Untreated Decay Research Articles

Dental Caries of Refugee Children Compared With US Children

Dental care is a major unmet health need of refugee children. Many refugee children have never received oral health care or been exposed to common preventive oral health measures, such as a toothbrush, fluoridated toothpaste, or fluoridated water. Oral health problems among refugee children are most likely to be detected first by pediatricians and family practitioners. Given the increased influx of refugees into the United States, particularly children, it is important for the pediatric community to be aware of potential oral health problems among refugee children and be able to make referrals for treatment and recommendations for the prevention of future oral diseases. The purpose of this study was to describe the prevalence of caries experience and untreated decay among newly arrived refugee children stratified by their region of origin and compared with US children. Oral health assessments were conducted within 1 month of arrival to the United States as part of the Refugee Health Assessment Program of the Massachusetts Department of Public Health. The outcome variables include caries experience and untreated decay. Caries experience is determined by the presence of an untreated caries lesion, a restoration, or a permanent molar tooth that is missing because it has been extracted as a result of dental caries. Untreated caries is detected when 0.5 mm of tooth structure is lost and there is brown coloration of the walls of the cavity. Comparisons of the refugee children with US children in Third National Health and Nutrition Examination Survey data were made using chi2 test of independence and multiple logistic regression. Oral health screenings were performed on 224 newly arrived refugees who ranged in age from 6 months to 18 years and had a mean age of 10.6 years (SD: 4.82; median: 10.7 years). African refugees represented 53.6%, with the majority from Somalia, Liberia, and Sudan. Eastern European refugees composed 26.8% of the study sample. The remaining 19.6% come from a number of countries, such as Afghanistan, Pakistan, and the Middle East. Refugee children had 51.3% caries experience and 48.7% with untreated decay. Caries experience in refugees varied by region of origin, with 38% from Africa exhibiting a history of caries compared with 79.7% of Eastern Europeans. The highest proportion of children with no obvious dental problems was from Africa (40.5%) compared with 16.9% from Eastern Europe. US children had caries experience similar to that of refugees (49.3%) but significantly lower risk of untreated decay (22.8%). Comparisons between refugee children and US children found significant differences for treatment urgency, untreated caries, extent of dental caries, and presence of oral pain. White refugee children, primarily from Eastern Europe, were 2.8 times as likely to have caries experience compared with white US children, with 9.4 times the risk of untreated decay compared with white US children. In contrast, African refugee children were only half as likely to have caries experience compared with white US children (95% confidence interval: 0.3-0.7) and African American children (95% confidence interval: 0.3-0.7). However, African refugee children were similar to African American children in risk of untreated decay (odds ratio: 0.94). African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared with similarly aged Eastern European refugee children. They were also less likely to have ever been to a dentist. Possible reasons for these findings may include differences in exposure to natural fluoride in the drinking water, dietary differences, access to professional care, and cultural beliefs and practices. The prevalence of caries experience and untreated caries differed significantly between refugee children and US children. These differences varied significantly by race. When refugee children were compared with US children, the African refugee children had only half the caries experience of either white or African American children. However, African refugee children had similar likelihood of having untreated caries as compared with African American children, despite that very few African children had previous access to professional dental care. These findings are consistent with previous studies on health disparities in the United States. White refugee children, primarily from Eastern Europe, were also 3 times as likely to have caries experience compared with either white or African American children and were 9.4 times as likely to have untreated caries as white US children. Refugee children are more likely to establish primary medical care before seeking dental treatment. With the limited access to dental care among refugees, pediatricians should be particularly alert to the risk of oral diseases among refugee children.

ACU column 15.3 (August 2004).

Many families must choose to set aside oral health concerns until pain or limited function forces them to seek care. As America's poor struggle to find affordable oral health care, the limited numbers of clinicians who provide it also face many challenges. The complexities of this problem include a shortage of health professionals who are committed to providing services to the underserved (in particular, to underinsured and uninsured individuals and families). Moreover, having dental insurance does not ensure access to care. Many private sector dentists do not accept Medicaid because of historically low reimbursement rates and cumbersome administrative requirements. The result is a tremendous burden of oral disease on America's poor, increased by health disparities between majority and minority racial and ethnic groups, resulting in compromised overall health for whole communities. The following narratives describe the journeys of two community-based dentists, one rural and one urban, who between them have devoted over 30 years to working in some of America's poor and underserved communities. They have designed, implemented, evaluated and sustained oral health programs in their communities and, consequently, have made inroads to eliminating oral health disparities. Although their stories are quite different, both report that success in part grew out of collaborative partnerships. Both agree that the practice of transdisciplinary health care is among the most rewarding facets of their daily work. Scott Wolpin, DMD, a founding member of ACU, is the Dental Director of the Choptank Community Health Center on the Eastern Shore of Maryland, a rural area where the median household income is well below the national average. The Eastern Shore of Maryland suffers from a disproportionately high incidence of children's dental disease compared with national averages (whereas the U.S. average for untreated dental decay in five year olds is 29%, on the Eastern Shore it is 82%). Here, Dr. Wolpin tells about his work at Choptank. There are many gaps in the provision of oral health services to America's medically underserved. As a frontline clinician in a rural community health center, I have days when I silently cry inside from empathy for my patients and from my own exhaustion and I have other days when the smiles of relief and gratitude from patients young and old make the work deeply meaningful. A typical day in a community-based clinic can be harried and unpredictable, but it is very likely to be filled with unannounced visits from people suffering with toothaches or swellings who were referred from an emergency room the night before. On such a day, I will most likely have to perform difficult procedures that, in most private practices, would be referred to dental specialists. These severe problems are usually found in the mouths of uninsured patients. A common scene finds me assessing the oral trauma of an uncooperative child who was injured in a car accident while not strapped in to a car seat, as the entire family tries to squeeze into my small [End Page 313] treatment room. The fact that family resources are stretched very thin means that this family's first visit to me is more sudden and difficult than it would be for a family with a regular source of care for oral health who could leave the other children at home with a babysitter. Working with an underserved community can be emotionally exhausting. Trying to communicate postoperative instructions, explanations of needed procedures or the severity of a disease is very frustrating when it is clear the family does not understand what I am saying. It is discouraging when I see my patients put buying cigarettes before oral health care. I also worry about what to do when there is nowhere to refer patients with complicated health care needs. These are just some of the daily stresses of providing community-based oral health care. Running a community-based clinic requires flexibility and willingness to break the rules...

The relationship between healthful eating practices and dental caries in children aged 2–5 years in the United States, 1988–1994

As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children. The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years. The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth. Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children. Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis.

Recent decades have seen a trend to treat juvenile idiopathic arthritis (JIA) with increasing immunosuppression to improve the long-term outcome. Poor oral hygiene and dental decay cause significant morbidity, and patients with chronic disease (who may be further immunocompromised by treatment) are at greater risk. This study investigated patients with JIA using standard measures of oral health. One hundred and forty-nine patients with JIA were included. The children were attending a regional paediatric rheumatology service and the adults were attending an adult rheumatology clinic. Random age- and sex-matched healthy controls were recruited from a dental teaching hospital. The structured dental examination included standard epidemiological indices of oral hygiene (gingival index, plaque index, oral cleanliness index) and dental decay [DMFT (decayed, missing or filled teeth) index]. JIA patients, at all ages, had increased levels of dental decay and poor oral hygiene. This increased level of decay was statistically significant in the patients aged 0-11 yr. Significant levels of untreated caries and increased levels of missing teeth were found in JIA, suggesting that patients with JIA had less restorative dental treatment, with tooth extraction often the chosen option for the treatment of dental decay. This is the largest study of oral health in JIA and is cross-sectional with non-diseased controls. It shows significantly increased levels of poor oral hygiene and dental decay in patients with JIA. The high levels of untreated dental decay suggest barriers to dental care. These results emphasize the role of regular dental care in the multidisciplinary management of JIA.

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study.

The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. In this cross-sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. Examinations were carried out in two local clinics by standardized examiners. One hundred twenty-nine dentate persons were examined. The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14-20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14-20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.

Dental caries in the primary dentition: assessing prevalence of cavitated and noncavitated lesions.

Dental caries in the primary dentition has received renewed attention in recent years because caries in the primary dentition is predictive of later caries experience, and because of efforts to address early childhood caries. More detailed caries diagnostic criteria have been developed and used for the permanent teeth; however, such criteria have not been widely adopted for caries diagnosis in the primary dentition. As part of the Iowa Fluoride Study, caries diagnostic criteria were developed specifically for the primary teeth. The criteria included noncavitated (d1) lesions and cavitated (d2-3) lesions. Examinations were conducted on 698 children in the primary dentition by two trained examiners who did duplicate examinations on 11 percent (n = 67) of these children. Interexaminer agreement for any d1 and any d2-3 lesions at the person level was 100 percent. At the tooth level for d1d2-3f, there was 98.5 percent agreement and kappa was .91. For d1 at the tooth level, agreement was 97.0 percent agreement and kappa = .24. For d2-3 it was 99.4 percent agreement and kappa = .81. Prevalence of untreated d2-3 was 16.5 percent, while that of d1 was 24.1 percent. Nearly 73 percent had no d2-3 or filled surfaces, while over 63 percent had no d1, d2-3, or filled surfaces. Decay experience was most common on the primary second molars. About 56 percent of untreated d2-3 decay was located in the pits and fissures, while 58 percent of d1 decay was located on smooth surfaces. Despite some concern with reliability of diagnosing d1 lesions, it appears that the d1d2-3 criteria are informative and useful in assessing the primary dentition.

Healthy children 2010: Implications for pediatric nursing practice

Healthy children 2010: Implications for pediatric nursing practice

Sickle cell anemia and dental caries: a literature review and pilot study.

The purpose of this cohort study was to determine whether individuals with sickle cell anemia (SCA) were more susceptible to dental caries than non-sickle-cell control subjects. A review of the literature suggests several reasons why individuals with SCA may be at increased risk. Thirty-five cases of SCA aged 6 years and older were identified from a screening of 15,900 current patient files at the Howard University College of Dentistry Dental Clinic. A total of 140 non-SCA control subjects (four per case), frequency-matched on enrollment period (+/- 5 yrs) and age (+/- 2 yrs if under age 21, or +/- 5 yrs if 21 or over), was selected by a nonbiased method from the same dental clinic files. SCA cases and controls were identical on mean age (30.4 +/- 19 yrs, ranging from 5 to 92 yrs) and were similar in sex distribution (males: 34% of SCA cases, 40% of controls). The mean number of permanent teeth present was very similar for SCA cases and controls (23.4 +/- 6.4 vs. 24.2 +/- 6.4). The mean DMFT was 21% higher in the SCA cases (12.0 +/- 8.4 vs. 9.9 +/- 6.9), and the mean DMFS was 26% higher in the SCA cases (33.0 +/- 32.3 vs. 26.2 +/- 27.7). While there was virtually no difference in DMFS between SCA cases and controls for 6- to 19-year-olds, for subjects aged 20 and older, the DMFS was 30.4% higher in the SCD cases. For all ages, the M component for SCA cases was 40.7% higher, and the D component was 20.0% higher, while the F component was only 3.5% higher than for controls. Untreated decay (the D/D+F surfaces ratio) was 24.4% higher in the SCA cases. The findings from this pilot study suggest that SCA cases have a higher susceptibility to dental caries and/or that SCA patients may have different treatment pathways once caries is detected. While none of the observed differences was statistically significant, these findings were of clinical interest and should be pursued in future large-scale studies.

Tooth loss in the very old: 13-15-year incidence among elderly Iowans.

Very few studies have reported tooth loss incidence over a period of 10 years or more, and fewer have reported tooth loss occurrence in subjects aged 80 and older, so that the long-term pattern of tooth loss in the very old is largely unknown. This study assessed 13-15-year tooth loss incidence among a cohort of Iowans, aged 65 and older at baseline. Oral examinations were conducted on 520 subjects beginning in 1983, and periodically until 1988, with another round of examinations conducted on surviving members of the initial cohort during 1996-98. Of the 73 remaining subjects, 45 subjects lost a total of 153 teeth during the period (mean=2.1 teeth lost), with a maximum of 17 teeth lost. Molars were the most commonly lost teeth, while canines and maxillary incisors were the least commonly lost. Bivariate analyses found that tooth loss was associated with untreated decay at baseline and level of periodontal attachment loss at earlier examinations. Logistic regression identified only greater severity of attachment loss as a significant risk factor for tooth loss (Adjusted odds ratio=2.4, P=0.006). The impact of tooth loss on subjects' lives was assessed using OHIP and other questions. The occurrence of tooth loss over the study period had little impact, but the number of remaining teeth significantly impacted subjects' ability to eat or chew food, swallow, or their willingness to smile. These results suggest that tooth loss continues in the very old, that periodontal attachment loss is associated with tooth loss in this age group, and that loss of teeth over one's lifetime does affect certain quality-of-life measures.

Aspects of tooth decay in recently arrived refugees

ObjectiveTo measure and compare the prevalence and distribution of tooth decay among two refugee groups recently arrived in Australia. MethodThe study included refugees aged 15–44 years from Iraq and the former Yugoslavia and random, age‐matched social security recipients attending for emergency dental care in 1996. ResultsIn younger persons, former Yugoslavian refugees had significantly greater decay experience than Iraqis and emergency care recipients. Refugees had significantly more untreated decay than emergency care recipients and a similar distribution of untreated decayed teeth, with only 15% having none and more than 10% having high decay levels. More than 33% of emergency care recipients had no untreated decay and less than 5% had high levels. ConclusionSignificant differences were found between refugees and emergency dental care recipients, with refugees having a higher prevalence and more uniform distribution of untreated decay. ImplicationsConsistent with public health objectives, the finding that refugees had significantly more untreated decay than other disadvantaged Australians provides support for improved access to dental care during the settlement period.

The role of the pediatrician in the oral health of children: A national survey.

To assess pediatricians' knowledge, attitudes, and professional experience regarding oral health, and to determine willingness to incorporate fluoride varnish into their practices. Poor and minority children suffer disproportionately from dental caries and have limited access to dental care. In a recent analysis of national survey data, the General Accounting Office reported that poor children had 5 times more untreated decay than did children from higher income families. Untreated decay can lead to problems with eating, speaking, and attending to learning. Children who are poor suffer 12 times the number of restricted activity days because of dental problems, compared with more affluent children. Despite higher rates of dental decay, poor children had one half the number of dental visits compared with higher income children in 1996. Medicaid's Early Periodic Screening Diagnosis and Treatment (EPSDT) program is intended to provide regular dental screenings and appropriate treatment but has apparently played a limited role in improving access to dental care for poor children. According to a report by the Office of the Inspector General of the Department of Health and Human Services, only 20% of children under 21 years of age, who were enrolled in Medicaid and eligible for EPSDT, actually received preventive dental services. By increasing their involvement in oral health prevention during well-child care visits, pediatricians may be able to play an important role in improving the dental health of their patients who have difficulty obtaining access to professional dental care. However, it is unclear to what degree pediatricians are knowledgeable about preventive oral health and the extent to which they may already be participating in prevention and assessment. Also, little is known about the incidence of dental problems in pediatric practice, and whether pediatricians perceive barriers to their patients' receiving professional dental care. Finally, it is important to know how pediatricians value the promotion of oral health and whether they would be willing to take on additional activities aimed at its improvement. We addressed these questions in a national survey of pediatricians. We surveyed a national sample of 1600 pediatricians randomly selected from the American Medical Association Master File to assess their knowledge, current practice, and opinion on their role in the promotion of oral health; experience with dental decay among patients and in referring patients for professional dental care; and willingness to apply fluoride varnish. Of 1386 eligible survey recipients, 862 returned surveys for a response rate of 62%. Respondents reported seeing dental problems regularly. Two thirds of respondents observed caries in their school-aged patients at least once a month. Of the respondents, 55% reported difficulty achieving successful dental referrals for their uninsured patients and 38% reported difficulty referring their Medicaid patients. More than 90% of the respondents agreed that they had an important role in identifying dental problems and counseling families on the prevention of caries. Moreover, respondents were interested in increasing their involvement: 74% expressed a willingness to apply fluoride varnish in their practices. One half of the respondents, however, reported no previous training in dental health issues during medical school or residency, and only 9% correctly answered all 4 knowledge questions. Access to dental care and unmet dental health needs are serious, under addressed problems for poor and minority children in the United States. In promoting preventive oral health, pediatricians benefit all children and particularly the underserved. We know of 2 states, Washington and North Carolina, that have acknowledged, through the provision of reimbursement, that pediatricians have a unique opportunity at well-child care visits to provide caries prevention c

DENTAL CARIES PREVALENCE AND DENTAL CARE UTILIZATION AMONG THE VERY OLD

This article reports on coronal and root caries prevalence and dental care utilization patterns of elderly Iowans aged 79 years or older. The sample for this study was 449 people who were surviving members of the Iowa 65+ Rural Health Study cohort originally recruited in 1981. The authors focused their analyses on the 342 of these who were dentate. Examinations were conducted in subjects' homes by trained and calibrated examiners, using a halogen headlight, a mouth mirror, a color-coded periodontal probe and a no. 23 explorer. The mean age of subjects was 85.1 years (range 79-101 years), and they had a mean of 19.4 remaining teeth. Nearly all subjects (96 percent) had coronal decay experience, while 23 percent of the subjects had untreated coronal decay, about one-fourth of which was recurrent. Nearly two-thirds (64 percent) of the sample had root caries experience, with 23 percent having untreated root caries. Utilization of dental services was high among the dentate elderly, with nearly three-quarters reporting having visited a dentist within the past year. Nearly all reported that they paid for dental care themselves with no third-party coverage. The findings from this study of the very old suggest that coronal and root caries remain prevalent, with high levels of dental care utilization among those who have retained natural teeth. As the U.S. population ages, and more teeth are retained, demand for dental services in the population of the oldest elderly people is likely to increase.

Functional status and untreated dental caries among nursing home residents aged 65 and over.

This descriptive study examined the relationship between untreated dental caries and functional status among 958 dentate nursing home residents aged 65 and over. Functional status was measured by the Physical Self-Maintenance Scale (PSMS). The PSMS assessment revealed that 32% of subjects were unable to perform all activities, and only 10% could perform all activities. Overall, 59% of subjects had untreated coronal decay and 46% had untreated root decay. In bivariate analysis, untreated coronal and root caries experiences were significantly associated with PSMS limitations, lack of dental care utilization, sex, and number of remaining teeth. Stratified analysis suggested an interaction between functional status and dental care utilization. Among subjects who had received dental care in the preceding year, PSMS status was not significantly related to untreated caries experience; but among subjects who had not received care, PSMS status was significantly related to untreated caries experience. In logistic regression analysis of untreated root decay, a significant interaction was found between PSMS status and dental care utilization. However, in logistic regression analysis of untreated coronal caries, no significant interaction was found; significant independent effects were found for dental care utilization and number of remaining teeth, but not for PSMS status.

Deprivation and dental caries status of 5-year-old children in Scotland.

The aim of this study was to investigate the relationship between the dental caries status of 5-year-old children in Scotland and deprivation, as assessed by the Carstairs score and its DEPCAT categories, which are composite descriptors of socio-economic status. Anonymous records, including postcode sector of residence, from the 1995/96 Scottish Health Board's Dental Epidemiological Programme 5-year-old survey were linked though a multi-stage process to their corresponding Carstairs scores and DEPCAT categories. The data were analysed to investigate the relationship between d3t, mt, ft, d3mft, proportion 'free' of caries experience and socio-economic status for Scotland. When analysed by DEPCAT the mean d3mft ranged from 1.48 for children resident in the most affluent postcode areas (DEPCAT 1) to 4.87 for those in DEPCAT 7. The mean d3mft from the 1995/96 survey of 5-year-old children in Scotland was 2.93. For the percentage 'free' of caries experience (d3mft = 0) the findings in this study ranged from 62.4% (DEPCAT 1) to 19.8% (DEPCAT 7). The d3t and mt components of d3mft and mean d3mft showed a strong positive association with increasing deprivation. The proportion of 5-year-olds experiencing decay was also significantly associated with a more deprived Carstairs score. The f component showed no association with deprivation. The Care Index (ft/d3mft x 100%) ranged from 10.8% (DEPCAT 1) to 2.9% (DEPCAT 7). There was a striking association between increasing deprivation and increasing caries experience. Children from the most deprived areas had significantly more untreated decay and missing teeth. In a population with low levels of restorative intervention, no association was found between deprivation and the amount of restorative care received by Scottish 5-year-old children.

Should the dental practice postcode be used for enhanced capitation payments for children?

Objective Investigate the appropriateness of the under fives' enhanced capitation scheme. Design Calculation of mean caries indices for socially deprived wards (Jarman score 2.5 or greater) and less socially deprived wards (Jarman score below 2.5) in Sheffield using dental epidemiology data and social deprivation data. Calculation of electoral ward dental registration rate using health authority population register data and dental practice board data. Setting Within a health authority using population data already held by the health authority. Results Children living in deprived wards are 1.5 times as likely to have experienced decay (47% versus 31%). Of those children with decay, children in deprived wards have more teeth which have experienced decay (mean dmft (dmft > 0) 5.4) and more untreated decay (mean dt (dmft > 0) 3.4) compared with their peers in less deprived wards (mean dmft (dmft > 0) 4.6 and mean dt (dmft > 0) 3.1). Dental Practice Board data is based upon dental practice postcode, hence some Sheffield electoral wards have dental registration levels as high as 1400 per 1000 residents. Conclusions The principle of targeting dental need by use of Jarman Score is appropriate, however the targeting is undermined by the use of dental practice postcode as the basis of payments. Payment should be based upon the home postcode of the child patient.

Oral health status and treatment needs of Canadian adults aged 85 years and over.

In an oral health survey, 1375 adults aged 85 and older were examined in North York, Canada. Only 31% of dentate nursing home residents and 47% of dentate independently living subjects had received dental care in the year previous to examination. The overall prevalence of edentulism was 66%, and about 80% of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated decay, and 47% of nursing home residents had untreated root decay. Regarding clinically defined treatment needs, high levels of unmet need were identified in subjects from both types of residences. Among nursing home residents, about 45% of dentate subjects required tooth extraction, and 56% required prosthodontic treatment. Although only 27% of dentate independently living residents required tooth extraction, over 60% needed restorative treatment. Higher prevalence of both untreated decay and unmet treatment needs was associated with lower utilization of dental care for dentate subjects. For edentulous subjects, prosthetic treatment was required by 70% of nursing home residents and by 51% of independently living subjects. These results indicate that, for both nursing home and independently living residents, dental diseases and treatment needs continue through out the lifespan.

Dental health in children with cancer

This study investigated the dental health of children (aged 1–14 years) diagnosed with cancer 4–36 months earlier. Sixty patients were examined and interviewed; 43% had untreated decay and only 35%...

Oral Health Status of Special Athletes in the San Francisco Bay Area

A standardized oral health screening protocol was developed for assessing the oral health status of athletes participating in annual Special Olympics events at sites across the country. This paper reports on results at the San Francisco Bay Area Special Olympics event, where 385 athletes participated in the oral health screening. Trained dental screeners determined the presence or absence of edentulism, untreated decay, filled teeth, missing teeth, tooth injury, fluorosis, and gingival signs, as well as treatment urgency. The frequency of mouth cleaning, having a mouth guard, use of tobacco, and presence or absence of pain were self-reported. Overall, child athletes 9-20 years of age had more untreated decay and substantially more missing permanent teeth than 9-20-year-old children represented in the 1986-87 National Institute of Dental Research Survey of U.S. School Children. Prevalence of missing teeth among adult athletes compared favorably with data from the Third National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System Survey. Approximately one-third of child and adult athletes were determined to need dental care. Continued use of a standardized screening protocol could allow state-specific data to be available on the oral health status of this population; trends could be tracked; and needs could be identified, with strategies developed to meet those needs.

Factors affecting levels of untreated caries in a sample of 14-15-year-old adolescents in Northern Ireland

Dental caries experience in children in Northern Ireland is the highest in the United Kingdom. The aims were to examine the levels of untreated decay in a sample of 14-15-year-old children from an area known to have high dental needs and to relate them to factors which affect dental attendance. A sample of 470 pupils aged 14-15 years who attended the 4th form of second level schools in North and West Belfast was obtained and closed questionnaires were distributed 2 weeks prior to the dental examination. 417 pupils were included in the analysis (inclusion rate 88.7%). The mean D value was 1.52 and the D/DMFT mean was 0.31. Individual factors which had significant associations with untreated decay were social class, time since the last dental visit, dental anxiety ratings and the type of dentist attended (mean D of 2.78 for those attending community service dentists and 1.24 for those attending general dental practitioners). Stepwise multiple regression models were constructed with dependent variables of D and the D/DMFT ratio, and the above independent variables remained significantly related to the outcome variables, with the exception of the type of dentist attended. Those attending the community service had higher social needs and longer intervals since dental treatment. Factors related to dental attendance are important in relation to the level of untreated decay but exclusive analysis of the type of dental service attended can be misleading. An active approach is required in order to improve the status of pupils with the highest needs.

He Prevalence Of Oro-Facial Pain And Discomfort Among 16-Year Old Students In Kelantan - A Pilot Study

A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of oro-facial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the precedingfour weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of oro-facial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states isplanned.