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Biomedical subjects

N B Pitts

Publications and source records attributed to N B Pitts.

At least 73 records · Page 4Linked to original sources
PubMed1997

British Association for the Study of Community Dentistry (BASCD) guidance on the statistical aspects of training and calibration of examiners for surveys of child dental health. A BASCD coordinated dental epidemiology programme quality standard.

The British Association for the Study of Community Dentistry (BASCD) is responsible for the coordination of locally based surveys of child dental health which permit local and national comparisons between health authorities and regions. These surveys began in 1985/86 in England and Wales, 1987/88 in Scotland and 1993/94 in Northern Ireland. BASCD has taken an increasing lead in setting quality standards in discussion with the NHS Epidemiology Coordinators of the Dental Epidemiology Programme. This paper comprises guidance on the statistical aspects of training and calibration of examiners for these surveys.

Adolescent↗
PubMed1997

Patterns of change and results overview 1985/6-1995/6 from the British Association for the Study of Community Dentistry (BASCD) coordinated National Health Service surveys of caries prevalence.

This paper collates the results of all the surveys conducted under the BASCD coordinated National Health Service surveys of caries prevalence conducted between 1985/86 and 1995/96. First the patterns of change in the dental health of 5-year-old children are considered for the period 1987-1995. Then the patterns of change in the dental health of adolescents between 1988-1994 are examined and summarised. Lastly summary tables present key data from the last 10 years of survey results grouped by variable.

Adolescent↗
PubMed1997

Patient caries status in the context of practical, evidence-based management of the initial caries lesion.

This consideration of the determination of patient caries status in the context of practical, evidence-based management of the initial caries lesion relates to assessments of caries in individuals. It provides the diagnostic basis for the related topics of radiographic monitoring, caries activity testing, and lesion management strategies that follow in subsequent papers. The "totality" of caries experience must be recognized in making individual assessments; this ranges from sub-clinical, to initial, and then dentinal (including hidden) lesions. The detection of initial and dentine lesions using existing diagnostic tools is imperfect and to an extent unreliable, but, notwithstanding the limitations of existing technology, this step is of pivotal importance. Similarly, the measurement of lesion extent and depth by existing methods is problematic but possible. Having identified different types of caries, categorization of lesions by the appropriate management "option" permits clear statements of intent to be made to both patients and dental funding agencies. The NAC/PCA/PCA + OCA system is suggested as a simple and explicit method of describing caries status for individual lesions and for communicating their current caries status to patients.

Dental Caries↗
PubMed1996

Detection of dental decay and its extent using a.c. impedance spectroscopy.

Dental caries (decay), the most prevalent of diseases, represents a health problem of immense proportions. It principally affects posterior (back) teeth on occlusal (biting) and approximal (adjacent contacting) surfaces. Caries starts as a subsurface demineralization of enamel, may progress to the underlying dentine and, eventually, to cavitation of the surface. Accurate diagnosis before cavitation would permit targeted preventive treatment, thereby significantly improving dental health and reducing the need for expensive drilling and filling. Inaccessibility of caries initiation sites and recent changes in lesion morphology contribute to the relatively poor accuracy of conventional diagnostic methods. Among alternative techniques, measurements of electrical resistance have shown the most promise. Here we describe a new experimental technique that demonstrates an outstanding 100% correlation between a.c. impedance measurements of whole teeth and the actual extent of approximal caries in vitro. Only relatively minor modifications should be required to transfer the technique to in vivo applications.

Dental Care↗
PubMed1996

Impedance spectroscopy of teeth with and without approximal caries lesions--an in vitro study.

Caries diagnosis by the measurement of electrical resistance is hampered by polarization effects when dc or single-low-frequency ac currents are used. Electrical impedance spectroscopy, measuring impedance over a large range of frequencies, will provide more detailed information about the electrical characteristics of teeth. It was the aim of this study (a) to characterize the complex impedance behavior of whole extracted teeth, measured at the approximal surface, and (b) to identify parameters of the complex impedance behavior of the teeth which would be useful in distinguishing between degrees of carious involvement. Thirty-nine extracted premolar teeth with 59 unrestored and undamaged (excepting caries) approximal surfaces were selected. The tooth surfaces were divided into three groups according to their macroscopic appearance: sound (group S, n = 16), white- or brown-spot lesion present (group L, n = 33), or cavitated (group C, n = 10). The teeth were inserted into a jig which allowed for counter-electrode contact via a conducting gel. The working electrode consisted of a carbonated fiber material. Electrical impedance measurements were performed over a maximum range of about 1 MHz to 0.1 Hz. We analyzed electrical impedance data by fitting equivalent circuits. Fit was evaluated numerically and visually. The complex impedance spectra divided naturally into three groups which corresponded almost perfectly with the classifications of S,L, and C. The groups differed most in the dc resistance (Rdc), as calculated from the impedance parameters. Mean Rdc for groups S, L, and C were 68 M omega, 5.9 M omega, and 321 k omega, respectively. These means were significantly different from each other (log-transformed data, ANOVA, p < 0.001; Tukey multiple comparisons, p < 0.001). It is concluded that the in vitro performance of electrical impedance spectroscopy in differentiating among sound, non-cavitated carious, and cavitated approximal tooth surfaces is excellent.

Analysis of Variance↗
PubMed1996

The use of bitewing radiographs in the management of dental caries: scientific and practical considerations.

The objective of this paper is to synthesize published research on the use of radiographs in caries diagnosis in order to produce recommendations for guidelines that are clinically oriented but scientifically based. The options available include the use of various types of radiographic examination alone or in conjunction with other diagnostic aids. The outcomes should facilitate the optimal management of lesions as either preventive care advised (PCA) or operative care advised (OCA). Small initial lesions (PCA) require prompt detection, the application of appropriate preventive care and subsequent monitoring to maintain the most favourable tooth state achievable in the long term. Larger dentinal lesions (OCA) also require prompt detection so that appropriate high-quality operative care can be provided before further loss of tooth substance. Evidence was collected from the literature by updating several recent reviews by the author. The values employed were broadly analogous to those of the Canadian Task Force on the Periodic Health Examination. The use of ionizing radiation is always associated with a degree of risk: therefore all exposures must be kept as low as is reasonably achievable. Present evidence on the balance of risk and benefit indicates that the diagnostic yield for caries diagnosis is high enough to justify individualized examinations, particularly as changes in the morphology of caries have rendered clinical diagnosis of dentinal lesions less sensitive. This issue must be kept under review as alternative diagnostic technologies develop. There is good evidence that initial posterior bitewing radiographs are required for all new dentate patients over five years of age with posterior teeth. This procedure is required as an adjunct to clinical examination for the detection of caries on both the approximal and occlusal surfaces of the teeth. Although a 'blanket' regimen of routine radiographic examination at fixed intervals cannot be advocated, individualized bitewing examinations at varying frequencies determined on the basis of caries risk are supported. At the initial visit, an assessment of caries risk of the individual patient should be made. Varying intervals of first radiographic recall can then be suggested on the basis of differing degrees of risk. At present, risk assessment is imprecise, and risk status may change over time. Therefore, intervals between subsequent radiographic examinations must be re-assessed for each period. The purpose of detecting individual lesions should be to facilitate the planning of appropriate preventive treatment decisions based on lesion severity, caries risk and the patient. Different treatment should be employed for lesions in the PCA and OCA categories. Further rigorous studies are required to evaluate diagnostic methods appropriate for use in individual patient care, epidemiology and clinical research, and to increase the understanding of how findings from these applications inter-relate. Development and validation of reliable methods of caries risk assessment which are usable in general practice is a priority. Investigations of the processes involved in, and the outcomes of, dental decision-making are required to ensure that existing and new methods are used appropriately. Further work should develop and evaluate effective mechanisms of disseminating and implementing research findings by information transfer to dental educators and clinicians.

Decision Making↗
PubMed1996

The dental caries experience of 14-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1994/95.

This paper reports the results of standardised clinical survey examinations of 127,481 14-year-old children across the United Kingdom. These 1994/95 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and contribute to assessments of the provision of dental services. The criteria and conventions of the British Association for the Study of Community Dentistry trainers' pack 1992/93 were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography, fibre-optic transillumination or compressed air. The results demonstrated a wide variation in prevalence across the UK, the mean D3MFT for the former English regions (of the National Health Service) and the other UK 'territories' ranging from 1.2 (South West Thames) to 4.1 (Northern Ireland). The overall mean D3MFT across the UK was 1.93 (D3T = 0.63, MT = 0.15, FT = 1.15). Overall, 57 percent of children had evidence of (dentinal) caries experience (D3MFT > 0), although means ranged from 42 percent (South Wales Thames) to 81 percent (Northern Ireland). The inclusion of data from Northern Ireland for the first time in this series confirms that dental caries prevalence is higher in the province than in other areas of the UK. Trends since the 1990/91 surveys can be assessed for Great Britain. These demonstrate an overall fall in D3MFT of 20 percent since 1990/91 (from 2.30 to 1.85). This is, however, due to the 35 percent reduction in the number of fillings (1.68 to 1.09) which was partially offset by an increase in unrestored dentinal decay of 41 percent (0.44 to 0.62). These findings (taken together with results from regions reporting in 1986/87) demonstrate that although overall improvements have continued in this age group, the rate of improvement has slowed and that changes in the pattern of provision of care for those with disease experience continue to give some cause for concern. On average, across the UK, only 59 percent of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range 48 to 69 percent).

Adolescent↗
PubMed1996

Developmental defects of enamel in regularly attending adolescent dental patients in Scotland; prevalence and patient awareness.

Contemporary dental literature contains many reports of the prevalence of developmental defects of enamel in a variety of populations. Little information is available relating to patients' perceptions of such defects. The aim of this study was to compare the prevalence of developmental defects of enamel in a sample of regularly attending adolescent dental patients with the patients' own views as to whether they thought they had marks on their teeth. The index used for the assessment of defects, the SCOTS Version of the Modified DDE Index (SCOTS/DDE Index), includes both a dentist and patient assessment of defects. Four hundred and eighty-five adolescent dental patients of 41 general dental practitioners in Scotland were examined under standardised conditions in a mobile dental surgery by one trained and calibrated examiner. Approximately half the sample had some sort of developmental defect of enamel, as classified by the SCOTS/DDE Index. However, only 14 per cent of the sample claimed to be aware of marks on their front teeth which would not brush off.

Adolescent↗
PubMed1996

The Chief Scientist reports ... Monitoring the dental health of Scottish children using routinely collected data.

Since the introduction in 1990 of the capitation scheme of payment for the dental care of children, information for those children registered in the scheme has been collected by General Dental Practitioners on a regular (usually annual) basis using form GP17C. These forms are processed centrally by the Dental Practice Division in Edinburgh. The information collected includes data on the dental caries experience of the child as assessed by the dentist. This paper considers some of the problems associated with the collection of this data, as currently undertaken, and its potential usefulness in monitoring the dental health of Scottish children.

Adolescent↗
PubMed1995

Dental fluorosis.

Explore the source record for details and available documents.

Adolescent↗
PubMed1995

Preventive Care Advised (PCA)/Operative Care Advised (OCA)--categorising caries by the management option.

Currently a range of systems and classifications are used by clinicians, epidemiologists and clinical research workers to sub-divide carious lesions into different grades. These systems are based on the depth of the lesion and/or the presence/absence of macroscopic cavitation. In order to improve upon the meaningfulness and comparability of such systems in the light of increasing knowledge about the disease process, lesion behaviour and caries management options, the authors propose a new system of categorisation that differentiates between lesions which normally require operative intervention and those which do not. In future, it is proposed that in addition to existing conventional criteria, diagnostic systems should also allow results to be expressed in terms of 1) lesions for which appropriate non-invasive Preventive Care Is Advised (PCA lesions) and 2) lesions for which Operative Care Is Advised (OCA lesions). Locally acceptable sub-divisions may have to be developed and agreed for certain specific applications. The adoption of this additional nomenclature and approach in the future should aid communications between the different groups involved in caries diagnosis and research. It may facilitate the dissemination of research findings, as well as helping to "drive" researchers working on caries diagnostic methods to focus on techniques which will aid in the accurate assessment of lesion activity and behaviour. Such a focus should also increase our understanding of treatment decision making and promote the development of clinical guidelines. The facility to retain existing criteria in parallel, for local and other purposes, would preserve comparability with data collected previously.

Communication↗
PubMed1995

The effect of placing a clear pit and fissure sealant on the validity and reproducibility of occlusal caries diagnosis.

The purpose of this in vitro study was to assess the validity and reproducibility of the diagnosis of fissure caries prior to and following the placement of a clear sealant. One hundred and twelve extracted molar teeth were examined by 7 experienced clinicians. Each examiner conducted four visual examinations, 2 prior to and 2 after sealing, allowing an assessment of reproducibility. The teeth were subsequently serially sectioned to provide the histological validation. After placement of a sealant, a significant (p < 0.05) loss of sensitivity was found for the diagnosis of enamel lesions and dentine lesions, but specificity was not altered. The overall reproducibility expressed by the kappa statistic was 0.60 and 0.47, before and after sealing, respectively. The examiners significantly (p < 0.001) underestimated the severity of lesions detected after sealing compared to their assessment prior to sealing. The investigation suggests that sealed surfaces require careful assessment and monitoring.

Dental Caries↗
PubMed1995

The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1993/94.

This paper reports the results of standardised clinical caries examinations of 191,770 five-year-old children from across Great Britain. These 1993/94 coordinated surveys were the latest in a series which seeks to monitor the dental health of children and to assess the provision of dental services. The criteria and conventions of the British Association for the Study of Community Dentistry trainers' pack of 1992/93 were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (d3) threshold using a visual method without radiography or fibre-optic transillumination. The results demonstrated a wide variation in prevalence across Great Britain, with mean dmft for regions and countries ranging from 1.1 in the West Midlands to 3.2 in Scotland. The mean value for dmft across Great Britain was 1.92 (d = 1.38, m = 0.30, f = 0.24). Overall, 45 per cent of children had evidence of caries experience (dmft > 0), although the means ranged between 32 per cent (SW Thames) and 62 per cent (Scotland). Trends over time demonstrate a deterioration in overall dmft of 11 per cent since 1989/90, comprising a fall in the number of fillings and an increase in untreated decay of 30 per cent. These findings demonstrate the continuing need for more effective preventive and treatment services for this important age group.

Child, Preschool↗
PubMed1994

Child dental health--is it still good news?

Dental caries levels in children, according to national surveys, have improved in the last decade. However, there are indications that changes may now be occurring within the overall improving pattern of child dental health.

Adolescent↗
PubMed1994

Caries management strategies used by a group of Scottish dentists.

This study was designed to determine how dentists would manage carious lesions of differing severity and whether they would consider using non-invasive methods to manage lesions which were not severe enough to require a restoration. A group of 211 general dental practitioners were interviewed and asked to identify the point at which they would provide restorative treatment in a 12-year-old patient from a list of descriptions of lesions affecting buccal/lingual, occlusal and approximal surfaces. They were then asked how they would manage lesions which they would not restore. Most of the dentists said they would attempt to use some form of active non-invasive management technique. Principal among these would be teaching the patient how to maintain their oral hygiene and giving them dietary advice. The majority also felt that fluoride varnish or gel would help control a buccal or lingual surface lesion and that placement of a fissure sealant without any mechanical removal of tooth tissue would be a satisfactory way to control a lesion affecting an occlusal surface. The findings support the view that it may be useful to classify caries into two types: lesions for which preventive care is advised (PCA) or lesions for which operative care is advised (OCA).

Child↗
PubMed1994

The dental caries experience of 5-, 12- and 14-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1991/92, 1992/3 and 1990-91.

A series of caries prevalence surveys across Great Britain has been coordinated by the British Association for the Study of Community Dentistry (BASCD) since 1985/86 with the aim of monitoring caries experience in representative samples of school children aged 5, 12 and 14 years of age. The purpose of this report is to present the findings of the surveys of 14-, 5- and 12-year-old children carried out in 1990/91, 1991/92 and 1992/3 respectively. These point prevalence surveys were conducted at the caries into dentine level of diagnosis using clinical examination only and a standardised, predominantly visual, diagnostic method employed by trained and calibrated teams of examiners from each country/region of Great Britain. For the 14-year-old age group, 114,126 children from 179 health authorities/boards were examined. The weighted mean DMFT for the participating countries and regions was 2.30 (range, 1.42-3.55). At age 5 years, 205,444 children from 184 health authorities/boards were examined. The weighted mean dmft for the participating countries and regions was 1.86 (range, 1.04-2.88). At age 12 years, 151,143 children from 186 health authorities/boards were examined. The weighted mean DMFT for the participating countries and regions was 1.27 (range, 0.84-2.08). A wide geographical variation in the results was evident for all three age groups, demonstrating a consistent north-south pattern, with higher levels towards the north of Britain. Trends in caries experience in permanent teeth indicate that the decline is now much slower for 12-year-old than for 14-year-old children and slower than the rate for 12-year-old children during the previous 4 year interval between examinations. For 5-year-old children, overall, the general decline in caries experience has ceased, while increases in dmft and in proportions with untreated dentinal decay are now seen in most parts of Great Britain. The pattern of restorative care provided has deteriorated with a fall in the care index for 5- and 12-year-old children, this finding may be related to changes in service provision within the UK.

Adolescent↗
PubMed1994

Topics for general dental practioner continuing education: survey of Scottish views.

The provision of continuing education for general dental practitioners is expanding with a bewildering range of presentation methods and variation in quality. The first stage in the development of any educational programme should be identification of target audience needs, but little has been published on this subject. To draw the attention of providers of continuing education material to the perceived needs of general dental practitioners in one geographical region, a questionnaire survey was employed. Scottish general dental practitioners were asked to identify topics on which they needed continuing education. Sixty-five per cent responded. Conservative dentistry and periodontology were requested most frequently. The reasons for this and the wide range of topics requested are discussed.

Attitude of Health Personnel↗