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Biomedical subjects

T M Marthaler

Publications and source records attributed to T M Marthaler.

At least 19 recordsLinked to original sources
PubMed1992

Dental predictors of high caries increment in children.

A comprehensive set of dental variables was investigated to find the "best" combination of predictors for high caries increment in 7/8-year-old and 10/11-year-old children. Four populations with widely different caries prevalence were studied. Logistic regression analysis supplied multiple-input models by stepwise selection of predictors. A "low number of sound primary molars" was the best and most consistent predictor of high caries increment. The second best predictors were "high numbers of pre-cavity lesions on permanent first molars" (discolored pits and fissures in the younger age group and white spots on the smooth parts of buccolingual surfaces in the older age group). Inclusion of radiological variables did not substantially increase the quality of prediction. For practical application, models with various multiple inputs selected by stepwise procedures were compared with "fixed" three-input models. These three-input models resulted in predictive quality nearly equal to those of the multiple models. Traditional one-input models, containing DMFT or dmft, were inferior to the three-input models, particularly in the older age class. The lower the caries prevalence of the source data, the better was the prediction. As a summary measure characterizing the predictive performance of a model, we used the index "area under the receiver operating characteristic curve" A. For the 1984 data and the three-input models, the area was approximately 80%, and for the 1972 data, the area was 65-70%.

Age Factors↗
PubMed1992

[Caries prevention among the schoolchildren of Wil, SG 1963 to 1990 and the caries statistical results].

In 1963, a school-based preventive programme was organized in the community of Wil. Supervised toothbrushing with fluoride preparations 12 times per year was coordinated with an improvement of the quality of the between-meal snacks. In 1979, 1985 and 1990 fourteen-year-old pupils were dentally examined in Wil. There was a caries decrease between 1979 and 1985 as well as between 1985 and 1990, after the daily distribution of fluoride tablets was stopped in 1983 and the fluoride content of salt raised from 0.009 to 0.025%. Between 1979 and 1985 the fourteen-year-olds of Wil had fewer lesions than the pupils of Zurich and Glarus and between 1987 and 1990 caries prevalence in pupils of this age in the three areas mentioned ranged between 2.2 to 3.4 DMFT. In 1990 caries prevalence at the ages of 8 and 12 was also assessed in Wil. Prevalence levels were as low as in the cantons of Zurich (organized prevention at school since 1964) and Glarus (fluoridated salt, 250 ppm F, for households and bakeries since 1976) in 1987/88.

Adolescent↗
PubMed1992

Age-adjusted limits of fluoride intake to minimize the prevalence of fluorosis.

The range of optimal fluoride intake for adults, 1.5 to 4 mg per day, was adjusted for children and adolescents aged 1 to 19 by relating these limits to body weight and energy intake. Limits related to weight agreed well with the usually recommended ranges for supplemented fluorides. However, for children up to 6 years of age limits related to energy intake were twice as high as those related to body weight. These differences diminished with increasing age and were small between 16 and 19 years of age. New conservative limits were based on an interval for adults ranging from 1.45 to 2.9 mg fluoride per day. The new age-adjusted limits were compatible with most current recommendations.

Adolescent↗
PubMed1991

Caries prediction on the basis of past caries including precavity lesions.

The purpose of the present work was the construction of statistical models which allow the prediction of future high caries increments on the basis of the state of primary teeth and first molars taking into account both precavity lesions and DF experience. A child was considered to be experiencing 'high caries increment' when it had at least four new lesions (new DFS) 4 years after the first examination. Two data sets of children aged 7-10 years were analysed: (1) 803 children examined in 1980 and in 1984. The proportion of children with 'high caries increment' was 25.0%. (2) 477 children examined in 1984 and in 1988. In this group, the proportion of children with high caries increment was 16.6%. In the first group with higher prevalence of caries, sensitivity and specificity were found to be on average at 70%. In the second group, sensitivity and specificity were 77% on average. This results shows that caries prediction may be at least as successful when a 'refined' set of clinical data is used instead of a less extensive set of caries data complemented by salivary buffering capacity and microbiological data.

Child↗
PubMed1991

[Caries prevalence and gingival inflammation in recruits in 1985: the influence of prevention].

A total of 753 conscripts (age 20) examined in 1985 showed on average 8.6 DMF teeth upon clinical examination. When subjected to a standardized examination supplemented by bite-wing radiographs of the buccal segment, 0.5 MT, 4.2 DT and 5.4 FT equivalent to a DMFT of 10.1 were found. Three per cent of the subjects were caries-free (DFT = 0). Caries experience in anterior teeth DFS greater than 0) was diagnosed in 21% of the recruits but 85% of them had suffered dentinal caries or showed fillings on the bite-wing radiographs (DFS greater than 0). Among the total of 18.8 DF sites, 5 were D sites, and 83% of the D sites were dentinal radiolucencies in molars and premolars. An annual increase of 1.55 DFS was estimated for the age interval 15-20 years. Recruits from communities with preventive programs at school had 17.0 DFS (9.1 DMFT) while those from communities lacking organized prevention at school had 21.2 (11.3 DMFT). The recruits from the Canton of Vaud, who had benefited from a program of salt fluoridation, comprising salt for domestic use and for bakeries and restaurants, from 1970 to 1985, showed only 11.6 DFS (7.1 DMFT). There was less gingival bleeding and calculus in recruits from the Canton of Zurich where supervised toothbrushing has been carried out 4 to 6 times a year since 1963/64 at least through school-grades 1-6 than in the remaining recruits.

Adult↗
PubMed1991

[School dentistry in Zurich Canton: changes as a result of caries reduction of 80 to 85 percent].

In Switzerland annual examinations of school children in the individual communities and the priority for their conservation treatment have a tradition of more than half a century. Already 40 years ago, the majority of the cantons had passed legislation compelling the communities to organize school dental services. They were not uniformly defined, and the communities had great freedom how to comply with the law, e.g. to contract local dentists for the priority care of children or to build their own school dental clinic. When preventive methods became available, initiated 1953 by daily tablet intake at school, the introduction of preventive activities into the already existing school dental care was comparatively easy. It was mostly welcomed in the face of the very high caries prevalence. Supervised toothbrushing with a fluoride preparation (mostly gels with 1.2% F) 6 times a year has been a standard for many years. It is the cornerstone of the dental health education programs. These cover now approximately 80% of the children up to age 11-12 while for the older schoolchildren, coverage is markedly lower. Caries prevalence has declined by 70-84 percent since the late sixties. The most important factors for decline are listed in Table 1. In Western Germany, pedodontic care was not given priority. At the universities, pedodontics had no recognition as a professional or official branch of dentistry. There were numerous local initiatives to improve pedodontic care. Lack of official support, however, precluded most of these endeavours to gain momentum.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[The prevalence of deciduous dental caries in 16 communities of the Canton of Zurich in 1964 to 1988].

Caries prevalence in 16 communities of the Canton of Zurich decreased in the primary dentition by more than 70% from 1964 to 1988. This corresponds to the decrease in the permanent dentition during the same period. There was no increase of the caries prevalence in primary incisors (nursing bottle caries) detectable in the eighties. The caries prevalence in the city of Zurich was similar to that in the 16 rural communities. In other European countries, caries prevalence was higher in the eighties.

Age Factors↗
PubMed1991

[The determination of caries risk in schoolchildren based on microbiological-chemical analyses of the saliva and on the clinical dental status].

In a feasibility study for the determination of the caries risk in children by whole school class, the number of the colony forming units of mutans streptococci and lactobacilli in the stimulated saliva, the buffer capacity of the saliva and some chosen clinical indicators of increased caries risk were determined and evaluated in 103 schoolchildren (7 to 10 years old) in the city of Zurich. Mutans streptococci in the saliva were found in 73% of the children and lactobacilli in 77%. In 11% of the children, neither of the microorganisms were found. Sixty-three percent of the children showed a strong buffer capacity of the saliva and 12% a small one. On the basis of these results and some selected clinical factors, 30% of the children were classified as patients with a high caries risk and are now following an intensive prophylaxis program.

Age Factors↗
PubMed1990

Cariostatic efficacy of the combined use of fluorides.

There is ample evidence documenting that simultaneous use of several fluoride application techniques results in an enhanced cariostatic effect. A formula is presented which estimates the combined cariostatic efficacy of such multiple usage. For simultaneously applied topical fluorides, the formula seems to overestimate the combined efficacy. Both higher frequency of use and higher concentration result in increased topical fluoride efficacy. Within narrower limits, higher concentrations of fluoride in water or salt also enhance efficacy. The rapid and substantial decline of caries prevalence in some highly industrialized countries may, in part, be attributed to multiple fluoride usage, but other factors must also have exerted a beneficial effect.

Cariostatic Agents↗
PubMed1990

[Caries prevalence in Zurich schoolchildren in 1970, 1983 and 1988].

In 1988, a random sample of 657 school children of the City of Zurich was examined for dental caries using standardized methods. The children at age 12 and 14 had 2.36 and 4.24 DMFT, respectively. There was a decline of caries prevalence during the period 1983-1988. Compared with the earliest available data obtained in 1958 and 1961, the children of 1988 had 69 to 78% less DMFT, and 54 to 60% when compared with the data obtained in 1970.

Adolescent↗
PubMed1990

[Will discolored molar fissures within 4 years become carious more frequently than nondiscolored ones? Observations from 1975 to 1988].

Caries progression was studied in 5242 first molar fissures of children in the Canton of Zurich, Switzerland, in two observation periods, extending from 1975/76 to 1979/80 and from 1983/84 to 1987/88, respectively. DFT averages at age 12 in the children studied were fairly low, being 3.60 in 1975/76 and 2.21 in 1983/84. Fissures of first molars were classified as completely sound (Grade 0), discolored (Grades 1 and 2) or DF. An exploratory cross-sectional analysis revealed that there is a slow and linear increase of the percentage of DF fissures with increasing age. During the period 1975/76 to 1979/80, Grade 0 fissures became DF with a probability of 14 to 22% while 42 to 54% of the dark brown or black discolored fissures (Grade 2) were DF after four years. In the period 1983/84 to 1987/88, these percentages were lower. It was concluded that in this population with low caries activity there is little reason to apply preventive measures to fissures immediately after their eruption or later to those free from any discoloration.

Child↗
PubMed1990

[The development of the costs of school dental care in the Canton of Zurich from 1967 to 1986].

The costs of the school dental services in the Canton of Zurich between 1967 and 1986 were assessed. The data were compiled from the annually submitted requests for financial support which are made by each community to the Cantonal Health Department. The total costs decreased slowly because of the diminishing number of schoolchildren since 1975 and the continually decreasing caries prevalence. Nevertheless, the individual costs per child increased slightly even after correction of the inflation. No clearcut reason explains the unexpectedly slow cost-reduction of the school dental service in the canton. The costs per child were higher in the City of Zurich than in the other communities with a school dental clinic. The costs of dental treatment was lowest in communities with dentists under contract for the school dental service. The reasons for this fact and the advantages of the school dental clinics are discussed. A more transparent structuring of the school dental services in the different communities is necessary and would allow a better analysis.

Child↗
PubMed1989

[Prevalence of caries and fluorides].

In the whole of Switzerland, caries prevalence was high until 1960. Dental health education programs which included topical fluorides were introduced in the 1960's. Substantial declines of dental caries prevalence have been documented since 1968. In the canton of Zurich e.g. fourteen year-old children had an average of 23.8 cavities (most of them filled) in 1963 which was reduced to only 3.8 in 1987. Similar reductions, primarily due to multiple uses of fluorides, have also been obtained in younger age-groups and in other parts of Switzerland. On an epidemiological basis fluoridated salt reduced dental caries prevalence better than fluoride tablets. This is because tablets are only preferable for a minority of well-motivated families and required good compliance by the children. Modern research reveals that it is not the amount of ingested fluoride (acting systemically) but the frequency and duration of the contact of the fluoride with the erupted teeth which is most important. During pregnancy fluoride tablets benefit the mother's teeth and ensures a satisfactory fluoride level in the fetal skeleton. This is considered desirable as mothers' milk consistently contains only approximately 0.02 ppm fluoride. No caries-protective effect of the fetal fluoride, however, has been substantiated by pertinent research. Only a negligible cariostatic effect results by supplying fluoride to the infant. Caries prevention by fluoride begins to be important during the eruption of the primary teeth, at the latest at the eruption of the primary molars.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗