Headache Children with Temporomandibular Disorders have Several Types of Pain and other Symptoms

The aim was to investigate the association between temporomandibular disorders (TMD) and overall muscle tenderness, depressive symptoms, sleep difficulties, headache frequency and related symptoms in children with primary headache in comparison with controls. Based on an unselected population sample of 1135 Finnish schoolchildren classified according to the type of headache at age 12, altogether 297 children aged 13-14 from different headache groups and healthy controls were randomly selected for an interview and clinical examinations. Children with migraine had more TMD signs than children with nonmigrainous headaches or healthy controls. High TMD total scores were associated with palpation tenderness in other parts of the body and with frequent headache attacks. We conclude that children with overall headache, migraine in particular, and high total TMD scores showed an increased overall tenderness to muscle palpation and multiply manifested hypersensitivity pain.

An analysis of residual orthodontic treatment need in municipal health centres

OBJECTIVE

The aim of this study was to analyse residual orthodontic treatment need in Finnish municipal health centres.

SUBJECTS AND METHODS

A random sample of two age groups, 16- and 18-year-olds (n = 2212), from seven municipalities was invited for a clinical examination, and 1041 adolescents participated. Two calibrated orthodontists blindly examined the participants for residual treatment need, applying the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Self-perceived treatment need, satisfaction with occlusal function, and dental appearance were evaluated with a questionnaire. Differences between objective and self-perceived treatment need and between treated and untreated adolescents were analysed using the chi-square test.

RESULTS

A total of 18.8 per cent of all adolescents had DHC grade 4 or 5 and/or AC category 8-10, indicating a definite need for treatment. In the analysis between treated and untreated adolescents, orthodontic treatment history or gender had no statistically significant association with the objectively defined need (P > 0.05). Self-perceived treatment need was reported by 9.6 per cent of adolescents. This need was more common among treated (13.9 per cent) than untreated (4.6 per cent) adolescents (P < 0.001). Among all adolescents, satisfaction with occlusal function was high, 91.3 per cent; 78.9 per cent of adolescents were satisfied with their dental appearance. The main reasons for dissatisfaction and self-perceived need were visible contact point displacements.

CONCLUSIONS

The observed proportion of residual orthodontic treatment need is in line with earlier findings. The high satisfaction with occlusal function reflects the applied selection criteria; orthodontic treatment of displacements causing only aesthetic concern is not prioritized.

Administration of Bifidobacterium animalis subsp. lactis BB-12 in early childhood: a post-trial effect on caries occurrence at four years of age

Probiotic bifidobacteria are widely used in the prevention of childhood diseases. These bacteria are also associated with caries occurrence. The present secondary analysis in a low-caries population evaluated the effect of early administration of Bifidobacterium animalis subsp. lactis BB-12 (BB-12) on caries occurrence and identified markers of dental decay in early childhood. In the original randomized, double-blind, placebo-controlled study (NCT00638677, http://www.clinicaltrials.gov), infants (n = 106) received BB-12, xylitol or sorbitol tablets from the age of 1-2 months to 2 years with a slow-release pacifier or a spoon (daily dose of BB-12 10(10) colony-forming units, polyol 200-600 mg). The present data were collected using clinical examinations and questionnaires at the age of 4 years. The occurrence of dental caries was assessed using the International Caries Detection and Assessment System. Oral hygiene status and mutans streptococci (MS) levels were also determined. No differences were detected between the study groups in the occurrence of enamel caries (p = 0.268) or obvious dentinal caries (p = 0.201). The occurrence of caries was associated with daily consumption of sweet drinks (p = 0.028), visible plaque observed (p = 0.002) and MS detected in the dental plaque (p = 0.002). Administration of BB-12 in infancy does not seem to increase or decrease the occurrence of caries by 4 years of age in a low-caries population.

Dissolution of xylitol from a food supplement administered with a novel slow-release pacifier: preliminary results

AIM

The aim of the study was to monitor the pattern of release and salivary xylitol concentrations during sucking of a slow-release pacifier used to deliver a novel food supplement.

METHODS

The food supplement tablet contained 300 mg xylitol and 0.5 x 10(10) colony-forming units of Bifidobacterium lactis Bb-12 (Bb-12). The reference tablet contained 300 mg xylitol and was used by 10 adults (mean age 32 years) in the study. Whole saliva samples were collected with 2.5 min intervals during pacifier sucking. The salivary xylitol concentrations were determined using an enzyme assay kit.

RESULTS

All subjects showed salivary xylitol concentrations exceeding 1% at least at one collection point. The xylitol and xylitol-Bb-12 tablets showed similar dissolving with no clear concentration peaks (comparison of saliva collection times; p = 0.139).

CONCLUSION

Xylitol released from the food supplement, delivered with the novel pacifier, may result in salivary xylitol concentrations high enough to inhibit mutans streptococci in vivo.

The caries-preventive effect of xylitol/maltitol and erythritol/maltitol lozenges: results of a double-blinded, cluster-randomized clinical trial in an area of natural fluoridation

OBJECTIVE

Xylitol studies suggest caries reductions in the order of 50%. Based on animal/microbial studies, erythritol potentially has caries-preventive properties. However, clinical studies are required to confirm this. The aim of the study was to investigate the additional caries-preventive effect of xylitol/maltitol and erythritol/maltitol lozenges delivered at school, relative to controls receiving comprehensive prevention, in a low-caries prevalence population.

METHODS

A 4-year, cluster-randomized, double-blinded clinical trial. Five hundred and seventy-nine 10-year-old consenting subjects from 21 schools were randomly assigned to one of five groups. Four groups used the lozenges on school days, in three teacher-supervised sessions daily, over 1 or 2 years. The daily amount was 4.7 g/4.6 g for xylitol/maltitol and 4.5 g/4.2 g for erythritol/maltitol. The groups received free examinations and care in the public health centre. Four hundred and ninety-six children were analysed. The main outcome measure was dentin caries increment based on a clinical examination at 4 years since the start. The groups were compared in relation to the increment using hierarchical logistic regression to adjust for potential clustering.

RESULTS

Use of xylitol/maltitol or erythritol/maltitol lozenges did not result in caries reduction. A strong relationship between baseline caries prevalence and the 4-year increment was observed (OR = 7.38; 95% CI: 3.78-14.41).

CONCLUSIONS

The results suggest that in relatively low-caries conditions the school-based use of xylitol/maltitol or erythritol/maltitol lozenges would not have additional caries-preventive effect when compared with comprehensive prevention.

Comparison of treatment costs and outcome in public orthodontic services in Finland

The objectives of the study were to compare the costs and outcome of orthodontic treatment in eight municipal health centres in Finland. A random sample of the age groups of 16- and 18-year-olds (n = 1109) living in these municipalities was clinically examined by two calibrated orthodontists. The acceptability of the morphology and function of the occlusion were assessed with the Occlusal Morphology and Function Index (OMFI). The data concerning previous orthodontic treatment were collected from the patient records of all subjects (n = 608) who reported previous or ongoing orthodontic treatment or who could not recall if they had received orthodontic treatment. The health centres were grouped into an early and a late timing group according to the mean age of starting the treatment. The mean age for starting orthodontic treatment was 8.0 years (SD 1.9) in the early group and 10.7 years (SD 2.3) in the late group. The visit costs and the costs of orthodontic appliances without overheads comprised the operating costs. The cost-effectiveness of orthodontic services was measured by estimating how much each health centre had to have paid for one per cent unit of acceptable morphology and acceptable function of occlusion. The mean appliance costs were higher in the late timing group and the mean visit costs higher in the early timing group. The mean operating costs per case were €720 in the early and €649 in the late timing group. However, there was a great variation within both groups. The cost of one per cent unit of acceptable morphology was the same in the two timing groups, while the cost of one per cent unit of acceptable function was lower in the early timing group. The low operating costs as such did not totally explain the better cost-effectiveness of orthodontic care. Furthermore, the cost-effectiveness was not directly connected with the timing of treatment.

Mutans streptococci colonization associates with the occupation of caretaker, a practise-based study

BACKGROUND

The early mutans streptococci (MS) bacteria colonization is connected to early childhood caries. The aim of this study is to examine associations between the MS-colonization and background factors in young children, in order to enhance the oral health program in a low caries prevalence community.

SUBJECTS AND DESIGN

An age cohort of 512 children was screened for MS in the oral biofilm at the age of 18 months. The caretakers were, using a structured form, interviewed of demographical factors and habits connected to oral health: antibiotic treatments, child's appetite, frequency of night feeding, use of sugary products or drinks, and maternal xylitol use. The associations were evaluated with logistic regression analysis.

RESULTS

Mutans streptococci colonization was significantly associated with both the occupation of the caretaker and the non-Finnish background.

CONCLUSION

The early MS-colonization, in preschool children, strongly associates with the socioeconomic status of the family.

Acceptability of adolescents' occlusion in Finnish municipal health centres with differing timing of orthodontic treatment

The objective of the study was to compare the acceptability of occlusion among orthodontically treated and untreated adolescents in eight Finnish municipal health centres applying different timing of treatment. A random sample of 16- and 18-year olds (n = 2325) living in these municipalities was invited for a clinical examination, and 1109 adolescents participated. Two calibrated orthodontists blindly examined the participants for the acceptability of occlusion with the Occlusal Morphology and Function Index. The history of orthodontic treatment was elicited by questionnaire. The impact of the history and timing of treatment on the acceptability of occlusion was analysed with logistic regression analysis. The history of orthodontic treatment decreased the odds for acceptability of morphology [odds ratio (OR) = 0.719, 95 per cent confidence limit (CL), P = 0.016] and acceptability of function (OR = 0.724, 95 per cent CL, P = 0.018). The early timing of treatment increased the odds for acceptability of morphology (OR = 1.370, 95 per cent CL, P = 0.042) and of function (OR = 1.420, 95 per cent CL, P = 0.023). No substantial differences were observed in the acceptability of occlusion between the early and late timing health centres. However, the proportion of subjects with acceptable occlusion was slightly higher in the early than in the late timing group. These findings suggest that when examining the effect of timing on treatment outcome, factors other than acceptability of occlusion should be concomitantly evaluated. Consequently, in this context, the duration and cost of treatment need to be investigated.

Acceptability of dental appearance in a group of Finnish 16- to 25-year-olds

OBJECTIVE

To define a grade in the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) that would differentiate between esthetically acceptable and unacceptable occlusions and that would also be both subjectively and objectively meaningful.

MATERIALS AND METHODS

Dental appearance and self-perceived orthodontic treatment need were analyzed in a group of Finnish young adults (171 males, 263 females, age range 16-25 years). Subjective data were gathered using a questionnaire, and the respondents were requested to score their dental appearance on a visual analog type 10-grade scale. Professional assessment of dental appearance was performed by two orthodontists using the AC of the IOTN. The cutoff value between esthetically acceptable and unacceptable occlusions was defined using receiver operating characteristic curves.

RESULTS

Sixty-six percent of orthodontically treated and 74% of the untreated respondents were satisfied with their own dental appearance. Every third respondent reported one or more disturbing traits in their dentition. The most frequently expressed reason for dissatisfaction was crowding; girls expressed dissatisfaction more often than boys did (P = .005). A self-perceived treatment need was reported infrequently by 8% of orthodontically treated and 6% of untreated respondents. In the logistic regression analysis, self-perceived need for orthodontic treatment was the only significant factor explaining dissatisfaction with own dental esthetics. On the applied scales, grades 1 and 2 fulfilled the criteria for satisfactory dental esthetics.

CONCLUSION

The results suggest that the AC grade 3 could serve as a cutoff value between esthetically acceptable and unacceptable occlusions.

Dental fear: one single clinical question for measurement

A new dental fear measurement instrument, the Short Dental Fear Question (SDFQ), was developed and tested for clinical practice purposes. The correlations of the SDFQ with the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) were tested in 15-16-year-old adolescents. The Spearman correlations (rs) between the dental fear measurement instruments were: SDFQ – DFS: r_s = 0.79, n = 26; DFS – DAS: r_s = 0.72, n = 26; SDFQ– DAS: r_s = 0.69, n = 27. DAS and DFS mean scores were clearly higher in the SDFQ fear group than SDFQ in the relaxed group. The SDFQ is a short and compact instrument which might be convenient for the measurement of dental fear in clinical practice.

Oral health programme for preschool children: a prospective, controlled study

BACKGROUND

New perspectives are needed for oral health programmes (OHPs). The aim was to evaluate the preventive effect of a risk-based OHP in comparison with a traditional programme.

DESIGN

An age cohort of 794 Finnish children, 446 in the intervention group and 348 in the control group, was followed from 18 months to 5 years of age. The children were screened for mutans streptococci (MS) in the dental biofilm. The main outcome measure was the proportion of children with dental caries (decayed, missing, or filled primary teeth > 0) at the age of 5 years. The intervention, targeted to MS-positive subjects in the intervention group only, was based on repeated health education to the caretakers and xylitol lozenges for the child. Dental hygienists carried out the programme.

RESULTS

OHP was effective in white-collar families [numbers needed to treat (NNT) = 3, 95% CI 2-11]. Factors significantly associated with caries at 5 years were MS colonization at 18 months, occupation of caretaker, but also gender when incipient carious lesions were included in the index.

CONCLUSION

Early risk-based OHP, targeted to the families of MS-positive children, can reduce the risk for caries in white-collar families. For blue-collar families, different kinds of methods in caries prevention and support are needed.

Orthodontic treatment practices in Finnish municipal health centres with differing timing of treatment

The aim of this study was to compare orthodontic practices in eight Finnish municipal health centres selected on the basis of an earlier survey to represent early and late timing of treatment. The health centres were grouped according to the mean age of starting treatment; earlier versus later than 9 years of age. A random sample of 16 and 18 year olds (n = 2325) living in these municipalities were invited for a clinical examination, and 1109 adolescents participated. The participants reported on their previous or ongoing orthodontic treatment by means of a questionnaire. Data on orthodontic treatment received were collected from the dental files of the adolescents who reported a treatment history and for those who did not recall exactly whether or not they had received orthodontic treatment. Analysis of the non-respondents was made on the basis of their dental files. Differences between the features of orthodontic treatment in the early and late starting health centres were analysed using a two-tailed t-test. In the early group, 70 per cent, and in the late group 42 per cent, of adolescents had a history of orthodontic treatment. General dentists carried out 90 per cent of the treatment in the early group and specialists every third treatment in the late group. An early start resulted in more frequent visits (P = 0.004) and a longer treatment duration (P < 0.001), while later timing resulted in an increase in the number of appliances (P < 0.001).

Trends in finnish public orthodontic care from the professionals' perspective

The study maps out orthodontic care in Finnish municipal health centres in 2001, describes changes during the previous ten years reported by chief dental officers, and assesses the views of orthodontists on current public orthodontic services. The data were collected by questionnaires sent to all health centres and all orthodontists in Finland. Of all 0-18-year-olds, 11% were receiving orthodontic treatment with an appliance (range 2-43% among the health centres). The most frequently used appliances were headgear, quadhelix, and fixed appliances. Limited economic resources and the lack of orthodontic expertise were mentioned by the chief dental officers as factors decreasing the volume of services. The orthodontists mentioned the large regional variation and the lack of national guidelines as the most important aspects that should be improved on a national basis. To bring about improvement, they suggested increasing the number of specialist orthodontists and the delegation of orthodontic tasks to auxiliaries.

Are Signs of Temporomandibular Disorders Stable and Predictable in Adolescents With Headache?

The aim of the present study was to study changes in signs and symptoms of temporomandibular disorders (TMD) and factors predicting TMD signs in adolescents with and without headache. A population-based sample ( n = 212) of 13-year-olds with and without headache was re-examined at the age of 16. The study included a questionnaire, face-to-face interview and somatic examination. In addition, a neurological examination, a muscle evaluation and a stomatognathic examination were performed. Significant changes were seen in TMD signs during the follow-up, but TMD signs at the end of the follow-up could not be predicted by baseline headache, sleeping difficulties, depression or muscle pain. TMD signs at the age of 16 were associated with female gender and muscle pain. We conclude that considerable changes in TMD signs occur in the follow-up of adolescents with and without headache. Headache-related TMD are not predictable in adolescents with and without headache.

Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care

The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis.

Familial occurrence of signs of temporomandibular disorders in headache children and their mothers

OBJECTIVE

Earlier studies have provided evidence of genetic inheritance of headache, especially migraine, but no familial occurrence has been found regarding temporomandibular disorders (TMD). In adults, headache and TMD have been found to be associated with each other, but studies on children are few. The aim of the present study was to test the hypothesis that there is no association between signs of TMD in 13-year-old headache children and their mothers.

MATERIAL AND METHODS

The study population was a nested case-control study of the population-based Finnish Family Competence Study originally consisting of over 1000 families. A structured questionnaire was sent to the families of 6-year-old children. A clinical examination was performed in 96 children with headache and 96 pairwise controls. At the age of 13 years, 75 of these same 96 children with headache and 79 of 96 headache-free controls participated in pediatric and stomatognathic examinations. Moreover, the mothers (n=154) filled in a structured headache questionnaire and participated in the stomatognathic examination.

RESULTS

No association between mother's and child's TMD signs was found. There was a significant association between signs of TMD and both migraine and tension-type headache in children. In mothers, the association was significant only between migraine and TMD signs.

CONCLUSIONS

Familial occurrence of signs of TMD cannot be found in headache children and their mothers.

Psychological factors and responses to artificial interferences in subjects with and without a history of temporomandibular disorders

OBJECTIVE

It has often been suggested that psychological factors play a role in temporomandibular disorders (TMD). However, reports on psychological factors in TMD patients and controls have been equivocal. In a previous double-blind randomized controlled study, subjects with a TMD history showed more clinical signs and subjective symptoms and adapted less well to the artificial interferences than subjects without an earlier TMD history. In the present study, we analyzed the associations of psychological factors with symptom responses and adaptation to interferences.

MATERIAL AND METHODS

Before the intervention, the subjects filled in questionnaires dealing with personality traits, level of psychological and somatic stress symptoms, coping strategies, and health beliefs. Every day during the 2-week follow-up period, the subjects rated the intensity of their symptoms on 9 modified visual analog scales (VAS).

RESULTS

Health hardiness, positive socialization history and inhibition of aggression were associated with weaker symptom responses and better adaptation to true artificial interferences. Some personality characteristics in subjects with an earlier TMD history tended to associate with higher symptom reporting despite the type of intervention.

CONCLUSIONS

Psychological factors appeared significant for the symptom responses to artificial interferences, and they seem to play a different role in responses in subjects with an earlier TMD history compared to those without.

Subjective reactions to intervention with artificial interferences in subjects with and without a history of temporomandibular disorders

In a previous double-blind randomized controlled study, subjects with a history of temporomandibular disorder (TMD) reacted to artificial interference with more signs of TMD than did subjects with no TMD history. In the present study, we analysed the subjective reactions of these individuals on several symptom scales. Every day during the 2-week follow-up period, the subjects rated the intensity of their symptoms on 9 VAS scales (occlusal discomfort, chewing difficulties, tender teeth, fatigue in the jaws, headache, facial pain, opening difficulty, bruxism, ear symptoms). Subjects with a history of TMD and true interferences reported stronger symptoms than subjects with no TMD history and placebo interferences. The most prominent symptoms were occlusal discomfort and chewing difficulties. The difference in outcome between the groups with and without a TMD history suggests that there are individual differences in vulnerability to occlusal interferences. It is likely that the etiological role of occlusal interferences in TMD has not been correctly addressed in previous studies on artificial interferences.

Occurrence of clinical signs of temporomandibular disorders in adult Finns

AIMS

To study the age- and gender-related prevalence of signs of temporomandibular disorders (TMD) in the Finnish adult population.

METHODS

A clinical health examination was performed as a part of a Health 2000 Health Examination Survey in 2000 and 2001. A nationally representative sample included 8,028 Finns at least 30 years of age, of whom 79% participated also in an oral health investigation, including examination of the stomatognathic system in order to assess the presence of certain TMD signs: maximum interincisal distance < 40 mm, pain in temporomandibular joints or masticatory muscles, and sounds in temporomandibular joints (crepitation, clicking).

RESULTS

Thirty-eight percent of the subjects had at least 1 sign of TMD. All the signs studied were more common in women than men. Overall, signs of TMD were also associated with age; the older the subject, the higher the prevalence of the TMD signs. However, when stratified by gender, the association with age was not as clear, and gender differences were observed in the prevalence of the single TMD signs at different ages.

CONCLUSION

Signs of TMD may be more common among the elderly than is usually reported.

Recurrent tinnitus and associated ear symptoms in adults

This study aimed to reveal in general population the prevalence, associations, and statistical model of recurrent tinnitus by means of a mailed questionnaire. The study sample consisted of 1720 randomly selected adults who were classified into three subgroups: recurrent (once a month or more often), occasional (less often than once a month), and no tinnitus. According to age and gender standardized prevalence, recurrent tinnitus was reported in 15% of the sample. It was statistically highly significantly associated with earache, fullness of ears shoulder pain, the 25-years age group, and visits to a physician. The strongest predictor of recurrent tinnitus was fullness of ears followed by earache, shoulder ache, and temporomandibular disorder pain. We conclude that recurrent tinnitus seems to be quite common in adults and associated with earache and fullness of ears In patients with tinnitus without clinical findings, the examination of the stomatognathic system and cervical spine is recommended.

Risk-based early prevention in comparison with routine prevention of dental caries: a 7-year follow-up of a controlled clinical trial; clinical and economic aspects

Background

The results in an earlier study with 2–5-year-old children indicated that, in comparison with conventional prevention, a risk-based prevention programme was effective in reducing dental caries in a low-caries community. The aim of the present study was to examine the clinical and economic findings seven years after the cessation of the targeted programme, from the perspective of public health care.

Methods

The present material was collected from the dental records of the public health care centres, and included all dental visits after the 5-year examination until the 12-year examination. The groups were compared in relation to clinically detected caries at the age of 12 years, the number of dental visits needed from 5 to 12 years of age, and the estimation of running costs during these years. Statistical analyses included univariate analysis of variance, and calculation of absolute risk reduction and number needed to treat (NNT) values.

Results

At the age of 12 years, DMF was significantly related to the risk category determined ten years earlier, in both study groups. In the risk-based group, the absolute risk reduction for caries in permanent dentition was 0.13 (95% confidence interval 0.06 – 0.21), and the associated NNT value was 8 (95% confidence interval 5 – 17). The total number of preventive, as well as restorative visits was lower in the risk-based than in the routine prevention group. The findings indicate that early risk-based prevention can be correctly targeted, clinically effective, and economically profitable also from the long-term point of view.

Conclusion

Early prevention of dental caries also has long-term benefits in a 7-year follow-up perspective. This seems to hold true as regards targeting, as well as clinical and economic effectiveness. Success in risk-based prevention enables successful work division, and consequently, economic effectiveness.

Assessment of Caries Risk in Preschool Children

The study aimed to assess the additional caries-predictive value of visible plaque, gingival bleeding, and the reported use of fluorides and candies, when combined with the information about mutans streptococci (MS) and incipient carious lesions. The subjects were 2 years of age at the baseline examination (n = 226), and they were all given conventional prevention during the 3-year follow-up period. None of the studied single risk indicators reached an accuracy of 80% in predicting the 3-year caries increment. At best, the accuracy was 75% for the MS strip. Use of candies and incipient caries lesions had additional caries-predictive value (multiple logistic regression analysis). The combined use of these three risk indicators resulted in an accuracy of 81%. The present results indicate that in 2-year-old children, the combination of two or three risk indicators (MS strip, incipient caries lesions, and use of candies) might have caries-predictive power enough for clinical implications.

Characteristics of subjects with secondary otalgia

AIMS

To investigate whether secondary otalgia is associated with cervical spine disorder (CSD), temporomandibular disorders (TMD), or both, and to describe the pain characteristics and the comorbidity of secondary otalgia in subjects with and without CSD and TMD.

METHODS

A mailed questionnaire was sent to a random sample of 2,500 people aged 25 to 65 years. Altogether 1,720 recipients responded. Inclusion criteria were pain inside or around the ear without infection, tumor, or trauma, of 6 or more months duration, and a pain frequency of at least once a month. Altogether 152 respondents fulfilled the criteria, and of these 100 participated in the clinical examinations and interviews.

RESULTS

Based on standardized examinations and interviews, 91 subjects had secondary otalgia and 9 had primary otalgia. Most (85%) of the 91 subjects with secondary otalgia also had signs and symptoms of TMD and/or CSD and were therefore classified into 3 groups: CSD (35%), TMD (20%), or "Combination," ie, signs and symptoms of both TMD and CSD (30%). Subjects without CSD or TMD (15%) reported the same level of intensity and impact of otalgia on daily living and psychological distress as the others but less frequent head and neck pain and fewer sleep-related problems.

CONCLUSIONS

Most of the subjects reporting secondary otalgia also suffered from CSD or TMD or both. Thus, in patients with secondary otalgia, an examination of the cervical spine and the stomatognathic system should be routinely performed.

Use of xylitol chewing gum in daycare centers: a follow-up study in Savonlinna, Finland

The use of toothbrushes in daycare centers has been questioned because of the possibility of infections spreading through unsupervised brushing. Several field studies have demonstrated a caries-preventive effect of xylitol chewing gum--a measure that could be a practical way of taking care of oral hygiene during daycare hours without brushing. A community trial was conducted in Savonlinna, Finland to test the caries-preventive effect of xylitol chewing gum at these centers. A total of 921 children were recruited. The daycare centers were randomly distributed to xylitol chewing gum or brushing groups. An additional 270 children who had not been in daycare centers were later organized into an external reference group in order to check whether the children in the daycare centers were representative of all children in Savonlinna. The results revealed a statistically significant but clinically small difference between the xylitol and brushing groups in favor of the xylitol group. Many families used the daycare services irregularly. Changes in workplace, periods of unemployment, the birth of other children in the family, etc., affect the likelihood of families keeping their children in a daycare center for many years. Despite the fact that conditions were not optimal, oral health status in the xylitol group was a little bit better than in the control group. The use of xylitol can therefore be recommended, especially if the personnel do not have the possibility to supervise the brushing.

Occlusal status in orthodontically treated and untreated adolescents

In order to evaluate the outcome of orthodontic care, all available 16-year-old adolescents (n = 138) living within the catchment area of one Finnish health center were invited for a clinical examination. A total of 126 adolescents participated, corresponding to 79% of the whole age cohort. Of these, 47% had been treated orthodontically, 2% were still wearing appliances, and 51% were untreated. In 80% of cases, a non-extraction treatment was carried out. All occlusions were evaluated using a recently developed occlusal morphology and functional index (OMFI) based on assessment of 6 morphological and 4 functional traits which are classified applying an acceptable-non-acceptable dichotomy. The occlusal status in untreated individuals was used as a second reference in comparisons between the treated and untreated occlusions. The morphological criteria for an acceptable occlusion were met by 42% of the participants and the functional criteria by 64%. Although the treated occlusions failed to meet the criteria of morphological acceptability more often than the untreated ones (73% vs 40%), the proportions of non-acceptable occlusions were fairly high among untreated occlusions. The main reasons for non-acceptability were the failure of the canine relationship, overbite, and protrusion movement to fulfill the criteria of acceptability. Only 19% of the adolescents had occlusions classified as acceptable, both morphologically and functionally. In the evaluated health center, the allocation of resources resulted in a high coverage of orthodontic care. However, our results indicate that the general occlusal status in the examined age cohort did not reach an optimal level.

Reproducibility of characteristics assessing the occlusion of young adults

The aim of the present investigation was to analyze the reproducibility in the assessment of six morphological and three functional characteristics included in a new method evaluating the occlusion in young adults. These characteristics comprised coincidence of midlines, overjet, overbite, canine relationship, crossbite, scissors bite, recurrent deviation on opening, guided lateral excursions, and discrepancy between the centric relation and the intercuspal position. The study was conducted in three stages: (1) five observers assessed the occlusions of five volunteers, (2) seven observers assessed nine volunteers, and (3) five observers assessed nine volunteers. Two calibrated orthodontists were used as references. For numerical variables, the nonparametric method for repeated measurements (Friedman's test) was used to test the significance of differences, while the proportion of agreement was calculated for categorical assessments. The results were analyzed using two precision levels: within a measurement unit/the same category and an acceptable/nonacceptable dichotomy. The magnitude of systematic differences was small and of minor clinical importance except in measurements of recurrent deviation on opening. The proportional agreement for acceptance was good in the assessment of overjet, coincidence of midlines, crossbite, scissors bite, open bite, and discrepancy between the centric relation and the intercuspal position. Moderate agreement was achieved in the assessment of overbite, canine relationship, recurrent deviation on opening, and guided lateral excursions. Among the nonacceptable cases, the agreement ranged from poor to good. The results indicated that noncalibrated observers assess categorical characteristics inconsistently.

Effect of artificial occlusal interferences depends on previous experience of temporomandibular disorders

Studies on artificial interferences in subjects with no temporomandibular (TMD) history have shown adaptation to the interference within a fairly short period of time. The role of occlusal factors in the etiology of TMD has therefore been questioned. The results might have been different, however, if subjects with a prior TMD history had been included in the study groups. To test this assumption in a randomized double-blind clinical set-up, we included healthy women without (n = 26) as well as with (n = 21) an earlier TMD history. Both groups were randomly divided into true and placebo interference groups. Artificial interferences were introduced in the true interference groups and simulated in the placebo groups. The subjects were followed for 2 weeks, after which the interferences were removed. The subjects without a TMD history showed fairly good adaptation to the interferences, but the subjects with a TMD history and true interferences showed a significant increase in clinical signs compared to the other groups. We suggest that the etiological role of occlusal interferences in TMD may not have been correctly addressed in previous studies with artificial interferences and allow no conclusions as regards TMD etiology.

Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders

In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders CTMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (chi2 5.71; P.017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z-2.63; P.009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.

Occlusion and temporomandibular disorders (TMD): still unsolved question?

The rejection of the occlusal hypothesis cannot be justified with the present empirical evidence.

Determinants of tension-type headache in children

The objective of this study was to study the prevalence, characteristics and predisposing factors of tension-type headache in children. An unselected population-based questionnaire study was carried out in 1409 Finnish schoolchildren aged 12 years. Of them, 1135 (81%) returned an acceptably completed questionnaire. The prevalence of episodic tension-type headache in children was 12% (138 of 1135). Children with episodic tension-type headache also often reported characteristics of pain typical for migraine. Children with frequent and persistent episodic tension-type headache reported stabbing and severe occipital pain, phonophobia and abdominal pain significantly more often than children with infrequent episodic tension-type headache. Neck-shoulder symptoms, symptoms of depression and oromandibular dysfunction were each independently associated with episodic tension-type headache. The father's occupation of a lower-level white-collar worker put the child at a four-fold risk for episodic tension-type headache. We conclude that episodic tension-type headache is as common as migraine in children. It can be associated with depression, oromandibular dysfunction and muscular stress. Especially children with frequent and persistent episodic tension-type headache report characteristics of pain typical for migraine.

Signs and symptoms of temporomandibular disorders in children with different types of headache

Headache is a common symptom among children and teenagers. Both bruxism and muscle and joint tenderness have been found in children with headache. Children with migraine headache report more temporomandibular disorder (TMD) symptoms than do those with tension-type headache. The aim of the present study was to investigate the association of different types of headache with TMD and sex in children. Altogether 297 randomly selected schoolchildren aged 13-14 years participated in a blind study setting. There were no statistically significant differences between the headache groups with regard to TMD signs, although the migraine and migraine-type headache groups had the highest percentage of subjects with more severe TMD signs. Nor were there any statistical differences between sexes or between the headache groups with regard to subjective symptoms of TMD. The present results with children differed from earlier results with adults. First, no association was found between tension headache and TMD, and, second, no sex difference in TMD children was observed at this age.

Morphological, functional and aesthetic criteria of acceptable mature occlusion

At present, there are no generally accepted criteria that could easily be applied to the evaluation of occlusal acceptability in clinical examinations at population level. The present study analyses the opinions of Finnish orthodontists and general practitioners on the characteristics required for acceptable occlusion in the full permanent dentition. A questionnaire was sent to all 37 health centres where at least one orthodontist was employed, 31 regionally comparable health centres without an orthodontist, 12 private orthodontists, and 13 orthodontists working at university dental clinics. Seventy-four orthodontists returned the questionnaire giving a response rate of 80 per cent. They were asked to give their views on the importance of morphology, function, long-term stability, and dental appearance as elements of acceptable occlusion. They were also encouraged to indicate other significant characteristics and requested to assess the relative significance of these features. In general, the respondents expressed the need to assess morphological, functional and aesthetic aspects of occlusion as a whole. Good function, rather than morphology, was considered to be the most important feature of an acceptable occlusion, with a relative significance of 40 per cent (range 20-90 per cent). According to the respondents, the acceptability of occlusion is determined not only by morphological features, but also by the functional status and long-term stability, as well as by the patient's opinion of the dental appearance.

Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up

Xylitol is effective as a noncariogenic or even cariostatic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) which shed easily into saliva from plaque. We have earlier shown that habitual xylitol consumption of mothers was associated with a statistically significant reduction in the probability of mother-child transmission of MS assessed at 2 years of age. The aim of the present study was to assess the children's MS counts 1 and 4 years after the maternal xylitol consumption had been discontinued. At baseline, during pregnancy, all mothers (n = 195) showed high salivary levels of MS. The mothers were randomly assigned to xylitol, fluoride (F) and chlorhexidine (CHX) groups. In the xylitol group, the mothers chewed xylitol-sweetened gum, for 21 months, starting 3 months after delivery. In the two control groups, the mothers received CHX or F varnish treatments at 6, 12 and 18 months after delivery. At the 2-year examination, 169 mother-child pairs participated. At the 3-year and 6-year examinations, there were 159 and 147 children in the study, respectively. For children's MS analyses, visible plaque was collected using toothpicks at the age of 3 and paraffin-stimulated saliva at the age of 6. The persons involved in the collection and analysis of the microbiological samples were blinded as to the study design and group. Both the plaque and salivary MS were cultured on Mitis salivarius agars containing bacitracin. In all groups, the colonization percentages increased during the follow-up. At the 3-year examination, the children's risk of having MS colonization was 2.3-fold in the F group (95% CI 1.3-4.2) compared to the xylitol group. This difference was statistically significant. Even at 6 years of age, the salivary MS levels were significantly lower in the xylitol group than in the other groups (ANOVA, p<0.001). In conclusion, the earlier demonstrated, xylitol-associated reduction in the probability of mother-child transmission of MS was still found in the children's MS counts at the age of 3 and 6 years.

Self-reported dental health, treatment need and attendance among older adults in two areas of Finland

OBJECTIVE

The purpose of the study was to assess differences in dental health, need for care and attendance among older adults in two areas of Finland with contrasting socio-cultural and economic backgrounds. A further aim was to analyse and compare the determinants of oral health and dental visiting patterns.

BASIC RESEARCH DESIGN AND PARTICIPANTS

FINRISK senior survey was conducted by the National Public Health Institute in the two areas in 1997. Data were collected through a postal questionnaire, a health examination and an interview, which included questions of number of extracted teeth, dental treatment need and utilisation. The sample consisted of 1,500 persons, 250 women and 500 men aged 65-74 years in both areas; the response rate was 86%.

RESULTS

Forty-one per cent of the respondents reported having lost all their teeth and 44% had visited a dentist during the past year. Differences between the areas concerning both dental health and attendance were considerable. Respondents living in North Karelia had lost more teeth and visited a dentist more seldom than respondents in the Helsinki region. Risk indicators for the number of extracted teeth differed between the areas, while determinants for the dental attendance during the previous year were almost identical. The major predictors for a dental visit during the previous year were number of teeth and household income. Self-perceived need for dental care was minor. Functional capacity, medically compromising diagnoses or medication did not play any apparent role in dental attendance.

CONCLUSIONS

The number of teeth together with income are the principal determinants for dental visits among older persons in Finland.

Sealants and xylitol chewing gum are equal in caries prevention

Sealants and xylitol have been demonstrated to prevent dental decay, but their effect has never been compared in the same study. Regular use of xylitol chewing gum during 2 or 3 school years was compared with application of occlusal sealants in a randomized study. The reliability of the clinical observations was controlled by examining the presence of dental decay in the same teeth from bitewing radiographs in a blind study. After 5 years, no statistically significant differences between the sealant and xylitol groups were found. The results were in line with the results from separate studies with sealants or xylitol. There were no great differences between the costs of the measures. The selection between the compared preventive measures has to be made on the basis of practical aspects such as caries occurrence, availability of personnel and other resources, opportunity costs, cooperation with schools, and other local conditions.

Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age

Studies have shown that prevention of mutans streptococci (MS) colonization in early childhood can lead to prevention of dental decay. In the microbiological part of the present study in Ylivieska, Finland, with 195 mothers with high salivary MS levels, regular maternal use of xylitol chewing gum resulted in a statistically significant reduction in MS colonization in their children's teeth at the age of 2 years compared with teeth in children whose mothers received fluoride or chlorhexidine varnish treatment. The children did not chew gum or receive varnish treatments. For the present study, the children were examined annually for caries occurrence by experienced clinicians who did not know whether the children were colonized with MS. Regardless of the maternal prevention group, the presence of MS colonization in children at the age of 2 years was significantly related to each child's age at the first caries attack in the primary dentition. In children at the age of 5 years, the dentinal caries (dmf) in the xylitol group was reduced by about 70% as compared with that in the fluoride or chlorhexidine group. We conclude that maternal use of xylitol chewing gum can prevent dental caries in their children by prohibiting the transmission of MS from mother to child.

Xylitol candies in caries prevention: results of a field study in Estonian children

All field studies have unequivocally reported significant reductions in dental caries occurrence associated with the use of chewing gum containing xylitol. No other xylitol products besides chewing gum have so far been tested in field trials. A 5-year follow-up study with 2- or 3-year xylitol consumption periods began in Estonia in 1994 with 740 10-year-old children in 12 schools at baseline examinations. For the study, 3 clusters each including 3-5 schools were formed on the basis of baseline caries experience. The products were used under the supervision of the teachers 3 times per day during school days but not during weekends or during the 3-month summer holiday. The daily dose of xylitol was 5 g in all groups. The children were examined every year in September by two experienced clinicians. Dental caries was recorded according to WHO criteria. After 3 years, all xylitol groups showed a highly significant 35%-60% reduction in caries incident, compared with the corresponding control groups. The differences between candies, between candies and chewing gum, and between 2- and 3-year users in the xylitol groups were non-systematic, indicating no trends between the groups. The results suggest that not only xylitol chewing gum but also xylitol candies are effective in caries prevention, and that a school-based delivery system seems to offer a practical way to distribute and control the use of the xylitol products.