Lill-Kari Wendt

Abstract – The aim of the present study was to clinically evaluate fissure sealants on the occlusal fissures and buccal pits of permanent first and second molars after 20 and 15 years, respectively. The population consisted of 72 children, each of whom had had their four first molars sealed between 1977 and 1980. At the annual examinations, all caries‐free, newly erupted second molars were sealed. When sealant was applied to the second molars, the first molars were checked and sealant was reapplied to those that had deficient sealants. At the follow‐up, when the subjects were 26–27 years of age, 27 in the original group had moved from the community. Thus, the present result is based on 45 subjects. One hundred and fifty‐three sealed first molars and 161 sealed second molars were available for inspection. At the follow‐up examination of the first molars 20 years after sealant had been applied, 65% showed complete retention, 22% partial retention without caries, and 13% caries or restoration in the occlusal fissures or buccal pits. At the 15‐year follow‐up of the second molars, the corresponding figures were 65%, 30%, and 5%, respectively. Of the restored or carious molars, significantly more were found in the mandible than in the maxilla (P<0.001). This longitudinal study showed that pit and fissure sealants – applied during childhood – have a long‐lasting, caries‐preventive effect.

The aim of the present study was to evaluate the long-term results of a systematic fissure sealing programme of the occlusal surfaces of newly erupted permanent first molars. All 15-year-olds (n=815) who had been regularly treated at seven Public Dental Service clinics in Jönköping County, Sweden, since the eruption of their permanent first molars participated in the study. Data on fissure sealing and restorative treatment were extracted from the dental records of the patients. When the patients were 15 years of age, it was found that 6% of the original 2456 sealed occlusal permanent first molars had received Class II restorations. Seventy-eight per cent of the remaining 2322 sealed occlusal surfaces were judged to be caries-free by the child's ordinary dentist. This long-term retrospective study indicates that a structured fissure sealing programme is of great benefit for oral health.

The aim of the present field study was to evaluate a new strategy for the dental care of pre-school children which includes an early caries risk assessment and early preventive care. One hundred and sixty-seven children were studied from 1 to 6 years of age (intervention group). A group of 125 children from the same clinic (historical control) was used as a comparison group. On the basis of the clinical examinations of the children and the interviews with the parents when the children were 3 years of age, the children in the intervention group were divided into four different risk groups: no (n = 95),low (n = 33), moderate (n = 30), and high caries risk (n = 9). Only 8 of the 95 children who had been placed in the no caries risk group at 3 years of age developed manifest carious lesions in their primary cuspids and molars by 6 years of age. At 6 years of age 81% in the intervention group were free of manifest carious lesions, compared with 55% in the comparison group (P < 0.001). Furthermore, the mean numbers of defs were 0.6 for children in the intervention group and 2.7 in the comparison group. Thus, this field study indicates that early primary prevention (before the onset of caries attack) and a structured and systematic approach to dental care for pre-school children result in good oral health for the children and may be economically profitable for a society with organized public dental service for pre-school children.

A decreasing proportion of children require operative treatment each year and an increasing proportion of children will at recall require no operative care. This would provide resources to give individualised prevention to children at risk for developing new carious lesions. From 3 years of age, however, the prevalence of caries increases up to the age when the primary dentition exfoliates, even though the children attend regular dental service programmes yearly, and for some children dental caries remains a significant problem. The purpose of the present study was to describe the dental health of a group of 6-year-old children living in Sweden, with special reference to caries prevalence at 3 years of age and to immigrant status. At 6 years of age, 45% of the children were free of initial and manifest carious lesions in the primary cuspids and molars. The mean caries increment between 3 and 6 years was 0.9 tooth surfaces for children who were caries free at 3 years of age compared to 4.5 tooth surfaces for children with manifest carious lesions at the same age. The mean caries increment from 3 to 6 years was 1.3 in the non-immigrant group and 3.6 in the immigrant group. For the majority of the children in this study, current preventive dental care seems sufficient. However, for about one-third of the children (children with carious lesions at 3 years of age and/or immigrant status), current caries preventive programme used in the Public Dental Service are inadequate.

The present study focused on the type of restorative material used and the reasons for replacements of restorations in the primary and the young permanent dentition. All patients with restorations and who were 8 and 19 years of age in 1995 and were regularly treated at 11 Public Dental Health clinics in Jönköping County, Sweden, participated in the study. Data were extracted from the records for all types of restorations in canines and molars for the preceeding of 5 years for the 8-year-olds (i.e. from 3 to 8 years of age; n = 546) and for approximal restorations in premolars and molars for the preceeding 13 years for the 19-year-olds (i.e. from 6 to 19 years of age; n = 606). In all, 6012 restorations were evaluated. The two most common restorative materials used in the primary dentition were compomer and glass ionomer cement and in the young permanent dentition composite and amalgam. In the primary dentition, 29% of the restorations had been replaced and 4% of the teeth with restorations had been extracted. Thus, 33% of the restorations in the primary dentition failed. The corresponding figure for the young permanent dentition was 13%. The most common reason for replacements in the permanent dentition was secondary caries. That restorations often fail because of caries and that the development of secondary caries is not prevented by replacement of an old restoration indicate that more attention should be paid to preventive dental care for patients with restorations in the primary as well as in the young permanent dentition.

The purpose of the study was to investigate if parents of toddlers could be taught how to discover dental caries in their children and, if carious lesions were found, contact the the child's dentist. The study was designed as a prospective study, starting with 671 children aged one year. Children examined and caries-free at one year of age were divided into two groups, an experimental and a control group. In connection with the clinical examination, the parents of the children in the experimental group were trained using a colour photo to recognize the first sign of initial dental caries on buccal surfaces of upper incisors and encouraged to contact the dentist as soon as they discovered caries in the teeth of their children. Eighteen parents contacted the dentist when the children were between one and three years of age, but none due to carious lesions. The children in the control group were re-examined at two years of age. About eight per cent of the children in the control group had manifest or initial caries at that age, predominantely in the upper incisors. At three years of age 27 per cent of the children in both the experimental and control group had detectable caries. This study has clearly shown that parents are not able to diagnose caries in their toddlers-at least they are not able to seek advice or dental treatment.

Scientific epidemiological studies of dental health in children three years of age are relatively few in Sweden. The aim of this study was to describe the oral health of three-year-old children living in Sweden, with special reference to immigration and failure to attend health examinations. All of 671 children requested to take part in an earlier investigation (Wendt et al. 1991) were invited for a new dental examination at three years of age. A total of 632 children were examined. At the age of three years 71.7 per cent of the children were caries free. Of the children with caries, 33.5 per cent were immigrants and of the total number of immigrants, 50.5 per cent had caries compared to 21.9 per cent of the non-immigrant children. Among those children, who failed to attend the earlier investigations at one or two years of age, 61.5 per cent had caries at the age of three. Compared to studies on dental health in three-year-old children from the 70's and 80's (Hugoson et al. 1986), this study shows that dental health in three-year-old children has not improved significantly during the last decade. Furthermore, this study supports the suggestion that special preventive dental programmes should be developed for immigrant children and that extra attention should be paid to children who fail to attend health examinations and their families.