Cariology: preventive dentistry The limitations of a 'high-risk'approach for the prevention of dental caries

Batchelor P, Sheiham A Community Dent Oral Epidemiol 2002; 30: 302–312

Using UK and US epidemiological data, the authors argue that there are no identifiable high risk caries groups.

There are at least 3 current public health approaches to caries prevention. One is to identify risk groups and target them, another is to target identified individuals, and a third is to target the whole population. This study compared data from US longitudinal surveys of caries in children, and UK (BASCD) data from 5-, 12- and 14-year-olds.

In the US data, caries was distributed similarly in different sub-populations, irrespective of ethnic groups, age or water fluoride levels. The relationship between caries prevalence and mean DMFT scores was remarkably similar for the US and UK data. This similarity held also for the 12- and 14-year-olds in the UK. The authors conclude that when 80% of the caries occurs in 20% of any population, this will be at a mean DMFT of about 1 at any age.

The authors comment that new caries is spread throughout the population, and not mainly in groups or individuals who have already experienced it, which means that the whole population is the appropriate target for public health approaches to prevention.

Haematology: periodontics A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients

Akintoye SO, Brennan MT et al. Oral Surg 2002; 94: 581–588

No relationship was found between periodontal status and septicaemia or death after the transplant.

Stem cell and marrow transplants involve a risk of septicaemia which may cause death. It has been suggested that patients with advanced periodontitis may be at greater risk because of a greater bacterial load with higher potential for entry to the body. This study reviewed records for 77 patients, each with at least 14 teeth and receiving full myeloablative immunosuppression for allografts.

Simple dental treatment, including extractions, was given to 66 patients 1-3 weeks before transplant. In the first 100 days, 49 subjects had clinical signs of septicaemia and gave positive blood cultures, 21 yielded 2 or more species, and 9 of these died. Twelve other subjects also died. There was no relationship between survival and either bone loss or septicaemia of likely periodontal or oral cavity origin.

Orthodontics: oral surgery The esthetic outcome of autotransplanted premolars replacing maxillary incisors

Czochrowska EM, Stenvik A et al. Dent Traumatol 2002; 18: 237–245

Poor aesthetic outcome was related to position and restoration of the transplanted teeth.

In this study, 22 premolars transplanted to replace incisors were compared aesthetically with intact contralateral incisors 4 years later. Professional assessment (match, deviate or mismatch) was made twice up to 4 weeks apart by the same observer, and based on colour of tooth and adjacent soft tissues, and shape and position of the tooth. After answering questions on similar criteria, patients were asked to rate their aesthetic satisfaction (satisfied, acceptable or dissatisfied).

There was close agreement between the patient and professional assessments: of 16 'satisfied' patient responses, 11 were seen as a match and 5 as deviates; of 2 'acceptables', 1 was a match and 1 a mismatch; of 4 'dissatisfieds', 1 was a match, 1 a deviate and 2 were mismatches. Orthodontic treatment was associated with better aesthetics. In view of higher reported satisfaction with single tooth implant replacements, the authors recommend interdisciplinary planning of autotransplants.

Occlusion: behavioural science Reported bruxism and stress experience

Ahlberg J, Rantala M et al. Community Dent Oral Epidemiol 2002; 30: 405–408

In a Finnish company, frequent bruxism was related to greater psychological stress.

A questionnaire was sent to 1784 employees aged 30-55 yrs, who were involved in journalism and all aspects of broadcasting. Subjects were asked about themselves and their work, frequency of bruxism, perceived stress and healthcare use. The response rate was 75%.

Frequent bruxism was associated with more stress in all work groups (OR = 5.0), and with female gender (OR = 2.3). It was also related to more frequent health care use, and inversely related to age and administrative work. The authors review other literature and conclude that there is little evidence for occlusal interference as a cause of bruxism, but increasing evidence for stress, which appears to be a growing problem at work.