[Oral health problems in nursing homes, revision of oral health care delivery is needed].

INTRODUCTION: Prevalence of oral health problems among nursing home residents is common, they suffer from oral diseases and need dental service. The aim of this study was to examine clinical oral health of Icelandic nursing home residents and their oral health quality of life. MATERIAL AND METHODS: Total (N=82) residents in two nursing homes in Reykjavik gave their consent to be involved in this descriptive cross-sectional study. Residents participated in a clinical oral health examination at site and answered oral health quality of life questionnaire. RESULTS: Total 89% (N=73) residents completed the study, mean age 86.8 years (SD=5.7, range 73-100 years), of whom third had their own teeth and like had teeth, and partial dentures, while 41.1% were completely edentulous. The clinical oral health examination showed high prevalence of untreated oral health problems (67%). Residents with the worst oral health scored significantly higher than those who were better dentate, affecting their oral health quality of life (p=0.014), functional limitation (p=0.002) and physical disability (p=0.000). Most oral health problems interrelated to chewing, eating and limited ability to eat certain foods affecting their capability of food intake. CONCLUSION: Current administration of oral health care in nursing home needs alteration and the qualification in geriatric oral health and oral health care must be guaranteed among nursing staff in these settings. The public and health professions should work together in oral care matters in nursing homes to maintain oral health and lifelong oral health quality of life among residents.

Opinions and Treatment Decisions for Dental Erosive Wear: A Questionnaire Survey among Icelandic Dentists.

Dental erosive wear (DEW) is common among children and adolescents, and a survey of Icelandic children showed that 30.7% of 15-year-olds were diagnosed with the condition. Objective. To gain knowledge about dental practitioners' experiences, opinions, and treatment decisions. Materials and Methods. A precoded questionnaire, previously used among Norwegian dentists, was sent electronically to all dentists in Iceland (n = 341). Results. The response rate was 64.2%, and 58% of dentists were male. More than half of the clinicians (54%) thought that prevalence had increased the last 10-15 years, and 67% reported it to be more common in male. Most (96%) recorded presence of DEW, but only 4% used a detailed scoring system. Lesions were mostly on occlusal surfaces of first mandibular molars (73%), on palatal in upper anterior teeth (61%), and on occlusal of maxillary first molars (36%). Most dentists (74%) reported a probable cause, e.g., high consumption of carbonated beverages (98%), acidic juices (68%), sport drinks (58%), reflux (54%), and eating disorders (20%). Dietary history was often recorded by 38%, and 65% never measured saliva. Most of the dentists (88%) treated patients themselves, and half of them preferred prevention with high fluoride and resin sealants. While some dentists wanted to restore teeth more invasively, most considered to restore with a filling. Conclusion. Icelandic dentists seem to be well educated for diagnosis and treatment of dental erosion, and dentists are aware of a minimally invasive approach. Clinical Significance. It is challenging for dentists to make the best treatment decision for patients with DEW, both in a short perspective and long perspective. At present, little is known about their knowledge and treatment approach, and there is no standard treatment which can be recommended. Therefore, the present study investigated dental practitioners' treatment decisions, as well as knowledge, experiences, and awareness of DEW.

Prevalence of dental erosion in children: a national survey.

OBJECTIVES: To measure the prevalence of dental erosion in permanent teeth in Iceland as part of the National Oral Health Survey. METHODS: A representative, nationwide sample of 2251 Icelandic children, 20% of those aged 6, 12 and 15 year, was examined. Dental erosion was recorded for all erupted permanent teeth and graded using the modified scale of Lussi. RESULTS: Erosion was not seen in the permanent teeth of six-year-olds, but was present in 15.7% of 12-year-olds, more frequently in boys than girls (19.9% boys, 11.0% girls; P < 0.001). Among 15-year-olds, dental erosion was seen among 30.7% of subjects (38.3% boys, 22.7% girls; P < 0.001). Severity of erosion was mostly scored as grade I, with only 5.5% of 15-year-olds scored as grade II, mostly on tooth 46 (4.3%) and 36 (4.2%). For 12-year-olds, 0.9% had erosion scores of grade II mostly on tooth 46 (0.8%) and 36 (0.7%). No subjects had erosion of grade III. The most common clinical manifestation of erosion was the appearance of cup-like lesions on the cusps of lower first molars. CONCLUSIONS: Dental erosion was frequently present by the age of 12; the prevalence doubled by age 15 and was seen almost twice as often among boys than girls. Teeth most frequently showing signs of erosion were the lower first molars. The rapidly growing prevalence of erosion demonstrated by this nationwide survey emphasizes the need for further research into the aetiology of erosion and possible methods of preventing and treating this emerging dental problem.

Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS.

OBJECTIVES: The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers. METHODS: A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade. RESULTS: D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y. CONCLUSIONS: Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

A standardized photographic method for evaluating enamel opacities including fluorosis.

OBJECTIVES: The objective of this study was to demonstrate the reproducibility of a standardized photographic technique for recording fluorosis when used by a group of epidemiologists as part of a large multicentred European study. METHODS: Studies were first carried out to develop the equipment specification and photographic method. The author (JAC) was then trained and calibrated in this method. She was then responsible for the training and calibration of examiners from a further six European study sites. The method involved taking two transparencies of the permanent maxillary central incisors of 8-year-old children, the first after 8 s while the teeth were still wet and the second after 105 s when the teeth had been allowed to dry out naturally. Data were collected at a central location during a training/calibration exercise and subsequently, during the conduct of a large study to measure fluorosis prevalence, at the seven sites. Intra- and interexaminer reproducibility of the photographic method were measured by grading the transparencies produced by all the examiners according to the DDE and TF indices. RESULTS: The time period in which the transparencies were taken was to within 4 s among the examiners. Transparencies scored according to the TF index gave a range of Kappa values of 0.45-0.66 for intraexaminer reliability and 0.32-0.55 for interexaminer reliability. When using the DDE index Kappa values ranged from 0.43 to 0.70 for intraexaminer reliability and from 0.34 to 0.69 for interexaminer reliability. CONCLUSION: The photographic method was mostly robust and reproducible when used by epidemiologists from seven European study sites.

A comparison of the prevalence of fluorosis in 8-year-old children from seven European study sites using a standardized methodology.

OBJECTIVES: The objectives of this study were to report on the prevalence of enamel opacities from seven European study sites using a standardized photographic method, and to investigate the importance of variables responsible for enamel fluorosis. METHODS: The sample comprised a randomly selected group of 300 8-year-old children in each of the study areas. One examiner from each area was trained and calibrated in the use of a standardized photographic technique. Two transparencies were taken of each child's permanent maxillary central incisor teeth; one to represent the teeth 'wet' and one when the teeth had been allowed to dry out naturally for 105 s. The transparencies were viewed 'blind' by the author (JAC) and scored using the DDE and TF indices. Data relating to variables considered to be associated with enamel fluorosis were also collected. RESULTS: The prevalence of diffuse opacities ranged from 61% in fluoridated Cork (Ireland) to 28% in Athens (Greece). The percentage of subjects with a TF score of three or more ranged from 4% in Cork and nonfluoridated Haarlem (the Netherlands) to zero in Oulu (Finland) and Athens. Fluoridated water and the prolonged use of fluoride tablets were found to be significant contributory factors to fluorosis. CONCLUSIONS: The prevalence of fluorosis was found to be highest in fluoridated Cork. The prolonged use of fluoride supplements was also found to be a significant risk indicator associated with fluorosis.

A European perspective on fluoride use in seven countries.

OBJECTIVES: The aim of this study was to collate data on national policies for the use of fluoride in the seven European countries participating in the FLINT project. METHODS: Policies on the use of fluoride were obtained for each of the study areas. Data collected included the presence of water fluoridation and regulations governing fluoride toothpaste and fluoride supplements. RESULTS: In Ireland 74% of the population had a fluoridated water supply but in all the other countries fluoride toothpaste was the principal form of delivering fluoride, usually recommended as a dose of a pea-sized amount. Fluoride supplement use varied considerably between countries. The Netherlands had the clearest regulations covering the use of fluoride supplements and definition of at-risk individuals. Most countries, even if they recognized particular caries-risk did not define the term clearly. In Iceland all children were regarded as being at high risk of developing caries. CONCLUSION: Considerable variation exists between European countries in their policies for fluoride use and no clear definitions of high-caries-risk individuals were found. The results show that there is even a lack of coherent thought and planning within the different countries, let alone between them.

Dental erosion in Icelandic teenagers in relation to dietary and lifestyle factors.

High consumption of fruit juices and carbonated drinks has been related to dental erosion. Teenage male Icelanders consume about 800 ml of carbonated drinks per day on average and this corresponds with the main age group and gender of patients seen with erosion. This study examined the prevalence of dental erosion in 15-year-old children in Reykjavík and looked at the association between erosion and some lifestyle factors in a case-control study drawn from the same sample. A 20% sample of the 15-year-cohort population (n = 278) was selected. Dental erosion was classified by location and severity (1 = enamel erosion; 2 = dentine erosion; 3 = severe dentine erosion) and was seen in 21.6% of subjects (68.3% male; 72% scored as grade 1; 23% grade 2; 5% grade 3). Control subjects were the first healthy subjects examined after a case subject had beens diagnosed. In the case-control study, information was gathered by multiple-choice questionnaire on symptoms of gastric reflux, tooth sensitivity, some lifestyle and dietar-factors. Several lifestyle and dietary factors, previously shown to be significantly related to dental caries in Icelandic teenagers, showed no significant relationship to tooth erosion. Although dietary factors are probably important in causing erosion, dietary recall questionnaires did not help in discovering individuals likely to develop erosion.

[Erosive drinks on the icelandic market.].

OBJECTIVE: Dental erosion seems to be a growing health problem in Iceland. The international literature indicates that beverages such as carbonated drinks and fruit juices have considerable potential to causes tooth erosion. The aim of this study was to assess the erosive potential of drinks on the Icelandic market. MATERIALS AND METHOD: This study measured, on three occasions: (1) pH before titration and (2) the volume of 1.0M sodium hydroxide required to raise the pH of 50 ml of the beverages to pH 5.5, pH 7.0 and pH 10.0. RESULTS: The pH before titration ranged from pH 2.03-6.79 and the volume of 0.1M sodium hydroxide required to bring the beverages to pH 5.5 ranged from 0.54 to 5.92ml, pH 7.0 ranged from 0.42 to 7.73ml and pH 10.0 ranged from 2.23 to 9.10ml. This study showed that citrus fruit juices (grapefruit and orange juice) needed the most base to neutralize of the beverages tested. The milk-based beverages had an initial pH above 5.5 and are therefore non-erosive, with the exception of milk-derived lactic acid and drinks containing lactic acid aimed especially at the child market. Carbonated drinks, sport drinks and energy drinks were relatively easy to neutralize despite having a lower pH than fruit drinks. CONCLUSIONS: It is concluded that many soft drinks have considerable erosive potential and several of these are particularly targeted at the age groups found in other Icelandic studies to consume large amounts of soft drinks and to have tooth erosion.