Abstract: OBJECTIVE: To determine the current prevalence and severity of caries in primary dentition in a preschool population in 2 provinces in China, and to investigate the relationship between caries experience and sociodemographic factors, parental characteristics, dietary habits, and oral hygiene practice. METHOD AND MATERIALS: A cross-sectional survey was conducted on a representative sample of Chinese preschool children aged 3 to 5 years. Clinical examinations were carried out on 2,014 children using the method and criteria established by the World Health Organization. Structured questionnaires for information related to the sociodemographic background, oral hygiene practices, and dietary habits of the children were completed by their mothers. RESULTS: Overall, 45% of children were caries free, and 14% had rampant caries. The mean dmft and dmfs values were 2.57 and 4.25, respectively. The caries prevalence and severity increased with age. The children from rural areas brushed their teeth less regularly and had a higher level of caries experience than those from urban areas. Significant predictors of caries experience were location, area, age, mother's education level, and consumption of fruit juice from a feeding bottle. CONCLUSIONS: These data indicate that a high proportion of young Chinese children had dental caries and that most decayed teeth were left untreated. The prevalence and severity of caries was associated with socioeconomic status and dietary factors in this sample of children.

Abstract: AIMS: To determine orofacial pain (OFP) characteristics, associated disability, and effect on quality of life in elderly community-dwelling Chinese people. METHODS: A cross-sectional survey involving elderly people registered with the Family Medicine Unit of the University of Hong Kong served as the sampling frame. Elderly people with recent OFP symptoms and a comparison control group without OFP participated. Standard questions were asked about OFP conditions in the previous month and the Oral Health Impact Profile (OHIP-14), General Health Questionnaire (GHQ-12), and pain-related disability questions were administered prior to a standard clinical examination. RESULTS: Ninety-five people with OFP and 100 people without OFP participated. The median number of pain symptoms per subject was 2.0. Toothache was the most common symptom (58.9%); shooting pain across the face and muscle tenderness were the least common (6.3%). More than half of the pain participants described moderate to severe OFP. The prevalences of patients with neurological/vascular (NV), musculoligamentous/soft tissue (MST), or dentoalveolar (DA) OFP were 35.8%, 33.7%, and 30.5%, respectively. Chronic OFP was common (80%). The mean OHIP-14 summary score was significantly higher in OFP subjects than controls (P < .001) and significantly higher in the MST and DA subgroups than in the NV subgroup (P < .001). GHQ scores of > or = 4, indicating greater psychological distress, were more common in OFP subjects than controls (P < .01). Twenty percent of OFP subjects indicated that their conditions interfered with daily life activities, and in 9.9% it affected ability to work. CONCLUSION: OFP had a substantial detrimental impact on daily life activities, psychological distress level, and quality of life in Chinese elders. MST and DA conditions had the greatest adverse impact on quality of life.

Abstract: The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT = 3.2, MT = 5.2, FT = 0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.

Abstract: Successful use of atraumatic restorative treatment (ART) in children has been reported, but little information is available regarding its use in older adults. The hypothesis of this study was that survival rates of root restorations placed by both ART and the conventional technique were similar. Root-surface caries lesions in 103 institutionalized elders in Hong Kong were treated randomly by either: (1) the conventional approach-caries removed by dental burs, and the cavity filled with light-cured resin-modified glass ionomer; or (2) the ART approach-caries removed by hand instruments, and the cavity filled with chemically cured high-strength glass ionomer. In total, 84 conventional and 78 ART restorations were placed. After 12 months, 63 conventional and 59 ART restorations were reviewed, and the respective 12-month survival rates were 91.7% and 87.0% (p > 0.05). It is concluded that the survival rates of both types of root restorations were high and similar.

Abstract: Managing the change from traditional to problem-based learning (PBL) curricula is complex because PBL employs problem cases as the vehicle for learning. Each problem case covers a wide range of different learning issues across many disciplines and is coordinated by different facilitators drawn from the school's multidisciplinary pool. The objective of this project was to adapt an interactive computer program to manage a problem-based dental curriculum. Through application of a commercial database software--CATs (Curriculum Analysis Tools)--an electronic database for all modules of a five-year problem-based program was developed. This involved inputting basic information on each problem case relating to competencies covered, key words (learning objectives), participating faculty, independent study, and homework assignments, as well as inputting information on contact hours. General reports were generated to provide an overview of the curriculum. In addition, competency, key word, manpower, and clock-hour reports at three levels (individual PBL course component, yearly, and the entire curriculum) were produced. Implications and uses of such reports are discussed. The adaptation of electronic technology for managing dental curricula for use in a PBL curriculum has implications for all those involved in managing new-style PBL dental curricula and those who have concerns about managing the PBL process.

Abstract: OBJECTIVE: To describe the prevalence of dental erosion and associated factors in preschool children in Guangxi and Hubei provinces of China. METHODS: Dental examinations were carried out on 1949 children aged 3-5 years. Measurement of erosion was confined to primary maxillary incisors. The erosion index used was based upon the 1993 UK National Survey of Children's Dental Health. The children's general information as well as social background and dietary habits were collected based on a structured questionnaire. RESULTS: A total of 112 children (5.7%) showed erosion on their maxillary incisors. Ninety-five (4.9%) was scored as being confined to enamel and 17 (0.9%) as erosion extending into dentine or pulp. There was a positive association between erosion and social class in terms of parental education. A significantly higher prevalence of erosion was observed in children whose parents had post-secondary education than those whose parents had secondary or lower level of education. There was also a correlation between the presence of dental erosion and intake of fruit drink from a feeding bottle or consumption of fruit drinks at bedtime. CONCLUSION: Erosion is not a serious problem for dental heath in Chinese preschool children. The prevalence of erosion is associated with social and dietary factors in this sample of children.

Abstract: PURPOSE: To describe the caries status and oral health-related behaviors of three- to five-year-old Chinese children by their ethnic background, and to identify potential determinants of caries experience. MATERIALS AND METHODS: A cross-sectional survey was undertaken in a multi-ethnic province (Guangxi) in Southern China. Representative samples of preschool children from two ethnic groups (Han and an ethnic minority Zhuang: 487 Han and 470 Zhuang children) were examined using decayed, missing, filled teeth/surface (dmft/dmfs) indices. The children's general information as well as their personal oral hygiene practices and dietary habits were collected based on a structured questionnaire. RESULTS: Overall, 60% of children had caries with a mean dmft value of 3.01. Zhuang children had a significantly higher prevalence of rampant caries (13% vs. 9%), mean dmft (3.36 vs. 2.66) and mean dmfs (5.10 vs. 3.76) than the Han children. Decayed teeth/surfaces dominated the dmft/dmfs indices for both Han and Zhuang children. Multiple regression analysis showed that ethnicity and drinking fruit juice from feeding bottles during babyhood were significantly related to dmft. CONCLUSION: There was a higher level of caries experience in the Zhuang ethnic minority than in Han preschool children.

Abstract: The authors describe the acceptance and efficiency of an outreach dental service, which provided oral health care to persons with special needs in Hong Kong. Portable dental equipment was transported to various institutions. Basic dental care including prevention, scaling, restoration, extraction, and denture repair was provided free of charge. Elderly adults living in institutions were the main service recipients, but other people with special needs, including physically disabled and persons with mental retardation were also reached. One-third of the patients had dental pain or sensitivity, and 70% had not visited a dentist for more than three years. Dental care was provided to 6,867 patients over four years. Feedback from the patients showed that more than 90% of them were satisfied with the service. These findings indicate that patients with special needs in Hong Kong are in great need of dental care. An outreach dental service appears to be both appropriate and efficient in providing care to these persons.

Abstract: OBJECTIVES: To describe the oral health status of institutionalized elderly in Hong Kong. METHODS: Older adults in 56 elderly homes were clinically examined in the institution by one of two calibrated dentists using standard methods recommended by the World Health Organization. Information on their perceived oral health status and behaviour was obtained from an interview. RESULTS: A total of 3153 elderly aged 65 years or above (mean = 79.8) were examined. Around 20% of them were edentulous. The mean DMFT score was 23.0 (DT = 2.6; MT = 20.1; FT = 0.3). The percentage of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets (according to the highest CPI score) were 1, 2, 41, 37 and 20 respectively. Two-thirds of the elderly reported having difficulties chewing, and over half had not visited a dentist for over 5 years. CONCLUSION: The oral health status of institutionalised elderly in Hong Kong is poor and needs to be improved.

Abstract: OBJECTIVES: This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. METHODS: One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK, were administered to the study group prior to surgery. Standardized surgical and analgesic protocols were followed. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days, completing both OHIP-14 and OHQoLUK daily. RESULTS: Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P<0.01) and this remained evident on POD2 (P<0.01), POD3 (P<0.01), POD4 (P<0.01) and POD5 (P<0.05). By POD6 and POD7 there was no significant difference in quality of life compared with preoperative status (P>0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. CONCLUSION: The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.

Abstract: PURPOSE: In this study, we evaluated patients' perceptions of changes in oral health-related quality of life (OHQOL) over a 6-month period after third molar surgery. Patients and Methods: One hundred patients participated in this prospective study. Two specific OHQOL measures, the 14-item Oral Health Impact Profile (OHIP-14) and the 16-item UK Oral Health-Related Quality of Life measure (QHQoL-UK), were administered to the study group before surgery. Standardized surgical and analgesic protocols were used. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days and were contacted at 1, 3, and 6 months after surgery. RESULTS: Both measures identified a significant deterioration in quality of life in the immediate postoperative period (P <.01). However, there was an improvement in OHQOL compared with preoperative status at 1 (P <.05), 3 (P <.05), and 6 (P <.01) months after surgery. Patients perceived physical, social, and psychologic changes in life quality after surgery. Previous pericoronitis was associated with changes in quality of life (P <.05). CONCLUSION: The study concludes that third molar surgery is associated with changes in OHQOL. This has implications for understanding the value of third molar surgery from patients' perspectives and in assessing health gain.

Abstract: The performances of patient-centred outcome measures after oral surgery were evaluated in a prospective cohort study of 100 patients who had third molar extractions. Participants self-completed a questionnaire incorporating a general health (12-item short form health survey: SF-12) and two specific outcome scales to oral health (oral health impact profile: OHIP-14, and The United Kingdom Oral Health related Quality of Life measure: OHQoL-UK) preoperatively, daily during the immediate postoperative period, and at the review appointment (7-days later). Ninety-seven completed the study. History of 'taking time off' work/study because of pericoronitis during the past year was significantly associated with preoperative OHIP-14 and OHQoL-UK scores. There were significant differences in SF-12, OHIP-14, OHQoL-UK scores during the immediate postoperative period compared with preoperatively, when postoperative symptoms were prevalent. At the review appointment, OHIP-14 and OHQoL-UKscores were associated with clinical findings. The measures were valid and sensate in relation to oral surgery. However, those specific to oral health were more discerning than the general scale.

Abstract: OBJECTIVES: This study investigated the effect of two factors: conditioning methods and light-curing techniques on the marginal adaptation of Dyract AP (Dentsply DeTrey, Germany). The 'pulse activation' curing technique was compared with a conventional light-curing technique for their effectiveness in reducing marginal gaps in restorations that were conditioned with three different protocols. MATERIALS and METHODS: Cylindrical cavities, 3mm in diameter, were prepared in extracted human molar teeth. They were restored with Dyract AP using Prime&Bond NT (PBNT; Dentsply DeTrey) as the adhesive. Cavities were etched with: Conditioner36/PBNT (group 1), Non-Rinse Conditioner (NRC)/PBNT (group 2), and PBNT only (group 3). Either conventional or the 'pulse activation' technique was used for light-curing of the material. Epoxy resin replicas were obtained from longitudinal sections of the specimens, and the restoration-tooth interfaces were examined using scanning electron microscopy. Marginal qualities along the resin-dentin interfaces were further measured using image analysis and analyzed using nonparametric statistical methods. RESULTS: With the conventional curing technique, enamel margin fractures were frequently observed. Marginal gaps were found along the compomer-dentin interfaces irrespective of the conditioning protocol. A significantly lower percentage of gap-containing margins were found in cavities that were conditioned with 36% phosphoric acid. With the 'pulse activation' technique, no marginal gap was found along compomer-dentin interfaces that were etched with either Conditioner36 or NRC. More than 90% of the total margin length were excellent. No cohesive failure of enamel could be observed along cavosurface margins. SIGNIFICANCE: The 'pulse activation' curing technique significantly improves the marginal integrity of Dyract AP when Conditioner36/Prime&Bond NT and NRC/Prime&Bond NT are used as conditioning/bonding systems. The use of Prime&Bond NT without etching is not recommended, as marginal gaps are present irrespective of the curing techniques employed.

Abstract: PURPOSE: To evaluate the clinical behavior of a compomer restorative system, Dyract AP, placed in combination with Non-Rinse Conditioner and Prime&Bond NT in permanent posterior teeth. MATERIALS AND METHODS: Fifty Class II and 41 Class I restorations were placed in 39 patients in a dental teaching hospital. The restorations were evaluated directly at baseline and after 6, 12 and 24 months using the modified USPHS-Ryge criteria. Clinical photographs, polyvinylsiloxane impressions and bitewing radiographs of each restoration were taken for indirect assessment. RESULTS: After 2 years, all 76 restorations were evaluated in situ. Color matching ability and surface characteristics were excellent. A gradual deterioration in marginal discoloration and marginal integrity was noted. The percentages of Alfa scores for each criterion at the 24-month evaluation were: color match 96%, marginal discoloration 50%, marginal integrity 26%, anatomic form 97% and surface texture 95%. Five of the restorations (6%) had experienced partial fracture or recurrent caries. After 6, 12 and 24 months, the net mean occlusal wear values were 18.5 microm, 35.7 microm and 55.9 microm, respectively. There was no statistically significant difference between Class I and II restorations for each criterion (Fisher's exact test, P > 0.05).

Abstract: OBJECTIVE: To compare the clinical performance of two glass-ionomer cements, ChemFlex (Dentsply DeTrey) and Fuji IX GP (GC), when used with the atraumatic restorative treatment (ART) approach in China. METHODS: Eighty-nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included. A split-mouth design was used in which the two materials were randomly placed on contralateral sides. The performance of the restorations was assessed directly and also indirectly from die-stone replicas at baseline and after 6, 12, and 24 months. RESULTS: The 24-month cumulative survival rates of ART restorations in the primary teeth were 93 and 90% for the ChemFlex and Fuji IX GP class I restorations, respectively, while 40 and 46% of class II restorations placed with the respective materials were satisfactory. In the permanent dentition, only class I restorations were involved and the cumulative survival rates were 95 and 96% for ChemFlex and Fuji IX GP. For the primary teeth after 24 months, net mean occlusal wear was 87 microm for ChemFlex and 85 microm for Fuji IX GP. The occlusal wear in the permanent teeth was 75 microm for ChemFlex and 79 microm for Fuji IX GP. CONCLUSION: The clinical performance of both materials over a 24-month period was similar and the survival rates of class I ART restorations in both primary and permanent teeth were high.

Abstract: OBJECTIVES: This in vitro study evaluated the marginal adaptation of compomer restorations placed using three different conditioning protocols. MATERIALS AND METHODS: Thirty extracted caries-free molars with 3mm diameter cylindrical cavity preparations were divided randomly into three groups based upon the conditioning treatment used: (I) 36% phosphoric acid; (II) non-rinse conditioner (NRC, Dentsply DeTrey); and (III) no conditioning. Cavities were restored with Dyract AP using Prime&Bond NT (Dentsply DeTrey) as an adhesive. Silicone impressions of the briefly etched enamel surfaces were taken after finishing the restorations. Each sample was then longitudinally sectioned and impressions were taken. Epoxy resin replicas were prepared for SEM analysis. Qualitative and quantitative assessment were performed separately for the enamel- and dentine-restorative interface. RESULTS: Enamel fractures and open margins along the enamel-restorative margin were observed in some specimens in each group. No statistically significant difference was found in the percentage of gaps/cohesive failures between specimens prepared using different conditioning methods. For the dentine-restorative interface, uniform hybrid layers and long resin tags were often observed in Groups I and II. The hybrid layer in Group III was irregular and discontinuous along the interface. A significant difference (p<0.01) in the proportion of marginal gap was found between Group I (2%) and Group III (30%). CONCLUSIONS: Pre-treating the cavity with 36% phosphoric acid significantly improved the adaptation of the compomer and adhesive to dentine compared with no etching. The marginal quality at the enamel-compomer interface was not affected by the conditioning method used.

Abstract: OBJECTIVE: The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system, Dyract AP, placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth. METHOD AND MATERIALS: Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist. The restorations were evaluated directly, with modified US Public Health Service criteria, and indirectly, with color slides and polyvinyl siloxane impressions, at baseline and 6 months and 1 year after placement. Preoperative and 1-year postoperative bitewing radiographs were also taken. RESULTS: All 82 restorations available for 1-year evaluation were in situ. No postoperative sensitivity or pulpal problems were reported. Four Class II restorations (4.9%) failed because of partial fracture or recurrent caries. The percentages of Alfa score for each criterion were color match, 95.1%; marginal discoloration, 57.3%; marginal integrity, 35.4%; anatomic form, 98.8%; and surface texture, 91.5%. The average wear rate of Dyract AP was low (18.5 +/- 11.7 microns at 6 months and 35.7 +/- 13.6 microns at 12 months). CONCLUSION: The excellent handling characteristics, the good clinical performance, and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas.

Abstract: OBJECTIVE: To evaluate the safety and effectiveness of a new glass ionomer restorative, ChemFlex, and to compare its clinical performance and wear to another popular material, Fuji IX GP, when used with the atraumatic restorative treatment (ART) approach in posterior teeth in school children. METHODS: Ninety-two subjects aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were selected. A split-mouth experimental design was used in which the two restorative materials were randomly placed on contralateral sides. The restorations were assessed directly and also indirectly from color transparencies and die replicas. RESULTS: After one year, the success rates of ART restorations in the primary teeth were 96.6% for ChemFlex restorations and 89.7% for Fuji IX GP restorations placed in the Class I cavity preparations, whereas only 46.2% (ChemFlex) and 61.5% (Fuji IX GP) of Class II restorations were assessed as clinically satisfactory. In the permanent dentition, the success rates were 94.6% and 98.2% for ChemFlex and Fuji IX GP, respectively; however, there was no statistically significant difference between the two restoratives for either the permanent or primary teeth. The mean occlusal wear after one year in the permanent teeth was 53.2 microns for ChemFlex and 56.3 microns for Fuji IX GP. Again, there were no statistically significant differences in wear between the two materials (P > 0.05). CONCLUSION: The clinical performance of both ChemFlex and Fuji IX GP over a 12-month period was highly satisfactory and completely adequate for the ART technique, particularly in Class I cavities.