The document discusses how people with mental illness are in greater need of oral health care as drug treatments for severe mental disorders can lead to oral dryness, tooth decay, gum disease, dental restorations, and tooth extractions. It also notes that people with severe mental disorders accompanied by avolition can lose motivation to maintain oral hygiene. Finally, it mentions how candies, gums, and drinks used to avoid oral dryness by this population can lead to tooth decay.

1. 7조 통합본(main)

2. 7조 24번 노가연

3.  the use of xylitol to decrease mother-child
transmission of mutans streptococci
 Xylitol promotes mineralization
 non-fermentable by oral bacteria
 decreases counts of mutans streptococci (MS)
as well as the amount of plaque

4.  Some MS strains are inhibited by xylitol
 MS cells are thought to incorporate xylitol as
xylitol-5-phosphate through the major route
of sugar transport
 ―Xylitol effects‖
: 5-7 g xylitol/day, 3 times/day

7.  S.mutans :a major etiological agent of dental
caries
 the study, xylitol chewing gum consumption
was compared with fluoride and
chlorhexidine varnish treatments
colonization percentages
Xylitol 10%
CHX 29%
F 49%

9.  xylitol prevented
enrichment of S.
mutans, while sorbitol
had the opposite effect

10.  a decrease in the amount of plaque in
association with habitual xylitol
consumption
 xylitol gum has been found to be superior
to sorbitol gum in retarding regrowth of
supragingival plaque
 Xylitol doses decreasing MS counts also
reduce the amount of plaque
 ―effective‖ doses of xylitol may not reduce
plaque in individuals with very poor oral
hygiene

11.  Several studies have shown that
xylitolreduces dental plaque as well as the
number of mutans streptococci.
 Xylitol-based caries prevention may be worth
it.

12. 43 이성은

13.  Non- or low-calorgenic sucrose substitute가
현재 캔디, 껌, 음료수 등의 다양한 분야에 사용되
고 있음
 치과의사로서 설탕대체물이 구강건강에 어떠한 영
향을 주는지 알아야함
 여기서는 현재 사용되는 sucrose substitute가 구
강건강과 치아우식예방에 어떠한 영향을 주는지
살펴보도록 하겠다.

14.  In vitro model
 Animal model
 In vivo monitoring of acid production by
human dental plaque bacteria (human plaque
pH method)
 Intraoral cariogenicity tests or
demineralisation

15.  자당대체료는 구강건강을 개선시키는데 사용됨
 즉 무독성, 발암성이 없고 소화작용에 있어 온전해
야함
 다음표는 자당대체료가 무독성임을 나타냄

16. oligos
acchari
de
Sugar alcohol High intensity
sweetener
palatin
ose
xylitol sorbito
l
malitol Sucral
ose
aspart
ame
sweetness 0.42 1.0 0.6-
0.7
0.75-
0.8
600 160
Energy(kcal/g) 4 3 3 2 0 4
Absorption in small
intestine
Almost
all
mostly mostly Partial none none
Absorption in large
intestine
Almost
none
partial partial Almost
compl
ete
None none
Side effect no yes yes Yes no no
Cost(yen/kg) 1000 800 130 300 60000 10000

17. - Regular sweetner를 자당대체물로 바꿨을때,식후
규칙적으로 자당대체물을 함유한 껌을 씹었을때
충치유발억제효과를 나타내었음
- 자당대체물은 무칼로리성이며, 항우식작용을 나타
냄
Mutans streptococci에 의한 자당으로부터의 글루칸 합
성 저해
타액과 치면세균막에서 Mutans streptococci수 감소시킴
완충능력을 증가시키고 치면세균막의 Ph증가시킴
법랑질 탈회억제와 재광화

18.  여러가지 sucrose substitute를 혼합하여 사용시
더 효과적임
(예, aspartame을 maltitol과 xylitol과 함께복용추
천)
 sucrose substitute의 양은 감미료보다 식품보존
료로 사용되는 양이 더 많음
 많은 양의 sugar alcohol은 장 트러불을 일으킬
수 있음

19.  충치유발을 줄이기위해 전문가로부터 무칼로리성
의 감미료가 추천될 수 있음
 새로운 영양이 잡힌 sucrose substitute가 요구됨
 구강건조증은 충치유발을 높이는데 무칼로리성 껌
을 이용해 타액분비를 유도하고 충치유발을 억제
할 수 있음
 식품에 충치예방이라는 라벨링이 표시되는 것을
권장

20.  Sucrose substitutes and their role in caries
prevention, takashi matsukubo, international
dental journal(2006)56,,119-130

21. 폴리클 7조
49번 장혁준

22.  Despite being one of the United States‘ 10 greatest public
health achievements of the 20th century (Centers for
Disease Control and Prevention, 2000), community water
fluoridation receives only qualified endorsement from
some systematic reviews of its effectiveness in preventing
dental caries.
 Children
→ effective, but reluctant to quantify the effect.
(∵poor quality of many studies)
 Adults
→ lack of evidence.
⇒ it hampers the development of health policy.
ex) economic evaluation → no caries-preventive benefit.

23.  Before 1990 (now outdated)
→ fluoridated water was effective only
when ingested prior to tooth eruption
 Will potential benefits be limited to people
born after implementation of fluoridation, or
might there be additional benefits for people
born before implementation?

24.  Effects were compared between the pre-fluoridation
cohort born before 1960 (n=2,270) and the cohort born
between 1960 and 1990 (n=1,509).
 Residential history questionnaires determined the
percentage of each person‘s lifetime exposed to
fluoridated water.
 Examiners recorded decayed, missing, and filled teeth
(DMF-Teeth) and decayed and filled tooth surfaces (DF-
Surfaces).
 Socio-demographic and preventive dental behaviors were
included in multivariable least squares regression models
adjusted for potential confounding.

25.  The exposure of interest was proportion of lifetime
exposure to fluoridated drinking water.
 The fluoridation database (Australian Research Centre
for Populaiton Oral Health) registers fluoride
concentarations for 99.4% of the Australian
population.
 <0.3 ppm F = 0
0.3 ~ 0.7 ppm F = 0.5
≥0.7 ppm F = 1.0
 The number of years at each concentration was
multiplied by the concentration.

30. M. Bravo, J. Montero, J.J. Bravo, P. Baca and J.C. Llodra
16번 김은혜

31.  Little is known about the effect of
discontinuation of sealant or fluoride varnish.
 The purpose of this study was to compare
sealant with fluoride varnish in the prevention
of occlusal caries in permanent first molars of
children over a nine-year period: 4 yrs for
program evaluation plus 5 yrs of
discontinuation.

36.  Results of the active period of the project at both
24 and 48 mos indicated that both treatments
were effective, and that the sealants performed
better than the varnish.
 Furthermore, the caries reduction figures up to
48 mos were within the published range of
pooled preventive fractions in available meta-
analyses.
 The same conclusions apply to the nine year
results, with a higher loss in preventive effect for
varnish (43.9% at 4 yrs and 27.3% at 9 yrs) vs.
sealant (76.3% at 4 yrs and 65.4% at 9 yrs).

37.  The long-term success, measured by
retention and caries prevention, of second-
generation (chemically cured) fissure sealants
has been well-documented.
 However, to our knowledge, 9 yrs is the
longest follow-up period to date in a study of
caries reduction with a third-generation
(visible-lightcured) sealant or fluoride varnish,
although comparisons of varnish with other
studies should be interpreted with caution
because of the 5 yrs of discontinuation

38. 45 이용진

46. Main journal
7조 44번 이시은
Inlernalional Dental Journal (2001) 51,
399406

47.  The Vipeholm studies were published
showing that sugar eaten in the form of large
toffees between meals resulted in severe
damage to the teeth.
 However, consumption of sugar even at high
levels was not importantly associated with
increased damage when the sugar was taken
up to four times a day with meals.
 It was also concluded that carious lesions
occurred despite avoidance of sugar.

48.  Another study showed the importance of the
length of time that is given to the teeth to
remineralise as a determinant of the amount
of caries which develops.
 Bowen concluded that it is not necessarily the
frequency of ingestion of sugars that is
related to development of caries, but the
duration that sugars are available to
microorganisms in the mouth.

49.  The report mentioned that population
analyses suggest that less than 18kg per
person per year of sucrose intake is linked to
lower rates of dental disease.

52.  It is impossible to see a threshold level in
these data.

54.  These data do suggest that there is a decline
of caries prevalence in Japan, concomitant
with the increase of the use of fluoride
toothpaste

56.  The steep increase in the number of caries
free children occurred when fluoride became
available.
 In this period, sugar consumption was
continuously high.

57.  Retention of food, food impaction, the
presence of fluoride and the age of dental
plaque are all strongly related to oral hygiene.

58.  Bratthal proposed three factors, bacteria, diet
and susceptibility to disease contributing to
the development of caries.
 most of the criteria are not easily diagnosed,
cannot be influenced and are not site-specific.

60.  Caries prevalence in many EU countries has
declined, while the sugar consumption per
person per year has remained approximately
stable.
 The decrease in caries prevalence is primarily
attributed to increased exposure to fluorides
(toothpastes) and improved oral hygiene
techniques

61. 7조
10번
김범호

62.  Numerous chemical factors, such as pH,
titratable acidity, degree of saturation, kind
of acid, and chelating properties, have been
identified to influence the erosive potential of
acids.

63.  However, compared with the chemical factors,
limited information exists about the effects of
the physical or physico-chemical aspects of
the acid on dental erosion.

64.  Therefore, the aim of this in vitro study was
to investigate the effects of viscosity changes
of different acidic solutions on dental erosion.
The null hypothesis was that the erosivity of
citric acid and phosphoric acid at different pH
values is not affected by their viscosity.

65.  Citric acid (CA) and phosphoric acid (PA)
solutions at pH levels of 2.5, 3.0, and 3.5
were used.
 CA solutions at pH 2.5, 3.0, and 3.5 were
obtained by the addition of 2.81, 3.3, and
4.17 g/L (Fluka, Buchs, Switzerland),
respectively, to de-ionized water.

66.  PA solutions at the respective pH values were
obtained by the addition of 30.5, 109.3, and
110.3 mL/L, respectively from a 3 mol/L
stock solution (Merck, Darmstadt, Germany)
to de-ionized water.

67.  The kinetic viscosities of the acidic solutions
were adjusted to 1.5, 3, 6, 12, and 24
mm2/sec, respectively, by the addition of
hydroxypropyl cellulose (HPC, Grade LM, HPC,
Nippon Soda Company, Tokyo, Japan) at
different concentrations.

68.  The respective acidic solutions were dropped
from a reservoir into an inclined (45°) channel
which was made from polyvinyl chloride (8
mm in length) at a flow rate of 1 mL/min,
which directed the acidic solutions over the
surface of an enamel specimen (Fig. 1).

69.  Figure 1. Flow incline
allowing for rinsing 8
specimens in parallel.
 (a) Plastic tubes
attached to the pump
(internal diameter, 3
mm).
 (b) Acid drops.
 (c) Inclined U-form
channel (depth, 0.68
mm; width, 2.00 mm).
 (d) Enamel sample

70.  Enamel loss by CA and PA at different viscosities.

71.  We have shown that the erosive potential of
acids is dependent not only on various
chemical properties, such as pH, but also on
the viscosity of the acidic solution.

72.  Since the erosive enamel loss decreased with
increasing viscosity, it can be assumed that
the relative stickiness of the acid solutions
with higher viscosity decreased the ion
exchange and clearance of dissolution
products.

73.  At a higher viscosity, this static layer might
be thicker and less undersaturated, so that
enamel erosion decreased.

74. Effects of an Oral Health
Promotion Program in People
with Mental Illness
Journal of Dental Research, Jul 29, 2009
74
5번 권오인
폴리클 7조
F. Almomani, K. Williams, D. Catley and C.
Brown

75. I. Introduction
75
1. 장애인들은 구강질환에 대해 더 많은 주의가 필요하다.
1) 중증 정신장애인들의 약물치료는
구강건조증, 치아우식, 치주질환, 치아수복, 발치 등을
초래할 수 있으며,
(Kenkre and Spadigam, 2000; Friedlander and Marder, 2002)
2) avolition을 동반한 중증 정신장애인은
구강위생유지 의욕을 상실할 수도 있다.
3) 또한, 구강건조증을 피하기 위해 이용하는 사탕이나 껌, 음료수 등은
치아 우식을 유발할 수 있다.
따라서, 중증 정신장애인들에게는 예방적인 구강건강교육이 특별히
중요하다.

76. I. Introduction
76
2. 중증 장애인에게, 구강건강교육의 효과는 분명 긍정적이다.
(Almomani et al., 2006),
- 하지만 그 효과는 약하고 오래가지 못한다. (Kay and Locker, 1996)
3. 구강건강교육은 개인의 동기를 유발시킬 때 효과가 커질 수 있다.
- 동기면담(MI ; motivation interviewing)은
건강에 대한 태도를 광범위하게 변화시키는 데에 동기를 부여해주며
(Resnicow et al., 2002; Burke et al., 2003, 2004; Hettema et al.,
2005; Rubak et al., 2005),
- 이는 특히, 구강위생에도 잘 적용된다(Weinstein et al., 2004).

77. I. Introduction
77
4. MI는
- 개인들은 바꾸도록 설득하는 외적(external) 이유를 제공하기 보다는,
- 자발적 조절에 대한 개인들의 내적(internal) 동기를 유발할 수 있는
특별한 방법을 사용한다. (Ryan and Deci, 2000;
Williams et al., 2000).

78. I. Introduction
78
※ MI(motivation interviewing; 동기면담) 이란?
- 동기면담은 (1) 협동성(Collaboration), (2) 유발성(Evocation), 그리고 (3) 자
율성(Autonomy)의 세 가지기본 정신(Spirit)에 기초하고 있다(Arkowitz, 2009).
- 동기면담에서는
1) 치료자가 환자와 협동적이어야 하며, 권위적인 자세를 피하며,
환자를 치료자와 대등한 위치의 조력자로 대함(협동성).
2) 환자를 직접적으로 설득하고 특정한 방향으로 교육하는 대신에
치료자가 환자의 관심과 생각을 자발적으로 이끌어내는 데 초점맞춤(유발성)
3) 치료자가 환자의 행동에 대해서 즉각적인 선택을 하도록 몰아가지 않으며,
환자의 행동 변화를 유발하는 힘과 동기는
개인 안에 내재한다고 믿는다(자율성)
Ref : [건강 검진 후 상담에서 동기면담의 활용], 서울아산병원 건강증진센터 정신과, 서울대학교병원 헬스케
어시스템 강남센터 정신과1, 순천향대학교병원 건강증진센터 영상의학과2, 김병수․윤대현1․한내진2
의료커뮤니케이션 제 4 권 제 2 호 pp 98～106, 2009

79. I. Introduction
79
5. 연구의 목적
1) 구강건강교육을 시작하기 직전에 간단한 MI를 제공하는 것이
교육 효과를 증가시킬 수 있는지를 조사하는 것이다.
2) 4주에서 8주동안
① 구강건강교육만 하는 것과
② 구강건강교육과 MI를 병행하는 것을 비교하면,
- 후자의 경우가
plaque index를 낮추고,
Oral health knowledge를 증가시키며,
자발적인 self-regulation을 증가시킬 것이라고 가정했다.

80. II. Methods
80
연구방법
1. 60명의 지원자들에게 동의를 얻어 실험을 시행했으며, 56명이 완료
(탈락자는 이사를 가거나, 입원을 했음)
- 완료 시점에서,
- MI 집단은 27명 (여자12, 남자15)
- 구강교육 집단은 29명 (여자18, 남자 11)

81. II. Methods
81
연구방법
2. 모든 수치는시작 시점을 baseline으로 잡고
4주, 8주 간의 following intervention으로 얻었다.
(1) Plaque accumulation
- Quigley-Hein plaque index를 측정하여, 평균을 냈음.
(2) Oral health knowledge
- 15개의 질문을 만들어서, 3명의 전문가가 직접 면담함
(3) Self – regulation
- Treatment Self-regulation Questionnaire(TSRQ)를 사용, 정기
적으로 칫솔질을 하는 것에 대하여, ‗자발적으로‘ 인지 ‗관리를 받아서‘인
지

82. II. Methods
82
연구방법
3. MI를 활용한 개입
(1) MI전문가들과의 15분~20분 가량의 짧은 면담이 실행
- 성과를 평가하고, 피드백을 제공
(2) MI는 구강교육을 받기 전에 시행되었으며,
- 매일 행하는 칫솔질과 구강건강과 관련한 개인수치를 측정하여,
장단점과 동기, 자신감 등을 평가하였다.
(장단점이란, 구강을 건강하게 유지했을 때의 장단점)
(3) 모든 참가자들은 기계적 잇솔질과 알림 기능, 주 단위의 전화 알림
등을 함에 있어서 필요한 팜플렛을 두 개씩 받았다.

83. III. Data & Results
83

84. III. Data & Results
84
1. Oral hygiene 결과

85. III. Data & Results
85
2. Oral health knowledge 결과

86. III. Data & Results
86
3. Oral health knowledge 결과
- 두 그룹의 차이가 크지 않음!

87. IV. Discussion
87
1. 이 실험 결과는 구강교육을 함에 있어, MI를 병행하는 것이 매우
유용하다는 것을 뒷받침한다.
- plaque index : 1.7 감소 vs 0.8 감소
2. 예상치 못했던 결과는,
MI병행 그룹에서 oral health knowledge가 크게 증가한 것이다.
- MI 병행 그룹은 MI 상담에 의해 동기가 부여됐기 때문에,
이어지는 구강교육에 더욱 적극적으로 임하였기 때문으로 생각

88. IV. Discussion
88
3. oral health knowledge의 증가는 MI그룹의 낮은 plaque index에도
기여했으리라 여겨진다.
- 4주, 8주의 oral health knowledge와 plaque index score의 변화
가
비슷한 양상을 보임

89. IV. Discussion
89
3. oral health knowledge의 증가는 MI그룹의 낮은 plaque index에도
기여했으리라 여겨진다.
- 4주, 8주의 oral health knowledge와 plaque index score의 변화
가
비슷한 양상을 보임
- self-care의 어려움은 병과 치료에 대한 지식의 부족을 반영한다는
연구 결과도 있음 ((Skaret et al., 2003; Weinstein et al., 2004).

90. IV. Discussion
90
4. MI병행은 자발적인 규제에 큰 향상을 주리라 가정했는데,
실험 결과는 가정과 다소 차이가 있었지만,
- external 이나 autonomous한 규제보다는
introjective에 다소 더 영향을 주었다.
- 이 결과는 선천적 정신질환자의 천성을 반영할 수도 있고,
항정신병약물치료가 동기를 저하시켜 개인들이 내적인 규제를 지켜
가는 것에 지장을 주는 것으로도 생각할 수 있다.

91. IV. Discussion
91
5. 이 실험의 가장 큰 한계는, follow-up 기간의 부족이었다.
- 8주보다 더 긴 시간 동안 추적을 하지 못했음이 유감이다.
6. 또 다른 한계는, 실험의 설계에 있어서
MI 그룹이 구강건강과 관련해서 더 많은 시간을 보냈다는 점이다.
- 이것 자체가 MI 그룹의 교육효과를 더 높였을 수도 있다.

92. V. Implication
92
1. 이 실험 결과는, 정신장애인들에게 구강위생 관리가 매우 필요함을 보
여주고 있다.
- 정신 장애인의 plaque index는 3.5, 비장애인은 0.9~1.9 (Quigley
and Hein, 1962; Williford et al., 1967; Van Der Weijden et al.,
1998).
2. 구강건강 교육 뿐만 아니라, 동기부여가 병행된 교육은
구강건강 수치를 크게 개선시킬 수 있다.
3. 구강건강교육 전에 짧은 MI 상담을 병행함으로써,
구강위생을 크게 개선시킬 수 있으며,
이는 장애인뿐만 아니라, 비장애인들에게도 적용될 수 있을 것이다.

93. 7조 통합본(sub)

94. 7조 24번 노가연

95.  (1) What are the minimum dose and
frequency for the use of xylitol-containing
chewing gum for significantly lowering
mutans streptococci levels?
 (2) Can delivery vehicles be produced that are
applicable in settings where chewing gum or
similar confections might be permitted?

97.  Total Area Under the
Curve (AUC) for the
2 products did
 not differ
significantly
 (pellet gum—
 63.0 ng.min/mL,
 syrup—
 59.0 ng.min/mL).

98.  A controlled study of complex design with
xylitol-containing candies and gum was
conducted in children about 10 yrs old(This
age group was targeted because of the potential to protect
erupting second permanent molars)
 (xylitol-maltitol or xylitol-polydextrose) or
gum at 5 grams per day
 Result: 35 to 60% reductions in caries
incidence in the test groups relative to
the control individuals, and no difference
between xylitol delivery vehicles

99.  brushing twice daily with fluoride toothpaste
with 10% xylitol or fluoride toothpaste alone,
reported a 12% reduction in decayed/filled
surfaces (DFS) and an 11% reduction in
decayed/filled buccal and lingual surfaces
(DFS-BL)

100.  is possible that frequent lower-dose
exposure to xylitol is beneficial without the
effort of maintaining special programs.

101.  In spite of the considerable evidence that xylitol
is an effective caries-preventive and cariostatic
agent, an effective delivery system for xylitol,
especially for children, demanding minimal
adherence yet safe, has not been developed
(5 to 6 grams and 3 exposures)
 the xylitol toothpaste studies suggesting that
lower doses and less-frequent exposures might
be effective, but the synergistic effects of xylitol
and fluoride or triclosan cannot be ruled out.
 Studies of new vehicles for xylitol, such as a
xylitol-releasing dummy and a pediatric syrup,
have been conducted.

102. 43 이성은

103.  This study aimed to appraise clinical
evidence and its risk from bias regarding the
effects of xylitol in comparison with sorbitol
 A number of review of clinical trials
comparing xylitol with sorbitol is published

104.  Systemic search strategy
: on the basis of their listed title and abstract,
article from the research result were selected
 Inclusion criteria
- Tested caries-related primary outcome
- Compared the effects of xylitol with those of
sorbitol
- Included rest and control group
- Used a prospective group
 Extraction of data from accepted trials
 Statistical analysis

105.  Literature search
- Out of nine article, eight article were accepted
 Dataset extraction
-chewing 10.5g of gum containing 100% xylitol
five times daily for 5 min per time is associated
with a 3.5-times greater rehardening of soft
brownish discoloured carious lesion(vs sorbitol
gum)
-chewing 10.5g of gum containing 100% xylitol
for 5 min five times deaily for 2 years with 50-
70% fewer caries lesion after 5 year (vs sorbitol
gum)

106.  For all other dataset, the information
reported on the number of participant lost to
follow up at the time of assesement was
insufficient to enable sensitivity analysis
 It would lead to different conclusion if worst-
case scenario were assumed

107.  The chewing of 65% xylitol gum five times per
day was observed to have a preventive effect
against caries after 40 month, but not after
20 months(chewing time was twice) -> time
factor*
 Chewing gum containing 589mg sorbitol
over a 2year period was observed to be more
effective in preventing caries than chewing
589mg xylitol gum

108.  However, 589mg xylitol gum was observed to
be more preventive than sorbitol after 3 year
 The three timed per day intake of 2.67g
xylitol syrup over 10.5 months was no more
effective in preventing caries than a twice
daily intake of 4.0g
-> time, dosage important!

109.  Xylitol has been assumed to have specific
anticariogenic properties
 The result of this systematic search indicatea
general lack trial covering this topic
 The evidence found in support of xylitol over
sorbitol is contradaictory, contains a high risk
for selection and attrition bias and may be
limited

110.  Effect of xylitol versus sorbitol: a quantitative
sstematic review of clinical trial, steffen
mickednausch, internaional dental
journal2012;62;175-188

111. 폴리클 7조
49번 장혁준

115.  It seems reasonable to assume that the use of a
fluoride dentifrice is likely to increase plaque
fluoride concentrations significantly for up to 12
hrs in areas where the water contains fluoride
close to 1.0 ppm, but not in areas with above-
optimum fluoride levels in the drinking water.
 Plaque calcium and fluoride concentrations were
positively related under each of the 4 conditions.
Thus, considering that most people do not
completely remove dental plaque after tooth
brushing, the amount of fluoride retained in
plaque can play an important role in caries
control.

116. S.O. Griffin, E. Oong, W. Kohn, B. Vidakovic, B.F. Gooch, J. Bader,
J. Clarkson, M.R. Fontana, D.M. Meyer
16번 김은혜

117.  A barrier to providing sealants is concern
about inadvertently sealing over caries.
 The purpose of this meta-analysis is to
examine the effectiveness of dental sealants
in preventing the progression of caries
lesions in the pits and fissures of permanent
teeth.

118.  We searched electronic databases for
comparative studies examining caries
progression in sealed permanent teeth.
 We used a random-effects model to estimate
percentage reduction in the probability of
caries progression in sealed vs. unsealed
carious teeth.

119.  Our outcome measure was the percentage of
caries lesions progressing, where progression
was defined as demineralization or loss of
tooth structure.
 To measure effectiveness, we calculated the
relative risk ratio (RR) and its 95% confidence
interval (CI).
R = % lesions progressing (SEALED)
% lesions progressing (NOT SEALED)

124.  In conclusion, the evidence supports the
placement of sealants over non-cavitated
caries lesions in the pits and fissures of
permanent teeth in children, adolescents, and
young adults.
 Despite variations in study design and
conduct, subgroup and sensitivity analyses
found the effect to be consistent in size and
direction.

125. 45 이용진

130. 7조 44번 이시은
International Dental Journal (2001 ) 51. 389-
391

131.  Major improvements in the oral health status
of the general public have been observed in
many parts of the world as is shown by the
continuous decline in caries prevalence in
children and adolescents.
 This is generally ascribed to better oral
hygiene and use of fluoride toothpaste.

132.  Dr. Anne Nordblad, STAKES, National
Research and Development Centre for Welfare
and Health (SF) and Dr. Jos van den Heuvel,
Ministry of Health, Welfare and Sport (NL), co-
presidents of the FDI Public Health Section,
chaired the symposium.
 Chief dental officers and key representatives
of various fields of dentistry from all over the
world attended the symposium.

133.  The percentage of caries-free 5 to 6-year-old
children has increased to more than 50
percent.
 The caries prevalence in adolescents (1 2-
year-olds) in Europe decreased from high or
moderate levels in the 1980s to a low level in
the 1990s.

134.  This decrease occurred despite the
unchanged diet of the population and has
been attributed to regular mechanical tooth
cleaning using fluoridated toothpaste.

135.  Diet plays a role in the development of caries
and erosion but not in periodontal disease.
 The association between sugar/sucrose
consumption and caries vanishes when
fluoride toothpaste becomes generally used
at population level.
 Thus, regular plaque removal with a fluoride-
containing toothpaste is more effective in
caries control than dietary restrictions

136.  The use of fluoride toothpaste has resulted in
a decrease in the prevalence of dental caries
even though no significant change in the
consumption of fermentable carbohydrates
has taken place.
 If the teeth were brushed twice a day with a
fluoride containing toothpaste, foods
identified as cariogenic became a risk to the
teeth only when consumed more than seven
times a day.

137.  Current and expected future improved oral
hygiene and the use of fluoride containing
toothpaste have made recommendations on
cariogenic foods less necessary at population
level

138. 10번 김범호

139.  The aim of this study was to estimate the
prevalence of periodontal disease and
treatment needs in a population with the aid
of the CPITN index, to discover cases of
periodontal disease and recommend
treatment. The study was also designed to be
a first step for monitoring the changes in the
disease status over time in the studied
population.

140.  The examination included 214 subjects, aged
18 to 60, 84 women (39.25 per cent) and 130
men (60.75 per cent).
 The subjects were factory workers in a textile
mill and comprised a representative sample
of workers and staff members from a list of
1500 employees chosen by a simple random
sampling technique.

141.  All examinations were conducted under the
same conditions, in a dental chair by a single
examiner to avoid inter-examiner variability.

142.  The periodontal examination estimated the
number of healthy sextants (score 0), the
number of sextants with gingival bleeding
(score 1), the number of sextants with
calculus (score 2) and the number of sextants
with periodontal pockets (score 3 [4-5mm] or
4 [>6mm])

143.  Of 214 examined subjects, 20 (9.34 per cent)
had no signs of periodontal disease (code 0);
46 (21.49 per cent) presented gingival
bleeding after gentle probing (code 1); 40
(18.69 per cent) had supra- or subgingival
calculus (code 2); 70 (32.71 per cent)
presented pathologic pockets 4-5mm deep
(code 3); 38 (17.76 per cent) had pathologic
pockets 6mm or deeper (code 4).

144.  Subjects were classified into different
treatment need categories, according to the
highest score recorded during the
examination, as follows:
 0 (no treatment) - subjects with code 0
 I (improvement in personal oral hygiene) –
subjects with code 1
 II (I + scaling) - subjects with code 2 and
code 3.
 III (I+I1 +complex treatment) - subjects with
code 4.

145.  The aim of the study was to determine the
prevalence of periodontal disease and the
treatment needs in a population of 214
factory workers in Romania. Of those
examined, 9.34 per cent were in periodontal
health (code 0), 21.49 per cent had gingival
bleeding (code l), 18.69 per cent had supra-
or subgingival calculus (code 2), 32.71 per
cent presented with pathological pockets 4-
5mm deep (code 3) and 17.76 per cent had
pathological pockets 6mm or deeper (code 4).

146.  The distribution of these subjects among the
treatment need categories revealed that
30.83 per cent would need improvement in
personal oral hygiene (I), 51.40 per cent from
the subjects would need treatment (I) +
scaling (XI) and 17.76 per cent would need
treatment (I + I I) + complex treatment (I I I).

147. Results of oral health and hygiene
education
in an institution for multiple
handicapped
children in Indonesia
Adi S.A.W. Adiwoso
Jakarta, Indonesia
Taco Pilot
Gieten, The Netherlands
International Dental Journal (1999)49, 82-
89
14
7
5번 권오인
폴리클 7조

148. I. summary
14
8
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% 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.

149. II. Introduction
14
9
1. children with such handicaps often have different patterns of dental
caries and
missing teeth. Plaque control, gingival and periodontal health are
frequently
poor compared to children of the same age without handicaps.
2. These specific problems have received attention in a number of
industrialised
countries and special oral health care for the handicapped is now
actively
promoted.

150. III. Materials and Methods
15
0
1. The participants

151. III. Materials and Methods
15
1
2. The programme
1) OHE material was designed and adjusted to the parents‘ education
level. The parents were grouped according to the educational level of the
mother and each group consisted of not more than seven persons.
OHE lectures were also given to the teachers and to the therapists
working at the institution, to increase general knowledge, create support
for the programme
and better understanding of the physical conditions and the special care
needed for the handicapped children.
2) At the first visit children were taken to the dental clinic, they were
accompanied by the persons who were responsible for the oral cleaning.
At the dental clinic children were seated on the dental chair or remained
seated in their wheelchair. Instruments used for the plaque scoring
consisted of an operating light, mouth
mirror, explorer, disclosing solution, cotton buds and a special piece of

152. III. Materials and Methods
15
2
2. The programme
3) Tooth brushing instruction according to the Bass technique was
demonstrated.
4) a fluoride gel was applied with a cotton bud on the teeth surfaces and
left in place for 20-30 minutes before the patients were allowed to rinse.
5) The children returned a week after the first visit together with the
persons who were responsible for the oral hygiene. A review and
evaluation of oral cleaning
was then conducted and if the oral hygiene was not adequate, training
and teaching of toothbrushing was repeated.

153. III. Materials and Methods
15
3
3. Examination and Calibration
1) The plaque scores were taken and noted according to Albertson30.
- Scores:
0 = no plaque present;
1 = plaque covering 1/3 of the surface;
2 = plaque covering more than 1/3,
but less than 2/3 of the exposed tooth surface.
3 = plaque covering more than 2/3 of the exposed tooth Surface;
2) The plaque score was taken of each child every 4-6 months leading to
8 scores taken over a period of 32 months.

154. IV. Results
15
4
1. Inquiries revealed the following reasons for non-participation:
the parents of 27 children preferred their own family dentist and/or they
knew already about oral health education
2. The results of the oral health education and plaque control programme,
as expressed in the mean plaque scores (between 0 and 18) are
presented in Table 3.

155. IV. Results
15
5
1. Inquiries revealed the following reasons for non-participation:
the parents of 27 children preferred their own family dentist and/or they
knew already about oral health education
2. The results of the oral health education and plaque control programme,
as expressed in the mean plaque scores (between 0 and 18) are
presented in Table 3.

156. V. Discussion
15
6
1. It can be concluded that specially designed oral health education and
plaque control programmes can be developed gradually, gaining more
support of the staff of the institute and the parents. The participation rate
at the start of the project was relatively low. However, this was not
unexpected as it was a completely new activity at YPAC and in fact, in
Indonesia as a country.
2. The decrease in mean plaque scores in the present study over 32
months seems to be somewhat smaller than the results obtained by
Brown over a three year period% and by Nicolaci and Tessini over an 18
months period26, but greater than reported by Shaw and Shaw over two
years2‘. However, as in the present study all showed a gradual decrease in
plaque scores over time. Comparisons remain difficult because of
differences in study groups, OHE methods and plaque recording.

157. V. Discussion
15
7
3. One of the reasons for the continuing decrease in plaque scores
obtained in this study might have been the tailored approach to all parties
concerned. Oral
hygiene and the specific procedures were not left to the individual
handicapped person, but taken as a compulsory part of their general care
carried out by mother,
nurse or maid or under very close supervision at home, and repeatedly re-
enforced by professional personnel at the YPAC institute.
4. In conclusion, the specially designed oral health and hygiene
programme for handicapped children involving staff and therapists of the
institute, and parents and carers, is effective and of clinical significance. It
is probably one of the first of its kind in a developing country, and was
successfully developed by an initiative for collaboration between the
Indonesian and the Dutch Dental Associations.