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Biomedical subjects

P J Riordan

Publications and source records attributed to P J Riordan.

At least 19 recordsLinked to original sources
PubMed2005

Impact of new prostheses on the oral health related quality of life of edentulous patients.

OBJECTIVE: A study was conducted to evaluate the impact of the placement of complete dentures by using the Global Oral Health Assessment Index (GOHAI). BACKGROUND: Oral health quality of life indicators can be used to evaluate the effects of dental treatments. MATERIAL AND METHODS: The 26 participants were treated in a French University Clinic during 2002. They were randomly divided into two groups. Each group received new prostheses, but evaluation of the quality of life was made at different periods [baseline, denture placement (group 1), 6 and 12 weeks (group 2) after placement]. A questionnaire was used to collect information on patient's satisfaction with the previous and new prostheses. Nonparametric tests were used to test the relationships between patients' satisfaction or baseline data and GOHAI variations with time as well as to compare mean values of GOHAI within each group. RESULTS: At baseline, the impact of oral health problems was apparent; the mean GOHAI-Add score was 45.8 (10.2). Six weeks after placement of the new denture, there was no difference in GOHAI scores compared with the initial assessment. An improvement in GOHAI score was observed 12 weeks after the participants received their new dentures (p < 0.05). Change in GOHAI-Add scores was negatively correlated with the initial GOHAI-Add score. Patients who preferred the new prosthesis enjoyed a positive change in GOHAI scores (p < 0.001). There was a relationship between participants' satisfaction with the new dentures and change in GOHAI scores (p < 0.05). CONCLUSION: The GOHAI can be used to evaluate needs for and effect of the making of new complete dentures.

Adult↗
PubMed2005

Tooth follicle extirpation and uvulectomy.

Migration is not only the movement of people, but also of their culture, customs and beliefs. As more people from developing countries in Africa migrate to industrialized countries, the more likely health professionals will find themselves providing care for people of whose customs and practices they have little knowledge. This review of the literature suggests that removal of deciduous canine follicles and uvulectomy are frequently practised in some African and neighbouring countries. Reasons given for deciduous canine extirpation include the prevention of vomiting, fever and diarrhoea. The indications for uvulectomy appear widespread, including treatment for persistent fever, coughing and growth retardation. The practices are usually performed by traditional healers. Risks for children who undergo these procedures are extensive, including septicaemia, potential for HIV transmission, numerous dental complications and death. With improved understanding between Western health teams and local, traditional people, an improved system may develop whereby the two systems can work together in providing improved health outcomes for the people.

Africa↗
PubMed2003

Evaluation of a dental care program for school beginners in a Paris suburb.

OBJECTIVES: Dental care for children is available in France, but the method of administration is cumbersome: care is generally provided by private dentists, and parents can claim reimbursement of at least 70% of the costs afterwards. In the Département of Val d'Oise (north of Paris and including some densely populated suburbs), a scheme is in place to provide 100% reimbursement. To encourage participation, schoolchildren are screened by dentists who advise if treatment is needed. The objective of this study was to ascertain the effectiveness of screening as a stimulus for seeking dental care. METHODS: In two towns, 6-7-year-old schoolchildren were cluster-sampled to give 507 participants. At screening, about half of the participants were found to be in need of operative treatment. Questionnaires about demographic and other background factors were sent home. From those needing treatment, 186 (77%) sets of questionnaires were returned. These persons were the analytical basis of the study. Six months after screening, the 186 participants were examined to estimate whether they had sought and received treatment as advised. RESULTS: The majority of the participants came from low socioeconomic and deprived backgrounds. Most of the parents were born in countries outside Europe. Only about one-quarter of the children advised to seek treatment had actually done so after 6 months. Slightly under half of those who were treated had claimed the reimbursable amount after the treatment. Of the 186 participants needing treatment, 24% had more than 4 dt + DT but 70% of these had not received any care. CONCLUSION: These findings suggest that even when costs are totally reimbursed, most children in need of care do not receive it; the greater the need of care, the lower the likelihood of getting it. The deprived people and immigrants frequently inhabiting the Parisian suburbs seem to experience cultural, financial, linguistic, and administrative barriers to care, which impede uptake and which must be changed if these children are to enjoy improved dental health.

Child↗
PubMed2003

Validation of an oral health quality of life index (GOHAI) in France.

UNLABELLED: Oral health has traditionally been defined in terms of disease. Today, health is seen in a wider context: taking into account its impact on everyday living. Several indices attempt to capture this dimension. The Geriatric Oral Health Assessment Index (GOHAI) has been adapted for general use and tested on adult samples, mainly in North America. Language, cultural norms and the health care system in France are different and this raises the need to validate the GOHAI in France before it receives widespread use. OBJECTIVES: The purpose of this study was to test the validity of a French version of the GOHAI. METHODS: The GOHAI is based on responses to a 12-item self-administered questionnaire. The items were translated into French, back-translated and compared with the original. After pilot testing and minor modifications, the French version was administered to a group of low-income persons benefiting from the national health insurance system (n = 260, 18-45 years). Measures for stability and internal consistency were calculated. Concurrent and discriminant validity were assessed. RESULTS: Cronbach's alpha (0.86) showed a high internal consistency and homogeneity between items. Item-scale correlations varied between 0.40 and 0.78. Repeat administration of the GOHAI to 32 participants gave weighted kappa coefficients from 0.51 to 0.87 and a Pearson's correlation coefficient of 0.87. Low GOHAI scores were associated with perceptions of poor oral and general health, low satisfaction with oral health and a perceived need for dental care. There were significant relationships between the GOHAI score and most objective measures of dental status except FT. Younger, well-educated and higher income respondents were more likely to have a high GOHAI score. CONCLUSION: The French version of the GOHAI exhibits satisfactory psychometric properties but two items (one about swallowing, the other with complex sentence structure) had poor stability.

Adolescent↗
PubMed2002

Dental screening of older adults living in residential aged care facilities in Perth.

BACKGROUND: This study aimed to estimate the dental treatment needs and oral health status of a sample of older adults in residential aged care facilities in Perth. METHODS: The 348 participants (> or = 65 years) were interviewed and screened in 25 facilities. The screenings were carried out by one examiner using a mirror and a portable light. RESULTS: Over half (52 per cent) of the participants were edentulous and 45 per cent of those edentulous participants for whom a recording was made (n=174) had oral mucosal conditions. The 164 dentate participants had a mean of 12 disease-free standing teeth, a mean decayed, missing or filled teeth (DMFT) of 24.7 (mean DT 0.8, mean FT 5.3) and half of them required the removal of supragingival calculus. Of those with root caries experience (n=127), a mean of 1.3 untreated decayed roots and a mean of 1.9 roots covered in plaque were recorded. The majority of the participants (83 per cent) were pensioners eligible for government subsidized dental care and 47 per cent were reported by the Directors of Nursing to have dementia. CONCLUSIONS: The data collected here demonstrate poor oral health conditions and a substantial treatment need in a neglected population. More people in nursing homes and hostels are keeping their natural teeth compared with a similar population studied 13 years ago.

Aged↗
PubMed1999

Fluoride supplements for young children: an analysis of the literature focusing on benefits and risks.

The use of fluoride supplements to prevent caries has been advised for more than 100 years, but serious promotion of this strategy occurred only after the effectiveness of water fluoridation was established, in the late 1950s and 1960s. Although the effectiveness of fluoride supplements was apparently endorsed by many small clinical studies, closer examination of the experimental conditions of these, their methods and the analysis of their results undermined confidence in their findings. It is likely that confounding resulted in spurious conclusions in many of them. More modern, well-conducted clinical trials of supplements suggest that today, in children also exposed to fluoride from other sources such as toothpaste, the marginal effect of fluoride supplements is very small. There is evidence that fluoride lozenges, designed to maximise any local effect, may have a small caries preventive effect, particularly in deciduous teeth. Overall, poor compliance makes fluoride supplements a poor public health measure. Supplement use by young children is associated with a substantial risk of dental fluorosis. Fluorosis is an issue about which the public is becoming concerned in several countries and this concern, if translated into opposition to all fluoride use, could jeopardise the most successful caries preventive aid we have. The potential for dental fluorosis, concern about the public's reaction to this, the poor effectiveness of supplements and the public's poor compliance with their use are persuasive arguments for a radical reduction in the use of supplements by young children. Recent changes in fluoride dosage schedules and deferment of the age of commencing the use of supplements, implemented in many countries, have followed from these concerns. Supplements formulated as lozenges maximise topical exposure of enamel to fluoride and such products may offer older children and some adults a way of maintaining an elevated fluoride level in saliva at times when toothbrushing is not practical.

Cariostatic Agents↗
PubMed1999

Fluoride supplements and caries in a non-fluoridated child population.

In Norway, there is no water fluoridation and little naturally occurring fluoride in drinking water. Fluoride toothpaste is used by 95% of the population and there is a long tradition of use of fluoride supplements. The purpose of this study was to analyse whether children who used fluoride toothpaste regularly and complied with the recommendations for use of fluoride supplements had less caries than other children at the age of 8 years. Most fluoride supplements sold in Norway are lozenge-type tablets, which allow for extended enamel exposure to fluoride. All children (n = 551) born in 1988 living in a suburban community in Norway were invited to participate. In those who participated (n = 470), caries was registered clinically and radiographically and parents provided data on use of supplements. Thirty-eight percent of the children had used fluoride supplements regularly during the period 0.5 to 4.0 years of age and 66% used supplements regularly at the age of 6 to 8 years. Multivariate analyses showed that the children complying with the recommendations for use of fluoride supplements during the period 0.5 to 4.0 years of age had lower caries experience (dmfs) and fewer decayed surfaces (ds) in primary teeth than other children. No significant associations were found between supplement use in childhood and caries prevalence (DMFS) or number of decayed surfaces (DS) in permanent teeth at the age of 8 years. Supplement use from 6 to 8 years of age was not associated with caries occurrence either in primary or in permanent teeth. Both mother's education and the quality of dental hygiene were inversely associated with caries occurrence.

Analysis of Variance↗
PubMed1997

Can organised dental care for children be both good and cheap?

Children's dental services evolved from emergency, pain-relieving and later amalgam-based care systems of the early and middle 20th century. The pattern of occurrence of dental caries is different today and young teenagers have very few teeth affected by caries. Restoration of lesions in permanent teeth, typically on occlusal or buccal/lingual surfaces, is technically simple. Paradoxically, dental students today are expected to master a vast amount of knowledge, including information on new dental materials and techniques. New dentists who choose to provide dental care for children as a career will spend most of their days placing fissure sealants, applying topical fluorides and inserting predominantly single-surface restorations. Because of their expensive training, new dentists will nevertheless expect high earnings, and this results in a high cost for children's dental care. The opportunity cost is other health services foregone. In developing countries where there are few dentists, they are almost not available for children at all. Costs could be reduced by reducing the number of interventions, and by reducing staff costs. Fewer interventions could be achieved by longer recall intervals: several studies and experience from places where this has been implemented indicate that is safe and effective. Widespread delegation of operative work to appropriately trained dental hygienists or therapists would reduce staff costs. Dental therapists are better substitutes for dentists in children's care because they are trained to do most of the clinical procedures that are necessary in children's dentistry. In Western Australia and South Australia, most dental care for children is provided by dental therapists. The costs of care are much lower and the outcome, as measured by caries experience and numbers of treated patients, is equivalent to or even better than European dentist-based services. Already, in some places, politicians and others are querying the need for organised children's dental care. Increased effectiveness will make continuation of children's dental services easier to sustain.

Adolescent↗
PubMed1996

The place of fluoride supplements in caries prevention today.

There are very few scientifically good clinical trials of fluoride supplements, and those that can be considered methodologically adequate suggest that the contribution of fluoride supplements to caries prevention is slight. This may be partly a consequence of the fact that fluoride is much more widely available today than was the case a generation ago when fluoride toothpaste was not widely used and water fluoridation was not fully implemented. Although some families are conscientious in their use, compliance with fluoride supplement recommendations is generally poor over longer periods, making them a poor public health measure. There is substantial evidence that supplements cause dental fluorosis when used in accordance with recommendations for infants and small children. If the public becomes concerned about dental fluorosis as an aesthetic problem, all fluoride use may be put at risk. Supplements should no longer be recommended for caries prevention in children in areas with little fluoride in water but may be useful for persons with intractable caries risks. If supplements are recommended for children, a more cautious dosage schedule should be used. The fact that supplements have been recommended uncritically for many years on the basis of inadequate research raises questions about the standards of dental science.

Cariostatic Agents↗
PubMed1995

Recall intervals, dental hygienists and quality in child dental care.

Decline in dental disease and the need to provide dental care efficiently suggest changes in clinical and administrative routines in public dental care provision for children. A field project in Norway demonstrated productivity gains after the introduction of individualized recall intervals and using dental hygienists to conduct recall examinations. The purpose of the present study was to assess changes in the quality of dental health outcome and changes in the quality of the process of dental care provision. Recall intervals were increased from a target of 12 months to 16 and 18 months in two districts. Dental hygienists undertook all recall examinations and referred to dentists those patients who required operative care. Bitewing radiographs were inspected for all 18-yr-olds who were examined in 1989, 1990 and 1991 (n = 956) and for those who were examined before the changes were implemented in 1987 (n = 300). For each child, approximal caries on 24 surfaces was scored according to a 4-point severity scale. Clinical records were examined to determine what treatment had been provided. For each year after the changes were implemented, the quality of health outcome was assessed by comparing the radiographic caries prevalence and the number of sound surfaces with 1987 data. Quality in the process of care provision was indicated by the treatment decisions for approximal caries and by the proportion of uninterpretable surfaces on radiographs for each study year. The mean number of sound surfaces increased over time. A declining proportion of sound surfaces was restored over the study period, and almost all caries lesions extending deep into dentine were restored. Radiographic quality improved during the project period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Secular changes in treatment in a school dental service.

The caries decline has affected child dental treatment in many countries. There has been a change towards fewer extractions and pulpotomies in deciduous teeth, and restorative techniques and restorations in deciduous and permanent teeth have become less complex. New materials, particularly glass ionomer cements (GIC), have found acceptance. The School Dental Service (SDS) in Western Australia (WA), one of the world's largest dental care organisations, holds good data on children's dental health and on the types of treatment provided since 1980. This paper reports these data. Oral health is recorded as caries experience on a random sample of patients. Treatment provided is recorded by operators after each patient visit and collated monthly. About 240,000 children (> 90 per cent of those eligible) and currently enrolled in the SDS and the clinical staffing is about 150-160 dental therapists and 27 dentists. Caries experience has fallen in all age groups in recent years, except that in 1992 and 1993 dmft rose slightly in six-year-old children. All types of operative treatment are used less frequently now than in 1980. In deciduous teeth restorations, GIC dominates but amalgam remains the most widely chosen material in permanent teeth. The use of fissure sealants (using GIC) peaked in 1988 and, as a result of management decisions, has declined since then. The decline in the need for dental treatment has reduced costs and enabled the SDS to offer care to an expanding group of children in WA. The results achieved by the SDS in WA demonstrate that a service based primarily on dental auxiliaries is viable and efficient.

Adolescent↗
PubMed1994

Effect of fluoride in amalgam on secondary caries incidence.

Caries incidence is falling in many developed countries but is believed to be increasing in developing countries. Insofar as treatment for caries is provided, ordinary amalgam restorations are usually the standard choice. These carry a risk of failing due to secondary caries. The aim of this study was to compare the occurrence of secondary caries adjacent to fluoride-containing amalgam with that adjacent to a conventional amalgam under field conditions in Bahrain. Children (n = 415) aged 6-14 yr who required occlusal restorations in two homologous contralateral permanent molar teeth were identified. Using the split-mouth design, one tooth received a fluoride-containing amalgam filling and the other a conventional amalgam restoration. A random method was used to determine which type of filling was placed on each side. After 4 yr, 357 children were still available for examination; of these 5 had to be eliminated from analysis for various reasons. Of the 704 teeth in the analysis, secondary caries had occurred in 135 (86 conventional amalgam, 49 fluoridated amalgam). By comparison with the conventional amalgam, the effectiveness of the fluoride amalgam was 43% (95% C.I. 24.4%, 57.1%) and the net gain 10.3% (95% C.I. 4.75%, 16.3%). The relative risk was 0.570 (95% C.I. 0.444%, 0.731%). Since fluoride amalgam has identical handling properties to conventional amalgam, performs similarly under clinical conditions and costs about the same, it should be the amalgam of choice for restorations in communities where the incidence of secondary caries is high.

Adolescent↗
PubMed1994

Radiographic caries diagnosis by clinicians in Norway and Western Australia.

In connection with continuing education courses in Norway and Western Australia (WA), dealing with caries diagnosis and treatment decisions, pre-tests were conducted. The pre-tests involved 433 dentists in Norway (ND), and 62 dentists (WAD) and 108 dental therapists (WAT) in WA, altogether 603 clinicians. Radiographs of 68 approximal surfaces were to be diagnosed and a treatment proposal was requested for each surface. ND showed the best overall diagnostic quality measured by the area beneath ROC-curve (P < 0.00001). The frequency of false-positive diagnoses (over-registrations) on sound surfaces varied between 7.1% (ND) and 11.9% (WAT) while the frequency of true-positive scores for lesions in the outer half of dentine varied from 57.4% (ND) to 48.1% (WAT). The mean numbers of restorations suggested by the three groups of clinicians were: ND: 14.3; WAD: 13.0; and WAT: 14.5. None of the differences was statistically significant. The proportion of sound surfaces proposed filled varied considerably between the groups, from 4.3% among Norwegian dentists to 10.6% among WAT (P < 0.0001). Of the lesions penetrating the outer half of dentine, the ND group would have restored 34.5% and the Australian clinicians somewhat fewer: WAD 25.6% and WAT 26.5%. The 11.3% of the ND who proposed more than two fillings on sound surfaces were responsible for 51.2% of the total number of filling proposals on sound surfaces. The corresponding numbers in the Australian group were 19.4% (WAD) and 33.3% (WAT) who made 73.6% and 75.7% of the restorative proposals on sound surfaces respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Outcome measures in split mouth caries trials and their statistical evaluation.

The split mouth study design in trials of fissure sealants and restorative materials neatly controls for confounding by many of the variables associated with poor retention of sealants and occurrence of dental caries. Traditionally, the outcome measures used in split mouth trials have been material retention, (per cent) effectiveness and net gain. A survey of the literature revealed that a large proportion of split mouth studies report no statistical evaluation of outcome measures. In those studies in which statistical evaluation had been conducted, McNemar's X2 was the test most frequently used. This statistic is appropriate for comparing differences between "success" and "failure" tooth pairs (or "positives" and "negatives" in split mouth terminology) but it cannot evaluate directly effectiveness and net gain. The distributions of effectiveness and net gain are different and it would be desirable to estimate confidence intervals for them. In this paper, we consider these statistics, suggest methods by which confidence intervals may be calculated, and provide examples of the calculations. We demonstrate the close relationship between effectiveness (as used in split mouth trials) and relative effect and relative risk (as used in general epidemiological analysis) and recommend that relative risk should be the preferred outcome measure for split mouth trials. Whatever outcome measure is chosen in split mouth trials should always be subjected to statistical evaluation, preferably by the calculation of confidence intervals.

Bias↗