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Biomedical subjects

N B Pitts

Publications and source records attributed to N B Pitts.

At least 109 records · Page 6Linked to original sources
PubMed1992

The Chief Scientist reports.... Problems in mounting and maintaining longitudinal studies--examples from dental health services research.

There already exists a body of literature on the conduct of classical epidemiological studies. However, guidelines tend towards detailing how such studies should be conducted and may not prepare the reader for the less-than-perfect scenarios that will inevitably be encountered. The Dental Health Services Research Unit in Dundee has been involved in longitudinal studies of dental treatment and dental health since its inception in 1979. The problems encountered in this research are considered under the headings of mounting the studies, samples, data collection, external changes, internal changes, dissemination and curtailment. It is hoped that a description of the often unpredictable problems associated with a particular set of studies will provide an insight which may assist others embarking on analogous projects in health services research.

Clinical Protocols↗
PubMed1991

The clinical behaviour of free smooth surface carious lesions monitored over 2 years in a group of Scottish children.

As far as the authors are aware, no large-scale clinical studies of free smooth surface caries have been carried out in the past, although carious lesions on these surfaces can be diagnosed at an 'early' stage. In this study on a group of 2854 13-year-old children, caries affecting the free smooth surfaces (buccal and lingual) was found to be a common problem, with a total of 2917 lesions observed on molar teeth at the first examination. Most of the lesions involved no macroscopic loss of tooth contour. When the children were examined 2 years later, three-quarters of the lesions had either remained static or regressed. Free smooth surface lesions were more likely to develop initially, and more likely to progress, in individuals with poor oral hygiene. Free smooth surface caries experience showed a positive correlation with occlusal and approximal decay experience. The number of free smooth surface carious lesions can be used as a predictor of caries risk. Strategies for diagnosis and prevention are suggested for patients presenting with free smooth surface caries on molar teeth.

Adolescent↗
PubMed1991

Five-year longitudinal study of restorative treatment received by Scottish children.

This prospective 5-year longitudinal study followed the dental care of a large, representative group of children initially examined in Scotland during the 1983 UK survey of children's dental health. The Dental Health Services Research Unit at the University of Dundee monitored the restorative treatment provided in the General Dental Service and the Community Dental Service for 1568 children aged 5, 8, 12 and 15 years in 1983, using information provided via the Scottish National Health Service. Over a 5-year period, records of attendance were received for 85% of the children (1340). A large amount of restorative care, distributed very unevenly across the sample, was provided. On average, attenders attended once per year (range over 5 years: 1-20) and received approximately one filling in each of the 5 years (range over 5 years: 0-58). The majority of restorative care (80.6% of the 8057 restorations) comprised amalgam fillings in posterior teeth, frequently (89%) involving the occlusal surface. This pattern of treatment has implications for planning cost-effective preventive care. Factors shown to have a significant influence on the number of amalgam fillings placed were initial caries prevalence, number of courses of treatment, age group and service.

Adolescent↗
PubMed1991

Initial development and in vitro evaluation of the HPL device for obtaining reproducible bitewing radiographs of children.

A new beam-aiming and collimating film holder, the HPL device, has been developed to facilitate the production of reproducible serial bitewing radiographs. The device holds two films in the mouth simultaneously and is held in position extraorally. Serial bitewing radiographs of skulls of children aged 7, 10, and 14 years taken with (1) a "freehand" technique, (2) a Rinn film holder, and (3) the HPL device were evaluated for degree of reproducibility, potential diagnostic yield, and technical errors. Compared with the other techniques, the HPL device produced a smaller number of overlapped surfaces and substantially fewer technical errors. In vivo studies of the new device are therefore indicated. The restriction of the field of primary and secondary irradiation may lead to a substantial reduction in absorbed radiation dose compared with other techniques.

Adolescent↗
PubMed1991

Diagnostic methods for caries: what is appropriate when?

A Workshop was held which invited a range of speakers to consider separately the different diagnostic tools presently available for the detection of caries and then the various applications to which these tools can be put. Each presentation was followed by a vigorous discussion period. It was concluded that there is no one single method suitable for all anatomical sites and degrees of caries and that the requirements for epidemiological surveys, clinical trials and individual patient care are different. The choice of appropriate diagnostic technique(s) should be made, in each situation, on the basis of published performance data which has to be regularly re-evaluated due to the pace of change.

DMF Index↗
PubMed1991

Effects of diagnostic threshold and overlapped approximal surfaces on reported caries status.

The aims of this study were to examine the influence upon reported caries status of: 1) employing different diagnostic thresholds and 2) using differing conventions for treating approximal surfaces which appeared overlapped on posterior bitewing radiographs. Caries prevalence data from a group of 211 Scottish schoolchildren aged 5-15 yr studied during a trial of elective temporary tooth separation in general dental practice in Scotland were used. In this "moderate" caries group, values for dmft/DMFT rose significantly (P less than 0.001) when the D1 diagnostic threshold (all grades of lesion accepted) was applied in comparison with the D3 threshold (only caries into dentine recognised); dmft increasing from 3.9 to 5.4 and DMFT increasing from 1.7 to 4.7. This demonstrated that an over-optimistic impression of overall caries levels may be given when only the D3 threshold is used uncritically. In this study the status of approximal surfaces which were overlapped on bitewing radiographs was assessed by direct clinical examination using the temporary elective tooth separation technique. The investigation showed that, for this juvenile population, most (81.8% mesial, 93.1% distal) overlapped approximal surfaces were sound. Significantly more mesial than distal surfaces were found to be overlapped.

Adolescent↗
PubMed1991

The use of bitewing positioning devices in children's dentistry.

The use of film-holding, beam-aiming devices have been shown to have a number of potential advantages in achieving high quality bitweing radiographs, however, little information is available about their acceptability to children. The aims of this study were: (1) to determine the level of acceptance of a conventional type of film positioner to child patients in a general practice setting in Scotland and (2) to compare the acceptability to children of bitewing procedures using: the freehand technique, a 'Rinn' positioner and a new positioner, the 'HPL' device. In the general practice group, following modifications made during a pilot study, 211 children aged 3-15 years were offered a bitewing examination with a modified Rinn positioner at recall. The overall acceptance rate of the bitewing procedure was 82.5%. All 10 children aged 3-4 years offered bitewings refused, while 77 (69%) of subjects aged 5-9 years accepted, as did all the 89 children aged 10-15 years. In the comparison of acceptability investigation, three groups of 30 children aged 6-15 years requiring bitewing radiographs were selected at random. Each group had a different bitewing technique carried out by the same operator. The children's acceptance of all three techniques was high (87-97%) and no statistically significant difference was found between the acceptability of the freehand method and those involving film positioning devices. Although the unmodified Rinn design suffered from a number of problems, the modified version was found to be acceptable by many children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Scottish dentists' use of and opinions regarding bitewing radiography.

This study examined Scottish dentists' claimed use of and opinions regarding bitewing radiography. Information was obtained from a questionnaire sent to all dentists practising in Scotland in 1987 and from national statistics published in the Annual Reports of the Dental Practice Boards in the UK. The response rate to the questionnaire was 72% (926 general dental practitioners and 201 clinical community dental officers). Respondents considered radiography to be of value for the detection of approximal caries, assessment of caries progression and evaluation of alveolar periodontal support. They considered it to be of less value for a variety of other tasks, including detecting occlusal caries, unerupted teeth or calculus. One hundred and fifty-eight dentists (15% of respondents) claimed not to have taken any bitewings of their 12-year-old patients in the preceding year. Those respondents who did claim to have exposed some bitewings said that approximately one-quarter of this patient group had received the examination in the past year. The overall Health Service statistics appear to confirm that the utilization of radiography by dentists practising in Scotland is somewhat lower than that by dentists in England and Wales, a factor which requires further investigation.

Attitude of Health Personnel↗
PubMed1991

Oral hygiene, gingivitis and periodontal status of Libyan school children.

There is relatively little information about the dental health of Libyan children, so this study was initiated to assess the level of oral hygiene and the gingival and periodontal status in children living in urban and rural parts of Libya. Two thousands and fifteen children aged 7-16 years were examined during 1987 using World Health Organization criteria. The oral hygiene was found to be good (mean oral hygiene index = 0.12); boys demonstrated significantly worse oral hygiene than girls (P less than 0.001). Overall, gingival inflammation was categorised as mild (mean gingival index = 0.05). Boys had more gingivitis than girls (P less than 0.001). Periodontal pockets of more than 3.5 mm were found in 4.1 per cent of 15-16-year-old children.

Adolescent↗
PubMed1991

The diagnosis of dental caries: 2. The detection of approximal, root surface and recurrent lesions.

The range of diagnostic techniques used to detect and monitor dental caries which are available to practitioners has broadened in recent years. Following the consideration of the assessment of caries in buccal, lingual and occlusal surfaces in the first article in this series, this second article gives a description of the diagnostic methods currently employed in the detection of primary caries in approximal and root surfaces as well as those used for recurrent lesions. The third paper will discuss the rationale for the use of these techniques and provide an overview of present and potential future diagnostic techniques.

Dental Caries↗
PubMed1990

A reappraisal of the value of the bitewing radiograph in the diagnosis of posterior approximal caries.

The aim of this paper was to re-assess the available literature examining the value of the bitewing radiograph in the diagnosis of approximal caries and to compare the relative values of radiographic and clinical examinations. To this end, results from 29 research studies have been re-presented and tabulated. These results show that the use of the bitewing radiograph is essential if much approximal caries is not to be missed. It is particularly important in the detection of the small lesion which may be managed preventively rather than operatively. Although there is a proper need to ensure that radiographic exposures are minimised, the evidence suggests that both clinicians and epidemiologists must balance this need with the ethical issues associated with failing to employ an established diagnostic aid.

Bicuspid↗
PubMed1990

Restorative treatment thresholds reported to be used by dentists in Scotland.

A questionnaire was sent by post to all dentists practising in the General Dental Service and the Community Dental Service in Scotland; 72% of them (1127) completed and returned it. Three sets of descriptions of carious lesions, ordered on the basis of increasing degree of severity, were supplied. One was based on the radiographic appearance of lesions affecting approximal surfaces, the others on the visual/tactile appearance of lesions affecting free smooth surfaces (buccal and lingual) and occlusal surfaces. For each type of surface the dentists were asked which description indicated the minimum point at which a filling ought to be provided (restorative treatment threshold) in 12- and 30-year-old patients. Overall, the majority of dentists said they would intervene earlier in the case of a 12-year-old than in the case of a 30-year-old patient. Many dentists indicated they would fill an approximal lesion whose radiolucency was confined to the enamel (44.2% for a 12-year-old, 20.1% for a 30-year-old). A further substantial proportion gave a response which suggested that the amelodentinal junction would be the critical decision point (25.8% for a 12-year-old, 19.3% for a 30-year-old). Many also felt that a filling ought to be provided prior to visible cavitation for lesions of the occlusal surfaces (55.1% for a 12-year-old, 22.1% for a 30-year-old); fewer advocated the same treatment threshold for lesions affecting buccal/lingual surfaces (24.1% for a 12-year-old, 9.2% for a 30-year-old).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

A profile of orthodontic treatment in the general dental service in Scotland 1979-1987.

The study casts and records of two samples of patients who had received orthodontic treatment involving the use of appliances within the General Dental Service (GDS) in Scotland during 1979/81 and 1986/87 were examined to study the pattern of treatment, and to determine whether there had been any change over this period. Both samples contained a wide range of malocclusions which were treated mostly with removable appliances. Although few fixed appliances were used and few lower arch treatments were carried out there was a trend towards a greater use of these appliances and an increase in these treatments in 1986/87 compared with 1979/81. There was no change in the infrequent use of headgear while functional appliances were used in only six of the treatments in the 1986/87 sample as compared to none in the 1979/81 sample. In the more recent sample many more treatments were undertaken by 'specialist' General Dental Practitioners (i.e. those who work in the GDS, but limit their practice to orthodontics) and fewer treatments were undertaken under the direction of a Consultant Orthodontist.

Adolescent↗
PubMed1990

Initial comparison between endoscopic and conventional methods of caries diagnosis.

This study was designed to assess the feasibility and practicability of the employment of endoscopic methods for the diagnosis of dental caries and to compare the diagnostic performance, in posterior teeth, of visual endoscopic caries diagnosis (with and without the benefit of differential fluorescence) with that of conventional visual diagnosis, bite-wing radiography, and conventional transillumination. The two endoscopic methods were found to be clinically practicable, to be able to demonstrate the presence of small carious lesions, and to have both advantages and disadvantages compared to conventional methods. When all tooth sites were compared, the results indicated that the endoscopic methods may detect a greater number of carious lesions than do conventional visual, radiographic, or fiber-optic transilluminational methods of caries diagnosis. Further investigations involving histologic validation of diagnoses as well as larger numbers of patients and multiple examiners are indicated.

Adolescent↗