Dental hygienists as health care providers.
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Biomedical subjects
Publications and source records attributed to D E Barmes.
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The F content of foods and beverages comprising a substantial proportion of the Hungarian diet has been determined. Vegetables and fruits grown in three areas where the mean F content of water was 0.09 mg/l, 0.81 mg/l and 1.91 mg/l did not reflect these differences. In contrast, the F content of cooking water has made demonstrable contribution to the F content of cooked foods. Significant elevation in F concentration was also found in some meat products, where the inclusion of bone dust or fragments is suggested by corresponding increase in Ca content.
Average daily dietary intakes of F were determined for 67 kindergarten children (X age 3.9 years) and 118 schoolchildren (X age 14.0 years), resident in one of three areas where the concentration of naturally occurring F in the household water ranged 0.06-0.11 mg/l, 0.05-1.10 mg/l and 1.6-3.1 mg/l. Mean daily F intakes increased consistently and significantly with increasing F content of the water in all dietary categories in both age groups. Due to relatively low water and high milk consumption, F from foods has made a greater contribution to total F intake (40-53% over the whole sample) than F in water ingested as such, or in beverages. The total amount of F ingested from dietary sources is considered safe even at the highest intake levels found (X = 0.44 mg/day, SD = 0.11 at 3.9 years; 1.49 mg/day, SD = 0.35 at 14.0 years).
The Al, Ca and Mg content of 147 kinds of foods and beverages, representing a large proportion of the Hungarian diet, has been determined using replicate samples. Dietary intakes of these minerals by 67 kindergarten children and 139 schoolchildren have been assessed. The richest sources of Al were: parsley, celery, gherkins, barley-malt; of Ca: dairy products, celery, parsley, savoy; of Mg: dried beans and peas, parsley, dill, maize-flour, rice, gherkins, chocolate. Flavouring agents (e.g. salt, pepper, paprika, caraway-seed) had very high concentrations of all three minerals and poppy-seeds that of Ca and Mg. The presence of bone-dust or fragments elevated the Ca content of some meats and cooked dishes. The main source of dietary intake of all three minerals was food; as opposed to F, the contribution of water-borne Al, Ca and Mg was negligible. Based on average values, the daily intake of all three minerals was satisfactory in both age groups. Mg intake was marginally below the recommended limit for a few children, but no signs of Mg deficiency were seen.
Selected interactions were examined between F, Al, Ca and Mg intakes and their manifestations in dental health parameters and biological samples relating to Hungarian children. The prevalence (DMFT, DMFS) and severity (SR) of caries were inversely related to the F concentration of household water and to the amount of F ingested from foods, beverages and tap or well water. Dental fluorosis and the F content of enamel, plaque, saliva, urine, nails and hair were directly related to the F content of water and to dietary F intake. The high significance levels and absolute consistency of associations lend strong support to the biological interdependence of the variables involved. In contrast, no associations were found between Mg ingestion and F utilization. Despite numerous inverse trends and some statistically significant inverse associations suggesting that dietary Al and Ca interfere with F uptake, the biological significance of the latter findings needs further exploration. Inhaled F amounted to less than 0.17% of the total F intake. The F content of frequently prescribed non-dental medicines ranged from below 0.00001 to 0.014 mg/g; their contribution to total F intake is considered insignificant.
Associations were examined between caries experience and the volume of tea consumed/day by schoolchildren in Palmyra, Syria. Girls had significantly high DMFT scores and consumed less tea than boys.
Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.
At the Global Oral Data Bank of the WHO, the results of CPITN surveys from many countries are received, analysed and stored. An overview of CPITN data for adults in the key age group 35-44 years of age is presented. Tentative conclusions are that the periodontal conditions for which specific interventions (oral hygiene instruction--scaling--etc.) might be considered are of notable magnitude in adult populations. However, for the large majority, in most of the populations observed, the progress of periodontal diseases has been slow and seems to be compatible with the retention of the natural dentition until at least the age of fifty, i.e. a few years beyond the upper age limit of the group from which the data were derived. Compared with previous perceptions this conclusion permits a much more optimistic outlook for periodontal health and for the retention of a functioning dentition for life.
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Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.
Based on a literature review and recent surveys, the needs and implementation of preventive dentistry in China have been estimated. The average DMFT of 12- and 15-yr-old schoolchildren in Beijing were 1.61 and 2.11 respectively. The caries prevalence was higher in the coastal cities in the south. The caries rate was also higher in urban areas than in rural areas. There were some controversies in the results of fluoridation studies with one study reporting as high as 47.2% of the children to be afflicted with enamel fluorosis. The community periodontal disease status and treatment needs index (CPTNI) showed that 93% of the 12-yr-olds had bleeding, 98% had calculus and 15% had shallow pockets, with 100% of the children needing prophylaxis. There was a high prevalence of dental malocclusion with 54% of schoolchildren with dental anomalies, of whom 36% needed treatment. Much emphasis had been placed on oral pathology, oral medicine and maxillofacial surgery in the curriculum of Stomatology in Chinese dental schools.
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CPITN data from 40 countries have been used to assess periodontal status at ages 12, 15 and 35-44 years. There are broad differences in the numbers of healthy sextants between developing countries and those which are highly industrialized. At 12 years this component of the Index could provide the basis of a global indicator of periodontal health--not less than 3 healthy sextants per child by the year 2000. At 15 years zero sextants with periodontal pockets is a feasible aim. It is less easy to set goals for periodontal health in adults.
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Individual samples of urine, fingernails, head-hair, saliva, plaque and enamel were collected from three groups of Hungarian children, aged 14 years, who were exposed to contrasting water fluoride levels (less than or equal to 0.11 ppm; 0.5-1.1 ppm; 1.6-3.1 ppm). The mean fluoride concentration of the samples increased consistently and significantly, but mostly non-proportionately, with increasing water fluoride level. With the exception of plaque, the materials examined are considered suitable indicators of exposure to or systemic utilization of fluoride for population groups. Caries experience decreased with increasing fluoride exposure. Dental fluorosis constituted no clinical or aesthetic problem.