A survey of specialist paediatric dental services in Sweden: results from 2003, and trends since 1983.

UNLABELLED: The child population in Sweden has changed dramatically during the last 20 years. Changes have also occurred within the Public Dental Service (PDS), regarding the provision of dental care to children and adolescents. All these changes may affect the referral pattern and provision of specialist dental care for children and adolescents. OBJECTIVES: The primary aim of this study was to survey the services provided by specialists in paediatric dentistry in Sweden during 2003. A secondary aim was to compare the results with previous surveys. METHODS: A Web-based survey was sent to all 34 specialist paediatric dentistry clinics and was answered by all clinics. Data were compared with results from the surveys performed in 1983, 1989, and 1996. RESULTS: The number of paediatric dentists had been relatively constant over the last 20 years, whereas the number of children referred to paediatric dentists had increased by 28% since 1983. It was estimated that 1.3% of all children in Sweden are treated at a specialist paediatric dental clinic in 2003. Dental treatment need in combination with behaviour management problems (BMP) was the main reason for referral and occurred in 37% of all referrals. The proportion of medically compromised children/children with disabilities had increased from 6% in 1983 to 22% in 2003. The number of patients treated using sedation and general anaesthesia had increased since 1983, and particularly since 1996. CONCLUSIONS: Despite improvements in dental health among children and adolescents in Sweden during the last 20 years, an increasing number of children are referred for specialist paediatric dental treatment. There is an urgent need to increase the number of specialist paediatric dentists in Sweden in order to ensure the continuation of high quality of dental care for children and adolescents.

Caries and salivary status in young adults with type 1 diabetes.

The aim of this study was to evaluate the salivary status, prevalence of caries and the status of primary dentition, when primary teeth were exfoliated, in 41 patients, 18-24 years of age, with type 1 diabetes since childhood in comparison with age- and sex-matched non-diabetic controls. The blood glucose and glycosylated haemoglobin concentration (HbA1c), dosage of daily insulin and retinal fundus photography was recorded for the diabetic group. According to the concentration of HbA1c, the diabetic patients were divided into well and poorly controlled groups. The study was based on three intra-oral photos, dental examination including intra-oral radiographs, flow rate and buffering capacity of the saliva and amount of Streptococcus mutans and Lactobacilli. Retrospective data regarding the primary dentition was found in the dental files of each patient, and are based on the last registration for respective tooth before exfoliation. The patients with type 1 diabetes, without any relationship to metabolic control, displayed more initial buccal caries compared to healthy controls (p<0.01). No significant differences concerning the status of saliva (neither flow rate, buffering capacity nor amount of Streptococcus mutans and Lactobacilli), manifest caries or the status of the primary dentition were seen. We conclude that initial, but not manifest caries seems to be overrepresented in young adults with type 1 diabetes. These patients, thus, need more intense efforts regarding dental health care to prevent the development from initial to manifest caries.

Proximal caries prevalence in 19-year-olds living in Sweden. A radiographic study in four counties.

A random sample of all 19-year-olds in four counties in the middle of Sweden in 1994 constituted the group studied. The material consisted of posterior bitewing radiographs from 511 19-year-old patients. The purpose was to study the prevalence and distribution of initial and manifest caries. It was found that on the manifest caries level 56% of the subjects were 'free from caries', in good correspondence with the official epidemiological data from the Swedish National Board of Health and Welfare, but only 27% when initial caries was added. Initial caries lesions constituted 90% of all lesions. The distribution of caries was highly skewed on the manifest caries level whereas initial caries had a broader distribution. Thus, on the surface level 75% of the individuals had 16% of all manifest caries and restorations, and 33% of all initial caries. A high correlation was found between initial and manifest caries, besides increasing with the number of initial lesions. Thus, only 2.5% of individuals without initial caries had manifest caries, compared to 54% of individuals with more than eight affected surfaces. A correlation was also found between the prevalence of manifest caries and restoration. The prevalence of initial caries and its obvious significance for further caries development should be a reason for finding new strategies in caries prevention on a population basis.

Class I and II posterior composite resin restorations after 5 and 10 years.

The aim of the present study was to compare and evaluate Class I- and Class II-restorations performed in two different composite posterior materials after 5 and 10 years. Both materials were introduced in 1983 and adapted to stress-bearing restorations. The only difference between the two materials was that one contained barium-aluminium silicate, which made the material radiopaque. All 137 restorations were performed according to standardized clinical procedures by two experienced clinicians and placed in premolars (59) or molars (78). Forty-five of the restorations were Class I and 92 Class II. The restorations were followed for the first 5 years according to the U. S. Public Health Service (USPHS) evaluation criteria. After 10 years an evaluation based on the documentation sent in by the patient's present dentist was made. Of the original 137 restorations, 127 could be examined after 5 years and 117 after 10 years. The evaluation showed that after 5 years, 114 of the examined restorations were in clinical function and after 10 years 92, which means 90 and 79 per cent respectively, of the restorations evaluated.

Class II restorations in six different posterior composite resins: five-year results.

Class II restorations of six light cured posterior composite resin materials (the intermediates Occlusin, P 30, Fulfil, Profile and the microfine Heliomolar and Distalite) were followed for five years. The results from three years have been reported earlier (Lundin et al 1990). At baseline twenty-four dentists from seven different clinics of the Public Dental Health Services in the country of Bohuslän placed 247 Class II restorations on 213 patients of the ordinary clientele visiting the clinics. Before starting the operators were instructed and trained in performing the restorations according to a standardized clinical procedure. The restorations were evaluated, according to a specially designed assessment form using the USPHS criteria, after one week, three years and five years. Stone casts were used to quantitatively categorize the occlusal wear according to the Leinfelder method. After five years the failure rate (USPHS rating Charlie) was 27 restorations out of assessed 176, i.e. 15%. The most common reason for failure was secondary caries. Fulfil had the highest failure rate among the intermediate materials (Chi-Square, p < 0.05). Assessment of wear showed that Profile, compared to the other intermediate materials, had worn the most and the two microfine materials Heliomolar and Distalite, compared to all the intermediate materials had worn the least. This study confirms the results from three years, that clinically acceptable results can be obtained with posterior composite resin materials when used in a proper and scheduled manner.

Analysis of paediatric dental services provided at a regional hospital in Sweden. Dental treatment need in medically compromised children referred for dental consultation.

All inpatients at a regional hospital in Sweden referred for a paediatric dental consultation (n = 269) were studied retrospectively during a two-year period. The children were studied concerning their medical and oral condition and subsequent dental treatment. The most frequent medical condition among the referred children was insulin dependent diabetes mellitus (20%), asthma (9%) and epilepsy (7%). Children with asthma exhibited a significantly increased caries prevalence (p < 0.01) compared to other chronically sick children. Of the children examined 53% were diagnosed with diseases or abnormalities in the oral cavity requiring treatment. Gingivitis, disturbances in occlusal development and dental caries were the most commonly found diagnoses Acute dental or oral problems were diagnosed in 9% of the children. The mean time allocated for each patient was 60 minutes. Thirty percent of the children were subsequently treated at the paediatric dentistry specialist clinic. In conclusion the study emphasises the need of paediatric dental consultation services at regional hospitals.

Cure profiles of visible-light-cured Class II composite restorations in vivo and in vitro.

The degrees of conversion of posterior composite material in Class II restorations performed in vivo and in vitro were studied by means of the Raman spectroscopy method. Class II restorations in 13 contralateral pairs of premolars were analyzed. The average difference of the ratio I 1610 cm-1/I 1640 cm-1 between the in vivo- and in vitro-performed restorations was 0.42. This indicates a higher grade of conversion in the in vivo situation.

Marginal leakage in occlusally loaded, etched, class-II composite resin restorations.

Microleakage was studied in class-II cavities restored with a calcium hydroxide liner and an adhesive system combined with two different posterior composite resins. The restorations were exposed to repeated loading when immersed in dye solution. The teeth were cut, and microleakage along the cavity walls and into dentin was evaluated by light microscopy. Dye penetration at the interface between the cavity and the restoration was recorded in 61% of the loaded and in 30% of the unloaded teeth. The difference between loaded and unloaded was greater for the teeth lined with Life than with Gluma dentin bonding.

Class II composite resin restorations: a three-year clinical study of six different posterior composites.

Class II restorations of five light-cured posterior composite materials (Occlusion, P 30, Fulfil, Profile and Heliomolar) were followed for three years, and restorations of another material (Distalite) were followed for two years. Twenty-four dentists from The Public Dental Health Service in the county of Bohuslän placed 242 Class II restorations in 213 patients. The restorations were evaluated after three years using the USPHS criteria. Stone casts were used to categorize quantitatively the amount of occlusal wear according to the Leinfelder method. No differences could be found between the different materials regarding clinical properties. The failure rate (USPHS ratings Charlie) was low, 6.5 per cent. The average occlusal wear after three years for most of the materials was about 100 micrometers. Heliomolar showed a better resistance to wear compared with the other materials.

Studies on posterior composite resins with special reference to class II restorations.

Longevity, clinical performance and some related factors of posterior composite resin restorations were investigated through clinical follow-up and laboratory studies in vivo and in vitro. Class I and Class II restorations using two experimental posterior composite resin materials were followed clinically for a four-year period. USPHS evaluation criteria were used. Assessments of wear were also made indirectly using the Leinfelder method. Marginal leakage of bacteria (in vivo) and of dye (in vitro) were studied on modified loaded Class II composite resin restorations lined with GlumaR and LifeR. The grade of conversion (cure) of the posterior composite resin material and the colonization of bacteria at proximal tooth surfaces restored with posterior composite resins were evaluated. Seven per cent of the restorations were evaluated as failures and had to be replaced during a 4-year period. The failures were mainly due to fractures and postoperative sensitivity. The calculated occlusal wear rate was 34-40 microns/year. Occlusal loading of Class II restorations in vitro resulted in a higher frequency of restorations with marginal leakage. The marginal leakage for occlusally-loaded Class II restorations in vivo and in vitro could be reduced if dentine bonding was utilized. The grade of conversion (cure) was increased in the in vivo situation compared to the in vitro. Bacterial colonization of strepococcus mutans on the proximal surfaces of posterior composite restorations showed higher frequencies compared to that on sound tooth surfaces. From the results of these studies, it may be concluded that the tested posterior composite resin materials can be used in Class I and II restorations with a good prognosis for at least 4 years. When posterior composite resins are used as restorative for posterior teeth, the following conditions should be considered: The occlusal loading should be minimal, dentin bonding should be used, the increased risk of colonization of streptococcus mutans should be acted on and regular clinical and radiographical follow-up should be performed.

Marginal bacterial leakage and pulp reactions in Class II composite resin restorations in vivo.

The presence of stainable bacteria under restorations and pulp reactions in 36 teeth restored in vivo with a modified Class II composite resin restoration with two different dentine treatment techniques were studied on three separate follow-up occasions (1-3, 7-10 and 28-32 days). Half of the cavities showed stainable bacteria at the cavity margins and bottoms. Teeth restored with method A (Gluma/Occlusin) showed significantly fewer restorations with stainable bacteria then teeth restored with method B (Life/Occlusin) (p less than 0.05). Significantly more restorations with detectable bacteria were found after 28-32 days and restorative method B (p less than 0.05). There were no differences in occurrence and grade of pulp inflammation for the different dentine treatment techniques and time periods.

Class I and II composite resin restorations: 4-year clinical follow up.

The clinical properties and longevity of two posterior composite materials were studied during a 4-year period. 137 Class I and II restorations in 65 patients were evaluated directly using USPHS criteria. Araldite casts were used to categorize quantitatively the amount of occlusal wear according to the Leinfelder method. No differences could be found between the two materials regarding clinical properties and failure rate. The overall success rate was high (84%). The average occlusal deterioration after 4 years was about 140 microns.

Regression of structural cardiovascular changes by antihypertensive therapy in spontaneously hypertensive rats.

Trophic adrenergic influences may in part potentiate the pressure dependent development of structural cardiovascular changes in hypertension. Regression of such changes by antihypertensive treatment should therefore be most successful if adrenergic blocking drugs are used. In the present study spontaneously hypertensive rats (SHR) received either alpha-methyldopa, metoprolol, felodipine, a new vasodilating Ca2+-antagonist, or metoprolol and felodipine in combination for 10 weeks. Their left ventricles were weighed and resistance vessel design was analysed using a haemodynamic technique. Arterial pressure (MAP) was equally reduced by metoprolol and felodipine. Despite their different modes of action cardiovascular design was also equally affected. The combined regimen reduced average MAP more than either drug alone. It also caused more pronounced regression of cardiovascular structural changes. Methyldopa lowered MAP less than either metoprolol or felodipine and had only modest effects on cardiovascular design. Thus, the extent of MAP reduction, regardless of which therapeutic regimen is used to induce it, determines the extent of regression of structural cardiovascular changes during antihypertensive treatment.