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Evidence regarding the caries-inhibiting effect of chlorhexidine varnish is inconclusive. This study investigated the caries-inhibiting effect of the varnish EC40 on pits and fissures of first permanent molars. A two-year randomized controlled trial was carried out among 461 six- to seven-year-old children. In a split-mouth design, one group of molars received EC40 at baseline, 6, 12, and 18 months, and another group at baseline, 3, 12, and 15 months. Control molars did not receive EC40. Adherence to the treatment protocol was good. The dropout rate was 17%. Blinded examiners performed dental examinations. The caries-inhibiting effects of the two EC40 application schemes were comparable. The prevented fraction of caries was 25% (95%CI, 1%, 49%, p = 0.04) after 2 years and 9% (95%CI, -11%, 29%, p = 0.20) one year after termination of the trial, suggesting a short-term benefit from the use of EC40. The efficiency of EC40 is questionable in low-caries-incidence child populations. [ABSTRACT FROM AUTHOR]

Aim: The primary objective was to determine, based on the available published evidence, the efficacy of powered toothbrushing following a brushing exercise and secondary to what magnitude this effect is dependent on the plaque index score, power supply and mode of action., Material and Methods: The PubMed-MEDLINE and Cochrane CENTRAL databases were searched through and up to August 2014 to identify appropriate studies. The outcome measurement was the weighted mean (WM) percentage plaque score reduction of a full-mouth assessment following subject brushing., Results: The search yielded 2420 titles and abstracts. Ultimately, 58 articles with 146 brushing exercises as separate legs were selected. The overall effect of a powered brushing exercise provides a 46% WM plaque score reduction. One hundred and six experiments provided data as assessed according to the Quigley and Hein plaque index. The WM reduction from baseline in plaque scores was 36%. A WM plaque score reduction of 65% was observed in 39 experiments using the Navy plaque index. Subanalysis on power supply and mode of action showed WM plaque score reductions ranging from 33% up to 71% depending on plaque index score., Conclusion: The efficacy in plaque removal following a brushing exercise using a powered toothbrush provides a WM plaque score reduction of 46% on average, with a range of 36-65% dependent on the index scale to score plaque. The available evidence indicates that the power supply (rechargeable or replaceable battery), mode of action, as well as brushing duration and type of instructions are factors which contribute to the variation in the observed efficacy., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

Background: Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries.The objective of the study was to assess and compare the effect of a single application of 38% SDF with ART sealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste., Methods: The prospective community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant treatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces that were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as surfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children., Results: In the brushing group, caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing children than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated children (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072)., Conclusions: A one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly reduced the onset of caries over a period of 18 months., Trial Registration Number: German Clinical Trial Register DRKS00003427.

Oral health care volunteering in developing countries based on the traditional Western model does not contribute to sustainable improvement and has, presumably, negative consequences for the local health care system. The oral health care can and should be delivered more efficacious. To achieve efficacious and sustainable results, the 'Basis package of oral care' of the World Health Organization offers a good manual. In addition, the Dutch branch of Dental Health International can support non-governmental organizations in establishing volunteering oral health care delivery programmes in order to improve the preventive care, the accessibility of care, the working conditions of the local oral health care providers, and the medical hygiene.

Caries is a dynamic process which can develop either progressively or regressively under the all-determining influence of oral health behaviour. Management of caries therefore involves first of all: diagnostics, monitoring and preventive care and treatment which result in good oral health behaviour. The oral care provider should recognize all phases ofprogression of the caries process, and should be able to differentiate the symptoms which indicate an active or inactive process. A well maintained patient dossier is necessary to monitor this process over time. Following this procedure, the oral care provider is in a position to guide the patient with relevant information in order to achieve the final objective, good oral health.

Hardly any data are available on the clinical consequences of untreated severe caries, because there is no method to quantify the prevalence of oral conditions resulting from untreated caries. In the Philippines, an index was developed which records for (the location of) each tooth whether caries has reached the dental pulp, whether ulceration is present in the surrounding soft tissues due to sharp edges of fragments of a tooth lost due to caries, or whether a fistula or abscess is present. By adding the index to the existing Decayed Missing Filled Tooth index, insight is provided on the extent and the consequences of untreated caries and research may be carried out on its possible impact on the general health and wellbeing of national populations.

Caries is the most prevalent oral disease in children. The majority of caries in toddlers remains untreated, with toothaches as a consequence. Although toothache is an important determinant of the quality of life, prevalence data on toothaches hardly exist. Research results indicate that children's quality of life improves after caries treatment. The question remains which type of treatment is preferable. To address this question, evidence from randomized controlled clinical trials on various treatment methods is needed.

Objective: The aim of this study was to systematically review the present literature on the effect of chlorhexidine varnish (CHX-V) on root caries., Materials and Methods: The MEDLINE-PubMed, the Cochrane-CENTRAL and EMBASE databases were searched through December 2010 to identify any appropriate studies. Root caries incidence and root caries activity were selected as outcome variables., Results: An independent screening of the unique titles and abstracts of 24 MEDLINE-PubMed, 14 Cochrane-CENTRAL and 18 EMBASE papers resulted in 6 publications that met the eligibility criteria. Data extraction provided no conclusive evidence that the application of CHX-V is effective in patients when regular professional oral prophylaxis is performed. If effective, the 40% CHX-V was found to provide a benefit over a control or fluoride varnish. CHX-V at lower concentrations (1 and 10%) may provide protection against root caries in high-risk patients (such as geriatric and xerostomia patients) in the absence of regular professional oral prophylaxis., Conclusion: Within the limitations of this review, it may be concluded that in the absence of regular professional tooth cleaning and oral hygiene instructions, CHX-V may provide a beneficial effect in patients in need of special care. The strength of this recommendation is graded as 'weak'., (Copyright © 2011 S. Karger AG, Basel.)

For the dental care of parents and children, people in the Netherlands rely especially on the advice of the Ivory Cross. The basis of this advice is plaque removal with fluoride toothpaste. When this offers insufficient protection, one usually finds irregular and careless dental hygiene. Information and instruction concerning daily and careful dental hygiene should receive the highest priority of dental care professionals. If a patient's own dental care cannot be brought up to standard or if this cannot be done immediately, then (temporary) support can be provided by dental professionals in the form of preventive treatment. Doing this, however, without improving the self care of patients has to be regarded an inadequate treatment modality.

First, the development of dental health care for children in the Netherlands is discussed. Caries prevalence among children has declined sharply. The present situation, however, makes clear that the majority of carious cavities in the temporary dentition remain untreated. This has led to the conclusion that the level of restorative care has to increase. On the basis of new insights in cariology gained in recent decades, the authors of this article argue for abandoning the old paradigm of restorative treatment in favour of prevention in the treatment of caries.

Background: The objective of this study was to evaluate the effect of an oscillating/rotating/pulsating powered toothbrush on plaque and gingivitis prevention over a 9-month period., Methods: The study had an examiner-masked, randomized, three-group parallel design. A total of 122 subjects >or= 18 years of age in good general health and with at least five teeth per quadrant and no pockets >or= 5 mm were included. A 3-week preexperimental period of extensive oral home care, including rinses, was started to improve gingival health. Professional oral hygiene instruction with a manual brush was provided. At baseline, subjects were assigned to one of three regimens: twice daily brushing with a manual toothbrush, a manual toothbrush and the use of floss, or a powered toothbrush. Subjects were professionally instructed in their regimen and given a prophylaxis. Two weeks later, oral hygiene reinforcement was provided. Gingival bleeding, plaque, staining, and gingival abrasion were assessed during the preexperimental period and at baseline, 10 weeks, and 6 and 9 months., Results: There was a significant reduction in plaque and gingivitis from the preexperimental period to baseline. At 10 weeks and 6 and 9 months, the level of plaque was statistically significantly lower with the powered toothbrush versus the other two regimens (P

Objectives: This study aimed to test the following hypotheses: (1) a carry-over effect of EC40 does not occur in a split-mouth model, (2) two consecutive applications of EC40 varnish with an interval of 3 months per year has a better inhibiting effect on mutans streptococci in pit and fissure plaque of permanent first molars of 6-7-year olds than a repeated application at each 6 months and (3) EC40 exerts an inhibiting effect on mutans streptococci for at least a 6-month duration., Methods: Using a split-mouth design, test molars received EC40 on fissures and pits and control molars remained without treatment. One group of test molars received EC40 at baseline, 6, 12 and 18 months and another group at baseline, 3, 12 and 15 months. Plaque samples were taken from pits and fissures of test and control molars at baseline, 6, 9, 12 and 24 months. A mixed ANOVA model was used to analyze the data., Results: The first hypothesis was accepted, the second rejected and the third accepted., Conclusions: Twice a year EC40 application on pits and fissures of permanent first molars of 6-7-year-old children can significantly reduce mutans streptococci numbers for a 6-month period, but the reductions were small.

Objectives: This study aimed to determine whether salivary mutans streptococci (MS) counts in Chinese children had any value in the prediction of new caries in the permanent dentition in the age interval of 6.5-8.5 years., Methods: Four hundred and thirty-three 6-7-year-old children participated in this 2-year longitudinal study. Salivary MS counts were obtained at baseline with the spatula method. Dentin and enamel caries was recorded at baseline and at the follow-up, 2 years later. Spearman's correlation coefficients were computed. Past caries experience variables at baseline were entered into a multiple regression model with caries increment of the permanent dentition as dependent variable. MS counts were subsequently entered into the model to assess the additional caries predictive value., Results: Spearman's correlation coefficient for MS counts and caries experience of the primary dentition at baseline was 0.48 and for MS counts and caries increment in the permanent dentition 0.12. In the multiple regression model caries increment of the permanent dentition had an adjusted R2 of 0.17 when the past caries experience variables were entered. Adding MS counts in the regression model did not change the R2 value., Conclusions: Salivary MS counts did not add any caries predictive value when past caries experience variables were used as caries predictors in this Chinese child population.

The methodology for the assessment of a negative or positive test in caries prediction models has not received much attention. This study aims to explain how utility technology could be applied in a caries prediction model for the assessment of the cut-off between a negative and a positive test. In this study loss of utilities was assigned to false outcomes of the prediction test. A regression equation with past caries experience variables of 11-year-old children and caries increment in the 11- to 15-year forecast period as outcome was computed. The adjusted explained variance for caries increment was 0.45. Formulas were constructed for the loss of utilities for false-negative tests whereas false-positive tests were corrected with a fixed loss of utilities. Each 11-year-old child of the 252 children was screened at various points of the regression equation. Loss of utilities was calculated for each child on the basis of the validation criterion, the outcome of the test and the actual caries increment of the child. The point on the regression equation with the least loss of utilities for the whole group was taken as the cut-off between a negative and a positive test. If the validation criterion for the prediction period was set on no caries, the prediction model resulted in a sensitivity of 84% and a specificity of 73%. This prediction model has potential when caries incidence is low and resources limited., (Copyright 2007 S. Karger AG, Basel.)

The number of publications reporting on the survival of ART sealants and ART restorations has increased considerably in recent years. A systematic investigation of their longevity is therefore warranted. Based on three exclusion criteria, a literature search in the electronic libraries Pubmed and Medline revealed 28 eligible publications for inclusion in a meta-analysis. High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in primary dentitions over 3 years were found (95% after 1 year to 86% after 3 years). These rates were statistically significantly higher than for those of multiple-surface ART restorations in primary dentitions (p<0.0001). High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in permanent dentitions over 6 years were found (97% after 1 year to 72% after 6 years). The mean annual failure rates for single-surface ART restorations using high-viscosity glass-ionomer in primary and permanent dentitions and for multiple-surface ART restorations in primary dentitions are 4.7%, 4.7% and 17%, respectively. The number of studies reporting on the retention and caries preventive effect of ART sealants was low. It is concluded that single-surface ART restorations using high-viscosity glass-ionomer in both primary and permanent dentitions show high survival rates. Medium-viscosity glass-ionomer should not be used for ART restorations.

There is inconclusive evidence about the relationship between toothbrush wear and plaque removal. This randomized cross-over clinical trial aimed to validate or invalidate non-inferiority in the plaque-removal efficacy of old vs. new toothbrushes in the hands of 7- and 8-year-old children. The lower limit for non-inferiority was set a priori as a difference in plaque score<15%. Children (n=101) brushed, in the first session, with either their 14-month-old toothbrush or a new one, and in the second session vice versa. The mean Quigley-Hein plaque score, before and after children brushed with old brushes, was 2.9 and 2.4, and with new brushes 2.8 and 2.1. The plaque score after they brushed with the new toothbrush was 10.9% lower (p<0.001) than after they brushed with the old toothbrush. The confidence interval of 7.6%-13.9% was within the acceptance band (<15%), and non-inferiority of old toothbrushes in the hands of these children was validated.

This systematic review aimed to determine the caries-inhibiting effect of chlorhexidine (CHX) varnishes on the permanent dentition of children, adolescents and young adults, and to explore two possibly related factors, namely application frequency and the time between evaluation and the last application. The literature search identified 14 publications of randomized controlled trials or controlled clinical trials where the effect of CHX varnish was compared with placebo controls or controls that received no preventive treatment. To obtain uniform outcome effects, the prevented fraction and 95% confidence intervals of caries increment were calculated. Owing to insufficient data presentation, only eight publications were included. Another two publications were included after receiving additional data from the authors. This systematic review did not result in a meta-analysis as an overall prevented fraction could not be computed because of the large variation of outcome results. The variation could not be explained by the time between evaluation and last application but might be explained by application frequency. It is tentatively concluded that CHX varnish has a moderate caries-inhibiting effect when applied every 3-4 months. However, this effect seems to have diminished by around 2 yr after the last application. There is no evidence for a caries-inhibiting effect of CHX varnish with longer intervals between applications.

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: The aim of the present study is to investigate variables of the past caries experience as indicators of future caries in a Chinese child population., Methods: Caries was recorded at baseline and 2 years later in 433, 6-7-year-old Chinese children. Correlation coefficients between variables of the past caries experience and caries increment were calculated. Stepwise logistic regression analyses provided predictor variables. ROC curves presenting sensitivity as function of (100-specificity) were employed to summarize the obtained information. The area under the ROC curves was used as a measure of predictive accuracy., Results: Twelve variables of baseline caries experience had a significant (p

The aim of the present trial was to (1) compare the caries-preventive effect of glass ionomer sealants, placed according to the atraumatic restorative treatment (ART) procedure, with composite resin sealants over time and (2) investigate the caries-preventive effect after complete disappearance of sealant material. Forty-six boys and 57 girls, mean age 7.8 years, were randomly divided into two treatment groups in a parallel-group study design. A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups. Evaluation took place annually for 5 years by calibrated examiners. After 5 years, 86% composite resin and 88% glass ionomer sealants did not survive. Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished: 0-1, 1-2 and 2-3 years. In the 2- to 3-year group, 13 and 3% of pits and fissures previously sealed with composite resin and glass ionomer, respectively, were diagnosed as having developed a dentine lesion. The relative risks (95% CI) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3, 4 and 5 years were 0.22 (0.06-0.82), 0.32 (0.14-0.73) and 0.28 (0.13-0.61), respectively. The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1-2 and 2-3 years were 0.26 (0.14-0.48) and 0.25 (0.09-0.68), respectively. We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants, placed using the ART procedure, was between 3.1 and 4.5 times higher than that of composite resin sealants after 3-5 years. Furthermore, high-viscosity (ART) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period. A well-designed clinical trial using different types of oral health personnel should be implemented to confirm these initial results.

A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice. All infants who consumed sugary supplementary food or rice that was pre-chewed by the mother, or who fell asleep with the breast nipple in their mouths, had ECC. Infants without those habits, and who were breastfed up to 12 months, had no ECC. Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995). The present study indicates that, in this population, besides the consumption of sugars and pre-chewed rice, nocturnal breastfeeding after the age of 12 months poses a risk of developing ECC.

In 101 fluoride toothpastes, bought in local shops in Burkina Faso (n = 3), China (n = 5), Myanmar (n = 22), Nepal (n = 19), Philippines (n = 13), Syria (n = 22), Togo (n = 7) and Vietnam (n = 10), the total and free ionisable fluoride concentrations were established. The total fluoride concentration of the toothpastes was determined by gas liquid chromatography. The amount of soluble fluoride was measured after dilution in artificial saliva and treatment of the supernatants with acidic phosphatase. The free fluoride concentration in this mixture was measured with a fluoride electrode. Twenty-five percent of all toothpastes contained less than 738 ppm total fluoride, and another 25% contained between 738 and 977 ppm fluoride. Regarding free ionisable fluoride the 25th, 50th, and 75th percentile contained < or =275, 780 and 990 ppm fluoride, respectively. Of the 61 toothpastes with declared fluoride concentration, 75% contained a total F concentration of > or =89% of the declared concentration. In 25% of these toothpastes the free ionisable fluoride was < or =55% of the declared fluoride, and in another 25% of the pastes the free ionisable fluoride concentration was > or =89% of the declared fluoride. In conclusion, deficiencies were found regarding the total as well as the free ionisable fluoride concentration of toothpastes bought in non-established market economy countries. Unclear labelling concerning the type and concentration of fluoride was often encountered. A need for quality control of fluoride toothpastes is recommended., (Copyright (c) 2005 S. Karger AG, Basel.)

The aim of this paper is to describe and analyse the oral health situation in Syria in the last two decades and to propose recommendations for improvement of the current situation. The epidemiological data on caries of the last two decades did not indicate a decrease in the DMFT value of various age groups, nor was a decrease in the percentage of untreated caries apparent. The unequal distribution of oral health care continued to exist throughout the country, despite an enormous increase in the number of dentists from about 2,000 in 1985 to about 14,500 in 2002. The affluent part of the population is served with technically oriented expensive dental services. The public sector suffers from limited finance, the absence of appropriate technology in restorative dentistry and the lack of a community and preventive oriented approach. It is recommended to utilise dental hygienists in the public sector, since these auxiliaries if appropriately trained can offer the preventive and curative oral care wanted and demanded by the poor and that the government and the people can afford.

By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the probability of correct and incorrect decisions are multiplied by the utility of the decision outcomes. The treatment outcome with the highest expected utility should be selected. Complex decision tasks such as the estimation of an individual's caries risk or the diagnosis of bone disorders are currently available as computer applications. Also, a preliminary version of a computer programme which detects caries lesions from bitewing radiographs independent from the dentist has become available. It is expected that the applicability of decision analyses will increase when implemented in the dental practice software packages.

The ability of dentists to select caries risk patients on the basis of what they see and know, varies considerably. There is a need for objective methods. Methods using bacterial counts and salivary tests appeared to be inferior compared to methods based on the caries experience of the patient. There are two models, Nexø and Dentoprog, using the caries experience as caries predictor. The well documented Nexø method does not predict caries increment, but gives the provider a tool to target preventive intervention to those patients in need. The Dentoprog method is accurate, but has only one level of caries risk, which is considered by most providers as too low and thus unpractical.

This paper presents a method, which, on the basis of the caries experience, predicts the caries increment up to the age of 15 years. This method provides the best caries prediction so far available. By applying the principles of medical decision-making cut-off points of risk can be assessed, whereby children can be selected as at risk or not at risk. The method is applicable in child populations with different caries incidences and meets the requirements of accuracy. With the user-friendly method, more than 80% of the children at risk can be identified and selected.

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 subject of several studies. However, since functional demands can vary from individual to individual, this number cannot be defined exactly. It has been demonstrated that shortened dental arches comprising the front teeth and the premolars, can meet the requirements of a functional dentition. The shortened dental arch concept may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth. It implies that the prompt replacement of absent molars by a removable partial denture leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence, and not contradict current theories of occlusion and fits well in a problem-solving approach.

Unlabelled: A study in West Java has indicated that involvement of primary health care personnel and schoolteachers in oral health education (OHE) at primary schools is a feasible approach that is sustainable., Aim: The present study aims to assess the effects of that school-based OHE programme on pupils who had completed the programme one and a half years ago., Methods: Eight experimental and six control primary schools in the same area participated in the study. Out of each school 10 children, aged 8-12-years old, were randomly selected., Results: ANOVA with age and gender as co-variables showed statistically significantly lower (21%) habitual plaque scores among children from experimental schools as compared to those from control schools. Tooth brushing effectiveness had significantly improved among experimental children and they took longer for tooth brushing when supervised. The dmft/dmfs values were comparable but the DMFT/DMFS values of children from experimental schools tended to be lower (not statistically significant) than of those from control schools. Differences in oral health knowledge were apparent but self-reported habits pertaining to oral health were comparable between children from experimental and control schools., Conclusion: This school-based OHE programme had a moderate positive effect on oral health knowledge and on habitual plaque levels and on the effectiveness of tooth brushing. The effects on caries levels and on self-reported behaviour were inconclusive.

This study aimed to determine whether salivary mutans streptococci and lactobacilli counts could add any value to a combination of caries experience variables that was recently presented for the prediction of caries. Sixty-nine children at the age of 7.5 yr participated in this longitudinal study. Microbiological data were obtained at the ages of 7.5, 9.5 and 11.5 yr and caries data at the ages of 7.5. 9.5. 11.5, 13.5 and 15.5 yr. Spearman's correlation coefficients were computed, and forward multiple regression analyses were carried out using bacterial counts and caries experience parameters as explanatory variables and caries increment as a dependent variable. The explained variance (adjusted R2 value) was the measure used to assess the additional value of bacterial counts to the caries predictive potential of the combined parameters of the past caries experience. Correlation coefficients between bacterial counts and 4-yr caries increment were from 0.22 tip to 0.54. In all cases, the simultaneous streptococcus mutans-lactobacilli counts showed a statistically non-significant additional adjusted R2 value of <0.06. The results do not lend support to the concept that these salivary bacterial counts are useful additional caries predictors for the mixed dentition, when a combination of caries experience parameters is used.

This study aimed to select past caries experience variables as caries predictors and to compare their prognostic accuracy with the variables used in a method of caries prognosis developed in a Swiss child population. The data used for the analyses originated from an 8-year longitudinal study starting in 1980 on caries of 7.5-year-old Dutch children. Stepwise logistic regression analyses provided predictor variables. The newly introduced variables D23fi, D(123)i and D23pifi were interchangeable and the most powerful caries predictors. For the sake of uniformity and ease of application, D23fi (number of fissures of the permanent first molar with non-cavitated or cavitated caries lesions) was chosen as the first variable in the logistic regression equations. The gain in accuracy of the second and third predictor variables (number of sound primary molars and the number of buccal and lingual smooth surfaces of the permanent first molar with non-cavitated or cavitated caries) in the regression equations was limited. The D1 condition of surfaces could be omitted from the prediction models. The present forced three-predictor-regression equations for 7.5-, 9.5- and 11.5-year-old children were evaluated to assess their prognostic performance by using the area under the ROC curve as a measure of prognostic quality. For the present regression equations, the area under the ROC curve was 81-87%, which was higher compared to the Swiss regression equations for caries prognosis.

Aim: The purpose of this paper is to review the most recent epidemiological data (1985-2000) on dental caries and periodontal diseases in Vietnam in an attempt to obtain a 'baseline' for future national oral health surveys., Methods: Studies on periodontal diseases and caries were included when CPITN and WHO caries criteria had been applied and when the sample size was at least n = 200 for each age group., Results: Almost all subjects had calculus. The median number of sextants with calculus in the 15-19-year- and in the 35-44-year-olds was 4.2 and 5.0, respectively. Only 2-7% of the 35-44-year-olds had one or more deep periodontal pockets. The estimated DMFT of the 12-, 15- and 35-44-year-olds was 1.8, 2.0 and 5.4, respectively, in the years around 1990., Conclusion: This review shows that (often neglected) epidemiological studies from the past on caries and periodontal diseases can contain comprehensive data sets that provide an estimate of the past oral health status which may serve as a baseline for future national surveys.

Aim: To estimate the prevalence and severity of dental caries and periodontal diseases in Syria and to determine possible secular changes in the last two decades., Methods: Epidemiological studies performed between 1980-1999, using the WHO criteria for dental caries and the CPITN criteria for periodontal diseases in Syria were retrieved and reviewed., Results: The caries experience of 5-year-old children was high (dmft of 4.7-5.2). The estimated DMFT score of 12-year-old Syrian children was 1.9-2.3. A secular change of the caries experience in the last two decades was not apparent. The amount of untreated caries lesions was high and had not changed substantially in the last two decades. The D component comprised 72-90% of the DMFT of 12-15-year-old children and 26-30% of the DMFT of 35-44-year-old Syrians. The majority of 15-24-year-olds, and more than 80% of the 35-44-year-olds had calculus. Despite the widespread and chronic existence of calculus, only 3-11% of the 35-44-year-old persons had one or more deep periodontal pockets., Conclusion: The caries experience in Syria is moderately low and does not seem to have changed in the last two decades. The increased output of graduate dentists in the last decade has not changed the large amount of untreated caries lesions. In Syria, where the prevalence of unmet (caries) treatment needs is high, regular removal of calculus (scaling) for the sake of preventing periodontal pockets should not have a high priority in the oral health services.

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.