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While originally developed in response to a need to provide effective restorative and preventive treatment in underserved communities where running water and electricity might not always be available, over the past two decades, the atraumatic restorative treatment (ART) approach has become a worldwide phenomenon; used not only in some of the poorest developing countries but also in some of the most wealthy. The ART approach involves the removal of infected dentine with hand-instruments followed by the placement of a restoration where the adjacent pits and fissures are sealed simultaneously using high viscosity glass-ionomer inserted under finger pressure. Reliable results can only be obtained if the treatment protocol, as described in this article, is closely followed. ART should be considered as a therapeutic option especially in children, anxious patients and those with special needs.

In 1984 an oral health survey of Hong Kong adults aged 35-44 years revealed that 15% of subjects presented with metal shell crown restorations, often as components of fixed-bridge reconstructions. The aim of this study was to describe the patterns and means of use of shell crowns, and to describe the patterns of tooth loss in patients who presented with such restorations, attending for treatment at the dental teaching hospital in Hong Kong over a 2-year period. A total of 1563 such patients attended. The records, which included radiographs, of 165 of these patients aged 35 years and above, obtained by means of a systematic sampling frame, were studied by one trained examiner. On initial presentation each patient was found to have a mean of 4.0 shell crowns, 77% of these being components of bridge restorations. The bridges involved a mean of only 3.9 units (retainers and pontics). The tooth type most commonly replaced by a bridge of this type was the first molar. It was concluded that most shell crowns used in this patient group are abutment retainers for predominantly short-span bridge restorations.

To study the feasibility of providing Atraumatic Restorative Treatment (ART) in schools and in rural areas in China, and to evaluate the acceptance and effectiveness of the treatment.The study was conducted among 272 grade one students chosen from four different secondary schools in Deyang of Sichuan Province, China. The mean age of the subjects was 12.5 years. 107 boys and 165 girls were found at the baseline examination to have teeth that were suitable for receiving ART fillings or sealants. The treatments were performed within a month using the glass ionomer Ketac-Molar manufactured by ESPE. Evaluation was carried out at 3 months, one year and two years after treatment.ART fillings were placed in 295 permanent teeth, and the 1-year and 2-year success rates were 95.7% and 91.1% respectively. ART sealants were placed in another 191 permanent teeth, and the 3-month, 1-year and 2-year success rates were 95.2%, 89.1% and 78.8% respectively. The incidence of recurrent caries was very low after two years, which were 2.1% and 0.6% for the fillings and sealants respectively. ART was accepted by the majority of the students.ART is a simple, acceptable technique, and is suitable for widespread adoption in China.

To update information on the dental caries status of children living in the Southwestern part of China for planning appropriate dental care services and to obtain information on caries level in rural areas.All first year students studying in seven secondary schools (two in urban, two in peri-urban and three in rural areas) in Sichuan Province were surveyed. The students were clinically examined in their schools using procedures and diagnostic criteria recommended by the World Health Organization.A total of 1,542 children, 12-13 years of age, were examined of which 660, 519 and 363 were from the urban, peri-urban and rural schools respectively. The prevalence of caries experience was highest in urban children (30%), followed by peri-urban children (21%) and lowest in rural children (13%). The respective DMFT index scores for the urban, peri-urban and rural children were 0.62, 0.38 and 0.18. The differences were statistically significant (P0.001). The major component of the DMFT index was untreated decay (DT) in all three areas.There was a clear trend of increasing prevalence and severity of dental caries in children as the survey sites moved from rural, through peri-urban to urban areas. Thus, estimates of dental caries in Chinese child populations of this age based on surveys conducted in urban areas will probably lead to gross over-estimation as over 80% of the people live in rural areas.

This study was conducted retrospectively to evaluate the clinical performance of preventive resin restorations. Five hundred thirty-two restorations in 351 patients had been in the mouth for a mean of 16.5 %/- 7.6 months. The clinical performance was determined with a modified version of the US Public Health Service rating system. In 79.9% of the restorations, the marginal discoloration was rated as Alfa (no discoloration), while only 0.9% were scored as Charlie (discoloration penetrating in a pulpal direction). The marginal adaptation was rated as Oscar (fully sealed) in 28.4% of restorations; in only 0.4% of restorations, rated as Charlie or Delta, was the dentin or base exposed. In 98.3% of the restorations evaluated, the anatomic form was rated as Alfa (continuous with existing anatomic form). Recurrent caries was associated with 2.3% of the restorations. Chi-squared tests failed to reveal any statistically significant relationships between the clinical performance of the restorations and the length of time in the mouth.

As with all indices which impose numerical scales on a biological process, there are limitations with CPITN which must be identified and recognised. The limitations are due to the index being used for purposes for which it was not originally designed and recent advances in understanding which question the underlying assumptions of the index. Whilst questioning whether these limitations are sufficient to abandon the CPITN in favour of a new index, suggestions are made for modifications to the existing system. These include, the recording of each of the clinical indicators separately, as well as including the measurement of total loss of attachment. In addition an extension of the treatment need scale from four to five points is suggested.

Epidemiological studies on periodontal diseases conducted in many countries employing different indices have generally shown advanced periodontal destruction to be more prevalent in adult males than in adult females. The 1984 Hong Kong survey of adult oral health, using the Community Periodontal Index of Treatment Needs (CPITN) to determine periodontal status, revealed that in males aged 35 to 44 years the prevalence of deep pockets was 23 per cent, compared with 9 per cent in females (P less than 0.01). Males had a mean of 0.4 sextants with deep pockets whereas females had a mean of only 0.1 sextants so affected (P less than 0.01). Females were found to have a significantly larger proportion of healthy sextants (P less than 0.01). The observed sex difference in disease prevalence may have been influenced by the fact that fewer teeth were present in the females, but it could not be explained by differences in reported oral hygiene measures and practices.

The technique of photographic superimposition of postmortem specimens (dried skull or head) positioned identically to the orientation in an antemortem smiling photograph is now a recognized method for personal identification of human remains. Previous methods used to produce the postmortem photographs were problematic as orientation of the specimen could not be easily adjusted and positions were not reproducible. The objective of this paper is to describe the design and method of use of purpose-constructed equipment intended to alleviate these problems. The equipment comprises a skull-holding jig based conceptually on the Royal Berkshire Hospital halo frame. This is mounted on a pan-and-tilt device, incorporating calibrated measurement scales, enabling independent movements in each of the Cartesian coordinates. A camera is attached to an adjustable mount running on twin parallel rails allowing the camera-to-specimen distance to be varied. The equipment has proven to be straightforward in use and offers considerable advantages over previously described methods for producing postmortem photographs.

An attempt is described to use a hand-held force-indentation probe to investigate changes in the consistency of gingiva resulting from chronic inflammation. As the probe is hand-held the gingiva must be indented to about half its depth to reduce the error resulting from hand-shake. Thus the probe measures a combination of hardness and depth of the tissue, as confirmed by tests on rubber. The repeatability of the results obtained from the probe is good, though large variations can occur. Tests on rubber demonstrated that this was not due to the device or the hand-held technique. Force-indentation curves were obtained from 36 patients and were classified by buccal or papillae site and by the gingival index (GI) of two scorers. The mean force-indentation curves for each classification were compared and were found to be related to the GI, there being a significant difference between each pair of curves. Although there is no direct evidence that the force-indentation curves are measuring the same thing as the GI, the results show that the probe may be a useful tool in objectively studying changes in the condition of gingiva.