Evaluation of school-based prevention program in Turkey: Results of a 24-month study.

OBJECTIVE: In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kirikkale Provincial center were monitored for 2 years after a variety of protective applications. MATERIALS AND METHODS: Three hundred and twenty-two children at the age of 7-11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) - was given hygiene training only; Group 2 - with medium level cavity activity (2-4 cavities in average) - oral hygiene training + surface restoration applied; Group 3 - children with 2-4 cavities on average - oral hygiene training + professional flour gel applied; Group 4 - children with 2-4 cavities in average - oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) - oral hygiene training + surface restoration + professional flour gel combination applied. RESULTS: At the end of the 2(nd) year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1-5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01). CONCLUSION: These findings have showed that, in Kirikkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.

Evaluation of the clinical success of class I cavities prepared by an Er:YAG laser-5-year follow-up study.

The purpose of this study was to evaluate, after 5 years, the clinical success of preparing class 1 composite resin restorations with an Er:YAG laser. Sixty-five teeth of 30 patients were included in the study, and an Er:YAG laser emitting at a wavelength of 2.94 µm was used for the class I cavity preparations with not more than one third of the mesiodistal width of the occlusal surfaces of each tooth. All cavities were restored with a light-cured composite resin, following a single bond application. After the baseline examination, restorations were reevaluated by the same experienced clinician after 5 years, using the modified Ryge criteria. At the end of 5 years, 41 of the 65 restorations were evaluated in 22 patients and scored. With respect to marginal discoloration, anatomic form, color match, and surface texture, significant differences were found between baselines tested after 5 years. Clinical evaluation of postoperative sensitivity showed that 90.2 % were rated as alpha. All restorations evaluated in this study demonstrated acceptable clinical performance within the evaluation period based on the alpha and bravo ratings for clinically satisfactory restorations. Further evaluations are necessary for a better clinical performance analysis.

Rural dentistry: Is it an imagination or obligation in community dental health education?

During the past two decades, epidemiologic studies in less developed or developing countries have clearly reported that caries prevalence shows the distinctive patterns over the word, even though it is declining in many developed countries. Due to huge rural districts where arrival is problematic and ineffective dental and preventive care centers in most suburban districts, there has been significant difference between the different parts of the communities to provide dental care service, and unfortunately the sole preventive measure has been limited with the advising of using the tooth brush and paste. The problems are usually arisen not only from the inadequacy of trained personnel but also from the absence of an effective economic and pragmatic system which aims to effectively dispense the dental service to all over the country. For this reason, the basic aim of dental care should be to carry out the many dental services in a multidisciplinary manner within the first appointment and to serve the people at their own homes and/or districts. Clearly, the needed multidisciplinary dental care system can lead to a new educational doctrine for rural dental practice. This versatile and practical training program based on specific perceived needs of a specific population(s) could need a new educational program. So, various preventive and/or restorative procedures included by this new doctrine could be named as "rural dentistry." In this review, with the examples from the many in vivo studies carried out under rural conditions over the world, the probable practices in this specific dental doctrine have generally been exemplified.

Incidence of postoperative pain after single- and multi-visit endodontic treatment in teeth with vital and non-vital pulp.

OBJECTIVES: To assess the incidence of postoperative pain after single- and multi-visit endodontic treatment of teeth with vital and non-vital pulp. METHODS: In total, 306 patients with teeth requiring endodontic treatment were identified and were included in this study. Two experienced clinicians treated the patients, who were randomly assigned to two groups. While the teeth of patients in group 1 were obturated, group 2 were temporarily sealed and obturated after one week. Three days after the root canal instrumentation of each tooth, the patients were asked whether they experienced any postoperative pain and to rate the level of discomfort as no, mild, moderate, or severe pain. Data were analyzed statistically using the chi-square test. RESULTS: No significant difference in postoperative pain was found between vital and non-vital teeth (P>.01). Mild, moderate, and severe pain occurred in 31.4, 13.7, and 4.6% of vital teeth, respectively. Postoperative pain occurred in 107 (69.9%) and 106 (69.3%) teeth in the single- and multi-visit treatment groups, respectively. There was no significant difference in postoperative pain between the two groups (P>.01). CONCLUSIONS: The prevalence of postoperative pain did not differ between vital and non-vital teeth. The majority of patients in either groups reported no or only mild pain.

Prevalence of dental anxiety in 7- to 11-year-old children and its relationship to dental caries.

OBJECTIVES: The aims of this cross-sectional study were to evaluate the level of fear of dental procedures among schoolchildren and assess the relationship between caries experience and fear of dental procedures. SUBJECTS AND METHODS: 275 children aged 7-11 years were recruited for the study. Before conducting a dental examination, each subject was asked to independently complete a Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) questionnaire. Children having a score of > or =38 were included in the group 'with dental fear' while those scoring <38 were placed in the 'without dental fear' group. All dental examinations were performed on the school premises according to WHO criteria. RESULTS: Mean CFSS-DS value was 28.1, and the number of children who experienced dental fear was 40 (14.5%). It was found that Decayed, Missing and Filled Surface Index (DMFS-dfs) increased significantly with increasing CFSS-DS values. Fear scores were highest for 'Choking' (3.3), 'Injections' (2.6) and 'Having somebody put instruments in their mouth' (2.6). No significant differences in fear scores between boys and girls were found in this study. CONCLUSIONS: The data showed prevalence of dental fear in the 7-11-year-old children of this study. Dental fear scores decreased with increasing age.

A combined application of ART-fluoride varnish for immigrant junior field-workers: 12-months follow-up field trial in rural Anatolia.

PURPOSE: Immigrant junior-field-workers in south eastern Anatolia, Turkey, had an impact on agriculture economy, and to provide an optimal dental service is crucial due to their multiple medical and dental problems. So, a combined preventive-operative method including ART-fissure sealant/restoration and fluoride varnish application was evaluated in terms of caries increment, cariogenic bacteria and lesion behavior at one-year follow-up period. MATERIALS AND METHODS: A total of 27 children with 147 pit and fissure lesions displaying discoloration were included in this study. Of these, 15 children with 75 lesions and 12 children with 72 lesions were divided as test and control groups, respectively. Baseline caries values of each groups were 3.4 +/- 1.4 and 2.5 +/- 1.6 for test and control groups respectively (p < 0.05). Bacteriologic sampling was undertaken with the dip-slide method (Vivadent). A combined preventive-operative method was performed for the test group but not for the control group. After six months and one year, children were re-examined with respect to cariogenic bacteria in plaque, new caries occurrence and lesion characteristics. RESULTS: Mean caries increment (deltaDMFT) for both the control and the test group were 1.91 +/- 1.53 and 0.26 +/- 0.43, respectively. The difference was found to be statistically significant (t = 8.35, p < 0.0001). More lesions in the control group did progress to cavitation than in the test group. A linear relationship was observed between plaque MS-score and cavitation, indicating that when plaque MS levels are high, cavitation does easily occur in the control group and vice versa in the test group (p < 0.0001for all variables). CONCLUSION: It could be argued from these findings that a combined preventive-operative method could be applicable not only to treatment of dentinal lesions but also to retard, even prevent, the initial caries on pits and fissures of permanent teeth in rural districts where any other routine dental/preventive care is not feasible, and compliance of the individual's hygiene is inadequate.

Atraumatic restorative treatment with resin-modified glass ionomer material: short-term results of a pilot study.

OBJECTIVES: The aim of this study was to assess the feasibility of the resin-modified glass ionomer (RMGI) material in atraumatic restorative treatment (ART) approach and compare RMGI with the high-strength traditional glass ionomer cement (GIC) in permanent teeth with one or more surface-carious cavities. MATERIALS AND METHODS: This study was conducted in a village school in rural southeastern Anatolia, Turkey. The RMGI and GIC restorations with the ART technique were placed randomly employing a split mouth design. In addition, the ART approach was used when necessary for both primary and/or permanent teeth with no pulpal involvement and no perceived pain before treatment. Ninety-one fillings were placed on contralateral molar pairs of 37 children. Baseline and 6-month evaluation of the fillings were made with the classic ART, modified Ryge and USPHS criteria. RESULTS: Based on the ART criteria, 100% of RMGI and 92.4% of GIC restorations were classified as successful after 6 months, and the difference between the 2 groups was statistically significant (p=0.009). While marginal discoloration was the commonest failure in the RMGI group according to both the modified Ryge and USPHS criteria, unsatisfactory surface texture and low anatomic form were the commonly seen failures in the ART technique. CONCLUSION: Generally, for each rating system, RMGI exhibited better clinical performance than GIC in all categories, except for marginal discoloration. Results based on the 6-month evaluation show that RMGI can be an alternative material to the GIC.