Changes and trends in attack distributions and progression of dental caries in three age cohorts in Finland

Impact of school sealant programs on oral health among youth and identification of potential barriers to implementation

BACKGROUND

School sealant programs (SSPs) increase sealant prevalence among children lacking access to oral health care. SSPs, however, are substantially underused. From 2013 through 2018, the Centers for Disease Control and Prevention funded 18 states for SSP activities in high-need schools (≥ 50% free and reduced-price meal program participation). From 2019 through 2020, the authors assessed SSPs' impact in reducing caries and how states expanded SSPs. The authors also discuss potential barriers to expansion.

METHODS

For Aim 1, the authors used a published methodology and SSP baseline screening and 1-year retention data to estimate averted caries over 9 years attributable to SSPs. For Aim 2, the authors used state responses to an online survey, phone interviews, and annual administrative reports.

RESULTS

Using data for 62,750 children attending 18.6% of high-need schools in 16 states, the authors estimated that 7.5% of sound, unsealed molars would develop caries annually without sealants and placing 4 sealants would prevent caries in 1 molar. Fourteen states reported SSP expansion in high-need schools. The 2 most frequently reported barriers to SSP expansion were levels of funding and policies requiring dentists to be present at assessment or sealant placement.

CONCLUSIONS

The authors found that SSPs typically served children at elevated caries risk and reduced caries. In addition, the authors identified funding levels and policies governing supervision of dental hygienists as possible barriers to SSP expansion.

PRACTICAL IMPLICATIONS

Increasing SSP prevalence could reduce caries. Further research on potential barriers to SSP implementation identified in this study could provide critical information for long-term SSP sustainability.

Caries Progression Rates Revisited: A Systematic Review

Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d₃/D₃), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09–0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

Calculating averted caries attributable to school-based sealant programs with a minimal data set

OBJECTIVES

We describe a methodology for school-based sealant programs (SBSP) to estimate averted cavities, (i.e., difference in cavities without and with SBSP) over 9 years using a minimal data set.

METHODS

A Markov model was used to estimate averted cavities. SBSP would input estimates of their annual attack rate (AR) and 1-year retention rate. The model estimated retention 2+ years after placement with a functional form obtained from the literature. Assuming a constant AR, SBSP can estimate their AR with child-level data collected prior to sealant placement on sealant presence, number of decayed/filled first molars, and age. We demonstrate the methodology with data from the Wisconsin SBSP. Finally, we examine how sensitive averted cavities obtained with this methodology is if an SBSP were to over or underestimate their AR or 1-year retention.

RESULTS

Demonstrating the methodology with estimated AR (= 7 percent) and 1-year retention (= 92 percent) from the Wisconsin SBSP data, we found that placing 31,324 sealants averted 10,718 cavities. Sensitivity analysis indicated that for any AR, the magnitude of the error (percent) in estimating averted cavities was always less than the magnitude of the error in specifying the AR and equal to the error in specifying the 1-year retention rate. We also found that estimates of averted cavities were more robust to misspecifications of AR for higher- versus lower-risk children.

CONCLUSIONS

With Excel (Microsoft Corporation, Redmond, WA, USA) spreadsheets available upon request, SBSP can use this methodology to generate reasonable estimates of their impact with a minimal data set.

What is an appropriate caries diagnosis?

This aim of this paper is to spur a discussion of the direction of caries-lesion detection activities in clinical dental practice. It is argued that since the dental clinician's caries-related decision making is a script-matching enterprise in which clinical decisions are made on the basis of 'this-lesion-needs-this-kind-of-treatment' reasoning, the methods and strategies employed for caries lesion detection should accommodate this fact. This may be done by employing a clinical visual-tactile method for caries lesion detection that evaluates the two aspects that are crucial for appropriate caries management: lesion activity and surface integrity. The use of diagnostic methods that do not assess these features directly but involve assumptions about activity status and surface integrity should be avoided. This includes the use of bite-wing radiography for the detection of approximal caries lesions, as it may be shown that plain reliance on radiographs leads to considerable overtreatment. If clinical dentistry is to retain its status as a profession committed to doing good, changes in diagnostic practices along these lines are warranted.

Children's use of dental services in the five Nordic countries

BACKGROUND

An increase in the use of general practitioner services for children has taken place since the 1980s in the Nordic countries, but little is known about the use of dental services during this time.

AIM

To compare differences in children's use of dental services in the five Nordic countries and to analyse changes over time from the 1980s to the 1990s.

METHODS

The participants were 20 500 children aged 2-17 years from Denmark, Finland, Iceland, Norway and Sweden. Cross-sectional population surveys using random samples comprising 3000 children in each country were conducted in 1984 and 1996. Changes over time in the use of dental services were studied in each country by age, sex, level of parental education and living area.

RESULTS

The prevalence of children's utilisation of dental services varied between 60% and 34% in 1984, and between 42% and 30% in 1996. A clear change towards decreasing utilisation over time (p<0.05) was found in all countries except Finland, where utilisation increased statistically significantly (p<0.05). Odds ratios (1984 _ 1.00) for the changes ranged between 0.66 (95% confidence interval 0.58 to 0.75) in Sweden and 0.71 (0.62 to 0.81) in Iceland, while the corresponding figure was 1.32 (1.16 to 1.48) in Finland. In 1996, children from families with the lowest education in Finland and Norway used dental services more frequently than children from families with higher education.

CONCLUSION

Children's use of dental services decreased significantly in four of the five Nordic countries between the mid-1980s and the mid-1990s.

Dental and oral radiographic findings in first-year university students in 1982 and 2002 in Helsinki, Finland

OBJECTIVE

This study is part of a larger research program, at the Finnish Student Health Service in Helsinki, in which changes in the dental and oral health of first-year university students (born in Helsinki) in the years 1982 and 2002 were compared.

MATERIAL AND METHODS

Panoramic radiographs were taken of 176 students in 1982, mean age 19.8 years (SD+/-0.7), and of 231 in 2002, mean age 20.2 (SD+/-0.7). DMFT index, caries and periapical changes, alveolar bone resorption, wisdom teeth, supernumerary, missing, and persisting deciduous teeth were evaluated from the radiographs. The chi-squared test and non-parametric tests were used to analyze the statistical significance of differences between the study groups and between genders.

RESULTS

The DMFT index diminished from 11.0 (SD +/- 4.2) to 2.9 (SD +/- 3.3) (p < 0.0001). In 2002, 27.9% of the students had a DMFT index of zero (in 1982, 0%, p < 0.000). The mean number of endodontically treated teeth diminished from 0.1 to 0.03 (p < 0.05). The number of impacted wisdom teeth increased in males from mean 0.41 to 0.69 (p < 0.05).

CONCLUSIONS

An improvement in dental health was obvious in the year 2002. The favorable change in DMFT index is a trend that has been going on for several decades in Finland, probably as a result of the use of fluorides and better education in dental hygiene. The change might also be connected with improved general health.