An investigation into the use of a dental hygienist in school screening.

OBJECTIVE: A pilot study to measure the validity of using a hygienist to carry out school screening. DESIGN: Following a standard training programme a dental hygienist (DH), recruited from general practice, a newly appointed dental officer (DO) and an epidemiologist (SDO), who acted as the standard, all screened the same group of school children on two occasions. SETTING: An inner city school with known high levels of disease. PARTICIPANTS: Ninety-eight 7- and 8-year-old children attending school. MAIN OUTCOME MEASURES: For each clinician the levels of referral, the reasons for referral and the repeatability were measured. RESULTS: The hygienist referred 26 children (27%) for further examination while the DO and the SDO both referred 61 (62%). The DO achieved the required standards of sensitivity and specificity when results were compared with the SDO but the hygienist did not. Intra-examiner reliability in all three clinicians was good. CONCLUSIONS: The standard training programme used to prepare dental officers to carry out school screening to an agreed standard was insufficient for this hygienist's needs.

Evaluation of a teaching aid for dental students.

A new teaching aid to assist undergraduate dental students to learn charting methods was developed. The aim of this study was to evaluate the effectiveness of the aid. Baseline charting tests were completed by 58 inexperienced clinical students at the start of a weekly half-day attachment at 3 community dental service (CDS) teaching clinics. These students were randomly assigned, in their tutor groups, to act as either test or control groups. The test group was actively taught charting with the new aid over their first 5-week attachment and control students were taught in the traditional way. Final charting tests were completed at the end of the attachments by all students and their results compared with baseline test results. The test group improved their mean scores from 20 out of a possible 50 marks at baseline to 36 at final test, a mean increase of 15 marks and an improvement of 71%. The control group scored a mean of 18 marks at baseline and improved this to 25, an increase of 7 marks, an improvement of 39%. It is concluded that the new teaching aid is more effective in assisting the students to learn charting than the traditional method.

The effects of different conventions regarding missing primary incisors in epidemiological studies.

OBJECTIVE: To assess the effects of two different conventions regarding the scoring of missing primary incisors in epidemiological studies. DESIGN: During 1995/96 a sample of 5-year-old children was examined as part of the national programme of surveys coordinated by the British Association for the Study of Community Dentistry. The fate of missing incisors was recorded according to two conventions and the resulting mean dmfts and components compared. SUBJECTS: Eight hundred and twenty-six randomly sampled 5-year-old children were examined by two trained and calibrated examiners under standardised conditions in their primary schools in North, Central and South Manchester. RESULTS: The overall mean dmft was 3.40 under the new convention and 3.60 with the old, a difference of 5.6%. The mean mt was depressed by 23% from 0.86 to 0.66 under the new convention. The differential between old and new conventions increased with dmft. The district with the highest mean dmft was affected most by the application of the new convention; the mean dmft was depressed by 8.5% from 4.33 to 3.96 and the mean mt was depressed by 32% from 1.17 to 0.80. All differences were significant (P < 0.01). CONCLUSION: A change in convention affected the results to varying degrees depending on the disease level of the population group being surveyed.

Sickle cell disorder and orofacial pain in Jamaican patients.

AIM: The aim of this study was to investigate the prevalence of orofacial pain in a large group of sickle cell disorder (SCD) sufferers. METHODS: In 1996, 51 Jamaican adults and teenagers with SCD and 51 matched subjects (non-SCD) without any sickle cell problems were questioned about their experience of pain in the maxilla or mandible, and pain in their teeth. The subjects, aged 13 to 45 years, had oral examinations and the state of the teeth was recorded together with the presence or absence of deep periodontal pockets, vertical or horizontal mobility, sepsis, trauma and severe erosion. RESULTS: Mandibular or maxillary pain during the previous 12 months was reported by 49% of those with SCD and only 8% of the non-SCD subjects. Among the SCD group reporting this pain, 68% were found to have no dental problems which could have caused the pain. Dental disease accounted for the facial pain in all non-SCD subjects. Headaches were experienced by 77% of the SCD group and only 47% of the non-SCD group. Experience of toothache during the previous year was reported by 67% of the SCD group and 57% of the non-SCD. In half of these SCD subjects there was no obvious dental pathology to account for the dental pain but none of the controls had dental pain in the absence of dental pathology. CONCLUSION: People who suffer from sickle cell disorders are likely to suffer orofacial and dental pain in the absence of dental pathology and this is probably because of sickling crises within the microcirculation of the facial bones and dental pulps and small areas of necrosis in the bone marrow.

Sickle cell disorder and orofacial pain in Jamaican patients

AIM: the aim of this study was to investigate the prevalence of orofacial pain in a large group of sickle cell disorder (SCD) sufferers. METHODS: In 1996, 51 Jamaican adults and teenagers with SCD and 51 matched subjects (non-SCD) without any sickle cell problems were questioned about their experience of pian in the maxilla or mandible, and pain in their teeth. The subjects, aged 13 to 45 years, had oral examinations and the state of the teeth was recorded together with the presence or absence of deep periodontal pockets, vertical or horizontal mobility, sepsis, trauma and servere erosion. RESULTS: Mandibular or maxillary pain during the previous 12 months was reported by 49 percent of those with SCD and only 8 percent of the non-SCD subjects. Among the SCD group reporting this pain, 68 percent were found to have no dental problems which could have caused the pain. Dental disease accounted for the facial pain in all non-SCD subjects. Headaches were experienced by 77 percent of the SCD group and only 47 percent of the non-SCD group. Experience of toothache during the previous year was reported by 67 percent of the SCD group and 57 percent of the non-SCD. In half on these SCD subjects there was no obvious dental pathology to account for the dental pain but none of the controls had dental pin in the absence of dental pathology. CONCLUSION: People who suffer from sickle cell disorders are likely to suffer orofacial and dental pain in the absence of dental pathology and this is probably because of sickling crises within the microcirculation of the facial bones and dental pulps and small areas of necrosis in the bone marrow(AU)

Dental health status associated with documented dental attendance patterns in adolescents.

OBJECTIVE: To investigate the dental health of adolescents who exhibited four different patterns of documented dental attendance in regard to caries experience and types of treatment they received. DESIGN: The adolescents were categorised according to whether they had been asymptomatic or symptomatic attenders in childhood and whether this had changed in early adolescence. Asymptomatic attenders were those who attended for examinations at least twice in any three year period. Symptomatic attenders were those who attended for examinations less frequently than this. SUBJECTS: Treatment notes of 254, 13-15-year-old subjects who reported they were patients at one of 12 general dental practices or two community clinics were used to document attendance during the previous six years. RESULTS: Those who attended asymptomatically throughout the study period of six years had fewer teeth extracted and more sealed teeth than those who attended symptomatically. CONCLUSIONS: Among adolescents dental attendance in the absence of symptoms is associated with fewer missing teeth and wider provision of fissure sealants.

Dental caries, fluorosis and the cosmetic implications of different TF scores in 14-year-old adolescents.

The aims of this study were to determine the opinions of a group of adolescents about the cosmetic acceptability of a range of fluorosis, investigate the prevalence and severity of fluorosis in the sample and consider the extent to which fluorosis levels were related to their dental caries experience. A random sample of 534 14-year-old pupils from the non-fluoridated industrial city of Manchester were examined for caries and fluorosis. Each subject then examined six photographs of upper anterior teeth showing a range of TF scores 0-4 and were asked to rate the appearance of each as either very poor, poor, acceptable, good or very good and to indicate whether they would request treatment if their teeth were so affected. Four hundred and seventy-six subjects (89 per cent) had TF scores of 0. Of the 58 subjects (11 per cent) with fluorosis, 27 (5 per cent) scored TF = 1; 22 (4 per cent) TF = 2; 7 (1 per cent) TF = 3 and one subject scored TF = 4. The subjects who had no fluorosis had a mean DMFT of 3.0 which was significantly higher than the mean of 2.2 among those with any fluorosis. The proportion of subjects who rated the photographs as poor or very poor fell from 29 per cent for TF score 0 to 15 per cent for TF score 2 and then increased to 92 per cent for TF score 3. The responses of the subjects regarding their desire for treatment matched closely with their opinions on appearance; the majority of subjects expressed concern over the appearance of teeth with TF scores of 3 and higher. It is concluded that the prevalence of aesthetically objectionable dental fluorosis was low and that mild fluorosis was associated with a lower risk of dental caries and a more acceptable appearance. It is essential that a balanced view of the relative benefits and risks of the use of fluorides is maintained and proven benefits are not overwhelmed by largely unfounded aesthetic concerns.

Dental caries in children from two Libyan cities with different levels of fluoride in their drinking water.

The aims of this study were to (1) demonstrate the feasibility of collecting dental epidemiological data suitable for planning purposes in Libya and (2) record the caries prevalence in Benghazi so that, following an increase in the fluoride concentration of the drinking water, potential changes in dental caries prevalence could be assessed. Random sampling resulted in the examination of 833 six-year-old and 704 twelve-year-old children from Benghazi (0.8 mg/t F-) and Jardinah (1.8 mg/t F-). For both six- and twelve-year-old children the caries prevalence in Jardinah was significantly lower than in Benghazi. Within Benghazi the caries prevalence was lower in state than private schools for the six-year-old children. Little evidence of dental treatment was found for the six or twelve-year-old pupils at either examination site.

Documented dental attendance patterns during childhood and adolescence.

This 6-year retrospective study investigated the dental visiting habits of 263 working class adolescents in Greater Manchester. The aims of the study were to determine when young people were most likely to change their attendance patterns and to identify which subjects were most likely to stop seeking routine care. The frequency and reasons for all dental attendances made over a 6-year period were documented using clinical notes from general practices and community clinics. At the end of the study period, when the subjects were 13-15 years old, 62% were found to be maintaining an asymptomatic pattern of attendance, that is attending for examinations in the absence of symptoms. Sixteen per cent had stopped attending for check-ups and throughout the 6 years 10% attended only when they had symptoms or very rarely for check-ups. The number of subjects seeking routine care declined from the age of 9 years and those who continued to attend for examinations did so with a reduced frequency than when they were younger. It is concluded that encouragement to continue asymptomatic attendance should commence during the last years at primary school (10-11 years of age), a strategy which could result in up to 90% of the population of young adults retaining an asymptomatic dental attendance pattern.

A five year follow up into changes in caries experience amongst a sample of 12 year old children from Athens.

A five year follow up study of the dental health of 12 year old children in Athens has recorded a significant (P < 0.01) 32.3 per cent reduction in DMFT. In 1988 the mean DMFT score was 2.41 compared with 1.63 in 1993. The caries reduction may be due in part to increased marketing of fluoride dentifrice by a number of competing national and international companies.

A 30-month study investigating the effect of adding triclosan/copolymer to a fluoride dentifrice.

The aims of the study were (1) to compare the anticaries efficacy of a silica abrasive dentifrice containing 0.24% NaF and 0.3% triclosan/2.0% copolymer with a similar dentifrice without the triclosan/copolymer and (2) to study any disturbance of the oral mucosa associated with the test formulation. A double-blind, random, unsupervised, 30-month longitudinal clinical trial was conducted on 3,462 children who were initially 11-13 years of age. Two trained and calibrated dentists each examined approximately half the children. Examinations were undertaken at baseline, 15 months and 30 months. No significant differences were found between the DFS or DFT mean increments for the two dentifrice groups after 15 or 30 months. At 30 months the 90% confidence interval for the ratio of the mean increments satisfied the ADA criteria for equivalence. It is concluded that a 0.24% NaF/silica abrasive dentifrice containing 0.3% triclosan/2.0% copolymer is equivalent in its anticaries efficacy to a similar dentifrice without the addition of triclosan/copolymer. No side effects attributable to the test or control dentifrices were observed at any time during the study.

An investigation into the use of a voice operated data input system.

The aim of this study was to evaluate a voice operated data collection system intended for use in epidemiological surveys. Three groups of 45 adolescents, with similar caries experience, were examined by one examiner in schools. The caries data resulting from these examinations were collected in three ways; keyboard activated input to a portable computer, paper chart recording followed by manual input on return to base and examiner voice activated input direct to the computer. Maximum levels of accuracy were found with all three methods. The quickest method of collection in the field was by paper chart with a mean collection time per subject of 2.59 min, followed by 3.15 min for the manual keyboard method and 4.07 min for the voice activated method. When all the factors affecting time were taken into consideration it was found that overall the manual keyboard method was significantly faster than both the paper chart method and the voice activated method.

Factors affecting dental attendance among school leavers and young workers in Greater Manchester.

The aim of this study was to investigate those factors which could influence adolescents in their dental attendance habits. Discussion groups were formed with school pupils in their final school year and with Youth Training Scheme trainees who had been working for six months or more. Fourteen discussions, involving 97 adolescents, were carried out and recorded on tape. Analysis of these tapes permitted comparison of the responses of the school leavers and the trainees which revealed some recurring themes. No major differences were found between the adolescents in their views on dental attendance before and after leaving school. Many respondents said that they had been able to decide for themselves about going to the dentist since they were 12, 13 or 14 years old, well before school leaving time. A low perception of need and a high level of confidence in self-care were widely reported and these tended to reduce the likelihood of attendance. The desire to maintain or produce a good dental appearance was frequently given as the main motive for attending the dentist.