An assessment of cross-infection control procedures among English-speaking Caribbean general dental practitioners. A regional preliminary study.

A survey was undertaken to assess the level of compliance with recommended infection control procedures among English-speaking Caribbean general dental practitioners. A four page questionnaire was sent to all practitioners in 18 English-speaking Caribbean islands. A response rate of 32 per cent was obtained. A large proportion of dentists followed the recommended barrier techniques particularly the use of gloves and facemasks. The most commonly available methods of sterilisation were steam autoclaves (82 per cent) and cold solutions (94 per cent). Seventy four per cent of respondents had received hepatitis B vaccination. A high percentage of dentists showed willingness to treat HBV (95 per cent) and HIV (84 per cent) carriers and this level of willingness to treat infectious patients has rarely been reported previously. There is an urgent need for further improvements to avoid getting inoculation injuries and splatters in the face or eyes with body fluids. Disposal of sharps and collection of solid waste are to be upgraded. The Caribbean Atlantic Regional Dental Association is planning to carry out similar research before the end of the year 2000.

Discussions with a dentist.

PIP: The author, a dentist in the West Indies, describes his use of posters and leaflets to educate his patients about HIV/AIDS. Although these materials are placed in both the waiting and treatment rooms, this alone does not guarantee they are read. The dentist introduces discussion about AIDS into his exchanges with patients, when feasible. For example, while waiting for local anesthesia to take effect, the author may ask his patients for reactions to the AIDS materials or determine if they are aware of how HIV is transmitted. Male patients are frequently observed to pick up materials on AIDS and pregnancy to take home for their wives. Infection control practices are demonstrated to those who are concerned about contracting HIV through dental procedures.^ieng

Oral health knowledge and behaviours and barriers to dental attendance of school children and adolescents in the Caribbean island of Antigua.

The purpose of the questionnaire survey was to gather data on dental health knowledge from 12 year-old school children and 15-19 year-old adolescents including self-reported dental behaviours and factors affecting regular dental attendance. The completed questionnaires of 350 children and 345 adolescents were analysed. The majority of young people were able to correctly identify the functions of teeth and cariogenic foods, and were also aware of the signs of periodontal disease. However, they incorrectly defined the meaning of dental caries and dental plaque. Also students claimed good oral hygiene behaviour and willingness to receive necessary treatment for a carious tooth from a dentist. Sixty five per cent of children and 74 per cent of adolescents, went to a dentist at some time and were likely to receive extraction at their last visit. Cost and fear were found to be the common barriers for regular dental attendance.

A frequency survey of sugary foods and drinks consumption in school children and adolescents in a West Indian island--Antigua.

In 1991, the pattern of sugar consumption in samples of 172 12-year-old children and 231 15-19-year-old adolescents was studied. Twenty-four hour dietary records of five consecutive days were obtained from each subject. The frequency of total sugary food and drink episodes for children was 3.16 and 3.71 for adolescents. This was mainly accounted for by the consumption of sugary items at meals for both age groups. Students mostly consumed sweetened drinks at meals, especially at breakfast and ate sugary foods between meal times, particularly between lunch and dinner. Sweetened tea and juice were the most popular drinks and confectionery was the most popular snack food.

Case report: a hazard caused by a lower partial denture.

Although dentures are cosmetic, as well as functional appliances, they can sometimes cause various oral conditions or life-threatening hazards to patients. A case is presented here of an unusual complication of a partial lower denture.

Periodontal treatment needs in 12 and 15 to 19-year-old school children in the Caribbean Island of Antigua, 1990.

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19-year-olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year-old children and 456 adolescents (15-19 years) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and > or = 6 mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46% in 12-year-olds and 56% in 15-19 year-olds. 4 or 5 mm pockets were found in 14% of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26% of 12-year-olds and 14% of adolescents had periodontally healthy mouths. Scaling and oral hygiene instruction were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low -3% only.

Periodontal treatment needs in 12 and 15 to 19 year old school children in the Caribbean island of Antigua, 1990

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19 year olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year old children and 456 adolescents (15 to 19) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and >6mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46 percent in 12 year olds and 56 percent in 15 -19 year olds. 4 or 5 mm pockets were found in 14 percent of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26 percent of 12 year olds and 14 percent of adolescents had priodontally healthy mouths. Scaling and hygiene instructions were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low - 3 percent. (AU)

Various reasons for permanent tooth extractions in a Caribbean population--Antigua.

A study was undertaken in September 1990 to investigate the reasons for permanent tooth extractions in Antigua. Eight out of 10 dentists on the island were requested to record permanent tooth extractions, including tooth type and reasons for extraction, during a 6 week study period. All 8 dentists provided data which indicated that 471 teeth were Extractions for orthodontic and impaction reasons comprised 4.3 per cent of tooth extrac-irregularly attending dental services. The principle reason for extractions was caries (61.6 per cent). Periodontitis (29.9 per cent) was the next most frequent reason for extractions and it became the predominant indication for tooth loss after 40 years of age. Extractions for orthodontic and impaction reasons comprised 4.3 per cent of tooth extraction, but these causes disappeared after 30 years of age. Restorable teeth were not commonly removed. The tooth types most frequently extracted due to caries were lower first molars and upper molars. Most commonly extracted, periodontally involved teeth were lower central incisors and upper third molars.

Dental caries experience and enamel opacities in children residing in urban and rural areas of Antigua with different levels of natural fluoride in drinking water.

In 1988/89, a national study was carried out to investigate the prevalence of caries experience among children aged 5 to 6, 12, and 15 to 19 years and also to measure the level of dental fluorosis among 12 to 14 year-old pupils attending schools in urban and rural areas in Antigua with various levels of natural fluoride in public water. In the first part of the study, all three age groups who were life-long residents of three areas with 0.1-0.2 ppmF (urban), 0.1-0.3 ppmF (rural) and 0.6-1.0 ppmF (rural) showed that the caries levels for each age group were not significantly different among the three fluoride communities or between urban and rural samples. In all three age groups, occlusal surfaces were more frequently affected by caries, and untreated dental caries was common. In part two of the survey, the Tooth Surface Index of Fluorosis (TSIF) was used to record fluorotic enamel defects among children aged 12 to 14 years who were life-long residents of 0.1-0.3 ppm fluoride and 0.6-1.0 ppm fluoride areas. In the low fluoride areas, mottling was absent in 97 per cent of facial surfaces of anterior maxillary teeth. In contrast, in the 0.6-1.0 ppm fluoride area, the value was 87 per cent. In both communities mottling was limited to a whitish colour. Analysis of the highest TSIF scores revealed that statistically significant differences were apparent in children with fluorosis between two communities.

Prevalence of dental caries and enamel defects in the primary dentition of Antiguan pre-school children aged 3-4 years including an assessment of their habits.

In 1989 a national survey was carried out on children aged 3 to 4 years attending nursery schools, to investigate the prevalence of caries experience, nursing bottle caries and enamel defects in the primary dentition, and these children's dentally related habits. In the first part of the study, examination of 482 Antiguan children showed that the dmft and dmfs values were 0.80 and 1.26 respectively, and that 77 per cent of the children were caries free; 4.6 per cent of children had nursing bottle caries; and enamel defects occurred in 24 per cent of children. No significant difference was found in oral health between urban and rural samples. In the second part, which was an interview survey, habits such as thumb sucking (13 per cent), not brushing their teeth (3 per cent), and swallowing fluoride toothpaste (13 per cent) were found among 369 children. In the third (a questionnaire) survey, a response rate of 63 per cent was obtained. Significantly more of the children with nursing bottle caries (78.6 per cent) had the habit of sleeping with a feeding bottle than occurred in caries free children (25.6 per cent), but there was no difference in the infant feeding pattern. The children with enamel defects were breast fed for a shorter period and had an earlier introduction to bottle feeding, compared with children without enamel defects. In the final part of the survey, an assessment of snack eating habits at school, a 58 per cent response rate was achieved. The majority of children often brought healthier snacks, together with daily sugar-rich drinks. Significantly more caries free children brought sugary snacks less frequently than children with caries experience.

Prevalence of dental caries and enamel defects in the primary dentition of Antiguan pre-school children aged 3-4 years including an assessment of their habits

In 1989 a national survey was carried out on children aged 3 to 4 years attending nursery schools, to investigate the prevalence of caries experience, nursing bottle caries and enamel defects in the primary dentition, and these children's dentally related habits. In the first part of the study, examination of 482 Antiguan children showed that the dmft and dmfs values were 0.80 and 1.26 respectively, and that 77 percent of the children were caries free; 4.6 percent of children had nursing bottle caries; and enamel defects occurred in 24 percent of children. No significant differences was found in oral health between urban and rural samples. In the second part, which was an interview survey, habits such as thumb sucking (13 percent), not brushing their teeth (3 percent), and swallowing fluoride toothpaste (13 percent) were found among 369 children. In the third (a questionnaire) survey, a response rate of 63 per cent was obtained. Significantly more of the children with nursing bottle caries (78.6 percent) had the habit of sleeping with a feeding bottle than occurred in caries free children (25.6 percent), but there was no difference in the infant feeding pattern. The children with enamel defects were breast fed for a shorter period and had an earlier introduction to bottle feeding, compared with children without enamel defects. In the final part of the survey, an assessment of snack eating habits at school, a 58 percent response rate was achieved. The majority of children often brought healthier snacks, together with daily sugar-rich drinks. Significantly more caries free children brought sugary snacks less frequently than children with caries experience. (AU)

Simplified cross-infection control: a study of cost, time and patient flow in Antigua.

This study was designed to assess the factors, such as cost of imported dental materials, time spent on cross-infection control procedures and the limited number of dental instruments, that determine the suitability of cross-infection control methods in a government dental clinic in a developing country. During the 6-month study period, 510 adult patients received extraction treatment, the mean treatment time for each patient being 8-9 min. In each session, it was found that every 1-1 1/2 hours, instruments had to be autoclaved again for the treatment of further patients, but patient-flow was maintained. Between patients, a hand washing time of 20-25 s with chlorhexidine was recorded. Every 1 1/2-2 hours a new pair of gloves had to be used. Work surfaces were disinfected with either 1 per cent chlorine or 2 per cent glutaraldehyde. Extraction of 22 teeth per session was completed within the available working time of 3-3 1/2 hours at a cost for materials of US 50 cents per patient. These cross-infection control procedures were deemed suitable for use in the Government Dental Clinic.

Prevalence of dental caries in 12-year old school children in Antigua - abstract

In 1987, an epidemiological study was done to determine the prevalence of dental caries in 12-year-old school children in Antigua. Seventeen schools were randomly selected, and all children in their 12th year of age were enrolled in the study. There were 159 (42 per cent) boys and 218 (58 per cent) girls for a total of 377. Children were examined in the supine position in a chair at the school. The extent of caries were determined, using the criteria of dentinal involvement. The mean number of decayed, missing and filled teeth (DMF) per child was 0.7. Sixty-eight per cent of children were free of caries-, 20 per cent had 53 per cent decayed teeth, 10 per cent had 12 per cent of missing teeth, and 2 per cent of children had 5 per cent of filled teeth. It was concluded that the prevalence of dental caries in 12-year-old school children was low (AU)

Pulsated jet subgingival irrigation with 0.1% chlorhexidine, simplified oral hygiene and chronic periodontitis.

This study investigated the efficacy of a 0.1% chlorhexidine preparation as an aid to a basic oral hygiene programme comprising only baseline root and crown debridement, instruction in bass brushing without emphasis on interdental cleaning, and pulsated mono-jet subgingival irrigation. Baseline data for plaque index, papilla bleeding index and probeable pocket depth were similar in both test and control groups. Mean values for all 3 parameters were clearly lower in the chlorhexidine group, both at the end of the period of active treatment and up to 2 months thereafter. These differences were statistically significant for P1I at day 28, PBI at day 56 and PPD at days 56 and 84, but not at day 168. Proportionately more sites generally showed improvement in the chlorhexidine group at all times. It was concluded that 0.1% chlorhexidine significantly enhances the effects of the practical oral hygiene regime described.