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It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Background: More conservative techniques for managing dental caries including 'partial' and 'no caries removal' have been increasingly of interest., Aim: To compare children's behaviour and pain perception, also technique acceptability (parents and dentists), when approximal dentinal lesions (ICDAS 3-5) in primary molars (3-8-year-olds) were managed with three treatment strategies; conventional restorations (CR), hall technique (HT), and non-restorative caries treatment (NRCT)., Design: Secondary care-based, three-arm parallel-group, randomised controlled trial, with 169 participants treated by 12 dentists., Outcome Measures: child's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (5-point Likert scales)., Results: Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) (P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated 'very low' or 'low' in 88% NRCT, 81% HT, and 72% CR (P = 0.11, CI = 0.10 to 0.12). NRCT and HT were 'very easy' or 'easy' to perform for >77% of dentists, compared to 50% in CR group (P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort (P = 0.46, CI = 0.45 to 0.48)., Conclusions: Dentists reported more negative behaviour in CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar., (© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care-based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists' level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR (ClinicalTrials.gov NCT01797458)., (© International & American Associations for Dental Research.)

When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more 'biological' and fewer 'surgical' approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth.

The Hall Technique (HT) is a method for managing carious primary molars. Decay is sealed under pre-formed metal crowns without any caries removal, tooth preparation, or local anesthesia. The aim of this study was to compare HT clinical/radiographic failure rates with General Dental Practitioners' (GDPs) standard (control) restorations. We conducted a split-mouth, randomized control trial (132 children, aged 3-10 yrs, GDPs n = 17) in Scotland. There were 264 study teeth with initial lesions, 42% of which were radiographically > half-way into dentin, and 67% of which had Class II restorations. Teeth were randomized to HT (intervention) or GDPs' usual treatment (control). Annual clinical/radiographic follow-up data were recorded. Ninety-one patients (69%) had 48 months' minimum follow-up. At 60 months, 'Major' failures (irreversible pulpitis, loss of vitality, abscess, or unrestorable tooth) were recorded: HT, 3 (3%); control restorations, 15 (16.5%) (p = 0.000488; NNT 8); and 'Minor' failures (reversible pulpitis, restoration loss/wear/fracture; or secondary caries): HT, 4 (5%); control restorations, 38 (42%) (p < 0.000001; NNT 3). Overall, there were follow-up data for 130 patients (2-60 mos): 'Major' failures: HT, 3 (2%); control restorations, 22 (17%) (p = 0.000004; NNT 7); and 'Minor' failures, HT, 7 (5%); control restorations, 60 (46%) (p < 0.000001; NNT 3). Sealing in caries by the Hall Technique statistically, and clinically, significantly outperformed GDPs' standard restorations in the long term (Trial registration no. ISRCTN 47267892).

Background: Preformed metal crowns (PMCs) are recommended by the British Society of Paediatric Dentistry (BSPD) for restoring badly broken down primary molar teeth. However, few dental practitioners adopt this technique in clinical practice, citing cost and clinical difficulty as reasons for this. Whilst there is a subjective impression by clinical academics that PMCs provide a more durable restoration than filling materials, there appears to be little evidence within the literature to support this., Objectives: The primary aim of this systematic review was to compare clinical outcomes for primary molar teeth restored using PMCs compared to those restored with filling materials., Search Strategy: The literature was searched using: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); System for Information on Grey Literature in Europe (SIGLE) (1976 to August 2005). Relevant publications' reference lists were reviewed for relevant articles. The most recent search was carried out on 24 August 2005., Selection Criteria: Randomised controlled trials (RCTs) that assessed the effectiveness of PMCs compared with filling materials or where there had been no treatment in children with untreated tooth decay in one or more primary molar teeth., Data Collection and Analysis: Two review authors independently assessed the title and abstracts for each article from the search results to decide whether it was likely to be relevant. Full papers were obtained for relevant articles and all three review authors studied these., Main Results: Forty-seven records were retrieved by the search strategies of which some were duplicates. Of these, 14 studies were scrutinised. No studies met the inclusion criteria and six studies were excluded from the review as they were either retrospective in design or reported as prospective outcomes but not randomised. No data were available for extraction and analysis and therefore, no conclusion could be made as to whether PMCs were more successful than filling materials for restoring primary molar teeth., Authors' Conclusions: No RCTs were available for appraisal. Whilst this technique is recommended by the BSPD for use in clinical practice, the evidence to support this is not strong, consisting mainly of case reports and uncontrolled studies. It is important that the absence of evidence for PMCs is not misinterpreted as evidence for their lack of efficacy. There is a strong need for prospective RCTs comparing PMCs and fillings for managing decayed primary molar teeth. The lower levels of evidence that have been produced, however, have strength in that the clinical outcomes are consistently in favour of PMCs, despite many of the studies placing PMCs on the most damaged of the pair of teeth being analysed.

Background: There is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique., Aim: To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method - the Hall technique., Setting: General dental practice, in Scotland., Method: A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types., Results: For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% (95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% (95% confidence interval 83.2% to 88.4%), and for five years was 80.5% (95% confidence interval 76.5% to 83.9%)., Conclusions: Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended.

Design: This paper reports the results of standardised clinical caries examinations of 106,694 twelve-year-old children from England, Wales, the Isle of Man and Jersey. These 2000/01 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services., Method: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards, and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination., Results: Once again a wide variation in caries prevalence across the United Kingdom was demonstrated, with mean values for D3MFT for the English 'regions' (of the National Health Service) and Wales ranging from 0.63 in the West Midlands to 1.31 in Wales. The mean value for DMFT across England Wales was 0.89 (D3T=0.39, MT=0.07, FT=0.43). Overall, 38% of children had evidence of caries experience at the dentinal level of detection (D3MFT>0), although the means ranged between 30% (West Midlands) and 51% (Wales). The mean D3MFT for those with disease at this threshold was 2.35. Trends over time demonstrate an improvement of 11% in overall D3MFT since 1996/97, compared to the 15% seen over the previous four year period. FT and care index fell. The number of fillings provided in 2000/01 and thus the care index, remained low. On average across England and Wales, only 48% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts: 30% to 78%). The use of the SiC index highlights dental health inequalities., Conclusion: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Objective: This paper reports the results of standardised clinical caries examinations of 199,440 5-year-old children from across Great Britain. These 1999/2000 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services., Method: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination., Results: The results again demonstrated a wide variation in prevalence across Britain, with mean values for d3mft for the current English regions (of the National Health Service) and for Wales and Scotland ranging from 0.94 in the West Midlands to 2.55 in Scotland. Mean d3mft across Great Britain was 1.57 (d3t=1.14. mt=0.22, ft=0.21). Overall, 40% of children had evidence of dentinal caries experience (d3mft>0), although the means ranged between 30% (West Midlands) and 55% (Scotland). The distribution of caries was highly skewed. Thus the British mean caries experience for those with the disease was 3.88, as opposed to the overall mean of 1.57. Trends over time demonstrate a modest improvement of 4% in overall d3mft for Britain since 1997/98, compared with the 8.6% improvement seen for the two previous years. All three components with dmft have also fallen. The care index has remained virtually unchanged in Britain as a whole (13.6% in 1999/2000, compared to 13.9% in 1997/8). Regional/country means for 1999/2000 ranged from 8-20%. This indicator has not, however, regained the levels seen in the past., Conclusion: There has been some improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dental decay has not changed; significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

Objective: To determine the survival of 'PD' Black Copper Cement when used as a dental filling material in carious primary teeth., Design: A prospective study., Setting: Dundee Dental Hospital, Dundee., Subjects: Fifty children with carious primary molars had 82 dental restorations placed in the initial study. For the follow-up study, 45 restorations were available., Results: Over 65% of the Black Copper Cement restorations placed in the initial study failed. Modification of restoration technique reduced the total loss of filling material to 18% of cases., Conclusion: To take advantage of the cariostatic properties of black copper cement may require it to be used as a lining under a less soluble restorative material.

Design: This paper reports the results of standardised clinical caries examinations of 121.550 14-year-old children from across the United Kingdom, Jersey and the Isle of Man. These 1998/99 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and to assess the delivery of dental services., Method: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibreoptic transillumination., Results: These demonstrated, once again, a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English regional offices (of the National Health Service) and the other UK countries ranging from 1.17 in West Midlands to 3.65 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.76 (D3T=0.59, MT=0.15, FT=1.02). Overall, 54% of children had evidence of caries experience at the dentinal level (D3MFT>0), although the means ranged between 43% (South East) and 78% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 3.24. Trends over time demonstrate an improvement of 10% in overall D3MFT for Great Britain since 1994/95, compared to the 21% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in mean MT since 1994/95, while FT and care index have fallen. The number of fillings provided in 1998/99 and thus the care index, remains low, on average across the UK, only 58% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 34% to 83%)., Conclusion: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Objective: This paper reports the results of standardised clinical caries examinations of 176,781 5-year-old children from across the United Kingdom. These 1997/98 co-ordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services., Method: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine threshold using a visual method without radiography or fibre-optic transillumination., Results: The results again demonstrated a wide variation in prevalence across the UK, with mean values for d3mft for the current English regions (of the National Health Service) and the other UK 'territories' ranging from 1.02 in the West Midlands to 2.92 in Northern Ireland. Mean d3mft across the UK was 1.68 (d3t = 1.18, mt = 0.26, ft = 0.23). Overall, 43% of children had evidence of caries experience (d3mft > 0), although the means ranged between 33% (West Midlands) and 63% (Northern Ireland). The distribution of caries was highly skewed. Thus the UK mean caries experience for those with disease was 3.94, as opposed to the overall mean of 1.68. Trends over time demonstrate a modest improvement of 8.7% in overall d3mft for Great Britain since 1995/96, compared to the small improvement seen two years ago and the deterioration seen four years previously. Both dt and mt have fallen while ft remained unchanged. The care index has increased in all but one region/territory (14% in 1997/8, compared to 12% in 1995/6). Regional/country means for 1997/8 ranged from 9-23%. This indicator has not, however, regained the levels seen in the past., Conclusion: There has been some improvement in the dental health of 5-year-old children. Overall, the provision of operative care for those with dentinal decay has also improved; however, significant groups remain within the population of 5-year-old children who have dental disease and who are in need of dental care.

Design: This paper reports the results of standardised clinical caries examinations of 129,941 twelve-year-old children from across the United Kingdom and the Isle of Man. These 1996/97 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services., Method: The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography or fibre-optic transillumination., Results: These demonstrated once again a wide variation in prevalence across the United Kingdom, with mean values for D3MFT for the current English 'regions' (of the National Health Service) and the other UK 'territories' ranging from 0.66 in Thames South to 2.55 in Northern Ireland. The mean value for D3MFT across the United Kingdom was 1.13 (D3T = 0.48, MT = 0.10, FT = 0.54). Overall, 44% of children had evidence of caries experience at the dentinal level of detection (D3MFT > 0), although the means ranged between 31% (Thames South) and 72% (Northern Ireland). The mean D3MFT for those with disease at this threshold was 2.55. Trends over time demonstrate an improvement of 15% in overall D3MFT for Great Britain since 1992/93, compared to the 20% seen over the previous four year period. Over recent years the overall trend in this age group seems to be towards lower values. However, there has been no improvement in either mean DT or mean MT since 1992/93, while FT and care index have fallen. The number of fillings provided in 1996/97 and thus the care index, remain low, on average across the UK, only 48% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual districts and boards: 27 to 76)., Conclusion: Taken together, these findings demonstrate the continuing need for more effective preventive strategies and treatment services for this important age group.

Background: The British Association for the Study of Community Dentistry (BASCD) has, in conjunction with the National Health Service (NHS), been coordinating a series of epidemiological surveys of caries prevalence across various parts of the United Kingdom (UK) since 1985/6., The Team: mounting and maintaining this programme of surveys has relied on the hard work and enthusiasm of many individuals working within the NHS from across the UK. The whole team is vital to the success of the programme and the Dental Epidemiology NHS "regional' Coordinators and "regional' trainers play a key role., The Surveys: to date, seven surveys of 5-year-old children have been undertaken biennially since 1985/86, three surveys of 14-year-old children have been carried out at four intervals since 1986/87, while three surveys of 12-year-old children have been completed since 1988-89 at corresponding intervals., Diagnostic Criteria: the diagnostic criteria used in the programme developed from a 1983 consensus meeting and have slowly been developed with experience of how they were interpreted and used across the UK., Training and Calibration: a number of national exercises have been held as the programme has developed which have improved our understanding of how criteria are being interpreted locally and have helped to improve the quality of the programme., Quality Standards: include a trainer's pack for caries diagnosis, developed in 1992, which comprises 50 slides and a matching series of overhead transparencies. Guideline documents have also been produced for 1) sampling for surveys of child dental health and 2) for the statistical aspects of training and calibration of examiners for such surveys., Challenges and the Future: include incorporating the mechanics of the programme within the evolving purchaser/provider environment of the NHS and the inevitable tensions between disparate local and national needs. The results of the programme are to be disseminated more widely and are now incorporated into a number of formal NHS data systems used to plan and monitor public health and services. Updated data-entry and processing software is now being developed by BASCD for this programme and consideration is being given to modules to allow the extension of the programme to include public health assessments of orthodontic need and developmental defects of enamel.

This paper outlines the current (1996/97) version of the diagnostic criteria relating to dental caries employed in the BASCD coordinated NHS Dental Epidemiology Programme. Some of the details as to how these criteria have evolved over the past 13 years. since the original guidelines publication (Palmer et al., 1984), can be found in a previous publication (Pitts, 1993) and in an earlier paper in this supplement (Pitts and Evans, 1997).

This paper reports the results of standardised clinical caries examinations of 172,659 five-year-old children from across the United Kingdom. These 1995/96 coordinated surveys are the latest in a series which seek to monitor the dental health of children and to assess the delivery of dental services. The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating Health Authorities and Boards and caries was diagnosed at the caries into dentine (d3) threshold using a visual method without radiography or fibre-optic transillumination. The results demonstrated once again a wide variation in prevalence across the United Kingdom, with mean values for d3 mft for the current English regions (of the National Health Service) and the other UK territories ranging from 1.08 in the West Midlands to 3.04 in Northern Ireland. The mean value for d3mft across the United Kingdom was 1.84 (d3t = 1.32, mt = 0.30, ft = 0.22). Overall, 44 per cent of children had evidence of caries experience at the dentinal level of detection (d3mft > 0), although the means ranged between 33 per cent (West Midlands) and 63 per cent (Northern Ireland). Trends over time demonstrate a modest improvement of 6.7 per cent in overall d3mft for Great Britain since 1993/94, compared with the modest deterioration seen two years previously. Over recent years the overall trend in this age group seems to be flat, with evidence that there are minor deviations above and below a plateau value. However, there have been some changes. Both dt and the proportion with d > 0 have increased while ft and care index have fallen. The number of fillings provided in 1995/96, and thus the care index, remain low (UK mean care index = 12 per cent, regional/country means range from 8-20 per cent). These findings demonstrate the continuing need for more effective preventive and treatment services for this important age group.

In 1994, the dental health of 327 5-year-old children who had lived in continuously fluoridated (at 1.0 mg/IF-) Newcastle was compared with the dental health of 335 children of the same age in non-fluoridated (less than 0.1 mg/IF-) south east Northumberland. The caries prevalance in social class groups I + II, III, IV + V children was compared both within and between the two areas. The prevalence of dental caries in the three social groupings I + II, III, and IV + V (and the mean dmft) respectively, was 23 percent (0.59), 39 percent (1.21) and 31 percent (1.17) in the fluoridated area, and 38 percent (1.46), 47 percent (2.04) and 62 percent (2.74) in the non-fluoridated area. Differences between the fluoridated and non-fluoridated areas were observed in all social class groupings but the greatest difference in the percentage of children with decay experience occurred in social groups IV + V. There has been a fall in caries experience in all social groups in both the fluoridated and non-fluoridated areas since a previous survey in 1987. However, this reduction was not enough to obviate the disadvantage of social background. Reduction in caries experience especially amongst social classes I and II has meant that the power of water fluoridation to reduce caries experience has diminished. Refinement of the instruments for classifying socio-economic position has the potential to demonstrate greater degrees of inequality than the crude measures such as occupational class as used in this study.

This paper reports the results of standardised clinical survey examinations of 127,481 14-year-old children across the United Kingdom. These 1994/95 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and contribute to assessments of the provision of dental services. The criteria and conventions of the British Association for the Study of Community Dentistry trainers' pack 1992/93 were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D3) threshold using a visual method without radiography, fibre-optic transillumination or compressed air. The results demonstrated a wide variation in prevalence across the UK, the mean D3MFT for the former English regions (of the National Health Service) and the other UK 'territories' ranging from 1.2 (South West Thames) to 4.1 (Northern Ireland). The overall mean D3MFT across the UK was 1.93 (D3T = 0.63, MT = 0.15, FT = 1.15). Overall, 57 percent of children had evidence of (dentinal) caries experience (D3MFT > 0), although means ranged from 42 percent (South Wales Thames) to 81 percent (Northern Ireland). The inclusion of data from Northern Ireland for the first time in this series confirms that dental caries prevalence is higher in the province than in other areas of the UK. Trends since the 1990/91 surveys can be assessed for Great Britain. These demonstrate an overall fall in D3MFT of 20 percent since 1990/91 (from 2.30 to 1.85). This is, however, due to the 35 percent reduction in the number of fillings (1.68 to 1.09) which was partially offset by an increase in unrestored dentinal decay of 41 percent (0.44 to 0.62). These findings (taken together with results from regions reporting in 1986/87) demonstrate that although overall improvements have continued in this age group, the rate of improvement has slowed and that changes in the pattern of provision of care for those with disease experience continue to give some cause for concern. On average, across the UK, only 59 percent of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range 48 to 69 percent).

In 1994, the dental health of 496 5-year-old children who had lived in continuously fluoridated (at 1.0 mg F/litre) Newcastle was compared with the dental health of 436 children of the same age in non-fluoridated (less than 0.1 mg F/litre) south east Northumberland. The study also reported changes in the dental health of 5-year-old children in four surveys in these areas during the period 1976 to 1994. The mean dmft of children in the fluoridated area was 1.33 compared with 2.41 in the non-fluoridated area--a difference of 1.08 per child (45%). The corresponding dmfs scores were 2.80 in the fluoridated area and 5.77 in the non-fluoridated area--a difference of 2.97 tooth surfaces per child (52%). Thirty-nine per cent of children in the fluoridated area had experienced dental caries, compared with 55% in the non-fluoridated area. Only 10% of children in the fluoridated area had experienced dental caries in more than four teeth, compared with 22% in the non-fluoridated area. The prevalences of lifetime experience of toothache, extractions and general anaesthesia for dental extractions were greater in the non-fluoridated area than in the fluoridated area. When the results of this survey were compared with the results of similar surveys in the same areas in 1976, 1981 and 1987, it appeared that there has been a further reduction in dental caries levels following the levelling off observed between 1976 and 1981.

An epidemiological study was carried out involving 677 children and young adults aged between 3 and 19 years who were attending special schools in South Glamorgan. The children and young adults were examined for caries and periodontal disease. Their dental attendance pattern and the dental service they used were recorded, and their mobility and posture, and comprehension and cooperation, were assessed. The results showed that the majority were receiving regular dental care and that the caries experience of 12- and 14-year-old children was lower than that of children of the same ages in other state schools. Five-year-old children were found to have a dmft of 4.18, which was significantly higher than that of similar-aged children attending state schools. Forty-seven per cent of the children and young adults were found to have periodontal disease; the greatest percentage (60%) was found in the young adults in the 15-19-year-old age group. Caries experience and gingival health were not related to the subjects' mobility and posture but caries experience was greater and gingival health was poorer in subjects who had reduced comprehension and cooperation. The study highlighted deficiencies in the service provided for this group, especially for pre-school children.