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.

Age-specific findings on endodontic treatments performed by private dentists in Finland in 2012 and 2017: a nationwide register-based observation.

AIM: To evaluate age-specific aspects and changes in volume and content of endodontic treatment for adults visiting private dentists in Finland in 2012 and 2017. METHODOLOGY: This study utilized register-based data of private dental care. The observation unit of the aggregated macro-level data was age group, with 5-year age groups from 20 to 24 years onwards and the oldest group combining all patients aged 90 years and over. Data from years 2012 and 2017 included all the oral health care of 2.04 million patients receiving reimbursement for treatment by private dentists; a total of 183 932 patients received at least one endodontic treatment and were analysed. The number of teeth receiving endodontic treatment was counted separately as pulp cappings, pulpotomies and root canal fillings according to number of canals filled per tooth. Statistical associations were assessed as correlation coefficients. RESULTS: The mean age of endodontic patients was 53.6 years in 2012 and 55.9 years in 2017. In both years, 38% were aged from 50 to 64 years. In 2012, 9.9%, and in 2017, 8.0% of patients received at least one endodontic treatment; the older the patients, the fewer received endodontic treatment (r = -0.9). From 2012 to 2017, numbers of all patients and treatments decreased, endodontic patients and treatments even more notably, and in all age groups. Per thousand patients in 2017, 62.1 teeth received root canal treatment and 14.9 pulp capping. Pulp capping comprised 19.2%, pulpotomies 0.8% and root canal fillings 80.0% of teeth receiving endodontic treatment. Of root filled teeth, 45.1% received filling in one canal, 17.0% in two and 37.9% in three or more canals, multi-canal options being less frequent in older patients (r = -0.94). CONCLUSIONS: Endodontic treatment, received by 9% of adult patients visiting private dentists in Finland, was strongly age-dependent, showing a decreasing trend with age and time.

Impact of systemic diseases and tooth-based factors on outcome of root canal treatment.

AIM: To investigate the impact of systemic health and tooth-based factors on the outcome of root canal treatment (RCT). METHODOLOGY: The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008-2011. The inclusion criteria were diagnosable pre- and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically 'healthy' and 'healing' cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi-squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT. RESULTS: The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10-83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow-up period was 6-71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P < 0.001), in teeth with optimal root filling quality (OR = 2.5; P < 0.001), in teeth restored with indirect restorations (OR = 3.7; P = 0.002) and in teeth with none/mild alveolar bone loss (OR = 2.4; P = 0.003). CONCLUSIONS: DM diminished the success of RCT, especially in teeth with apical periodontitis. However, tooth-based factors had a more profound impact on the outcome of RCT. This should be considered in clinical decision-making and in assessment of RCT prognosis.

Age of patient at the extraction of the third molar.

The purpose of this study was to assess the age of patients at the time of extraction of third molars. Our data included all routine and surgical extractions of third molars (n=8199 teeth) performed by general and specialist dentists of the public oral health services of the city of Helsinki over the period 2013-2014. Measurements included patient's age, gender, the identified third molar, the type of anaesthesia, the method of extraction, and the diagnosis at extraction. Patients' ages ranged from 10 to 99years. We found significant differences between younger and older age groups: third molar extractions occurred more often for women than for men below the age of 30years (P<0.001) and vice versa for patients older than 30. Extractions were more prevalent for the upper jaw (P<0.001), and surgical extractions were more common than routine extractions (P<0.001) below the age of 40years, but the corresponding prevalences reversed after the age of 40years. Diagnoses at extraction differed between younger and older patients. We conclude that the treatment pattern of third molars at public health services varies greatly over a lifetime, and that a greater variety exists than had been reported previously from oral and maxillofacial units.

Signs of disease occur in the majority of third molars in an adult population.

The purpose of this study was to assess clinical and radiographic signs of disease in third molars within a population that is representative of the Finnish adult population aged 30 years and older. A two-stage stratified cluster sampling method was used to collect the 6005 subjects, who were examined clinically and also by panoramic radiography. The state of impaction, presence of dentinal caries and/or restorations, presence of root canal fillings, periodontal pocket depth, and additional pathological findings such as over-eruption and widened follicle were assessed. Signs of disease in the third molars were found in 47% of the adult population and in 97% of those subjects with third molars. At least one sign of disease occurred in 82% of erupted third molars compared to 74% of those impacted in soft tissue and 33% impacted in bone (P<0.001). A diseased third molar was more often located in the mandible (60%) than in the maxilla (40%) (P<0.001), and was more often found in men (57%) than in women (43%) (P<0.05). It is concluded that signs of disease in third molars in the target population are more common than has been reported previously.

Prevalence of apical periodontitis in root filled teeth: findings from a nationwide survey in Finland.

AIM: To assess the prevalence of apical periodontitis in the Finnish population aged 30 years and older and relate it to the technical quality of root filling by the type of tooth. METHODOLOGY: As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects (n = 5335) aged 30-95 years (mean 50.2 years) to assess the apical and endodontic status of their teeth (n = 120635). Apical periodontitis (AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3 mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval. RESULTS: Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P < 0.001; OR = 6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women (OR = 2.0; 95% CI 1.7, 2.4) and men (OR = 2.5; 95% CI 2.1, 2.9). CONCLUSIONS: AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential.

Role of Employment in 11-Year Changes of Clinical Oral Health: A Multilevel Longitudinal Analysis.

The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y ( n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health-related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health-related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health. Knowledge Transfer Statement: The findings of this study can help clinicians and oral health policy makers to reorient oral health services toward those who are unemployed as a risk group for poor oral health. The research highlights the role of employment in the longitudinal changes of clinically determined oral health, taking into consideration other socioeconomic factors. The study concluded that unemployment seemed to have a role in social inequalities of oral health.

The Shape of the Dose-Response Relationship between Sugars and Caries in Adults.

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults' Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

Is prosthodontic treatment age-dependent in patients 60 years and older in Public Dental Services?

Prosthodontic treatment is a common procedure for the elderly as tooth loss is a reality in old age. Dentists take care of increasingly older patients with physiological age manifesting as cognitive impairment, frailty or multiple chronic diseases or who have side effects of medicines. We evaluated how patients' age affects prosthodontic treatment choice and whether we could identify the age when a change in practice occurs. In addition, we determined how common the treatment method of fixed prostheses is among patients aged 60 years or over in Public Dental Services (PDS) and how common rehabilitation of dentition with new dentures is compared with repair of existing dentures. Our data cover all patients aged 60 years and older (n = 130,060) treated in Helsinki PDS in 2007-2012. Data were aggregated into seven groups: 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, and 90 years and over. During the 6-year period, the mean annual number of the population was about 114,000 and the mean annual number of patients treated with prosthodontics 1700. Prosthodontic treatment choices (repair, removable prosthodontics, fixed prostheses, fibre-reinforced composite fixed prostheses) vary by age; the older the patient, the rarer fixed or fibre-reinforced composite fixed prostheses and removable prostheses and the more frequent repairs (P < 0.001). Denture repair was virtually the only treatment that patients over 90 years received. Based on our results, the age at which prosthodontic treatment practices in PDS change is around 70 years. Beyond this age, fixed prosthodontic treatment modalities are very rare and repairs are more common.

School-based intervention to promote preadolescents' gingival health: a community trial.

OBJECTIVES: Evaluation of the effectiveness of a school-based oral health promotion intervention on preadolescents' gingival health. METHODS: A community trial designed for a 3-month intervention study in a representative sample of 9-year-olds (n = 457) in 16 schools in Tehran, Iran. The schools were randomly assigned to three intervention groups and one control group, each group comprising two boys' and two girls' schools. The first group of children (n = 115) received intervention via class work, solving a set of puzzles containing oral health messages, under supervision of their health counsellor. The second group (n = 114), intervention via parents, included an oral health education leaflet and a brushing diary for supervising the child's tooth-brushing; the third group (n = 111) received a combination of both these interventions. The control group (n = 117) had no intervention. Effects of the intervention were assessed as changes in dental plaque and gingival bleeding. Improvements in gingival health were recorded when half of the index teeth with plaque at baseline became clean (acceptable oral hygiene) or when all index teeth with bleeding at baseline became healthy (healthy gingiva). Statistical analysis included chi square, anova, t-test, Number Needed to Treat (NNT) and generalized estimating equations (GEE). RESULTS: At baseline, none of the children were free of plaque and all except for three boys had bleeding. After the trial, acceptable oral hygiene was more frequent in the parental-aid (P < 0.001) and the combined groups (P < 0.05), and healthy gingiva in both groups (P < 0.001) in comparison with the control group. Outcomes in the class-work group did not differ from those in the control group. The GEE models confirmed a strong intervention effect on healthy gingiva in both groups where parents were involved: parental-aid group (OR = 7.7, 95% CI: 2.2-27.7) and combined group (OR = 6.6, 95% CI: 2.0-22.1). In all intervention groups more girls than boys achieved healthy gingiva (OR = 2.5-2.6). Parents' education showed no impact on the outcome. CONCLUSIONS: When a school-based oral health intervention involves parents it may result in a significant improvement in the gingival health of preadolescents with poor gingival health at baseline.

Cynical hostility as a determinant of poor oral health status in an adult population.

Our aim in this study was to determine whether there is an association between cynical hostility and clinically determined poor oral health, and whether this association is confounded by socioeconomic position and mediated by health behavior. The sample consisted of 4,207 dentate Finns, 30-64 yr of age. Oral health was measured in terms of numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets (> or = 4 mm). Cynical hostility was measured using the cynical distrust self-administered questionnaire. The subjects with the highest level of cynical hostility had fewer teeth, and a greater number of decayed teeth as well as teeth with deepened periodontal pockets compared to subjects with the lowest level of cynical hostility. The associations between cynical hostility and number of missing and decayed teeth were clearly confounded by level of education. Poor oral health behavior was shown to be a possible mediator between cynical hostility and number of decayed teeth, but not of missing teeth or teeth with deepened periodontal pockets. General health-related behavior did not serve as a possible mediator in any of the associations. In conclusion, cynical hostility can be considered as a risk marker for poor oral health. Interventions aimed to improve oral health should focus on psychosocial factors and on less-educated subjects.

A cluster randomised trial of effectiveness of educational intervention in primary health care on early childhood caries.

Early childhood caries (ECC) remains a serious problem in several developing and developed countries. This cluster randomised trial evaluated the impact of a 6-month educational intervention on ECC. The trial targeted 12- to 15-month-old children (n = 242) and their mothers in Tehran, Iran, visiting 18 public health centres, randomly selected and assigned to two intervention groups and one control group. At baseline, each mother was interviewed and each child underwent a dental examination of all teeth for the number of decayed teeth (dt) and of upper central incisors for the number of teeth with enamel caries (de). All mothers in the two intervention groups (A and B) received oral health instructions from the vaccination staff. In addition, group A received extra reminders. The outcome was defined as increments in the number of teeth with dt or de, as percentages of children developing new dt or de, and as the number needed to treat (NNT). No new de appeared in group A, the mean de increment in group B was 0.2 (SD = 0.6), and in the controls, it was 0.4 (SD = 0.7) (p < 0.05). The percentages of children developing new de were 0, 14, and 26%, respectively. No differences in dt increments were found. Regarding de, NNT for group A was 4 and for B 9; the figures for dt were 13 and 17, respectively. In conclusion, oral health education given to mothers by general health staff is a valuable tool to prevent caries in infants and toddlers.

Restorative treatment threshold reported by Iranian dentists.

OBJECTIVE: To study Iranian dentists' conceptions of the earliest stage to place a restoration on proximal caries lesions. BASIC RESEARCH DESIGN: A questionnaire survey was carried out among the participants of two annual dental meetings in Tehran, Iran, in December 2004 and July 2005. The questionnaire was filled in anonymously and returned during the meeting days. The questions covered two patient paper cases with schematic drawings of the radiolucency of proximal caries lesions according to bitewing radiographs from 20-year-old patients: one high-caries case and one low-caries case. Dentists' gender, age, working experience and place, and participation in continuing education served as background data. In total, 1,033 dentists completed the questionnaire, 63% were men. Statistical evaluation was by the Chi square test and logistic regression. MAIN OUTCOME MEASURES: Respondents were to select from four alternatives the earliest stage in the progression of a lesion at which they would intervene by restorative treatment. RESULTS: For the high-caries case, 77% of the respondents chose to restore a caries lesion confined to enamel; activity in continuing education was the strongest factor (OR = 1.4) to explain dentists' restoring a lesion no earlier than in dentine. For the low-caries case, 32% chose to restore a lesion in enamel. Restoring a lesion no earlier than in dentine was more likely (OR = 1.5) among female dentists. CONCLUSION: Iranian dentists seem to prefer early restorative intervention, which indicates a need to focus on the preventive aspects of caries treatment both in dental curricula and in continuing education.

Study motives and career choices of Iranian dental students.

OBJECTIVES: To investigate the study motives and career choices of Iranian senior dental students in relation to their background factors. SUBJECTS AND METHODS: During the spring term 2005, a questionnaire survey was administered to 327 senior dental students in seven randomly selected state dental schools in Iran. The questionnaire requested information on age, gender, parents' employment in dentistry, previous education and employment in dental hygiene, study motives, and career choices. Statistical analyses were made using independent sample t test, factor analysis, and binary logistic regression model. RESULTS: Based on the factor analysis, which explained 73% of the total variance, five motive dimensions were identified: altruism and intellectual challenges, characteristics of the profession, social status and security, other person's recommendation, and failure to be admitted to other study programmes. The mean for the 'characteristics of the profession' dimension was lower among the students with at least one parent employed in dentistry (p = 0.03). The 'altruism and intellectual challenges' dimension was reported to be more influential by the students with background in dental hygiene (32 students) compared to the others (p < 0.001). Engaging in postgraduate studies was the first career preference of 189 (70%) of the respondents. Those with a background in dental hygiene were less inclined to enter postgraduate courses (p < 0.001), but more eager to be employed in either the public or the private sector (p < 0.001), and to enter the community oral health and research field (p < 0.001) than the others. CONCLUSION: Personal characteristics and motives of the students play a major role in shaping their career preferences.

Tooth loss and prosthodontic rehabilitation among 35- to 44-year-old Iranians.

This study aimed to investigate the frequency of tooth loss and the magnitude of prosthodontic rehabilitation based on socio-demographic information among 35- to 44-year-old Iranians. Data (n = 8240) were collected by 33 examiners as part of a national survey using WHO criteria for sampling and clinical diagnosis. Gender, age, place of residence and level of education served as socio-demographic information. The number of teeth, functional dentition (subjects with 20 or more teeth) and prosthodontic rehabilitation were used as clinical variables. The chi-square test and logistic regression analysis were the methods of statistical evaluation. Of all subjects, 3% were edentulous. Of dentate subjects, 3% had 1-9 teeth, 21% had 10-19 teeth, 37% had 20-24 teeth and 39% had 25-28 teeth. In total, 76% of dentate subjects enjoyed a functional dentition. Among dentate subjects, 11% of the men and 16% of the women had prosthodontic rehabilitation with higher figures (P < 0.001) among women, older subjects and urban residents. Having a functional dentition was more likely among those with higher levels of education [odds ratios (OR) = 1.8, 95% confidence intervals (CI) = 1.6-2.1]. Women (OR = 2.4, 95% CI = 1.8-3.0) and urban residents (OR = 2.4, 95% CI = 1.8-3.3) were the most likely groups to have prosthodontic rehabilitation. Having prosthodontic rehabilitation was more likely among those lacking a functional dentition (OR = 6.0, 95% CI = 4.8-7.6). The greatest unmet treatment needs were found among those without a functional dentition. Functional dentition should be set as a primary oral health goal among working-age adults.

Dental findings in diabetic adults.

The dental status of dentate diabetic adults (n = 299) and its associations with diabetes-related factors was explored in Tehran, Iran. Presence of diabetes-related complications made no difference in mean values of DMFT, but was associated with a higher number of decayed and missing teeth, and fewer filled teeth. Higher level of HbA1c was associated with higher DMFT for men, but not for women. In conclusion, the results suggest a possible association between the level of metabolic control of diabetes mellitus and cumulative caries experience.

Oral health and treatment needs among 15-year-olds in Tehran, Iran.

OBJECTIVES: To study oral health status and treatment need among 15-year-olds in Tehran, Iran in relation to their parents' level of education. METHODS: A cross-sectional study based on the WHO criteria, was carried out in 2004 among 15-year-olds (n=506) in Tehran. Data collection was by a self-administered questionnaire and a clinical dental examination to assess dental caries, periodontal conditions and orthodontic treatment needs. RESULTS: Mean DMFT was 2.1 (95%CI=1.9, 2.4), which comprised DT=0.9, MT=0.2, and FT=1.0. The mean SiC index was 5.2 (95%CI=4.8, 5.5). Mean numbers of sextants with PI scores 0, 1, and 2 were 0.6, 2.1, and 3.3 respectively, and with CPI scores 0, 1, and 2, were 2.1, 3.5 and 0.4 respectively. Need for caries (DT>0) treatment existed in 40% of subjects, for scaling (CPI=2) in 24%, for oral hygiene instructions in 100%, and for orthodontic treatment in 26%. Subjects with caries and dental plaque were fewer among those whose parents had a high level of education (p<0.05). Presence of dental plaque was associated with DT>0 (OR=1.8, p=0.01) and CPI>0 (OR=11.2, p<0.001). CONCLUSION: Poor level of oral hygiene among the present 15-year-olds calls for school-based oral health promotion activities focusing on oral self-care.

Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm.

OBJECTIVES: To investigate the impact of feeding habits and daytime sugar intake on the prevalence of early childhood caries in a population where prolonged breastfeeding is a norm. METHODS: A cross-sectional study was carried out at 18 of 102 public health centers in Tehran. During a 4-day period at each center, between 20 and 35 children aged 1-3 years were enrolled, resulting in a sample of 504 children. In structured interviews, mothers were asked to give information about their child's feeding habits, daytime sugar intake, and their family's background. Sugar intake during the night was operationalized as separately calculated burdens of nighttime breastfeeding and bottle-feeding. Clinical dental examinations followed the World Health Organization criteria. Data analysis included chi-square test, t-test, ANOVA, and logistic regression modeling. RESULTS: Of the children, 56% were solely breastfed (mean duration 16.6 months; 95% CI 16.0-17.2), 42% were both breastfed and bottle-fed, and 2% were solely bottle-fed. Mean duration of breastfeeding for the solely breastfed 24- to 36-month olds was 22.8 months (95% CI 21.8-23.9). At bedtime, 69% were breastfed, 11% bottle-fed, and 20% were not fed at all. With respect to feeding during the night, 72% of children were breastfed, 12% were bottle-fed with milk, 1% received a bottle with water, while 15% were not fed. Early childhood caries (ECC) occurred in 3-26% of the children, depending on age group (P < 0.001). The burden of milk-bottle feeding at night was a clear determinant for ECC (OR = 5.5) whereas breastfeeding per se, its duration, the burden of breastfeeding at night, and daytime sugar intake were not. CONCLUSION: On account of its association with ECC, milk-bottle feeding at night should be limited, whereas prolonged breastfeeding appears to have no such negative dental consequences.

Reasons for and parental satisfaction with children's dental care under general anaesthesia.

OBJECTIVES: The aim of this study was to describe why healthy children's previous treatment experiences can be reasons for their dental treatment under general anaesthesia (GA), and to describe their parents' experiences and satisfaction with that treatment. SUBJECTS AND METHODS: The data cover those children (n=102) below 16 years of age who, being otherwise healthy, were referred for Public Dental Service GA dental care in Helsinki, Finland, over the course of one year because of serious difficulties in dental treatment. The parents were given a self-administered questionnaire inquiring about their child's previous experiences of dental care, and about their access to and satisfaction with the present GA treatment. Data on the children's dental state were taken from patient records. RESULTS: The children's mean age was 6.4 years (SD=2.6 years), and the mean number of teeth with untreated caries was 7.7 (SD=3.0). Of the total sample, 32% had undergone four or more previous unsuccessful dental visits. At the time of their first difficulties in dental care, 39% were below 3 years of age. The older the child, the more serious was her or his parents' ranking of the difficulties met during dental care (P=0.02). From the parents' point of view, dental fear was the most important reason for treatment failures, followed by pain. Seeking GA treatment had been easy for 93% of parents, and most of them were also satisfied with their child's present GA treatment. CONCLUSIONS: The most important factors leading to the use of GA, as reported by the parents, are dental fear and repeated unpleasant experiences during dental care, and therefore, these should always be properly diagnosed, prevented and controlled.

Salivary findings, daily medication and root caries in the old elderly.

Root caries is one of the main dental problems among the dentate old elderly. The aim of our study was to evaluate the occurrence of root caries in 196 dentate elderly (mean age 79.3) in relation to their salivary flow rate, buffering capacity and salivary microbial counts. These subjects participated in the oral health component of the Helsinki Aging Study in 1990-1991. Clinical oral examinations included assessment of the state of root surfaces and salivary flow rates, both paraffin-wax-stimulated and unstimulated. Salivary buffering capacity and the growth of salivary mutans streptococci, lactobacilli and yeasts were determined by means of commercially available kits. Root caries occurred in 52% of men and in 35% of women (p < 0.05). Number of decayed (DRS) and decayed or filled (DFRS) root surfaces correlated (r = 0.16 to 0.26) with salivary microbial counts. No correlation appeared between DRS and subjects' salivary flow rates. Basic estimates on the association between DRS and salivary findings showed that microbial counts only produced significant odds ratios, from 2.0 to 3.5. However, in a log-linear model high salivary mutans streptococci and yeast counts together with male gender were associated with greater occurrence of root caries.