Severity Of Dental Disease Research Articles

Optimizing dental screening protocols for children with special healthcare needs: Enhancing access and prevention

Children with special healthcare needs face significant barriers to accessing dental care, resulting in higher rates of untreated dental disease and poorer oral health outcomes compared to their peers. Optimizing dental screening protocols tailored to the unique needs of this population is crucial to enhancing access to care and preventing dental disease. This paper explores the challenges in accessing dental care for children with special healthcare needs, reviews current screening protocols, and proposes strategies for optimization. The literature review highlights the multifactorial nature of barriers to care, including socioeconomic factors, physical and cognitive limitations, and cultural considerations. Despite existing challenges, success stories and emerging technologies offer promising avenues for improvement. Multidisciplinary collaboration, tailored screening protocols, technology integration, community outreach, and policy advocacy are identified as key strategies for optimization. The proposed strategies are underpinned by the principles of equity, inclusivity, and person-centered care. Implementation plans include pilot programs, professional training, and integration with existing healthcare systems. Evaluation metrics will assess the effectiveness and sustainability of optimized screening protocols. Expected outcomes include increased access to dental care, reduced prevalence and severity of dental disease, improved oral health-related quality of life, and cost-effectiveness. The conclusion emphasizes the importance of ongoing evaluation and adaptation to meet the evolving needs of children with special healthcare needs. This paper calls for concerted efforts from stakeholders across healthcare, education, policy, and advocacy sectors to implement and support the proposed strategies. By optimizing dental screening protocols, we can make significant strides towards enhancing access to care and improving oral health outcomes for children with special healthcare needs.

Prevalence of Early Childhood Caries in South Africa: Protocol for a Systematic Review.

BackgroundYoung children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes.ObjectiveThe purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years.MethodsAll cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted.ResultsThe protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020.ConclusionsThe results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa.Trial RegistrationPROSPERO CRD42018112161; International Registered Report Identifier (IRRID)DERR1-10.2196/25795

The impact of periodontal disease and dental cleaning procedures on serum and urine kidney biomarkers in dogs and cats.

The objective of this study was to evaluate the benefits and inherent risks of dental cleaning procedures, based on serum and urine biomarkers for kidney function and tissue damage, in dogs and cats. Thirty-one asymptomatic, mostly older dogs (14 neutered male and 17 ovariohysterectomized female dogs of various breeds between 3 and 14 years old) and cats (19 neutered male and 12 ovariohysterectomized female domestic short hair cats between 2 and 16 years old) diagnosed with periodontal disease on physical exam, and recommended by their veterinarian to have dental cleaning under general anesthesia were evaluated in a prospective study. Serum and urine samples were collected from dogs and cats 1 week before, 6 hours after, and again 1 week after the dental cleaning procedure. Samples were analyzed for biomarkers of kidney function [serum creatinine (Cr), symmetric dimethylarginine (SDMA), and blood urea nitrogen (BUN), and urine for specific gravity (USG) and protein:creatinine (UPC) ratio]. A panel of biomarkers for renal tissue damage was also assessed [serum β-aminoisobutyric acid (BAIB), and urine cystatin B and clusterin]. Samples collected one week before dental cleaning procedures showed that increased age and severity of dental disease were linked to abnormal kidney function biomarker values (age: elevated SDMA and Cr concentrations and isosthenuric USG values; disease severity: elevated UPC ratios) as well as elevated urine cystatin B and clusterin concentrations. Directly after the dental cleaning procedure, an increased number of cats with elevated SDMA concentrations was observed (specifically in cats with longer duration of dental procedures). Extended duration of dental procedures (≥60 min) was linked to increased urine cystatin B and clusterin concentrations, whereas shorter duration procedures was linked to decreased urine cystatin B and clusterin. Higher SDMA concentrations persisted in cats one week after the dental cleaning procedures and were linked to elevated UPC ratios one week before cleaning procedures. In conclusion, the results of this study indicate a link between severity of dental disease, renal tissue injury, and impaired renal function. Longer duration dental procedures in cats may carry inherent risks of kidney injury and impaired renal function.

Correlation of streptococcus mutans and streptococcus sobrinus colonization with and without caries experience in preschool children.

The aciduric mutans streptococci (MS) group, including Streptococcus mutans (SM) and Streptococcus sobrinus (SS), is highly cariogenic. Relationship between increments in dental caries and the presence of these species is not yet clarified. It is of great importance to separately determine the presence of these two species for understanding their role in dental caries, accurate prediction, and effective prevention. Hence, this study was undertaken to detect the presence of SM and SS in plaque samples of caries-free (CF), early childhood caries (ECC), and severe early childhood caries (S-ECC) and also to compare the possible relationship between these species with the occurrence of ECC. In all, 120 healthy children between 3 and 6 years of age were randomly allocated into three groups: Group A (n = 40) CF, Group B (n = 40) ECC, and Group C (n = 40) S-ECC. Plaque samples were collected from all approximal surface and gingivobuccal surfaces of teeth using a sterile universal scaler and dmft/dmfs scores were taken. The presence of SM and SS was evaluated using real-time polymerase chain reaction. The presence of SM in CF, ECC, and S-ECC was 10.0%, 27.5%, and 42.5%, respectively, and SS was 5.0%, 40.0%, and 47.5% in CF, ECC, and S-ECC, respectively. Comparison of mean relative quantification (RQ) values of SM between three study groups showed significant results between CF and S-ECC at P value 0.003. Comparison of mean RQ values of SS showed significant results between CF to ECC and CF to S-ECC at P value <0.001. This study showed significant results between the mean dmft/dmfs scores in three study groups and the presence of high levels of SM and SS in ECC and S-ECC groups. However, the study showed weak positive correlation between dmfs scores and both SM and SS species in ECC and S-ECC. Higher levels of SS were more closely related to the caries-active lesions leading to severity of dental disease, that is, both in ECC and S-ECC. There was significant difference between mean dmft/dmfs scores in three study groups and it also showed positive correlation between dmfs scores and SM and SS colonization in ECC and S-ECC status.

The Importance of Oral Health in Immigrant and Refugee Children.

According to the Migration Policy Institute, 2017 data revealed that a historic high 44.5 million people living in the United States (US) were foreign-born (Zong, J., et.al., 2019), more than double the number from 1990 (U.S. Immigrant Population and Share over Time. 1850-Present, 2019). Since the creation of the Refugee Resettlement Program in 1980, refugee families have settled in the US more than in any other country in the world (Radford, J., 2019). In 2018, for the first time, Canada overtook the US in numbers of refugees accepted (Zong, J., et. al., 2019). Foreign-born people now account for 13.7% of the total US population (Zong, J., et. al., 2019). Further, a quarter of children in the United States currently live in households with at least one foreign-born parent (America’s Children in Brief: Key National Indicators of Well-Being, 2018). These population shifts are important to note because immigrant and refugee families bring cultural influences and health experiences from their home countries which can greatly affect the overall health and well-being of children. For these new arrivals, oral health is often a significant health issue. The severity of dental disease varies with country of origin as well as cultural beliefs that can hinder access to care even once it is available to them (Obeng, C.S. Culture and dental health among African immigrant school-aged children in the United States, 200; Tiwari, T.; Albino, J. Acculturation and Pediatric Minority Oral Health Interventions, 2017). As pediatricians and primary care providers, we should acknowledge that oral health is important and impacts overall health. Healthcare providers should be able to recognize oral health problems, make appropriate referrals, and effectively communicate with families to address knowledge gaps in high-risk communities.

Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia.

To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012-2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (p<.001). Common medical comorbidities appear evenly distributed: autism (12%), cardiac anomalies (14%), developmental delay (14%), genetic syndromes/chromosomal disorders (13%), and neurological disorders (12%). Younger age groups (1 to 2 years and 3 to 5 years) had a high percentage of hospitalizations due to the extent and severity of the dental disease (83%) and behavior (77%) (p<0.001). No single comorbidity was seen more often than others in this patient population. The range of medical conditions in this population may be a reflection of the range of pediatric specialty services at Children's Hospital of NewYork-Presbyterian.

A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children

The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health–focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health–related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).

Risk Factors for Development of Chronic Kidney Disease in Cats.

BackgroundIdentification of risk factors for development of chronic kidney disease (CKD) in cats may aid in its earlier detection.Hypothesis/objectivesEvaluation of clinical and questionnaire data will identify risk factors for development of azotemic CKD in cats.AnimalsOne hundred and forty‐eight client‐owned geriatric (>9 years) cats.MethodsCats were recruited into the study and followed longitudinally for a variable time. Owners were asked to complete a questionnaire regarding their pet at enrollment. Additional data regarding dental disease were obtained when available by development of a dental categorization system. Variables were explored in univariable and multivariable Cox regression models.ResultsIn the final multivariable Cox regression model, annual/frequent vaccination (P value, .003; hazard ratio, 5.68; 95% confidence interval, 1.83–17.64), moderate dental disease (P value, .008; hazard ratio, 13.83; 95% confidence interval, 2.01–94.99), and severe dental disease (P value, .001; hazard ratio, 35.35; 95% confidence interval, 4.31–289.73) predicted development of azotemic CKD.ConclusionOur study suggests independent associations between both vaccination frequency and severity of dental disease and development of CKD. Further studies to explore the pathophysiological mechanism of renal injury for these risk factors are warranted.

Dental disease patterns in methamphetamine users: Findings in a large urban sample

BackgroundThe authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface. MethodsUsing a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease. ResultsOn all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance. ConclusionsMA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive. Practical ImplicationsThe prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

Risk of dental disease non-battle injuries and severity of dental disease in deployed U.S. Army personnel.

Dental Disease and Non-Battle Injuries (D-DNBI) continue to be a problem among U.S. Army active duty (AD), U.S. Army National Guard (ARNG), and U.S. Army Reserve (USAR) deployed soldiers to Operation Iraqi Freedom/Operation New Dawn in Iraq and Operation Enduring Freedom in Afghanistan. A previous study reported the annual rates to be 136 D-DNBI per 1,000 personnel for AD, 152 for ARNG, and 184 for USAR. The objectives of this study were to describe D-DNBI incidence and to determine risk factors for dental encounters and high severity diagnoses for deployed soldiers. The 78 diagnoses were classified into three categories based on severity. Poisson regression was used to compare D-DNBI rates and logistic regression was used to analyze the risk of high severity D-DNBI. In both campaigns, Reserve had a higher risk of D-DNBI than active duty. For Afghanistan, ARNG and USAR demonstrated over 50% increased risk of D-DNBI compared to AD. In Iraq, USAR had a 17% increased risk over AD. Females had a higher risk of D-DNBI (>50%) compared to males in both campaigns. High severity D-DNBI made up 2.77% of all diagnoses. Within Afghanistan, there was a 4.6% increased risk of high severity D-DNBI for each additional deployment month.

Obesity and dental decay: inference on the role of dietary sugar.

ObjectiveTo evaluate the relationship of children’s obesity and dental decay.MethodsWe measured parameters related to obesity and dental decay in 8,275 4th and 5th grade Kuwaiti children (average age = 11.36 years) in a cross-sectional study. First to determine body weight, height, age for computation of BMI . Second, to determine numbers of teeth, numbers of fillings and numbers of untreated decayed teeth to determine extent and severity of dental disease. From these measurements, we computed measures of dental decay in children from four body weight categories; obese, overweight, normal healthy weight and underweight children.ResultsThe percentage of children with decayed or filled teeth varied inversely with the body weight category. The percentage of decayed or filled teeth decreased from 15.61% (n=193) in underweight children, to 13.03% (n=4,094) in normal healthy weight children, to 9.73% (n=1,786) in overweight children to 7.87% (n=2,202) in obese children. Differences between all groups were statistically significant. Male children in this population had more dental decay than female children but the reduction of tooth decay as a function of BMI was greater in male children.ConclusionsThe finding of an inverse obesity-dental decay relationship contradicts the obesity-sugar and the obesity-dental decay relationship hypotheses. Sugar is well recognized as necessary and sufficient for dental decay. Sugar is also hypothesized to be a leading co-factor in obesity. If the later hypothesis is true, one would expect dental decay to increase with obesity. This was not found. The reasons for this inverse relationship are not currently clear.

The association between cancer treatments and oral diseases

MEDLINE/PubMed and EMBASE. The review included papers published between January 1, 1990 and December 31, 2008. The primary outcome was to retrieve all literature containing original data on dental caries, periodontal disease and pre-cancer dental clearance protocols in cancer patients undergoing head and neck radiotherapy, chemotherapy or combined treatment modalities. Excluded studies included systematic and non-systematic reviews, microbiology studies, growth and development studies, organ transplant studies, studies eliciting dental complications through questionnaires, studies reporting data from previous publications, phase I and II trials, opinion papers, case reports, articles published before 1990, and publications from the 1990 National Cancer Institute Monographs, which were based on the 1989 National Institutes of Health Development Consensus Conference on the Oral Complications of Cancer Therapies. Each article was independently evaluated by two reviewers with pilot-tested collection forms customised for reviewing dental disease data. Dental caries was assessed by the presence (Y/N), DMFT/dmft (decayed, missing, and filled teeth: DMFT for permanent adult teeth and dmft signifying deciduous teeth), and DMFS/dmfs indexes (decayed, missing, and filled surfaces: DMFS for permanent adult teeth and dmfs signifying deciduous teeth), if available. In addition, periodontal health was assessed using the plaque and gingival indexes. Further data collected for each article such as type of study, blinding, presence of control group, scale validity, and sample size were used to determine quality outcomes utilised to determine the weighted prevalence of caries and dental infection. Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (n=457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (n=189). The gingival index for patients who were post-chemotherapy was 1.02 (n=162). The weighted prevalence of dental infection/abscess during chemotherapy was reported in three studies and was 5.8%. Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses is beneficial in patients who are post-radiotherapy. There continues to be a lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.

Periodontal Disease and Potent Bisphosphonates Induce Maxillary Osteonecrosis in the Rat

Statement of the Problem: Bisphosphonate related osteonecrosis of the jaws (BRONJ) is a devastating complication of BP therapy in bone cancer and osteoporosis patients. BRONJ is defined as exposed bone in the maxillofacial region that has persisted for more than 8 weeks in patients with current or previous BP treatment, without a history of radiation to the jaws. BRONJ causes severe pain, swelling, infection, fistulae, and jaw fracture, all of which significantly impact patients' quality of life. Despite the increasing number of cases since the first report in 2003, no validated treatment protocols exist. A rather puzzling, and still unanswered, question is why BP related osteonecrosis affects only the jaw. The oral cavity comprises a unique environment, where the oral mucosa, alveolar bone, periodontal organ, teeth, and muscles perform a series of complicated, specialized functions. Hypotheses attempting to explain the unique localization of BRONJ include altered bone remodeling, angiogenesis inhibition, constant microtrauma, and bacterial infection. However, the mechanisms of high jaw sensitivity to BP treatment remain unidentified. In the great majority of cases, BRONJ occurs after extraction of teeth deemed unrestorable due to the severity of dental disease, or around teeth with active periodontal or periapical disease. Although not always reported as the initiating factor, inflammation of the periodontal tissues is present in the majority of BRONJ cases. Interestingly, oral preventive measures decrease BRONJ incidence, further emphasizing the importance of dental disease in BRONJ pathophysiology.

A systematic review of dental disease in patients undergoing cancer therapy

IntroductionThis purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies.Review methodA systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies.ResultsSixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%.ConclusionsPatients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy.

Clinical dental examinations of 357 donkeys in the UK. Part 2: Epidemiological studies on the potential relationships between different dental disorders, and between dental disease and systemic disorders

Dental disease has been shown to be a risk factor for weight loss and colic in horses. No extensive clinical studies in donkeys have investigated the potential relationship between different dental disorders, or between dental disease and systemic disorders. To determine possible associations between dental disease and body condition score, weight loss, the need for supplemental feeding and prevalence of colic in donkeys of all ages, and to gain a better understanding of the pathogenesis of dental disease by the determination of associations between different dental disorders. A prospective cross-sectional analysis of clinical dental examinations of 357 donkeys in The Donkey Sanctuary, Sidmouth was performed. Other epidemiological factors such as estimated age group, body condition score, weight loss, medical history and supplemental feeding were also recorded, and multiple regression analyses were performed to determine possible associations. Donkeys from older age groups were more likely to have dental disease, poor body condition score and suffered previous colic episodes. The presence of dental disease was also significantly associated with weight loss, colic, low body condition score and the need for supplemental feeding. The presence of diastemata, periodontal disease, wave mouth, smooth mouth and step mouth are frequently associated with the presence of other dental disorders. In addition to oral-related pain, dental disease can cause significant systemic disorders and so has increased welfare implications in donkeys. Some dental disorders promote the development of other types of dental abnormalities and thus increase the severity of dental disease in individual animals. POTENTIAL SIGNIFICANCE: Effective treatment of dental disorders slows down the progression of dental disease and decreases the risk of developing some medical disorders such as colic and weight loss that are associated with dental disease.

Response

MADAM We have read with great interest the letter from Arzi and Verstraete (2009) in which the claim is made that “any study attempting to document the prevalence and severity of dental disease in animals under general anaesthesia should be considered incomplete without dental radiographs”. The essence of the argumentation of Arzi and Verstraete (2009) in favour of routine dental radiographs for the diagnosis of periodontal disease is that more periodontal lesions can be discovered and that the periodontal lesions may appear more severe than recorded in the clinical examination. The validity of this postulate remains uncertain, owing to the fact that a clinical examination can be made of surfaces that cannot be adequately reflected in radiographs. What is beyond doubt, however, is that different measurements reflect different periodontal disease constructs. Hence, the clinical attachment level recordings provide measures of the level of the fibrous attachment of the tooth, whereas the radiographic recordings aim to measure the position and morphology of the alveolar bone in the mesial, interradicular and distal aspects of the tooth. This is a crucial distinction because it is well known that the clinical attachment level in the normal, healthy periodontium is positioned at the cemento-enamel junction, that is the normal level has a precise anatomical definition (Schroeder and Listgarten 1971, Page and Schroeder 1982), whereas this is not the case for the normal crestal bone level. The unclear definition of the “normal” bone level has clear implications for the assessment of both the prevalence and the extent and severity of the periodontal breakdown that may have occurred, and unclear estimates may result when epidemiological studies of the prevalence and extent of periodontal disease are based on radiographs only (Page and Schroeder 1982). The alveolar bone level and the fibrous attachment level do not coincide in periodontal lesions, and alveolar bone level measurements are therefore biased towards exaggerating the extent and severity of periodontal lesions, as these are defined by the connective tissue fibrous attachment level of the tooth. This discrepancy should be considered in the light of the additional disadvantage of radiographs for periodontal diagnosis: That they are ill-suited to reflect the periodontal status at the buccal and lingual/palatal aspects of the teeth, just as their use in a longitudinal perspective necessitates the use of strictly reproducible radiographic techniques. While we agree that radiographs can be of value for oral health screening and specific periodontal treatment planning purposes in veterinary practice, we also agree with the views expressed by Salvi and others (2008) that a radiographic analysis can be no more than “confirmatory to the periodontal chart”. Hence, our decision (Kortegaard and others 2008) to base our research study on clinical recordings only.

Objective interpretation of dental disease in rabbits, guinea pigs and chinchillas

Summary Objective: Objective interpretation of dental disease in rabbits, guinea pigs and chinchillas with the use of anatomical reference lines. Material and methods: Skull radiographs (laterolateral and dorsoventral view) of 528 small mammals (204 rabbits, 151 guinea pigs and 173 chinchillas) were measured and analysed exactly in connection with a thorough intra- and extraoral clinical examination. 464 animals showed variable signs of malocclusion whereas 64 animals had a normocclusion. The clinical and radiographic changes of 224 individuals (52 rabbits, 41 guinea pigs and 131 chinchillas) were additionally compared with post mortem findings. Results: Particularly the comparison of the prepared skulls with the radiographs of the identical animals enabled the acquirement of species specific anatomical reference lines, that facilitate the objectice assessment of severity of dental disease in elodont species. Conclusion and clinical relevance: Using these reference lines the extent of malocclusion in rabbits, guinea pigs and chinchillas can be acquired more exactly and the results are reproducible by different examiners (staging). In addition to this these special lines facilitate to accurately monitor the progress of dental changes and thus to predict a probable long-term prognosis. The reference lines are absolutely applicable for daily use in practice.

Trends in the referral and treatment of new patients at a free emergency dental clinic since 1989.

To investigate the changes in the pattern of new patient referral and treatment at a dental hospital emergency clinic since the introduction of the new dental contract in 1989. A prospective survey and review of clinical records. The examination and emergency clinic at Cardiff Dental Hospital. 500 consecutive new patients attending the clinic in May/June in 1989, 1993, 1994 and 1995. Numbers of referrals; source of referral; geographical distribution of patients; registration with general dental practitioners; type of dental disease; treatment received. New patient attendances increased by 56% since 1989. Referrals from family doctors and dentists decreased while self-referrals increased. Self-referral by patients not registered with family dentists increased by 56%. Extraction of teeth was the commonest form of treatment in all years and increased by 72%. Numbers of patients attending for dental treatment at this setting increased substantially after 1989. Increasing numbers of these patients were inappropriately self-referred for treatment. Patients increasingly selected extraction of teeth as the primary treatment rather than restorative procedures. These changes appeared to be unrelated both to the severity of dental disease at presentation and to socio-economic status.

The dental hygienist as dental care advocate for persons with disabilities.

Although there is a trend towards reduction in the severity of dental disease in persons with disabilities, gaps in the provision of dental services remain. As an advocate of dental care for persons with disabilities, the dental hygienist can personalize the provision of dental services and assist in removing barriers to care. Currently, hygienists function as dental advocates in primary, secondary, and tertiary care settings to various degrees. However, the impact they have is affected by a number of factors, including limited numbers of trained personnel, lack of dental awareness of the public and other health professionals, and access issues such as the cost of dental services, transportation difficulties, and the poor design of office buildings and dental offices. As the dental needs of underserved individuals are increasingly emphasized, it should be expected that educational institutions will prepare more dental hygienists to serve persons with disabilities. This emphasis and the efforts of dental hygienist advocates currently working with other health service providers, health planners, legislators, and health financiers may help persons with disabilities receive needed dental services.