Future of preventive dentistry. Caries in children ignored.
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Biomedical subjects
Publications and source records attributed to G B Winter.
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A recent clinical trial investigated the cariostatic effectiveness of a low (550 ppm) fluoride toothpaste in comparison with a standard (1050 ppm) control paste in pre-school children who were 2-years-old at the start of the 3-year trial. The present study has investigated the prevalence of enamel opacities in permanent incisor teeth and of caries in children who had taken part. As well as children from test and control groups, a third group of non-trial children were included in the sample. A total of 1,523 children were examined in schools and had photographs taken of their upper permanent incisor teeth. The latter were scored using the Thylstrup and Fejerskov (TF) index for fluorosis and the modified Developmental Defects of Enamel (DDE) index. Differences between the groups were small in real terms but using the TF index the child and tooth prevalence of opacities were significantly lower in the children who had used the test paste with a lower fluoride content; the same trend was seen in diffuse defects scored using the modified DDE index. There was no significant difference in the prevalence of caries in either primary or permanent teeth although the trend in both cases was for slightly more disease in children who had used the test paste.
A 13-year-old boy with taurodontism and disproportionate short stature is described. Parental consanguinity suggests the possibility of an autosomal recessive mode of inheritance.
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The most recent epidemiological data on the prevalence of dental caries in children indicate a halting of the increasing levels in many developing countries and a continuing decrease in many highly industrialized countries of the world. However, a further fall in caries levels predicted for 5-yr-old children in the U.K. has not occurred and the decline in caries may have begun to level out. 'Polarization' of caries to a minority of high-risk individuals is occurring in the developed world, with 20-25% of children accounting for more than 50% of the disease. Socio-economic factors are important in determining the proportion of high-risk children in these countries. The multifactorial aetiology of caries allows a number of different interpretations to account for changes in the prevalence of the disease with time, in both the developing and developed countries. These changes are variously ascribed to alterations in dietary habits, especially the consumption of sugar; variations in the patterns of oral hygiene; increased contact with trace elements, especially fluoride, in the environment; changes in the ecology and/or virulence of oral and dental plaque microflora and alterations in the oral protective mechanisms including the immune status. The epidemiological evidence available on the relationship of all these social, environmental and other factors to changes in the prevalence levels of caries does not, however, fully explain all the changes that have been observed. The claim that caries is no longer a public health problem is premature, as it ignores the still high proportion of individuals with tooth decay throughout the world.
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One well recognised cause of enamel opacities is excessive fluoride ingestion during the period of tooth development. In the past, "fluorosis", or opacities arising from this cause, has been reported to occur in children given fluoride supplements. In a large experiment in dental health education, fluoride supplements were given regularly to many of the children in two out of three experimental groups. 126 children were dentally examined 10 yr after the scheme began, of whom 79 had regularly received fluoride drops and/or tablets for at least part of the period between birth and 5 yr of age. Labial surfaces of each child's erupted incisor teeth were examined for enamel opacities. 75% of the 126 children had at least one affected tooth. There was a statistically insignificant, but consistent, trend for the prevalence of opacities to increase with increasing duration of use of fluoride supplements.
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In the mid-1970's, a scheme was set up providing dental health education at home visits to mothers with young children. A free supply of fluoride supplements for their children was offered to mothers in two of the three groups taking part. In the 10th year, 126 of the children were examined for caries and gingivitis. Few statistically significant results were seen in this small sample remaining from the scheme, but trends for better dental health amongst children whose mothers had been visited at home had been seen in a previous assessment and were seen again here.
In this double-blind trial, the anticaries effectiveness of a test toothpaste formulated for young children with 550 ppm F was compared with that of a positive control toothpaste containing 1055 ppm fluoride. More than 3000 2-year-old children were enrolled in the study and after 3 years of toothpaste use, 2177 (72 per cent) were examined. From a clinical and radiographic assessment, more than half the children were found to be caries free and only 32 (1.5 per cent) had evidence of rampant caries. There appeared to be little or no difference between children who had used test or control pastes, either in caries or in plaque levels. On the basis of this clinical trial the experimental toothpaste with 550 ppm fluoride would appear to have a similar anticaries efficacy to that of the control toothpaste. Differences were seen in relation to sex of the child and to social class. Girls had lower levels of plaque than boys but more carious teeth. Children from families in higher social classes had fewer carious teeth and lower levels of plaque.
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Despite the considerable reduction in the prevalence of dental caries in children in most industrialized societies, there remains a minority with relatively high levels of disease. The part played by diet, hygiene and medication in the incidence of caries in this susceptible group of the child population is reviewed. Methods are suggested by which these parameters may be assessed and utilized in the prediction of high caries risk children in population groups. Supplementary evidence by means of special tests will be required to support these observations and identify the remainder at risk.
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