Effect of individual structured and qualified feedback on improving clinical performance of dental students in clinical courses-randomised controlled study.

AIM: Analysis of the effect of individual structured and qualified feedback (FB) on practical skills development of dental students during clinical courses. METHODS: Fifty-three final-year dental students at Jena University Hospital participated in this prospective randomised controlled interventional study. Two calibrated assessors evaluated 128 pre- and post-assessments of 4 different dental treatment steps performed by dental students during the integrated clinical course in restorative dentistry and prosthodontics and the clinical course paediatric dentistry. The assessment included direct observation, graded and non-grading evaluation and was documented with a specific FB assessment tool. Dental students in the intervention group (IG) received an elaborated, structured and qualified FB after the pre-assessment that focussed on individual strengths and weaknesses, providing specific suggestions for improvement and establishing a personal learning goal. Participants were randomly allocated to the IG and the control group (CG). RESULTS: In both groups, dental students significantly enhanced their performance, but the difference was higher in the IG than in the CG. Large effect sizes (ES) were observed in all observed items, but FB had largest effect size in improving technical skills (ES = 1.6), followed by management (ES = 1.3) and communication skills (ES = 0.8). Factors with the highest influence on FB in enhancing dental students' clinical performance were their insight into their own mistakes or omissions, the observed dental treatment step and the duration of FB. CONCLUSION: Individual structured and qualified FB is an effective method to enhance dental students' professional performances and to individually guide the learning process.

Status and perception of oral health in 6-17-year-old psychiatric inpatients-randomized controlled trial.

AIM: The following are the aims of the study: assessment of oral health status, oral health-related quality of life (OHRQoL) and the effect of oral health care training over OHRQoL in children and adolescents hospitalized with mental disorders. METHODOLOGY: This randomized case controlled prospective interventional study involved 81 child and adolescent psychiatric inpatients (CAP) aged between 6 and 17 years (mean age 10.6 ± 2.4 years), compared to 81 mentally healthy patients attending routine dental examinations (DC group) matched according to age and sex of the CAP group. Oral examinations were performed by two calibrated dentists. OHRQoL was assessed with the German version of the Child Perceptions Questionnaire. CAP inpatients were randomly divided in two equal subgroups, an intervention (IG) and a non-intervention group (non-IG). The IG received oral health care training at admission to the hospital. RESULTS: CAP inpatients, especially those with stress-related disorders, revealed significantly higher caries prevalence and experience than DC patients. Although OHRQoL did not differ from the German reference values, CAP inpatients compensated higher impairment due to oral symptoms and functional limitations with lower impairment due to emotional and social well-being. OHRQoL increased in all CAP patients during hospitalization, regardless of receiving oral health care training. CONCLUSION: Poorer oral health of CAP inpatients was not accompanied by higher impairment of OHRQoL. Oral problems seem to be overshined by better self-perceived emotional and social well-being. OHRQoL was not improved by individualized oral health care training. CLINICAL RELEVANCE: Children and adolescents with mental disorders are at risk for oral diseases and need referral to dental services.

[Influence of Fissure Sealants on Dental Health of Elementary School Children in Weimar - A Longitudinal Observational Study under Real-life Conditions]. / Einfluss der Fissurenversiegelung auf die Zahngesundheit von Weimarer Grundschülern ­ Eine longitudinale Beobachtungsstudie unter Alltagsbedingungen.

The aim of the present observational study was to assess the effect of the number and timing of placing fissure sealants (FS) on caries prevalence in elementary school children under real-life conditions. Methods: Oral health data from 7- to 10-year-old elementary school children (n=505) attending 4 consecutive annual checkups between 2004 and 2009 was extracted from the public health service database. The number of intact FS and the number of teeth affected by caries was scored according to WHO standard (1997). Results: 34.9% pupils had at least one, 10% 4 FS. Children without FS had a higher dental caries rate compared to peers with FS (0.2 DT/0.4 DMFT vs. 0.1 DT/0.2 DMFT). Pupils with 4 FS showed the lowest number of teeth with caries (0 DT/0 DMFT). Children with an early application of FS had a lower D-component than children with a later or missing application (0.1 DT vs. 0.2 DT). Pupils with less than 4 FS had a higher risk of developing caries in their permanent dentition compared to peers with 4 FS (OR 4.36). Conclusion: FS is an effective caries preventive measure under real-life conditions. Early application and sealing of all 4 molars can optimize the prevention of caries in the permanent dentition.

Evaluation of a regional German interdisciplinary oral health programme for children from birth to 5 years of age.

OBJECTIVES: The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary oral health programme (OHP) for early childhood caries (ECC) in 5-year-old German children. MATERIAL AND METHODS: All parents of newborns (n = 1162; born 2009/2010) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to attend a dental examination in the Jena University Hospital. Participating children were included in a caries-risk-related recall system with continuous oral care over 5 years. The caries-risk assessment tool of the AAPD was used to determine the likelihood of carious lesion development and to categorize the children at low, moderate or high risk for caries. High-risk children received fluoride varnish. Families (n = 563) who gave their approval for final examination after 5 years were invited again and examined by a blinded clinician. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Children were allocated to prevention (PG) and control group (CG) and matched on the basis of age, sex, ethnicity and socio-economic status (SES). RESULTS: Two hundred and eighty-nine children (mean age 5.2 ± 0.7 years; 46.7 % female) were examined. Children in the PG (n = 174) showed significantly lower caries prevalence and experience (10.9 %, 0.2 ± 0.7 d3-4mft) than children in the CG (57.4 %, 2.9 ± 3.8 d3-4mft). Multivariate analysis found that low SES, early start of tooth brushing, supervision/regular second brush by parent, regular dental visits and duration of breast-/bottle-feeding >1 year were significantly related to d3-4mft. CONCLUSIONS: The OHP was an effective approach for preventing early childhood caries in preschool children. CLINICAL RELEVANCE: A programme consisting of early maternal counselling, establishment of a dental home, and inclusion of the children in a caries-risk-related recall system with continuous dental care and fluoride varnish application can prevent ECC. TRIAL REGISTRATION: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Dental enamel defects in German medieval and early-modern-age populations.

SUMMARY: Aim of this study was to investigate the frequency and type of developmental defects of enamel (DDE) in a medieval and an early-modern-age population from Thuringia, Germany. Sixty-six skeletons subdivided into 31 single burials (12th/13th c.) and 35 individuals buried in groups (15th/16th c.) were examined. DDE were classified on 1,246 teeth according to the DDE index. Molar-incisor-hypomineralisation (MIH), a special type of DDE, was recorded according to the European Academy of Paediatric Dentistry (EAPD) criteria. DDE was found in 89.4% of the individuals (single burials 90.3% and group burials 88.6%). Hypoplastic pits were the most frequent defect in primary teeth and linear enamel hypoplasia (LEH) in permanent teeth. 13 individuals (24.1%) showed at least one hypomineralised permanent tooth, 12.2% had MIH on at least one first permanent molar and 10.0% in permanent incisors. Second primary molars were affected in 8.0% of the children and juveniles. No individual suffered from affected molars and incisors in combination. Endogenous factors like nutritional deficiencies and health problems in early childhood could have been aetiological reasons of DDE and MIH. The frequency of DDE and MIH might have been masked by extended carious lesions, dental wear and ante-mortem tooth loss.

The need for repeated dental care under general anaesthesia in children.

AIM: Though the use of advanced behaviour management may facilitate dental treatment in children, some patients still require comprehensive care under general anaesthesia (GA). This is especially true for young children and/or medically compromised children. Thus, this study aimed to provide information about children undergoing GA with regard to age, sex and medical conditions (ICD-10), repeated treatments, dental procedures and recall. MATERIALS AND METHODS: A total of 464 medically compromised children treated under GA in a dental university clinic between 2004 and 2012 were included. Patients` records were analysed retrospectively using SPSS (Version 21.0) and R for statistical analysis. RESULTS: More than 75% of the patients were younger than six years when receiving initial GA. The proportion of children subjected to repeated treatments was low, at 11% for a second and <2% for a third round of GA. The greatest proportion of dental care consisted of restorative therapy and tooth extractions. The recall behaviour observed between the first and second GA revealed no significant influence on the time elapsed in between events (p>0.05). CONCLUSION: Oral care in children with medical conditions is mostly caries-related, and repeated treatment may be necessary, though it was generally uncommon in this university-based study population.

Effect of a thin-neck pacifier on primary dentition: a randomized controlled trial.

OBJECTIVES: To evaluate changes in occlusal characteristics in the primary dentition that occur after introducing a thin-neck pacifier (TNP) to children with previously diagnosed pacifier-associated anterior open bite (AOB) and increased overjet. SETTING AND SAMPLE POPULATION: Department of Preventive and Pediatric Dentistry, Jena University Hospital, Germany. Subjects were 86 children (mean age 20.3 months) with a pacifier-associated open bite or overjet ≥2 mm. MATERIAL & METHODS: Randomized controlled trial. Subjects were randomly assigned: group I (n = 28), intervention group using a TNP; group II (n = 30), control group, using a conventional or physiological pacifier; and group III (n = 28), intervention group, Gold standard, weaned off pacifier. Participants were re-examined after 3, 6, 9 and 12 months by an operator, blinded for the treatment. RESULTS: After 12 months data for 63 children (mean age 33.1 months) were analyzed (I: n = 24; II: n = 22; III: n = 17). There was a significant difference between the groups regarding mean overjet (group I: 2.7 ± 0.5 mm, group II: 3.2 ± 0.7 mm, group III: 2.4 ± 0.5 mm, Kruskal-Wallis, p = 0.002) and AOB (group I: -1.2 ± 0.3 mm, group II: -2.2 ± 0.3 mm, group III: -0.8 ± 0.8 mm, Kruskal-Wallis, p < 0.001). The differences between group I and II regarding increased overjet (3.1 ± 0.2 mm vs. 3.6 ± 0.3 mm, Mann-Whitney, p < 0.001) and extent of AOB (-1.2 ± 0.3 mm vs. -2.2 ± 0.3 mm, Mann-Whitney, p < 0.001) were statistically significant. CONCLUSION: Use of TNP resulted in better clinical measurements for in overjet and overbite compared with the continuing use of conventional or physiological pacifiers.

[Oral health status of students with and without disabilities in Erfurt, Germany]. / Mundgesundheit von Erfurter Schüler/innen mit und ohne Behinderungen.

AIM: The aim of this study was to make a comparison of the oral health status of students with and without disabilities (Sw/D, Sw/oD) aged 6-18 years from the city of Erfurt. METHODS: 328 students with mental retardation (MR), physical disability (PD) and hearing impairment (HI) were examined according to WHO standard (1997). The control group consisted of 400 age-matched Sw/oD. Data analysis was performed in age groups 6-12 and 13-18 years. RESULTS: Caries prevalence of 6- to 12-year-old Sw/D (68.7%) was significantly higher than in Sw/oD (57%) (p=0.019).The caries experience of Sw/D was 2.3 dmft/0.5 DMFT and 1.6 dmft/0.4 DMFT of Sw/oD. PD had a lower restorative index than other Sw/D (p ≥ 0.023). There was no difference in caries prevalence and caries experience among 13- to 18-year-old Sw/D (51%; 1.9 DMFT) and Sw/oD (59%; 2.1 DMFT). MR had a lower prevalence of fissure sealants and less sealed teeth (p ≤ 0.042) and their periodontal health was inferior compared to other Sw/D. CONCLUSION: Intensive preventive measures should be intensified to compensate for oral health inequalities, particularly in MR.

Elevated serum 25(OH)-vitamin D levels are negatively correlated with molar-incisor hypomineralization.

To date, the precise etiology of molar-incisor hypomineralization (MIH) is uncertain. Vitamin D plays a key role in hard tissue formation. Therefore, this study aimed to analyze the relationship between serum 25-hydroxy-vitamin D (25(OH)D) status and dental health data obtained from 1,048 children in a 10-year follow-up of the Munich GINIplus and LISAplus birth cohorts. The dental examination included the diagnosis of MIH and recording of (non-)cavitated caries lesions in primary and permanent teeth. Serum 25(OH)D concentrations were taken from blood samples of the 10-year investigation and measured with a fully automated, modular system. Different logistic regression and Poisson hurdle models were calculated. MIH was diagnosed in 13.6% of the study population. Approximately 16.4% of the children demonstrated caries-related defects (D3-4MFS > 0). The mean season-adjusted concentration of 25(OH)D was 75.8 nmol/l (standard deviation 22.0 nmol/l). After adjusting for sex, age, body mass index, parental education, equivalent income, and television/personal computer (TV/PC) viewing hours, a 10 nmol/l increase in serum 25(OH)D concentrations was significantly associated with a lower odds ratio of having MIH (OR = 0.89; P = 0.006). Furthermore, higher 25(OH)D values were associated with a lower number of caries-affected permanent teeth. It is concluded that elevated serum 25(OH)D concentrations were associated with better dental health parameters.

Success rates of manual restorative treatment (MRT) with amalgam in permanent teeth in high caries-risk Filipino children.

OBJECTIVES: The objective of the study is to evaluate the success rate of amalgam restorations in manually prepared cavities under field conditions within a comprehensive school-based oral health-care program in high caries-risk children. MATERIALS AND METHODS: A total of 1322 restorations were placed in the permanent teeth of 619 high caries risk Filipino children by two dentists and two trained health-care workers. Only hand instruments and an encapsulated amalgam, mixed with a manually powered amalgamator, were used. The restorations were evaluated after a service time of 1 to 5 years using modified atraumatic restorative treatment (ART) criteria. RESULTS: The overall success rate of the amalgam restorations was 95.3% (n = 1260) after a mean service time of 2.7 years (SD = 1.4). Multiple-surface restorations showed significantly higher failure rates (11.4%) than single-surface occlusal (4.7%) and single-surface non-occlusal (2.1%) restorations; 93.6% of large restorations was performed successfully, but had a risk of failure twice to that of small restorations (odds ratio (OR) = 2.141). The score of the decayed, missing, and filled teeth (DMFT) index had significant influence on the success rate. The risk of restoration failure increased by 11.5% for each unit increase in DMFT (OR = 1.148). Neither the operator nor age nor gender of the patient had a significant effect on the success rate of the restorations. CONCLUSION: Amalgam was performed satisfactorily as a filling material when placed under field conditions in manually prepared cavities in the permanent dentition of high caries-risk children. Success of the restorations was influenced by the patient's caries experience (DMFT), restoration size, and service time. CLINICAL RELEVANCE: Manual restorative treatment (MRT) amalgam restorations were performed satisfactorily, but higher dental caries experience and large cavities contribute to lower success rates.

Clinical success of stainless steel crowns placed under general anaesthesia in primary molars: an observational follow up study.

AIM: Quality assessment of stainless steel crowns (SSCs) placed in primary molars of high caries risk children after 1, 3 and 5 years of service time. MATERIAL AND METHODS: Out of 1149 SSCs placed 1, 3 or 5 years before the evaluation period in 558 children, 428 (37.2%) SSCs were clinically evaluated in 171 (30.6%) children aged between 1.1 and 8.6 years. Marginal adaptation, extension and proximal contacts of SSCs, plaque and gingival bleeding at SSC were assessed. Caries experience was recorded by WHO standards. RESULTS: Caries experience was 7.8 dmft/18.4 dmfs before treatment. The overall success rate of SSCs was 97.2%, regardless of the extent of carious lesions or pulp treatment of the tooth. Loss of SSCs (1.9%), pathological tooth mobility (0.7%) and perforation of the crown (0.2%) were scored as clinical failures. The majority of SSCs had sealed margins and the marginal extension reached sub-gingival level. Open proximal contacts occurred mesially and distally (21.7%, 20%). All qualitative defects increased with service time. Secondary caries was not diagnosed. Of the SSCs, 46.4% were free of dental plaque. Gingival bleeding after probing was observed in 72.1% of all SSCs. Gingivitis was significantly associated with increased dmft-values (OR=1.108, 95%CI: 1.03-1.19) and plaque at SSCs (OR=0.29, 95%CI: 0.18-0.47). Children with migration background exhibited significantly more often insufficient oral hygiene and higher rates of gingival bleeding and caries experience than did German children. CONCLUSIONS: SSCs are clinically successful restorations in primary molars of high caries risk children. High caries prevalence and insufficient oral hygiene were greater determining factors for the occurrence of gingivitis than the quality of the SSCs.

Dental caries and microbiota in children with black stain and non-discoloured dental plaque.

AIM: We aimed to assess caries experience and microbiota in systemically healthy children with black stain (BS) and non-discoloured plaque. METHODS: Forty-six children with BS and 47 counterparts with non-discoloured plaque aged 7.9 ± 1.3 years were clinically examined. Dental caries was scored using WHO criteria. Samples of BS and non-discoloured dental plaque were collected from tooth surfaces. The DNA of the samples was extracted and real-time PCR was performed to determine the total number of bacteria and the species Streptococcus mutans, S. sobrinus, Lactobacillus sp., Actinomyces naeslundii, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum. RESULTS: Children with BS had lower DMFT (p = 0.013), lower DT values (p = 0.005) and a tendency to lower caries prevalence (p = 0.061) than children with non-discoloured plaque. Plaque samples of the BS group contained higher numbers of A. naeslundii (p = 0.005) and lower numbers of F. nucleatum (p = 0.001) and Lactobacillus sp. (p = 0.001) compared to the non-discoloured plaque samples of the control group. Comparing the children with BS and non-discoloured plaque, higher counts for A. naeslundii (p = 0.013) were observed in caries-free children with BS while in caries-affected children with BS, lower counts of F. nucleatum (p = 0.007) were found. Counts of Lactobacillus sp. were higher in non-discoloured plaque samples than in BS of caries-free and caries-affected children. CONCLUSION: Results suggest that the different microbial composition of BS might be associated with the lower caries experience in affected subjects. The role of black-pigmented bacteria associated with periodontitis needs further studies.

[Dental health of first molars among Westphalian immigrants and German students]. / Zahngesundheit erster Molaren bei westfälischen Migranten und deutschen Schülern.

The aim of this study was to assess the health status of the occlusal surface on the first molars of Westphalian students, of whom 41.0% were immigrants. The prevalence and retention of fissure sealants (FS) and caries experience was scored for 161 students aged 8 and 10 years. Logistic regression analysis was used to predict the influence of sex, ethnicity, and retention of FS on the occlusal caries risk of the first molars. There was no difference in caries prevalence and experience in 8-year-old German students and immigrants (5.6%/10.5%; 0.07 DMFT/0.21 DMFT), both parameters were significantly higher in 10-year-old immigrants than in German students (25.5%/9.5%; 0.55 DMFT/0.11 DMFT). The prevalence and number of molars with FS was not different between German students and immigrants at 8 years (39.1%, 1.28 FS; 33.8%, 0.94 FS) and at 10 years of age (47.4%, 1.68 FS; 39.4%, 1.17 FS). The occlusal caries risk of first molars without FS was significantly higher in 8-year-old immigrants than in German students (OR 4.62). FS should be used more frequently in daily dental practice. To improve the quality of FS, stricter implementation of guideline-based standards is required.

Evaluation of an oral health promotion program at the time of birth on dental caries in 5-year-old children in Vorarlberg, Austria.

OBJECTIVES: The aim of this study was to evaluate the effect of an early oral health promotion program (OHPP) on oral health of 5-year-old children in Austria by providing new mothers with dental health counseling. METHODS: Qualified dental health educators visited all mothers at time after birth in regional hospitals in Vorarlberg and counseled them regarding the oral health of their children as a one-off intervention. Mothers were given comprehensive oral hygiene instructions for their children and themselves (daily use of fluoride toothpaste, restoration of own caries lesions), which included practical tooth brush training and dietary counseling by the use of brief motivational interviewing and anticipatory guidance approaches. After 5 years, a case-cohort study was conducted to evaluate the program with annual dental check-ups of 471 children and a parent survey. Dental caries was scored using WHO diagnostic criteria at dentine level without radiography. To compare oral health parameters (dmfs/dmft, care index), children were allocated to intervention and control group and matched on basis of age, sex, ethnicity, and socio-economic status (SES) and analyzed statistically. RESULTS: Children whose mothers participated in the OHPP showed significantly lower caries prevalence and experience (33.2%; 3.2 ± 7.4 d3-4 mfs/1.5 ± 2.5 d3-4 mft) than children whose mothers did not participate (42.6%; 5.2 ± 6.4 d3-4 mfs/2.4 ± 4.1 d3-4 mft). Bivariate analysis showed that ethnicity, SES, age at which toothbrushing started, supervision of toothbrushing, use of fluoride salt, and use of fluoride toothpaste were significantly related to d3-4 mft. CONCLUSIONS: The OHPP was an effective community-based preventive approach for improving oral health in preschool children.

[Oral health of pregnant women and their awareness of oral hygiene]. / Die Mundgesundheit von Schwangeren und deren Mundgesundheitsbewusstsein.

AIM: Pregnancy is related with changes in oral health. While the medical care of pregnant women in Germany is well-regulated, there are no structured recommendations for dental examinations. During an "Oral Health Awareness Week" the periodontal conditions of pregnant women in the Federal State of Thuringia (Germany) were examined. METHODS: 85 pregnant women participated in this study. Oral health indices (PSI, BoP and DMFT) were recorded. 61 of the 85 women followed the invitation to repeat the investigations after parturition. Additionally, birth weight and height of the newborn were recorded. RESULTS: There were no correlations between periodontal condition and birth weight. However, pregnant women demonstrated in high levels periodontal inflammation (only 1.2% showed periodontal health). Pregnant woman with periodontitis (PSI 3 and 4) demonstrated clear deficiencies in health education regarding oral health and adverse pregnancy outcomes. CONCLUSIONS: These findings implicate the importance of periodontal care in pregnant women. An association between periodontitis and reduced birth weight was not observed in the studied Thuringian cohort.

[Early childhood caries and associated risk factors among infants in the German federal state of Brandenburg]. / Frühkindliche Karies und assoziierte Risikofaktoren bei Kleinkindern im Land Brandenburg.

The objective of this study was to determine the caries experience in a representative sample of infants aged 13-36 months in the federal state of Brandenburg in relation to their parents' health behavior and social status. Calibrated public health service dentists examined 661 children in ten districts according to WHO standards (1997). Data on the parents' health behavior and their social status were acquired via questionnaire. The prevalence of caries was 7.4% on enamel-level (d1-4) and 5.3% on dentin-level (d3-4). The caries experience was 0.3 d1-4mft/0.2 d3-4mft. Fifty-two percent of the total caries burden was concentrated on 2% of the children. The restorative index was 19.9% and the care index 10%, respectively. Children of 25-36 months of age and with a lower social status and those who were bottle-fed at night revealed a significantly higher caries risk (OR 3.84, p = 0.005; OR 7.34, p < 0.0001; OR 2.4, p = 0.022) compared to younger children, children with a higher social status, or those without nocturnal bottle use. Intersectoral prevention programs in day-care centers are the favored preventive approach to compensate the socially determined health inequality. The low care index needs to be communicated with the dental association to improve the accessibility of infants in dental practice.

[Evaluation of a school-based intensified preventive program for high caries risk children in the Eneppe-Ruhr district]. / Evaluation eines zahnärztlichen Intensivprophylaxeprogramms für Kinder mit einem erhöhten Kariesrisiko im Ennepe-Ruhr-Kreis.

The aim of the present study was to assess the dental health of high caries risk elementary students from the Ennepe-Ruhr district (Westphalia) who were involved in school-based basic and intensified preventive programs. Furthermore, the efficacy of the intensified preventive program (IPP) was evaluated in comparison to the basic preventive program (BPP). Students with intensified preventive care and their parents were asked about their ethnic background, social status, oral health attitudes, and behavior as well as the perception and acceptance of the IPP. A total of 127 students involved in the IPP took part in this study; 106 students participating in the BPP served as the control group. Dental caries were scored according to the 1997 WHO standard. Caries prevalence and experience did not differ between students participating in the BPP or IPP. Migration-related shortcomings in terms of dental self-reliance and the use of fluoridated salt were found. Future IPPs should focus on a holistic and setting-based preventive strategy considering migration-related characteristics.

PUFA--an index of clinical consequences of untreated dental caries.

RATIONALE: Dental caries is a global public health problem, especially in children. Most caries in developing countries remains untreated. Only limited data are available on the clinical consequences of untreated dental caries because there is no measure to quantify the prevalence and severity of oral conditions resulting from untreated dental caries. OBJECTIVES: To present a new index to evaluate the prevalence and severity of oral conditions resulting from untreated dental caries. To validate the index within the Philippines National Oral Health Survey, 2006. METHODS: The PUFA index records the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a). RESULTS: Good kappa values show the reliability of the index. The prevalence of PUFA/pufa >0 was 85% and 56% for 6- and 12-year-olds, respectively. The mean number of teeth affected (PUFA/pufa) was 3.5 and 1.2 for 6- and 12-year-olds, respectively. In 6- and 12-year-olds, 40% and 41% of decayed teeth had progressed to odontogenic infections. CONCLUSION: The PUFA index complements classical caries indices with relevant information for epidemiologists and health care planners.

Comparison of visual inspection and different radiographic methods for dentin caries detection on occlusal surfaces.

OBJECTIVES: The aim of the present study was to assess the validity of the digital phosphor plate radiographic technique (Gendex Dental Systems) on occlusal surfaces in comparison with visual examination and conventional E- and F-speed films. METHODS: The study material consisted of 54 non-cavitated third molars with a range of appearances, including apparently sound surfaces. Each surface was visually examined (VI) according to the criteria established by Ekstrand et al. Three radiographic images (E-speed, F-speed, digital phosphor plate film) were taken of each molar. The standardized radiograph technique used an alignment fixture to reproduce the focus-to-object distance as well as the object-to-film distance. Afterwards each tooth was cut into sections in the buccolingual direction with a microtome saw, and caries extension was assessed using light microscopy (LM) and microradiography (MR). The statistical analysis included the calculation of sensitivity (SE), specificity (SP) and A(z) values. RESULTS: The following validity parameters were found for the tested diagnostic methods on the dentin caries level: VI/LM, 68.0 SE/93.1 SP/0.698 A(z); VI/MR, 68.2/87.5/0.751; E-speed/LM, 76.0/78.6/0.637; E-speed/MR, 77.3/74.2/0.681; F-speed/LM, 64.0/67.9/0.507; F-speed/MR, 68.2/67.7/0.594; Gendex/LM, 60.0/85.7/0.629; and Gendex/MR, 59.1/80.6/0.586. CONCLUSION: The methods used showed different levels of validity: E- and F-speed films were linked to higher sensitivity values, whereas a higher specificity was recorded for the tested imaging plate system. In accordance with the diagnostic performance, the digital system can be recommended for practical use and potentially help prevent overtreatment thanks to its high SP.