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In a collaboration between the Dutch and Indonesian Dental Associations a system for oral health care for multiple handicapped children was initiated in a large care and rehabilitation institution in Jakarta, Indonesia. Part of the project was to develop a programme for oral health and hygiene education (OHE), with a specific plaque control component. This programme was aimed not only at the handicapped children but also at their parents and the teaching and (para) medical staff of the institution. A study to investigate the feasibility, acceptability and effectiveness of the OHE programme was carried out over a period of 2 1/2 years. The programme was well accepted, effective and of clinical significance. It is probably one of the first of its kind in a developing country.

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There is no reason to believe that periodontal diseases in industrialised and developing countries are in principle different. That is, not in the sense that the problem is caused by a different set of periodontal diseases, with different micro-organisms and a different natural history, needing a different approach towards prevention and treatment. Indeed, from a public health perspective the relative similarities in periodontal conditions around the world are far more striking than the differences. The view that periodontal diseases are a much more prevalent and a severe problem in the developing countries seems to be true only in terms of poorer oral hygiene and considerably greater calculus retention, already at a young age, but not so clear for periodontal destruction in adults.

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The purpose of this study was to investigate the relationship between clinical parameters and periodontitis in a population receiving no regular prophylactic dental care. From a sample of 164 adult rural and urban Tanzanian subjects aged between 30 and 44 years, 16% were identified with periodontitis according to the criteria that at least three teeth had a probing depth > or = 6 mm. Subjects with periodontitis in this sample exhibited a much higher bleeding tendency (at sites where periodontal pockets and did not exist) than subjects without periodontitis, but dental plaque scores were comparable. Sensitivity and specificity values and odds ratios indicated a strong association between bleeding on probing and the presence of periodontitis. This may indicate that people from a population deprived of regular dental care with a high tendency of bleeding on probing are more prone to develop periodontitis. Whether bleeding on probing could serve as a marker in this population to identify subjects who develop future periodontal destruction has to be explored through further longitudinal studies.

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This study was conducted on 10 anterior and premolar teeth that were scheduled for endodontic treatment. After length of tooth determination, a series of test K-file handles were locked at lengths varying from 3 mm short to 0.5 mm long of the foramen. Samples of impedance were taken at each length with a digital signal processor at six different frequencies and for each of seven different irrigants or canal conditions. A total of five different root canal irrigants were used in each tooth (RC Prep, 70% isopropyl alcohol, 14.45% EDTA sodium solution, normal saline, and 5.25% NaOCl), along with two variations of a dry canal. The greatest impedance changes occurred +/- 0.25 mm from the foramen. No significant difference was noted in prediction error at different frequencies (p > 0.05); however, prediction error was significant with respect to different irrigants (p < 0.02). Conductive irrigants demonstrated less change of electrical characteristics with length than nonconductive irrigants, thus allowing a greater prediction of file position in relation to the foramen using electrically nonconductive irrigants.

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The Intercountry Centre for Oral Health opened in Chiangmai, Thailand, in November, 1981. In 1984, as part of its mandate to promote new approaches to the delivery of oral health care, it initiated a demonstration project known as the Community Care Model for Oral Health. Logistic, financial and organisational difficulties prevented the full implementation of the original plan. Nevertheless, consideration of the strengths and weaknesses of the Model has provided valuable suggestions for adoption by national and international health agencies interested in adopting a primary health care approach to the delivery of oral health services. Important features which could be appropriate for disadvantaged communities include: integration into the existing health service infrastructure; emphasis on health promotion and prevention; minimal clinical interventions; an in-built monitoring and evaluation system based on epidemiological principles, full community participation in planning and implementation; the establishment of specific targets and goals; the instruction of all health personnel, teachers and senior students in the basic principles of the recognition, prevention and control of oral diseases and conditions; the application of relevant principles of Performance Logic to training; and the provision of a clear career path for all health personnel.

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Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.

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This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.

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Periodontal conditions were assessed by CPITN and loss of attachment in 601 elderly people randomly selected in Kitakyushu, Japan. The percentage of edentulous persons was 21 per cent, 38 per cent and 65 per cent in the 65-74 year, 75-84 year and 85 years and older groups, respectively. In dentate persons, over 60 per cent had pocket probing depths of 4mm or more; in the majority loss of attachment did not exceed 5mm. The mean numbers of sextants with pocket probing depths of 4-5mm (CPITN 3) and probing depths of 6mm and more (CPITN 4) were similar in each age group. The mean numbers of sextants with both pockets and loss of attachment showed no clear difference among groups. Only the mean number of excluded (no, or only one tooth) sextants increased with increasing age from 1.9 to 3.1. It could therefore be suggested that in the population examined the progress of periodontal destruction with increasing age might not be shown by an increase in pocket probing depth, loss of attachment or gingival recession, but only by an increase in tooth loss. The results for the remaining teeth show that a) severe loss of periodontal attachment (6mm or more) was not frequently encountered, b) recession (attachment loss without pocketing) was present at only very low levels, c) the main periodontal problem seemed to be pocketing, which could be treated. It is therefore tempting to suggest that some of the teeth already lost, could have been saved if proper self- and professional care had been applied.

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The general acceptance and use of the CPITN system worldwide has provided, in a very short time, a vast amount of data on periodontal diseases. This data has been entered into the WHO Global Oral Data Bank, from which, after analysis, much valuable information has been derived. Overall the CPITN system is seen as having more than fulfilled the initial hopes invested in it. It has provided a simple yet effective method for measuring and monitoring the magnitude, prevalence and severity of periodontal diseases throughout the world, as well as helping in our understanding of the disease process.

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Extraction is the most common dental treatment provided for people in rural and suburban areas in many less-industrialised countries. By comparison, restorative care is rarely provided. In order to improve such situations, a treatment technique has been developed based only on hand excavation of carious lesions and using glass-ionomer cement as a filling material and a sealant. This Atraumatic Restorative Treatment (ART) technique follows the concept of minimal intervention and does not require electrically driven equipment. This paper reports on the longevity of fillings and sealants placed using the technique under field conditions in rural Thailand. Dental caries was treated using the ART technique in one village, whilst the population in a second village received restorative care (amalgam fillings) through mobile dental units. A third village was the control. After one year, 79 per cent of single surface ART fillings and 55 per cent of ART fillings of greater than one surface placed in deciduous teeth were judged successful. The success rate of ART fillings in the permanent dentition (mainly single surface fillings) was 93 per cent and the retention rate for sealants was 78 per cent. Children were pleased at having received treatment by this technique and showed little fear. The ART technique is a promising caries treatment procedure for use in rural and sub-urban areas in less-industrialised countries.

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In 1985 the Health Department of the Italian Telephone Company decided to launch an oral health programme for all its employees and their relatives, with the collaboration of the WHO Collaborating Centre of the Clinica Odontoiatrica Ospedale S. Paolo, Milan. The programme started with an epidemiological survey of dental and periodontal condition; following data analysis, the company also contracted with private dentists to provide oral care. Four years later, in 1989, several studies were set up to evaluate the programme. The WHO Collaborating Centre Milan was requested to evaluate the periodontal care given to a sample of persons living in the Milan area. Seventy-seven individuals with established periodontal lesions were selected out of a group of 678 aged between 35 and 44 years examined in 1985. The same periodontal and dental indices used in 1985, CPITN (Community Periodontal Index of Treatment Needs) and DMFT (decayed, missing, filled teeth), were re-evaluated in these 77 persons and information about any periodontal care since 1985 was collected and checked against the reimbursement records of the Telephone Company. There was an increase in the percentage of persons with deep pockets (from 55.8 to 72.7 per cent), and of the mean of sextants affected (from 0.9 to 1.9). These individuals had been treated for dental problems, as demonstrated by an increase in the F component and a reduction of the D component of the DMFT, but had undergone virtually no treatment for periodontal problems. This may be considered as a longitudinal study on the natural progression of periodontal pathology in individuals with established periodontal lesions.

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Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.

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A CPITN survey was conducted on 1958 institutionalised elderly people aged 59 years and older at 29 of the 30 public and private institutions in the city of Kitakyushu, Japan. About 60 per cent of the sample was edentulous, and the prevalence of periodontal conditions was high. The percentages of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets were 3, 4, 32, 52, and 9 per cent respectively. Half the sextants in the dentate subjects were scored as excluded (less than two teeth), indicating that many teeth were missing. Only very few sextants were healthy. These findings indicate the importance of preventive programmes for periodontal diseases in the younger generations, because (a) dental care for the elderly population becomes more difficult with increasing age and (b) periodontal care, if it is available at all, is provided too late for most people.

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The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15-19 years and 35-44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5-15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other diseases.

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Results of more than 100 CPITN surveys from over 60 countries for the age group 15-19 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the mean number of sextants affected per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. The most frequently observed condition in adolescents was score 2 (calculus with or without bleeding). Calculus seems to be much more prevalent in non-industrialized than in industrialized countries. Although some shallow pocketing of 4 or 5 mm was present in two-thirds of all populations observed, it affected mostly only a minority of the sample and then only in one or two sextants. However, a few surveys showed a relatively high prevalence of pocketing. As the surveys were carried out in adolescents, such high figures indicate serious problems ahead.

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Results of almost 100 CPITN surveys in more than 50 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the percentages of persons according to the highest score per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. Calculus and shallow pocketing were the most frequently observed conditions. With a few exceptions, the percentages of persons and the mean number of sextants per person with deep pockets were small to very small. The assumed differences between industrialized and non-industrialized countries with regard to periodontal health were not reflected in the survey data examined. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before the age of 50. For the large majority in most of the populations observed, the progress of periodontal diseases seems to be compatible with the retention of a natural dentition into older age. Nevertheless, the periodontal problem is of considerable magnitude and importance, as 5-20 per cent of populations are affected by a serious, irreversible condition at the age of 40, which is a high percentage compared with almost every other disease that afflicts mankind.

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The extend and severity of periodontal diseases in The Netherlands are discussed using data of a large epidemiologic oral health survey in 1986. The perspective on treatment is presented with some notes on the basic issues in health and disease. The often heard statement, that the periodontal disease problem is much more severe in developing countries compared with the industrialized countries, could not be confirmed.

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In a stratified multi-stage random sample, 1600 persons of 60 years and older in Shanghai, People's Republic of China, were investigated for periodontal conditions using the CPITN method. Periodontal conditions seemed to deteriorate steadily but rather slowly with increasing age. In the older age groups, there was a trend for an increased proportion of both subjects and sextants scoring CPITN code 4 (deep pockets). The increase in tooth loss with increasing age was more clearly visible: increasing percentages of edentulousness and decreasing mean numbers of teeth remaining in dentate subjects.

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