First-time isolation of Candida dubliniensis from plaque and carious dentine of primary teeth.

AIM: To determine those organisms of the genus Candida associated with dental caries by investigating samples from active carious lesions. Within the genus Candida, the species Candida albicans and Candida dubliniensis are capable of forming chlamydospores and germ tubes. Until it became possible in 1995 to differentiate between the two species taxonomically, C. dubliniensis was falsely identified as C. albicans. Whilst the importance of C. albicans for rapidly progressing early childhood caries (ECC) has been recognised, so far there have been only reports about C. dubliniensis in connection with children/mothers who have been infected with HIV or already developed AIDS. In the present study, C. dubliniensis was for the first time isolated from plaque and carious dentine of a healthy five-year-old boy. METHODS: As part of the investigation, a number of samples were collected from individual children affected by active dental caries. Amongst the samples, one in particular indicated that Candida species might be involved. The patient was a five-year-old boy with ECC of the primary dentition, scheduled for restorative treatment under general anaesthesia. Before treatment, a salivary, plaque (region of 54/55) and soft carious dentine sample from the tooth 51 was taken before extraction. The counts of yeasts, lactobacilli (LB) and mutans streptococci were determined in the samples. RESULTS: The boy's dmft was 11, which was dominated by the d component. In the saliva of the boy, LB and mutans streptococci (MS) were detected. In plaque and carious dentine, MS and most interestingly C. dubliniensis were present. The yeasts were visualised in carious dentine by means of scanning electron micrographs. CONCLUSIONS: Plaque and carious dentine may be a further habitat of C. dubliniensis.

[Dependence of caries protective effect of fluoride varnishes applications on first permanent molars in schoolchildren on the intensity of caries of temporary teeth].

There are four-year clinical research results of the efficacy of the varnishes with different fluoride compounds on first permanent molars in young schoolchildren depending on the lesion of caries of temporary molars. It was determined that for children, whose molars were healthy during the basic examination, the highest caries protective effect was achieved with the help of varnish, containing CaF(2) (the reduction of increase of the intensity of caries of permanent molars formed 59.7%), and for children with initial high lesion of caries of permanent molars the best caries preventive effect was achieved with the varnish "Bifluorid 12®" (the reduction of increase of the intensity of caries of permanent molars formed 52.5%).

[The suitability of orthodontical groups of indications (OGI) for preventive dental examinations of the public health service]. / Die Eignung der "Kieferorthopädischen Indikationsgruppen" (KIG) für die zahnärztliche Vorsorgeuntersuchung des Offentlichen Gesundheitsdienstes (OGD).

In the context of the dental preventive medical examinations of the public health service, the orthodontical data-gathering in children's day-care centre and schools, in contrast to the diagnoses of caries disease, was made was based so far on a non-uniform methodology. In order to provide in future, also in the orthodontical sector, data material that is usable for comparative national and local health reporting, a uniform methodology should form the basis for the data acquisition. The present study makes a contribution to this objective. A goal of the work was to test two different collection instruments for their suitability as objective tools in the context of the preventive dental medical examinations. The occurrence and the severity level of dentofacial anomalies as well as the orthodontic treatment status of Thuringian school children of defined age groups (9 to 11 years old, 12 to 13 years old) were recorded and the orthodontic treatment need was determined. In the younger age group valid the orthodontical groups of indications (OGI) were found for the first time in Germany; in the older group we tested the already long established Dental Aesthetic Index (DAI) and equipment application recommended by the World Health Organization (WHO). The work was a component of the task spectrum of the WHO Collaboration Centre "Prevention of Oral disease" of the Health Centre for Preventive Dentistry at the Centre for Tooth, Mouth and Jaw Dentistry of the Friedrich Schiller University of Jena in Thuringia. As investigation region, a rural area ("Landkreis Eichsfeld") of Thuringia was choosen. The study was arranged into a sociological and a clinical-epidemiological part. Altogether 1845 pupils were recruited from national schools. The questionnaire was based on the WHO-initiated "International Collaborative Study of Oral Health Outcomes" (ICS II study). The investigations took place in the context of the preventive medical examinations of the public health service. The results were based on the answers and findings of 691 probants of the group of the 9-11 years old (AG 1) and 774 probants of the group of the 12-13 years old (AG 2). The sociological results of both age groups reflected social restrictions regarding the presence of dentofacial anomalies in an order of magnitude of 20% in the AG 1 and 7.3% in the AG 2. In the AG 1 11.4% confirmed an orthodontical treatment and 47.9% of the probants examined indicated a desire for treatment. On the other hand, the proportion of orthodontically treated in AG 2 amounted to 31.1% and 37.8% expressed a desire for treatment. Dentofacial anomalies determined with the help of the OGI in the AG 1 as the most frequent were in the form of a distal bite (sagittal stage/group of D) with 55.5% of the examined pupils being documented. However here severity development stages 1 and 2 outweighed. Proportionally followed: confining (group E) with 21% and the vertical stage/deep bite (group T) with 7.8%. All other groups were represented by only small proportions, craniofacial anomalies (group A) were not diagnosed. Anomalies with severity development 1 and 2 were determined in 64.1% of the examined children. In the AG 2 examined with the DAI, the anomalies of space conditions with 58% exceeded anomalies of occlusion conditions with 38.9% and anomalies of dentition with 9.8%. An urgent orthodontical treatment need was determined in the AG 1 with 35.9% of the probants (severity development 3 to 5) and in the AG 2 with 16.8% (DAI values over 32). In the AG 2 too, over 60% DAI values from 13 to 25 were determined, 26% exhibited DAI values between 26 and 31. During the statistic evaluation the "Statistical Package found for Social Sciences (SPSS)" version 11.51 S with a significant level of 5% was used. Derived from the results of our analysis, the recommendation can be made that the methodology of the Orthodontical Groups of Indications for the employment is to be regarded as a possibility with dental preventive medical examinations in the public health service as a suitable equipment and so far allows the subjective estimate of the orthodontical treatment necessity to be made.

Oral health in 8-9 year-old children in Saxony-Anhalt (Germany) and in two Hungarian cities (Budapest and Debrecen).

OBJECTIVE: This paper reports the results of standardised oral examination (dmft/DMFT, CPI) of 1,090 8-9 year-old children from Saxony-Anhalt (Germany) and 906 8-9 year-old children from Budapest and Debrecen (Hungary) to assess the oral health condition after the political changes and the transformation of the dental care systems in Eastern Germany and in Hungary respectively. METHOD: Children were randomly selected from urban and suburban areas in one of the new Federal States of Germany. Hungarian children were selected from Budapest and Debrecen. The clinical examinations were based on WHO criteria. RESULTS: The mean dmft of the German children was 3.5 (95% CI: 3.33-3.68); the corresponding mean in the Hungarian sample was 2.3 (95% CI: 2.19-2.55). In both samples the decayed (d) component was the highest within the dmft. The mean DMFT in the German sample was 0.7 (DT = 0.4, FT = 0.3, MT = 0); in Hungary the corresponding means were 0.4 (DT = 0.3, FT = 0.1, MT = 0). Initial inflammation was the most common gingivial condition found. CONCLUSION: In general the oral health status of both groups was poor. The major problem was the high percentage of children with caries that needed treatment.

[Caries prevention with fluoride varnishes among preschool children]. / Kariesprophylaxe mit Fluoridlacken bei Vorschulkindern.

AIM: The aim of the study was to assess the caries inhibition effect of fluoride varnishes among preschool children with high caries risk. At the same time, the suitability of this measure should be examined in the frame of group prevention programmes in kindergartens. METHOD: This was an examiner-blind, clinically controlled 2-year study with 200 randomly selected 2- to 4-year-old preschool children with high caries risk. At the baseline, caries-free surfaces, initial caries lesions as well as the caries status (dmfs) were recorded. After the baseline, all subjects were divided into 3 groups. Subjects of group A received every 6 months (altogether four times) applications with the fluoride varnish Fluoridin N5 (VOCO GmbH, Cuxhaven, Germany), children of the group B received every 6 months (altogether four times) applications with Duraphat (Colgate Palmolive GmbH, Hamburg, Germany), while the subjects of group C did not receive any fluoride varnish applications and constituted the control group. A final examination was performed after two years similar to the baseline. Statistical analysis was based on the SPSS programme at a significance level of 95%. RESULTS AND CONCLUSIONS: The results confirmed the caries inhibition efficacy of both fluoride varnishes. This is shown as well in the almost constant number of caries-free surfaces and initial caries lesions in the two F-groups during the observation period. The caries-free surfaces in group C were significantly reduced along with an increase of initial caries lesions. The caries reduction, based on the control group, amounted in group A to 56% and in group B to 57%. The results documented the caries inhibition effect of both fluoride varnishes which are suitable for intensive group prevention programmes for pre-school children.

Assessment of manual restorative treatment (MRT) with amalgam in high-caries Filipino children: results after 2 years.

BACKGROUND: The atraumatic restorative treatment (ART), using only hand instruments and glass-ionomer cement as adhesive material is recommended for restorative dental treatment in disadvantaged communities lacking electricity and sophisticated dental equipment. Research is required on more durable restorative materials appropriate for populations with high-caries experience. OBJECTIVES: The aim of the study was to evaluate, under field conditions, the applicability and effectiveness of an encapsulated amalgam as restorative material in ART prepared cavities in permanent teeth of children with high-caries rates. As the definition of ART restricts the manual treatment to adhesive materials the approach used is called the manual restorative treatment (MRT). METHODS: Two dentists and two trained healthcare workers, using hand instruments and an encapsulated amalgam that was mixed with a manually driven triturator, placed a total of 934 restorations in the permanent dentition in 466 children. Due to irregular school attendance of Filipino children only 611 restorations could be evaluated by one independent dentist. The average age at reassessment of restorations was 27 +/- 4.5 months. RESULTS: 93.3% of the restorations were acceptable. The failure rate of occlusal surface restorations was 5.6% compared with 13.6% of buccal surface fillings. The survival rate of large occlusal restorations was 95.1% compared with 93.7% for small restorations. The survival of MRT restorations was not influenced by the experience and professional level of the operator. CONCLUSIONS: Amalgam is a suitable MRT material, especially for extensive occlusal lesions in high-caries populations. Studies of longer duration are needed to confirm this finding.

Oral healthcare in transition in Eastern Europe.

Big changes have occurred in the oral healthcare delivery systems of most Eastern European countries since the fall of the Berlin wall in 1989 and the demise of communism in the former USSR in 1991. In the new situation it was necessary to reform the political and social systems including healthcare. Reforms were started to improve the economy and, in comparison with Western Europe, the generally lower living standards. It is difficult to obtain comprehensive data on oral healthcare in Eastern European countries but this paper reports data from nine countries and provides a 'macro' view of the current situation in these countries. Many countries seem to have adopted a Bismarckian model for the provision of oral healthcare based on a sickness insurance system.

[Oral health in Europe with changing socioeconomic structures as seen by the epidemiologist]. / Die Mundgesundheit in Europa im Wandel sozioökonomischer Strukturen aus der Sicht des Epidemiologen.

During the 20th century in Europe remarkable results were obtained in health and social care systems which positively influenced general and oral health. Among others this was favoured by the WHO-initiated multinational movement "Health for all by the year 2000". Political changes in Eastern Europe levelled the way for constructive collaboration also in the field of health promotion. In contrast to this, economic deprivation in all European countries limits the financing of continually increasing costs of dental care. Oral health improved during the last decades, although differences in the health level between socioeconomic classes increased. In Eastern Europe the transformation process towards a new dental care system is quite difficult and is still going on. The establishment of new health-structures depends on socioeconomic resources and has so far attained different levels in various countries. The epidemiological situation also varies greatly. In general, caries prevalence is higher than in Western Europe.

Plaque removal efficacy of a newly developed powered toothbrush in the primary dentition of pre-school children.

A cross-over, single-blind clinical study was performed to compare a powered and a manual toothbrush for their ability to remove plaque from the teeth of pre-school children. Seventy-three randomly selected 4- to 6-year-old children from two kindergarten classes in Erfurt, Germany participated in the study. A new powered children's toothbrush (Rowenta) and a currently marketed manual children's toothbrush (Elmex) were used for an assessment period of two weeks each. Then the groups were crossed over to use the alternate toothbrush for another two weeks. Whole mouth, gingival margin and interproximal plaque area levels were determined using the Rustogi et al. plaque index. Statistical analysis of the data showed significantly effective (p < 0.05) plaque removal with both toothbrushes, immediately after toothbrushing and at one and two weeks, compared to the respective baseline scores. The statistical analysis also demonstrated that the powered toothbrush was significantly (p < 0.05) better on percent plaque reduction on all tooth areas compared to the manual toothbrush, except at two weeks with the interproximal assessment.

[Long-term results with dental treatment concepts for disabled children]. / Langzeiterfahrungen mit zahnärztlichen Therapie konzepten für behinderte Kinder.

More than 10 years ago 400 mentally and physically handicapped children aged 3 to 18 years were included in a dental care program to improve their oral health status. Besides dental treatment a comprehensive preventive program (tooth brushing, application of fluorides, dietetic recommendations) was carried out. The results prove a significant caries reduction and an increase in caries free children. A reduction of dental plaque and marginal inflammations were also observed. To prevent the carious destruction of the dentition of the handicapped, these patients should receive regular prevention-oriented dental care from the age of 3 years.

[Changes in the epidemiological profile of dentofacial anomalies and in the status of orthodontic treatment between 1979 and 1989 in the city and district of Leipzig (an ICS-I replication study). International Study of Dental Manpower System]. / Veränderungen im epidemiologischen Profil dento-fazialer Anomalien und des kieferorthopädischen Behandlungsstandes zwischen 1979 und 1989 im Stadt- und Landkreis Leipzig (ICS-I-Replikationsstudie).

Ten years after the Leipzig ICS-I-Study a replication study was performed in analogous fashion and in the same territory. Using the COCSTOC methods changes in the prevalence of dental-facial anomalies and the orthodontic state of treatment were determined in a random sample of 13-14-year-old school children. The prevalence of anomalies had decreased within a decade from 43% to 35%. At the same time the percentage of children not under treatment decreased from 14% to 10%. The causes are seen mainly in the area under consideration and the related preservation of the support zone until the physiological replacement of teeth as well as a reduced extraction rate for primary and permanent teeth.

[Investigation of caries occurrence and occlusal restoration in beginning school children in Erfurt compared to Marburg an der Lahn]. / Untersuching über Kariesbefall und Gebisssanierung bei Schulanfängern in Erfurt im Vergleich zu Marburg a.d. Lahn.

At the end of 1990 in the area of Erfurt 309 and in and around Marburg an der Lahn 348 school beginners were examined by one children's dentist under identical conditions. The results (milk teeth) showed that the caries incidence (dmfs) was comparable in both regions. However, the proportion of restored milk teeth tended to be higher in Erfurt than in Marburg. In addition, the differences in individual caries incidence were more marked. In Marburg there were more caries-free children, but children whose teeth had been damaged by caries were more seriously damaged than those in Erfurt.

[Efficacy of therapeutic and preventive measures with the help of bite wing radiographs]. / Effektivitätsbewertung therapeutischer und präventiver Massnahmen mit Hilfe der Bissflügelaufnahme.

The effectiveness of caries diagnosis as seen in bite-wing pictures in the lateral dental segments was evaluated with reference to therapeutic and preventive control. Bite-wing x-rays of 328 patients aged 15-18 were included in the evaluation. The approximal segments from the ist premolars to the 2nd molars were taken into consideration. Further treatment was found to be necessary in 110 patients on the basis of the diagnoses exposed filling edge/split edge (45%), caries in dentine not adjacent to pulp (30%), secondary caries (15%) and caries in dentine adjacent to pulp (10%). Following an initial diagnosis of enamel lesions, preventive measures were necessary in 180 patients. The results document the importance of radiological checks of the permanent teeth in the approximal segments in youths. Bite-wing x-rays are also an effective means of monitoring the effectiveness of preventive measures.

[Fluoride accumulation of the surface enamel of primary tooth after supervised brushing with a low dose-fluoridated dentifrice]. / Fluoridanreicherung im Oberflächenschmelz von Milchzähnen nach kontrollierter Zahn- und Mundhygieneaktion mit einer niedrig dosierten Fluoridzahnpaste.

The fluoride accumulation on the surface enamel of primary incisive using a low dosed fluoridated dentifrice (0.085% F) was determined in vivo in comparison with a placebo dentifrice within a longitudinal study. After 12 months supervised brushing the superior incisive of the preschool children used the fluoridated dentifrice show a fluoride concentration of 609 ppm, after 20 months 612 ppm fluoride. The fluoride concentration of the surface enamel of the placebo group was 380 (after 12 months) and 385 ppm fluoride (after 20 months). Presume the optimal caries prevention should not reach by only using the low dosed fluoridated dentifrice.

[Comparison of oral health in metropolitan and nonmetropolitan district of Leipzig in 1979 and 1989 (ICS I replication study)]. / Vergleich des oralen Gesundheitszustandes 1979 und 1989 im Stadt- und Landkreis Leipzig (ICS-I-Replikationsstudie).

In 1989 the Leipzig-ICS-I study from 1979 was replated according to the same methodology on randomized probands (N = 2693). A significant reduction of the dmft-value (27%) and DMF-value (50 resp. 27%) with clear increased f(F)-value was found at 8/9 and 13/14, years olds. At the same time there was a caries increment of 1.9 DMFT from 1979 to 16 DMFT in 1989 in the age group of 35-44 years. Again in this group was found a very low edentulousness (0.3%) and a very high number of natural teeth (25.9). During 10 years the prevalence of dentofacial anomalies decreased about 25.6% (13 to 14 years old) and in the adult group the prostetic treatment needs decreased by half. The results reveal an essential improved oral health status in consequence of intensive dental care. Unsatisfied is the periodontal status. 90% of subjects need oral hygiene measures.

[The caries-protective efficacy of 2 fluoride varnishes in a 2-year controlled clinical trial]. / Kariesprotektive Wirksamkeit zweier Fluoridlacke in einer klinisch kontrollierten Zweijahresstudie.

The aim of this randomized, double-blind study was to measure the cariostatic effect of Bifluorid 12 (VOCO GmbH), containing 6% sodium fluoride and 6% calcium fluoride and Laweflour-Schüttellack (LAW), containing 5% sodium fluoride in comparing of placebo varnish. The caries study included 400 schoolchildren, aged 12-14 years. The tests according to the DMFS were carried out by two independent examiners. The 400 children were divided into 3 test and 1 placebo group, each group consisting of 100 subjects. After two years there was a significant inhibition of caries increment in all test groups compared to placebo group. Percentage caries reduction ranged from 25 to 30%. The highest effect was stated at proximal surfaces.