Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium.

Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and "precision," data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies (N = 55,143) using previously developed permanent dentition tooth surface-level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.

Behaviour management problems in Finnish children with operated congenital heart disease: a practice-based study.

PURPOSE: This retrospective, practice-based study investigates behaviour management problems (BMPs) in dental care among Finnish children with operated congenital heart disease (CHD). METHODS: All the heart-operated children born between the years 1997 and 1999 were identified in the national ProCardio database (n = 570). Primary dental care records were requested from this population and were eventually received from 211 patients. Information on gender, diagnosis, number of heart operations and perioperative care were collected from the ProCardio database, and the CHDs were categorised as shunting/stenotic/complex/other defects. Data on BMP/dental fear, oral conscious sedation, dental general anaesthesia (DGA) and past and present caries indices at 6, 12 and 15 years (d/D, dmft/DMFT) were assessed. RESULTS: Notes on behaviour management problems or dental fear were found in 19% of the study population. BMPs in dental care were more frequent among boys. Children with re-operations, longer post-operative intensive care stay and hospitalisation, and complications had not more BMP than others. Those children diagnosed with syndromes had more BMP often than the rest. Past and present caries experience were significantly associated with BMP, need of oral conscious sedation and DGA. Oral conscious sedation, nitrogen oxide sedation and dental general anaesthesia were used in 17/211, 2/221 and 24/211 CHD patients, respectively. CONCLUSION: Dental caries remains a main factor associated with BMP in the CHD population. Need for oral conscious sedation and DGA were rather common. To maintain a good oral health and to avoid development of BMP, CHD children benefit from focus in health promotion and preventive care.

MMP Inhibitors and Dentin Bonding: Systematic Review and Meta-Analysis.

OBJECTIVES: Resin-dentin bond strength decreases over time. This reduction is related to the loss of hybrid layer integrity. Collagenolytic enzymes, especially matrix metalloproteinases (MMPs), are responsible for the degradation of the collagen matrix of the hybrid layer. Various MMP inhibitors with the ability to prevent enzymatic degradation have been identified. This study aimed to systematically review the literature for studies which evaluated the effect of MMP inhibitors on the immediate and aged dentin bond strengths. Study SelectionScreening and analysis were carried out by two reviewers. Two databases were searched, and from a total of 740 articles, 43 were accepted for full review. 21 articles with 0.2%-2% chlorhexidine (CHX) treatments were included for meta-analysis. A risk of bias assessment was performed on all studies chosen for meta-analysis. A variety of MMP inhibitors have been studied, CHX being the most widely used. CONCLUSIONS: A clear trend for a lower loss of dentin bond strength was observed with different MMP inhibitors. In meta-analysis, no significant difference was seen between the CHX and control in the immediate bond strengths. Bond strengths in the CHX group were significantly higher than the control group after aging (P < 0.001). The percentage of fractures occurring at the adhesive interface increased after aging. Five out of 21 studies included in the meta-analysis had high and the rest medium risk of bias. More long-term studies with lower risks of bias should be carried out to increase the reliability of results. Clinical RelevanceThe use of MMP inhibition with chlorhexidine can be recommended to increase the longevity of resin-dentin bond strength.

Dental caries and attendance to dental care in Finnish children with operated congenital heart disease. A practice based follow-up study.

PURPOSE: Oral health of children with congenital heart disease (CHD) is of utmost importance. This study aimed to investigate the prevalence of dental caries and attendance to dental care in Finnish heart-operated CHD patients born in 1997-1999. METHODS: The cohort of children born in 1997-1999 was selected using a national register on all heart-operated children in Finland. Gender, general health problems, diagnosis, type of the heart defect (shunting, stenotic and complex defects), and number of operations were available and included in the analyses. Dental records from primary health care were collected from municipalities with their permission. The data comprised of the number of dental examinations and data on caries status (dt, DT, dmft, DMFT) at the age of 7 (grade 1), 11 (grade 5) and 15 (grade 8) years and at the most recent examination. The control group consisted of dental data on patients born in 1997-1999 provided by the City of Oulu, Finland (n = 3356). RESULTS: Oral patient records of 215/570 children were obtained. The difference between the defect types was statistically significant both for DT (p = 0.046) and DMFT (p = 0.009) at the age of 15 (grade 8). The prevalence of caries did not differ between the study population and the controls. High present and past caries experiences were not associated with higher number of visits to oral health care, especially to oral hygienist, or with oral health promotion. National obligations concerning dental visits were not implemented in all municipalities. CONCLUSION: There seems to be a need for oral health promotion and preventive means implemented by oral hygienists among those with CHD.

Validating and assessing the oral health-related quality of life among Hungarian children with cleft lip and palate using Child-OIDP scale.

AIMS: To validate the Child-Oral Impact on Daily Performance (Child-OIDP) in the Hungarian language and to explore the oral health-related quality of life (OHRQoL) and associated factors among Hungarian children with cleft lip or/and palate (CLP). METHODS: This cross-sectional study consists of a survey and clinical examination among conveniently selected children with CLP visiting the Pécs cleft lip and palate clinic, Pécs, Hungary. OHRQoL was assessed using the Hungarian version of Child-OIDP. Additionally, a validated structural questionnaire was used for gathering information related to oral hygiene practice. Clinical examination was done to register the dental status using ICDAS criteria, consequences of untreated dental caries (pufa), and bleeding on probing. Results were presented as proportions, means, and standard deviations (SD). Construct validity and internal reliability of the Hungarian Child-OIDP was assessed using the Pearson and Spearman's correlation coefficients, respectively. The logistic regression model examined the association between OHRQoL and explanatory variables. RESULTS: A total of 45 children with CLP participated in this study. The Hungarian Child-OIDP had the Cronbach's alpha value 0.73, and the Spearman's correlation coefficient was 0.31. The mean (SD) Child-OIDP score among the study participants was 4.4 (7.0) and three-fifths (65.9%, n = 27) of the participants reported impact in one or more items of the OHRQoL scale. Tooth brushing was more frequent among 6-10-year-olds compared to 11-16-year-olds. The proportion of those requiring restorative treatment need (DS ≥ 1) was 90.2% (n = 37), those with PUFA/pufa (score ≥ 1) was 24.4% (n = 10), and those with bleeding on probing (> 15%) was 63.4% (n = 26). Children aged 11-16 years had a higher impact on OHRQoL compared to the younger ones. Girls had a higher impact on OHRQoL compared to boys. Children with clefts involving both lip and palate had poorer OHRQoL than the rest. The same was true for those having a high dental caries rate. CONCLUSION: The Hungarian Child-OIDP was a reliable and valid measure. There was a substantial impact on OHRQoL among Hungarian children and adolescents with CLP. Age, gender, cleft type and dental caries were associated with poor OHRQoL.

Validating a short form of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) in Finnish language.

AIM: This study aimed to adapt the short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ), and the Family Impact Scale (FIS) in the Finnish language and to test its validity and reliability. Another aim was to compare the background factors of parents with respect to P-CPQ and FIS outcomes. METHODS: This study was conducted among a convenient sample of parents who visited the public dental clinic in Sievi, Finland, from May to October 2016. A total of 54 parents of 2-8-year-old children completed the short-form of the P-CPQ questionnaire and 50 parents of 2-8-year-olds completed the FIS questionnaire while visiting for their children's routine dental check-up. Parents completed the self-administered P-CPQ and FIS questionnaires. Reliability and validity of the short-form of the P-CPQ and FIS were assessed. Differences between gender, and family size were evaluated using the Mann-Whitney U test and the differences between age groups were evaluated using the Kruskal-Wallis one-way ANOVA test. RESULT: The Finnish versions of both the short forms of the P-CPQ and FIS had alpha values within the acceptable range. The scales also showed good construct validity. Toddlers (2-4-year olds) had the highest scores for both the P-CPQ and FIS-8 subscales. Likewise, families with 5 or more children had high FIS scores. CONCLUSION: The short form of the P-CPQ and FIS in Finnish language are valid and reliable. The oral health of the child seems to have the greatest family impact among parents with five or more children and in families with 2-4-year olds.

The effect of a brief computer-assisted intervention on oral health-related behaviours among adolescents.

AIM: The aim of this study was to see if a brief, computer-assisted intervention tool could be pleasant to use for adolescents. Another aim was to evaluate if the computer programme could affect adolescents' oral health-related behaviours. MATERIALS AND METHODS: Study design: For oral health promotion on schoolchildren, a computer-assisted intervention with personal feedback was performed. The effectiveness of the programme on participants' oral health behaviours as well as the feasibility of the programme were evaluated by responses of the participants. The study was conducted on 13-15 year-old schoolchildren (n=112). The computer programme included 19 questions about oral health-related behaviours and it provided personal feedback and tips towards better oral health. Additionally, the participants gave feedback about the programme. After four weeks, the intervention was repeated, the same questions were asked again, and the effect of the intervention on oral health behaviours was evaluated. RESULTS: More than half of the children considered the computer programme useful, girls (56.9%) more often than boys (44.9%) (p = 0.057). Almost everyone reported having learnt new information through the programme. Most of the new information concerned oral hygiene and the effects of different beverages on dental health (over 40% on both issues). Both genders reported having changed their oral health behaviours towards better habits. Girls generally improved their meal quality, while boys cut down on snacking and used more xylitol products. The computer-assisted intervention gave positive results and the programme seemed to be easy and pleasant to use for both adolescents and oral health professionals. STATISTICS: The results concerning the computer programme were described as frequencies, distributions and graphically. Chi-square test or Fisher's exact test was used when compared distributions between different questions and gender as well as questions and groups. The participants were categorised into three groups according to their sum scores (calculated from responses to the questions on oral health-related behaviours). The differences between the sum scores at baseline and after the intervention were analysed with the paired samples t-test. CONCLUSIONS: Information technology seems to have a remarkable potential in motivating patients towards better oral health behaviours.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. METHODS: Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. RESULTS: Several clinical-based recommendations and statements were agreed upon. CONCLUSION: There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

Outcome of Chair-Side Dental Fear Treatment: Long-Term Follow-Up in Public Health Setting.

AIM: Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000-2005. METHODS: A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. RESULTS: The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. CONCLUSIONS: A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.

The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents.

BACKGROUND: Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH. REVIEW: Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF4 can cause acid-resistant surface coatings and when Sn2+/F- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn2+-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives. CONCLUSION: Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn2+.

Dental attendance after treatment under dental general analgesia (DGA): a data-based follow-up study.

AIMS: To investigate dental attendance of patients in different age groups after dental general analgesia (DGA) and procedures performed on these patients during the DGA and in dental care after the DGA during the follow-up period of almost 3 years. METHODS: The study population consisted of 66 patients who were treated under DGA at a municipal health centre in Oulu, Finland between September 2010 and June 2011. The electronic patient files of the DGA patients were accessible for data collection for the follow-up period of nearly 3 years. The statistical analyses included Chi square tests and logistic regression modelling. RESULTS: Approximately every sixth (14.9%) dental visit was missed or cancelled and nearly half (43.9%) of the studied subjects had at least one missed or cancelled appointment. The factors increasing the risk of missed or cancelled appointments and dental avoidance were endodontic treatment (OR 3.62), need of more than five dental restorations (OR 3.47), tooth extractions due to caries (OR 2.22), and male gender (OR 1.80). A total of 45.5% of the patients received non-invasive procedures. CONCLUSIONS: Patients who need DGA are evidently risk patients considering dental attendance. Nearly half of the patients in this study had non-attended or cancelled appointments. DGA patients' need of treatment after DGA is extensive, even comparable to the amount of procedures generally performed under DGA. The quality or amount of preventive procedures do not appear to be at the required level to reduce the number of non-attended appointments.

Survey of family-related factors of children treated under dental general anaesthesia.

AIM: Treatment under general anaesthesia (DGA) is a rising trend in Finland. There is a great need to investigate the causes leading to it. Our purpose was to examine family-related factors reported by parents, such as the family size and favoring DGA in the family, and their influence on children being treated under DGA. This survey was based on a questionnaire targeted to parents of children whose dental treatment could not be performed in a conventional setting. MATERIALS AND METHODS: Guardians of 87 healthy children treated under DGA at a municipal health center in the city of Oulu, Finland, between November 2014 and December 2015 answered the questionnaire on family-related background factors and on the respondent's own as well as their child's presumed dental fear. RESULTS: According to most guardians (83.9% of the cases), the reason for DGA was caries. Male gender, vague family structure, large number of siblings (?4), and DGA history in the family were all important family-related background factors leading to DGA. Self-reported parental dental fear was quite common (25.3%). Children's dental fear reported by parents was associated with DGA in almost half of the cases (46.0%). CONCLUSIONS: The survey highlights the role of the entire family in association with children ending up being treated under DGA. It is essential for the success of dental health care to also consider family-related factors when planning the treatment, particularly with children demanding DGA.

Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care. METHODS: A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified. RESULTS: An important outcome was that when local analgesia administered appropriately-correct choice of agent(s) and dosage, proper route of administration-it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years. CONCLUSION: When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.

The influence of general health on the need for dental general anaesthesia in children.

AIM: To analyse the occurrence and causes of dental general anaesthesia (DGA) in healthy and medically compromised children, and to investigate if there are differences between those groups considering factors associated with DGA and DGA procedures. METHODS: The data was collected from medical records of children under 7 years of age treated under DGA in the years 2009 and 2010 at the Oulu University Hospital, Finland. The children were divided into two groups: 0-35-month-olds and ≥36-month olds. Background information (year, age, gender, dental diagnosis, health) and the procedures performed were registered. The procedures were analysed considering the child's age and tooth types. RESULTS: The number of children treated under DGA increased between 2009 (58) and 2010 (82), particularly in the group of healthy children. The two main diagnoses leading to DGA were dental caries and dental fear. Dental caries as the first dental diagnosis leading to DGA was more common among the medically compromised children (61.5%) compared to the healthy children (38.6%). The procedures performed were similar among the two groups. However, they varied between the age groups and tooth types and even between upper and lower teeth. The medically compromised children had been treated more frequently under DGA in the past. CONCLUSIONS: The threshold for treating medically compromised children under DGA seems to be lower than for healthy children. However, the occurrence of DGA among healthy children has increased recently. To avoid unnecessary DGA, the control of caries should be carried out according to individual needs and independent of whether the child is healthy or has a chronic disease.

Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT.

OBJECTIVE: This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention. METHODS: Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency. RESULTS: In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention. CONCLUSIONS: Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.

Dental anomalies associated with cleft lip and palate in Northern Finland.

AIM: Despite the reported occurrence of dental anomalies of cleft lip and palate, little is known about their prevalence in children from Northern Finland with cleft lip and palate. The aim was to investigate the prevalence of dental anomalies among patients with different types of clefts in Northern Finland. MATERIALS AND METHODS: Design and Statistics: patient records of 139 subjects aged three years and older (with clefts treated in Oulu University Hospital, Finland during the period 1996-2010 (total n. 183) were analysed for dental anomalies including the number of teeth, morphological and developmental anomalies and their association with the cleft type. The analyses were carried out using Chi-square test and Fisher's exact test. Differences between the groups were considered statistically significant at p values < 0.05. RESULTS: More than half of the patients had clefts of the hard palate, 18% of the lip and palate, and 13% of the lip. At least one dental anomaly was detected in 47% of the study population. Almost one in three (26.6%) subjects had at least one anomaly and 17.9% had two or three anomalies. The most common type of anomaly in permanent teeth were missing teeth followed by supernumerary teeth. Supernumerary teeth were significantly more apparent when the lip was involved in the cleft compared with palatal clefts. Missing teeth were less prevalent among those 5 years or younger. The prevalence of different anomalies was significantly associated with the cleft type in both age groups. CONCLUSIONS: Dental anomalies are more prevalent among cleft children than in the general population in Finland. The most prevalent anomalies associated with cleft were missing and supernumerary teeth.

Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey.

AIM: To determine causes leading to dental care under general anaesthesia (DGA) in public health care reported by the patients or the parents/caregivers. STUDY DESIGN: All the patients referred to DGA at the Municipal Health Centre, Oulu, Finland, during 10 months were invited to participate in the present cross-sectional survey. They were sent a questionnaire on indications for referral to DGA, dental fear, possible reasons for it as well as prior treatment of dental fear. For measuring overall dental fear, the modified Corah dental anxiety scale (MCDAS) and visual analogue scale (VAS) forms were also included in the questionnaire. RESULTS: The most common self-reported indication for referral to DGA was dental fear (63.9%). For children and adolescents (<18 years), need for extensive care was the second most common reported cause. The great majority of the respondents reported having dental fear (90.8%). Dental fear was more common among females than males, but the difference between the genders was not statistically significant. The most common cause for dental fear was earlier negative experiences in dental care (51.9%). The mean MCDAS score was 19.0 (SD 5.7; 5-25) indicating severe dental anxiety. An increasing trend towards older age groups could be seen in VAS scores reporting fear of pain, needles, scaling, scolding by the dentist, extractions, as well as endodontic treatment. Dental fear had been taken into consideration in dental treatment preceding DGA. CONCLUSION: Dental fear is the most common self-reported indication for referral to DGA and should be taken into consideration.

Validity of a questionnaire in estimating restorative treatment need among young adults.

OBJECTIVE: There are no verified anamnestic sets of questions for assessing restorative treatment need. Finnish conscripts responded to a computer-based questionnaire on oral health during their oral health screening in 2011. This study compared the outcomes of the screening and the questionnaire concerning restorative treatment need with the aim of finding and validating a set of questions with the best association between the two methods. CLINICAL SETTING: The study group comprised 8,566 conscripts. Of 50 original questions, 22 questions were chosen for closer analysis. The generalised linear mixed model was used to calculate the OR values (95% CI) for each of these questions, using restorative treatment need at individual level as the response variable. Questions with the best association (Q1-Q10) were selected for the final set; the inclusion criterion was p < 0.05. The area under curve (AUC) value was calculated for the sum function of these 10 questions. RESULTS: Among the final set of 10 questions, the OR values varied between 1.12 and 4.61. The AUC value was 0.75. By increasing the number of positive responses to 8 questions, the odds for restorative treatment need were OR 69.27 and increased to infinity with 10 questions. CONCLUSIONS: A selected set of questions together with clinical screening, or even alone, can be a valid instrument for screening people for restorative treatment need. The method is particularly useful in large populations. This statistical method might identify appropriate sets of questions for different contexts.

Geographical distribution of dental caries prevalence and associated factors in young adults in Finland.

Oral health of the young has been reported to be associated with the place of residence, due to differences in socio-economic status. The results of studies on the effect of fluoride in drinking water on caries prevalence have been contradictory. The main aim of our study was to investigate the geographical distribution of dental caries prevalence in Finland and analyse possible regional, associated factors. Oral health of 13,564 men born between 1990 and 1992 was screened using a method based on criteria of the World Health Organization for epidemiological studies by 15 calibrated dentists in 20/24 garrisons of the Finnish Defence Forces in 2011. Mean DMFT and DT values in provinces were calculated. Multilevel analysis was applied to the data using generalized linear mixed models and a logit link function. The binary outcome variable was the cariological treatment need (yes/no) and the garrison was treated as random effect. Mean DMFT and DT values varied significantly between provinces in Finland. Increased levels of fluoride in drinking water, Swedish as the main language in the municipality, and living in urban areas were protective factors against cariological treatment need. Dentist density did not affect caries prevalence. The geographical distribution of dental caries further supported estimates of the protective effects of high fluoride levels in drinking water, Swedish as the main language in the municipality, as well as living in urban areas. Effect of fluoride on caries prevalence still exists, and association with the socio-economic status was confirmed.

Caries experience in primary teeth of four birth cohorts: a practice-based study.

AIM: To investigate the survival of caries-free primary teeth in four age cohorts in the city of Kemi, Finland, as well as association of survival of primary teeth among boys and girls and among high and low caries risk individuals. STUDY DESIGN: This was a practice-based follow-up study based on dental records. METHODS: The data were collected from the electronic oral health patient records of the municipal health centre of the city of Kemi, covering four different birth cohorts (1985, 1990, 1995 and 2000). The total number of children was 4,488. STATISTICS: Kaplan-Meier curves were drawn to illustrate the survival of caries-free primary molars . Statistical difference between the groups was analysed using the log-rank test and Cox proportional hazards regression analysis. The retrospective caries risk definition for individuals was based on the early restorations in the first permanent molars. RESULTS: In the earlier cohorts, primary molars survived caries-free for a shorter period than in the later cohorts (p < 0.001). However, in the 2000 cohort, the survival curve, having shown at the beginning only some caries incidence, bended strongly downwards at the age of 8 years. The survival time of the primary molars remaining caries-free was shorter for those with high caries risk (p < 0.001) as well for boys compared with girls in all cohorts (p = 0.001). CONCLUSION: The course of the survival curve of the 2000 age cohort indicates a halt in the improvement of dental caries prevalence, but the follow-up period was too short to allow monitoring the progress further. Continuing oral health promotion to all children, and particularly risk individuals must be emphasised.