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Biomedical subjects

J H Nunn

Publications and source records attributed to J H Nunn.

At least 19 recordsLinked to original sources
PubMed1996

Prevalence of dental erosion and the implications for oral health.

The literature on dental erosion is made up of a number of areas, some of which are reviewed here: there are anecdotal case reports, linking a small number of clinical cases with a possible etiological factor. The second area of evidence concentrates on case control studies in which there is a strong association with dental erosion, for example, patients with bulimia. The final piece of epidemiological evidence is beginning to emerge as prevalence studies, but the information from prevalence data worldwide is scanty. It is difficult to compare prevalence studies because of the different indices used in the various studies and also because of the different teeth assessed in the sample. Standardization of indices used would overcome some of these differences as would the reporting of results in a comparable way. However, identifying the true prevalence of erosion per se is fraught with difficulty because there may be more than one etiological factor operating and attrition and or abrasion may complicate the picture, especially in older populations. Case reports frequently associate evidence of erosion with excessive use of particular drinks or foodstuffs so they must be viewed with caution. There is an increasing awareness, amongst the dental profession, of the potential for this particular form of tooth wear to occur. It is important that the dental team is vigilant and instigates preventive measures before tooth tissue loss becomes clinically significant. The importance of erosion in dental health promotion should not be overlooked.

Beverages↗
PubMed1995

The dental health of 3-year-old children in east Cumbria 1993.

A study of the dental health of 135 3-year-old children, with reference to social class group, was undertaken in East Cumbria District between September and December 1993. Caries free subjects numbered 110 (81.5 per cent), the mean number of decayed, missing, and filled teeth was 0.59; the value of the decayed component of the dmft index was 0.49. Caries experience was confined to 25 (18.5 per cent) individuals whose mean dmft was 3.20, seven of these subjects experienced rampant decay to the maxillary incisor teeth and three had received a dental general anaesthetic. An inverse relationship was demonstrated between dental caries and social class. Trauma to the maxillary incisors had occurred in 17 (12.6 per cent) children, with discolouration and fracture of the enamel and dentine the most prevalent types of injuries sustained. A relatively high proportion of the subjects, 39 (28.9 per cent), had experienced erosion to palatal surfaces of the maxillary incisors. The most prevalent type of erosion was that involving both enamel and dentine. Only 14 (10.4 per cent) children examined used fluoride supplements in this low-fluoride area; 98 (72.6 per cent) subjects reported registration with a dentist.

Cariostatic Agents↗
PubMed1994

A survey of referral patterns to a paediatric dentistry unit over a 2-year period.

Following the changes in October 1990 in the payment system for children's dental treatment within the General Dental Service in the UK there has been widespread concern that repercussions would be felt in other branches of dentistry. The aim of this survey was to investigate the referral of children for specialist care to the Department of Child Dental Health in Newcastle upon Tyne after the changes in 1990, so that consultant clinics and the provision of advice and treatment could be targeted more effectively. Information was obtained from the patients' referral letters and from their hospital records between March 1991 and March 1993. There were 513 referrals (excluding those for orthodontic treatment, extractions under general anaesthesia and acute emergencies), the number more than doubling during the 2-year survey period. 83% of these patients lived within 15 miles of the hospital. 84% of these referrals were from general dental practitioners, and the greater proportion were from those who graduated within the previous 4 years. The most common reason for referral involved behaviour problems. Changes in the payment system that occurred in 1990 may have been a contributory factor in explaining these findings.

Adolescent↗
PubMed1994

Prevalence of developmental defects of enamel in areas with differing water fluoride levels and socio-economic groups in Sri Lanka and England.

Defects of dental enamel were recorded in 607 12-year-old children in Sri Lanka and north-east England in 1990/91. In each country, children were included from areas which received drinking water containing 0.1, 0.5 or 1.0 ppm F. In some of these areas, children from both low and high socio-economic groups were examined. The index of Developmental Defects of Enamel (DDE) was recorded clinically for the undried buccal surfaces of 10 permanent teeth (maxillary incisors, canines and first premolars, and mandibular first molars). The results revealed a higher prevalence of enamel defects and more teeth affected per person in children in: the high socio-economic group than in the low socio-economic group in the 1.0 ppm F area in England: in the 1.0 ppm F area than in the 0.1 ppm F area in Sri Lanka (in the low socio-economic groups), and in the 1.0 ppm F area than in the 0.1 ppm F area in England (in the high socio-economic groups but not in the low socio-economic groups): in general in Sri Lanka than in England. The occurrence of diffuse opacities increased greatly with increasing water fluoride level. A high prevalence of hypoplastic lesions was recorded in Sri Lanka.

Child↗
PubMed1993

Urinary fluoride excretion in 4-year-old children in Sri Lanka and England.

Urine was collected over 24 h from children aged 4 years in Sri Lanka and England. Fifty-three children were from Dambulla, Sri Lanka, and 44 from Newcastle, England, both localities receiving drinking water containing 0.8-1.1 mgF/l. Urine volume was measured immediately after the 24-hour collection and samples of the collection from each child were frozen for transportation prior to 'blind' analysis in one laboratory for fluoride content. The mean 24-hour urine volumes were 504 ml (SD 198) in Sri Lanka and 449 ml (SD 196) in England (p = 0.17). The mean F concentrations were 1.19 ppm (SD 0.63) in Sri Lanka and 1.02 ppm (SD 0.42) in England (p = 0.12). The mean weights of fluoride excreted were 0.55 mgF/day (SD 0.30) in Sri Lanka and 0.42 mgF/day (SD 0.19) in England (p = 0.009). The distributions of weight of fluoride excreted were also dissimilar in shape between the two countries. The extent to which these small differences in fluoride excretion in urine reflect differences in fluoride intake needs to be investigated.

Child, Preschool↗
PubMed1993

Trends in the community dental service 1980-1990.

The recent past has seen many changes that have had an impact on the dental care of children: for example, demographic changes, changes in the prevalence of dental caries, changes in manpower and changes in the organisation of dental services. The community dental service (CDS) in particular has had a major role to play in the provision of care to many children in this country. An analysis of the statistical returns to the Department of Health for the community dental services in England and Wales for the years 1985-1990 shows that staffing in the CDS has declined from 1,544 (Whole Time Equivalents--WTE) to 1,309 (WTE) in 5 years. The total clinical hours worked has also reduced from 2.02 million to 1.59 million in ten years. Hours spent on administration have increased from 53,490 to 87,091 in the same period. Clinical time spent on treating handicapped adults has increased almost ten fold from 14,644 hours in 1980 to 122,463 hours in 1990. Time devoted to mother and child (pre-school) services in about the same as in 1985. Hours spent on school services have reduced from a peak of almost 2 million in 1985 to 1.38 million in 1989-90. Trends in eight aspects of dental treatment are presented.

Administrative Personnel↗
PubMed1993

Dental disease and current treatment needs in a group of physically handicapped children.

One hundred and twenty-nine physically handicapped children (89 males, 40 females) were dentally examined in a local authority residential special school taking pupils from a wide geographical area in the Northern Region, for caries, periodontal disease, malocclusions and treatment need using World Health Organization criteria. The children were aged between 3 and 17 years with a mean age of 10.7 years. Mean deciduous caries experience (dft) was 0.9 and the mean permanent caries experience (DMFT) was 2.0. The mean dfs/DMFS values were 2.5 and 3.4 respectively. A higher experience of deciduous caries was found in girls, dft = 1.3, than in boys who had a mean dft value of 0.8 and in the permanent dentition girls had a mean DMFT value of 2.8 compared with 1.6 for boys. Each component of the index was also higher for girls in both dentitions. The gender difference identified in caries experience extended to treatment need for the permanent dentition, where more girls were recorded as requiring treatment than boys. Of the 129 children, 126 were assessed for treatment co-operation. Only 18 (14.3 per cent) were assessed as being amenable to routine dental care, 66 (52.4 per cent) were thought likely to present some management problems and the remaining 42 (33.3 per cent) were thought to require all their treatment under a general anaesthetic.

Adolescent↗
PubMed1993

Distribution of developmental defects of enamel on ten tooth surfaces in children aged 12 years living in areas receiving different water fluoride levels in Sri Lanka and England.

The prevalence of enamel defects on ten tooth surfaces per subject was recorded in 1990/91 in 12-year-old children living in areas which received drinking water containing either 0.1, 0.5 or 1.0 ppm F, in Sri Lanka and in England. In some communities, children of high and low socioeconomic groups were included. The teeth included were: 46, 14, 13, 12, 11, 21, 22, 23, 24 and 36; buccal surfaces only were examined. One examiner examined all the children under natural light using the modified DDE index (Clarkson and O'Mullane, 1989). Teeth were not especially cleaned or dried. A 10 per cent re-examination of subjects indicated that examiner reproducibility was good. Data were presented for 547 subjects (168 in Sri Lanka and 379 in England). While the maxillary central incisors were affected most often in England and in the 0.1 ppm F area in Sri Lanka, this was not the case in the 0.5 and 1.0 ppm F areas in Sri Lanka where prevalence was highest in premolar and canine teeth. Demarcated and diffuse opacities predominated in the 1.0 ppm F areas in both countries, while hypoplastic lesions were prevalent in Sri Lanka in the 0.1 and 0.5 ppm F areas, especially in maxillary incisor teeth. Nearly half the lesions extended to more than one-third of the tooth surface in the 1.0 ppm F areas. The findings indicate that maxillary canine and premolar teeth are affected much more in high fluoride areas in Sri Lanka and it is suggested that this may be due to their later development relative to incisors and first molars.

Child↗
PubMed1993

"Killer" canine removal and its sequelae in Addis Ababa.

Children and adolescents, aged 2 to 18 years, from 300 poor families in Addis Ababa were examined to determine the prevalence of the traditional practice of primary canine tooth removal. Fifteen percent of the primary canine teeth were found to have been affected, and 7% of the permanent canines had been damaged by this practice. A questionnaire to a subset of 40 families revealed some of the reasons that this procedure is still carried out, in spite of the considerable associated morbidity.

Adolescent↗
PubMed1993

Assessment of enamel opacities in children in Sri Lanka and England using a photographic method.

Colour photographs were taken of the labial surface of both maxillary central incisor teeth of children aged 12 years, living in Sri Lanka and England. In each country, children were included who lived in communities receiving drinking water containing 0.1, 0.5 and 1.0 ppm F, and within these communities children were classed as high or low socio-economic (SE) status. The photographs were examined 'blind' by two examiners independently. These pertained to 670 children, 332 in Sri Lanka and 338 in England. The index of Developmental Defects of Enamel (DDE) was used, as modified by Clarkson and O'Mullane (1989), to measure type and extent of opacity. Intra- and inter-examiner agreement was substantial. Prevalence of opacities ranged from about a quarter of teeth in the 0.1 ppm F area in Sri Lanka to over 60 per cent of teeth in the high socio-economic group in the 1.0 ppm F area in England. Higher prevalences of opacities were recorded in: (1) the high SE group than the low SE group in the 1.0 ppm F area in England, (2) the 1.0 ppm F area than in the 0.1 ppm F area in both countries, (3) in Sri Lanka than in England in low SE groups in the 1.0 ppm F areas. The greatest differences occurred in diffuse opacities. When these data were compared with results of clinical examinations of these same tooth-surfaces by one examiner (n = 506) more teeth were graded 'normal' clinically and more teeth graded as having opacities photographically. Both demarcated and diffuse opacities were scored more frequently from photographs than clinically in both countries.

Chi-Square Distribution↗
PubMed1993

The dental health of adults in an integrated urban development in Addis Ababa, Ethiopia.

Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, periodontal disease, malocclusions and enamel opacities. These adults were the parents of children cared for by an independent charitable organisation, the Ethiopian Gemini Trust. The prevalence of dental caries was generally low with a mean DMFT for the sample of 2.7 (+/- 0.2) and a mean DMFS of 6.7 (+/- 0.6), although one adult had a DMFS of 62. A high proportion of the adults (83.5 per cent) had calculus, but only 2 per cent had deep pocketing. Twenty-three per cent of the adults had a malocclusion and for 6 per cent of these this was moderate to severe. The most prevalent enamel defects were hypoplasias and diffuse opacities with 22 per cent of adults having one or more index teeth affected. Access to dental services was virtually non-existent as judged by the clinical status of these adults.

Adolescent↗
PubMed1992

Dental health of children in an integrated urban development programme for destitute mothers with twins in Addis Ababa.

The Ethiopian Gemini Trust in Addis Ababa is a charitable organisation which cares for mothers who have delivered twins or triplets. A dental preventive programme for the disadvantaged children in the Trust was begun and this paper describes the first objective of the programme, the determination of the levels of dental disease. Caries, periodontal disease, malocclusion and enamel opacities were recorded.

Adolescent↗
PubMed1992

The prevalence of developmental defects of enamel in 15-16-year-old children residing in three districts (natural fluoride, adjusted fluoride, low fluoride) in the north east of England.

Developmental defects of enamel were assessed in 15-year-old children born and continuously resident in three communities in the north east of England. In naturally fluoridated Hartlepool (F = 1.0-1.3 ppm), artificially fluoridated Newcastle (F = 1.0 ppm) and non-fluoridated Middlesbrough (F < 0.2 ppm) 361, 356 and 376 children respectively were examined. Conventional clinical recording and a photographic technique where colour slides are assessed at random were used and compared. Scoring in both assessments was done by using a modified version of both the Murray and Shaw index and the developmental defects of enamel index. In the clinical assessment more white lines and diffuse opacities were found in the fluoridated areas than in the non-fluoridated area. More opacities were recorded using the photographic assessment than with the clinical assessment, but a similar trend of an increased prevalence of white lines and diffuse opacities was observed using the photographic method. Overall, there was only a small increase in the prevalence of milder forms of enamel defects in fluoridated compared with non-fluoridated areas.

Adolescent↗
PubMed1991

The effect of residence and social class on dental caries experience in 15-16-year-old children living in three towns (natural fluoride, adjusted fluoride and low fluoride) in the north east of England.

Caries experience in 1374 children aged 15-16 years from three towns in the north east of England with varying concentrations of fluoride in drinking water, was determined. The mean DMFT values for 15-year-old continuous residents was 1.7 in Hartlepool (natural F 1.0-1.3 ppm), 2.5 in Newcastle (F adjusted to 1.0 ppm) and 3.3 in Middlesbrough (F = 0.2 ppm). Forty per cent of Hartlepool 15-year-olds were caries free, compared with 30% in Newcastle and 24% in Middlesbrough. Caries prevalence for both Hartlepool and Newcastle 'continuous residents' was lower than for non-continuous residents, whereas in Middlesbrough, the low fluoride area, non-continuous residents had a lower DMF value than those who had lived in Middlesbrough all their lives. There was a slight trend in both Newcastle and Middlesbrough for DMFT values to increase from social class I to social class V, but no discernable trend was observed in Hartlepool. The results for Hartlepool 15-year-olds were very similar to those reported by Weaver in 1949.

Adolescent↗
PubMed1991

Dental caries and dental anomalies in children treated by chemotherapy for malignant disease: a study in the north of England.

Fifty-two children in remission from childhood cancer and 41 siblings underwent a full clinical and radiographic dental examination. All the children had received chemotherapy. The leukaemic patients had received radiotherapy also, but not involving the jaws. There was no significant difference in dental caries experience between the treated children and the siblings, but significantly more dental anomalies were detected radiographically in the treated group.

Abnormalities, Drug-Induced↗
PubMed1990

Fragile X (Martin Bell) syndrome and dental care.

A case is presented, and the literature reviewed, of a child with fragile X syndrome. Dental features associated with this prevalent syndrome are outlined, as are the implications for dentistry of the other clinical features of cardiac anomalies and joint hyperextensibility.

Cleft Palate↗
PubMed1990

Dental health of handicapped children; results of a questionnaire to parents.

A questionnaire survey of parents of handicapped children, to complement a clinical examination, was carried out in 25 special schools in Newcastle and Northumberland. From the data collected a number of important issues are raised. Some parents have to travel greater distances than are necessary given the availability of dental services locally, either because it is more convenient or because their child requires special care. As a result perhaps the frequency of attendance of children with handicaps is poorer than that of normal children. With exceptions, most children were assessed as being amenable to routine dental care, and over one third of wheelchair bound patients claimed to be regular attenders, yet a smaller minority of handicapped child patients were seen routinely in general dental practice, compared with the usual child population. The need for greater efforts on the part of parents, dentists and other health care providers in improving the dental health of handicapped children is underlined.

Adolescent↗