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Background: Etoricoxib is a second-generation cyclooxygenase-2-inhibitor approved in 2012 for short-term treatment of pain associated with dental surgery. Objectives: To evaluate etoricoxib utilization in dental patients in the Nordic countries, including its off-label use. Methods: The entire populations of Denmark, Finland, Sweden and Norway with etoricoxib prescriptions written by dentists and dispensed in 2012-2014 were evaluated using national register data. Nationwide estimates of etoricoxib utilization were generated according to year, gender, age, dose and package size. Off-label use in paediatric patients, prescribed doses >90 mg/day or for dental contacts not associated with surgical procedures, and concomitant administration with anticoagulants were evaluated. Results: Utilization of etoricoxib for dental pain was low (1615 prescriptions: Finland, 907; Sweden, 359; Norway, 337; Denmark, 12). Overall, 70% of the prescriptions were without an associated dental procedure. Moreover, 58%, 55%, 10% and 58% of the prescriptions in Denmark, Finland, Sweden and Norway, respectively, were for >90 mg/day doses. Few paediatric prescriptions were dispensed (n < 10), and only a small overlap (n = 21) was observed between etoricoxib and anticoagulant prescriptions. Conclusions: Given the low overall number of prescriptions, it is unlikely that off-label use of etoricoxib within dentistry in the Nordic countries is an important public health concern. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to study the effect of adaptive image processing on the visibility of anatomical structures in storage phosphor plate (SPP) panoramic images.Materials and Methods: Three hundred SPP panoramic X-ray radiographs of children and adolescents were used. The radiographs were post-processed using general operator processor (GOP) technology, resulting in both a standard-processed and a GOP-processed radiograph. Four specialists in dental radiology compared the structural image quality of all standard-processed and GOP-processed panorama images for six anatomical structures, using a six-point scale for visual grading characteristics (VGC) analysis.Results: For three of the anatomic structures - the root canal space of the mandibular left first premolar, mandibular canal left side and periodontal ligament space of the mandibular right first molar - there was a statistically significant difference to the GOP's advantage. For the three remaining structures - dentino-enamel junction of the maxillary right first molar, crista alveolaris of the mandibular left molar area and floor of maxillary sinus right side - no significant difference between standard processing and GOP processing was obtained.Conclusions: The study demonstrates that it is possible to improve the quality of SPP radiographs and the visibility of anatomical structures by using the GOP technique. Manufacturers' image-processing programs can be further developed, as there is a possibility of improving the diagnostic content of an image with external processing. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.Materials and Methods: A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.Results: Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.Conclusions: This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy is a commonly used treatment modality in head and neck cancer; however, it also negatively affects healthy structures. Direct damage to oral soft and hard tissue frequently occurs with radiotherapy. In this study, we aimed to evaluate the effect of radiotherapy on bone surrounding titanium dental implants via biomechanical and molecular methods.Materials and Methods: Fifty-four implants were inserted in the left tibiae of 18 adult male New Zealand rabbits (3 implants in each rabbit). After 4 weeks of the implant surgery, the left tibiae of 12 rabbits were subjected to a single dose of irradiation (15 Gy or 30 Gy). Four weeks after the irradiation, rabbits were sacrificed and removal torque test was done for the biomechanical evaluation. Bone morphogenetic protein-2 (Bmp-2) and fibroblast growth factor-2 (Fgf-2) expression analyses were performed with Real-time PCR. Statistical analysis was done using SPSS.Results: The control group showed significantly higher removal torque value than the 15 and 30 Gy irradiation groups, and the 15 Gy irradiation group had higher removal torque value than the 30 Gy irradiation group (p < .001). The 15 Gy and 30 Gy irradiation groups had significantly lower Bmp-2 and Fgf-2 mRNA expressions than the control group (p < .001). In addition, the 30 Gy irradiation group had significantly lower Bmp-2 (p < .01) and Fgf-2 mRNA expressions (p < .001) than the 15 Gy group.Conclusion: Radiotherapy with 15 and 30 Gy doses can adversely affect osseointegration of implants by reducing the quality of bone and impairing the bone-to-implant contact. The mechanism of action seems to be related to alterations in Bmp-2 and Fgf-2 mRNA expressions. [ABSTRACT FROM AUTHOR]

Objective: Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.Materials and Methods: A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.Results: The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19.Conclusions: The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands. [ABSTRACT FROM AUTHOR]

Objective: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention.Materials and Methods: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients.Results: The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54).Conclusions: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training. [ABSTRACT FROM AUTHOR]

Introduction: Significance testing for comparison of the baseline differences between the intervention arms has received a strong condemnation. The goal of this study was to assess the prevalence of randomized controlled trials (RCTs) comparing the baseline characteristics between intervention groups using significance tests in top ten impact factor dental journals.Materials and Methods: RCTs published in 10 high impact factor dental journals were searched in PubMed database. Literature search was limited to time duration of 5 years from September 2012 to August 2017.Results: We analysed 521 RCTs after excluding 47 non-RCT articles from the total of 568 articles. Baseline demographic characteristics table was not reported in 45.9% of the RCTs and 26.2% of the RCTs did not report table of baseline clinical characteristics. In 38.9% of the studies, significance testing was employed to compare baseline differences between the intervention arms.Conclusions: Many trials published in the reputed dental journals failed to follow the recommendations of CONSORT statement regarding reporting of baseline tables and avoiding comparison of baseline differences with significance test. [ABSTRACT FROM AUTHOR]

Background. Treatment strategies have changed with efforts on arresting carious lesions suspected to have an intact surface sparing operative treatment for cavitated lesions. Radiography is still the most recommended adjunct method in the diagnosis of clinically inaccessible approximal surfaces. Bitewing radiography. The major drawback of bitewing radiography for caries diagnosis is that the clinical state of the surface cannot be determined; i.e. if cavitation has developed or the demineralized surface is still intact. Based on studies of the relationship between radiographic lesion depth and clinical cavitation in approximal surfaces, a threshold for operative treatment decision has been suggested when a lesion is observed radiographically more than one-third into dentine. However, the results from previous studies are contradictory and the majority of studies are ∼25 years old. In addition, there are few longitudinal observational studies on the behaviour of dentinal carious lesions, particularly in adults. Cone beam computed tomography. Cone beam CT is an advanced 3-dimensional radiographic modality, which seems much more accurate than intra-oral modalities for displaying cavitation in approximal surfaces. Nonetheless, there are several drawbacks with CBCT, such as radiation dose, costs and imaging artefacts. Therefore, CBCT cannot be advocated at current as a primary radiographic examination with the aim of diagnosing cavitated carious lesions. Conclusions. Bitewing radiography is, thus, still state-of-the-art as an adjunct in diagnosing carious lesions in clinically inaccessible approximal surfaces. The risk for cavitation is related to lesion depth, but new studies are needed in both child and adult populations to validate current thresholds for the operative treatment decision based on the radiographic lesion depth. [ABSTRACT FROM AUTHOR]

Objective. Pit and fissure sealants have been used for many decades to prevent the initiation of caries on susceptible tooth surfaces. The purpose of this study was to analyze the peer-reviewed published scientific literature on pit and fissure sealants over the last 50 years. Materials and methods. On the PubMed database, all publications on pit and fissure sealants from 1962-2011 were extracted using the search phrase [(pit OR fissure) AND (sealant OR sealants OR adhesive)]. Details of all retrievals were individually entered into SPSS for analysis. Results. A total of 2829 publications were found. The mean number of authors was 2.73 ± 1.90 (range = 1-23). Although single-authorship was the modal group with 32.1%, it had a sustained decrease from 75.0% for 1962-1971 to 17.6% for 2002-2011. On the contrary, publications with three or more authors increased from 8.3% to 47.3% during the same period. Human studies accounted for 88.6% and clinical trial was 11.9%, followed by reviews at 10.2% and randomized controlled trials at 6.9%. English was the language of reporting for 82.0% of the studies. Conclusion. It is anticipated that future research on pit and fissure sealants will focus on newer and more effective materials. [ABSTRACT FROM AUTHOR]

Objective. To determine if the differing contrast resolution of various LCD monitors affects the reliability or accuracy of measurements of proposed implant sites. Materials and methods. Edentulous areas of human dry skulls were marked with radiopaque markers in order to standardize the plane of the transverse cross-sections of the ridges and path of measurements. The skulls were imaged by a CBCT device and the images stored in proprietary format on the workstation. The data sets were then transferred, with the proprietary reformatting software, to two different laptops using CDs. Transverse cross-sectional images of the ridges were reformatted on all three computers and ridge dimensions were recorded using the linear measurement tool of the proprietary software. Ridge dimensions were recorded directly from the three different monitors by two observers and compared to measurements recorded directly from the bone. The measurement errors and intra- and inter-examiner reliability were calculated for each monitor and compared with each other. Results. Intra- and inter-examiner reliability scores for the measurements recorded from all three devices were very high and ranged between 0.993-0.999. The mean of the absolute errors was 0.55 mm for the workstation, 0.61 mm for laptop 1 and 0.68 mm for laptop 2. The absolute errors were statistically significant for all three monitors ( p-value < 0.001), but there was no statistically significant difference between the absolute errors obtained from the three monitors. Conclusions. No differences in the reliability or accuracy of measurements of implant site dimensions were obtained using color LCD monitors with different contrast resolution capabilities. [ABSTRACT FROM AUTHOR]

Objective. The aims were to determine whether means of different fear-related items were similar in 1998 and 2001 and to find a common factor structure of the modified CFSS-DS for children at different ages. Materials and methods: Independent random samples of 6-, 9-, 12- and 15-year olds were drawn in two cities in 1998 and 2001 ( n = 180 per age group from each city). The study group in 2001 comprised 282, 265, 281 and 234 subjects aged 6, 9, 12 and 15 years, respectively. Each child received a modified CFSS-DS form to be filled out at home. Mean scores of different fear-related items were reported for each age group for both data sets. Confirmatory factor analyses (CFA) were performed to test whether the three factor structures revealed for 6-, 9- and 12-15-year olds in 1998 fitted the 2001 data. Multiple group CFA was used to test for the equivalence of the factorial structure across age groups (configural invariance). Results. The age-specific patterns of the means for individual fear-related items in 2001 corresponded to the mean values for 1998. When age-specific factor structures were tested separately for each age group, the factor structure for 9-year-olds was, in general, the best-fitting overall structure. The factor structure had a good fit for all age groups, but the loadings differed at different ages. Conclusions. The modified CFSS-DS provides consistent factor structures for children at different ages and reflects the changes in manifestations of dental fear during growth. [ABSTRACT FROM AUTHOR]

Objective. To examine the properties, validity and responsiveness of the Family Impact Scale in a consecutive clinical sample of patients undergoing dental treatment under general anaesthesia. Materials and methods. A consecutive clinical sample of parents/caregivers of children receiving dental treatment under general anaesthesia provided data using the Family Impact Scale (FIS) component of the COHQOL© Questionnaire. The first questionnaire was completed before treatment, the follow-up questionnaire 1-4 weeks afterward. Treatment-associated changes in the FIS and its components were determined by comparing baseline and follow-up data. Results. Baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up). All FIS items showed large relative decreases in prevalence, the greatest seen in those relating to having sleep disrupted, blaming others, being upset, the child requiring more attention, financial difficulties and having to take time off work. Factor analysis largely confirmed the underlying factor structure, with three sub-scales ( parental/family, parental emotions and family conflict) identified. The parental/family and parental emotions sub-scales showed the greatest treatment-associated improvement, with large effect sizes. There was a moderate improvement in scores on the family conflict sub-scale. The overall FIS showed a large improvement. Conclusion. Treating children with severe caries under general anaesthesia results in OHRQoL improvements for the family. Severe dental caries is not merely a restorative and preventive challenge for those who treat children; it has far-reaching effects on those who share the household and care for the affected child. [ABSTRACT FROM AUTHOR]

Objective. To assess the prevalence and severity of dental pain on the daily lives of adolescents and their families in Brazil, and, in terms of socio-economic status, whether there are differences in the prevalence of impacts. Material and Methods. In a cross-sectional survey of a random sample of 14 to 15-year-olds in Brazil, the prevalence and severity of dental pain, and how dental pain affects daily functioning, were assessed using a child-related questionnaire. A family-related questionnaire included questions on a child pain inventory and the pain-related impacts on the daily lives of the child's family members. Results. 14.5% of children reported high impact levels on their daily lives related to dental pain, the more so among girls than among boys, i.e. 16.7% compared to 11.6%. Significantly more impacts occurred in lower socio-economic class children than in higher, i.e. 19.7% versus 7.8%. The prevalence of impacts among children who reported dental pain (n=354) was high; 64.7% reporting that concentration at school was affected, 55.6% that home activities were affected, and 51.4% that leisure activities were affected. There was a significant relationship between impacts of dental pain on children and families. Overall prevalence of impacts on children's families was 15.2%. The most frequent family dimensions affected were: in carrying out normal household activities (19.7%) and in visiting friends and relatives (17.7%). Emotional stability was the most frequent psychological activity dimension affected (14.1%); 9.6% of parents were woken up as a result of their child's dental pain on an average of 3.7 nights per week. Conclusions. Dental pain has considerable impact on the daily lives of adolescents and their families in Brazil. There are many more dental pain-related impacts in girls and in lower social class children. [ABSTRACT FROM AUTHOR]

Objective. To investigate the potential use of two-dimensional digital images as an alternative to orthodontic casts in the assessment of malocclusion and orthodoantic treatment need. Material and Methods. Assessment of malocclusion (Angle's classification of molars, overjet, and overbite) and orthodontic treatment need (Index of Orthodontic Treatment Need (IOTN): Dental Health Component (DHC) and Aesthetic Component (AC)) was conducted on 313 study casts and their images by two trained and calibrated examiners. Agreement of orthodontic treatment need and Angle's molar classification was assessed employing Kappa statistics (κ). Agreement of overjet and overbite (measured in mm) was assessed in comparison and correlation analyses. Inter- and intra-examiner reliability of assessment was investigated. Results. There was substantial agreement of the molar relationship classifications (κ >0.70), orthodontic treatment need as assessed by IOTN-DHC (κ =0.79) and IOTN-AC (κ =0.56) between measurements obtained from orthodontic casts and their images. There was also substantial agreement of measurements of overjet and overbite as obtained from orthodontic casts and their images. The standardized directional differences of overjet and overbite were ≤0.2. The intra-class correlation coefficients of assessments of overjet and overbite obtained from orthodontic casts and their images were >0.90. Inter- and intra-examiner reliability for the assessment of malocclusion and orthodontic treatment need was acceptable. Conclusion. Two-dimensional digital images can be used as an alternative to casts in assessment of malocclusion and orthodontic treatment need. [ABSTRACT FROM AUTHOR]

Objective. New radiographic techniques have made it possible to color-code intra-oral digital radiographs. The purpose of the present study was to compare the accuracy and precision of marginal bone level measurements in digital radiographs with and without color coding. Material and methods. Periapical digital radiographs of 21 patients were processed with and without a color-coding algorithm. The patients had periodontal surgery immediately after exposure of radiographs, and vertical distances from the cemento-enamel junction (CEJ) to the most apical part of the marginal bone were measured clinically. The measured values were considered as a reference standard and subtracted from the corresponding radiographic vertical distance. Seven observers contributed to the radiographic measurements under the same viewing conditions. Results. No statistically significant differences were found between absolute differences of vertical distances obtained from radiographs and their corresponding reference standards in the two types of radiograph. Intra- and inter-observer variability was not significant. Conclusion. Color-coded digital radiographs did not provide a more favorable accuracy when assessing marginal alveolar bone levels than black-and-white radiographs and thus did not improve measurement of such levels. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the prevalence of periodontal disease in different groups of tobacco users. Participants ( n = 1674) were selected from an initial random sample of residents in the Stockholm region. Socio-demographic characteristics and life-time history of tobacco use were registered in a self-completed questionnaire, followed by a clinical examination. Cumulative life-time tobacco use was analyzed in pack-years and can-years as the exposure of interest. Among participants, 50.8% were females and 49.2% were males. Life-time tobacco use was categorized into four mutually exclusive categories. Approximately, two-thirds of snuff users had combined snuff use with cigarette smoking during their life. Tobacco users had a higher prevalence of periodontal disease compared to never users. Exclusive smokers and mixed users presented the less favorable situation. Unhealthy periodontal conditions increased with increasing exposure to smoking, most evidently at the level of 15 or more pack-years. There was a significant positive association between current or former smoking and periodontal disease (OR = 2.7, CI = 1.7-4.3 and OR = 2.0, CI = 1.2-3.3, respectively) even after adjustment for plaque level. An indication of association was also apparent with former snuff use. Plaque was independently associated with periodontal disease, with a dose gradient. Smoking is associated with periodontal disease independently of plaque. Combining cigarette smoking and snuff use during life does not convey a decreased probability of being diagnosed with periodontal disease compared to smoking exclusively. [ABSTRACT FROM AUTHOR]

The aim was to analyze prevailing oral hygiene practices among urban Saudi Arabians in relation to age, gender, and socio-economic background. Structured interviews were performed with 1155 regular patients at two centers providing dental care for university and military staff and their families, respectively, in the city of Makkah. Consecutive patients were stratified according to gender and age into 6 age categories from 10 to 60 years, with 50 male or female subjects in each group at each center. Oral hygiene habits were correlated with the subject's age and gender, and analyzed statistically using a generalized linear model. It was found that 73% used a toothbrush daily, while a miswak was used daily by 65%. Significant differences were found between genders and age groups, and between the centers. Regular miswak use was more prevalent among men (P < 0.01), while women used toothbrush more than miswak (P < 0.05). Regular miswak use was more frequent at older age (P < 0.001) and tooth brushing was less prevalent. Forty-four percent of the 51- to 60-year-old patients at the military center never used a toothbrush. Regular toothbrush use was more prevalent in the youngest age groups (P < 0.001). Among the 10- to 15-year-olds, 45% at the university center used only a toothbrush, while no adolescents at the military center used only a toothbrush. We conclude that there are large differences in current oral hygiene habits among Saudi Arabians, and that these are related mainly to age and socio-economic level, and to a lesser extent gender. This should be taken into account when planning oral health strategies for different categories. [ABSTRACT FROM AUTHOR]

The major aim of the study was to investigate whether differences concerning acceptance of dental treatment and amnesia after rectal sedation with midazolam can be explained by temperament traits in the child. Fifty children (1.5 4.0 years), consecutively referred for dental extractions because of dental trauma or caries, were sedated with midazolam 0.3 mg kg(-1) rectally. Level of sedation (state of mind) was assessed according to Wilton before and 10 min after administration of the sedative. The children's acceptance of procedures during the oral examination, the administration of the sedative, and the dental treatment were assessed according to Holst. Acceptance of an injection of local anesthesia and tooth extraction was dichotomized as satisfactory (n = 26) or unsatisfactory (n = 24). The parent assessed temperament using the Emotionality Activity Sociability (EAS) Scale of Child Temperament. Amnesia was evaluated by the parent on the following day. The relation between temperament and outcome variables was analyzed using a multiple logistic regression analysis. Children regarded as shy by the parent were at significantly greater risk of unsatisfactory acceptance of the dental treatment (P< 0.05). High scores of negative emotionality were significantly related to less amnesia (P < 0.05). We conclude that parental ratings of their child's temperament are valuable in predicting a child's acceptance of dental treatment under sedation. [ABSTRACT FROM AUTHOR]

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P< 0.001). Preventive dental services were provided more frequently by the public than the private system (P< 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system. [ABSTRACT FROM AUTHOR]

This study compares dental caries reduction in Belgian 12-year-old children of different socioeconomic status in 1983 and 1998. Moreover, the relative effect of dental health factors on caries reduction is estimated. In the region of Brussels, children in the 7th grade at the same schools participated in cohort 1983 (n = 533) and in cohort 1998 (n = 496). DMFT, DMFS, and dental fluorosis were clinically recorded. The socioeconomic status of the children was established on the basis of their parents' education and profession. Data on children's home-based and professional dental health care habits were registered. Caries reduction was observed in both privileged and non-privileged children. However, non-privileged children, in cohort 1983 and cohort 1998, had significantly higher DMF scores than privileged children (P < 0.01). Dental fluorosis was more often identified in privileged children than in non-privileged ones. Most of the dental factors relating to children's home based and professional care were associated with caries reduction. Caries reduction was strongly related to socioeconomic status; non-privileged children registered lower than their counterparts. [ABSTRACT FROM AUTHOR]

Previous dental caries studies in Bangladesh have been performed on non-randomized samples, using various clinical criteria. Estimates of dental caries prevalence in 12-year-olds are therefore uncertain. In the present study a clustered, stratified random sampling procedure was used. Dental caries was stored as DMFT in accordance with the WHO recommendations and related to oral hygiene and various behavioral and social variables. The caries experience was found to be low, with a mean DMFT score of experience was 0.97. Poor oral hygiene and bleeding gingiva were frequently detected. Dental caries associated with sex, oral hygiene (girls), and use of dental services (more caries among frequent users than non-users). A Correlation matrix analyzing the most influential independent variables indicated that sex and oral hygiene seemed to have an independent effect, whereas a web of social factors interfered with the use of dental services' variable. [ABSTRACT FROM AUTHOR]

In Finland, adults born in 1961 or later were progressively entitled to subsidies for dental care from private practitioners during 1986-90, while at the same time having access to care in the Public Dental Service. The aim of this study was to compare the effects of attendance frequency of private dental care on treatment costs and treatment spectrum for the heaviest and lowest users over a period. Three separate cohorts of recipients of reimbursements were formed, using the Social Insurance Register. The highest and lowest cost groups in 1986, 1990, and 1994 were followed up to 1997. Initially, the mean numbers of visits were 1.2-1.3 and 5.2-5.6 and cost Euro 48 53 and Euro 358-379 among low users and heavy users, respectively, in all cohorts. Among the heavy users (the high-cost category) infrequent attendance was related to higher and frequent attendance to lower mean annual costs of care. Among the low users (the low-cost category the opposite was true. Those who initially belonged to the high-cost category received in 1997 significantly more (P < 0.01) restorative treatment and, to a lesser extent, more (P < 0.01) preventive and periodontal treatment than those belonging to the low-cost category. Frequent dental care seemed to benefit those who received a lot of care. Frequency of attendance was not associated with being a low or a heavy user, indicating rigid check-up routines. The inclusion of simple oral health data would greatly improve the usefulness of the register as an evaluation tool for health-political decisions. [ABSTRACT FROM AUTHOR]

The aqueous phase of glass ionomer cements enables fluoride ions to diffuse and to be released from the material. The matrix of resin composites is much less hydrophilic, and fluoride incorporated in the material is only released in small amounts. It was the purpose of the present work to study the influence of resin matrix formulation on the fluoride release from experimental, fluoride-containing resin composites. The resin composites were based on methacrylate monomers and the adduct of maleic anhydride and HEMA (2-hydroxyethyl methacrylate). The resin composites contained 1 w% or 5 w% of AlF3*3H2O. A glass ionomer cement and a compomer were used as controls. Five disks of each material were stored in distilled water at room temperature. By means of a fluoride sensitive electrode, the fluoride release from disk-shaped specimens was determined periodically over 3 years. The glass ionomer cement released the most fluoride (1.54 +/- 4 microg/cm2 after 1 year and 248 +/- 7 microg/cm2 after 3 years). The compomer released relatively little fluoride during the 1st year (30 +/- 1 microg/cm2) but after this time the rate of fluoride release became equal to that of the glass ionomer cement, resulting in a release of 122 +/- 8 microg/cm2 after 3 years. Regarding the resin composites, the fluoride release increased with the hydrophilicity and the acid character of the polymer matrix. The release, however, was significantly lower than that from the glass ionomer cement and the compomer and ranged from 1.2 +/- 0.07 to 42 +/- 3.9 microg/cm2 at 1 year and from 2.3 +/- 0.16 to 79 +/- 6 microg/cm2 at 3 years. [ABSTRACT FROM AUTHOR]

The aim of this study was to measure the quality of children's dental healthcare from the oral health records of 10-year-olds and from the numbers of children in risk groups. The focus was on dental healthcare and markers of dental records. A representative sample of women expecting their first child was selected in southwestern Finland. Children's dental health, dmft/DMFT = 0, was recorded in 45% of cases with a mean DMFT index of 0.5, and dmft/DMFT > or = 5 in 15%) of the children. Late-appearing caries (caries-free at the age of 5 years but caries-existing thereafter) was present in 31% (258/828) of the children. The focus on restorative dental healthcare was appropriate. The use of sweets was documented in 23% of cases and tooth-brushing in 28%. A total of 26% of the children had gingivitis in every segment. The study illustrates that only one of the targets has bees fully reached. [ABSTRACT FROM AUTHOR]

Hypersensitivity reactions of the oral mucosa comprise an array of clinical manifestations. Some of the reactions are difficult to differentiate from toxic reactions. Hypersensitivity reactions of type I, type III, and type IV are well known, although, especially for types I and III, they are rarely encountered. Type-I reactions are most frequently seen related to application of polymers in the oral cavity, such as orthodontic bonding and fissure sealant materials. There may also be systemic manifestations such as urticaria. Type-IV reactions may be seen related to most dental materials used, from amalgam and gold to polymers. These reactions appear as chronic reddening and/or ulceration of the oral mucosa. Lichenoid reactions have histopathological characteristics compatible with type-IV hypersensitivity reactions and are the most prevalent material-adverse reactions seen in the oral cavity. A special variety inside the lips with multiple papules and/or diffuse redness has recently been identified. This lesion comprises a serious treatment challenge. Skin patch tests, applying a series of dental materials in non-toxic concentrations on the skin, have been used to identify sensitization. However, the value of those tests can be questioned. Exacerbation of geographic stomatitis may be another form of hypersensitivity to dental materials. [ABSTRACT FROM AUTHOR]

Dentistry usually is 'wet work' with risk of damage to the skin barrier, and the hands may be exposed to skin irritants and contact-sensitizing substances used in dental materials or gloves. Airway irritants may also be present. This study assessed the consequences of work-related skin and airway symptoms among dentists in terms of contact with health authorities, sick leave, or changes in the professional career. A questionnaire on these factors was answered by more than 3000 Swedish dentists. Only 6% of the respondents had consulted a physician, although 22% had noted work-related skin symptoms. In 2% the skin symptoms had caused sick leave, and about 2% had reported their skin symptoms as an occupational disease. Two per cent had consulted a physician owing to work-related airway symptoms, which is a minor part of the 13% who had experienced such symptoms when in contact with dental materials. Twenty-five dentists (<1%) had been on sick leave because of work-related airway symptoms. Only 1 dentists reported change of activities or occupation owing to work-related skin or airway symptoms, and in most cases these symptoms only contributed to their decision. In summary, whereas sick leave in dentists because of musculoskeletal problems may be common, the present study shows that this is not the case for work-related skin or airway symptoms, and such symptoms seldom affect the dentists' professional career. [ABSTRACT FROM AUTHOR]

The present investigation was a comparative study of 169 highly fearful dental patients, some of whom received regular dental care (n = 28) and some who never, or only when absolutely necessary, utilized dental care (n = 141). It was hypothesized that phobic avoidance is related to anticipatory stress and anxiety reactions, negative oral health effects, psychological distress, and negative social consequences. Background factors (sex, age, education, and dental attendance pattern), dental anxiety, general fears, general state and trait anxiety, mood states, depression, and quality of life effects were studied. Data were analyzed with descriptive statistics and with exploratory factor and multiple logistic regression analysis. It was shown that dental anxiety is significantly higher among the avoiders and this is in particular evident for anticipatory dental anxiety. Oral health differed between the groups, and it was shown that avoiders had significantly more missing teeth, whereas regular attenders had significantly more filled teeth. The avoiders reported a stronger negative impact on their daily life, whereas there were no significant differences between the groups with regard to general emotions. The logistic regression analysis showed that phobic avoidance was predicted only by anticipated dental anxiety and missing teeth. It was concluded that differences between high dental fear patients with regular dental care and phobic avoidance were mainly related to anticipated fear and anxiety, oral health effects, and concomitant negative life consequences. These results are discussed in terms of subjective stress, negative cognitions, social support, and coping-strategies. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the short-term efficacy of cognitive therapy and applied relaxation in dental fear treatment and to compare these methods with conventional pharmacological sedation (nitrous oxide sedation). Patients (n = 65) with severe dental fear were randomly assigned to the different treatment methods and received 10 weekly sessions of individual therapy. Dropout rates were low, and all patients who completed the therapy sessions were able to receive dental treatment. Scores on dental fear tests were significantly reduced compared with pretreatment level for all treatment groups. There were no major differences between treatment methods in this short-term perspective. [ABSTRACT FROM AUTHOR]

Our aim was to identify determinants of utilization of dental services among 20- to 34-year-old Danes as outlined in a conceptual framework. Our sample consisted of a sample of 464 individuals who had been interviewed by 10 experienced interviewers from The Danish National Institute of Social Research. Our questionnaire comprised a battery of questions based on our conceptual model. The analysis was done in a hierarchical manner using a framework with three steps: Predisposing factors --> Enabling factors --> Need factors --> Utilization. Associations were evaluated with multivariate logistic regression analysis and expressed as odds ratios. The following factors were significantly associated with irregular use of dental services: age, sex, exercise habits, cost of dental treatment, dental anxiety, and perceived condition of teeth. Our findings suggest that a strategy aiming to increase young people's dental attendance should focus on the transition period that is, when the youngsters leave the public dental health care system and have to make use of the private system. The strategy should also take into account that young men are more likely to become non-users. A concerted effort could be dedicated to the non-negligible group of individuals with dental anxiety and dental phobia. [ABSTRACT FROM AUTHOR]

This comprehensive study was carried out to describe and analyze the oral health status, perceived oral health problems, patients' costs, and oral health behavior in a group of patients with primary Sjögren syndrome (PSS). In particular, the objective of this report was to assess whether Sjögren syndrome patients had more dental caries experience than a control group. Data were collected by means of interviews and clinical oral examinations. The study comprised 53 patients with PSS and a control group of 53 persons matched by age. Among the younger patients the number of decayed, missing, or filled teeth (DMFT) was 22.3, compared with 18.8 among controls (P< 0.05). In parallel, the DMFT in the old-age PSS patients was 26.2, against a DMFT of 22.1 for controls (P< 0.001). On average, the young patients had seven teeth missing, whereas two missing teeth were found among controls (P < 0.01). PSS patients had more frequent dental visits--every 3-4 months (40%)--than controls (19%). In parallel, 78% of the PSS patients brushed their teeth more than twice daily, compared with 28% of the control group. The PSS patient group reported having had more teeth extracted, more trouble with their teeth during lifetime, and higher expenses for dental treatment than controls. In spite of the more regular oral health care practices than the general population, PSS patients had experienced more dental caries and more radical dental treatment. It is suggested that the National Health Insurance should give emphasis to preventive care to patients with PSS. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the structural relationships between dental anxiety, mood, and general anxiety among 220 dentally anxious patients who participated in a clinical study. A structural equation modeling analysis (SEM) was applied by using the LISREL program on the hypothesized latent variables dental anxiety, mood, and general anxiety, which were measured by means of several psychometric tests. The final model showed that mood and general anxiety had positive factor loadings on dental anxiety. However, the impact of the general anxiety latent variable was not significant as compared with the mood factor. Another finding was that the residual variance for the latent variable dental anxiety was 0.68, indicating that a major portion of the variance is still unexplained by the tested variables. In conclusion, this study showed a relationship between dental anxiety, general anxiety, and mood among dentally anxious patients. [ABSTRACT FROM AUTHOR]

The emergence of permanent teeth was studied in 187 Finnish children who had longitudinal records of the emergence of all permanent teeth except third molars. Exact emergence dates were known for about one third of the teeth. Emergence ages of the remaining teeth were based on their presence and absence at clinical examinations. We calculated ages at clinical eruption of permanent teeth and tooth counts at half year intervals. Ages corresponding to counts of permanent teeth from 1 to 27 are also given. The schedules presented, which slow means, standard deviations, and percentage distributions, are expected to serve as useful references in clinical dentistry, pediatrics, forensics, and research. The mandibular central incisor emerged before the first molar of the same jaw in 68% of the children. A change in the emergence order of these teeth in Finns seems to have occurred in the 1960s. A visual comparison of dental maturity curves based on tooth counts with curves based on tooth mineralization in a previous Finnish radiographic study showed that the mean curves had roughly the same form, whereas the forms of standard deviation curves differed distinctly. It appears that the two methods to assess dental maturity are not interchangeable in practice. Tooth counts can be used in maturity estimations up to about 13 years of age, whereas the radiographic method works best to about 11 years. [ABSTRACT FROM AUTHOR]

The aim of this study was to obtain information on restorative dental care in Finland and to analyze the changes in treatment over a 5-year period. A random sample of dentists was drawn from the registers of the health authorities and the dental association in Finland, and in the spring of 1997 a questionnaire was sent requesting the dentists to record information for each restoration placed during a given period. A total of 1,229 dentists were contacted, and 659 responded. The dentists treated 5,305 adults during the study period and placed 6,322 restorations. The most common restorative material was composite resin, which was used in 74.9% of the restorations, whereas amalgam was used in 4.8% and glass ionomers in 9.4% of the restorations. The median ages of failed restorations were nearly 12 years for amalgam, slightly less than 5 years for composite, and slightly more than 4 years for glass ionomer. The results indicate that clinical dentistry in Finland has made a definite step towards the post-amalgam era. However, the functional periods of the failed tooth-colored restorations were disappointingly short and warrant some serious consideration. [ABSTRACT FROM AUTHOR]

One thousand Finnish people aged 20 years and more were interviewed to investigate how people perceive dentists' yellow page advertisements and which attributes they find attractive. Each subject was asked to identify the advertisement that captured his/her attention the most and which one least from a double-page spread of dentists' yellow page ads. The subjects were then asked to give the reason for the decisions, which was duly recorded. Various characteristics of the ads were recorded. In the analyses the five most commonly attractive and the five most commonly unattractive ads were compared with all the others shown to the subjects. The five most commonly chosen attractive advertisements were larger and had less text density than the others (P < 0.001). In contrast, use of frames decreased by fourfold the probability of being chosen. The subjects most often reported use of pictures or photograph, clarity of the ad, and large size as the reasons for choosing their favorite ad. Commonly expressed reasons for disliking an ad were small print, being boring or uninformative, and an unclear or muddled look. All three ads designed by advertising professionals were among the five most commonly attractive, whereas all five most commonly unattractive ads were planned by dentists themselves. Dentists plan their yellow page advertisements alone much too often. This results in ads that consumers do not necessarily distinguish from the mass of others. Consumers appreciated use of a picture or photograph and a clear message in large ads. Common criticisms were small print and a boring, uninformative, or unclear appearance. [ABSTRACT FROM AUTHOR]

The caries preventive outcome of a school-based program with salivary; lactobacillus counts as sugar-motivating tool was evaluated in six cohorts of totally 936 adolescents in a comprehensive school in Sweden. Students from a neighboring district with similar socioeconomic structure but with no corresponding dental health-promoting activities were selected as reference. The program started in the beginning of the 7th grade (13 years) and was terminated at the end of the 9th grade (16 years). Salivary lactobacilli were evaluated semi-annually with a dip-slide method and used for individual counseling. Dental caries was scored from the dental records and bitewing radiographs of each 4th participant at baseline and at 16 and 19 years of age. The number of salivary lactobacilli decreased significantly (P< 0.05) in all cohorts but one during the program. There was no significant difference in the increment of caries (DFS) between the participants from the study and reference schools, either at the end of the program or at 19 years of age. The increment of proximal enamel caries was slightly lower in the study group compared with the reference group (P< 0.05) at the final registration. Considering the time and efforts spent, the results did not seem to justify a school-based intervention with lactobacillus counts as a sugar-motivating tool in an adolescent low-caries population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate factors related to caries in 6-17-year-olds in 2 groups of Norwegian counties between 1966 and 1983. The average number of surfaces filled and permanent teeth extracted due to caries declined in the 4 northern counties from 1967. An increase was recorded in the 7 southwestern counties until 1971, then a decline. In the 1960s significantly more surfaces were filled and teeth extracted in the north compared to the southwest. Based on intra-county comparisons, the decline in surfaces treated was greater in the north between 1967 and 1983; 5.4 +/- 0.4 vs 3.7 +/- 0.7, P < 0.01. The averages were 1.9 surfaces treated in the north and the southwest in 1983. Higher infant mortality, lower percentage of people with completed senior secondary education, and more inhabitants per doctor and per dentist in the north indicate a less favorable situation than in the southwest. School-based fluoride programs had been implemented in both groups from the mid-1960s and around 60% participated when fluoride toothpaste became freely marketed in 1971. More fluoride programs and more fluoride tablets were available to children in the north; this may indicate a preventive attitude among dentists. The decline of caries started at different times in different parts of Norway. In the rural north with the most unfavorable situation, the decline was greater and started years before fluoride toothpaste came on to the market. The early decline may partly be ascribed to the school-based fluoride programs, the continued decline to several factors. [ABSTRACT FROM AUTHOR]

In this methodological study we investigated the usefulness and reliability of a questionnaire designed to capture 4 aspects of parental dental attitudes: dental knowledge, child oral health behavior, perceived importance of dental related aims, and parental responsibility. The study was undertaken in a group of 140 parents of schoolchildren aged 8-12 years from four comprehensive schools in Sweden. Test-retest reliability, quantified by the intraclass correlation coefficient (ICC) or by Cohen's kappa, varied from acceptable to excellent for different aspects of the questionnaire. The knowledge and responsibility-taking sections were also answered by a group of dental experts who showed a high level of internal agreement. Expert profiles, to which the parental assessments could be compared, were created. Exploration of the 4 aspects showed that this group of parents commonly had a multifocal view on the etiology and prevention of caries. Correlations between their knowledge assessments and the assessments made by the expert group varied from moderately negative to strongly positive. The parents revealed a high degree of dental-related motivation and responsibility, particularly according to oral health behaviors. In conclusion, the results indicate that this 4-part psychometric questionnaire might be a suitable instrument in investigations of priority and responsibility-taking as new aspects of parental dental attitudes, along with dental knowledge and child oral health behaviors. [ABSTRACT FROM AUTHOR]

The aim was to study patients' preferences about outcomes of mandibular third molar removal and non-removal using multi-attribute utility (MAU) methodology. The study comprised three stages. Stage 1: Elicitation of domains, i.e. main areas of patients' lives which could be affected by third molar removal and non-removal. Stage 2a: Interdomain weighting was obtained by relative weighting of the domains elicited in Stage 1. Stage 2b: Intradomain weighting obtained by patients' designation of values for different health states of each domain. Stage 3: Rating of outcomes. The patients were asked to imagine experiencing a variety of outcomes of mandibular third molar removal and non-removal, described in 19 short vignettes. The numbers of patients interviewed for the three stages were 30, 78, and 55, respectively. Five domains were identified. The mean relative weightings were approximately equal for the domains "Home and social life" and "General health and well-being", followed in order of importance by 'Job and studies" and "Health and comfort of mouth, teeth and gums". "Your appearance" received the lowest mean relative weighting. The vignette, which described the presence of a fluid-filled sac and suggested that this tooth must be removed, received the highest mean preference (least effect on patients' lives). The lowest mean preference (most effect on patients' lives) was generated by the vignette, which stated that the jaw was broken and that the teeth must be wired together for 6 weeks. We conclude that, from the patient's perspective, outcomes of non-removal were preferable to outcomes of mandibular third molar removal. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for non-attendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (< or = 0.26), but high negative predictive values (> or = 0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point > or = 13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was > or = 15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level. [ABSTRACT FROM AUTHOR]

The aims of the study were to investigate frequencies of low unstimulated whole saliva (UWS) levels and low serum ferritin (S-f) levels among individuals with active dental caries (ADC) and dental caries inactive (DCI) individuals and to compare the relationship between UWS and S-f levels. In this descriptive study, 48 ADC patients and 48 DCI individuals were compared. The two groups were matched regarding age and sex (30 females and 18 males in each group, age range 15-40 years). In the ADC group, 32 individuals (67%) had low (< or = 0.20 ml/min) UWS levels compared with 13 individuals (27%) in the DCI group. This difference was statistically significant (P < 0.001). The mean values of UWS were significantly lower in the ADC group compared to the DCI group (mean ml/min +/- SD) 0.20 +/- 0.13 and 0.33 +/- 0.24, respectively (P = 0.002). There were significant differences for females but not for males when comparing frequencies of low UWS levels (P < 0.001) and mean UWS levels (P = 0.002). There was no difference in S-f levels between the two groups. Neither was any correlation between UWS and S-f found. In conclusion, the significant negative relationship found between UWS and ADC indicates that a suppressed defense for dental caries activity could play a more important role in ADC than previously presumed, especially among females. The absence of a correlation between UWS and S-f might indicate that saliva secretion will not be stimulated by iron supplementation. [ABSTRACT FROM AUTHOR]