To investigate attrition of subjects in a longitudinal study of caries.
A radiographic study of caries and caries-associated factors was carried out in subjects, initially aged 14 years, and followed-up for six years. Attrition of subjects occurred at the last stage of the study.
A nationwide survey of subjects living in fishing, rural farming, and urban communities in Iceland.
A sub-sample of the nationwide random sample comprising 150 subjects was investigated using bitewing radiographs and a structured questionnaire to determine caries-risk factors. Subjects were re-examined at 16 years and 20 years using the same methods.
Mean caries increment from 14-16 years was 3.0 lesions (1.5 lesions/subject/year) but reduced to 2.6 lesions (0.7 lesions/subject/ year) by 20y. The proportion of subjects found to be caries-free at 14 years, 16 years and 20 years, was 29%, 17% and 10%, respectively. "Dropouts" from this study occurred mostly after 16 years. Analysis of subjects dropping out showed that they were least likely to be from the rural farming community but most likely from the fishing community. Those dropping out attended their dentist less frequently, had a higher consumption of carbonated drinks and a higher prevalence and incidence of caries by 16 years.
Subjects with high-risk behaviours, or residents in a fishing community were more likely to drop out of the study. Recognised advantages of conducting longitudinal studies of caries may, therefore, be lost.
The aim of this study, conducted in 1994, was to examine the association between approximal caries and sugar consumption in teenagers residing in three fluoride-deficient areas in Iceland while controlling for a number of behavioral, residential and microbiological factors. One hundred and fifty subjects (mean age 14 years) selected from the Icelandic Nutritional Survey (INS) were examined radiographically and they completed questionnaires about sugar consumption frequency. Total grams of sugar intake were obtained from the INS for each subject. Caries experience on approximal surfaces, diagnosed from radiographs, was used as the dependent variable in the analyses. Altogether 45.2% of subjects were caries free on approximal surfaces. The overall sample was found to have a mean DFS on approximal surfaces of 2.73 (s=4.36) per subject. Average daily total sugar intake was 170 g per subject and the mean number of sugar-eating occasions between meals was 5.32 (s=6.29) per subject. The regression model indicated that the frequency of between-meal sugar consumption was associated with approximal caries, with frequency of candy consumption being the most important of the sugar variables. In multivariate analysis, no relationship was found between dental caries and total daily intake of sugar, although a significant relationship between total sugar consumption and presence of caries was seen in bivariate analysis. Between-meal consumption of sugar remains a risk factor for the occurrence of dental caries, especially in populations with moderate-to-high levels of dental caries experience.
Patients often experience difficulties in applying topical steroids in orabase to the oral mucosa, particularly when large areas need to be covered. An aqueous hydrocortisone mouthwash solution has been developed, one that was anticipated to be more acceptable to patients. The solution contains hydrocortisone (0.3% w/v) in a 4.5% (w/v) 2-hydroxypropyl-beta-cyclodextrin solution. Hydroxypropylmethylcellulose (0.5% w/v) was used to increase the viscosity of the solution and to promote the hydrocortisonecyclodextrin complex. One hundred and two patients with aphthous ulceration, lichen planus, and other mucosal conditions used the mouthwash in an open clinical efficacy study. Most patients reported some or considerable improvement following a 2-week course of treatment with the mouthwash: 26 of 33 (78.8%) patients with aphthous ulceration were 'much better', as were 26 of 54 (48.1%) patients with lichen planus and 5 of 16 (31.3%) patients with other mucosal lesions. No serious side effects were reported. Aqueous mouthwash solutions offer a potential vehicle for topical steroid therapy of oral mucosal lesions.
Concern at the high prevalence of dental caries in Iceland prompted this survey of 158 preschool children in Reykjavik. On initial examination in 1987 45.8% of the children were caries-free and the prevalence of caries was a mean dmft 2.4 and a mean dmfs 3.3. A dietary questionnaire aimed at discovering the frequency of sugar consumption per week revealed a threshold value of 30 instances of sugar intake per week above which caries prevalence increased markedly. Some of this sugar is consumed in paediatric medicines, particularly antibiotics and anti-asthmatics, which are widely used in Iceland. Caries prevalence (dmft) for children taking such medicines regularly was 3.0 compared with 2.1 for remaining children (P less than 0.05). Those children who took fluoride tablets regularly had less caries (mean dmft 1.1) than those who used fluoride tablets irregularly or not at all (mean dmft 2.8; P less than 0.001). Samples of saliva from the dorsum of the tongue were taken for determination of numbers of Streptococcus mutans and lactobacilli. High bacterial counts were strongly associated with caries. Only 5% of children with more than 5 x 10(5 S. mutans cfu per ml were caries free but 27% of subjects had 67% of the total amount of caries for the group and all of these would have been detected by the bacterial test.
Two hundred and seventeen approximal spaces, initially caries free, in 58 patients were studied clinically and radiographically, at intervals of 6 months, for 3 years. Samples of approximal dental plaque were removed for culture of Streptococcus mutans, Streptococcus sobrinus, and lactobacilli. During the study approximal caries developed in 16 subjects (27.6%) at 30 sites (13.8%), involving 42 teeth. 56 of 58 (96.7%) subjects harboured S. mutans at some time during the study, 62.1% lactobacilli, and 29.3% had S. sobrinus. The counts of S. mutans were significantly higher in those subjects that also carried S. sobrinus than in the remaining subjects. A persisting high count of S. mutans > 10(5) colony-forming units per millilitre (CFU/ml) or a count that rose by > or = 1 x log10 CFU/ml during the study was seen in 25 of 30 sites that subsequently became carious (p 10(3) CFU/ml or rising by > or = 1 x log10 CFU/ml were seen in 17 of 30 sites that became carious (p
Caries prevalence and several caries-related factors were measured in 158 pre-school children in Reykjav?k, initially aged 4 years and followed longitudinally for 2 years. The mean dmfs at 4 years was 3.3 and rose to 5.8 at 6 years although 34% remained caries-free throughout the study. Caries was very unevenly distributed. Children with dmfs > or = 5 at 4 years were significantly more likely to have caries in their permanent dentition at 6 years than those with a lower caries score at 4 years. Almost all children carried Streptococcus mutans but only 58% carried lactobacilli at 4 years. Lactobacilli declined in numbers at 5 and 6 years as the number of open carious lesions decreased but the mean count of S. mutans remained fairly static (> 10(5) cfu/ml). There were strong associations between high counts of S. mutans or lactobacilli and caries. Salivary parameters were not as strongly associated with caries although a low salivary pH and low salivary flow rate were significantly associated with high caries scores. The misuse of sugar as determined by dietary questionnaire was strongly associated with a high caries score and low caries prevalence was found in those children that took fluoride tablets regularly.
In spite of having a high socioeconomic standing, in Iceland caries prevalence has remained stubbornly high. This study reports findings from a mixed fishing and farming community in East Iceland that has traditionally been associated with the highest prevalence of caries. A total of 188 children aged 3-16 yr (96.4% of residents of that age group) were examined. At 6 yr the mean dmfs score was 4.1, DMFS 0 and 48% were caries-free. The mean DMFS score at 12 yr was 4.7 and 22.6% remained caries-free but at 16 yr the DMFS score was 11.6 and no children were caries-free. Caries was unevenly distributed within each age group and was more prevalent among residents of the fishing town than the surrounding farming district. In a pilot study conducted in 1989 mean counts of Streptococcus mutans for children aged 4-7 yr were 2.6 x 10(5) cfu/ml and declined to 4.6 x 10(4) cfu/ml in 1990 after a program of chlorhexidine brushing had been added to the routine caries preventive measures adopted in this community. It may therefore be possible to screen Icelandic children for caries risk and apply preventive measures to those demonstrated to be most in need.
OBJECTIVES: Opacities in tooth enamel were found in 34% of 8-year-old Icelandic children in 1970. This study aimed to measure the current prevalence of non-fluorotic enamel opacities in the maxillary incisors and to determine if their occurrence was related to significant events in the medical history. DESIGN: The prevalence of demarcated enamel opacities was recorded photographically by calibrated examiners. SETTING: Subjects lived in Reykjavík, Iceland. SAMPLE AND METHODS: A random sample of 290 children aged eight years was examined in 1997-8. Parents were asked if the child had a history of (i) colic as an infant and/or (ii) repeated middle-ear infection. RESULTS: Demarcated white enamel lesions, not resembling fluorosis, were seen in 41% of children (teeth photographed wet) rising to 51% (teeth photographed dry). Enamel hypoplasia was seen in 11% of wet teeth and 15% of dry teeth. Parents of 94/288 children (32.6%) reported that their child had infant colic and 52/94 (55.3%) had received medication. Three episodes or more of middle-ear infections per year were reported for 123/290 (42.4%) children. Significant association was seen between the presence of demarcated enamel opacities and a history of otitis media. Diffuse enamel opacities, assumed to be fluorosis, were not associated with events reported from the medical history. CONCLUSIONS: Non-fluoride opacities of teeth are still prevalent in Icelandic children especially those with a history of infections in infancy. Without a careful diagnosis these opacities might be confused with fluorosis.
The present communication reports preliminary findings of haematological investigations carried out on patients attending an oral medicine clinic in the University of Iceland over a two year period. Patients have been referred to this newly-established clinic with candidosis, aphtous ulceration, sore tongues, burning mouth syndrome and other miscellaneous conditions. Many were investigated for underlying causes for their oral disorder. A high proportion of patients (33/45: 73%) referred for haematological investigation had abnormal findings largely related to a deficiency of iron (21/45: 47%). Most of these reported improvement in their oral discomfort after a course of iron tablets. Only two patients had abnormally reduced erythrocyte counts but a further 19 (42%) were found to have sideropaenia. Diabetes was diagnosed in two patients and one previously unknown case of megaloblastic anaemia was also discovered. The results were sufficiently encouraging to warrant continuing the clinic and collection of further data.
The purpose of this study was to review and analyze the records of herpes simplex infections from a specialist Oral Medicine clinic in Iceland, to investigate the clinical impression that the age of patients experiencing initial infection with this virus was higher than expected and that the character of the clinical picture of the disease had changed. Records of patients with herpes infections attending the Oral Medicine clinic covering a 3-year period were examined and the clinical and virological data analyzed. Diagnosis was based on clinical appearance, history, and viral identification with culture or detection of viral DNA by means of the polymerase chain reaction. Records of 60 patients (34 female) were included in the study (mean age, 23.1 years; range, 2 68 years). No patients were known or suspected to be positive for human immunodeficiency virus, none was known to be immunocompromised, and 38 patients (mean age, 16.6 years; 21 female) were diagnosed as having primary herpetic gingivostomatitis. Eighteen patients (mean age, 36.2 years; 11 female) had lesions of recurrent herpes simplex infection present on the oral mucosa. Primary infection with herpes simplex virus was more common in young adults than had been expected. Recurrent infections appeared on the oral mucosal even in otherwise healthy patients, and the clinical course of these infections in this age group sometimes followed a more severe course than that seen in young children.