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Biomedical subjects

R D Holt

Publications and source records attributed to R D Holt.

At least 55 records · Page 3Linked to original sources
PubMed1995

The changing pattern of day-care treatment for children in a London dental teaching hospital.

Day-stay general anaesthesia facilities may be employed to provide comprehensive dental care for children who are unable to accept treatment using alternative methods of patient management. This approach to delivery of care has been shown to be cost-effective, acceptable and efficaceous. This study was set up to investigate changes in the pattern of care provided in day-care facilities at a London dental teaching hospital over a 20-year period--1972 to 1992. The results show that the use of the facilities at this centre has increased with time, with a greater increase amongst older children in recent years. Although the main use is still for the treatment of caries, oral surgery procedures, especially those related to orthodontic treatment, have increased by 200% between 1982 and 1992. This correlates with the increase in older age groups being treated. Details of mean numbers of teeth restored and extracted for each age group are presented for 1992. They indicate, for the younger age groups, not only the high treatment needs of patients referred to the hospital, but also suggest a trend for more radical treatment planning in order to avoid further general anaesthesia. Readers are reminded that, despite its advantages, general anaesthesia should be avoided if possible.

Adolescent↗
PubMed1995

Mycoplasmas in plaque and saliva of children and their relationship to gingivitis.

Gingivitis is common in children but its etiology is not well understood. Results of earlier studies have suggested that mycoplasmas may have a role in the disease. In this study two plaque samples and one stimulated saliva sample were taken from each of a group of sixty (60) 5 to 9 year-old children and cultured selectively for mycoplasmas. Subjects had been selected on the basis of gingival status buccal to the most posterior tooth in an upper quadrant, 20 each having scores 0, 1, or 2 at this site using the Löe and Silness index. Plaque samples were taken from the adjacent tooth surface and from a second posterior site where the adjacent gingiva was free of signs of inflammation. Mycoplasmas were cultured from 54 saliva samples and from 57 plaque samples. Isolation frequency and numbers of mycoplasmas in relation to total anaerobic counts were consistently related to gingivitis scores in both plaque and saliva samples, with higher frequencies and proportions with increasing levels of gingival inflammation at the selected site. In plaque samples this finding held good for both comparisons between groups of subjects and for those between test and control sites within subjects. Findings would appear to confirm the suggestions of earlier studies that mycoplasmas in the oral cavity are associated with gingivitis in children.

Chi-Square Distribution↗
PubMed1995

The pattern of caries in a group of 5-year-old children and in the same cohort at 9 years of age.

A group of 1,006 children examined at 5 years of age was followed up after a further four year period. Thirty seven per cent of the group had some caries experience at the age of 5 years. Four years later this proportion had increased to 52 per cent. There was little caries in incisor teeth at the age of 5 with the disease affecting mainly primary molars, (especially second primary molars) and occlusal surfaces. Primary molars continued to experience new attack in the subsequent four years, with lesions affecting more first primary molars and more approximal than occlusal surfaces during this period. New caries was seen most often in children with previous disease experience but children with a lower dmfs of between 1 and 5 at 5 years experienced a similar increment to those with more extensive caries (dmfs > or = 6). In contrast, few lesions were seen in the children who had been caries free at 5 years. Children in the study had taken part in a trial of a lower fluoride toothpaste (550ppmF) especially formulated for young children. There was no difference in relative pattern of disease in test and control groups but the trend seen at the end of the trial for children who had used the test paste to have slightly higher levels of disease than those who had used a standard control paste (1,055ppmF) was seen again four years later.

Child↗
PubMed1994

The influence on partial denture design of a teaching video for general dental practitioners.

This evaluation was based on replies from a random sample of general dental practitioners who were asked to complete questionnaires before and after being sent a video and accompanying booklet on partial denture design. Forty per cent (257) of the original sample (636) completed and returned both questionnaires. A total of 212 respondents (82%) felt the video had been of value and 175 (68%) said they would be more likely to provide metal partial dentures after having watched it. The positive effects of the video were greatest amongst the most recently qualified. Despite some improvement after watching the video, there remained 105 (40%) who indicated that they would leave all partial denture design decisions to the technician on at least some occasions. Comparison of data from first and second questionnaires showed little evidence of substantial shifts in choice of denture design for a series of specific situations. It was concluded that whilst the programme had been well received and had produced changes in intention, there was less objective evidence of change.

Acrylic Resins↗
PubMed1994

Dental caries experience and defects of dental enamel among 12-year-old children in north London, Edinburgh, Glasgow and Dublin.

A multi-center study of caries experience and defects of dental enamel was conducted among 12-yr-old children in north London, Edinburgh, Glasgow and Dublin. None of the cities had water fluoridation except Dublin, which was included in the national program introduced in the Republic of Ireland in 1964. A random sample of children was drawn from state schools in each location and identical methods of clinical examination were used throughout under the same standardized conditions. All examiners were trained and calibrated with a reference examiner and achieved high levels of inter- and intra-examiner consistency. Mean DMFT values for the 4 cities were 1.27 (London), 1.39 (Edinburgh), 2.70 (Glasgow) and 1.48 (Dublin) (P < 0.001). Proportions of subjects free from caries in the same order were, 50, 47, 24 and 43% (P < 0.001), and child prevalence of diffuse opacities, 28, 29, 7 and 17% (P < 0.001), respectively. The relatively low caries levels recorded in London and Edinburgh (lower than Dublin) were considered to be related most probably to fluoride effects other than water fluoridation.

Analysis of Variance↗
PubMed1994

The preschool child: practical treatment planning.

The preschool years extend from birth up to the age of 4 years and represent the time of most rapid growth and development. During this period the child progresses from the edentulous state to having a fully erupted and functional primary dentition. Also during the preschool years important stages in development of underlying permanent teeth occur. Good management of the preschool child is an excellent practice builder: it leads to a motivated patient, happy to undergo any treatment necessary, and encourages confidence and improves the attitudes to oral health of other members of the family.

Child, Preschool↗
PubMed1994

Enamel opacities and dental caries in children who used a low fluoride toothpaste between 2 and 5 years of age.

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.

Cariostatic Agents↗
PubMed1993

Deafness and dentistry.

An article published last year in the British Medical Journal has illustrated that severe deafness does not preclude a career in medicine. My own experience and that of others prompts me to write that the same is true of dentistry. For patients who are deaf, dentists need to be aware of simple measures that may ease communication and avoid misunderstanding.

Communication↗
PubMed1993

Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars.

Diagnosis of early occlusal caries has proved more difficult than that affecting smooth or approximal surfaces. With time, this type of lesion has come to form a greater proportion of caries as a whole and its accurate diagnosis is consequently becoming more important. The most widely used methods of diagnosis are visual inspection and bitewing radiography but the value of both of these for occlusal caries has been questioned. The aim of this study was to investigate the validity of diagnosis using each of these two methods in extracted teeth. A total of 100 first permanent molars and 100 second primary molars were used and teeth and sites with questionable or borderline caries were selected for examination. The condition of the tooth on section was used to validate. In these samples sensitivity of radiographic diagnosis was greater than that of visual diagnosis. Both methods showed good specificity. When radiographs were used together with visual examination the status of 82% of first permanent molars and 91% of second primary molars were correctly classified.

Child↗
PubMed1993

The prevalence of dental caries and gingivitis and their relationship to social class amongst nursery-school children in Nairobi, Kenya.

Four hundred and forty-six children attending nursery schools in Nairobi were examined for caries and gingivitis. Assessment of social class was based on the occupation of the head of the child's household. Amongst 3-year-old children, 62% were caries-free and the mean dmft was 1.35. Amongst 5-year-olds 50% were caries-free and the mean dmft was 1.88. Thirty-seven per cent of the children had evidence of gingivitis, with the proportion changing little with age. There was no evidence of either caries or gingivitis being significantly related to social class, although children in the higher classes had more filled teeth.

Age Distribution↗
PubMed1991

A comparative assessment of the strengths of porcelain veneers for incisor teeth dependent on their design characteristics.

An in vitro study, using dynamic stress analysis and two dimensional photo-elasticity, carried out to relate the strength of porcelain veneers fabricated to three different designs, demonstrated that the 'window' type of preparation was the strongest compared with 'overlapped' and 'feathered' designs. It also confirmed that the strength of the veneer was not proportional to its thickness. It can be concluded that where strength is an important prerequisite, the most conservative type of veneer, namely the 'window' preparation, is the design of choice.

Acrylic Resins↗
PubMed1991

Dental treatment for children under general anaesthesia in day care facilities at a London dental hospital.

Day-stay facilities are gaining in popularity in general surgery, especially in surgery for children. In dentistry, day-stay care has been shown to be of great value for the treatment of specific groups of child patients, including handicapped and those too young to tolerate treatment with local anaesthetic alone. The present study considered the characteristics of 103 patients attending for treatment in the day-care facilities of the Eastman Dental Hospital, the morbidity of the technique and the acceptability of the service to those using it. Of the 103 patients, 46 were seen in the unit because they required minor oral surgery and 22 because of particular problems with management. Ninety-four patients had one or more symptoms following treatment. In at least 53 cases this related to the treatment and not to the anaesthetic. Despite a cost to the families in terms of money and time, the service proved acceptable to almost all of those who used it.

Anesthesia, Dental↗
PubMed1991

Foods and drinks at four daily time intervals in a group of young children.

This study provides information about snacks and drinks regularly consumed by a group of 2139 4-year-old children. Data were collected through a simple questionnaire completed at interview. Findings were related to caries levels measured at clinical examination 6 months later. Results confirmed that nearly all children had one or more snacks or drinks on most days. The most popular time for these was mid-afternoon. Sweet biscuits and fruit were the most popular snack foods and diluted fruit squash and milk the most popular drinks. Caries, as expressed in mean dmft, increased significantly with increasing number of intakes.

Child, Preschool↗
PubMed1990

The use of general anaesthesia for tooth extraction for child out-patients at a London dental hospital.

General anaesthesia in the dental chair carries a significant risk. Nevertheless, it has been widely used for the extraction of teeth for well over 100 years. Despite a decline in its use in general practice and the community dental services, a large proportion of children do have experience of extractions under general anaesthesia. A total of 3623 children had extractions as out-patients using this method at the hospital during the 2-year period of 1987 and 1988. The mean age of a sample of 836 children drawn from this population was 6.99 years (+/- 3.09 years). The mean number of teeth extracted per child was 4.14 (+/- 2.0). The effects of caries formed the reason for extractions in nearly 95% of children aged 9 years or less. Amongst those aged 10 years or more, 51% of extractions were for orthodontic purposes. Fewer (2970) children had received the same form of treatment during the earlier 2-year period of 1982 and 1983. The mean age of children treated more recently was lower and the mean number of teeth extracted per child had increased. The need continues for facilities to provide this relatively simple form of treatment for children.

Adolescent↗
PubMed1990

Caries in the preschool child: British trends.

The aim of this paper is to review the findings of studies carried out in Camden over a period of 20 years. Three studies were carried out using the same methods of interview and dental examination. A total of 1722 children were included, all samples being drawn from children attending maternal and child welfare clinics held in the district. Taken together, findings suggest that the prevalence of caries in this inner city area declined during the 1970s but has not continued to do so during the 1980s. Rampant caries also declined in the 1970s but the prevalence of this form of the disease appeared to have increased between 1980 and 1986. Changes in social class structure of the samples and in the ethnic origin of the children included may have contributed to the changes seen during the 1980s; a greater proportion of children came from single parent families or families where the father was unemployed and a higher proportion of children were of Asian origin. Although the use of sweetened comforters declined during the 1970s, by 1986 the level of use was little different to that seen in the mid-1960s. Despite changes in disease levels there has been little change in the need for treatment amongst preschool children. In 1986, 89 of the 91 children with some caries experience were in need of treatment.

Child, Preschool↗