed to the overall mean of 1.55; in Scotland the corresponding values were 4.98 and 2.76. Trends over time demonstrate virtually no change in the overall mean d3mft for England and Wales since 2001/2, although the mean value for those with dentine decay experience increased marginally from 3.83 to 3.90. In Scotland there had been deterioration in the overall mean (2.76 as compared to the 2.55 reported in 1999). The care index has also fallen (for example in England & Wales to 12% from 13.2% in 2001/2002 and 14.3% in 1999/2000). CONCLUSION: There has been no overall improvement in the dental health of 5 year old children over the last 2 years. Geographic variation in oral health is marked at both the local and national levels. Overall, the provision of operative care for those with dentinal decay has again decreased slightly. While many children enjoy good oral health, sizable groups remain within the population of 5 year old children who have a clinically significant burden of preventable dental disease.

Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM).

OBJECTIVES: To develop a method for recording dental caries at the D1 (enamel and dentine) diagnostic threshold (without loss of D3 information) and assess its reliability, 'benchmark' validity and potential effects on reported caries prevalence and needs assessment. METHODS: Multi-examiner training, calibration and validation trial. Two groups of 10 dental examiners were trained to diagnose dental caries at the D1 (enamel and dentine) diagnostic threshold under the conditions of a caries prevalence survey, prior to a calibration trial being undertaken. RESULTS: Where 'experienced examiners' were trained to examine at the D1 (enamel and dentine) diagnostic threshold, under the conditions of a cross-sectional epidemiological survey, there was no significant deterioration in inter-examiner agreement on the assessment of teeth and a significant difference in one of two comparisons on the assessment of surfaces using the kappa statistic. Assessed against a benchmark examiner, there was no significant loss of sensitivity at the D1 diagnostic threshold compared with the D3 threshold and, although there was a significant loss of specificity at the D1 threshold, all specificity values could be considered to be high. CONCLUSIONS: Modifying the diagnostic criteria typically used in surveys of caries prevalence (to allow assessment of the levels of enamel caries which could benefit from preventive care as well as dentinal caries requiring restorative care) in adolescents does not adversely affect the reliability or benchmark validity of experienced examiners to a significant degree.

In vitro validity of the Dundee Selectable Threshold Method for caries diagnosis (DSTM).

OBJECTIVES: It is not generally possible to assess diagnostic accuracy in dental surveys as no histological 'gold standards' are available, therefore examiner agreement tends to be used as a proxy for accuracy. The aim of this study was to investigate, using extracted teeth in arch models, the in vitro validity of a diagnostic system to assess caries at the D1 (enamel and dentine) and D3 (dentine) diagnostic thresholds, for epidemiological purposes. METHOD: Two groups of 10 dental examiners trained in the use of the Dundee Selectable Threshold Method for caries diagnosis (DSTM) each examined (on two occasions) 160 extracted permanent molar and premolar teeth set in arch models in phantom heads according to the codes and criteria of the DSTM. The teeth were subsequently radiographed and sectioned to provide validation of the diagnoses. RESULTS: Intra-examiner agreement according to the kappa statistic was substantial. In general terms the results of the in vitro validation exercise demonstrated significantly higher sensitivity values at the D1 diagnostic threshold than were found at the D3 diagnostic threshold with a consequent loss of specificity. CONCLUSIONS: The results of this in vitro validation exercise demonstrate that at the D1 diagnostic threshold the sensitivity of the DSTM was greater than at the D3 threshold indicating no loss of diagnostic accuracy at the D1 threshold.

A proposed method for assessing the quality of sealants--the CCC Sealant Evaluation System.

OBJECTIVES: The aim of this paper is to introduce the C (colour) C (coverage) C (caries) Sealant Evaluation System and to present results of its use on a sample of adolescent patients in Scotland. METHODS: Baseline data are presented from a 3-year prospective study in general dental practices across Scotland. Subjects were examined under standardised conditions by one trained and calibrated examiner. RESULTS: 78.6% of the subjects had one or more sealed teeth, over half of these sealants being judged inadequate. There was a low prevalence of dentine caries associated with the sealed teeth (2.8%). The CCC sealant Evaluation System proved practical as demonstrated by its use during the project and had substantial intra-examiner reproducibility. CONCLUSIONS: There was a high level of sealant provision; however, this provision may not be optimal in terms of both targeting of provision and sealant maintenance. The CCC sealant Evaluation System appeared to be a useful assessment tool for assessing sealed surfaces.

General dental practitioners diagnostic and treatment decisions related to fissure sealed surfaces.

OBJECTIVES: The purpose of this in-vitro study was to assess the validity and reproducibility of the diagnosis and treatment planned for occlusal surfaces prior to and following the placement of a clear sealant by a sample of general dental practitioners (GDPs). METHODS: 160 permanent posterior teeth were examined by 25 GDPs. The GDPs were not given any criteria and were therefore free to diagnose and plan care, as they felt appropriate. Each GDP conducted four examinations, two prior to and two after sealing. The teeth were serially sectioned to provide the validating criterion. RESULTS: After sealant placement, there was a statistically significant increase in specificity and decrease in sensitivity of both diagnostic and treatment decisions. The reproducibility expressed by the kappa-statistic was of the order of 0.5 prior to and after sealing with regard to diagnostic decisions. There was a general tendency to diagnose less disease after placement of a sealant (P<0. 001). There was also significantly less care (preventive or restorative) planned after sealant placement (P<0.001). CONCLUSIONS: The placement of a sealant resulted in the diagnosis of less disease and less restorative treatment. This may be appropriate as evidence exists to support the use of sealants as caries therapeutic agents.

Does social deprivation in 1, 2, 3 and 4-year-old Scottish infants influence the frequency isolation of caries-associated micro-organisms?

OBJECTIVES: The aim of this study was to determine if there are associations between the level of social deprivation/affluence and the frequency isolation of caries-associated micro-organisms (Streptococcus mutans, Streptococcus sobrinus, lactobacilli and yeasts) in a large cohort of infants examined annually from 1 to 4 years of age. METHODS: DEPCAT was used to measure the socio-economic status of all consented infants (n=1099--1392) born in Dundee during a 1 year period (total n=1974). Caries-associated micro-organisms were cultured from saliva when the infants were 1, 2, 3 and 4 years of age. Standardised dental examinations were also carried out annually. Log linear analysis, which controlled for caries, was used to look for associations between DEPCAT and the isolation frequency of caries-associated micro-organisms. RESULTS: When controlling for caries, there was an association between DEPCAT and the isolation frequency of yeasts when the infants were 1 and 2 but not when 3 and 4 years old, whereas lactobacilli were associated only when the infants were 3 and 4 years old. Correlations between S. mutans and social deprivation were usually dependent on the caries status of the infants. CONCLUSIONS: The relationship between social deprivation and the isolation frequencies of caries-associated micro-organisms is complex with lactobacilli developing an association when the infants were 3 and 4 years old in contrast to yeasts which were only associated when the infants were 1 and 2 years old. Streptococcus mutans was associated with social deprivation when the infants were 2 years old and older, but dependent on caries status in the 3 and 4 year olds.

BASCD surveys and computer communication. British Association for the Study of Community Dentistry.

The British Association for the Study of Community Dentistry (BASCD) has coordinated National Health Service surveys of the dental health of school children since 1985, when Wales and parts of England were included. Scotland joined in 1987 and Northern Ireland in 1994. This series spans an interesting time in the growth of accessible technology in both statistics and medical research. The purpose of this paper is to chart the development of this data base from pen and paper via microcomputers to the Internet. The annual work now involves calibration of examiners, data collection with portable computers or by manual transcription and subsequent 'punching', paper reports passed to regional coordinators who fill in spread sheets that are passed by e-mail or through posted discs to the data coordinating centre at the Dental Health Services Research Unit at the University of Dundee. The data is checked; statistical analyses are undertaken; a paper is prepared for print and the data is deposited on the BASCD Web Site. Four operating systems and at least eight software packages are used to produce and distribute the survey results.

Patterns of change and results overview 1985/6-1995/6 from the British Association for the Study of Community Dentistry (BASCD) coordinated National Health Service surveys of caries prevalence.

This paper collates the results of all the surveys conducted under the BASCD coordinated National Health Service surveys of caries prevalence conducted between 1985/86 and 1995/96. First the patterns of change in the dental health of 5-year-old children are considered for the period 1987-1995. Then the patterns of change in the dental health of adolescents between 1988-1994 are examined and summarised. Lastly summary tables present key data from the last 10 years of survey results grouped by variable.

British Association for the Study of Community Dentistry (BASCD) guidance on sampling for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the sampling for these surveys.

British Association for the Study of Community Dentistry (BASCD) guidance on the statistical aspects of training and calibration of examiners for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the statistical aspects of training and calibration of examiners for these surveys.

The dental caries experience of 14-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1998/99.

DESIGN: This paper reports the results of standardised clinical caries examinations of 121.550 14-year-old children from across the United Kingdom, Jersey and the Isle of Man. These 1998/99 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibreoptic transillumination. RESULTS: These demonstrated, once again, a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English regional offices (of the National Health Service) and the other UK countries ranging from 1.17 in West Midlands to 3.65 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.76 (D3T=0.59, MT=0.15, FT=1.02). Overall, 54% of children had evidence of caries experience at the dentinal level (D3MFT>0), although the means ranged between 43% (South East) and 78% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 3.24. Trends over time demonstrate an improvement of 10% in overall D3MFT for Great Britain since 1994/95, compared to the 21% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in mean MT since 1994/95, while FT and care index have fallen. The number of fillings provided in 1998/99 and thus the care index, remains low, on average across the UK, only 58% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 34% to 83%). CONCLUSION: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

The dental caries experience of 12-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1996/97.

DESIGN: This paper reports the results of standardised clinical caries examinations of 129,941 twelve-year-old children from across the United Kingdom and the Isle of Man. These 1996/97 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: These demonstrated once again a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English 'regions' (of the National Health Service) and the other UK 'territories' ranging from 0.66 in Thames South to 2.55 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.13 (D3T = 0.48, MT = 0.10, FT = 0.54). Overall, 44% of children had evidence of caries experience at the dentinal level of detection (D3MFT > 0), although the means ranged between 31% (Thames South) and 72% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 2.55. Trends over time demonstrate an improvement of 15% in overall D3MFT for Great Britain since 1992/93, compared to the 20% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in either mean DT or mean MT since 1992/93, while FT and care index have fallen. The number of fillings provided in 1996/97 and thus the care index, remain low, on average across the UK, only 48% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 27 to 76). CONCLUSION: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

The dental caries experience of 5-year-old children in the United Kingdom. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 1997/98.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 176,781 5-year-old children from across the United Kingdom. These 1997/98 co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in prevalence across the UK, with mean values for d3mft for the current English regions (of the National Health Service) and the other UK 'territories' ranging from 1.02 in the West Midlands to 2.92 in Northern Ireland. Mean d3mft across the UK was 1.68 (d3t = 1.18, mt = 0.26, ft = 0.23). Overall, 43% of children had evidence of caries experience (d3mft > 0), although the means ranged between 33% (West Midlands) and 63% (Northern Ireland). The distribution of caries was highly skewed. Thus the UK mean caries experience for those with disease was 3.94, as opposed to the overall mean of 1.68. Trends over time demonstrate a modest improvement of 8.7% in overall d3mft for Great Britain since 1995/96, compared to the small improvement seen two years ago and the deterioration seen four years previously. Both dt and mt have fallen while ft remained unchanged. The care index has increased in all but one region/territory (14% in 1997/8, compared to 12% in 1995/6). Regional/country means for 1997/8 ranged from 9-23%. This indicator has not, however, regained the levels seen in the past. CONCLUSION: There has been some improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dentinal decay has also improved; however, significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1999/2000.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 199,440 5-year-old children from across Great Britain. These 1999/2000 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in prevalence across Britain, with mean values for d3mft for the current English regions (of the National Health Service) and for Wales and Scotland ranging from 0.94 in the West Midlands to 2.55 in Scotland. Mean d3mft across Great Britain was 1.57 (d3t=1.14. mt=0.22, ft=0.21). Overall, 40% of children had evidence of dentinal caries experience (d3mft>0), although the means ranged between 30% (West Midlands) and 55% (Scotland). The distribution of caries was highly skewed. Thus the British mean caries experience for those with the disease was 3.88, as opposed to the overall mean of 1.57. Trends over time demonstrate a modest improvement of 4% in overall d3mft for Britain since 1997/98, compared with the 8.6% improvement seen for the two previous years. All three components with dmft have also fallen. The care index has remained virtually unchanged in Britain as a whole (13.6% in 1999/2000, compared to 13.9% in 1997/8). Regional/country means for 1999/2000 ranged from 8-20%. This indicator has not, however, regained the levels seen in the past. CONCLUSION: There has been some improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dental decay has not changed; significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

The dental caries experience of 14-year-old children in England and Wales. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 2002/2003.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 77,693 14-year-old children from across England, Wales, Jersey and the Isle of Man. These 2002/3 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: These demonstrated, once again, a wide variation in prevalence across the area surveyed, with mean values for D3MFT for the current English government offices (of the National Health Service) and the local Health Boards in Wales ranging from 0.99 in the South East to 2.10 in Wales (2.41 in the Isle of Man). The mean value for across England and Wales was 1.48 (D3T=0.56, MT=0.10, FT=0.82). Overall 49 per cent of 14-year-old children in England and Wales had evidence of dentinal caries experience (D3MFT>0), the regional/country means ranged between 37 per cent (South-East) and) and 60 percent in Wales (65 per cent, Isle of Man). The mean D3MFT for those with disease at this threshold was 3.03. Trends over time demonstrate an improvement of 4% in overall D3MFT for England and Wales, there has been only small improvement in mean MT since 1994/95, while FT and care index have fallen. The number of fillings provided in 2002/3 and thus the care index, remains low, on average across England and Wales, only 55% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual areas: 28% to 83%). CONCLUSION: These findings demonstrate a modest overall improvement in oral health, but a continuing need for more effective preventive strategies and treatment services for permanent teeth in this important age group. An average of half of the 14 year old children examined being affected by dentinal decay and a mean of three permanent teeth decayed into dentine for those children affected at this level of diagnosis is a poor start to charting oral health in the 21st Century in England and Wales.

The dental caries experience of 5-year-old children in England and Wales. Surveys co-ordinated by the British Association for the Study of Community Dentistry in 2001/2002.

OBJECTIVE: This paper reports the results of standardised clinical caries examinations of 170,731 5-year-old children from across England and Wales. These 2001/2002 co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. METHOD: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination. RESULTS: The results again demonstrated a wide variation in prevalence across Britain, with mean values for d3mft for the current English Strategic Health Authorities (SHA) (of the National Health Service), Wales and British 'territories' ranging from 0.75 in Jersey and 0.84 in Kent & Medway to 2.73 in Gwent and 2.47 in Greater Manchester. Mean d3mft across England and Wales was 1.52 (d.t = 1.11, mt = 0.20, ft = 0.20). Overall, 40% of children had evidence of caries experience (d3mft > 0); the percentages ranged between 23% (Jersey) or 29% (Essex) and 61% (Gwent) or 54% (Greater Manchester). The distribution of caries was highly skewed. Thus the mean caries experience for those with disease in England and Wales was 3.83, as opposed to the overall mean of 1.52. Trends over time demonstrate slight increase of 3% in overall d3mft for England and Wales since 1999/2000, compared to the 4% improvement seen for the two previous years. Of the three components of dmft, d3t and mt have increased while ft has fallen. The care index has also fallen (13.2% in 2001/2002, compared to 14.3% in 1999/2000); SHA/country percentages for 2001/2002 ranged from 8-29%. This indicator has not, however, regained the levels seen in the past. CONCLUSION: There has been no improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dentinal decay has decreased slightly; significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.