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Objectives: To develop a new model to establish teenagers’ perceptions of the aesthetic impact of fluorosis, in the context of overall facial appearance. This web-based model was used to compare different degrees of fluorosis at any one distance, while also comparing the same level of fluorosis at different ‘distances’. Methods: A 14-year-old subject was used as the model face. Different degrees of fluorosis were ‘built-up’ on this subject's teeth using digital simulation. A web-based questionnaire showed 30 photographs, displaying four levels of fluorosis, in addition to fluorosis-free, at five different ‘distances’. The closest images were shown with and without retractors, while the more distant pictures showed more of the subject's face. Teenage pupils (n = 217) were then asked to grade the acceptability of the appearances and indicate if they would wish treatment for each such appearance. Results: At any one distance, acceptability fell as fluorosis level increased. When the same degree of fluorosis was compared at different distances, acceptability improved as the teeth were viewed from further away. Pictures taken without retractors had higher acceptability than those taken with retractors in place. Conclusions: Teenagers can discriminate between various degrees of fluorosis. However, more distant viewing of fluorosed teeth, within the overall context of the face, improves acceptability of the appearance.

OBJECTIVES: To undertake a blind caries and fluorosis prevalence study of Grade 1 (aged 5/6 yr) and Grade 4-7 (aged 8-12 yr) children from naturally water-fluoridated (1 ppm, since 1985) Burghead, Findhorn and Kinloss (F), and nearby nonfluoridated Buckie and Portessie (N-F), in rural Morayshire, Scotland. METHODS: A blind clinical (+ 10% repeats) caries study of the above townships' 5/6-yr-old lifetime (15 F; 43 N-F), and 8-12-yr-old lifetime (55 F; 136 N-F)/school-lifetime (31 F; 37 N-F) residents was undertaken following bussing of these children to a common examination site in close-by Elgin Town Hall. Initially, each child was asked about their own perception of the aesthetics of their maxillary front teeth. Fluorosis was assessed clinically using the TF Index, as well as photographically - for later blind scoring (+ 10% repeats for lifetime 8-12-yr-olds) of slides by four dental and two lay 'jurors', alongside a now-established UK 'bench-mark' mildly mottled (TFI = 2), fluorosis comparator slide, judged in previous studies to be aesthetically lay-acceptable. In addition, by parental questionnaire, information was sought concerning their child's fluoride supplement and dentifrice usage histories. RESULTS: For 5/6-yr-olds, mean primary caries scores were 96.0% less in fluoridated than nonfluoridated subjects (P lt 0.01). In 8-12-yr-olds, DMFT values favoured water-fluoridated subjects; their caries-free trend was significant (P lt 0.001 overall). Clinically, 33% of all lifetime F subjects and 18% of all N-F pupils had fluorosed maxillary anterior teeth (P = 0.045), but no statistically significant difference was found between the 7% F and 3% N-F subjects with TFI scores gt 2 (P = 0.25). Photographically, 'jury' mottling assessment (+ 10% repeats) of projected slides resulted in at least 1 : 6 positive scores in 43.6% of F and 30.9% of N-F pupils, albeit they unanimously scored only nine F and five N-F children as having fluorosed teeth (P lt 0.01). In no case did all members score TFI gt 2. Dental and lay scorers rated TFI = (1/2) in only a further 9.1% and 5.5% of F subjects, respectively, compared to 0.7% and 1.5% respectively of N-F pupils. Again, TFI gt 2 was scored unanimously in no child. No differences were found regarding the children's own degree of anterior tooth aesthetic nonacceptability between F (11%) and N-F (12%) prevalence (P = 0.75). Finally, only one F child had taken F supplements and, while 26 N-F had used F drops, no significant relationship was found between their usage and TFI values in the latter group (P = 0.49). Additionally, no relationship was noted between clinical TFI scores and the age at which parents stated fluoridated dentifrice toothbrushing commenced, between 0 and 24 + months of age. CONCLUSIONS: Considerable caries benefit has accrued to those Morayshire rural children who have received naturally fluoridated water (at 1 ppm) throughout their lives, as compared to their socioeconomically similar, nonfluoridated rural counterparts. Furthermore, in spite of all but two subjects claiming to have brushed regularly with fluoridated dentifrice (and no evidence of the availability of nonfluoridated toothpaste being purchasable in the five townships), only borderline mild fluorosis disadvantages have been noted clinically, and none by the subjects' own aesthetic perceptions. Finally, no evidence was found to suggest any delay in permanent tooth eruption patterns of the F subjects. It would seem appropriate therefore, that adjustment of Scots' drinking waters' natural fluoride levels to 1 ppm should be pursued to extend similar dental advantages to the vast majority of that population (both young and old) which, it is well documented, has the worst dental health of mainland UK.

Objectives: To evaluate a modified tooth stain index and determine the effect of dietary factors on stain formation. Methods: At baseline, 182 adult volunteers were given a full oral prophylaxis followed by stain assessment using a modification of the Lobene index. This involved assigning separate scores to the mesial (M) and distal (D) sites of each tooth, in addition to the standard gingival area (G) and tooth body (B). For each site, stain intensity and areas were scored. The sum of (intensity×area) scores was calculated for all sites (GBMD-value) and for the gingival and body sites only (GB-value). The subjects used a standard abrasive dentifrice and a soft toothbrush for 6 weeks. Results: Stain was reassessed and the average increase in GBMD-value was 20.9 (sd=9.9) (buccal aspect) and 29.9 (sd=18.0) (lingual aspect). The corresponding GB-values were 4.4 (sd=4.8) and 12.5 (sd=10.2). The coefficients of variation of the GBMD index values were consistently lower than those of the GB values. Smoking and tea-drinking were found to be the only significant (p

To examine the effect of reported toothbrushing frequency and method of rinsing after brushing on caries experience and increment.Data are presented from 2621 adolescents (mean age 12.5 years at outset) participating in a 3-year double-blind caries clinical trial. At baseline, examiners questioned each participant about their toothbrushing habits, and at subsequent examinations, this information was obtained using a self-administered computer-based questionnaire. Participants used a fluoride-containing dentifrice throughout and clinical examinations were conducted using a mirror, CPITN probe and fibre-optic transillumination.The reported brushing frequency increased throughout the trial. Caries experience at baseline was inversely related to toothbrushing frequency with mean DMFS=9.66, 8.12 and 7.63 respectively for1/day, 1/day and1/day brushers (P0.001). Mean 3-year DMFS increments of 8.90, 6.63 and 5.48 (P0.01) were observed in those reporting to brush1/day, 1/day or1/day, on not less than two of the three clinical examinations during the trial. Caries increment was also significantly related to the claimed method used to rinse post-brushing. Overall frequency of brushing and rinsing method accounted for over 50% of the explained variance in the ANOVA model used to analyse the DMFS increments.Stated toothbrushing frequency and rinsing method after brushing were found to be strongly correlated with caries experience and caries increment. These factors should be reflected in the design of oral health education material and taken into account in the design and analysis of caries clinical trials.

This study reports on the caries susceptibility of tooth surfaces in 4294 adolescents (mean age 12.5 yr) during a 3-yr, double-blind clinical caries trial, conducted in Lanarkshire, Scotland, between 1988 and 1992. Children were selected on the grounds of dental maturity and past caries experience. Clinical examinations with mirror, CPITN probe and fibre optic trans-illumination were carried out on the permanent dentition, with the buccal pits of mandibular molars and palatal pits of maxillary molars being recorded as separate sites. At baseline 6061 surfaces were decayed (1.0% of 601 160 surfaces examined), 20 160 (3.4%) filled, and 10 909 (1.8%) missing due to caries. The number of surfaces recorded as sound at baseline in subjects completing the study was 454 663. Of these 8176 (1.8%) new surfaces were decayed, 14 832 (3.3%) filled and 4000 (0.9%) missing at the final examination. Molar occlusal surfaces showed greatest susceptibility to attack, 35.8% of those at risk becoming carious in the course of the study. All buccal and lingual smooth surfaces showed a low susceptibility, but 8.8% of buccal and palatal pits developed caries. At the final clinical - only examination, pit and fissure caries accounted for 48%, inter proximal surfaces for 39%, and smooth surfaces for 13% of caries prevalence. However, overall the contribution of these surfaces to 3-yr increments was, 40%, 47%, and 13%, respectively.

Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals. Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods. The acidogenic potential was assessed by pH measurement and analysis of acid anion production. Microradio-graphic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain. Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing-filled-surface score of the individuals. The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S. mutans strains.

A 6-yr double-blind study was undertaken to compare the caries inhibiting-effectiveness of (a) 1 mgF− tablets (daily at school) plus fortnightly rinsing at school with 1000 ppmF−; (b) 1 mgF− tablets plus placebo rinsing; and (c) placebo tablets plus 1000 ppmF− rinsing. Participants were aged 4.5–5 yr at outset of the trial. At baseline, and annually thereafter, clinical caries and bitewing X-ray examinations were undertaken, hence ethical approval for a negative control was not feasible. Fissure sealant presence was also recorded. Initially, 192 children from predominantly low socio-economic backgrounds were enrolled, and baseline analyses showed no significant differences between groups with respect to primary caries prevalence. After 6 yr, 112 children remained, by which time no significant differences were noted between DMFT and DMFS values for those in the active tablet/active rinse group, as compared to those in the placebo tablet/active rinse group. However, in relation to both indices, in permanent first molars, the effectiveness of the active tablet/placebo rinse regime appeared to be significantly poorer than the placebo tablet/active rinse programme. For the active tablet/active rinse group, the DMFT difference was significantly less than the active tablet/placebo rinse group (37.9%), although for the DMFS difference, significance was not achieved. Similar trends were noted when DMFT and DMFS values for all permanent teeth were considered. The occlusal caries prevalence in permanent first molars followed the DMFT pattern, but differences between combined tablet/rinsing children and tablet-only children could be ascribed solely to the effectiveness of sealant presence. As F− rinsing was supervised, the most likely explanation of these results is that children involved with active F− tablet ingestion were cither not receiving them, or these formulations were being used in such a manner that no extra benefit was obtained. Further cost-effectiveness studies would therefore seem necessary to determine whether ancillary employment would be justified in terms of increased caries benefit.

Salivary levels of mutans streptococci, Lactobacillus, Candida, and Veillonella species were investigated on three occasions at annual intervals in a group of 372 Scottish adolescents. Counts of the micro-organisms studied were logarithmically distributed, with Candida spp. being isolated from approximately half the subjects. Counts of lactobacilli, mutans streptococci, and candida were significantly intercorrelated, while veillonella were associated consistently with mutans streptococci alone. Levels of each of the four micro-organisms were significantly correlated over the three examinations, with levels of the Candida spp. being the most stable over the period studied.

As caries prevalence in some countries declines, and panel sizes for discriminating anti-caries clinical trials inevitably increase, the need for participant pre-selection grows to avoid escalating cost and manpower problems. Hence, retrospective analyses of data were undertaken, from a 3-yr double-blind caries clinical trial where a linear fluoride dose-response had been obtained. As a result, it was demonstrated that the eruption status of permanent second molars, in 3005 participants aged 11-12 yr at outset, when coupled with their baseline clinical DMFT values, provided a sound basis for panellist size prediction without loss of sensitivity. Thus, had only those subjects with DMFT greater than 4, with at least three of their permanent second molars erupted been selected following clinical baseline examination, the same sensitivity would have been achieved with 52% fewer subjects. Furthermore, using these criteria, selection can be made on site, in real time, and a child informed whether its immediate participation in a trial is possible.

A pilot study to determine whether 452 regular oral contraceptive users had a higher caries prevalence than 114 women not using those preparations found no significant variation between groups. Thus assumptions drawn from previous rodent studies do not justify the initiation of more complex laboratory-based human investigations.A pilot study conducted to investigate the relationship between human dental caries and use of different oral contraceptive (OC) formulations is presented. Subjects comprised 2 groups of women, 1 at an outpatient clinic and 1 at a family planning center. 452 regular users of OCs were compared for caries prevalence with 114 control women. Of dentally related data, only mean ages (P .01) and DMFS values (P .001) of those in the control and the high-estrogen group (.05 mg) were significantly different. In fact, all differences of statistical significance could be related to significant age differences alone. Therefore, use of OCs was not a significant variable. Thus, assumptions from previous rodent studies do not justify the initiation of more complex laboratory-based investigations.