Need of non-operative caries treatment in 16-year-olds from Northern Norway.

AIM: To assess the prevalence of proximal enamel lesions, the need for non-operative caries treatment and the quality of dental restorations in 869 students aged 16 years from Northern Norway. METHODS: All first year upper secondary school students in Tromsø and Balsfjord municipalities were invited to participate in an oral- and general health project (Fit Futures). The attendance rate was 90%, and all subjects born in 1994 (449 males and 420 females) were included in the present study. Dental caries was registered according to a 5-graded scale (1-2 = enamel lesions; 3-5 = dentinal lesions). Scores from 1 to 4 were used to register the quality of restorations (1 = good; 2 = acceptable; 3 = poor; 4 = unacceptable). RESULTS: Only 6% of the 16-year-olds were completely caries-free. There were 84% of the participants with proximal enamel lesions. A majority of them had either previously restored teeth (35%) or both restored teeth and untreated dentinal caries lesions (34%). When using the D-value of the DMFS-index as a diagnostic criterion, 39% of the participants were in need of restorative treatment. When proximal enamel lesions were included in the diagnosis, the number of participants in need of restorative and/or non-operative caries treatment was 85%. Over 1/3 of the participants presented with at least one restoration below an acceptable quality level. CONCLUSIONS: Dental caries is still a major health problem affecting the total teenage population. A non-operative treatment strategy should be considered relevant in order to reduce the need for restorative treatment.

Capping carious exposures in adults: a randomized controlled trial investigating mineral trioxide aggregate versus calcium hydroxide.

AIM: The aim of this multicentre, parallel-group randomized clinical trial was to compare the effectiveness of mineral trioxide aggregate (MTA) and a conventional calcium hydroxide liner (CH) as direct pulp capping materials in adult molars with carious pulpal exposure. METHODOLOGY: Seventy adults aged 18-55 years were randomly allocated to two parallel arms: MTA (White ProRoot, Dentsply, Tulsa Dental, Tulsa, OK, USA; n = 33) and CH (Dycal® , Dentsply DeTrey GmbH, Konstanz, Germany; n = 37). The teeth were temporized for 1 week with glass-ionomer (Fuji IX, GC Corp, Tokyo, Japan) and then permanently restored with a composite resin. The subjects were followed up after 1 week and at six, 12, 24 and 36 months. The primary outcome was the survival of the capped pulps, and the secondary outcome was postoperative pain after 1 week. Survival was defined as a nonsymptomatic tooth that responded to sensibility testing and did not exhibit periapical changes on radiograph. At each check-up, the pulp was tested for sensibility and a periapical radiograph was taken (excluding the radiographs taken at the 1-week follow-up). Kaplan-Meier survival analysis and log-rank test were used to assess the significant difference in the survival curves between groups. Chi-square test was used to assess the association between the materials and preoperative and postoperative pain. RESULTS: At 36 months, the Kaplan-Meier survival analysis showed a cumulative estimate rate of 85% for the MTA group and 52% for the CH group (P = 0.006). There was no significant association between the capping material and postoperative pain. CONCLUSIONS: Mineral trioxide aggregate performed more effectively than a conventional CH liner as a direct pulp capping material in molars with carious pulpal exposure in adult patients. This study has been registered at ClinicalTrials.gov, number NCT01224925.

Two outbreaks of diarrhoea in nurseries in Norway after farm visits, April to May 2009.

During a 2009 nationwide outbreak of sorbitolfermenting Escherichia coli O157 in Norway, the Norwegian Institute of Public Health was notified of diarrhoea outbreaks in two nurseries. A link to the nationwide outbreak was suspected and investigated, including retrospective cohort studies. Both nurseries had recently visited farms. Faecal specimens were obtained from symptomatic children as well as from the farm animals and tested for Campylobacter, Salmonella, Yersinia, Shigella and pathogenic E. coli, and isolates were further characterised. Nursery A had 12 symptomatic children, and we found the same strain of C. jejuni in faeces from children and lambs. Nursery B had nine symptomatic children, including one child with bloody diarrhoea carrying enterohaemorrhagic E. coli (EHEC) O26. EHEC O26 with a similar multiple-locus variable number tandem repeat analysis (MLVA)-profile was found in sheep. Five children had enteropathogenic E. coli (EPEC) O76. Animals were not tested for EPEC O76. We found no significant association between illness and risk factors for either nursery. The isolated pathogens differed from the one involved in the nationwide outbreak. In each nursery outbreak, the pathogens isolated from children matched those found in farm animals, implicating animal faeces as the source. Hygiene messages are important to prevent similar outbreaks.

Evaluation of a dental outreach teaching programme.

Dental health care is largely based on primary care. It is therefore logical to train students in external dental clinics in addition to university facilities. Consequently, the new dental curriculum at The University of Tromsø in Northern Norway has implemented outreach teaching and training as an extensive part of their curriculum. The overall opinion is that the external training has been very valuable both regarding volume and diversity of treatment experiences and has contributed substantially to the clinical maturity of the students. Educating the tutors is considered to be an essential part of the programme.

Severe consequences of healthcare-associated infections among residents of nursing homes: a cohort study.

The aim of this study was to identify the consequences of healthcare-associated infections in Norwegian nursing homes, to include debilitation, hospital transfer and mortality. We followed the residents of six nursing homes in two major cities in Norway during the period October 2004 to March 2005. For each resident with infection we randomly selected two controls among residents who did not have an infection. Cases and the controls were followed for 30 days as a cohort in order to measure the incidence of complications and risk ratio (RR) in the two groups. The incidence of infection was 5.2 per 1000 resident-days. After 30 days follow-up 10.9% of residents who had acquired infection demonstrated a reduction in overall physical condition compared with 4.8% in the unexposed group (RR: 2.3). Altogether 13.0% of residents with infections were admitted to hospital compared with 1.4% in the unexposed group (RR 9.2), and 16.1% residents with infections died in the nursing home during follow-up compared with 2.4% in the unexposed group (RR: 6.6). Residents with lower respiratory tract infections demonstrated higher morbidity and mortality. In conclusion, healthcare-associated infections cause severe consequences for people living in nursing homes, including debilitation, hospital admission and death.

A patient-centred approach to teaching and learning in dental student clinical practice.

A patient-centred clinical teaching profile in the undergraduate dental curriculum at The University of Tromsø is described. This teaching profile implies that treatment planning is primarily based on the patients' perceived needs and the students are trained to retrieve information from the patients in this context. The role of the clinical instructor is primarily as a facilitator rather than an expert. The 'best interest of the patient' is not always easy to disclose and consequences related to the patients' levels of understanding, students competence, educational challenges and professional ethics are topics for discussion through the clinical education programme.

A point prevalence survey of hospital-acquired infections and antimicrobial use in a paediatric hospital in north-western Russia.

We carried out a one-day prevalence survey of hospital-acquired infections (HAIs) and antimicrobial use in February 2006 in a paediatric hospital in Arkhangelsk, north-western Russia. A total 472 patients aged less than 18 years old were included in the study, of which 395 (84%) had been inpatients in the hospital for at least 48 h on the study day. The overall prevalence of HAI amongst the latter group of patients was 17% [67/395; 95% confidence interval (CI): 13.8-21.2] with upper respiratory tract infections being most frequently diagnosed (45%), followed by lower respiratory tract infections (19%) and urinary tract infections (12%). The highest proportion of HAI was found in patients less than one year old and in those with hospital stays of longer than 10 days. Antimicrobial agents were given to 39% of all hospitalized patients (183/472; 95% CI: 34.5-43.2). Cephalosporins accounted for 39% (82/211) of all antimicrobial prescriptions, followed by the penicillins (22%; 46/211). This study established a baseline for surveillance of HAI and antimicrobial use within the hospital, and facilitated the adoption of targeted infection control measures.

Healthcare-associated infection among residents of long-term care facilities: a cohort and nested case-control study.

Knowledge of infection control measures in nursing homes is limited. This study aimed to assess the incidence of, and potential risk factors for, healthcare-associated infection in long-term care facilities in Norway. Incidence of healthcare-associated infection was recorded prospectively in six long-term care facilities located in two major cities in Norway between 1 October 2004 and 31 March 2005. For each resident with an infection we aimed for two controls in a nested case-control study to identify potential risk factors. Incidence of infection was 5.2 per 1000 resident-days. Urinary and lower respiratory tract infections were the most common. Patients confined to their beds [odds ratio (OR=2.7)], who stayed <28 days (OR=1.5), had chronic heart disease (OR=1.3), urinary incontinence (OR=1.5), an indwelling urinary catheter (OR=2.0) or skin ulcers (OR=1.8) were shown to have a greater risk for infection. Age, sex and accommodated in a two- versus single-bed room were not significant factors. Incidence of infection in nursing homes in Norway is within the range reported from other countries. This study identified several important risk factors for healthcare-associated infection. There is a need to prevent infection by implementing infection control programmes including surveillance in long-term care facilities.

The oral ecosystem: implications for education.

We propose a model that is applicable to oral health education. The model describes the oral cavity in a complexity-based ecological context. This concept includes the premise that factors from different organisational levels (biological, individual, community, society) interact in a complex way with the potential to 'stress' the ecosystem and thereby provoke changes. This mode of action complies with the understanding of the oral cavity as a complex adaptive system. An ecological model is actively used in the undergraduate problem-based curriculum at the Faculty of Odontology, Malmö University, Sweden and has recently been applied as a conceptual basis for the new dental curriculum being established at the University of Tromsø in Northern Norway. The purpose is to encourage and promote an ecological, health-oriented view and to stimulate reflections on premises for oral health and diseases in an integrated context.

Endodontic status amongst 35-year-old Oslo citizens and changes over a 30-year period.

AIM: To determine the prevalence of apical periodontitis and quality of root fillings in 35-year-old citizens of Oslo, Norway in 2003, and to compare the results with data from the same age cohort collected by repetitive cross-sectional studies in 1973, 1984 and 1993. METHODOLOGY: A random sample of 250 35-year-old Oslo inhabitants was drawn from The National Bureau of Statistics Recordings. Attendance rate was 64%. Root filled teeth and teeth with periapical pathology were detected from panoramic radiographs and additional periapical radiographs of affected teeth were processed. The preriapical status was evaluated by applying the periapical index system (PAI). Chi-square and Student's t-tests were used for the evaluation of differences between the groups. RESULTS: Twenty-three per cent of the individuals examined had root filled teeth and 16% had at least one tooth with apical periodontitis. Root filled teeth were associated with PAI values of 1 and 2 (health) in 57% of cases. Prevalence of root filled teeth and apical periodontitis remained unchanged during the past 10 years. An increase in the proportion of root filled teeth with apical periodontitis from 18% in 1973 to 43% in 2003 was observed. CONCLUSIONS: Despite continuous improvement in dental health (reduced DMF-values) compared with the previous Oslo studies; there was no improvement in endodontic status from 1993 to 2003.

Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003.

The Norwegian Institute of Public Health initiated a national surveillance system for nosocomial infections in 2002. The system is based on two annual one-day prevalence surveys recording the four most common types of nosocomial infection: urinary tract infections; lower respiratory tract infections; surgical site infections and septicaemia. All acute care hospitals in Norway (N=76) were invited to participate in the four surveys in 2002 and 2003. The total prevalence of the four recorded nosocomial infections varied between 5.1% and 5.4% in the four surveys. In all surveys, nosocomial infections were located most frequently in the urinary tract (34%), followed by the lower respiratory tract (29%), surgical sites (28%) and septicaemia (8%). The prevalence surveys give a brief overview of the burden and distribution of nosocomial infections. The results can be used to prioritize further infection control measures and more detailed incidence surveillance of nosocomial infections.

Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003.

There were 42900 institution-beds in long-term care facilities for elderly persons in Norway in 2000. This is twice as many as in 1984. Of those living in an elderly people's care institution 77% were above 80 years. To determine the magnitude and distribution of nosocomial infections in such institutions, the Norwegian Institute of Public Health initiated a surveillance system. The system is based on two annual one-day prevalence surveys recording the four most common nosocomial infections: urinary tract infections, lower respiratory tract infections, surgical-site infections and skin infections, as well as antibiotic use. All long-term care facilities were invited to participate in the four surveys in 2002 and 2003. The total prevalence of the four recorded nosocomial infections varied between 6.6 and 7.3% in the four surveys. Nosocomial infections occurred most frequently in the urinary tract (50%), followed by infections of the skin (25%), of the lower respiratory tract (19%) and of surgical sites (5%). The prevalence of nosocomial infections was highest in rehabilitation and short-term wards, whereas the lowest prevalence was found in special units for persons with dementia. In all the surveys the prevalence of the four recorded nosocomial infections was higher than the prevalence of patients receiving antibiotics. The frequency of nosocomial infections in such facilities highlights the need for nosocomial infection surveillance in this population and a need to implement infection control measures, such as infection control programmes including surveillance of nosocomial infections.

Surgical-site infections at Kilimanjaro Christian Medical Center.

A five-month prospective survey of surgical-site infections (SSI) was conducted in the department of general surgery at Kilimanjaro Christian Medical Center, Tanzania. SSI were classified according to Centers for Disease Control and Prevention (CDC) criteria and identified by bedside surveillance and post-discharge follow-up. This study showed that 77 (19.4%) of the patients developed SSI. Twenty-eight (36.4%) of these infections were apparent only after discharge from hospital. Eighty-seven percent of those who developed SSI had received antibiotic prophylaxis. Significant risk factors for developing SSI during hospital stay were: operations classified as contaminated or dirty, operations lasting for more than 50 min and the length of preoperative stay. The only significant risk factor for those who developed SSI after discharge was having undergone a clean-contaminated operation. Staphylococcus aureus was the most frequently isolated micro-organism followed by Escherichia coli and Klebsiella spp., most of which were multi-resistant. An exception was S. aureus where 54.5% of the isolates were fully susceptible. The incidence of SSI and the prevalence of antibiotic resistance in this teaching and tertiary care hospital are high. The risk factors were similar to those reported from countries with more resources. The findings suggest that infection prevention measures, particularly antibiotic prophylaxis, should be re-evaluated.

Causal patterns of dental health in populations. An empirical approach.

In the present investigation we aimed to analyse causally the pattern of determinants leading to the maintenance of functional teeth in adults. Clinical and self-reported information was used. The hypothesis was that socio-economic conditions operate through psychosocial circumstances that influence lifestyle, and are thus related to oral hygiene and levels of remaining teeth. Testing of the patterns for adults residing in high- and low-fluoride areas did not reveal any principal differences in dental health, therefore further testing was combined for both fluoride areas. Further analysis also indicated that testing should be performed separately for each gender. Social structure and dental health-related lifestyle were important in an overall pattern of maintaining functional teeth, but general lifestyle and psychosocial conditions were not found to be part of the pattern influencing dental health. Gender-specific patterns were revealed. New hypotheses may be suggested for further research with regard to studying patterns of dental health in Lithuanian adults.

Clinical performance of 3 endodontic sealers.

OBJECTIVE: Calcium hydroxide is used in endodontics as an interappointment dressing. Its inclusion in salicylate resin or zinc oxide-eugenol-based sealers for filling root canals also may lead to a better treatment outcome. The purpose of the present study was to compare the clinical/radiographic treatment outcome of 3 sealers, 2 of which contain calcium hydroxide. STUDY DESIGN: Two hundred and four teeth underwent a standardized endodontic treatment regimen and were assigned to 1 of 3 groups at the time of root filling: group PS, teeth filled with gutta-percha and Procosol sealer; group CR, teeth filled with gutta-percha and CRCS sealer; and group SA, teeth filled with gutta-percha and Sealapex sealer. The results of the treatment were assessed yearly for up to 4 years by clinical and radiologic (periapical index scores) controls. The ridit statistic (r) was used to compare PAI scores among the groups. RESULTS: The overall treatment results were comparable with, but slightly poorer than, results previously obtained from patients seen at the Dental School at the University of Oslo. During the first year after filling, the mean ridit value decreased from .51 +/- .039 to .31 +/- .042 (Deltar = .20) in the SA group. Corresponding values went from .43 +/- .030 to .38 +/- .035 (Deltar = .05) in the PS group and from 37 +/- .045 to .34 +/- .050 (Deltar = .03) in the CR group. At the 2-year examination, teeth in group SA had slightly better periapical conditions (r =.22 +/-.045) than did teeth in group PA (r = .30 +/- .037) or in group CR (r = .30 +/- 052). The difference was statistically significant at P = .01. By years 3 and 4, no significant difference among the groups was detected. CONCLUSIONS: The overall influence of the sealer on treatment outcome was small. Root fillings with salicylate resin containing Ca(OH)2 may support more rapid healing of apical periodontitis or operative trauma, but the results after 3 and 4 years were as good for zinc oxide-eugenol-based sealers with or without Ca(OH)2.

Caries in populations--a theoretical, causal approach.

The focus of this paper is caries in populations. Caries is assessed as a phenomenon and as it occurs in populations. It is observed that in recent literature the notion of causation of caries is restricted to the biological process on the tooth surface. This may be sufficient to explain caries as a phenomenon, but it is argued that a biological causation is insufficient in order to understand caries and its variation in populations. The understanding of the determinants of a population's oral health has been seriously impeded by the absence of a theoretical framework. A framework would be useful to the extent that it would bridge relevant categories for portraying complex causal patterns of caries in populations. An approach to a framework has therefore been outlined, and the idea of such a framework has been confronted with three critical comments. The framework is as yet pragmatic, incomplete, uncertain and fragmented. Yet, even such an approach may invite greater precision in epidemiological concepts about causes of caries than presently prevails. The framework directs attention to health effects of collective phenomena that cannot be reduced to individual attributes. The image proposed in this paper is intended to spur discussion about important aspects of the epidemiology of caries in populations.

Is the observed association between periodontitis and atherosclerosis causal?

Most of the documentation of possible causal links between periodontitis and atherosclerosis-related diseases appears indirect or circumstantial. There is, however, an increasing number of both experimental and longitudinal epidemiological studies which seem to support a causal relationship. A critical evaluation of the epidemiological data available might therefore be appropriate. The present study is based on a literature search using Ovid medical data base covering the period from 1989 to October 2000 and applying specific inclusion criteria. Based on a critical evaluation of the 14 investigations selected from a total of 21 retrieved from the search, a causal relationship between periodontitis and atherosclerosis-related diseases appeared possible. However, the nature both of periodontitis and atherosclerosis is multifactorial, and caution should be exercised when implicating periodontal disease in the causation of atherosclerotic disorders.

The concept of disease: ethical challenges and relevance to dentistry and dental education.

Modern medicine and dentistry face fundamental ethical challenges. To treat or not to treat, that is the question! Can these challenges be met with a rigorous and consistent concept of disease? This is the key question of this article and the ensuing debate is of fundamental importance in the teaching of ethics to medical and dental students. The investigation of traditional concepts of disease reveals that they are flawed and do not withstand ethical challenges. An alternative concept of human ailment is elaborated on, based on the triad disease, illness and sickness. This model is applied to representative cases in medicine in general and dentistry in particular. It is argued that the concepts of disease, illness and sickness represent a framework for analysing and coping with inherent ethical challenges. This reveals that medicine and dentistry are concerned both with biological explanations and with questions of the virtuous life, i.e., both with science and with ethics. These considerations pose challenges for the health professions as a whole, but particularly for those concerned with educating the practitioners of the future.

Dental caries in adult Lithuanians.

There are few data on the incidence of dental caries in Lithuanian adults. The aim of the present study was to describe caries and treatment experience among 35-44 and 65-74-year-olds, and to relate this to certain selected independent variables (gender, urban/rural residence, drinking water fluoride levels, and years of education). A total of 680 subjects selected based on a stratified random sampling procedure (response rate 52%) were examined by one examiner. Dental caries was recorded as DMFT following the WHO recommendations. The results showed that the median DMFT scores were 18 for the 35-44-year-olds (n = 380) with median DT = 2, MT = 5, FT = 7. For the 65-74-year-olds (n = 300) the median DMFT was 24, with DT = 1, MT = 18, FT = 2, respectively. One percent of all 35 year-olds and 11% of 65-74-year-olds were edentulous. In the younger age group, statistically significant differences in the DMFT scores were related to gender, urbanization and drinking water fluoride levels. Participants from areas with high fluoride content in the drinking water (> 1.5 ppm F/1) had lower DT, MT, and FT values. Females and participants from urban areas had higher numbers of FT. Participants with more years of education had lower DT, MT, and higher FT values. In the elderly, DMFT scores were related to water fluoride levels and years of education. Individuals with more years of education had higher numbers of FT and lower MT values in this age group. Poor oral hygiene was associated with high numbers of DT in both age groups. The data indicate that dental caries is widespread among adult Lithuanians.