Effectiveness of fissure sealants on initial caries lesions (ICDAS 1-3) of permanent molars: A 4-year follow-up.

AIM: The aim of the present prospective study was to evaluate the retention and effectiveness of two types of sealants (clear vs. opaque) on early pit and fissure occlusal non-cavitated ICDAS II #1-3, caries lesions of permanent posterior teeth of children. MATERIALS AND METHODS: Study Design: 6986 pit and fissure occlusal surfaces were randomly sealed with clear or opaque sealants out of which, 5828 sealants were placed on sound and 1158 on questionable surfaces, while 3508 were clear and 3478 opaque sealants. The mean age of the sample at initial sealant placement was 9.5 (±2.9) years and the follow-up time was 12-48 months. The median (IQR, range) follow-up time was 17.9 (8.7-28.6) months. Study inclusion and exclusion criteria applied to the combined database in order to select the study sample. Teethmate™ F-1 natural and opaque sealants (Kuraray, Hattersheim am Main, Germany) were applied following the standard procedure of preparation with moisture control kept by cotton rolls handled Dri-Angles" and a 30 seconds acid-etch with 37% ortho-phosphoric acid gel was used followed by 10 sec air-water spraying washing and polymerization for 20x2 sec. Sealants were applied on sound tooth surfaces (ICDAS #0) with no visible defects or on surfaces with early caries lesions (ICDAS #1-3), randomly and interchangeably on the upper or lower Jaw. Total retention was considered when all pits and fissures were completely sealed, while partial or complete loss was scored as one code, although was registered separately. STATISTICS: Separate analyses were performed for each type of failure (loss of sealant or restoration). Cumulative probabilities of failure over time after sealant placement, overall or by specific characteristics, were calculated using the Kaplan-Meier method. Association between these characteristics and the hazard of failure were investigated using appropriate Cox proportional hazard models. RESULTS: Sealed surfaces with ICDAS II # 1-3, showed 100% higher probability of having a restoration and 60% higher probability of sealant loss, with both differences being statistically significant (aHR=2.03, p=0.046), adjusted for age, sex, type of sealant and location of surface. Opaque sealants presented statistically significant (p 0.009) higher re-application rate, while fissures had 70% statistically significant (p<0.001) higher probability for resealing with time compared to pits, with gender not affecting sealant retention while the earlier a sealant was placed on children's teeth, the more probable it was to need resealing or restoration (p <0.012). CONCLUSIONS: The therapeutic use of sealants on occlusal surfaces of posterior permanent molars with early carious lesions (ICDAS II 1-3) is inferior compared to sound surfaces, showing higher sealant failures and restorations.

Caries prevalence of 5, 12 and 15-year-old Greek children: a national pathfinder survey.

AIM: To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters. METHODS: A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index (CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents' educational status. RESULTS: Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living in rural areas demonstrated significantly higher dmft/DMFT values and less dental restorative care (CI), whereas children with fathers of a higher educational level showed significantly lower dmft/DMFT values. The significant caries (SIC) index value for the three age groups was 5.01, 4.83 and 7.07 respectively. Posterior occlusal surfaces of the permanent teeth presented most of the caries in the 12 (68%) and 15-year-old group (78%). CONCLUSIONS: Despite the decrease in the prevalence of caries in Greek children disparities remain. Children in rural areas and children with less educated parents had more caries and more untreated caries. All the above call for immediate intervention with comprehensive preventive programs and better geographic targeting of the dental services at a national level including targeted prevention of pit and fissure sealants on posterior permanent molars.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters. METHODS: A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance. RESULTS: The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds. CONCLUSIONS: The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Socio-behavioural factors influencing oral health of 12 and 15 year old Greek adolescents. A national pathfinder survey.

AIM: To estimate the frequency in use of oral health services, oral health self-assessment, oral hygiene practices of 12- and 15-year-old Greek children and adolescents, to investigate possible influences of these factors and other socio-demographic parameters on oral health. METHODS: A stratified cluster sample of 1224 12 year old and 1257 15 year old children and adolescents of Greek nationality were selected and examined by calibrated examiners. Clinical examination included recording of caries according to the British association for the study of community dentistry diagnostic criteria, while oral hygiene and periodontal status were assessed by means of the simplified debris and the community periodontal index. Subjects were interviewed to answer questions on socio-behavioural risk factors through a structured questionnaire. The student's t-test and ANOVA were used for statistical evaluation of the means and the chi-square test was applied for statistical comparison of the proportions. Multiple linear regression analysis was performed to assess the statistical association between variables. RESULTS: Caries experience and untreated caries were significantly higher among children and adolescents who visited the dentist only when in pain or for restoring a tooth, compared to those visiting for check-ups or prevention and having more frequent application of topical fluorides. Tooth brushing, at least twice a day, and flossing were significantly associated with periodontal and oral hygiene status, but not with caries presence. The multivariate analysis revealed that parental educational status and reason for visiting a dentist were strong determinants for caries experience and oral hygiene status but not for periodontal health of children and adolescents. CONCLUSIONS: This study has identified several socio-demographic and behavioural determinants for dental caries, oral hygiene and periodontal health of Greek children and adolescents.

Cytokines in gingival crevicular fluid of adolescents and young adults.

BACKGROUND/AIM: The purpose of this study was to compare the levels of the cytokines interleukin-1beta (IL-1beta), IL-4, and IL-8 in the gingival crevicular fluid (GCF) of adolescents and young adults. METHODS: Twenty-five adolescents aged between 14 and 16 years (Group A) and 20 periodontally healthy young adults aged between 25 and 35 years (Group B) were selected from two private dental clinics limited to pedodontics and periodontics respectively in Piraeus Greece. All subjects were systemically healthy. Clinical examination included probing pocket depth (PPD), presence or absence of plaque, and bleeding on probing (BOP). GCF was collected from four sites per subject. IL-1beta, IL-4, and IL-8, measured as total amounts (pg/30 s), were evaluated in 180 samples using a commercially available sandwich enzyme-linked immunosorbent assay. RESULTS: IL-1beta mean levels of Groups A and B were adjusted for BOP and PPD. Differences of IL-1beta mean levels between the two age groups were statistically significant (F = 50.245, P < 0.001) in favour of Group A. Adolescents showed statistically significantly lower mean levels of IL-4 than young adults in the presence of BOP (F = 10.690, P = 0.001). There was no statistically significant difference between adolescents and adults for the means of IL-8 adjusted for BOP and plaque presence (F = 2.032, P = 0.161). CONCLUSIONS: Within the limits of this study the differences reported in mean levels of IL-1beta and IL-4 may be attributed to the different age status.

A study to compare the effectiveness of temazepam and a chloral hydrate/hydroxyzine combination in sedating paediatric dental patients.

The study compared the effectiveness of temazepam and a mixture of chloral hydrate and hydroxyzine in sedating 20 young children aged 20 to 60 months (mean age 38.7 months). All the children exhibited negative behaviour during a screening visit and required at least two visits for restorative treatment with the use of sedation. The children were assigned randomly to receive either 50 mg/kg of chloral hydrate with 25 mg of hydroxyzine or 0.3 mg/kg of temazepam for the first visit, and the alternate regimen for the second visit, in a double-blind manner. Pulse rate and blood oxygen saturation levels were monitored before, during and after the operative procedures. All the treatment sessions were video-recorded and evaluated independently by three paediatric dentists for the degree of crying, movement, sleep and overall behaviour during specific procedures and at specific time intervals. The results showed no statistically significant differences between the two pharmacologic regimens with regard to crying, movement, sleep and overall behaviour. No significant difference in behaviour was found related to either the order of administration of the drugs or to the sex of the patients. It was concluded that 0.3 mg/kg temazepam and a mixture of 50 mg/kg chloral hydrate with 25 mg hydroxyzine had similar sedative effects on the children receiving dental treatment.