The purpose of the present study was to establish whether the number of intact teeth in Helsinki schoolchildren aged 7-13 years was rationally correlated with the wartime reduction in sugar consumption and, later, with dental health education programs in Finland. The period covered is 44 years. The results show that dental health education is effective in caries prevention and that enforced programs can lead to an improvement similar to that seen during the war.
Dental education in the Nordic countries was founded in the late 1800s, but the doctor's degree in dentistry (Ph.D.) was established somewhat later. Since the first dissertation in Finland in 1891, a total of 204 doctoral dentist candidates had defended their Ph.D. theses by 1991, 50% of them during the most recent 12 years. Over the 100-year period, 54% of the dentists' Ph.D. theses in Finland were defended at the University of Helsinki, 27% at Turku, 14% at Kuopio, and 5% at Oulu. Women constituted a minority of the candidates (23%) during the first 90 years but 54% from 1982 to 1991. From 1984 to 1993 a total of 374 dentist candidates in Finland, Norway, and Sweden defended their Ph.D. theses. The mean ages of the candidates ranged from 37.7 to 41.7 years for men and from 40.6 to 43.2 years for women. In the 10-year period on average 53 doctor's degrees were received per institute in Sweden, compared with 28 in Finland and 27 in Norway. In all three countries about 6 of 100 graduates in 1980s received a doctor's degree in dentistry. Almost all of these Ph.D. theses were written in English and based on collections of articles. Female candidates dominated in Finland (56%), compared with 34% in Sweden and 26% in Norway, where, however, women's contribution increased most rapidly, being tripled from early 1980s to 1990s.
The state of the occlusal surfaces of the first permanent molars (FPMs) in a representative group of subjects from seven to 15 years of age was followed retrospectively year by year. Data were taken from oral health records. Standardized charts include information on dental check-ups, oral health status, and the treatment given. The state of each occlusal surface was classified into four categories: (1) sound but unsealed, (2) sealed, (3) filled, or (4) decayed. An overall annual attack rate for all occlusal FPM surfaces was 5.9% per year, and for approximal surfaces, 1.3%. Occlusal caries attacks had been most prevalent between seven and nine years of age, whereas new approximal lesions had been most frequent from ages 11 to 13. The FPMs that had been sealed at the age of seven developed fewer caries than did any other group during the follow-up.
The quality of public oral health care, especially the quality of preventive treatment in relation to patients' oral health, was investigated. The population studied consisted of 367 subjects representing the 15-yr-olds living in Helsinki in 1986. Data were taken from the patients' oral health charts, obtained from municipal dental clinics. Clinical examination of the teeth and periodontium had been adequately documented in 98% of cases. In 84% of cases, status recordings matched those recorded previously. Preventive treatment, on the whole, seemed insufficient and stereotyped. Of all patients 55%, and of those in high risk groups only 57 congruent to 60% had had a topical application of fluoride at least once during treatment. Periodontal treatment was insufficient and did not correlate with recorded clinical findings. The results indicate that the concept of prevention and its selective use had not been fully adopted as routine.
Eating disorders are often associated with regurgitation of gastric contents into the mouth and dental erosion. In this study the dental status was evaluated in bulimic patients. Thirty-five bulimics, diagnosed in the Outpatient Departments of Psychiatry and Adolescent Psychiatry of the University Central Hospital in Helsinki, and 105 controls matched for age, sex, and educational level were examined clinically, and the factors associated with dental erosion and caries were evaluated in an interview. Severe dental erosion and dental caries were significantly commoner among bulimics than controls. Bulimics commonly had a low salivary flow rate, but other apparent risk factors of dental erosion did not differ from those of controls. A feeling of dry mouth was commoner among bulimics than controls, and bulimics had an increased tooth sensitivity to cold and touch. More should be done to protect teeth from dental erosion among bulimics, because loss of tooth tissue remains even if the eating disorder disappears.
This study investigated the occurrence of caries among 15-year-olds using the municipal oral health service in Helsinki in 1976 and in 1986. Data were collected from each subject's personal dental health file as recorded during routine check-ups by dentists in the health centre of the city of Helsinki in the year in question. All indicators showed a significant improvement (p less than 0.001) in dental health during the 10-year period. The percentage of intact teeth and surfaces increased markedly. The mean number of DMF teeth per person fell from 12.1 to 5.1 and that of proximal DF surfaces from 5.6 to 1.5. In the 1976 group, 63% of all occlusal surfaces had been filled or were decayed. Ten years later the figure was 26%. Proximal DFS percentages were 10 and 3%, respectively. The ratios of the total number of proximal to occlusal DFS were 0.6 in 1976 and 0.4 in 1986.
The adequacy and appropriateness of the oral health service were evaluated from patient records of 15-year-olds in Helsinki in 1976 and 1986. The subjects selected for the study represented the whole age group participating in public oral health service in the 2 years in question. During the 10 years, substantial decreases were seen in the mean numbers of dental visits (from 4.0 to 2.4) and fillings (from 2.9 to 1.2). The greatest decrease was seen in the number of fillings made in incisors. Slightly fewer preventive measures were carried out in 1986 than 10 years earlier, but no focusing on risk patients was seen. In the 2 years studied, 15-year-olds in the high-risk group received applications of topical fluorides and instructions on oral hygiene as often as those in the low-risk group. A major problem seemed to be the increasing number of unfinished courses of treatment among high-risk patients. We conclude that patients with a higher risk of caries should receive more attention with regard to both the preventive treatment given and ways of motivating them to complete their treatment courses.