Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation.

OBJECTIVE: Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults. METHODS: Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention. RESULTS: Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001). CONCLUSIONS: The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.

Treatment practices in caries prevention for 6-year-olds in Finland.

OBJECTIVES: To evaluate caries-preventive treatment practices in relation to caries state and eruption of first permanent molars (FPMs) among 6-year-olds (n = 3489) examined and treated in public dental clinics in Helsinki during 1992. METHODS: The study subjects were selected on the basis of their caries state using a two-point study design: the high-caries group (n = 99) had the greatest number of DT + dt, the cavity-free group (n = 32) had neither past nor present caries. Evaluation of dentists' caries-preventive treatment decisions was based on data from detailed personal oral health records. RESULTS: In total, 22% of the high-caries patients (mean DT + dt 8.7; range 4-18) had been judged by their dentists as high-risk patients. Eruption of FPMs had no influence on dentists' judgement on caries risk. A subject's number of DT + dt had no influence on the intensity of preventive treatment given, but those with a high-risk judgement from a dentist received more preventive measures per visit than did other high-caries patients. For high-caries patients with erupting FPMs, three visits in 10 included preventive intervention other than sealants, compared to nine in the cavity-free group. Intensity of oral hygiene instruction correlated with presence of erupting FPMs, yet 86% of the patients with erupting FPMs had received no oral hygiene instruction. CONCLUSIONS: Dentists should be encouraged to use standardized criteria, including data on caries state and eruption stage, in judging each patient's risk of caries to provide intensified caries-preventive treatment to those most in need.

Dental care of six-year-old high-caries patients in relation to their cooperation.

OBJECTIVE: To evaluate caries occurrence in, and dental care given to, 6-year-old high-caries patients in relation to their cooperation as judged by the dentist. DESIGN: Retrospective evaluation study. SETTING: Children selected on the basis of their high number of decayed teeth (dt + DT). Data from personal oral health records. PARTICIPANTS: High-caries children aged 6 years (n = 97) clinically examined and treated in public dental clinics in Helsinki, Finland, with mean dt + DT = 8.7, range 4-18. OUTCOME MEASURES: Data covering ages 3 to 7 years: utilization of dental services, operative and preventive treatment by visit. RESULTS: Treatment strategy for the 6-year-old high-caries patients was not preventive-oriented. High-caries patients had three to four times as many visits as all 6-year-old children on average, but the visits had mostly served for operative treatment. Dentists had judged 34% of the high-caries patients to be non-cooperative. These patients had more past and present caries in their deciduous teeth (P < 0.01), more dental visits (P < 0.01), and received more demanding treatment (P < 0.001) than the cooperative high-caries patients. Caries preventive treatment given to all high-caries patients was rare, number of preventive interventions per patient and per visit (intensity) tended to correlate negatively with patients' cooperation (r = -0.12 and r = -0.23). Treatment courses were completed in 39% among the non-cooperative and in 63 per cent among the cooperative high-caries patients (P < 0.05). CONCLUSION: Dentists should be encouraged to integrate preventive interventions more closely into the treatment of non-cooperative high-caries children.

Dentists' decisions on caries risk and preventive treatment by dental state among 15-year-old adolescents.

OBJECTIVE: To evaluate dentists' decisions on caries risk and preventive treatment in relation to their clinical findings among 15-year-old children. DESIGN: Two groups of children were selected on the basis of subjects' number of decayed teeth. Data were also used from personal oral health records. PARTICIPANTS: 15-year-old children (n = 132) clinically checked and treated in public dental clinics in Helsinki. The high-risk group (n = 100) had the greatest numbers of decayed teeth (DT + dt), the low-risk group (n = 32) was cavity-free. OUTCOME MEASURES: Dental state, treatment decision, preventive and operative treatment recorded by visit, were used for assessment of caries risk and individual needs for caries prevention, and for evaluation of diversity and intensity of preventive treatment given to each patient. RESULTS: Dentists had judged only 17 per cent of the high-risk patients (mean DT + dt 6.5; range 4-16) as being at high risk of caries. Preventive measures were given only on one out of three visits. One out of two preventive measures was application of fluoride varnish and only one out of ten was dietary counselling. Patients with more decayed surfaces had been given more diversified (P < 0.01) and more intensive (P < 0.005) preventive treatment than had those with none or only a few caries lesions. Despite this, only 4 per cent of the patients with DS = 8-27 had been given four different preventive measures, and one patient out of seven had been left without any caries-preventive intervention. CONCLUSION: To meet individual needs of high caries-risk patients, the variety and intensity of preventive measures directed towards them need to be further improved.

Decrease in and polarization of dental caries occurrence among child and youth populations, 1976-1993.

With data on children's dental state from 1976 to 1993, we evaluated how the size of the high-caries group has changed concurrently with simultaneously decreasing mean numbers of teeth with past or current caries. Information related to all dental check-ups done for 5- and 15-year-olds in Helsinki, some 4,000 subjects of each age by year, consisted of numbers of teeth with caries experience (dmft or DMFT) and of all decayed teeth (dt + DT). Polarization of dental caries was described as the proportion of high-caries groups in each year, both in terms of caries experience and current untreated caries, diagnosed at subjects' annual clinical dental check-ups. For 5-year-olds, the high-caries group by caries experience included patients with their dmft > or = 3. For 15-year-olds the limits were set at DMFT > or = 6 and DMFT > or = 15. The high-caries group in terms of untreated caries was similar for both age groups: dt + DT > or = 3. Furthermore, polarization of caries was calculated as the share of numbers of both dmf or DMF teeth and dt + DT in each high-caries group of the total number of such teeth in the entire age cohort. During the 17 years, mean dmft for 5-year-olds decreased from 4.6 to 0.8 and mean dt + DT from 0.9 to 0.6. In 1993, 78% had their dmft = 0, whereas only 8% of the patients accounted for 76% of all decayed teeth. For 15-year-olds the decrease was even greater: their DMFT fell from 12.1 to 3.0 and their dt + DT from 3.1 to 0.8. However, only 26% had their DMFT = 0 in 1993, with 55% of all dt + DT occurring in 10% of the patients. The present results confirmed a strong polarization in caries for both age cohorts, showing the need for renewed strategies in preventive caries treatment.

Evaluation of preventive treatment by risk of caries among 13-year-olds.

Implementation of caries preventive treatment in relation to the risk of caries was studied among 13-year-olds (n = 132) in two groups treated in the same public dental clinics in Helsinki: caries patients (n = 100) had the greatest numbers of decayed teeth (DT+dt), 5.5 on average, whereas cavity-free patients (n = 32) had intact teeth. Data taken from patients' personal oral health records served for evaluation of individual need for caries prevention, risk of caries, and preventive treatment given to each patient. Patients with any caries lesions or erupting teeth or poor oral hygiene were considered to be at risk of caries and in need of preventive treatment. The more caries lesions a patient had, the more prevention was expected to have been given. Preventive treatment of caries was weakly or only moderately in accordance with patients' individual needs and risk of developing caries, although patients with more caries lesions tended to have been given more preventive treatment than did those with none or only a few lesions. The majority of preventive measures given were applications of fluoride varnish, whereas motivation of and instruction in oral health care habits remained weak. However, patients whom their dentists had judged to be at high risk of caries received more intensified preventive treatment than did other caries patients. As a conclusion, intensification of caries prevention among high-risk patients is still needed. Dentists should always consider each patient's risk of developing caries to improve quality of preventive treatment.