The present study used a novel approach to assess the relationship between untreated caries lesions and defective and non-defective dental restorations and the incidence of gingival inflammation and the progression of chronic inflammatory periodontal diseases at the approximal surfaces of posterior teeth and at the adjacent surface of the neighboring tooth in adolescents over a period of 3 years. Two hundred-twenty-seven (227) 13-year-old schoolchildren were examined clinically and radiographically at baseline and annually at three subsequent occasions. At each site the alveolar bone height and presence of gingival bleeding were assessed. Incipient caries lesions, manifest caries, and defective and non-defective restorations were identified at the same site and also at the adjacent approximal tooth surface at all examinations, both clinically and radiographically. The data were analyzed by the multi-level logistic regression and variance components analyses. On average, 32, 8.5, 7, and 10% of the sites, respectively, were diagnosed as having incipient caries, manifest caries, and defective and non-defective restorations. There was a significant association between the presence of untreated manifest caries lesions, non-defective and defective dental restorations, and the progression of periodontal support loss. Also there was an association between presence of defective restorations and manifest caries and the incidence of gingival inflammation. Consistently, factors detected at the involved site and at the adjacent site had significant effects. The present study indicates that untreated cavities and dental restorations are predisposing factors with a significant negative effect on periodontal health in adolescents.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of two oral hygiene training programs on the control of plaque and the prevention of gingival inflammation in adolescents was evaluated during a 3-year period. A population of 227 Brazilian schoolchildren were divided into 3 groups. The first group received a comprehensive program based on individual needs and included information sessions pertaining to the etiology and prevention of dental diseases together with extensive training in self-diagnosis and oral hygiene. In addition, an information session was arranged for parents and teachers of these children. The second group received a less comprehensive program consisting of conventional oral hygiene training. The third group (control) received no preventive program. The programs were presented through frequent initial training sessions ensued by infrequent follow-up visits. During the experimental period, the two oral hygiene training programs involved 3.5 and 1.5 hours per child, respectively. The children were examined clinically at baseline and annually over the next 3 years to assess plaque and gingival bleeding and the data were analyzed by a multi-level variance component analysis. All children showed a perpetual improvement in their oral hygiene and gingival state during the course of the study. However, the improvements observed in the comprehensive group were significantly better than that of the control group. Results from the less comprehensive group were not significantly different from the control group. Longer exposure to the programs appeared to produce more improvement; children with higher plaque and gingivitis scores prior to the program showed less favorable results; girls exhibited better results than boys.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied the periodontal disease progression and the relationship between some forms of destructive periodontitis in a group of Brazilian adolescents with high prevalence of periodontal destruction, and evaluated the adequacy of reducing data by limiting the measurement of disease to first molars and by aggregating and pooling site-scores into subject-level scores. Over a period of 3 years 222 adolescents were examined annually by bite-wing radiographs. Individuals displaying arc-shaped bone lesions adjacent to greater than or equal to 2 first molars were diagnosed as juvenile periodontitis (JP) patients, while those with greater than or equal to 1 first molars showing vertical lesions were regarded as periodontal risk subjects. Teenagers with greater than or equal to 2 first molars exhibiting longitudinal bone loss were defined as high-risk patients. At the ages of 13 and 16 years, 3 (1.3%) and 4 (1.8%) subjects had JP, while 12 (5.4%) and 28 (12.6%) were regarded as periodontal risks; 8 (3.6%) subjects were assigned to the high-risk group; 4 (1.8%) 13-year olds had greater than or equal to 1 first molars missing; hence, no loss of posterior teeth occurred over a period of 3 years. Analyzing the data at the site-level revealed progressive loss and little fluctuation in the alveolar bone height in the high-risk group, and a more pronounced bone loss at the mesial than at the distal surfaces. Simpler data sets were constructed by aggregating some of the site-scores or by pooling these into subject-level scores.(ABSTRACT TRUNCATED AT 250 WORDS)

This study evaluated the effects of a new oral hygiene training program on approximal caries in a population of 12-13-year-old Brazilian schoolchildren with a well-established habit of daily toothbrushing with a F dentifrice. Two hundred twenty-two children were randomly allocated into two test groups (I and II) and one control group (III). Group I subjects were trained to establish needs-related oral hygiene habits based on self-diagnosis and a new behavioral principle, the 'linking method', for establishment of habits. The first three visits (20 minutes each) were scheduled at two-day intervals. They were recalled for a monthly check-up during the first 4 months, and then every 3 months for reevaluation of the results based on self-diagnosis. Group II subjects were recalled at the same intervals for detailed oral hygiene instruction on how to clean every tooth surface using dental tape, toothbrush, and fluoride dentifrice. Group I developed significantly fewer (p < 0.001) new approximal manifest (dentin) caries lesions than groups II and III. The mean values (SEM) were 2.3 (0.29), 4.7 (0.59), and 5.3 (0.68), respectively. The conclusions from our study are: In a toothbrushing population using fluoride dentifrices and fluoridated drinking water, the oral hygiene training program with behavioral modification significantly reduced caries incidence on approximal surfaces. Frequent repetition of training in meticulous oral hygiene is almost redundant.

The effect upon dental health knowledge and dental health behavior of a comprehensive and a less comprehensive preventive program was compared in a 3-yr follow up study. The comprehensive program included active participation of the students and parental involvement. The study group consisted of 186 Brazilian schoolchildren 13 yr of age at the start of the program. A reference group from another school of similar socioeconomic level was included in the analyses. The data were collected from questionnaires filled in by the children under surveillance after the completion of the program. Significant differences in knowledge as well as in reported behavior were observed. The children enrolled in the comprehensive program in general scored higher in dental health knowledge than did those in the less comprehensive program. However, the latter group of children seemed to have acquired more correct knowledge during the period than had the control and reference children. Similar results were obtained concerning reported dental health behavior.