Pro-inflammatory, pleiotropic, and anti-inflammatory TNF-alpha, IL-6, and IL-10 in experimental porcine intervertebral disk degeneration.

The aim of this study was to check the balance between tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-10 (IL-10) in well-developed end-stage disk disease in the disk itself as well as in paradiskal spine. In 6 domestic pigs the cranial bony end plate of the L4 vertebra was perforated to the nucleus pulposus. At 3 months the degenerated experimental and contiguous control disks, together with the adjoining bony and cartilaginous vertebral end plates, bone marrow, and spinal ligaments, were excised and used for immunohistochemical analysis. In general, there were more TNF-alpha and in particular IL-10 positive cells in the degenerated disks than in the control disks, whereas the number of IL-6 labeled cells did not differ among sites or between control and experimental intervertebral disks. These results suggest that TNF-alpha and IL-10 are involved in the late reparatory phases of the experimental disk lesion. Use of an experimental model showed that strictly disk-directed manipulation and degeneration are also reflected in the contiguous vertebrae, including adjoining cartilage, bone, marrow, and ligaments.

Children with Down Syndrome: oral development and morphology after use of palatal plates between 6 and 18 months of age.

OBJECTIVES: The aim of this study was to describe oral development and morphology in 18-month-old children with Down syndrome (DS) treated with palatal plates in combination with structured communication and speech training. The aim is further to describe the design of the palatal plates, compliance in their use and to give a brief report of their effect on oral motor function and speech. SAMPLE AND METHODS: Forty-two children with DS were followed from < or = 6 months of age until 18+/-3 months old. In addition to language intervention, and oral motor and sensory stimulation provided by speech therapists for all children with DS in Sweden, palatal plates provided by dentists are included in the training programme. In the evaluation, the children in the project were compared with two control groups of children matched for age; one group of children with DS who had not been treated with palatal plates, and one group of children with normal development. RESULTS: Compared to the children with normal development, both groups of children with DS had fewer teeth erupted and a lower prevalence of sucking habits. Deviant morphology of the tongue in the form of diastase, lingua plicata or a sulcus in the anterior third of the tongue was only seen in children with DS. All children with normal development had positive values for overjet compared to 53% of the children with DS. The palatal plates were used 2-3 times daily for a total mean time of 15 min. Compliance in use of the plates decreased with age, mainly due to eruption of teeth and subsequent loss of retention. Evaluation of oral motor function and speech show that the children with DS in the project had better motor prerequisites for articulation than the control children with DS. CONCLUSION: Palatal plate therapy did not affect oral parameters, i.e., eruption of teeth, types and prevalence of sucking habits, tongue morphology and symptoms of hypotonia. In combination with oral motor and sensory stimulation, palatal plate therapy had a positive effect on oral motor performance and prerequisites for articulation.

Evaluation of caries preventive measures.

This article describes the aims, methods and baseline results of a project evaluating preventive measures within a selected high-risk group. In 1995 a cohort of 3373 12-year-olds was examined with regard to caries. A high-risk group was identified and randomly divided in four different groups, receiving different preventive programs. The whole study group will be examined every other year until the adolescents are 18 years old. The high-risk group will be examined every year and given the four different preventive measures until the adolescents are 18 years of age. A questionnaire will be answered by the adolescents every other year, in order to learn more about the links between demographic data, social background, lifestyle and health behaviour. Analysis of baseline results showed that the social distribution of the study group is comparable to that of the background population as well as to the distribution in rural and urban areas. The mean DMFT was 1.5, which is in accordance with the national figure. The 28 dentists who collect the data and perform the caries diagnostics were calibrated and the mean inter- and intra-reproducibility was 0.78 and 0.82, respectively. In conclusion, it seems that the study group is representative of 12-year-olds in Sweden; thus, inferences drawn from the results of the project may be valid for adolescents in Sweden as a whole.

Treatment of traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age have been studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten. The study material comprised 3007 dental records from the Public Dental Health Service. Of these, 1040 contained information on dental injuries. Out of 1000 injured primary teeth, 32% were lost, either avulsed at the time of the accident or extracted due to complications. A majority (92%) of the extractions was performed at the first or second follow-up. A total of 690 tooth injury episodes had occurred in the permanent dentition, involving 981 teeth. In 10% of the teeth more than one diagnosis was recorded for the same tooth. 416 restorations were performed due to crown fractures, the majority at the emergency visit. 44% of the patients had to come back one or more times to revise the composite restoration. Complicated fractures or serious luxation injuries constituted only 5% of the total number of injuries in the permanent dentition. 77 (8%) of the traumatised teeth were treated endodontically. Two percent of the teeth with uncomplicated crown fractures required endodontic treatment due to pulp necrosis, while 28% of teeth with a combination of crown fractures and luxation injury were endodontically treated. Out of 6 avulsed incisors, 4 survived after endodontic treatment. A total of 7 incisors were lost as a consequence of the injuries. A specialist treated 4% of the patients.

Distribution of caries in 12-year-old children in Sweden. Social and oral health-related behavioural patterns.

OBJECTIVE: To describe the distribution of caries in 12-year-old children in Sweden according to socio-demographic and oral health related behaviour. PARTICIPANTS: The study group consisted of 3,373 12-year-old children residing in catchments of 26 different public dental health clinics in Sweden, geographically well represented. METHOD: The clinical examination for dental caries was performed by 28 calibrated dentists. A questionnaire on lifestyle was distributed to the children with questions on ethnicity, socio-economic level and oral health as well as overall health attitudes. RESULTS: The proportion of 12-year-old children with no experience of dentine caries was 47% and 35% were completely free from all caries. Intraoral distribution of caries showed most lesions on the first molar mesial surface, with 80% enamel and 20% dentine caries. Almost all children brushed their teeth twice a day and a third of the children had an extra intake of fluoride. Decayed surfaces including enamel caries (DeS) was chosen as a measure of ongoing caries and used when dividing children into three caries groups; caries free (50%), 1-3 lesions (40%) and the high caries group (10%) with more than 3 lesions. These groups showed distribution differences. More non-Swedish children, children from workers' homes, and children who brushed their teeth less than twice a day were found in the high caries group. More children from workers' homes living in big cities and snacking more than once a week were also found in the high caries group. This could not be shown for other social groups. Also children who had an extra intake of fluoride were classified in the high caries group.

Nursing students' experiences of the effects of continual process-oriented group supervision.

AIM: To describe and analyse the nursing students' experiences of the effects of process-orientated group supervision. BACKGROUND: There is a need to promote the development of the nursing student's professional identity and preparedness to act as well as to provide the opportunity for reflection and setting up a group supervision programme. METHOD: This paper is an in-depth study using both quantitative and qualitative methodologies. An open-ended interview form including 24 items and four open-ended questions was used and 80 nursing students answered a questionnaire. The data were analysed by a factor analysis with varimax rotation and by open coding. FINDINGS: The three analysis factors were labelled: 'Increased patient attentiveness', Increased empathy ability', and 'Increased insight and security'. From the findings of the qualitative analysis two main categories emerged: 'Increased ability to communicate' and 'Personal growth'. CONCLUSIONS: The findings of this study suggest that there is an association between the effects of group supervision and the nursing students' development of a nurse identity.

Costs for prevention of dental caries in a group of Swedish teenagers.

The aim of this study was to analyse the costs for 4 years of prevention of dental caries in 92 Swedish adolescents. Using records, the total time allocated to prevention between 1987 and 1991 was calculated. Costs for prevention was assessed from the total cost for dental service at the clinic. The cost for one hour of dental service was SEK 860, 80 pounds. The total cost for prevention in the study group during 4 years was SEK 40,162, 3,744 pounds. The amount spent on prevention in the low or average caries active group of adolescents during 4 years was less than half the sum spent in the high caries active group.

Traumatic dental injuries in a cohort of 16-year-olds in northern Sweden.

The prevalence and yearly incidence of traumatic tooth injury between 1 and 16 years of age were studied in a cohort of 16-year-olds, born in 1975, and residing in the County of Västerbotten, northern Sweden. The study comprised 3007 dental records from the public dental health service. The general distribution was 50.3% girls and 49.7% boys. The records showed that 35% of the children on one or more occasions had sustained injury to their primary or permanent dentition. The frequency was nearly twice as high for boys (64%) as for girls (36%). Twenty-five percent of the 16-year-olds had met with tooth injury more than once and this group consisted predominantly of boys. The incidence of injury episodes to primary and permanent teeth was 28 per 1000 per year. The boys had sustained trauma to their teeth most frequently when they were 4 years of age and between the ages of 8 and 11. This was also true for girls at 4 and at 9 years of age, although less evidently so. In the primary dentition, the majority of dental injuries had affected the supporting tissue of the maxillary incisors. In the permanent dentition, 75% of the traumatised teeth were upper incisors. Fractures of varying severity constituted 60% of all registered diagnoses in this dentition, followed by subluxation (19%) and concussion (11%).

Dental caries, tooth trauma, malocclusion, fluoride usage, toothbrushing and dietary habits in 4-year-old Swedish children: changes between 1967 and 1992.

The dental health of 4-year-old children in the city of Umeå, northern Sweden, has been followed in cross-sectional studies conducted in 1967, 1971, 1976, 1980, 1987 and 1992. Similar methods and criteria were used. Dental caries and background factors (fluoride usage, toothbrushing frequency and diet) were recorded. In 1971, 1987 and 1992 signs of tooth trauma and presence of malocclusion were also recorded, the latter also in 1976. The present paper summarizes the results of these studies. Between 1967 and 1992 the mean dmfs values declined from 7-8 to 1-8. The decline was greatest between 1967 and 1980 and then levelled off. Toothbrushing frequency was similar over the years, but parental help with brushing was more common in the more recent studies. The use of fluoride toothpaste increased. About 30% of the children had experienced tooth trauma. A unilateral crossbite was recorded in 18% and 16% of the children in 1971 and 1992, respectively, and an anterior open bite in about 35% and 41%, respectively; both types of malocclusion were related to a dummy- or finger-sucking habit.

Between-meal eating, toothbrushing frequency and dental caries in 4-year-old children in the north of Sweden.

Two hundred and forty-nine 4-year-old children were examined for dental caries, and data were collected on frequency of toothbrushing, use of fluorides, and intake of nine different snack products. Dental caries experience of children who brushed once or twice daily with parental help was significantly lower than that of children who brushed irregularly. The intake of snacks was high. Buns and cakes, ice cream, and sweet beverages were consumed more often than sweets. Children who had high snack intakes and brushed irregularly had significantly higher caries experience than those with low snack intakes and regular toothbrushing. Therefore irregular toothbrushing was shown to potentiate the impact of frequent snacking.

Oral findings in a group of newborn Swedish children.

Oral examinations were performed of 1021 newborn Swedish children, of whom 101 were re-examined after 2-3 or 4-5 months. The most common findings, registered in 74.9% of the children, were of oral mucosal cysts situated either palatally or on the alveolar ridges. The majority of the palatal cysts disappeared shortly after birth, and some alveolar cysts appeared after birth. Ankyloglossia was found in 2.5% of the children, and Fordyce spots in 1.0%. No natal teeth were found. The upper labial frenum was attached to the crest of the alveolar ridge in 76.7% of the children, palatally in 16.7% and buccally in 6.7%. The relationship of the alveolar ridges was recorded: the anterior segment of the mandibular ridge was distal to the maxillary in 99% of cases, and, posteriorly, the mandibular ridges were lingual to the maxillary in 97.6%. An open bite was found in 39.8% of the children.

Allocation of dental caries prevention in Swedish teenagers.

In this study, the hypothesis that teenagers with high caries activity on proximal surfaces receive more preventive care in the Swedish Public Dental Health Service than those with lower caries activity on these surfaces, was tested in an audit study. Dental records and bitewing radiographs from 1987 and 1991 were used to assess caries progression in 406 teenagers from the age of 13 to the age of 17. The time allocated to prevention during the period was also registered. Caries progression as a measure of disease activity was tested. The results showed that the hypothesis could not be verified. The Odds ratio was 1.35, indicating that the chance to get more than 15 min preventive time during 4 yr was only 1.35 times higher if you were highly caries active than if you were less caries active. Although the reproducibility of the method to use caries progression as a measure of disease activity was not high, it was considered a better indicator of active disease than the number of DMF surfaces.

Dental caries prevalence and related factors in 5-year-old children in Hong Kong.

One thousand five Hong Kong kindergarten children with a mean age of 5.75 +/- 0.46 years were sampled for caries prevalence and related factors. Samples were drawn from a total population of approximately 9,000 5-year-old children. Caries examination was conducted after the teeth were cleaned professionally using a sickle probe (Ash #54) and diagnostic criteria of the World Health Organization. Thirty-seven percent of children were caries-free and the mean dmft of all children was 3.2 +/- 3.92. The components of the dmft were dt = 2.93, mt = 0.04 and ft = 0.23. The dmfs was 5.10 +/- 7.80 with ds = 4.67, ms = 0.12, and fs = 0.31. The caries distribution was skewed, 18% with more than 10 dmfs and the most severely affected child having 54 decayed surfaces. Seventy-two per cent had never visited a dentist. A statistically significant positive correlation was found between the father's profession and caries prevalence. The age of the child at the first visit and the frequency of visits to the dentist were related directly to parental income. The primary mandibular first molar ranked highest among the teeth that needed treatment, mostly extraction. (Pediatr Dent 15: 116-19, 1993).

Caries in the preschool child: international trends.

Most studies on the prevalence and incidence of dental caries are carried out on schoolchildren and data on preschool children are comparably few. In most of the developing countries in South East Asia, children have a high prevalence of dental caries in the primary dentition, often in contrast to the situation in the permanent dentition. The reasons for this difference are not obvious, but may be linked to differences in diet. In Africa, dental caries prevalence in the preschool child seems to be increasing somewhat in countries or parts of countries where there is an increase in sugar intake, while it stays low in countries where a poor economy restricts sugar intake. The prevalence does not seem to be as high as in South East Asia. In most industrialized countries in northern Europe, in North America, in Australia and New Zealand, dental caries is decreasing, often linked to an increasing use of fluorides, to various types of dental health education programmes, etc. In many European countries, the prevalence in preschool children is, however, still high and caries in primary teeth is often left untreated. In Scandinavia, where all preschool children are included in an organized dental care programme, dental caries has been decreasing markedly during the 1970s and at the beginning of the 1980s. While the mean values for d.m.f.t. at present appear to be largely unchanged, there seems to be a change in the distribution of the disease. More and more children are totally free of the disease, while the group with high d.m.f. values has a tendency to increase.

Education and diet in the prevention of caries in the preschool child.

Caries prevalence studies of preschool children today show that caries is increasing in many of the developing countries. This is often blamed on a situation where confectionary, soft drinks and refined sugar-containing snacks have become easily available. Studies in Sweden in 1980 on 4 year olds showed a high sucrose consumption, and an increasing proportion of the daily energy intake coming from snacks. Recent studies from Norway have confirmed that the dietary pattern is established in early infancy during the period of primary socialization. In Sweden, nearly all children are taken regularly by their parents to child health centres for regular check-ups and vaccinations. In these centres dental health education is given when the child is about 6 months and 18 months of age. Children of refugees and immigrants in Sweden have a considerably higher prevalence of dental caries than Swedish children. A dental health education programme at the child health centre to Finnish immigrant parents has been carried out and evaluated. The information was given on three separate occasions in Finnish to one test group of Finnish parents, and in Swedish to another test group of Finnish parents. A third Finnish group was given information twice in Swedish. When the children were 3 years of age, the dental health of the group where the parents had been given information three times in Finnish was equally as good as the dental health of matched Swedish 3 year olds.

Periodontal conditions in a group of Swedish adolescents. (I). A descriptive epidemiologic study.

The aim of the present study was to describe, clinically and radiographically, the periodontal conditions in 16- and 18-year-old adolescents from Northern Sweden. The studied samples comprised 287 16-year-olds and 283 18-year-olds. The clinical examination included recording of presence of plaque, bleeding on probing and calculus, and measurements of attachment level and pocket depth. Alveolar bone level was measured on bite-wing radiographs. A history was taken of the individual's occupation, oral hygiene habits and tobacco use, health, medication and previous orthodontic treatment. The prevalence of attachment loss (AL) was 9.4% in the 16-year-olds and 19.4% in the 18-year-olds. Proximal AL was found in 2.8% and 4.9%, respectively, and proximal bone loss in 1% in both groups. With only a few exceptions (3 individuals out of 82), the individuals with AL had their loss either at buccal/lingual surfaces or at proximal surfaces. Calculus was present in 32.7% of the 16-year-olds and in 44.9% of the 18-year-olds. Pocket greater than 3 mm were found in 4%. No significant differences concerning the periodontal status or presence of plaque and calculus were detected between urban and rural groups or between sexes. Toothbrushing 2 or more times/day was performed by 84.3% of the 16-year-olds and by 83.7% of the 18-year-olds.

Dental health in urban and rural areas of central and western Bangladesh.

A survey of the prevalence of dental caries and periodontal disease was carried out in 826 individuals residing in Central and Western Bangladesh. The survey included 6, 12, 18 and 35-45 year olds in privileged and slum urban areas as well as in rural areas. Dmft, DMFT and CPITN indices were used. The results showed that the highest mean dmft-values were found in urban privileged children (5.0). The mean DMFT-values ranged from 1.1 (urban privileged 6 year olds) to 4.7 (rural 34-45 year olds). The percentage of 12 year old children affected by caries was higher than in the 18 and 35-45 year olds in all socioeconomic groups. No statistically significant differences were found in the mean DMFT values within the age groups between urban privileged, urban slum and rural people. There was a high prevalence of bleeding on probing and of calculus in all age groups. Except for the 6 year olds, less than 10% in all age groups had a healthy periodontium. In the 18 year olds, shallow pockets were found in 34% of the urban slum group and in 42% of the rural group, but not in the urban privileged group. Deep pockets (greater than 6 mm) were found in the 18 and 35-45 year olds, except in the urban privileged groups.

Dental health in 13-year-olds in Västerbotten County, Sweden. Changes over twenty years.

An epidemiological study of the prevalence of dental caries and gingivitis in 13-year-olds was carried out in the county of Västerbotten, Sweden, in 1987. Besides providing information on the dental health of this age group, prevalence data were compared with data from earlier surveys of the same age group carried out in 1967 and 1977, covering the same areas and applying the same diagnostic criteria and methods. The results showed a marked decrease in the prevalence of caries and gingivitis. The mean number of DMF surfaces was 4.6, compared to 9.0 in 1977 and 19.0 in 1967. The mean GBI% was reduced from 33% to 21% between 1977 and 1987. In contrast to the results from 1967 and 1977 the differences in mean DMF values between the three areas were nonsignificant in 1987. The decline in dental caries is most probably due to an extended regular dental care with a strong preventive approach. Only slight differences in dental health were found between the three areas in 1987 in contrast to in 1977 and 1967. The most likely reason was probably that larger resources had been allocated to preventive programmes in the rural areas than in the city of Umeå.

Folate treatment of diphenylhydantoin-induced gingival hyperplasia.

It has recently been reported that folic acid supplementation reduced DPH-induced gingival hyperplasia in cat and in a pilot study also in man. The present study was performed to further evaluate this therapy in man. Twenty-three children with DPH-treatment for more than 1 yr, and eight children with short-time DPH-treatment were randomly assigned to groups with and without daily supplementation of folic acid (5 mg Folacin) for 1 yr. Although the DPH-levels were in many cases below the lower reference value, the seizure control of the children was good before and during the year of study. The plasma and red cell folate levels were within or above the given reference values in all but one child. There were no significant changes in the size of the gingival hyperplasias after 1 yr of folate supplementation. Nine severely mentally retarded DPH-treated adults were also given supplementation with folic acid. Their serum DPH-levels were above the higher reference values both at the start and during the study. Their plasma and red cell folic acid levels were below the reference value at the start of the study, but as a consequence of the Folacin supplementation these values rose. The size of the gingival hyperplasias was significantly reduced. Seizure control was unchanged. Folate levels should be checked and supplementation with folic acid considered in patients on long-term anticonvulsive multipharmacy therapy.