The risk of colorectal cancer is not increased after a diagnosis of urothelial cancer: a population-based study.

BACKGROUND: The data about whether patients with a prior urothelial cancer (uca) are at increased risk of colorectal cancer (crc) are conflicting. We used a competing risks analysis to determine the risk of crc after uca. METHODS: Historical cohorts were assembled by record linkage of Manitoba Cancer Registry and Manitoba Health databases. The incidence of crc for individuals with uca as their first cancer between 1987 and 2009 was compared with the incidence for randomly selected age-and sex-matched individuals without a cancer diagnosis at the index date (uca diagnosis date). Three competing outcomes (crc, another primary cancer, and death) were evaluated by competing risks proportional hazards models with adjustment for relevant confounders. RESULTS: The cohorts of 4591 patients with uca and 22,312 without uca were followed for a total of 179,287 person-years (py). After uca, the rate of subsequent colon cancer in uca patients was 4.5 per 1000 py compared with 3.6 per 1000 py in the non-cancer cohort. In the multivariable analysis, no overall increase in crc risk was observed for patients first diagnosed with uca (hazard ratio: 0.88; 95% confidence interval: 0.70 to 1.1; p = 0.26). CONCLUSIONS: Because of similar crc risk, a similar crc screening strategy should be applied for individuals with and without uca.

Rapid improvement in symptoms and physical function following ibrutinib initiation in chronic lymphocytic leukemia and the associated changes in plasma cytokines.

A prospective pilot study was carried out on 34 CLL patients treated with ibrutinib, evaluating the effects on symptoms and physical function with changes in plasma exosomes (EXs), ß2-microglobulin (ß2M) and 26 plasma cytokines. The revised Edmonton Symptom Assessment Scale (ESAS-R) demonstrated moderate fatigue, shortness of breath and a sense of unwellness before treatment, which significantly improved within 2 weeks of starting ibrutinib. These changes were associated with a rapid improvement in sit-to-stand and 4 m walking speeds. The plasma levels of CCL11, IL-7, -8 and -10 dropped initially while the levels of TNF-α/-ß, CCL3, CCL4, CCL17, and IL-16 continued to decline for 12 months. Despite the initial lymphocytosis, plasma ß2M levels fell but no consistent change in plasma EXs occurred. Thus, ibrutinib can produce a rapid and sustained improvement in symptoms and physical function in CLL, associated with a decline in multiple plasma cytokines.

Incidence of right-sided colorectal cancer after breast cancer: a population-based study.

OBJECTIVES: Estrogen levels, which are involved in the development of breast cancer, may also be responsible for a higher incidence of right-sided colorectal neoplasia in women. Our objective was to determine the incidence of right-sided colorectal cancer (CRC) after the diagnosis of breast cancer. METHODS: All cases of breast cancers diagnosed between 1956 and 2006 were identified from the Manitoba Cancer Registry (MCR) and followed up until the diagnosis of any invasive cancer, death, migration out of the province, or 31 December 2006. Standardized incidence ratios (SIRs) for all CRC and right-sided CRC (cecum, ascending colon, and hepatic flexure) were calculated to compare the observed CRC incidence with that expected in the general population. Stratified analysis was performed to determine the risk at different follow-up time intervals, age at breast cancer diagnosis, and for tamoxifen use. RESULTS: There were 23,377 cases of breast cancer diagnosed between 1956 and 2006 with a total follow-up of 221,364 patient-years. The SIR for all CRC was 0.96 (95% confidence interval (CI) 0.87-1.06) and for right-sided CRC it was 1.02 (95% CI 0.87-1.20). The SIRs remained close to unity at different time intervals, for different age groups, and in analysis restricted to more recent years (1985-2006). Tamoxifen use did not alter the risk of all CRC (SIR 1.22; 95% CI 0.92-1.62) or right-sided CRC (SIR 0.90; 95% CI 0.48-1.54). CONCLUSIONS: There is no increase in the overall risk for CRC or for right-sided CRC after the diagnosis of breast cancer. CRC screening strategy for breast cancer survivors should be similar to that for the general population.

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.

Accuracy and reproducibility of conventional radiographic assessment and subtraction radiography in detecting demineralization in occlusal surfaces.

Subjective interpretation of paired digital radiographic images viewed side by side to assess occlusal lesion progression, arrest or remineralization is difficult. The aim of this study was to compare the accuracy and reproducibility of a digital subtraction radiography technique and visual assessment of paired digital images in detecting changes in mineral content within occlusal cavities. Forty molar teeth with occlusal cavities were placed in arches and baseline digital radiographs taken. Nineteen teeth were randomly selected and had acid placed in the cavities and digital images taken after 3, 6, 12, 18 and 24 h of acid exposure. Paired baseline images and those taken at the various time intervals were examined side by side and assessed for demineralization by five examiners. Subtraction images prepared from the paired images were assessed in the same way. One fifth of the images were re-examined to determine intra-examiner reproducibility. After 12 h or longer the diagnostic accuracy (mean area under the ROC curve = 0.92-0.98 for subtraction radiography), intra-examiner and inter-examiner reproducibility for detection of demineralization from the subtraction images was significantly better than viewing the paired images side by side (p < 0.01). The subtraction radiography system used was found to be more accurate and reproducible than visual assessment of paired digital images. As such the technique shows promise for monitoring occlusal lesion progression in clinical studies.

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.

A radiographic method of estimating surface area of amalgam restorations.

UNLABELLED: Mercury released from the surface of amalgam fillings has been linked to a variety of disorders, but without proof of correlation. Studies use surface counts to estimate this variable, but large-scale studies would require a tool to rapidly and accurately assess restoration surface area. OBJECTIVES: This study investigated digital analysis of conventional dental radiographs as a means of estimating amalgam surface area. METHODS: Amalgam fillings were placed in 40 typodont teeth, the surface areas of the restorations were determined by measuring standardized photomicrographs of each surface. The teeth were radiographed, and area of the radiographic image of the restorations was measured. Data were used to produce expressions to estimate actual area from radiographic area. RESULTS: Regression analyses showed that surface area estimation from radiographic area was more accurate than estimation from surface counts. The accuracy of the surface area count was further improved by combining the radiographic area with a photographic occlusal area measurement or surface count, the latter giving the highest correlation. CONCLUSIONS: This study demonstrated that two-dimensional dental radiographs may be used to estimate surface area of amalgam restorations.

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.

Preparation for the next major incident: are we ready?

BACKGROUND: In 1996, Carley and Mackway-Jones examined British hospital's readiness for a major incident. In the light of recent terrorist events in London, our group has re-visited the issue and conducted a telephone survey of relevant parties to investigate whether the situation has changed almost 10 years on. MATERIALS AND METHODS: A proforma was devised, and registrars in anaesthesia, accident and emergency medicine, general surgery and trauma and orthopaedics were telephoned in trauma units across the UK and questioned about their readiness to respond to a major incident. Major incident co-ordinators for each of the units were contacted, and their planning, readiness, training opportunities, and recent rehearsals were assessed. RESULTS: A total of 179 registrars were contacted in 34 different units throughout Britain. One hundred and forty four responses were obtained. Sixty eight registrars (47%) had not read any of their hospitals major incident plan. Only 77 (54%) of the registrars questioned felt confident in the knowledge of their specific role during a major incident. Major incident co-ordinators were contacted at 34 hospitals, and 17 responses obtained. It was remarkably difficult to achieve even that level of response. Rehearsal of major incident plans varied widely between hospitals with 82% of hospitals having practised within the past five years but only 35% were planning for a rehearsal in the next twelve months. 25% of hospitals that responded did not hold any teaching on major incident planning at their introduction sessions for junior and middle grade doctors. Limitations to improvement of major incident planning included: lack of funds, lack of a designated full-time major incident co-ordinator, and lack of technology. There was no significant difference between units within London and those in other regions. DISCUSSION: Preparedness for major incidents in the UK remains poor 10 years after Carley and Mackway-Jones examined the issue. Effective major incident plans require forethought, organisation, briefing of relevant staff and regular rehearsal. Increased resources should be provided for this at a local level and more regular rehearsals undertaken to ensure our preparedness for future major incidents.

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.

Characterizing the prevalence of chromosome instability in interval colorectal cancer.

A substantial proportion of colorectal cancers (CRCs) are interval CRCs (I-CRCs; i.e., CRCs diagnosed soon after a colonoscopy). Chromosomal instability (CIN) is defined as an increase in the rate of which whole chromosomes/large chromosomal fragments are gained or lost and is observed in 85% of non-hereditary CRCs. The contribution of CIN to the etiology of I-CRCs remains unknown. We established a fluorescence in situ hybridization (FISH) approach to characterize CIN by enumerating specific chromosomes and determined the prevalence of numerical CIN in a population-based cohort of I-CRCs and control (sporadic) CRCs. Using the population-based Manitoba Health administrative databases and Manitoba Cancer Registry, we identified an age, sex, and colonic site of CRC matched cohort of I-CRCs and controls and retrieved their archived paraffin-embedded tumor samples. FISH chromosome enumeration probes specifically recognizing the pericentric regions of chromosomes 8, 11, and 17 were first used on cell lines and then CRC tissue microarrays to detect aneusomy, which was then used to calculate a CIN score (CS). The 15th percentile CS for control CRC was used to define CIN phenotype. Mean CSs were similar in the control CRCs and I-CRCs; 82% of I-CRCs exhibited a CIN phenotype, which was similar to that in the control CRCs. This study suggests that CIN is the most prevalent contributor to genomic instability in I-CRCs. Further studies should evaluate CIN and microsatellite instability (MSI) in the same cohort of I-CRCs to corroborate our findings and to further assess concomitant contribution of CIN and MSI to I-CRCs.

Deprivation and dental caries status of 5-year-old children in Scotland.

OBJECTIVES: The aim of this study was to investigate the relationship between the dental caries status of 5-year-old children in Scotland and deprivation, as assessed by the Carstairs score and its DEPCAT categories, which are composite descriptors of socio-economic status. METHODS: Anonymous records, including postcode sector of residence, from the 1995/96 Scottish Health Board's Dental Epidemiological Programme 5-year-old survey were linked though a multi-stage process to their corresponding Carstairs scores and DEPCAT categories. The data were analysed to investigate the relationship between d3t, mt, ft, d3mft, proportion 'free' of caries experience and socio-economic status for Scotland. RESULTS: When analysed by DEPCAT the mean d3mft ranged from 1.48 for children resident in the most affluent postcode areas (DEPCAT 1) to 4.87 for those in DEPCAT 7. The mean d3mft from the 1995/96 survey of 5-year-old children in Scotland was 2.93. For the percentage 'free' of caries experience (d3mft = 0) the findings in this study ranged from 62.4% (DEPCAT 1) to 19.8% (DEPCAT 7). The d3t and mt components of d3mft and mean d3mft showed a strong positive association with increasing deprivation. The proportion of 5-year-olds experiencing decay was also significantly associated with a more deprived Carstairs score. The f component showed no association with deprivation. The Care Index (ft/d3mft x 100%) ranged from 10.8% (DEPCAT 1) to 2.9% (DEPCAT 7). CONCLUSIONS: There was a striking association between increasing deprivation and increasing caries experience. Children from the most deprived areas had significantly more untreated decay and missing teeth. In a population with low levels of restorative intervention, no association was found between deprivation and the amount of restorative care received by Scottish 5-year-old children.

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.

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.

Effect of use of 0.05% cetylpyridinium chloride mouthwash on normal oral flora.

OBJECTIVES: The aims of this study were to examine the effect of the use of a mouthwash containing 0.05% cetylpyridinium chloride (CPC) on (1) the composition of the normal oral microbial flora and (2) the establishment of non-oral bacterial species in the mouth. METHOD: In a double-blind study, 129 subjects used, twice daily for 6 weeks, either a randomly assigned test or placebo mouthwash. At baseline and at the completion of the study, a sample of the oral flora was obtained by asking each subject to "swish" around the mouth for 30 s, 10 ml of distilled water. The numbers of total colony forming units (CFU), facultative bacteria, streptococci, mutans streptococci, lactobacilli, staphylococci, yeasts and enterococci were enumerated after culture on eight non-selective and selective media. RESULTS: After 6 weeks use of either the test or placebo mouthwashes, there were no significant differences (analysis of variance) between the counts (CFU/ml of sample) for any of the microbial taxa. CONCLUSIONS: These data indicate that the use of a CPC-containing mouthwash does not alter the composition of the normal oral flora or result in the establishment of non-oral and potentially pathogenic bacteria in the mouth.

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.

Caries-associated micro-organisms in infants from different socio-economic backgrounds in Scotland.

OBJECTIVES: The aims of this study were: (1) to compare the frequency of isolation of mutans streptococci, (Streptococcus mutans, Steptococcus sobrinus), lactobacilli and yeasts (caries-associated micro-organisms) in the saliva of 1-year-old infants with and without dental caries; and (2) to determine if socio-economic background influenced the frequency isolation of bacteria and caries status. METHODS: 1393 1-year-old consented infants, who comprised 70. 3% of children born in Dundee during a 1year period, had saliva samples taken (tongue-loop method) for microbiological culture and were examined for dental caries (d(1)-threshold: enamel and dentine diagnostic threshold). Thirty-nine infants were diagnosed with caries and the frequencies of isolation of caries-associated micro-organisms (and absolute microbial counts) were compared with infants who were caries-free. In addition, associations were sought between the infants' socio-economic background, the frequency of isolation of caries-associated micro-organisms and caries status. RESULTS: Streptococcus mutans, lactobacilli and yeasts were isolated more frequently from those infants with caries compared to those who were caries-free (S. mutans: 29.7 vs 9.8%, P=0.0008; lactobacilli: 15.4 vs 4.3%, P=0.0073; yeasts: 23.7 vs 10.4%, P=0.0016-Fisher's exact test). There were no significant differences between the isolation frequencies of S. sobrinus (2.7 vs 1.3%, P=0.39) from those with and without caries. Significantly, more infants living in areas of high deprivation had caries compared to those from more affluent areas (DEPCAT 6 and 7 vs 1-5: 3.6 vs 1.9%, P=0.049), but, apart from yeasts, socio-economic background was not significantly associated with the isolation frequencies of any of the caries-associated micro-organisms. CONCLUSIONS: In infants as young as 1year of age, salivary S. mutans, lactobacilli and yeasts but not S. sobrinus were isolated significantly more frequently from those with caries compared to those who were caries-free. Apart from yeasts, socio-economic background did not influence the frequency of isolation of caries-associated micro-organisms. However, infants living in areas of highest deprivation had significantly higher frequencies of caries compared to those from more affluent areas.