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                                   RESULTS OF TOPICAL FLUORIDE WITH
                   ELMEX SOLUTIONS IN KINDERGARDEN CHILDREN



Authors :  Prof. Dr. COCARLA ELVIRA , head of the Department of Pediatric Dentistry, University of Medicine and Pharmacy  “ Iuliu Hatieganu “ , Cluj Napoca,
Romania.
                 Hygienists assistant : GEORGETA LILIAC




   Increasing fleuency of dental caries at early ages requires the augmentation of prophylaxis methods .  Fluoride  therapy , through any of the administration methods is still of heigh eficciency ( 1, 2, 5 ).
   Several data  from literature  ( 3,7,8 )  are reporting overall caries reduction of 40-50%  through fluoride applications.
     Many of the last year researches are based on the self – administered  techniques in children communities the most economic method being toothbrushing and toothpastes and a rinsing solutions ( 4,6 ).
     The  use of toothpastes , gels and rinsing solutions several times a year could decrease the freqvency of overall caries  with a percent of 20.
      Meantime with  the advantages of topical fluoride applications, the children also learned a correct toothbrushing technique.
       The  aim of this study was to determine the effects of toothbrushing with elmex  solutions  in kindergarden children during the period of activity in that community.
     

         Material   and  method


         This  study was carried out in 200 children with an overage age of three years.
 The children were divided into two equal study groups, each one of a hundred individuals.
          The first group served as a control group consisting of children who didn’t undergo our prophylaxis programme.
          The  second group was the study group with a number of a hundred children who followed our prophylaxis schedule.
          The  experiment lasted three years and all records were registered in files especially designed for this study.
          The  files  allowed us to register every affected toothsurface and also the  amount of the carious lesions and  other parametres, too.
          The study group underwent professionally fluorides applications ( topical fluoride) twice a year ( in  May and November )  .
          The  aim of this method was to allow each child to undergo 8 professionally fluoride applications.
          The  oscillating frequency of kindergarden attendance was the main reason for wich the aim of this study was attained only a small group of children, the average number of topical fluoride applications varying between 4 and 6.
          Every child brushed thoroughly his teeth, then the toothbrush was dried with the child’s own towel.
          5  to  6 drops of elmex solution were poured on the dried toothbrushed and the child was encoureged to do another brushing during two  three minutes and to spit out the foam without rinsing.
         At  the beginning of the study and at a six  months  recall, before fluoride application we recorded in the individual file all affected  toothsurfaces.
         According to the recorded data we determined the carious intensity index “m d f l s” and  we made a comparison follow-up in the two  groups.

         Results  and  discussion  

       At  the beginning of the study, the 2 groups were having similary values of the  “ m d f l s “  carious index, as they have been  registered in  table I.
m d f l s    =  0,9%  in the control group
m d f l s   =   1,14% in the study group
       during the study, because  of  the oscillating frequency of children’s attendance in kindergarden, the number of children who had a full-time activity declined to  59% in the  control group and 62% in the study group.
       The  comparison of  “ m d f l s “ index ( percent of  decoyed or filled toothsurfaces) at several recalls ( in  November 1992, 1993, 1994) rewals the high efficiency of the procedure.
        In  the control  group, the value of “ m d f l s “ index  rose strongly from 0,9% in  1992 to 3,89% in 1993 and finnaly  reached the 5,07% value in  November 1994.
      The  study group showed only a small increase in the value of  m d f l s  index, from 1,14% in 1992 to 1,67% in 1993 and  then to 1,98% in 1994.
        The  average value of annually decayed toothsurfaces  was  five times  higher in the control  group than in the study one. ( 2,17% in the control group and only 0,42% in the experimental group with  professional  topical  fluoride application).

Table  I  -  revolution  of  “ m d f l s “  index  in the  :

              1992               1993    1994
Study  sample    Nr.of          m d f l s
Children      index    Nr. of         m d f l s
Children       index    Nr. of         m d f l s
Children         index
I     control group    100              0,9%     78               3,86%     59                5,07%
II    study group    100             1,14%     85               1,67%     62                1,98%

 
Table II  -  Average value of affected toothsurfaces

I      Control group              2,17%
II     Study  group               0,42%

      Data  submided before pointed out that professionnally fluoride  application like the  elmex solutions bed to a definite decrease of the percent of new affected toothsurfaces.
      In addition we noticed a high  percent of carious – free children, maintained throughout the period in the study group, also we noticed  arrested carious lesions and a decrease in the number of penetrating carious  lesions.

        Conclusions  

      Topical  fluoride applications, as  toothbrushing with elmex solution is a valuable factor  in carious index decrease.

         Summary

   The  aim  of this study was to determine the effects toothbrushing  with rolmex solution in kindergarden  children.
   The study sample consisted of 200 children and was divided into two equal groups : a control  group and a study one.
     The  carious index “ m d f l s “ were determined at sereveral recalls in every group.
      The  results pionted out a small increase in the number of affected toothsurfaces  in the study  group while in the control group there was a very high increase.

               References

1.  Chow L. & all    -  J. Dental Rest, 1980, 59, 8, 1447-1452.
2.  Fim P, Zarnea L -   Pediatric Dentistry, Ed. Med., Bucuresti , 1973.
3.  Grim O. & all     -   Rev, Stomat. Bucuresti, 1983, 3,221-225
4.    Horowtz A, Horowtz H – f. Rev. Dent., 1980,6,89-94
5.    Kinzel W.    -  Caries  Res. 1976,10,96-103
6.    Levinson A, Weske G.,Ripa L, - f Rev. Dent. 1980,6,101-106
7.    Rugg – Gunn A,J,Nicholas K, - But. Dent. J 1981,150,9-12
8.    Schapira M, Hristea M., Maxim A – Rev. Stomat. Bucuresti, 1972,6,533-536



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REZULTATE  ALE  FLUORIZARII  LOCALE  CU  ELMEX
LA  PRESCOLARI



               Autori  :  Prof. Dr.  COCARLA ELVIRA , sef  Clinica de Stomatologie                         
                                Pediatrica, Facultatea de Medicina si Farmacie “ Iuliu  
                                 Hatieganu “ , Cluj – Napoca , Romania
                                 Asistent igienist  :  GEORGETA  LILIAC




            
1   Frecventa ridicata a cariei dentare  la varste tot mai mici  impune necesitatea  extinderii mijloacelor de profilaxie.  Printre acestea  , fluorizarea , sub oricare din formele de administrare  cunoscute , continua sa dovedeasca una dintre  metodele cele mai eficiente    
( 1,2,5 ).
              Datele din literatura  ( 3 ,7 , 8 ) atesta faptul ca  aplicarile topice de fluor , sunt in masura sa reduca procentul cariei dentare cu 40 – 50 % .
              Multe din cercetarile ultimilor ani , s-au axat insa pe tehnici de autoadministrare a fluorului in colectivitati de copii. Dintre cele mai economice  procedee s-au dovedit  periajele si clatirile cu solutii fluorurate ( 4 , 6 ).
              Utilizarea periajelor cu paste , geluri , solutii de fluor , de cateva ori pe an , ar reduce caria cu  20%  ( 4 ). Concomitent cu avantajul fluorizarii , copiii deprind  si o tehnica corecta de periaj. Ne-am oprit asupra acestei metode , verificand actiunea periajului  cu solutie Elmex  la copii prescolari , incepand cu grupa mica si continuand  pe toata durata cuprinderii in colectivitate.
               Metodologie
Au  fost luati in studiu un numar de  200 copii in varsta de trei ani ( grupele mici ), constituindu-se doua loturi :
               Lotul  I  -  martor
               Lotul  II -  experimental
Toti copiii au fost urmariti  timp de trei ani , pe baza unei foi de observatie  special concepute, care a permis notarea fiecarei suprafete  afectate si gradul acestei afectari , precum si alti parametrii. Pentru lotul experimental s-au preconizat  doua serii de fluorizari pe an, ( in lunile noiembrie si mai ) , a cate 4 sedinte fiecare , la interval de o saptamana. Deci fiecare copil trebuia sa beneficieze de 8 periaje pe an . Datorita faptului ca prezenta copiilor a inregistrat mari fluctuatii , dezideratul a fost atins la un numar mic de copii, majoritatea beneficiind in medie de 4  fluorizari pe an, cu variatii intre 3 si 6.
Avand in vedere varsta abordata , cu dificultatile inerente de colaborare , fiecarui copil
i-am efectuat un periaj  atent cu periuta si pasta de dinti  prezentate in gradinite , dupa care, pe periuta uscata cu prosopul  individual s-au aplicat 5-6 picaturi de solutie Elmex, facandu-se un nou periaj timp de 2-3 minute , fara a fi urmat de clatire , ci doar de indepartarea  spumei rezultate de pe buze.
Atat la inceputul actiunii , cat si la intervale de 6 luni inaintea reluarii seriei de fluorizari , am inregistrat in fisa individuala  , asa cum am amintit , toate suprafetele dentare afectate. Pe baza datelor consemnate am calculat indicii de intensitate ai cariei pe suprafata  (mdf/s)si am urmarit evolutia lor comparativ la cele doua loturi.
             
             Rezultate si discutii
                    Dupa cum reiese din tabel  si grafic , la inceputul studiului , cele doua loturi egale numeric au prezentat indici mdf/s apropiati  ca valori ( 0,9% lotul I martor si  1,14% lotul II  experimental.)  Pe parcurs , numarul copiilor cuprinsi  in studiu s-a redus inegal , ramanand relativ mic pentru loturile finale. Totusi compararea indicilor mdf/s ( procentul suprafetelor dentare cariate sau obturate )la anumite intervale , ( lunile noiembrie  ale anilor 1992 , 1993 , 1994 )evidentiaza pregnant eficienta metodei. Daca la lotul  martor indicele de intensitate a cariei , mdf/s , a avut o evolutie puternic ascendenta de la 0,9% in 1992 la 3,86 % in 1993 si 5,07 % in nov. 1994 , lotul fluorizat desi a prezentat si el o crestere  a intensitatii cariei in acelasi interval aceasta este semnificativ mai mica fata de lotul martor ( de la 1,14% la 1,67% si respectiv 1,98% )
Calculand procentul mediu annual de suprafete noi cariate , aceasta este de cinci ori mai mare la lotul martor  fata de lotul fluorizat ( 2,17% la lotul martor si numai 0,42% la lotul fluorizat).

          Tabel – Evolutia indicilor mdf/s  la cele doua loturi :


         LOT          
    
             1992
nr. copii        mdf/s    
            1993
nr. copii       mdf/s    
         1994
nr. copii        mdf/s

I  martor    
  100                0,9%    
     78              3,86%    
59                5,07%

II fluorizat    
  100                1,14%         
    85                1,67%    
62              1,98%


                Rata cresterii anuale

I martor              2,17%
II fluorizat          0,42%



Datele prezentate releva faptul ca aplicarea solutiei Elmex  prin periaj a dus la o diminuare neta a procentului de suprafete noi  cariate . In plus am putut observa  mentinerea unui procent  ridicat de copii  indemni de carie , dupa aceste intervale, la lotul fluorizat , stagnarea in evolutie a cariilor incipiente si reducerea numarului de carii complicate .
            In concluzie putem afirma ca fluorizarea locala , sub forma de periaj , s-a dovedit un factor  valoros in scaderea intensitatii procesului carios.


               R E Z U M A T
             S-a  urmarit  actiunea solutiei Elmex , aplicata prin periaj dentar, la un lot de copii prescolari , comparativ cu un lot martor. Valoarea  indicilor mdf/s  calculati la anumite intervale , la cele doua loturi , dovedeste o crestere nesemnificativa a procentului de suprafete noi cariate la lotul fluorizat , in timp ce la lotul martor cresterea este vertiginoasa.




            B I B L I O G R A F I E

1.    Chow l. si colab.  – J. Dent. Res.  1980 , 59, 8, 1447 – 1452.
2.    Firu P., Zarnea Livia  - Stomatologie Infantila , Ed. Med. Buc. 1973.
3.    Grivu ov. Si colab. -  Rev. Stomat. Buc. 1983, 3, 221- 225.
4.    Horowitz A. , Horowitz H.- J. Prev. Dent. , 1980 , 6, 89-94.
5.    Kinzel W.   - Caries  Res. 1976 , 10, 96-103.
6.    Levinson A, Kelske G,Ripa L, - J. Prev. Dent 1980 , 6, 101 – 106.
7.    Rugg – Gunn A, J, Nicholas K, - Brit. Dent . J. 1981, 150, 9-12.
8.    Schapira M, Hristea M, Maxim A, - Rev. Stomat. Buc. 1972 , 6, 533-536.