Institute of Dentistry, Department of Oral Public Health, University of Helsinki, Finland

Caries-preventive treatment approaches

for child and youth

at two extremes of dental health

in helsinki, finland

Sinikka Varsio

Academic dissertation

To be presented, with the permission of the Faculty of Medicine of the University of Helsinki, for public discussion in the main auditorium of the Institute of Dentistry, Mannerheimintie 172, Helsinki, on 24 September, 1999, at 12 noon.

Helsinki 1999

Supervised by

Docent Miira Vehkalahti, DDS, PhD

Department of Oral Public Health

Institute of Dentistry

University of Helsinki, Finland

Professor Heikki Murtomaa, DDS, PhD, MPH

Department of Oral Public Health

Institute of Dentistry

University of Helsinki, Finland

Reviewed by

Docent Eeva Widström, M.Sc, DDS, PhD

Karolinska Institute, Stockholm, Sweden and

Institute of Dentistry, University of Oulu, Finland

Docent Lars G. Petersson, DDS, PhD

Institute of Dentistry

University of Lund, Sweden

ISBN 951-45-8710-3 (HTML-version)

Yliopistopaino 1999

Electronic version available at http://ethesis.helsinki.fi

ABSTRACT

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 5- and 15-year-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, high-caries 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: sinikka.varsio@helsinki.fi.

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.