Caries-preventive Treatment Approaches for Child and Youth at Two Extremes of Dental Health in Helsinki, Finland

Varsio S. Caries-preventive treatment approaches for child and youth at two extremes of dental health in Helsinki, Finland. Department of Oral Public Health, University of Helsinki, Finland, 1999. 65 pp. ISBN 952-91-1150-9. This study determined the prevalence and distribution of dental caries among young populations during the last two decades in Helsinki, Finland, and evaluated dentists’ caries-preventive treatment approaches in real-life dental practice. Data on numbers of dmf or DMF teeth and of teeth with current untreated caries (dt+DT) were collected from the annual official statistics of the Helsinki City Health Department for all 5and 15year-olds clinically examined from 1976 to 1993, amounting to about 4,000 patients in both age-groups in each year. Polarization of dental caries was described as the proportion of high-caries groups in each year, and as the proportion of dt+DT and dmf or DMF teeth in each high-caries group of the total number of all such teeth in the entire age-group. The study on caries-preventive treatment practices was cross-sectional, with a two-point design, highcaries group vs. cavity-free group, covering data from 6-, 13-, and 15-year-old patients’ oral health records of the year 1992. The high-caries patients (n=294) had the greatest number of dt+DT (5.5 to 8.7, on average, the range 3 to 18). The cavity-free patients (n=88; dmft or DMFT=0, dt+DT=0) were randomly selected from the same clinics as were the high-caries cases. A strong polarization of caries was found, emphasizing the importance of using frequency distributions of subjects by caries indices in evaluation of caries occurrence in populations. Among the high-caries patients, the treatment strategy was filling-orientated with a slight tendency towards targeted preventive treatment. Dentists’ judgement of patients’ high risk for caries led a markedly improved caries prevention for these patients. However, dentists seemed to ignore instructions on individualized caries-preventive treatment and to place too much emphasis on clinical dental examinations and caries prevention for the cavity-free patients. Furthermore, uncompleted treatment courses were characteristic of the high-caries patients, offering evidence of the difficulties met in their treatment. Recommendations are given for actions at the administrative and organizational level as well as for dental teams: individualization of dental treatment and its outcome should be monitored and rewarded; dentists should judge each patient’s risk for caries, individualize check-up intervals, and integrate preventive measures into all dental visits of high-caries patients. The author’s address: Sinikka Varsio, Institute of Dentistry, Department of Oral Public Health, University of Helsinki, PO Box 41, FIN-00014 Helsinki, Finland. E-mail: [email protected]. LIST OF ORIGINAL PUBLICATIONS This thesis is based on the following publications referred to in the text by their Roman numerals. I Vehkalahti M, Tarkkonen L, Varsio S, Heikkilä P. Decrease in and polarization of dental caries occurrence among child and youth populations, 1976-1993. Caries Res 1997;31:161-5. II Varsio S, Vehkalahti M, Murtomaa H. Treatment practices in caries prevention for 6-year-olds in Finland. Community Dent Oral Epidemiol 1999;27 (in press). III Varsio S, Vehkalahti M. Evaluation of preventive treatment by risk of caries among 13-year-olds. Community Dent Oral Epidemiol 1996;24:277-81. IV Varsio S, Vehkalahti M. Dentists’ decisions on caries risk and preventive treatment by dental state among 15-year-old adolescents. Community Dent Health 1997;14:166-70. V Varsio S, Vehkalahti M, Murtomaa H. Dental care of six-year-old high-caries patients in relation to their cooperation. Community Dent Health 1999;16:171-5.