Dental health in Icelandic urban children aged 11 and 12 years

Evaluation of Gingival Health Status among 6- and 12-years-old Children in Dhamar City, Yemen: A Cross-sectional Study

INTRODUCTION

Epidemiological data on gingivitis in children are important for understanding the natural course of the disease, identifying its risk factors, and predicting its time trends. The objective of this study was to evaluate the prevalence and severity of gingivitis among 6- and 12-year-old school children in Dhamar city, Yemen.

MATERIALS AND METHODS

A total of 663 children (310 children of 6 years old and 353 children of 12 years old) were examined from 10 public primary schools. Gingival health status was assessed using the plaque index (PI), calculus index (CI), and gingival index (GI) on the six Ramfjord teeth. The latter index was used to categorize gingivitis severity at the subject level. Data were analyzed using independent f-test, chi-squared test, and Spearman's correlation. A p-value of < 0.05 was considered significant.

RESULTS

Both age groups had high mean of PI and GI with nonsignificant difference. The 12-year-old children had calculus deposits much higher than the 6-year-old group with significant difference. There was a significant correlation between age and gender of the whole sample with CI [(odds ratio, OR = 1.65, p = 0.003) and (OR = 0.74, p = 0.05) respectively]. Most of the participants presented with gingival inflammation, which was less in 12-year-old females.

CONCLUSION

Poor oral hygiene and mild gingivitis were highly prevalent among Yemeni school children.

CLINICAL SIGNIFICANCE

The early assessment and intervention of gingivitis and periodontitis will minimize the chance of tooth loss. It has been reported that marginal gingivitis begins early in childhood, increases in prevalence and severity at puberty, and then subsides slightly to the remainder of the second decade of life.

Assessment of Gingival Health Status among 5- and 12-Year-Old Children in Yemen: A Cross-Sectional Study

Purpose. There are limited data about the gingival health status in Yemeni children. The aim, therefore, was to assess oral hygiene status and prevalence and severity of gingivitis among Yemeni preschool and school children. Materials and Methods. A total of 5396 children were included from 5 representative Yemeni governorates: Sana'a, Hajjah, Hodeida, Hadramaut, and Taiz. Five-year olds (1292) were recruited from private kindergartens while 12-year olds (4104) were selected from public primary schools. Gingival health status was assessed using the plaque index (PI), calculus index (CAI), and gingival index (GI) on the 6 Ramfjord teeth. The latter index was used to categorize gingivitis severity at the subject level. Data were analyzed using simple hypothesis testing, as well as ordinal regression. Results. The 12-year old children had significantly much higher mean PI, CAI, and GI (P < 0.001) with 78.6% presenting with gingivitis and 47.8% with moderate gingivitis. In contrast, the figures were 27.2% and 3.1% in the younger group (P < 0.001). There were significant variations according to gender, area of residence, and governorate. Regression analysis revealed that mean PI (OR = 35), mean CAI (OR = 7.7), male gender (OR = 1.6), living in rural areas (OR = 1.4), and being from Hajjah or Sana'a were independent risk factors of gingivitis severity in the older group. For the 5-year olds, the determinants were mean PI (OR = 122), male gender (OR = 1.4), and living in Sana'a or Taiz. Conclusions. Bad oral hygiene and moderate gingivitis are highly prevalent among Yemeni preschool and school children. Geographical location appeared as important independent risk factors of gingival inflammation.

Trends in dental health among Icelandic urban children

Caries experience, oral hygiene and caries-related salivary parameters were recorded in a 20% representative sample of 12-year-old schoolchildren in Reykjavik, Iceland in 1991. The majority of the children was re-examined 3 years later in 1994. Trends in prevalence of caries and salivary bacteria were assessed by comparison with an analogous earlier longitudinal study (1984-87). Mean DFS values for 12-year-olds were 12.1 and 4.1, for 15-year-olds 23.3 and 11.3 in the earlier and later study, respectively. Reduction in DFS was 66% and 52% for the respective age groups. The decline was most pronounced in the group with low caries prevalence. Trends in caries experience were paralleled by salivary bacteria. The mean caries scores and frequency distributions of 15-year-olds in 1994 closely resembled those of 12-year-olds a decade earlier, suggesting a delay rather than a true fall in caries prevalence.

Using the DMF gender difference to assess the "major" role of fluoride toothpastes in the caries decline in industrialized countries: a meta-analysis

The regular use of fluoridated toothpastes has been ascribed a major role in the observed decline in caries prevalence in industrialized countries during the last 20 to 25 years, but only indirect evidence supports this claim. The purpose of this study was to test the hypothesis that the more frequent use of fluoride toothpastes by girls than by boys has reduced the relative age-specific D(M)FT gender difference, and that this difference should decrease with increasing age and fluoride toothpaste exposure among adolescents. The material comprised 8,777 subjects 12 to 17 years of age from the pre-fluoride toothpaste era (1946-1959) and 39,903 from the period when use of fluoride toothpaste had become common (1983-1993) in industrialized countries. Meta-analyses were done using the relative age-specific mean D(M)FT difference between girls and boys. Separate analyses were carried out for subgroups of studies/countries to check for confounding. Regardless of analytical approach, no evidence was found to support the hypothesis. It is concluded that the gender difference in fluoride exposure due to tooth brushing frequency is too small to matter, that the study lacked power, or that the role of fluoride toothpastes in the caries decline has been overrated.

Prevalence of gingivitis in 6-year-olds in Reykjavik, Iceland

As part of a wider investigation of malocclusion, the aim of this study was to determine the prevalence of gingivitis in 6-year-olds in Reykjavik. Parents and guardians of the 401 children in 8 schools were invited by letter to have their children take part. There were 230 positive replies (57%). The Gingival Bleeding Index was used to determine the condition of the gingiva on mesiobuccal and buccal surfaces of 6 selected teeth (totaling 12 surfaces). The results showed that 26% had healthy gingivae, 23% showed bleeding from one surface, 20% from two, 17% from three, and 15% from four to eight surfaces. There were no statistically significant differences in the number of bleeding surfaces between boys and girls. The mean GBI for the whole group was 16%. Gingivitis in this group was therefore prevalent but usually slight.

Restoring oral health. On the rise and fall of dental caries in Iceland

During the last decade, a continuous decrease in dental caries has been observed among schoolchildren in Iceland. In this paper, various epidemiological studies have been reviewed and summarized to illustrate caries prevalence, and how it has changed during the last decades. Furthermore, an attempt has been made to describe some of the factors involved and their possible effects on caries disease. During this period, sugar consumption increased, especially in the form of sweets and soft drinks. At the same time, the import of toothpaste increased, and preventive measures such as fissure sealants and fluoride rinsing programs were intensified. Other factors likely to have had an impact were changes in treatment philosophy and increased personnel resources. There does not seem to be any single factor responsible for the onset of the caries decline. It rather looks as if this was a multifactorial effect due to a number of different preventive measures. During recent years, a change in treatment philosophy, the evident increase in fluoride toothpaste consumption, and possible changes in the oral microbial flora, together with the use of fluoride varnishes, sealants, and increased manpower, may explain the decline.

Oral health in Latvian 15-year-olds

Oral hygiene, caries and periodontal conditions were assessed in a representative sample of 15-year-old Latvian schoolchildren, comprising 506 subjects. Caries, diagnosed on the cavity level, was detected in 97.6% of the population. The mean DMFT and DMFS were 8.1 and 14.1, respectively. Although 91% of the children had had restorative treatment, the D component accounted on average for 33% of the DMFS score. Visible dental plaque was found in 98.4% of the children; in a majority (88%) abundant plaque deposits were recorded. Community Periodontal Index of Treatment Needs (CPITN) was assessed by standard WHO methods. Deviation from periodontal health was observed in 90.7% of the children. Calculus was recorded in 26.1% and gingival pockets in 25.9% of the sample. Additionally, 38.7% of the children had gingival bleeding. The mean number of sextants with healthy periodontal conditions was 2.5. Calculus and pocketing averaged 0.6 and 0.4 sextants, respectively. Attachment loss, recorded in 11.7% of the subjects, did not exceed 3 mm. The results showed high caries prevalence, considerable need for treatment and virtual absence of oral hygiene.

Mutans streptococci, lactobacilli and caries experience in 12-year-old Icelandic urban children, 1984 and 1991

In order to evaluate changes in salivary counts of cariogenic bacteria and relate these to trends in caries experience, stimulated saliva was collected from a 20% random sample of 12-yr-old residents of Reykjavik, Iceland (252 children) in 1991 under conditions consistent with those of a survey conducted in 1984. The mean and median counts of salivary mutans streptococci and lactobacilli remained similar in the two studies. However, the frequency distribution at lower levels of mutans streptococci differed significantly between 1991 and 1984, e.g. in the present study 25.8% of the children had < 10(5) compared with 13.8% in the study 1984. The mean caries prevalence in the permanent dentition (DFStot) was 11.0, which is significantly lower than in 1984 (mean DFStot 28.8). A significant difference in caries prevalence was found at various levels of salivary mutans streptococci. Strep. mutans (serotype c/e/f) was carried by all mutans streptococci-positive children, save one child, who carried only Strep. sobrinus. The proportion of 12-yr-olds who carried Strep. sobrinus had decreased significantly to 15.7% from 34.0% in 1984. Significantly more children with Strep. sobrinus showed high levels of total mutans streptococci than children with only Strep. mutans. As the case was in 1984 significantly more Strep. sobrinus carriers had a high level of salivary lactobacilli as well as higher caries prevalence than the children who did not carry this species.

Changing time trend in caries prevalence in Norwegian children and adolescents

The purpose of the present study was to determine whether or not the decline in caries prevalence had continued among Norwegian 5-, 12- and 18-yr-olds from 1985 to 1991. The analysis was carried out at national, county and dental district level based on the annual census reports from public dental officers. Caries decline continued at national level. Some counties exhibited increases from 1 year to the next, more so in the last 3 years than in the first 3 years of observation, but not consistently. There was stronger evidence for a leveling out or reversal of caries trend at district than at county level. Reversal affected more 5- than 15-yr-olds and more 12- than 18-yr-olds. The chief dental officers in districts reporting a reversal of trend in caries prevalence and in comparison districts showing continued caries decline were interviewed by telephone concerning factors which might explain the observed caries trend. The interviews revealed no obvious explanation why caries prevalence increased in some dental districts while it continued to decline in others. It is concluded that a reversal in caries trend has occurred in some Norwegian dental districts between 1985 and 1991 and that there is a need for a more detailed study of the situation.

Caries experience in Icelandic 12-year-old urban children between 1984 and 1991

In order to evaluate trends in caries experience, a 20% random sample of 12-yr-old residents of Reykjavik, Iceland (252 children) was examined clinically and radiographically in 1991 under conditions consistent with those of the survey conducted in 1984. In addition to caries data, frequency of toothbrushing and use of fluoride dentifrice were recorded. The mean DFT and DFS were 3.0 and 4.1, respectively. The decrease in caries experience reached 60% with an annual fall in DFS of nearly 10%. During the 7-yr period between examinations the decline in DFT and DFS scores averaged 5.2 and 8, respectively, the annual reduction amounting to 0.7 DF teeth or 1.1 DF surfaces per child. The ratio of approximal/occlusal caries and the proportion of approximal caries were similar in both surveys. Fourteen percent of the children were free from manifest caries in 1991, but only 2% in 1984. Polarization between low and high prevalence individuals had intensified. Ninety-five percent of the children brushed their teeth regularly and 97% reported using a fluoride dentifrice.

Dental caries and Streptococcus mutans in a rural child population in Iceland

In spite of having a high socioeconomic standing, in Iceland caries prevalence has remained stubbornly high. This study reports findings from a mixed fishing and farming community in East Iceland that has traditionally been associated with the highest prevalence of caries. A total of 188 children aged 3-16 yr (96.4% of residents of that age group) were examined. At 6 yr the mean dmfs score was 4.1, DMFS 0 and 48% were caries-free. The mean DMFS score at 12 yr was 4.7 and 22.6% remained caries-free but at 16 yr the DMFS score was 11.6 and no children were caries-free. Caries was unevenly distributed within each age group and was more prevalent among residents of the fishing town than the surrounding farming district. In a pilot study conducted in 1989 mean counts of Streptococcus mutans for children aged 4-7 yr were 2.6 x 10(5) cfu/ml and declined to 4.6 x 10(4) cfu/ml in 1990 after a program of chlorhexidine brushing had been added to the routine caries preventive measures adopted in this community. It may therefore be possible to screen Icelandic children for caries risk and apply preventive measures to those demonstrated to be most in need.

Human strains of mutans streptococci show different cariogenic potential in the hamster model

The cariogenic potential of fresh humans strains of Streptococcus mutans and Streptococcus sobrinus was examined in hamsters maintained on a high sucrose diet. The strains 1B 16 (S. mutans) and B13 (S. sobrinus) isolated 20-25 yrs ago served as positive controls. Three series of experiments were run. Some strains were tested once and some strains were tested in all 3 experiments. The animals infected with S. sobrinus strains generally showed lower caries scores than those infected with S. mutans strains. Among the groups infected with the different strains of S. mutans the caries scores varied. In one of the experiments the caries score of the animals infected with one of the Icelandic S. mutans strains was significantly higher than that of the positive control group and the group infected with one of the fresh Swedish isolates. Thus, different strains of mutans streptococci where shown to induce varying caries activity in the hamster model.

Caries prevalence, Streptococcus mutans and sugar intake among 4-year-old urban children in Iceland

Concern at the high prevalence of dental caries in Iceland prompted this survey of 158 preschool children in Reykjavik. On initial examination in 1987 45.8% of the children were caries-free and the prevalence of caries was a mean dmft 2.4 and a mean dmfs 3.3. A dietary questionnaire aimed at discovering the frequency of sugar consumption per week revealed a threshold value of 30 instances of sugar intake per week above which caries prevalence increased markedly. Some of this sugar is consumed in paediatric medicines, particularly antibiotics and anti-asthmatics, which are widely used in Iceland. Caries prevalence (dmft) for children taking such medicines regularly was 3.0 compared with 2.1 for remaining children (P less than 0.05). Those children who took fluoride tablets regularly had less caries (mean dmft 1.1) than those who used fluoride tablets irregularly or not at all (mean dmft 2.8; P less than 0.001). Samples of saliva from the dorsum of the tongue were taken for determination of numbers of Streptococcus mutans and lactobacilli. High bacterial counts were strongly associated with caries. Only 5% of children with more than 5 x 10(5 S. mutans cfu per ml were caries free but 27% of subjects had 67% of the total amount of caries for the group and all of these would have been detected by the bacterial test.

Sugar consumption and caries experience in 12- and 13-year-old Icelandic children

Dietary habits with regard to sugar consumption and caries experience were studied in a group of 275 Icelandic children aged 12 and 13 years. The pattern of meals and sugar-containing food intake frequency were assessed by means of a dietary questionnaire. All dental examinations were performed by one examiner, using standardized methods and diagnostic criteria. Only 75% of the children had three regular meals daily. Breakfast and lunch were the most frequently omitted meals. Sweet buns were consumed by 32% of the children with meals and by 58% between meals, whereas soft drinks were consumed by 42% and 46%, respectively. Eighty-three per cent of the children reported eating sweets daily. The most popular products included confectionery, buns, cakes, and soft drinks, which constituted 53% of the intake with meals and 68% of that between meals. A higher caries incidence was associated with frequent intake of buns and cakes with meals and confectionery.

National survey of caries prevalence in 6-15-year-old children in France

The prevalence of dental caries in France is not known on a nationwide basis, despite the fact that a number of epidemiological studies have been conducted in various parts of the country. The aim of the present study was to provide a national baseline examination of the dental health of children in 1987 since, beginning in November, 1986, the sale of fluoridated salt began in France. A multi-stage probability sample of 19,366 children was selected as representative of the 6-to-15-year-old population. The sample covered all the 95 departments of France. Teams of well-calibrated examiners were constituted in each of the sixteen Faculties of Dental Surgery of France. The prevalence of caries for each age group was determined by means of DMFT, DMFS, dft, and dfs indices. Periodontal conditions were assessed by means of the Plaque Index (Silness and Löe, 1964), the Calculus Index (Marthaler, 1966), and the Gingival Index (Löe and Silness, 1963). Calculation of the mean DMFT index showed, respectively, 0.5 and 1.0 new carious teeth per year under and over the age of 11. The mean values of the DMFT index at ages 6, 12, and 15 were, respectively, 0.5, 4.2, and 6.9. Under the age of 11, the mean DMFS index increased by one between each successive age group and by nearly two over the age of 11. The mean values of the DMFS index at ages 6, 12, and 15 were, respectively, 0.8, 7.6, and 13.0. The percentage of caries-free children decreased from 32.2% at age 6 to 7.9% at age 15.

Mutans streptococci, lactobacilli and caries prevalence in 11- and 12-year-old Icelandic children

Since the caries prevalence has not declined in Iceland as it has in other European countries, it was of interest to study the presence of cariogenic bacteria in Icelandic children. The prevalence of salivary mutans streptococci and lactobacilli was examined in 217 11- and 12-yr-old Icelandic children and was related to their caries prevalence. In 2% of the children mutans streptococci were not found whereas 31% and 35% of the 11-yr-olds and 12-yr-olds respectively carried more than 10(6) CFU per ml saliva. Lactobacilli were not detected in 8% of the children whereas 28% of the 11-yr-olds and 23% of the 12-yr-olds had more than 10(5) CFU per ml saliva. The mean caries prevalence (DFS), initial caries included, for 11-yr-olds was 21.6 and for 12-yr-olds 28.8. Both mutans streptococci and lactobacilli were significantly correlated to each other as well as to caries prevalence. An increased number of these microorganisms, especially the mutans streptococci, were associated with an increased DFS. Children with high salivary counts of mutans streptococci and lactobacilli showed four times higher DFS than children with low numbers. The magnitude of salivary cariogenic bacteria as well as caries prevalence was found to resemble the situation in Sweden 10 yr ago. S. mutans (serotype c/e/f) was carried by all mutans streptococci positive children. S. sobrinus (serotype d/g) was found in 60 children (30.2%). Children with both S. mutans and S. sobrinus had significantly higher salivary counts of mutans streptococci and lactobacilli as well as caries prevalence than children with only S. mutans.