Oral health with focus on dental fear and dental caries in Swedish preschool child populations attending public dental health care: Trends over 30 years.

OBJECTIVES: To study changes in oral health with focus on reported dental fear prevalence and interrelationships between dental fear and prevalence of dental caries and performed restorative dental treatment in preschool child populations attending regular public dental health care between 1983 and 2013. METHODS: Every 10 years, random samples of about 100 children aged 3 and 5 years, respectively, took part in cross-sectional studies based on oral examination and a questionnaire. One question, put to the child and answered by the parent, mirrored dental fear: "What do you feel at the prospect of an appointment with a dentist?". Agreement to at least one of three alternatives, ill at ease, frightened and sick, indicated dental fear. Frightened and/or sick mirrored severe dental fear. 79%-94% of the samples answered the question and constituted the study group. Prevalence of caries and number of filled tooth surfaces were recorded. Dental parameters were presented in mean values. RESULTS: During the 30 years, dental fear prevalence was fairly constant. 21% of 3-year-olds and 15% of 5-year-olds reported dental fear in 2013. Positive relationships between dental fear prevalence and caries prevalence and number of filled tooth surfaces were found. Dental caries was reduced during the study time, but to a lesser degree in children with dental fear compared to children without dental fear. CONCLUSIONS: Although children were offered public dental health care, the prevalence of dental fear remained high. Children with dental fear are caries risk individuals.

Dental fear in school children and young adults attending public dental health care: prevalence and relationship to gender, oral disease and dental treatment; trends over 40 years.

PURPOSE: To study prevalence of dental fear and the relationship to gender, oral disease and dental treatment between 1973 and 2013 in school children and young adults attending public dental health care. METHODS: Every ten years from 1973 to 2013 random samples of about 100 individuals in each of the age groups 10, 15 and 20 years took part in a repeated cross-sectional study based on clinical parameters and a questionnaire. Dental fear was estimated by the question: "What do you feel at the prospect of an appointment with a dentist?". 75-99% of the samples answered the question. Agreement to at least one of the alternative answers: ill at ease, frightened and sick defined dental fear. Frightened and/or sick indicated severe dental fear. The prevalence of caries, gingivitis and number of filled tooth surfaces were calculated. Chi-square tests were used to show differences in proportions between groups and linear regression to show trends over time. RESULTS: Prevalence of dental fear declined in all age groups over time. In the 20-year olds dental fear was found in 29% of the sample and severe dental fear in 12% of girls and 5% of boys in 2013. Individuals with dental fear had higher mean caries prevalence and number of filled tooth surfaces compared with individuals without dental fear. CONCLUSIONS: This 40-year time trend study showed a reduction in dental fear prevalence in school children and young adults offered regular public dental health care based on prevention and a psychological approach. The prevalence of dental fear was still high in 2013 despite a significant decline in caries during the study period. Further improvements in the psychological approach when treating children are thus needed.

Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study.

BACKGROUND/AIM: Long-term splinting of teeth with intra-alveolar root fractures has been considered important for the deposition of hard tissue between the root fragments. The aim of this study was to compare the healing outcomes in teeth with intra-alveolar root fractures relative to splinting times in three dental centers in Scandinavia, using historical data. MATERIALS AND METHODS: A total of 512 maxillary and mandibular incisors from three dental trauma centers were included in the study. Two of the centers used long-term splinting protocols of two to three months while the other center used a short-term splinting protocol of one month or less. Three outcomes were evaluated: (1) Healing with hard tissue (dentin and/or cementum). (2) Healing with connective tissue (periodontal ligament) interposition with or without bone between the fragments. (3) Non-healing due to the coronal pulp being necrotic and infected with granulation tissue interposed between the fragments. RESULTS: The mean splinting times were 18, 81, and 110 days in the three centers. Long-term splinting resulted in hard tissue healing more frequently than short-term splinting. Short-term splinting resulted in more connective tissue/bony healing than long-term splinting, while there was no difference in the frequency of non-healing between long-term and short-term splinting protocols. CONCLUSIONS: While the results suggest that long-term splinting favors hard tissue deposition, one cannot, however, conclude that long-term splinting definitely favors hard tissue healing since the treatment protocols were not randomized among the three centers. More clinical studies on the role of splinting time need to be done.

Parental factors in early childhood are associated with approximal caries experience in young adults-A longitudinal study.

OBJECTIVES: To test the hypothesis that parental factors in early childhood influence approximal caries experience in young adults. METHODS: A cohort of 494 individuals was followed longitudinally from 1 to 20 years of age. Data were retrieved from parental interviews and questionnaires when the child was 1 and 3 years of age. At age 20, the participants underwent bitewing radiographic examination. Based on the number of approximal caries lesions (Da), stratified into initial (Di ) or manifest caries (Dm ) and approximal fillings (Fa), the participants were divided into two main groups: those with: (a) 0 Dim Fa (n = 244) and (b) >0 Dim Fa (n = 250). A subgroup was also created (≥8 Dim Fa; n = 33). RESULTS: Toothbrushing with fluoride toothpaste at 3 years of age less than twice a day (OR 1.6, 95% CI 1.0-2.6) and the participants' mothers' self-estimation of their oral health care as "less than optimal" were important risk factors for developing caries (>0 Dim Fa OR 2.0, 95% CI 1.3-3.1). An interaction effect between toothbrushing at 3 years of age less than twice a day and consumption of caries risk products > 3 times a day further increased the caries experience in young adults (≥8 Dim Fa OR 8.3, 95% CI 1.8-37.8) together with maternal anxiety about dental treatment (OR 7.4 95% CI 1.6-34.6). CONCLUSIONS: Parental factors in early childhood are associated with caries experience at 20 years of age.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 40 years (1973-2013). II. Review of clinical and radiographic findings.

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment. The frequency of edentulous individuals aged 40-70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture weareryounger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003. The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations.There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age groups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups. In age groups 10-30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the otheryears,1973-1993. The percentage of individuals with probing pocket depths > 4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth > 4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen. The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

Dental Implant Therapy for a Child with X-linked Hypohidrotic Ectodermal Dysplasia--Three Decades of Managed Care.

PURPOSE: The aim was to report on oral rehabilitation of a boy with X-linked hypohidrotic ectodermal dysplasia (XLHED) and anodontia of the mandible between ages 3 and 33 years where treatment involved dental implants and oral care management by a multidisciplinary team of specialists. MATERIALS AND METHODS: This case history report describes the clinical management of a boy born in 1979 with XLHED and anodontia of the mandible. Two implants were successfully placed in the anterior region of the mandible in 1985. Genetic analysis later verified the diagnosis by confirming a mutation in the EDA gene. The case description was based on review of the patient records and assessment of orofacial function. RESULTS: The patient had satisfactory orofacial appearance and function throughout his youth. He is still caries-free at age 33 and has experienced only minor oral complications. Dental management began at age 3, when he received a maxillary removable dental prosthesis. At age 7, he received a mandibular implant-supported overdenture. After two more implants in the mandible and orthodontic treatment in the maxilla, his oral rehabilitation was completed at age 22 with maxillary tooth-supported and mandibular implant-supported fixed dental prostheses. Regular follow-ups provided supervision of oral hygiene, caries prevention, and prosthetic maintenance. CONCLUSION: This long-term follow-up of a child with XLHED and anodontia in the mandible supports the use of dental implants, with consideration given to the dense bone quality associated with the diagnosis, to establish good orofacial function and appearance from childhood onward.

Prevalence of dental erosion and association with lifestyle factors in Swedish 20-year olds.

OBJECTIVE: To investigate the prevalence, distribution and severity of dental erosion and its association with lifestyle, oral and general health in young adults. MATERIALS AND METHODS: Four hundred and ninety-four individuals, 20-years of age, participated. Dental erosion in molars and maxillary incisors was evaluated. Caries, plaque and gingivitis were registered. Saliva samples were taken and the subjects were interviewed about behavioural and dietary habits and oral and general health. Body mass index (BMI) was calculated. The individuals were sub-divided into two groups according to the presence and absence of dental erosion: within the group with erosion was a sub-group of individuals with extensive erosion. RESULTS: Of the individuals 25% had no erosion, 75% had erosion and 18% had extensive erosion. Erosion was found in molars in 74% of the individuals and on buccal and palatal surfaces in maxillary incisors in 4% and 7%, respectively. Cupping was seen in 65% of individuals and severe erosion in molars in 1.6%. Compared to subjects with no erosion, those with extensive erosion had a higher consumption of soft drinks (p = 0.05), caries prevalence (p < 0.01), prevalence of mutans Streptococci (p < 0.01) and BMI (p < 0.05). Furthermore, subjects with erosion had higher caries prevalence (p < 0.01) and BMI (p < 0.01) than those with no erosion. CONCLUSIONS: Swedish young adults have a high prevalence of dental erosion, but the level of severe erosion is low. The study disclosed a relationship between dental erosion and behavioural factors, oral health and BMI.

Evaluation of preventive programs in high caries active preschool children.

Although caries prevalence in preschool children has dramatically decreased during the last decades it is still a large problem for a minor group of these children. Great efforts have been invested in finding effective preventive programs for the high caries active preschool children. However, few studies have evaluated and discussed which approach will give the best effect. The aim of the present study was to compare the effect of a "standard" preventive program with a series of programs with more extensive measures during a two-year period. At start one hundred and sixty high caries active preschool children (mean age 4 years) were included in the study. The children were randomly distributed to four groups. All groups were exposed to the basic program composed of dietary counselling, oral hygiene instructions and fluoride varnish application. Three groups were exposed to one additional preventive measure e.g. 1% chlorhexidine gel in trays, 0.2% NaF gel in trays or daily tooth brushing with 1% chlorhexidine gel. The programs were repeated seven times during the two-year study period and were executed by trained dental hygienists. Caries examination and saliva sampling for Streptococcus mutans measurements were performed at start of the study and after two years. The mean defs at start was between 10.8 and 12.6 for the four groups (NS). After two years the caries increment was 1.9 ds in the basic preventive group and between 1.9 and 2.6 (NS) in the other groups. Numerically there were more children in the chlorhexidine groups that showed reduction of Streptococcus mutans counts compared to the other groups, but the differences were small. The mean caries increment of about 1.9 ds per year in all groups indicate that all programs were effective taken into account that the children had about 11 defs at start. There were no differences in caries increment between the basic preventive group and the other groups. The conclusion was that addition of preventive measures on top of an effective basic program is a waste of resources. The effect on oral health of individual reinstruction and motivation, by a dental hygienist, seven times during the two-year study period should not be underestimated.

Aetiology of severe demarcated enamel opacities--an evaluation based on prospective medical and social data from 17,000 children.

During the 1970s dentists reported an increasing prevalence of a "new" type of enamel disturbance.The disturbance was very specific, with areas of demarcated hypomineralised enamel, and was mostly found in permanent first molars and incisors. Several studies have tried to reveal the aetiology behind the enamel disturbance but sofar no clear factors correlated have been found. The aim of the present study was to evaluate aetiological factors to severe demarcated opacities (SDO) in first permanent molars in a large cohort of children enrolled in the "All Babies in Southeast Sweden" (ABIS) project. ABIS is a prospective study of all children in five Swedish counties born between Oct 1, 1997 and Oct 1, 1999, in all about 17,000 children.They have been followed from birth with recording of a large number of factors on nutrition, diseases, medication, infections, social situation etc. With help from 89 Public Dental Service clinics in the same area preliminary examinations of the children, born between Oct 1,1997 and Oct 1,1999, reported 595 children with severe demarcated opacities (SDO) in first molars.These children and a randomly selected age matched group of 1,200 children were further invited to be examined by specialists in paediatric dentistry. At these examinations 224 severe cases were identified as well as 253 children completely without enamel disturbances among children registered in ABIS.These two groups were analysed according to any correlation between SDO and variables in the ABIS databank. The analyses showed no association between SDO and pre-, peri-, and neonatal data. However, we found a positive association between SDO and breastfeeding for more than 6 months (OR 1.9; 95% CI 1.1-3.2), late introduction of gruel (OR 1.9; 95% CI 1.1-2.9), and late introduction of infant formula (OR 1.8; 95% CI 1.2-2.9). A combination of these three variables increased the risk to develop SDO by more than five times (OR 5.1; 95% CI 1.6-15.7). No significant associations were found to other environmental, developmental, or medical factors. We conclude that nutritional conditions during first 6 months of life may influence the risk to develop severe demarcated opacities in first permanent molars.

BMI status in Swedish children and young adults in relation to caries prevalence.

Overweight and obesity are increasing as health problems at global level. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits. The aim of the present study was to investigate the relationship between body weight status and caries prevalence in an unselected population followed from pre-school years to young adulthood. The present investigation was designed as a longitudinal analysis of the association between overweight/obesity and dental caries in one population at 3, 6, 15 and 20 years of age. The result shows that adolescents (15 years) and young adults (20 years) who are overweight/obese had a statistically significantly higher caries prevalence than normal-weight young people. At 6 years of age, the odds (OR) of having caries among obese children are 2.5 times higher than the odds for caries among six-year-old children of normal weight (p = 0.04). At 3 years of age, no association between overweight/obesity and caries was found. To conclude, overweight and obese adolescents and young adults had more caries than normal-weight individuals. The present study emphasises the need for multidisciplinary approaches to change the lifestyle factors causing both overweight/obesity and dental caries.

Oral health in young adults with long-term, controlled asthma.

OBJECTIVE: To study oral health in young adults with long-term, controlled asthma. MATERIAL AND METHODS: Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits. RESULTS: The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups. CONCLUSION: Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

Oral health in pre-school children with asthma--followed from 3 to 6 years.

OBJECTIVE: The aim of this study was to investigate caries and its determinants in preschool children with and without asthma, followed from 3 to 6 years. METHODS AND SUBJECTS: Caries, plaque, and gingivitis were examined at 3 and 6 years of age in 64 asthmatic children and 50 matched, healthy control children. Furthermore, at 6 years radiographic examination and saliva sampling were conducted. The parents were interviewed about various oral health-related factors. RESULTS: Initial caries increment between 3 and 6 years of age was statistically significant higher for children with asthma compared with children without asthma (P < 0.05). Asthmatic children had more bleeding gingivitis and a higher consumption of sugary drinks than healthy children at 3 years of age (P < 0.05). At both 3 and 6 years of age, the asthmatic children were more frequently mouth breathers than healthy children, only statistically significant for 6-year olds (P < 0.05). CONCLUSION: Preschool children with asthma at 3 years of age run a higher risk of developing caries lesions until 6 years of age compared with children without asthma. Children with asthma have a higher prevalence of bleeding gingivitis, a higher intake of sugary drinks and are more frequently mouth breathers than preschool children without asthma.

Assessment of traumatic injuries to primary teeth in general practise and specialized paediatric dentistry.

AIM: The aim of this prospective study was to compare diagnosis, severity of trauma and treatment of traumatic injuries to the primary dentition in two groups of children, the first recommended for treatment by general practitioners and the second referred for treatment by a specialist paediatric dentist. MATERIALS AND METHODS: A total of 323 children with traumatic injuries, 184 boys and 139 girls aged 7-83 months, participated in the study. All the children had first presented at a Public Dental Service clinic where they were examined by general dentists who decided, based on the severity of the trauma, to assign each child to one of the following two groups: Group A--recommended for treatment at the general practise (166 children with 257 traumatized incisor teeth). Group B--recommended for referral to a specialist in paediatric dentistry (157 children with 261 traumatized incisor teeth). Even in Group A, the specialist controlled the treatment decisions. The clinical diagnose and follow-up followed the recommendations presented by Andreasen & Andreasen. RESULTS: The distribution of trauma by age was similar in both groups, with about 60% occurring between 1 and 3 years. More injured teeth were extracted in children in Group B (n = 111) than in Group A (n = 33). A higher percentage of intruded primary incisors were recorded in Group B (24%) compared with Group A (16%). Similarly, the percentage of concussions/subluxations, lateral luxations and complicated crown fractures was higher in Group B than in Group A. CONCLUSIONS: The group referred for specialist treatment had more severe injuries and needed more complicated treatment than the group recommended for care by general dentists. However, the rate of sequelae in permanent successors was the same in both.

Thirty year trends in the prevalence and distribution of dental caries in Swedish adults (1973-2003).

The aim of the present investigation is to report on the trends in the prevalence and severity of dental caries and dental status in an adult Swedish population over a 30-year period (1973-2003). Four cross-sectional epidemiological studies in 1973, 1983, 1993, and 2003 were performed in Jönköping, Sweden.A random sample of individuals aged 20, 30, 40, 50, 60, 70, and 80 years were examined clinically and radiographically, a total of 2521 individals. Diagnostic variables were edentulousness, number of teeth, initial and manifest caries lesions, restorations, fissure sealants, and quality of restorations (secondary caries and overhangs). The percentage of edentulous 40- to 70-year-old individuals decreased during the 30-year period from 16% to 1%. The distribution of individuals by DFS in the age groups 20-50 years showed a gradual shift towards a positively skewed distribution between the years 1973 to 2003. There was a steady decrease in mean number of DFS in the age groups 20-50 years. In the 20-year-olds the mean number of DFS decreased by 72% and for 50-year-olds, by 37%. In conclusion there has been a marked decrease in DFS in adults up to middle age and a marked reduction in edentulousness over a thirty year period. This shows that the decrease in caries levels in children and adolescents is also occurring among adults.

Oral health in preschool children with asthma.

OBJECTIVE: The aim of this study was to investigate oral health and its determinants in 3-year-old and 6-year-old children with asthma. METHODS AND SUBJECTS: Caries and gingivitis were examined in 127 asthmatic (all children with asthma in a selected area and born during a specific time period) and 117 matched, healthy control children. The parents were interviewed regarding various oral-health-related factors. RESULTS: The mean dfs (+/- standard deviation) in the 3-year-old with asthma was 1.4 +/- 3.2 compared with 0.5 +/- 1.2 in the controls (P < 0.05). The corresponding figures for the 6-year-old were 2.5 +/- 3.9 and 1.8 +/- 2.8. The 3-year-old asthmatic children had more gingival bleeding than the healthy controls (P < 0.05). There were no significant differences in gingivitis in the 6-year-old children. Asthmatic children reported higher consumption of sugar-containing drinks and were more frequently mouthbreathers than healthy children (P < 0.05). In 3-year-old children with asthma and immigrant background, the mean dfs was higher compared with immigrant children in the control group (P < 0.01). CONCLUSION: The results indicate that preschool children with asthma have higher caries prevalence than healthy children. The factors discriminating for caries in asthmatic children are higher intake of sugary drinks, mouth breathing, and immigrant background.

Body adiposity status in teenagers and snacking habits in early childhood in relation to approximal caries at 15 years of age.

BACKGROUND: The prevalence of overweight and obesity in children is steadily increasing in many countries. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits. OBJECTIVE: The purpose of this study was to investigate the relationship between body weight status in adolescents and snacking habits in early childhood to approximal caries prevalence at 15 years of age. METHODS: This study is part of a series of surveys of oral health in children followed from the ages of 1 year to 15 years. Body adiposity status was estimated at 13.5-16.4 years using the International Obesity Task Force cut-off values [age-specific body mass index (isoBMI)]. Information about snacking habits in early childhood was collected from interviews conducted at 1 year and 3 years. Approximal caries information was obtained from bitewing radiographs at 15 years. Data related to isoBMI and approximal caries were available in 402 teenagers. RESULT: Adolescents with isoBMI > or = 25 (n = 64) had an approximal caries prevalence that was a mean of 1.6 times higher than those with isoBMI < 25 (n = 338) (4.64 vs. 2.94; P = 0.014). Furthermore, children's snacking habits at an early age were associated with approximal caries at 15 years. CONCLUSION: Overweight and obese adolescents had more approximal caries than normal-weight individuals. Moreover, the frequent consumption of snacking products during early childhood appears to be a risk indicator for caries at 15 years. Future preventive programmes should therefore include, on a multidisciplinary level, strategies to prevent and reduce both obesity and dental caries at an early age.

Caries prevalence and distribution in individuals aged 3-20 years in Jönköping, Sweden, over a 30-year period (1973-2003).

BACKGROUND: Oral health status of individuals aged 3-80 years in the city of Jönköping, Sweden, has been assessed in a series of epidemiological studies over a 30-year period. AIM: To analyse the changes in caries prevalence and caries distribution in child population sample groups, based on studies performed in 1973, 1978, 1983, 1993, and 2003. DESIGN: Each time point included 500 randomly sampled individuals, divided into age groups of 3, 5, 10, 15, and 20 years. Results. Thirty-five per cent of 3-year-olds were caries free in 1973, compared with 69% 30 years later. Decayed and filled primary (dfs) and permanent surfaces (DFS) were reduced by 50-80% between 1973 and 2003. Adolescents aged 10 and 15 years exhibited the most pronounced reduction in DFS on the occlusal surfaces. By 2003, 90% of the proximal carious lesions in 15-year-olds were initial carious lesions. In 2003, about 60% of 15-year-olds had a DFS of < or = 5, while about 7% exhibited a DFS of > or = 26. CONCLUSIONS: Despite the dramatic decline in the prevalence of caries, caries remains a health problem among children, particularly those of preschool age. Continuous epidemiological studies are recommended to evaluate preventive measures.

Location, complications and treatment of mesiodentes--a retrospective study in children.

Out of approximately 11 500 children, who had been referred to the Department of Paediatric Dentistry at the Institute for Postgraduate Education,Jönköping, Sweden, 97 individuals had a total of 123 mesiodentes. Their dental records and radiographs were analysed in order to study the clinical and radiographic features of the mesiodentes, to record the complications caused by them and to evaluate different forms of treatment. In the present study, the predominant location of the mesiodentes was palatally with 39 per cent in an inverted position. Arrest of the permanent incisors eruption, midline diastema and displacement or rotation of the incisors, were the most common complications found. On the contrary, no follicular cysts or resorption of either the mesiodens or the adjacent teeth were found. Fourty-three out of the 97 individuals were radiographically followed and no pathological findings were recorded. This study shows that the risk of complications caused by the mesiodentes seems to be very low and therefore a more restrictive attitude towards their surgical removal can be recommended.

Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003). I. Review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to compare data on dental care habits and knowledge of oral health in four cross-sectional epidemiological studies carried out in 1973,1983,1993, and 2003. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993 and 2003 studies, which comprised 1,104, 1,078, and 987 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the four studies. An addition to the 1993 and 2003 investigations were questions concerning ethnic background. In 2003 approximately 90-95 per cent of all individuals were visiting the dentist on a regular basis every or every second year. The 30- and 40-yea r-olds, however, did not visit a dentist as regularly in 2003 as in 1993. In these age groups 21-24 per cent of the individuals, respectively, reported that they had not visited a dentist in the last 2 years. Almost all children 3-15 years old received their dental care within the Public Dental Service (PDS). During the period 1973-2003 an increase in percentage of individuals aged 20-50 years treated by the PDS was seen compared to private practice, while among 60-80 year-olds there were only minor changes. Most so-year-olds and older received their dental care by private practitioners. About 70-80 per cent of all adults in 2003 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who were frightened, 5-17 per cent, or felt discomfort at the prospect of an appointment with the dentist was more or less the same during the whole period. The knowledge of the etiology of dental diseases did not changed much between 1973 and 2003. The frequency of toothbrushing increased since 1973 and in 2003 more than 90 per cent of all individuals brushed their teeth twice or once a day. The use of dental floss and toothpicks decreased in 2003 compared to 1983 and 1993. Almost all individuals in 2003 used fluoride toothpaste. It was obvious that the dental team constituted the main source of dental health information. For the age groups 20 and 30 years information from friends and relatives was also important. In the age groups 3-20 years up to 45 per cent of the individuals were consuming soft drinks every day or several times a week.