OBJECTIVE:To compare the scoring of dental fluorosis by experienced examiners from digital photographs using the TF index. BASIC RESEARCH DESIGN:120 images were selected from 703 photographs obtained during a clinical trial (Tavener et al., 2004). The selection process was stratified so that the full range of defects seen in the main study was included. The children, aged 8-10 years, were from deprived areas of Manchester, England with fluoride levels in the drinking water of less the 0.1 ppm F. The photographs of the upper and lower anterior sextants were taken after cleaning and drying the teeth. The examiners were identified by searching Medline for individuals who had previously used the TF index or had experience of scoring dental fluorosis. Of the 12 examiners identified, 10 agreed to take part. Each examiner was provided with identical CDs containing a PowerPoint presentation of the images. Twelve images were duplicated and interspersed amongst the 120 images to assess intra examiner agreement. Each examiner was also supplied with a table listing the criteria and illustrations for each of the TF index scores (Fejerskov et al., 1988). RESULTS:The prevalence of fluorosis (TF > 0) amongst the 10 examiners ranged from 43% to 70% and from 2% to 13% for the more severe scores (TF 3 or 4). Paired agreements amongst subject scores for the 10 examiners, measured using a weighted Kappa score, ranged from 0.40 to 0.71. CONCLUSION:It is concluded that although the criteria for the TF index are well defined, it is possible that examiners may interpret the criteria in different ways and conditions in which images are viewed may need to be standardised. This study may explain some of the differences in the prevalence and severity of fluorosis reported in different studies. There is a need to standardise the methods used to score dental fluorosis.

Peroxide gels are effective in changing tooth colour but their effect on restorative materials has been poorly studied. The purpose of this investigation was to assess the impact of a commercially available whitening gel containing hydrogen peroxide and a sodium percarbonate formulation on the surface of restorative materials. A total of 12 subjects participated in a double-blinded crossover study. Each wore an intra-oral appliance containing five bovine enamel blocks restored with amalgam, posterior composite, microfilled composite, glass ionomer cement and porcelain. Appliances were worn continuously for 14 days and whitening products were applied twice daily. After 14 days the appliances were removed and values for roughness (Ra) were obtained using atomic force microscopy. Mean values of Ra were assessed between baseline and 14 days, and although minor variations were seen, there were no statistically significant differences detected for any material or any whitening product.

The ability to monitor longitudinally the development, arrest or resolution of early demineralised lesions is one strength of quantitative light-induced fluorescence (QLF). When taking sequential images of an individual’s teeth for monitoring it has been suggested that the subsequent images should be taken from the same position the baseline image. To assist in this process, video repositioning software is available that enables automatic capture of images once the system identifies that they are similar enough to the baseline comparator. The purpose of this study was to determine if the use of such software-assisted capture improves the reliability of subsequent QLF analysis. 20 subjects had 34 surfaces (buccal and occlusal) imaged by 2 examiners at baseline, and again 1 week later using both manual and software-assisted (VidRep) systems. Analysis of the three key reportable values for QLF (ΔF, lesion area, ΔQ) suggested that there is no significant improvement in reliability using VidRep although VidRep demonstrates additional advantages above and beyond image geometry, relating to the speed of subsequent image analysis.

This study compared fluorosis in the upper central incisors of children from socially diverse backgrounds who had received either 440- or 1,450-ppm F toothpaste from 12 months of age. The children were resident in non-fluoridated districts in the north-west of England. They received either 440- or 1,450-ppm F toothpaste and advice regarding its use until the age of 5–6 years. Dental fluorosis (TF index) was assessed on digital images of dried teeth when the children (n = 1,268) were 8–10 years old. In the less deprived districts the prevalences of fluorosis (TF ≧0) for the 1,450- and 440-ppm F groups were 34.5 and 23.7% (p = 0.006). In the deprived districts the prevalences of fluorosis were 25.2 and 19.5% (p = 0.2). Overall the prevalences of TF ≧2 were 7 and 2.1% for the 1,450- and 440-ppm F groups and 2.2 and 0.2% for TF ≧3. These differences were statistically significant (p < 0.003). There was a strong association between the deprivation status of wards and fluorosis. Only 1 subject with a TF score of 3 was identified in the two most deprived quintiles of the Townsend score. It is concluded that careful targeting of programmes of this type to children living in high caries risk deprived communities carries only a small risk of aesthetically objectionable fluorosis (TF >2) whether low or high fluoride toothpastes are used. High fluoride (1,450 ppm F) toothpastes should not be provided on a community basis to very young children in less deprived communities.

Objectives. To quantify the temperature increments in a simulated dental pulp following irradiation with an Er:YAG Laser, and to compare those increments when the laser is applied with and without water spray.Methods. Two cavities were prepared on either the buccal. or lingual aspect of sound extracted teeth using the laser. One cavity was prepared with water spray, the other without and the order of preparation randomised. Identical preparation parameters were used for both cavities. Temperature increments were measured in the pulp chamber using a calibrated thermocouple and a novel. pulp simulant.Results. Maximum increments were 4.0degreesC (water) and 24.7degreesC (no water). Water was shown to be highly significant in reducing the overall temperature increments in all cases (p < 0.001; paired t-test). None of the samples prepared up to a maximum of 135 J cumulative energy prepared with water spray exceeded that threshold at which pulpal. damage can be considered to occur. Only 25% of those prepared without water spray remained below this threshold.Discussion. Extrapolation of the figures suggests probably tolerable limits of continuous laser irradiation with water in excess to 160 J. With the incorporation of small breaks in the continuity of Laser irradiation that occur in the in vivo situation, the cumulative energy dose tolerated by the pulp should far exceed these figures.Conclusions. The Er:YAG Laser must be used in conjunction with water during cavity preparation. As such it should be considered as an effective tool. for clinical use based on predicted pulpal responses to thermal. stimuli. (C) 2003 Elsevier Ltd. All rights reserved.

OBJECTIVE:To determine the effectiveness of providing free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-old children living in areas with different levels of material deprivation.DESIGN:Five-year, examiner-blind, randomized, controlled, parallel-group, clinical trial. Children were randomly assigned to three groups.SETTING:Health Districts in the north-west of England with high levels of dental caries. Clinical examinations were performed in schools during the period October 1999 to April 2000 when the children were 5-6 years old.PARTICIPANTS:Children from 3-month birth cohorts resident in nine, nonfluoridated health districts.INTERVENTIONS:Toothpaste containing either 440 or 1450 ppm F and dental health literature posted at 3-month intervals and toothbrush provided annually from the age of 1-5 years. Comparison group received no intervention.MAIN OUTCOME MEASURES:Mean dmft and proportion of participants with dmft > 0, dmft > or = 4, upper primary incisor caries and extraction of one or more primary teeth. Outcomes tabulated for quartiles of participants based on the distribution of the Townsend index of material deprivation.RESULTS:A total of 3467 children were included in the final data analysis. The Townsend index was found to be useful in identifying groups of children with increased caries risk. Overall, participants in the programme using the high-fluoride toothpaste had significantly (P < 0.002) less caries than the comparison group with similar absolute reductions in mean dmft for the most- and least-deprived groups. Relative to the comparison group the association between deprivation and dental caries was changed so that in the most-deprived quartile those using the low-fluoride toothpaste tended to have less dental caries than the comparison group whereas in the least deprived they tended to have more. This difference in the association (slope) was statistically significant (P < 0.05). Provision of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions for participants in the most-deprived quartile (P < 0.05).CONCLUSION:The relative benefits of the programmes supplying the two toothpastes considered in this study are different depending on the deprivation status of the participants. For the most-deprived groups postal provision of either a low- or high-fluoride toothpaste provides similar levels of benefit. In the less deprived groups only provision of the high-fluoride toothpaste provided a benefit. The absolute caries reduction seen for provision of the high-fluoride toothpaste was not related to the deprivation status and hence the programme did not reduce deprivation-related health inequalities. Targeting the programme using the methods employed in this study is unlikely to improve the effectiveness of the programme.

Orofacial pain is often persistent, but it is not clear why it lasts in some patients but not in others. We aimed to describe the natural course of orofacial pain in a general population sample over a four-year period and to identify factors that would predict the persistence of pain. A cross- sectional population- based survey was conducted in the United Kingdom, involving 2504 participants ( participation rate 74%), of whom 646 ( 26%) reported orofacial pain. Overall, 424 ( 79% adjusted participation rate) of these individuals participated at the four- year follow- up, of whom 229 ( 54%) reported orofacial pain and 195 ( 46%) did not report such pain. Persistent orofacial pain was associated with females, older age, psychological distress, widespread body pain, and taking medication for orofacial pain at baseline. These findings may have implications for the identification and treatment of patients with orofacial pain.

OBJECTIVE:To assess the cost effectiveness of a postal toothpaste programme to prevent caries in 5-year-old children in the north west of England.PARTICIPANTS:Birth cohorts of children aged 12 months were recruited from high caries risk populations in nine health districts.DESIGN:The results of a randomised controlled trial to measure the effects of a postal toothpaste programme are used and related to the costs of running a similar programme. Children in the trial received free toothpaste on four occasions a year and a toothbrush once a year for four years from age 12 months to 5 years. When aged 5-6 years children were examined by trained, calibrated examiners using BASCD standards. Those who received toothpaste containing 1450 ppm F were found to have a significantly lower mean dmft than those who had not. The costs that would be incurred by a public dental service running such a postal toothpaste programme are identified, measured and related to the likely health improvement that could be achieved.MAIN OUTCOME MEASURES:The cost per tooth saved and the cost per child saved from caries experience and extraction experience.RESULTS:The estimated cost per tooth saved from carious attack was pounds sterling 80.83 and the cost per child of preventing caries experience was pounds sterling 424.38 and avoiding any extractions was pounds sterling 679.01. Analysis resulted in an overestimation of costs and underestimation of benefits.CONCLUSION:The programme achieved a significant caries reduction in children who received the 1450 ppm F toothpaste and the costs are now available to those considering provision of treatment services in areas where children are at high caries risk.

OBJECTIVE:To describe the health care seeking behaviour associated with orofacial pain (OFP) and determine factors associated with such behaviour.DESIGN:Cross-sectional population-based study using postal questionnaires.PARTICIPANTS:Adults aged 18-64 years from a general medical practice in south-east Cheshire, UK (participation rate 74%).RESULTS:Of the 2,504 respondents to the questionnaire 646 reported OFP, of whom 555 (86%) indicated whether or not they sought professional help. A total of 255 (46%) responded that they had sought advice. The majority had sought advice from their medical practitioner (57%) or dentist (51%), and 64% had taken medication because of OFP. The likelihood of seeking treatment increased linearly with age (p < 0.001) while gender, education and psychological distress did not show a significant association with seeking treatment. Persons who were regular dental attenders had an increased likelihood of seeking treatment for OFP (RR 1.4; 95% CI 1.1,1.8). Perception of illness had moderate association with healthcare seeking (RR 0.8; 95% CI 0.7,0.96). There was a significant trend of increasing RR with increasing total number of pain symptoms (p < 0.001), frequency of pain, duration of pain episodes, pain intensity and disability associated with pain. Participants who reported pain duration of more than three months had almost double the likelihood (RR 1.8; 95% CI 1.4,2.3) of seeking treatment. Decrease in self-reported control over pain and ability to decrease pain were both associated with an increased likelihood of seeking professional care (p < 0.001).CONCLUSIONS:The strongest predictors of health care seeking behaviour were different characteristics of pain.

Objectives. The aetiology of orofacial pain (OFP) is not well understood. We aimed to determine the relationship between OFP and local mechanical factors in an unselected general population sample.Methods. A cross-sectional population-based survey was conducted in the United Kingdom, involving 2504 participants (adjusted participation rate 74%). Postal questionnaire was used to collect information on OFP and local mechanical factors.Results. A significant association was found between OFP and a history of tooth grinding, facial, trauma, the jaw getting stuck or locked, a clicking or grating sound in the jaw joint when opening or closing the mouth, difficulty in opening the mouth wide, and chewing of pens or biting finger nails. The jaw getting stuck or locked had the highest relative risk of 2.7 (95% Cl: 2.3-3.2). A history of orthodontic treatment, having any type of dentures and using chewing gum were not associated with OFP. There was some evidence of heterogeneity between types of OFP and local mechanical factors.Conclusions. Local factors play an important role in the aetiology of OFP. (C) 2003 Elsevier Ltd. All rights reserved.

Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacial pain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population-based cross-sectional survey in the South-East Cheshire area of the United Kingdom involving 2504 individuals aged 18–65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread body pain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P<0.001). Several oral mechanical factors were significantly associated with both orofacial pain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of the process of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region.

Objective. The observation of higher rates of chronic widespread pain, the cardinal feature of fibromyalgia, in women has led to hypotheses about the role of sex hormonal factors in the aetiology of symptoms. There is little available evidence from epidemiological studies on their importance or role.Methods. A population postal survey was carried out involving 1178 female participants living in south-east Cheshire in the north-west of England.Results. Amongst pre- and peri-menopausal women, the risk of chronic widespread pain was unrelated either to the length of the menstrual cycle or the usual length of period reported by participants. Risk was similar in current users and non-users of the oral contraceptive pill, and amongst users there was no relationship with duration of use. However, the reporting of chronic widespread pain showed a relationship with total score on a premenstrual symptom questionnaire. However, this relationship was explained by pain symptoms. Amongst post-menopausal women, reporting chronic widespread pain was not related to age at menopause. An increased (but non-significant) risk of chronic widespread pain was associated with current hormone replacement therapy (HRT), which may be a consequence of HRT being prescribed for menopausal symptoms.Conclusion. This study, conducted on a large unselected population, has not demonstrated an association between sex hormonal factors and chronic widespread pain.

STUDY OBJECTIVE To determine the prevalence of oro-facial pain (OFP) in the population and within-population subgroups and to describe the associated disability. DESIGN Cross-sectional population study. SETTING General medical practice in South East Cheshire, United Kingdom. PARTICIPANTS A random sample of 4000 adults aged 18-65 years of whom 2504 responded (adjusted participation rate 74%). MAIN RESULTS The overall prevalence of OFP was 26% (95% Confidence Interval (CI) 24%, 28%). The prevalence of symptoms was higher in women (30%) than in men (21%) and in both sexes the highest (30%) prevalence was found in the 18-25 year age group and the lowest (22%) in the 56-65 age group. Of all the participants, 12% had pain in or around the eyes, 10% reported pain in and around the temples, 6% pain in front of the ears and 6% pain in the jaw joints. Only 46% of the participants with OFP had sought professional advice from a dentist or general medical practitioner and 17% had to take time off work or were unable to carry out normal activities because of pain. CONCLUSIONS OFP is a common symptom experienced by a quarter of the adult population, of whom only 46% seek treatment. The prevalence is higher in women and younger age groups.

The aim of this study was to determine the relationship between the prevalence of oro-facial pain (OFP) in the population and female hormonal factors. The cross-sectional population study was conducted in a general medical practice in the north-west of England. A random sample of 4000 adults aged 18-65 years were mailed questionnaires, of whom 2504 responded (adjusted participation rate 74%). Of these 1245 women provided information on both OFP and hormonal factors. For pre- or peri-menopausal women, there was no relationship between oral contraceptive use and OFP (age-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.81, 1.45), whilst a high score on a pre-menstrual symptom questionnaire was associated with an age-adjusted RR of 1.87 (95% CI 1.36, 2.57). Those who reported menstruating for 6 days or longer had moderate increase in risk of OFP (age-adjusted RR 1.39; 95% CI 1.01, 1.91). In post-menopausal women, there was a moderate relationship between hormone replacement therapy use and OFP (age-adjusted RR 1.46; 95% CI 1.02, 2.08). For women overall, there was an increased risk of OFP in those who reported ever having had painful periods (age-adjusted RR 1.47; 95% CI 1.20, 1.80), but no association was found with the number of children. This cross-sectional community-based study adds important information on the relationship between female hormonal factors and OFP. Women who report OFP are more likely to report symptoms associated with menstruation. This may indicate either the importance of hormones per se or identify a group of women who are more likely to report symptoms in general.

OBJECTIVE:To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries.DESIGN:Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old.SETTING:A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools.PARTICIPANTS:7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups.INTERVENTIONS:Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years.MAIN OUTCOME MEASURES:The dmft index, missing teeth and the prevalence of caries experience.RESULTS:An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship.CONCLUSION:This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.

. Acid etching is widely used in clinical dentistry to facilitate the mechanical retention of resin-based materials to teeth, in particular enamel surfaces. Several laser systems have been developed with the aim of modifying dental hard tissues and the Er:YAG (λ=2.94 µm) laser may offer a possible alternative to the acid etching technique. This study compares the shear bond strengths of composite beads attached to sound enamel surfaces prepared using either (a) no etching (negative control), (b) acid etching (positive control) or (c) Er:YAG laser etching, either with or without water, at one of three fluences: 15 J/cm 2 , 18 J/cm 2 or 24 J/cm 2 . A histological appraisal was also conducted using environmental scanning electron microscopy (ESEM) techniques. The mean shear bond strength for acid-etched enamel was 16.6 MPa (SD 4.4, n =10), whereas the best laser-etched mean bond strength obtained was 11.5 MPa (SD 4.1, n =11) using a fluence of 24 J/cm 2 with water. These values were significantly greater than those obtained for the negative control (no etching) of 4.4 MPa (SD 0.9, n =8). There was a significant positive correlation between the etching fluence and the shear bond strength, but pitting of the enamel surface at fluences above 25 J/cm 2 limited the maximum fluence for etching purposes. Although Er:YAG laser etching enhanced the retention of a resin-based material to an enamel surface when compared to a negative control, the mean shear bond strengths were significantly lower than those obtained using conventional acid etching. The optimal laser etching parameters in this study were shown to be 24 J/cm 2 in conjunction with water.

most frequently affected by dental caries. In 1987, 88% of the caries in US schoolchildren was found in pit and fissure surfaces and two thirds of the carious or filled surfaces were of the pit and fissure type [Brunelle, 1989]. It has been predicted that by the year 2000, 99% of carious lesions among 5to 17-year-old children will be on the occlusal surfaces [Soderholm, 1995]. With the development of minimal intervention techniques and a more preventive orientated approach to patient care new diagnostic systems are being evaluated for the early detection of occlusal caries. One of the most promising of the new diagnostic systems currently under investigation is the Electronic Caries Monitor (ECM, Borsboom Sensor Technology and Consultancy Group, Westeremden, The Netherlands). This system can be used to screen the occlusal surface of posterior teeth for caries after applying a conducting medium. The use of the ECM has been validated in vitro [Ricketts et al., 1997; Ashley et al., 1998] and has been shown to be accurate for the diagnosis of early occlusal caries. Whilst such in vitro studies provide an estimate of the accuracy of this diagnostic system, the clinical relevance of lesions detected by the ECM has not been established. One way of assessing the relevance of the ECM diagnosis would be to estimate how accurately the ECM predicts surfaces that will subsequently require or receive intervention. Short Communication

Prevotella intermedia- and Prevotella nigrescens-like organisms (PINLO) have been described as organisms which are phenotypically and biochemically similar to P. intermedia and P. nigrescens and the species P. pallens was created to include some of them. Other PINLO groups which do not fit the definition of P. pallens exist, and in this study these 'unidentified' Prevotella sp. were compared with P. corporis, P. intermedia, P. nigrescens and P. pallens using commercial identification kits, GLC, RAPD-PCR and partial 16S rRNA gene sequencing. The Rapid ID 32 A and the RapID ANA II system both identified all 'unidentified' Prevotella as P. intermedia. Similarly they gave this identification to all the species tested (with the exception of P. corporis using the RapID ANA II system) clearly demonstrating biochemical similarities. Gas liquid chromatography (GLC) analysis of the volatile end-products of fermentation could not distinguish between strains. RAPD-PCR using arbitrary primer L10 demonstrated intra-species homogeneity within PINLO strains with amplification profiles which differed from other Prevotella species tested. Cluster analysis of the amplification profiles confirmed species divisions and yielded a distinct 'unidentified' Prevotella cluster. Comparison of partial 16S rDNA sequences displayed 98% sequence similarity between the 'unidentified' Prevotella strains, although 2 strains, HST 1156 and HST 2160 displayed 100% identity. The highest similarity between groups was seen between 'unidentified' Prevotella strains and P. corporis (approximately 94% similarity). The DNA techniques used here confirm that 'unidentified' Prevotella strains are distinct from the other species of Prevotella tested, including P. pallens. Partial 16S rDNA sequence comparisons suggested a close relationship with P. corporis.