Periodontal awareness, health, and treatment need in dental school patients. II. Periodontal conditions

A systematic review of dental recall intervals and incidence of dental caries

BACKGROUND

Dental recall interval protocols are used to prevent dental disease through regular maintenance evaluations and preventive procedures. In this systematic review, the authors examined the evidence for the rationale behind a "one-recall-interval-fits-all" protocol, such as a six-month recall interval on caries incidence.

METHODS

The authors searched the PubMed database and reviewed titles, abstracts and full reports. They also searched the references of each full report and used the "Related articles" feature. They used a checklist validated for randomized and nonrandomized studies to conduct a quality assessment for each article.

RESULTS

The authors found seven articles representing six studies that met their inclusion criteria. The results of a randomized controlled trial showed no significant differences in oral health between patients recalled every 12 months and those recalled every 24 months. The investigators of one nonrandomized controlled trial reported that a two- to three-month recall interval significantly reduced the incidence and recurrence of caries. The investigators of an additional longitudinal non-randomized controlled study that compared three-, six- and 12-month recall intervals reported caries increments of 4.4, 4.0 and 4.9, respectively. The results of two retrospective studies showed that a specific recall interval did not alter caries incidence significantly. The results from a cross-sectional study suggested that a six-month recall interval was associated with more restored teeth but less active caries.

CONCLUSIONS

The authors conclude that the evidence for using a one-recall-interval-fits-all protocol to reduce caries incidence was weak. Studies that addressed the impact of recall interval on caries incidence were methodologically weak. The evidence was not strong enough to support using any specific one-recall-interval-fits-all protocol for all patients.

CLINICAL IMPLICATIONS

Using a one-recall-interval-fits-all protocol for caries prevention should be re-evaluated. On the basis of evidence from the randomized controlled trial, recall intervals could be extended to every two years. Evidence from the other studies revealed conflicting results for the efficacy of using any specific recall interval protocol. Because all of these studies had serious threats to validity, clinicians may wish to consider assigning recall intervals to patients on the basis of the patients' risk of developing caries. However, a discussion of a caries risk assessment is beyond the scope of this review.

Oral health knowledge and dental health practices among schoolchildren in Jerash district/Jordan

OBJECTIVE

This study aims at determining the oral health awareness level, the patterns of dental health practices and their potential relationship with certain socio-demographic factors, including gender (sex), mother's education and the socio-economic status of the family, among 14-15-year-old schoolchildren in Jerash Governorate, Northern Jordan.

PARTICIPANTS AND METHOD

Cross-sectional survey including 1362 public schoolchildren, who completed a self-administered structured questionnaire.

RESULTS

Overall, the level of oral health knowledge among the surveyed children was low. Of the 1362 schoolchildren included in this survey, only 18 and 17% did know the meaning of plaque and what plaque can cause, respectively. Female performance was significantly better than male performance on two of the six knowledge questions (P < 0.01). While 17% of children have never been to the dentist, there are 10% only who visit the dentist on regular basis. The majority (56%) of these pupils said they visit the dentist when there is a serious dental or oral health problem. Fear of the dentist and difficulty in obtaining an appointment with the dentist were the causes of irregular visit to the dental clinic in 28 and 19% of the cases, respectively.

CONCLUSION

Results of this study prove that oral health awareness level among public schoolchildren in Jordan is still poor and needs to be improved. Based upon these findings, the establishment of a long-term school-based oral health education programme in Jordan is highly recommended.

The effectiveness of routine dental checks: a systematic review of the evidence base

AIMS

To systematically review the effectiveness of routine dental checks of different recall frequencies in adults and children.

METHODS

Search methods included electronic bibliographic databases up to March 2001, relevant internet sites, citation checking and contact with experts and professional dental bodies.

INCLUSION CRITERIA

(1) STUDY DESIGN: any; (2) POPULATION: deciduous, mixed and permanent dentition; (3) INTERVENTION: 'Routine dental check': 'clinical examination, advice, charting (including monitoring of periodontal status) and report' as defined in the NHS Executive General Dental Service Statement of Dental Remuneration; (4) Comparator: no routine dental check or routine dental check(s) of different recall frequency; (5) PRIMARY OUTCOMES: caries, periodontal disease, quality of life, oral cancer.

RESULTS

Twenty eight studies were identified for the review. Studies were poorly reported and clinically heterogenous which restricted comparison between studies and limited generalisability to the UK situation. There was no consistency across multiple studies in the direction of effect of different dental check frequencies on measures of caries in deciduous mixed or permanent dentition, periodontal disease or oral cancer in permanent dentition. No studies were identified linking empirical measures of quality of life associated with oral health and dental check frequency.

CONCLUSIONS

There is no existing high quality evidence to support or refute the practice of encouraging six-monthly dental checks in adults and children.

Periodontal awareness among adult Finns in 1972 and 1990

Surveys were conducted in 1972 and 1990 to analyze conceptions among Finns of their own periodontal status. The interview samples, drawn to represent the Finnish population, aged 15 years and more, comprised 965 persons in 1972 and 1,006 in 1990. After excluding edentulous individuals, a total of 732 in 1972 and 853 in 1990 were accepted for the interview study. In 1990, 2% of the respondents stated that they currently had gingivitis, the percentage being highest in the youngest age group (6%). In both years there were no statistically significant differences between the age, education, and residence subgroups with regard to gingivitis: nearly 60% of those in all subgroups claimed that they had never had gingivitis. The proportions of those who had never experienced gingival bleeding were 54% in 1972 and 50% in 1990. During the first observation period the youngest age group (15-24 years) was the only one in which the increment in self-recognized gingivitis was accompanied by a higher proportion experiencing gingival bleeding. The overall low prevalence of self-recognized gingivitis is at variance with the estimated periodontal treatment need according to Finnish clinical epidemiologic data. Our results indicate that knowledge concerning periodontal disease is still poor in Finland.

Trends in toothbrushing and utilization of dental services in Finland

Prevention and control of common dental diseases highly depends on individual behavior, and during the last decades, individuals have increasingly been required to take responsibility for their own oral health. In Finland the rate of toothbrushing and dental visits were first surveyed nationwide in 1971 by interviews with a sample of 1063 individuals, drawn to represent the total population aged 15 yr and over. At the time, 68% of the 829 dentulous interviewees claimed to brush at least once a day. Using another sample of 1006 interviewees, drawn in the same manner, in 1990 the brushing rate was found to have increased to 91% in 853 dentulous subjects. Daily brushing was more frequent among women (98%) than men (83%). The most distinct positive change regarding brushing frequency was found among men and those with only elementary education. In 1971 the interval between the two most recent dental visits was 1 yr or less for 44% of all the interviewees and for 25% it was more than 5 yr. In 1990, 53% of the interviewees had visited a dentist within a year and the visiting interval was more than 5 yr for 16%. The youngest subjects were the most frequent visitors: 60% of them in 1971 and 74% in 1990. The results indicate a clear trend toward more frequent brushing in Finland. However, this trend regarding dental visits does not seem to be equally remarkable.

Primary reasons for extraction of permanent teeth in Norway: changes from 1968 to 1988

The purpose of the present study was to investigate time trends in primary reasons for extraction of permanent teeth in Norway from 1968 to 1988. Johansen studied reasons for extraction of 8757 teeth in 4216 patients during a 3-week period in 1968. Twenty years later a random sample of 500 Norwegian dentists provided particulars about all extractions carried out during a 2-week period. 350 dentists (70%) replied in 1988 but 96 of them had not extracted any teeth during the observation period. Reasons for extraction of 985 teeth from 692 patients were available for analysis. Caries and its sequelae accounted for 35%, periodontitis for 19%, and orthodontic reasons for 20% of extractions in 1988. A comparison of the distribution of extraction according to reasons for patients over 20 yr of age revealed a highly significant difference between 1968 and 1988 (P less than 0.001) mainly due to a decrease in the role of caries and an increase in extractions for other reasons. Caries and its sequelae accounted for a higher proportion of extractions than periodontitis at all ages over 20 yr in 1968, only up to 45 yr of age in 1988. Thus it is concluded that the observed time trend in primary reasons for extraction corroborates expectations based on declining caries prevalence, increasing retention of teeth and a rise in dental attendance in Norway during the last 20 yr.

Factors influencing the assessment of treatment needs

Epidemiologic surveys have provided data for health planning by estimating prevalence and incidence of diseases in populations. New ways of presenting epidemiologic data on periodontal diseases have changed our understanding of their extent and severity, and conversion of prevalence data into treatment need estimates has proved difficult. Furthermore, new concepts of the pathogenesis of periodontal diseases have questioned the validity of epidemiologic methods currently used. Treatment need assessments vary considerably between studies even when prevalence data from the same populations are similar. This may be due to lack of described goals for periodontal health. Various aspects of the concept of need for treatment are discussed. It is suggested that periodontal treatment need on a population level is defined as the intervention needed in order to change the existing periodontal condition to the described goal. Thus, treatment need assessments will have to include descriptive epidemiologic data as well as defined periodontal health goals. It is recommended that goals are described in terms compatible with the indicators used in the epidemiologic description of the disease status.

Periodontal awareness, health, and treatment need in dental school patients. III. Treatment need

The need for periodontal treatment in a group of dental school patients was estimated by means of the periodontal treatment need system (PTNS). The findings were related to information about the regularity of dental visits, awareness of own disease, and periodontal treatment experience. All the patients required motivation and oral hygiene instruction (treatment need, class A). All their quadrants needed scaling or adjustment of subgingival restorations (treatment need, class B). As many as 71% of the patients and about 49% of the quadrants needed periodontal surgery (treatment need, class C). The mean periodontal treatment time per patient was 279 min (4 h 39 min). The middle age group (30-59 years) required more treatment time than the oldest group (greater than or equal to 60 years). This was probably due to more missing teeth in the oldest age group. There were no significant differences in treatment need between males and females. The regular dental visitors had a greater periodontal treatment need than the individuals visiting their dentist less frequently. This finding emphasizes the responsibility of the general practitioner in diagnosing and treating periodontal disease.