Need For Restorative Care Research Articles

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.

Prevalence of Dental Caries and its Association with Risk Factors amongst Preschool Children of Bharakahu, Islamabad

Background: It is necessary to understand the prevalence and pattern of distribution of dental caries for better planning and execution of preventive activities in the right dimension. This study provided the base line data about prevalence of dental caries in pre-school children of Bharakahu, Islamabad, and its association with brushing, sugar consumption and previous dental visits.
 Material and Methods: A total of 384 preschool children aged 3-5-year-old were screened from periurban area of Bharakahu, Islamabad, using type IV screening method. Data about decayed, missing and filled teeth was recorded using decayed-missing-filled teeth (DMFT) index. Socio-demographics, brushing, sugar consumption and previous dental visits were also recorded and analyzed and their association with dental caries was assessed using Chi square and Odds ratio.
 Results: The overall caries prevalence among the sample was 49%. The mean DMFT score with 1 SD was 2.07±3.215. There was no significant difference in caries prevalence in relation to gender of the children. The most significant association was for brushing and low DMFT. Children who brushed their teeth were 4 times more likely to have a low DMFT score of <1 than those who did not brush at all (P<0.001). Likewise, those who had visited a dentist in the past were twice more likely to have a low DMFT (P=0.003). The association of low sugar consumption and a low DMFT score was statistically insignificant (OR 1.4; P=0.878). Hence, brushing turned out to be the most significant factor in determining the caries experience for a child.
 Conclusions: This study provided us with the baseline data regarding the prevalence of caries in primary school going children of Bharakahu. The prevalence of unmet dental treatment needs was reflected through a high number of ‘decayed teeth’ as compared to missing and filled ones highlighting the need for restorative care in these children.

Oral health status and treatment needs of children with special health care needs in rural and urban areas of Hyderabad - A cross sectional study.

Aim:The aim of the cross-sectional study was to ascertain the oral health status and treatment needs of special health care need children of age group 3–16 years in rural and urban areas of Hyderabad, Telangana, India.Materials and Method:To assess and compare the caries status, oral health status, oral hygiene measures, diet and treatment needs in rural and urban population. The data collected was processed and analyzed using the SPSS statistical software program.Results:Among 1000 subjects in rural and urban population highly significant difference was observed for Oral hygiene aids (P < 0.003) and for DMFT (P < 0.008) and no significant difference for dmft (P > 0.26). OHIs status showed no difference in primary and permanent in both rural and urban population (P > 1). Filled and missed were in DMFT, dmft was very low even though there were carious tooth in study population. Most of the children in rural and urban population required varied treatment needs like oral prophylaxis, restoration, pulp therapy, crowns and extractions.Conclusion:High prevalence of dental caries and the need for restorative care was noted in these children emphasizing the necessity of change of attitude towards oral health and improved oral care by repeated counselling of parents by primary health care physicians.

The Caries Management System: are preventive effects sustained postclinical trial?

ObjectivesTo report, at two and 4 years post‐trial, on the potential legacy of a 3‐year randomized controlled clinical trial (RCT) of the Caries Management System (CMS) at private general dental practices. The CMS was designed to reduce caries risk and need for restorative care.MethodsNineteen dental practices located in city, urban, and rural locations in both fluoridated and nonfluoridated communities participated in the RCT. Eight practices were lost to follow‐up post‐trial; however, baseline mean DMFT balance between CMS and control practices was maintained. At the control practices, caries management following usual practice continued to be delivered. The patient outcome measure was the cumulative increment in the DMFT index score, and the practice outcome measures included the practice‐mean and practice‐median increments of patient DMFT index scores. In covariable analysis (patient‐level unit of analysis), as the patients were clustered by practices, mean DMFT increments were determined through multilevel modeling analysis. Practice‐mean DMFT increments (practice‐level unit of analysis) and practice‐median DMFT increments (also practice level) were determined through general linear modeling analysis of covariance. In addition, a multiple variable logistic regression analysis of caries risk status was conducted.ResultsThe overall 4‐year post‐trial result (years 4–7) for CMS patients was a DMFT increment of 2.44 compared with 3.39 for control patients (P < 0.01), a difference equivalent to 28%. From the clinical trial baseline to the end of the post‐trial follow‐up period, the CMS and control increments were 6.13 and 8.66, respectively, a difference of 29% (P < 0.0001). Over the post‐trial period, the CMS and control practice‐mean DMFT increments were 2.16 and 3.10 (P = 0.055) and the respective increments from baseline to year 7 were 4.38 and 6.55 (P = 0.029), difference of 33%. The practice‐median DMFT increments during the 4‐year post‐trial period for CMS and control practices were 1.25 and 2.36 (P = 0.039), and the respective increments during the period from baseline to year 7 were 2.87 and 5.36 (P < 0.01), difference of 47%. Minimally elevated odds of being high risk were associated with baseline DMFT (OR = 1.17). Patients attending the CMS practices had lower odds of being high risk than those attending control practices (OR = 0.23, 95% CI = 0.06, 0.88).ConclusionIn practices where adherence to the CMS protocols was maintained during the 4‐year post‐trial follow‐up period, patients continued to benefit from a reduced risk of caries and, therefore, experienced lower needs for restorative treatment.

Oral health status of children with disability living in Albania.

Introduction:This study was carried out at nine (9) special schools for disabled children in Albania. The aim of the study is to determine the caries prevalence and oral hygiene status of children with different disabilities attending different schools for disabled at Albania.Methods:Participants are grouped according disability Autistic Spectrum Disorder, Down syndrome, Cerebral Palsy, Mental Retarded, Blind, Deaf-Mute and age group (0-5, 6-10, 11-14, 15-18 years old children). Caries and oral health status were examined and assessed according WHO 1997 criteria.Results:Overall caries prevalence at permanent dentition for all groups is 85.3% and for primary dentition 72%. The mean deft index is 3.4 ± 3.5(p≤0.029), mean DMFT= 4.9±4.6 (p≤0.001) with significance difference across type of disability (Kruskal-Wallis test) for both dentition. The mean OHI-S of total population is 1.91; there is significant difference across disability type (p≤0.001, Anova test) for OHI-S index. In total 43.2 % have good, 49.4% fair and 7.4% bad oral hygiene.Conclusions:The subjects in this study had a high prevalence of dental caries, poor oral hygiene and need for restorative care.

A Comparison of Caries Screening Approaches in Young Children

A Comparison of Caries Screening Approaches in Young Children

Geriatric restorative care - the need, the demand and the challenges.

Increased life expectancy is causing an explosion of the aging population that will continue now and in the foreseeable future. Improved quality of life at old age will demand tooth retention and consequently the need for restorative care. Retaining teeth disease free and maintaining them amidst multitude of risk factors associated with old age, is a multi- faceted challenge. This review article discusses the etiology of various dental diseases seen in older dentate population and their management keeping in mind the special needs of these matured people, so as to render a professional service that is sensitive and caring.

Association between use of asthma drugs and prevalence of demarcated opacities in permanent first molars in 6‐to‐8‐year‐old Danish children

Demarcated opacities in permanent first molars are common developmental tooth defects, characterized by areas with insufficient mineralization of the enamel. The defects present clinically as a continuum from creamy-white demarcated opacities, yellowish-brown demarcated opacities to macroscopic loss of tooth substance. The etiology is sparsely elucidated, but asthma drugs have been suspected to increase the prevalence. The aim of this study was to examine the prevalence of demarcated opacities in permanent first molars among 6-to-8-year-old children with prescriptions and without prescriptions for asthma drugs. In a cross-sectional study in two Danish municipalities, all children aged 6-8 years (n = 891) were included. A total of 745 (83.6%) went through a dental examination during which demarcated opacities and tooth substance loss due to these were recorded. The analyses were restricted to 647 children in whom all four permanent first molars had erupted. Data on use of asthma drugs from birth until the time of the dental examination were obtained from a population-based pharmaco-epidemiological prescription database. Among 47 children with prescriptions for both inhaled beta(2)-agonists and inhaled corticosteroids before the age of 3 years, 15 (31.9%) had demarcated opacities of any type, and six children (12.8%) had opacity-related loss of tooth substance. Among 264 children with no prescriptions for either inhaled or oral asthma drugs from birth until the date of the dental examination, 96 (36.4%) had demarcated opacities of any type, and 13 (4.9%) had opacity-related loss of tooth substance. The odds ratio (OR) of any demarcated opacity, and of opacity-related loss of tooth substance in children with prescriptions for both inhaled beta(2)-agonists and inhaled corticosteroids before the age of 3 years was 0.82 (95% CI: 0.39-1.65), and 2.42 (95% CI: 0.70-7.43). Children with prescriptions for inhaled asthma drugs before the age of 3 years did not have an overall increased risk of demarcated opacities in first permanent molar but they seemed to have an increased risk of the severe demarcated opacities, i.e. opacities resulting in macroscopic loss of tooth substance, and possibly a need for restorative care.

Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs.

BackgroundThe oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs.MethodsThis study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters.ResultsFifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years) and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7%) were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5) and parents' educational status (p = 0.43). The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6). Twenty-five (46.3%) had good oral hygiene, 17 (31.5%) had fair oral hygiene and 12 (22.2%) had poor oral hygiene, with no significant difference across gender (p = 1.11) and age groups (p = 0.07). Fifteen (27.8%) had gingivitis with no significant difference across age groups (p = 0.17). Forty-five (83.3%) had Angle's class I malocclusion, 6(11.1%) class II and 3 (5.6%) class III. Chronologic enamel hypoplasia was found in 9 (16.7%) of the total population. Up to 53.7% of the total population will require oral prophylaxis, 33.3% required restorations on their posterior teeth and 12.9% required veneers for labial facing of hypoplastic enamel.ConclusionThe subjects in this study had a high prevalence of dental caries and need for restorative care. They would benefit from parental education on diet modification, improvement of oral hygiene practices and regular dental visits.

How Much Does the DMFT Index Underestimate the Need for Restorative Care?

The DMFT index, which represents caries experience as recommended by the World Health Organization (clinical examination without radiographs), was compared with a modified DMFT index with radiographs. The purpose was to evaluate how much the DMFT index underestimates the need for restorative care. A cohort of 376 young adults (eighteen to twenty years old) was examined from March 2003 to December 2004. Dental screening was based on clinical examination and bilateral bitewing radiographs. DMFT index was calculated with and without radiographs to compare DMFT scores. The average DMFT was 1.42 higher with radiographs than without (6.35 vs. 4.93, respectively), and the D component was 1.75 higher. The Pearson correlation between DMFT indices was 0.899 (p<0.0001) and 0.759 between the D components (p<0.0001). A correlation was found between D with radiographs and smoking more than ten cigarettes per day (p=0.0069). Without radiographs, there is a 44 percent probability that the caries decay value will be lower than the actual value, thus causing a greater possibility of diagnostic errors. The findings indicate that assessing treatment needs for a population based only on DMFT screening is inadequate and incomplete without radiographs.

The Implications of Protocol-Based Care on Dental Services in the Military

Downsizing, limited resources, and increasing costs provide challenges to the military health system. Variations in the diagnosis and treatment of dental disease add to the demands on the delivery system to provide access and ensure quality for uniformed personnel. Evidence-based dentistry is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. An evidence-based practice combines individual clinical expertise with the best external evidence available from systematic review of research findings. It provides a scientific basis for patient care, planning and implementation of health services, and development of health policy. Practice guidelines formulated on scientific evidence can reduce variations in the diagnosis and treatment of various dental conditions. A risk assessment protocol for treating dental caries can reduce operative dental treatment recommended at the initial examination and decrease the need for restorative care during a military career.

TRENDS IN PER-PATIENT GROSS INCOME TO DENTAL PRACTICES FROM INSURED PATIENTS, 1980–1995

The authors discuss changes that occurred in per-patient gross income to dental practices from insured patients between 1980 and 1995. The current young-adult cohort appears to provide lower per-patient practice incomes compared with earlier young-adult cohorts. These changes may be the result of differences in the need for restorative care among young adults who benefited from the childhood caries decline of the 1970s and 1980s. If this reduced use of restorative services pattern persists as this young-adult cohort and succeeding cohorts age, the effect on dental practices could be substantial.

TRENDS IN DENTAL CARE AMONG INSURED AMERICANS: 1980 TO 1995

This article presents data on the use of a wide range of dental services by insured patients between 1980 and 1995. The patterns of dental care revealed in this study show clear trends that indicate profound improvements in oral health. These improvements are evident in all age groups, and the effect of the caries decline in children that began about 20 years ago has moved well into the adult population. As those born since about 1950 continue to age and represent an ever-increasing proportion of the population, the overall need for restorative care of all types will continue to diminish.

University of North Carolina Caries Risk Assessment Study. III. Multiple Factors in Caries Prevalence

The baseline caries experienced of approximately 5,000 children in South Carolina and Maine was used as the dependent variable in caries risk assessment analyses. Clinical, microbiologic, and demographic factors served as independent variables in a multivariate relationship to caries through regression and discriminant function analyses. Four factors--number of dental visits by the child in the past year, presence of white spot lesions, and both the urgency of need for restorative care and the future caries increment predicted by the examiner--associated significantly and consistently with caries prevalence in primary and permanent teeth of first and fifth graders at both study sites. Several factors associated significantly with caries prevalence at only one site or grade within a site, suggesting that wide applicability of a specific caries risk assessment model may be limited. In these analyses, sensitivity ranged from .60 to .72 and specificity varied from .86 to .91 in the four grade-site groups. The ultimate goal of this longitudinal study is to identify highly caries-prone children in time to prevent the occurrence of a future caries increment. Although the lack of consistent association of many variables, including microbiologic factors, with baseline caries prevalence was unexpected, it is expected that some of these variables will contribute predictive power in the prospective study.