Move of adults with mental retardation from institutions to community-based living: changes in the oral microbiological flora.

In the Western world, the policy of deinstitutionalization and integration of individuals with mental retardation is generally accepted. We tested the hypothesis that de-institutionalization may lead to changes of habits with a potential to influence oral health. When 57 adults with mental retardation moved from an institution to community-based living, their oral hygiene habits, gingival bleeding, and a three-day food record were registered one month before and 9 and 21 months after the move. Mutans streptococci and lactobacilli in saliva, P. intermedia/P. nigrescens, P. gingivalis, and A. actinomycetemcomitans in supragingival plaque, and C. albicans on mucous membranes were analyzed. After 21 months of community-based living, fewer persons showed high classes of mutans streptococci, growth of P. intermedia/P. nigrescens, and high frequency of sucrose intake, and more subjects showed growth of C. albicans. In a short perspective, the indicators of oral diseases suggest an unchanged or lower risk of oral diseases after the de-institutionalization of individuals with moderate or severe mental retardation.

Comparison of use of dental services by finnish immigrants and Swedes using national health statistics.

Dental statistics and treatment information collected by the National Social Insurance Board (NSIB) since the Dental Insurance Scheme was introduced in Sweden in 1974, give a unique opportunity to study the use of dental services by the adult population. Earlier studies showed that adult Finnish immigrants utilized dental services less, and had a greater need of dental care, than the Swedish population. The possible confounding effects of age and social class were not, however, controlled. The aim of this study was to compare use of dental services and dental treatment performed in matched groups of Finnish immigrants and Swedes using central statistics. All Finnish citizens between 17 and 64 yr old born on the 20th of any month and living in the county of Stockholm in 1975, altogether 1378 persons, were selected from the population register. For each Finn a Swedish "social twin" was selected with respect to age, sex and occupation. Information about use of dental services and treatment performed during 1975 was collected from the patient register at the NSIB. The study showed that Finnish immigrants in 1975 visited a dentist less often than the corresponding Swedish group. Those Finnish immigrants who received treatment had had more comprehensive and more expensive care than the Swedish comparison group. The study shows that there were significant differences in use of dental services by and treatment performed on Finnish immigrants and Swedes even when differences in demographic and socioeconomic distribution were controlled.

Social background and dental care habits and attitudes of Finnish immigrants in Sweden.

Foreign citizens today constitute 5% of the Swedish population. While several epidemiological investigations have dealt with dental care habits in the Swedish population, very little is known about the dental care habits of immigrants. This constitutes a factor of uncertainty in the planning of dental care. A random sample of 170 Finnish immigrants, 20-80 years old, in the community of Huddinge was selected. They were summoned to the Faculty Clinics for interview and clinical and radiographic examination. 143 persons appeared for examination. The interview showed that 46.6% of the subjects had never visited a dentist in Sweden though 80% of them intended to remain in Sweden. 19.8% still made more or less regular use of dental services in Finland. The low frequency of utilization of dental services is mainly due to the difficulty in obtaining dental care, lack of knowledge of Swedish, lack of interest and fear of pain. According to the present study Finns in Sweden utilize dental services to a smaller extent than Swedes. The decision of principle adopted by the Swedish parliament in 1968 that immigrants shall be able to live under the same conditions as the Swedes seems not to be fully achieved with regard to the dental care of Finnish immigrants.

Dental attendance of some of the common immigrant groups in Sweden.

The aim of this study was to see how Greek, Polish, Turkish, Yugoslavian and Finnish immigrants utilized dental services offered, as compared to Swedes. The study covered the years 1976-79, using figures from the National Social Insurance Board (NSIB). All foreign citizens of the aforementioned groups born on the 20th of any month and living in the country of Stockholm were selected, together with a comparison group of Swedish citizens. During the 4 yr in question, only 31% of the Greeks, 50% of the Poles, 28% of the Turks, 40% of the Yugoslavs and 75% of the Finns visited a dentist in Sweden, while 87% of the Swedes did. Few immigrants except some Finns went annually. A great majority of all Greeks, Turks and Yugoslavs either saw a dentist only once or else not at all during the whole period. Emergency treatment was significantly more common for these groups than for Poles, Finns or Swedes. The study revealed a fragmentary and episodic use of the dental services offered to most common immigrant groups in Sweden.

Swedish and Finnish dental practitioners' opinions of their undergraduate education.

Recently qualified dentists from a dental school in Stockholm, Sweden (n = 259) and the dental school in Kuopio, Finland (n = 103) were sent a questionnaire designed to obtain information concerning the perceived relevance of their undergraduate education to the practice of dentistry. The response rate was 71% for Stockholm and 82% for Kuopio. Except for minor differences, probably mainly due to economic resources and traditions in choice of treatment, the graduates in the two countries had comparable views of their basic education. In general, clinical dental subjects were highly valued, while basic science subjects but also subjects in medical and behavioral sciences were given low values. Our results indicate that, although prevention and behavioral sciences are stressed more and more in undergraduate education, the practice of clinical dentistry remains essentially unchanged and restorative dentistry is still very highly valued among recent graduates of these two dental schools.

Simplified preventive dentistry program for Chilean refugees: effectiveness of one versus two instructional sessions.

A simplified dental health program for newly arrived refugees was evaluated. The efficacy of presenting the program in one instructional session or two was compared. 193 Chilean refugees, granted residency in Stockholm in Spring 1981 or in Spring 1982, participated. The subjects were divided into two groups. One group received a dental health program only at the first visit, in conjunction with the baseline examination, and the other group was recalled for a further session 3 months after the baseline examination. Both groups were recalled for evaluation 6 months after the initial visit. At follow-up the groups comprised 94 and 65 subjects respectively. The mean relative reductions in gingivitis (relating GBI reduction to baseline GBI) were 33.2% (95% < I: 29.1 to 37.3%) in the single-visit group and 40.5% (95% < I: 35.9 to 45.8%) in the two-visit group. The reduction in periodontal pocket depth was mainly a reduction of shallow pockets. The maximum effect was attained after one instructional session.

Utilization of dental services in refugees in Sweden 1975-1985.

Prior to 1940 the population of Sweden was one of the most homogeneous in Europe, with only 0.5% foreign born. Fifty years later, in 1990, the proportion of immigrants was around 15%. In order to describe and analyze consumption of dental care in different refugee groups in Sweden, data registered by the Department of Immigration and the National Social Insurance Board, on a random sample of 2489 refugees arriving in Sweden 1975-85, were merged. Information on nationality, date of arrival in Sweden, date of granting of permanent resident status and statistics on consumption of dental care were retrieved. During the period studied a total of 50,521 refugees arrived in Sweden. The average interval between arrival in Sweden and the first dental visit was 4.5 yr (95% < 1: 4.2-4.7). The total treatment time during the first course of treatment was 165.5 min (95% < 1: 148.7-182.3). Consumption of dental care did not decrease with an increased number of treatments. Only 38% of the refugees had visited a dentist at all in Sweden. With increasing number of years in Sweden the number of courses of dental treatment increased, but 41% of the refugees who had visited the dentist in Sweden had done so only once. This study shows a low utilization of dental services among refugees in Sweden in general. Refugees with dental visits in Sweden, in particular, had a high dental consumption.

Caries prevalence among adults in communities with optimal and low water fluoride concentrations.

The aim of this study was to compare the dental health status of adults measured as caries prevalence in two socioeconomically similar communities with optimal and low water fluoride concentrations respectively. Other topical fluoride sources are also taken into consideration. The study is based on clinical and radiological examinations of 30-40-yr-old subjects who for all their lives have been drinking water with a fluoride concentration representative for the community. 260 individuals resident in the optimal fluoride area and 236 from the low fluoride are included in the study. The results show that caries prevalence was lower in the optimal fluoride area. Caries prevalence was higher in women than in men within both groups. The prevalence of primary caries was low but significantly higher in the low fluoride area, principally in the form of proximal caries. Caries prevalence was not influenced by other topical fluoride sources.

Intraindividual effect of daily supervised flossing on caries in schoolchildren.

The aim was to study the effect of flossing on proximal caries in children grouped according to different combinations of dietary and oral hygiene habits. 140 12--13-year-old children flossed the right or the left lateral region of the mouth once every school-day for 2 years by pulling a waxed floss once up and down through the proximal contacts. Proximal caries was recorded on bitewing films, taken at the baseline and at the 2-year registration. Diet history was obtained four times during the period. Oral hygiene was classified according to the number of bleeding points registered with a feather-loaded probe at the final examination. Caries increments on the control side during the experimental period were calculated for groups with the same habits. A logical border with respect to the amount of new caries was then established between suitable and unsuitable dietary habits as well as between sufficient and insufficient oral hygiene. No statistically significant difference was found between the control and experimental subgroups in the different combinations of dietary and oral hygiene habits, neither with respect to the whole material nor comparable contralateral surfaces. The numerical differences were so small that the technique of flossing studied here cannot be recommended.

Attitudes and knowledge about preventive dental care in Chilean refugees in Sweden.

The aim of this study was to evaluate the effects of a simplified oral health programme on attitudes to and knowledge of preventive dentistry. The subjects were Chilean refugees and the programme was delivered at one or two sessions in the form of group information/discussion. Because of increasing immigration, Sweden has become a multicultural society. The number of non-Nordic immigrants has doubled in the past decade. The major refugee groups have come from Iran, Chile and Poland. The subjects comprised 193 Chilean refugees: 106 in a single-visit group and 87 in a two-visit group. The oral health programme was completed by 94 and 65 subjects respectively and was evaluated after 6 months. Positive effects were discernible in attitudes to and knowledge of preventive dentistry, particularly with respect to oral hygiene. A key to success may have been group discussion in which the refugees could relate oral health problems to their own ethnic group. This could have an important function in bridging cultural, linguistic and situational barriers. Different forms of outreach programmes for oral health via groups, organisations or authorities in close contact with refugees shortly after arrival in Sweden are proposed. This approach may be particularly effective in a multicultural society and also in the context of the turbulent conditions the newly-arrived refugee experiences.

Prevalence of fluorosis and other enamel defects related to caries among adults in communities with optimal and low water fluoride concentrations.

The aim of this Swedish study, performed in 1982, was to determine the prevalence of fluorotic and nonfluorotic enamel defects among adults in areas with optimal and low fluoride concentrations in water. The fluorosis prevalence was also related to caries prevalence in these areas. The study was based on clinical examinations of subjects born between 1939-1951 who had been drinking water with a fluoride content representative of their area of residence all their lives. This water was the only appreciable source of fluoride during tooth formation. Two hundred and sixty individuals living in the optimal fluoride area were included in the study and 236 individuals from the low fluoride area. The results showed first, a low prevalence of mild dental fluorosis in the area with optimal fluoride content in its drinking water; secondly, a low prevalence of non-fluorotic enamel defects, which was, however, higher in the low fluoride area than in the optimal fluoride area; thirdly, that caries prevalence was lower among those with fluorotic enamel defects in the optimal fluoride area; and lastly, caries prevalence was not influenced by non-fluorotic enamel defects.

The Swedish National Dental Insurance's periodontal diagnosis. Used on an individual level.

The Swedish National Dental Insurance Board requires a periodontal diagnosis (FKF 2030 86.12GR) from general practitioners before treating patients, a process which is expensive. The Swedish National Dental Insurance-index (SNDI-index) is based on clinical data and radiographs and every tooth is assigned a rating between 0 and 4. From the time of introduction of the Swedish National Dental Insurance plan in 1974, data can have been collected for 1.7 million patients if the regulations were followed according to the Swedish National Dental Insurance Board in Stockholm, Sweden. It is of interest to examine whether all of these collected periodontal data reflect periodontal status. In this study includings 56 individuals, the Swedish National Dental Insurance-index, used on an individual level, correlated significantly with the individual changes in bone support (as percent of toothlength) of the tooth in 1979 (rs = -0.80, t = -9.7, p < 0.001, ci 95% = -0.88(-)-0.68) as well as in 1989 (rs = -0.79, t = -9.5, p < 0.001, ci 95% = -0.87(-)-0.67).

Computerized registration of epidemiological data from intraoral radiographs.

Software was developed for graphic registration of epidemiological dental data from intraoral radiographs. The measured variables included marginal bone level in relation to tooth and root length as well as proximal caries and restoration areas. Caries and peridontitis progress nowadays slowly in large populations. Registration methods must, therefore, offer high precision. The hard and software were first tested. After that the method's reliability or precision was studied. The precision of measuring marginal bone level as a per cent of total tooth or root length was found to vary between 0.3-4.3. The corresponding precision of measuring a caries area in relation to the whole crown area was 1.4%. Precision was also divided into its components and analysed in more detail. All registered tooth variables except the angle between the proximal marginal bone and the root surface gave satisfactory results indicating good reliability.

Effects of the new undergraduate dental curriculum of 1979.

A new curriculum for dental education was introduced in Sweden in 1979. Among other things the basic training was cut down from 10 to 9 semesters and a preregistration year in the Public Dental service was added. In this study two cohorts of dentists, one having studied under the old and one under the new curriculum, having 1 to 3 years practical experience of the dental profession, were asked to evaluate their undergraduate education as seen from a practising dentist's point of view. The results showed that the dentists trained under the new curriculum regarded their theoretical knowledge, clinical skills, and the relevance of their training generally higher than those trained under the old curriculum. However, the correlations between the old and the new curriculum with respect to the rankings of the individual subjects were high, indicating that no radical changes had occurred in the preference orders of the subjects. The self-estimated importance of different subjects for the dental profession may reflect the dentists' present working situation, e.g. the Public Dental Service or private practice.

Precision of computerized measurement of marginal alveolar bone height from bite-wing radiographs.

The digitizer technique has previously shown good precision when applied to measurements of alveolar marginal bone height on unstandardized periapical radiographs of adults. In this study the precision of the digitizer technique was evaluated for direct measurement of alveolar bone height on unstandardized bite-wing radiographs of young subjects with intact cemento-enamel junctions. Measurements of the distance between the cemento-enamel junction and the alveolar crest at 432 sites gave an agreement of 96.5% within a margin of error of 0.3 mm. The T-test showed no significant difference between repeated measurements of the same site. Regression analysis showed that the order of magnitude of the distance between the landmarks did not influence the results. The mean difference between repeated readings of the same site was 0.09 mm at a confidence limit of 99.9%. The study confirms that the digitizer technique is a reliable method for measurement of alveolar bone height on unstandardized bite-wing radiographs of young subjects.

Salivary levels of lactobacilli, buffer capacity and salivary flow rate related to caries activity among adults in communities with optimal and low water fluoride concentrations.

In several human studies, scientists have sought to elucidate the connection between caries activity, high levels of lactobacilli, low buffer capacity and a low salivary flow rate, separately or in combinations. The aims of the study were to investigate if there was a difference in caries activity among adults in optimal versus low fluoride areas. It was further investigated if this difference was related to high lactobacilli levels, low buffer capacity and low salivary flow rate, separately or in combination. Finally, it was analysed if the lactobacilli levels were lower in an area with optimal fluoride water concentration. The study is based on clinical examinations of 30-40 year olds who all their lives had drunk water with a fluoride concentration representative for the community. 260 individuals living in the optimal fluoride area and 236 from the low fluoride area are included in the study. The results show a caries activity significantly lower among those in the optimal fluoride area. It is also shown that these differences can not be explained by differences in lactobacilli levels, buffer capacity and salivary flow, neither separately nor in combination. The fluoride concentration in the drinking water is wholly decisive. No difference in lactobacilli levels between optimal and low fluoride areas were demonstrable in this study.

A retrospective study on the relevance of the dental curriculum in general practice.

The undergraduate dental curriculum in Swedish dental schools has recently been changed. The aim of this study was to estimate the opinions of recently qualified dentists concerning their undergraduate education received according to the old curriculum. A questionnaire was mailed to all graduates who qualified from the dental school in Huddinge between 1981-1983. The response rate was 71%. The respondents indicated that their theoretical knowledge was in general better in subjects closely related to clinical dentistry compared with basic biological subjects or behavioural science subjects. In most subjects clinical competence was closely related to the level of theoretical knowledge. The results of this study suggest that the "old" dental curriculum was successful in imparting knowledge concerning traditional dental subjects and preventive dentistry, but less successful in imparting knowledge concerning basic and medical sciences, behavioural subjects and in relating theoretical and practical skills.

Dental students' views on their education and study circumstances in Nordic countries.

The curricula at the Nordic dental schools are similar in their content but may vary in the placement of different subjects and the way of teaching them. The aim of this study was to analyse Nordic dental students social background, and their reasons for choosing dentistry, their opinions on the course, and their future professional plans. A combination of an open-ended and structured questionnaire was given to final year dental students at the dental schools in Aarhus, Bergen, Kuopio and Stockholm. The response rate as 83%. The main reasons for choosing dentistry were its combination of theory and practice (29%), and a wish to work with people (20%), whereas only 4% mentioned the "high status" of the profession. Regular day-time work was emphasized by female students. Most students considered the teaching load heavy. The time devoted to the different subjects was considered sufficient, except for behavioural science and medicine, where the time was too short. There was general dissatisfaction with the teachers pedagogical skills, and there was a feeling that teaching was regarded as secondary to research. Most students planned to become private practitioners. Between 25-55% of the students wanted to specialize, and oral surgery was the most popular specialization.

Number of remaining teeth among adults in communities with optimal and low water fluoride concentrations.

The aims of this study was to compare the dental health status measured as the number of remaining teeth, also considering local fluoride administration in two sociologically equal communities with optimal and low drinking water fluoride concentrations. The study is based on self-answer enquiries and clinical examinations. To be part of the study the subjects were required to have used a drinking water with a fluoride concentration representative of the community for all their lives. The participants were 30-40 years old: 320 met the criteria in the optimal fluoride concentration community compared to 284 in the low fluoride community. Of these 18% did not turn up to the clinical examination. The results of the study show no differences in the number of still remaining teeth between optimal and low fluoride communities respectively. There were also no statistically significant differences as to the reasons for toothloss. The number of remaining teeth were neither influenced by local fluoride administration in the two groups. Removable dentures were only present in 0.9% with no differences between optimal and low fluoride communities.

Variation of caries frequency with socio-economic background in unselected and extreme groups of 14-year old children in Malmö.

The purpose of the present investigation was to find out whether any correlation exists between socio-economic factors and caries frequency in unselected and extreme groups of 14-year old school children in Malmö. The material consisted of 360 randomly selected 14-year old school children in Malmö (1969) and their parents. The number of DF-surfaces was obtained from the records of the school dental service. Data on the parents' occupation and gross incomes in 1969 were obtained from the tax office in Amlmö. Extreme groups were obtained by chosen those 10% with the highest caries frequency (H'-group) and a corresponding group with the lowest frequency of caries (L'-group). These two subgroups were compared with a selection of 14-year old school children with high (H-group) and low (L-group) caries frequency, which have been analysed earlier in respect of socio-economic background. No significant correlation was found between socio-economic factors and caries frequency in the non-stratified selection. H'-group and L'-group, on the other hand, showed marked differences in socio-economic background. Compared with the H-group, the H'-group showed a higher number of DF-surfaces. This difference was due to variations in distribution of caries between different schools but was not clearly correlated to socio-economic factors. The differences in socio-economic distribution between H'-group and H-group like between L'-group and L-group were not found to be significant. The findings mean that the conclusions drawn regarding socio-economic factors and dental care regarding H- and L-group also can be regarded as representative of schoolchildren with extremely high and low caries frequency, respectively.