Screening of dental and sinus infections in rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased risk of infections. Screening for oral (dental and/or sinus) infection could be proposed before biologic disease-modifying antirheumatic drugs (bDMARDs) initiation but is not systematically recommended. The aim of our study was to assess the prevalence of oral infection in RA patients requiring bDMARDs. MATERIALS AND METHODS: This was a monocentric retrospective study. We included patients with RA and active disease requiring bDMARDs. Dental infection and sinusitis were assessed by a stomatologist and otorhinolaryngologist after clinical, panoramic dental X-ray and sinus CT evaluation. Factors associated with oral infections were analysed in uni- and multivariate models, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: We included 223 RA patients (79.4% women, mean disease duration 8.9 ± 8.6 years). The mean age was 54.4 ± 10.9 years and mean Disease Activity Score in 28 joints 5.5 ± 2.6. Systematic dental screening revealed infection requiring treatment before bDMARDs initiation in 46 (20.9%) patients. Sinusitis was diagnosed by the otorhinolaryngologist in 33 (14.8%) patients. Among the 223 patients, 69 (30.9%) had dental and/or sinus infection. On univariate analysis, active smoking was associated with increased probability of oral infection (OR = 2.16 [95% CI 1.02-4.57], P = .038) and methotrexate with reduced probability (OR = 0.43 [95% CI 0.23-0.81], P = .006). On multivariate analysis, no RA variables were associated with oral infection. CONCLUSION: In our study, asymptomatic oral infection was confirmed in one third of RA patients.

Paediatric dental pain and infection during the COVID period.

BACKGROUND: During the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection. In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities. METHOD: Presenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the "lockdown" period (23rd March- 14th June) during "normal" working hours and "out of hours" to either paediatric dentistry or OMFS. RESULTS: 420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the "lockdown" period. The vast majority of patients had antibiotics prescribed prior to attendance (80%). CONCLUSION: We have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further "lockdowns".

Prevalence of Candida albicans in primary endodontic infections associated with a higher frequency of apical periodontitis in type two diabetes mellitus patients.

To identify the prevalence of C. albicans in primary endodontic infections of type two diabetes mellitus (T2DM) patients and compare their clinical and radiographical characteristics with a non-diabetic control group, establishing the possible relationship between primary endodontic infection, T2DM, and C. albicans, since diabetes mellitus (DM), influences the development, course, and response to the treatment of apical periodontitis, but the presence of Candida albicans (C. albicans) has not been considered before. A total of 120 patients were selected and divided into two groups: 60 T2DM diagnosed patients and 60 non-diabetic controls. A clinical examination and radiographic analysis were performed to establish a periapical index score (PAI). Root canal samples were taken. Deoxyribonucleic acid (DNA) was extracted, and specific primers were used to identify C. albicans by polymerase chain reaction (PCR). A twofold increase in the prevalence of C. albicans in T2DM patients was observed in contrast to control patients (p = 0.0251). Sixty-five percent of T2DM patients with positive C. albicans scored a ≥ 3 PAI, while only 27% of the patients without C. albicans had a ≥ 3 PAI score (p = 0.0065). Long-term DM patients presented C. albicans more frequently (p < 0.0001). In this study, long-term T2DM patients carried C. albicans in their root canals more frequently when having a primary endodontic infection. Furthermore, this C. albicans presence seems to be related to a higher frequency of apical periodontitis.

Indications for root canal treatment in a Swedish county dental service: patient- and tooth-specific characteristics.

AIM: To study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden. METHODOLOGY: During a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics. RESULTS: The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%). CONCLUSIONS: In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Dental and Oral Lesions in HIV-Positive Individuals in East Bohemia--Czech Republic, Single Centre Experience.

BACKGROUND: Human immunodeficiency virus (HIV) continues to be a serious health issue and one of the world most devastating epidemics. An estimated 1.5 million people died from AIDS-related illnesses in 2013, and an estimated 37 million people with AIDS have died worldwide since the epidemic has begun. HIV infection is known for its oral manifestations which causes discomfort and pain for infected individuals. The objective of this study was to document oral conditions of HIV positive patients and the pattern and frequency of oral and dental lesions. METHODS: All patients with confirmed HIV infection who were treated at the Department of Dentistry, University Hospital in Hradec Králové, were examined. RESULTS: During the study period, 29 HIV positive patients were examined and treated--19 men, 10 women, with mean age of 32.9 years (range 22-58 years). 72.41% patients received ART. In total, all patients underwent 186 visits. The most frequent treatments were associated with teeth and periodontal lesions (71.80%), oral mucosal lesions were diagnosed and treated only in 3.96% cases. CONCLUSION: Since the introduction of ART, the frequency of oral mucosal lesions is minimal in patients with HIV infection.

Odontogenic Infections: A 1-year Retrospective Study.

OBJECTIVES: The purpose of this study was to analyze the prevalence, demographic patterns and management of odontogenic infections in patients undergoing treatment in an outpatient dental emergency service of a university hospital. MATERIALS AND METHODS: In a retrospective study of the year 2012, all patients suffering from odontogenic infections were included. Demographic data, diagnosis and the conducted treatment were analyzed. Odontogenic infections were defined as pulpitis, apical and marginal periodontitis, abscesses and pericoronitis. RESULTS: A total of 2,058 out of 4,209 emergency patients suffered from odontogenic infections. The majority (45.0%) had an apical periodontitis, 20.8% abscesses, 17.3% a marginal periodontitis, 16.3% a pulpitis and 5.8% a pericoronitis. Mean age was 37.5 ± 17.0 years standard deviation (SD) (1.2-96.4). Most patients were 20 to 29 years (24.6%), followed by the age group of 30 to 39 year old patients (21.0%). Males were affected more frequently (55.5%) than females (45.5%). Most of the patients (64.5%) of the patients received a dental or surgical treatment. Antibiotics were prescribed in 31.7% of cases. Amoxicillin was the most common prescribed antibiotic (54.5%). CONCLUSION: Odontogenic infections represent one of the main reasons for consulting the emergency service. Due to the high number of cases and the severe complications, dentists have to be familiar with the surgical management of odontogenic infections as well as the appropriate use of antibiotics. CLINICAL SIGNIFICANCE: Nearly half of all patients who sought, treatment in the emergency service had an odontogenic infectious disease. This should be considered for the organization and planning of the service.

Identification of Synergistetes in endodontic infections.

The bacterial phylum Synergistetes consists of Gram-negative anaerobes. Oral Synergistetes are divided in two main clusters, namely A and B. Increasing evidence demonstrates their involvement in etiology of oral infections, including apical periodontitis. This condition causes bone loss around the apex of the tooth, subsequent to pulp inflammation (pulpitis). Although the presence of Synergistetes has been confirmed in endodontic infections by molecular methods, these have not been morphologically identified in the affected apical region, and their prevalence among different endodontic infections has not been determined. Therefore, the aim of this study was to evaluate the prevalence, levels and morphology of oral Synergistetes clusters A and B, in apical root canal samples obtained of teeth with irreversible pulpitis, pulp necrosis and apical periodontitis, or previously root-filled teeth with apical periodontitis. For their detection, fluorescence in situ hybridization and epifluorescence microscopy were used. Synergistetes cluster A was not detected in pulpitis, but was found in both apical periodontitis groups, more frequently and at higher ranges in teeth which were previously root-filled. Microscopically, they appeared as straight or slightly curved long rods. Synergistetes cluster B was not detected in any of the cases. Fusobacteria and Actinomyces, which are well-established taxa in endodontic infections, were detected more frequently and at higher ranges than Synergistetes. In conclusion, Synergistetes cluster A constitutes part of the mixed apical microbiota in apical periodontitis, and may be involved in its pathogenesis.

Dental caries in primary and permanent molars in 7-8-year-old schoolchildren evaluated with Caries Assessment Spectrum and Treatment (CAST) index.

BACKGROUND: No reports on a caries pattern covering the full spectrum of the disease could be found in the literature. The aim of this study was to evaluate caries in primary and first permanent molars of 7-8-year-old Polish children by the Caries Assessment Spectrum and Treatment (CAST) index and to find whether there was any correlation between the caries stages in such teeth. METHODS: The study covered 284 7-8-year-old children from randomly selected schools in the Bialystok District, Poland. The prevalence of CAST categories was evaluated with regard to the first and second primary, and first permanent, molars. The Spearman's rank correlation coefficient was used to explore the correlation of the distribution of CAST codes among the evaluated teeth. The level of statistical significance was established at p < 0.05. The intra-examiner reliability was determined by the unweighted kappa coefficient. RESULTS: With regard to the permanent molars, caries was observed in 14.8% to 17.3% of the molar and most lesions were scored at the non-cavitation level. Caries in primary molars was most often recorded at the stage of cavitated dentine lesion. Teeth with pulpal involvement, sepsis and extracted due to caries were found to be more prevalent in first, and then in second primary molars. A strong correlation was found between the status of teeth from the right and left sides of the oral cavity. The correlation of the status of first and second primary teeth was stronger for the left than for the right side of the mouth, r was 0.627 and 0.472 in maxilla and 0.513 and 0.483 in mandible (p < 0.001), respectively. For the neighbouring primary and permanent molars the correlation was assessed to be weak. With regard to the teeth situated in opposite jaws the study revealed that the correlations were moderate - r between 0.33 and 0.49. The intra-examiner reliability was established at 0.96 for the primary dentition and at 0.878 for permanent molars. CONCLUSION: The strongest correlation found in the evaluated population concerned the distribution of caries in primary molars on the left side of the mouth. The study proved the usefulness of the CAST index in epidemiological surveys.

Incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population.

INTRODUCTION: This study was designed to evaluate incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population. METHODS: In this cross-sectional study, 3,150 patients (1,400 males and 1,750 females) with pain in the orofacial region were evaluated via clinical and radiographic examination to determine their pain source. Patients completed a standardized clinical questionnaire consisting of a numerical rating scale for pain intensity and chose verbal descriptors from short form McGill questionnaire to describe the quality of their pain. Visual analog scale (VAS) was used to score pain intensity. In addition, patients indicated sites to which pain referred by drawing on an illustration of the head and neck. Data were analyzed using chi-square, fisher exact, and Mann-Whitney tests. RESULTS: Two thousand and hundred twenty patients (67/3%) reported pain in sites that diagnostically differed from the pain source. According to statistical analysis, sex (P = 0.02), intensity of pain (0.04), and quality (P = 0.001) of pain influenced its referral nature, while age of patients and kind of stimulus had no considerable effect on pain referral (P > 0.05). CONCLUSION: The results of the present study show the prevalence of referred pain in the head, face, and neck region is moderately high. Therefore, in patients with orofacial pain, it is essential to carefully examination before carrying out treatment that could be inappropriate.

Causes and pattern of tooth extractions in children treated at the University of Port Harcourt Teaching Hospital.

BACKGROUND: Tooth mortality is mainly a reflection of untreated dental caries and periodontal disease and is considered a crude but useful measure for the dental status of a community. Oral health status of the people of Niger Delta particularly that of children, is currently vague. AIM: To investigate the reasons and pattern of tooth extractions among children who presented at the Paediatric dental clinic of University of Port Harcourt Teaching Hospital (UPTH). METHODS: A retrospective study of children aged 16 years and below who attended the paediatric dental clinic of UPTH for treatment from March 2008 to August 2010 was done. The following information was retrieved from hospital records of the patients: age, sex, indications for extraction and the extracted teeth. RESULTS: A total of 462 children aged between 2-16 years were seen out of which 115 (24.9%) patients had extraction. On the whole, 145 teeth were extracted. Dental caries and its sequelae (irreversible pulpitis, dentoalveolar abscess etc) accounted for the highest indication for extraction 71 (61.7%) while periodontal disease accounted for the least (2.6%). The other indications for extractions were trauma, orthodontic reasons and eruption anomalies. Primary teeth 103 (71.0%) were mostly affected with the anterior teeth (33.8%) being the most frequently involved. The molars (73.8%) were the most frequently involved teeth in the permanent dentition. CONCLUSION: Dental caries and its sequelae is the commonest reason for tooth extraction. Efforts must be made to improve the dental health awareness and status of Nigerian children in this region.

[Tooth decay complications incidence].

The aim of the article is to assess the quality of endodontic therapy and estimate further treatment needs. 900 orthopantomograms of 442 men and 458 women (aged 18-70) without any clinical manifestations of endodontic pathology were examined for endodontic treatment. 1,170 patients (41%) had additional intraoral radiographs taken for assessment of their periapical status. 2,852 (13.8%) of the 20,724 teeth examined had periapical lesions and/or root fillings. 2,503 of the 2,853 teeth were endodontically treated, only 1,011 of them (40.4%) having all their root canals obturated. 612 (41.3%) of the 1,492 (59.6%) teeth with inadequate root canal fillings hat a healthy apical periodontium. Of the 1,229 teeth to be endodontically treated 349 teeth required primary treatment, 880 required retreatment.

Relative contribution of restorative treatment to tooth extraction in a teaching institution.

Teeth can be extracted due to multiple factors. The aim of this retrospective cross-sectional study was to identify the relative contribution of restorative treatments to tooth loss. The study reviewed records of 826 patients (1102 teeth). Patient's gender, age and education were obtained. In addition to the main reason for extraction (caries, periodontal disease, pre-prosthetic extraction, restorative failure and remaining root), the following information was collected about each extracted tooth: type, the status of caries if any (primary or secondary) and pulpal status (normal or reversible pulpitis, irreversible pulpitis, necrotic or root canal treated) and type and size of restoration, if present. Following data collection, descriptive analysis was performed. A log-linear model was used to examine the association between restorative treatment and tooth loss and between reasons for tooth loss and type of tooth. Lower molars followed by upper molars were the most commonly extracted teeth. Teeth with no restorations or with crowns were less likely to be extracted (P < 0·001). Lower and upper molars and lower premolars were more likely to be extracted due to restorative failure, while lower anterior teeth were more likely to be extracted due to periodontal disease (P < 0·05). Twenty two per cent of the extractions was due to restorative failure, and at least 65·9% of these teeth had secondary caries. Gender, age and educational level were factors that affect tooth loss. In conclusion, teeth receiving multiple restorative therapies were more likely to be extracted.

Altered Prevalence of Pulp Diagnoses in Diabetes Mellitus Patients: A Retrospective Study.

INTRODUCTION: Diabetes mellitus (DM) is a complex multisystemic disorder that affects an estimated 21 million Americans. No studies have evaluated the association of DM with the prevalence of each pulpal diagnosis. The objective of this study was to compare the prevalence of each pulp diagnosis including symptomatic irreversible pulpitis (SIP), asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and pulp necrosis (PN) in DM patients against a nondiabetic control group. METHODS: A retrospective chart review was approved by Rutgers University Institutional Review Board. The prevalence of the diagnoses SIP, asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and PN was calculated from AxiUm (Exan software, Las Vegas, NV) electronic health records at Rutgers School of Dental Medicine. The chi-square test was used to see the relationship between the 2 categoric variables. Second, binary logistic regression analyses were performed for each group. RESULTS: A total of 2979 teeth were diagnosed with a pulp condition between April 2013 and November 2018. The total tooth number of DM patients was 682, whereas the tooth number of nondiabetic patients was 2297. In the subgroup of patients younger than 40 years old, SIP was notably more prevalent in DM patients. In addition, the prevalence of PN in elderly DM patients (60-69 years old) was significantly higher than in the control group. CONCLUSIONS: The prevalence of SIP in DM patients was significantly higher compared with the control group (<40 years old), suggesting the possibility that DM could hypersensitize the subgroup of patients younger than 40 years old to pulpitis pain.

Frequency and distribution of teeth requiring endodontic therapy in an Argentine population attending a specialty clinic in endodontics.

OBJECTIVES: To determine the frequency and distribution of 975 teeth in need of endodontic treatment in an Argentine patient pool and to compare the results with previously published surveys. METHODS: Of the 975 teeth from 860 individuals (age range 7-86 years) were endodontically treated during 2007 by postgraduate students enrolled in a specialisation programme in Endodontics. All patients were examined clinically and radiographically. For each case, information was collected in a questionnaire including location of the affected tooth, age and gender and reasons for endodontic treatment. Data were analysed by the Student t-test, the Fisher exact test, and the chi-square test with a significance of P < 0.05. RESULTS: Of the 975 treated teeth, 543 (55.69%) were maxillary and 432 (44.30%) mandibular teeth. 635 (65.13%) were from females and 340 (34.87%) from males. Significant differences were found between the maxillary and mandibular arch (P = 0.01). Molars and premolars required significantly more frequent endodontic treatment than canines and incisors (P < 0.001). The most frequently treated tooth was the mandibular right first molar (9.12%) followed by the mandibular left first molar (7.07%). The most frequently diagnosed pathosis was irreversible pulpitis (36.00%), pulp necrosis (30.80%), apical periodontitis or the presence of easily discernible periapical radiolucent areas (27.20%). Caries (59.18%) and failure of previous endodontic treatment (26.97%) were responsible for most of the affected teeth. CONCLUSIONS: Comparison with previous surveys revealed that more females than males received endodontic treatment and that mostly molars and premolars were in need of endodontic treatment. The high number of root filled teeth requiring retreatment is in agreement with a pattern similar to that observed in other countries and supports the need for more specialists in endodontics in the Republic of Argentina.

Prevalence of apical periodontitis and factors associated with the periradicular status.

AIM: The present study aimed at assessing the prevalence of apical periodontitis and identifying the factors associated with apical periodontitis, particularly the influence of the quality of root canal fillings and coronal restorations on the periradicular status. METHODOLOGY: The study population consisted of adult patients, men and women, seeking routine dental care at the Endodontic Clinic in the school teaching hospital between September 2006 and July 2008. For each patient complete oral examination and periapical radiographs were made for pathological teeth. All teeth were assessed individually. AP was diagnosed according to defined criteria, other variables were root fillings, coronal fillings, trauma and caries. The odds ratio and 95% confidence interval were used to calculate the risk of apical periodontitis related to tooth-specific risk indicators on the presence of apical periodontitis. A multiple logistic regression model to control for confounders and to determine their independent association with apical periodontitis was used also. RESULTS: AP was detected on teeth (63.79%). The prevalence of apical periodontitis in root canal-treated teeth was 39.5%. Of the dental variables caries, trauma, inadequate root fillings and inadequate restoration were significantly associated with AP. CONCLUSION: The prevalence of AP in this study group was higher than in other populations. The probability of AP increased significantly after root canal treatment and coronal filling and was closely associated with the quality of the filling.

Endodontic Indications among Patients Visiting a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Endodontics is the study of prevention, diagnosis and treatment of diseases or injuries to the dental pulp. The ultimate goal of modern dental care is tooth preservation and root canal therapy/treatment is an available therapeutic strategy to retain teeth. The aim of the study is to find the prevalence of patients visiting a tertiary care center who had endodontic indications. METHODS: The descriptive cross-sectional study included 516 patients accepted for endodontic treatment, between August 2019 and December 2019 in a tertiary care center. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 425-2019). Convenience sampling method was used. The data were entered in Statistical Package for Social Sciences version 20 software and analysed using descriptive statistics. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1740 patients, 516 (29.66%) (95% Confidence Interval= 21.46% - 27.51%) had endodontic indications. Symptomatic irreversible pulpitis 306 (59.30%) was the most prevalent pulpal disease. Maxillary teeth 300 (58.13%) had more endodontic diseases. While in individual dental elements most affected by endodontic diseases was the mandibular molar teeth 149 (28.87%). Females 348 (67.44%) were predominant for demanding endodontic management than males 168 (32.5%). CONCLUSIONS: More female patients and of younger age group in this study population demanded endodontic treatment. Irreversible pulpitis was responsible for the majority of the cases treated and more affected were the posterior teeth.

[Frequency of Candida in root canals of teeth with primary and persistent endodontic infections]. / Frecuencia de Candida en conductos radiculares de dientes con infección endodóntica primaria y persistente.

BACKGROUND: Microbiological identification in endodontic infections has focused mainly on bacteria without giving much attention to yeasts, which, due to their virulence factors, can affect the outcomes of root canal treatment. AIMS: To determine the frequency of Candida in anaerobic conditions in root canals with primary and persistent endodontic infection, as well as to evaluate a microbiological sampling method using aspiration compared to the traditional absorption method with paper points. METHODS: Fifty microbiological samples were obtained from teeth of 47 patients requiring endodontic treatments, due to either primary or persistent infections. Two microbiological sampling methods were used: an aspiration method, and the traditional paper point absorption method. In each of these methods, two types of medium were used (M1-M4). Samples were cultured under anaerobic conditions until reaching 0.5 McFarland turbidity, and then inoculated on Sabouraud dextrose, as well as on anaerobic enriched blood agar plates. Macroscopic and microscopic observations of the colonies were performed. The germ-tube test, growth on CHROMagar, and biochemical identification were performed on the isolated yeasts. RESULTS: Fungal infection was found in 18 (36%) samples out of the 50 teeth evaluated. In the 18 samples positive for fungal infection, 15 out of 36 (41.6%) teeth were taken from a primary infection, and 3 out of 14 (21.4%) from a persistent infection. The aspiration method using Sabouraud dextrose medium recovered a greater diversity of species. CONCLUSIONS: Yeasts frequency was higher in teeth with primary infections compared to teeth with persistent infections. The predominant yeast species was Candida albicans. The aspirating sampling method was more efficient in the recovery of Candida isolates than the traditional absorption method.

Oral health status associated with sociodemographic factors of Nepalese schoolchildren: a population-based study.

OBJECTIVES: The aim of this study was to investigate the oral health of Nepalese schoolchildren relative to their sociodemographic characteristics. METHODS: This school-based, cross-sectional study was conducted among 5-6-, 12- and 15-year-old Nepalese children in 18 randomly selected districts of the 75 in Nepal. Clinical parameters were recorded according to the World Health Organization (WHO) guidelines. Results were presented as mean (SD) and proportions; the chi-square test, t-test and one way-ANOVA were also performed. The risk of dental caries in association with the place of residence was presented according to the outcome of a binary logistic regression analysis. RESULTS: The mean d-value for the 5-6-year-old children was 5.0 (4.22), which was higher than the mean D-values for the 12- and 15-year-old subjects, of 1.3 (1.77) and 1.9 (2.28), respectively. The youngest children, as well as children from the Kathmandu Valley, were likely to have more untreated caries lesions than children in the other age groups. The mean number of teeth with severe consequences of dental caries (pulpitis/ulceration/fistula/abscess or pufa/PUFA) was 1.3 (1.91) for the 5-6-year-old children, 0.1 (0.35) for the 12-year-old children and 0.3 (0.75) for the 15-year-old children. All age groups had gingival bleeding on probing in more than 15% of teeth. Children from rural locations had significantly more gingival bleeding than urban children. The same was true for 15-year-old girls compared with boys of the same age. CONCLUSIONS: Among Nepalese children, oral diseases are common, and geographical variation is prevalent. The health policy should address the alarming oral health situation and need for urgent treatment and population-based preventive programmes that is evident in Nepal.

Incidence of pain conditions in dental practice in a Danish county.

From September 1981 to February 1982, an epidemiologic study was carried out on the incidence of pain conditions among patients between 18 and 70 yr of age in 30 dental practices in Ribe County, Denmark. A total of 35 464 patients consulted the 50 participating dentists during the study period. 823 patients consulted the dentist due to pain. The most frequent cause of pain was caries sequelae (pulpitis (35%) and acute apical periodontitis (31%)). There was a significant difference in the distribution of the diagnoses between patients with regular and non-regular dental care. Although the data in the present study may not be representative for the entire Danish population, it seems reasonable to assume that in Denmark there are at least 70 000 annual consultations to a dentist due to pain. Furthermore, a minimum of 4000 patients can be expected to be absent from work annually, due to illness caused by dental pain.

The prevalence of oral health problems in participants of the 1992 Olympic Games in Barcelona.

The Olympic Games are the focus of attention for millions of people in the world and provide the pinnacle of sporting excellence. The health and welfare of the participating sportsmen and women is paramount for successful competition and this must include oral health. The purpose of this paper is to describe a study undertaken at the Barcelona Olympic Games in 1992 into the attendance patterns and oral health of patients visiting the dental clinic provided in the Olympic Village. Recommendations are made for the conduct of future dental care facilities at Olympic Games and the collection of data.