Oral health-related quality of life in the Myanmar population: The first national oral health survey 2016 - 2017.

OBJECTIVES: To describe the oral health-related quality of life (OHRQoL) and its potential influencing factors within the Myanmar population. METHODS: Data were from the first national oral health survey, involving 3,513 participants aged 15-18 years, 35-44 years, and 60-74 years from 21 selected townships in Myanmar. Self-administered questionnaire-based surveys, conducted from December 2016 to January 2017, included socio-demographics, behavioral factors, self-reported oral conditions (number of teeth present, teeth and gingival conditions), and inquiries regarding OHRQoL (a set of 12 questions with 5 response options) using the recommended questions from WHO Oral Health Surveys. RESULTS: The most prevalent oral health issues were difficulties in chewing (32.2%) and biting foods (30.8%). In bivariate analysis, older individuals, rural residents, and participants with higher educational levels were associated with OHRQoL. In multiple regression analysis, self-reported number of teeth, teeth and gingival conditions were strong predictors of OHRQoL in all age groups. CONCLUSION: Self-rated oral health conditions predicted quality of life due to oral problems. The development of national oral health policies and strategies is imperative to facilitate early detection of oral health problems and promote the awareness of oral health importance.

Clinical evaluation of three caries removal approaches in primary teeth: a randomised controlled trial.

OBJECTIVE: To evaluate the clinical performance and radiographic outcome of glass ionomer cement (GIC) restoration in primary molars using three caries removal techniques. BASIC RESEARCH DESIGN: Randomised clinical controlled trial. CLINICAL SETTING: Two standard dental clinics in 2 hospitals near Bangkok. PARTICIPANTS: A total of 276 children, aged 6-11, having dentinal caries on the occlusal and/or proximal surface extending at least one-third of dentine without signs and/or symptoms of irreversible pulpitis. INTERVENTION: Children were randomly allocated into 3 study groups with different caries removal techniques: Group 1, partial soft caries removal at enamel-dentine junction (EDJ) by spoon excavation; Group 2, complete soft caries removal by spoon excavation; and Group 3, conventional caries removal by steel burs. All cavity preparations were restored with GIC (Fuji IX, GC Corp., Japan). MAIN OUTCOME MEASURES: Clinical and radiographic evaluations were carried out at 6 and 12 months after restoration. RESULTS: After 12 months, 89, 89, and 88 restorations in Groups 1, 2 and 3 were evaluated. The cumulative survival rates of GIC restorations in Groups 1, 2 and 3 were 83%, 83%, and 89% while the cumulative survival rates of pulp were 99%, 100% and 98% respectively. There were no statistically significant differences in the survival of GIC restorations or pulp in the three groups (p > 0.05). CONCLUSION: The clinical and radiographic evaluations after 12 months indicated that partial soft caries removal at EDJ followed by GIC restoration was comparable to that of ART and conventional approaches.

Effective use of self-care fluoride administration in Asia.

The caries-preventive benefits of fluoride are generally accepted by dental researchers and practicing professionals worldwide. The benefits of fluoride toothpastes and mouthrinses have been supported by several high-quality systematic reviews. The formulation of a fluoride toothpaste and biological (salivary flow rate) and behavioral factors (brushing frequency, brushing time, post-brushing rinsing practices, timing of brushing, and amount of toothpaste applied) can influence anticaries efficacy. Fluoride mouthrinses have simpler formulations and can have better oral fluoride retention profiles than fluoride toothpastes, depending on post-brushing rinsing behaviors. Fluoride continues to be the mainstay of caries control; however, there is still the need to determine the most effective approach for fluoride utilization in children and adults who remain caries-active.

Development of gold standard ion-selective electrode-based methods for fluoride analysis.

BACKGROUND/AIMS: Currently available techniques for fluoride analysis are not standardized. Therefore, this study was designed to develop standardized methods for analyzing fluoride in biological and nonbiological samples used for dental research. METHODS: A group of nine laboratories analyzed a set of standardized samples for fluoride concentration using their own methods. The group then reviewed existing analytical techniques for fluoride analysis, identified inconsistencies in the use of these techniques and conducted testing to resolve differences. Based on the results of the testing undertaken to define the best approaches for the analysis, the group developed recommendations for direct and microdiffusion methods using the fluoride ion-selective electrode. RESULTS: Initial results demonstrated that there was no consensus regarding the choice of analytical techniques for different types of samples. Although for several types of samples, the results of the fluoride analyses were similar among some laboratories, greater differences were observed for saliva, food and beverage samples. In spite of these initial differences, precise and true values of fluoride concentration, as well as smaller differences between laboratories, were obtained once the standardized methodologies were used. Intraclass correlation coefficients ranged from 0.90 to 0.93, for the analysis of a certified reference material, using the standardized methodologies. CONCLUSION: The results of this study demonstrate that the development and use of standardized protocols for F analysis significantly decreased differences among laboratories and resulted in more precise and true values.

Effects of glass ionomer cement, resin-based pit and fissure sealant and HF applications on occlusal caries in a developing country field trial.

The aim of this community-oriented study was to evaluate different methods to prevent fissure caries. The following products and measures were tested: 1) glass ionomer cement (GIC) applied by dentist; 2) same material applied by short term (3 days) trained personnel (teachers); 3) application of a 0.5% HF solution three times; 4) an established autopolymerized resin based sealant (Delton). The study was performed in Bangkok, Thailand, a city in a developing country experiencing increasing caries prevalence. Children with at least three sound permanent molars from two age groups, 7-8 and 12-13-yr-olds respectively were chosen from very low to medium socioeconomic level families. 1264 children were systematically assigned to experiment or control groups based on school and DMFT. For the younger age group, the 2 yr mean DFS occlusal increment in the Control group was 0.66 surfaces. Significantly lower increments were observed in the GIC experimental group: 0.17 surfaces applied by the teachers and 0.32 applied by dentist, corresponding to 74% and 52% reductions, respectively. The mean increment in the HF group was 0.44 surfaces, a 33% reduction in relation to the Control group. For the 12-13-yr-olds, the mean occlusal surface DF increment was 0.70 surfaces in the Control group. Almost no occlusal increment was found in the Delton group, 0.05 DFS, a 93% reduction. In the GIC Dentist group, the DFS increment was 0.48 and in the Teacher group 0.56, corresponding to 31% and 20% reduction, respectively. A slight and nonsignificant increase of caries in relation to the Control group was observed in the HF group.(ABSTRACT TRUNCATED AT 250 WORDS)

Atraumatic restorative treatment (ART): rationale, technique, and development.

Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.

Atraumatic restorative treatment (ART): a three-year community field trial in Thailand--survival of one-surface restorations in the permanent dentition.

This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.

An atraumatic restorative treatment (ART) technique: evaluation after one year.

Extraction is the most common dental treatment provided for people in rural and suburban areas in many less-industrialised countries. By comparison, restorative care is rarely provided. In order to improve such situations, a treatment technique has been developed based only on hand excavation of carious lesions and using glass-ionomer cement as a filling material and a sealant. This Atraumatic Restorative Treatment (ART) technique follows the concept of minimal intervention and does not require electrically driven equipment. This paper reports on the longevity of fillings and sealants placed using the technique under field conditions in rural Thailand. Dental caries was treated using the ART technique in one village, whilst the population in a second village received restorative care (amalgam fillings) through mobile dental units. A third village was the control. After one year, 79 per cent of single surface ART fillings and 55 per cent of ART fillings of greater than one surface placed in deciduous teeth were judged successful. The success rate of ART fillings in the permanent dentition (mainly single surface fillings) was 93 per cent and the retention rate for sealants was 78 per cent. Children were pleased at having received treatment by this technique and showed little fear. The ART technique is a promising caries treatment procedure for use in rural and sub-urban areas in less-industrialised countries.

The community care model of the Intercountry Centre for Oral Health at Chiangmai, Thailand.

The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

Perspectives in the effective use of fluoride in Asia.

Dental caries is the most prevalent chronic disease affecting human populations worldwide. The diverse disease patterns across and within countries are related to socio-behavioral determinants, demographic factors, environmental conditions, and the availability and accessibility of oral health services, in particular, exposure to disease prevention programs (Petersen, 2003, 2008a). Benefits of fluoride for caries prevention have been substantiated in many countries (Petersen and Lennon, 2004; Jones et al., 2005). In the second half of the 20th century, this focus shifted to the development and evaluation of fluoride toothpastes and rinses and, to a lesser extent, to alternatives to water fluoridation, such as salt and milk fluoridation. Most recently, efforts have been made to summarize this extensive database through systematic reviews of fluoride administration (McDonagh et al., 2000; Marinho et al., 2003; Australian Government, 2007). The Asian workshop held in Phan-Nga, Thailand, during March 22-24, 2011, aimed to discuss current information on fluoride and dental caries, as well as to try identifying barriers and opportunities that countries of Asia may have for implementing such programs. In addition, the intention was to give recommendations for including fluoride schemes within national public health programs.

Effect of CPP-ACP paste on dental caries in primary teeth: a randomized trial.

This clinical trial tested the effect of daily application of 10% w/v calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste for 1 yr when added to regular toothbrushing with fluoridated toothpaste to prevent dental caries in pre-school children. High-caries-risk children aged 2½ to 3½ yrs in a suburban area of central Thailand were assigned to receive either CPP-ACP (n = 150) or a placebo control (n = 146) in addition to fluoridated toothpaste. The International Caries Detection and Assessment System (ICDAS) was recorded at baseline, 6 mos, and 1 yr. At 1 yr, a significant increase in mean numbers of enamel and dentin caries lesions, as well as dmfs, was found in both groups (p < 0.001). No significant difference was observed between groups on these 3 outcome measures (p = 0.23, 0.84, and 0.91, respectively). The odds of enamel caries lesion transitions to a state of regression or stability, compared with progression from baseline, was also not different between groups [OR = 1.00, 95% CI (0.86, 1.17)]. This trial found that daily application of 10% w/v CPP-ACP paste on school days for 1 yr, when added to regular toothbrushing with a fluoride toothpaste, had no significant added effect in preventing caries in the primary dentition of these pre-school children (ClinicalTrials.gov number CT01 604109).

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Three-year evaluation of the ART approach in Class III and V restorations in permanent anterior teeth.

This study evaluated the survival of class III and V restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth, after 3 years. A total of 151 restorations were performed in 60 patients. After 3 years, 107 restorations (47 patients) were evaluated. Data were analyzed using exact 95% confidence interval. A total of 97 restorations (91% with 95% CI = 83-99), 76 class III (92% with 95% CI = 82-100) and 21 class V (88% with 95% CI = 77-98) were classified as successful. The survival rate of the ART approach in class III and V restorations in permanent anterior teeth was considered high.

Effect of an anticalculus toothpaste containing pyrophosphate on pyrophosphatase activity and the state of calcium phosphate in saliva.

Experiments were performed to determine if a pyrophosphate-containing anticalculus toothpaste could affect certain salivary constituents involved in the mineralization of dental plaque. The findings indicated no obvious changes in acid and alkaline pyrophosphatases, ionized calcium, total calcium, inorganic phosphate or pH in saliva for 1-135 min after brushing the teeth with the anticalculus toothpaste. Data obtained by brushing with the toothpaste three times daily for two weeks also confirmed these results. Our findings clearly indicate that pyrophosphate-stabilizing agents in the anticalculus toothpaste are not fully effective in the oral cavity. In addition, the pyrophosphate-containing toothpaste has no influence on the state of calcium and phosphate in saliva.

Blood and urinary aggregator and inhibitor composition in controls and renal-stone patients from northeastern Thailand.

Renal-stone disease (RSD) is common in the rural communities of northeastern Thailand. We report the biochemical composition of blood and urine in 25 healthy city dwellers (G1), 12 healthy village dwellers (G2) and 25 village dwellers who had RSD (G3). They were male with a range of ages between 20 and 50 years and were free of renal failure, urinary infection, urinary obstruction and systemic illness. The results showed that hypocitraturia, hypokalemia and hypokaliuria were more common in the latter 2 groups. The 24-h urinary citrate excretion correlated significantly with urinary potassium in G3 cases (r = 0.704, p = 0.0002). After potassium chloride supplementation, serum and urinary potassium increased remarkably (p less than 0.003 and p = 0.002, respectively), whereas urinary citrate remained unchanged. Our results suggest that the predominant abnormality in our RSD patients were hypocitraturia and potassium deficiency and that these may be related.