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Introduction: The difference in preventing dentine lesion development between resin-based and glass ionomer sealant materials is unclear. Two recently published reviews were unable to conclude on the difference because the comparison was an exclusion criterion in one review and there were statistical shortcomings in the relevant papers in the other (Cochrane) review., Objectives: The aim of the present investigation was to carry out a systematic review on the caries-preventive effect of these two types of sealant materials under more liberal exclusion criteria concerning the statistical presentations in the publications., Methods: Based on five exclusion criteria, the literature search in the electronic libraries PubMed and MEDLINE and the publications retrieved in the Cochrane review, revealed 12 eligible publications for analyses. A variety of glass ionomers and resin-based sealant materials had been applied in the included studies. Attributable risk (AR) was chosen rather than relative risk (RR), as used in the Cochrane review, because RR is very instable in a low caries population., Results: There was no consistent pattern observed with respect to the caries-preventive effect of either resin-based or glass ionomer sealants. Therefore, it was impossible to calculate an overall AR., Conclusions: There is no evidence that either resin-based or glass ionomer sealant material is superior to the other in preventing dentine lesion development in pits and fissures over time.

Objectives: In the early 1990s, the Ministry of Education in Syria introduced a school oral health programme based on preventive and educational activities only. A restorative component was missing at that time. A few years later, the Atraumatic Restorative Treatment (ART) approach was considered an option to complement the oral health programme but little was known about the longevity of ART restorations in permanent teeth. The null hypothesis which was researched in this trial was: there is no difference between the survival of restorations placed through the ART approach using glass ionomer and those produced through the traditional approach using amalgam (MTA) in permanent dentitions after 3 years., Methods: Using a parallel group design, 679 grade 2 children, with a mean age of 7.5 years, participated. A total of 369 children were treated through the ART and 310 children through the MTA approach. Eight dentists produced a total of 1118 single- and multiple-surface restorations., Results: The 3-year dropout of the single-surface restorations was 15.3%. Testing the null hypothesis for all single- and multiple-surface restorations revealed a statistically significant difference between the two approaches in favour of the ART approach (P = 0.04). The study showed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 82.1 (SE = 1.9%) and 76.9% (SE = 2.3%), respectively. The difference was not statistically significant. The number of 3-year surviving multiple-surface restorations was too low for further analyses. The main failure characteristics for both single-surface ART and MTA restorations were restoration missing and gross marginal defect. The 3-year survival percentage of both single-surface ART and MTA restorations varied widely among the eight operators resulting in an operator effect (P = 0.01)., Conclusions: The null hypothesis was rejected in favour of the ART approach. It is recommended to select the ART approach to complement the educational and preventive activities of the school oral health programme in Syria.

The minimum number of teeth needed to satisfy functional demands has been the subject of several studies. However, since functional demands--and consequently the number of teeth needed--can vary from individual to individual, this minimum number cannot be defined exactly. In general, occlusion of a complete dental arch is preferable. However, this goal might be neither attainable, for general, dental or financial reasons, nor necessary. Many studies demonstrate that shortened dental arches comprising the anterior and premolar regions can meet the requirements of a functional dentition. Consequently, when priorities have to be set, restorative therapy should be aimed at preserving the most strategic parts of the dental arch: the anterior and premolar regions. This also implies that in cases of a shortened dental arch, the prompt replacement of absent posterior molars by free-end removable partial dentures leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence: it does not contradict current theories of occlusion and fits well with a problem-solving approach. The concept offers some important advantages and may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth.

This study aimed to assess the clinical oral health outcome effects among schoolchildren participating in a school-based oral health education (OHE) programme. Local social, cultural and environmental conditions were determinants of the school-based OHE programme, which was compiled on the basis of prevailing beliefs and on what teachers and educational authorities considered to be important for the oral health of schoolchildren. Consequently, the practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of oral health education. The teachers were prepared to carry out weekly supervised toothbrushing sessions and monthly lessons on aspects of oral health for the school year in grade 4. Eight participating schools were selected for the clinical effect evaluation and four non-participating schools served as the control. In total, 309 children from the participating schools and 122 children from the non-participating schools were available for the evaluation. Their ages varied between 9 and 14 years. The mean plaque score, calculus score and gingival bleeding score at baseline and at follow-up examinations 3, 8, 15 and 36 months later were not significantly different for participating schools and controls. The mean DMFT value at baseline was 0.4 and 3 years later 0.9 in both the participating and control schools. In conclusion, the present study shows that the implemented school-based OHE programme did not result in significant reductions of the clinical parameters measured.

Different distributions of fluorotic dental enamel within the dentition have been described in the literature. This report describes two patterns of intraoral distribution. In nine Tanzanian low fluorosis communities with a prevalence of pitting fluorosis of less than 2% and in five moderate fluorosis communities with a prevalence of pitting fluorosis of 16-59%, incisors and first molars were the least affected teeth. In four high fluorosis communities with a prevalence of pitting fluorosis of 86-97%, maxillary incisors exhibited lower Thylstrup-Fejerskov Index values than the maxillary canines, premolars and molars. The mandibular teeth exhibited increasing Thylstrup-Fejerskov Index values from the anterior to the posterior region. The curves presenting the intraoral distribution of the severity of dental fluorosis corresponded with the curve presenting the completion time of primary enamel formation of the various tooth types, with the exception of the first molars in high fluorosis communities. The similarity of the curves suggests that the later in life enamel is completed, the higher is the severity of dental fluorosis. This relation seems to be explained by the prevailing feeding and dietary habits, which result in minimal intake of fluoride in the first 18 months of life during breastfeeding, followed by increasing fluoride ingestion in the following years through consumption of tea, seafish and F-containing magadi salt.

It has recently been suggested that magadi, a high-fluoride trona, which is added in cooking to tenderize certain vegetables and beans in two villages in Tanzania, significantly contributed to the prevalence and severity of dental fluorosis. This report aims to substantiate the significance of magadi as a determinant of dental fluorosis. Eighteen villages in four geographical areas (districts) with water supplies containing 0.2 to 0.8 mg/L of fluoride were selected. All schoolchildren aged 12 to 17 years (n = 1566) who had been born and raised in these villages were examined for dental fluorosis according to the Thylstrup-Fejerskov Index. Dietary history was recorded. The fluoride content of magadi samples was determined and the urinary fluoride excretion of pre-schoolchildren was assessed. The prevalence of dental fluorosis in nine coastal villages where tea and seafish were regularly consumed ranged from 7% to 46%. Severe (pitting) dental fluorosis was rarely seen. The low fluorosis levels observed in non-magadi consuming communities in coastal villages indicate that a fluoride content of up to 0.8 mg/L in drinking water is acceptable under the prevailing conditions of temperature and diet. In contrast, the prevalence of dental fluorosis in nine villages located inland at 1500 m altitude, where fluoride-containing magadi was consumed, ranged from 53% to 100%, and severe (pitting) fluorosis was highly prevalent, ranging from 18% to 97%. The village with the highest fluoride content in the magadi samples collected showed the highest level of fluorosis. The urinary fluoride excretion of pre-schoolchildren from different villages corresponded with the level of fluorosis and the fluoride content in the magadi samples of the respective villages. Data on dental fluorosis from the magadi-consuming communities provide strong evidence that consumption of magadi was the major determinant of the observed high prevalence and severity of fluorosis in inland villages at 1500 m altitude.

This study aimed at comparing the Thylstrup-Fejerskov index (TFI) and the Dean's Index (DI) which were applied on three communities with different severity of dental fluorosis. A total of 1565 children aged between 11 and 18 yr with a mean age of 14.7 were examined for dental fluorosis with the TFI and 1155 of these children were also examined with the DI. The measurement error for the TFI was 0.50 (10 scale point) compared to 0.53 for DI (6 scale point). The Kappa values and the measurement-remeasurement correlation appeared to be better for the TFI. No difficulties were encountered in applying the TFI in contrast to the DI, which caused uncertainties in assessing the "questionable" and "very mild" scores, and this may explain the relatively better reproducibility of the TFI. The correspondence between both indices was determined. TFI 0 corresponded well with DI 0. The conversion values for TFI 1, 2, 3 and 4 into DI scores were 0.3, 0.8, 1.4 and 2.4 respectively. The TFI 5-9 corresponded with DI score 4. TFI could discriminate the severe forms of dental fluorosis which were categorized in Dean's highest score 4. TFI was able to reveal more dental fluorosis than DI in communities with minor and moderate dental fluorosis. In the community with severe dental fluorosis where more than 85% of all teeth exhibited a DI > or = 1, both indices revealed a comparable prevalence of dental fluorosis. The TFI is considered a near ideal instrument.

The dental treatment demands of 824 patients attending regional dental clinics were recorded. Overall 86% of the patients sought treatment for pain, ranging from 77% to 97% in the different clinics. Caries was the main cause of pain. The proportion of patients with demands for aesthetics was 5%, prosthetics 2%, and check up 3%. The data indicated a need for emergency care. The type of curative treatment needed, mainly extractions, could well be performed by dental auxiliaries. Since the data was collected from patients among whom many visited the clinics in the late stages of painful oral diseases, it is assumed that it reflects only the tip of an iceberg that represents a much larger dormant demand (want) for emergency care among the population. Any strategy aiming to be effective in improving oral health should at least meet the emergency dental needs of the population. Consequently there is a definite need of data on dental treatment demands and wants for adequate planning of dental health care systems in their infancy in countries with limited financial resources.

A group of 268 children were checked for caries experience at the age of 7.2 yr later at the age of 9 and 4 yr later at the age of 11 yr. Caries experience of fissures in permanent first molars at the age of 7 yr served as a screening criterion for caries increment between the ages of 7 and 11 yr. This screening resulted in a sensitivity of 0.62, a specificity of 0.82, and a diagnostic power of 0.83 for total caries increment in the permanent dentition and in a sensitivity of 0.68, a specificity of 0.80, and a diagnostic power of 0.78 for caries increment in fissures of permanent first molars. It was concluded that this screening offered the best method available for identifying children at risk from fissure caries in their permanent first molars. Cost effectiveness of preventive treatment directed towards individuals, for instance the application of fissure sealants, can be improved by using this screening method.