Ilkka Paunio’s research while affiliated with University of Kuopio and other places

Abstract Nationwide and regional participation in the newly started public dental care system, occurrence of caries and proportion of children registered to be in need of restorative treatment during 1974–1979 were studied in 3-5-year-old Finnish children. The data were collected from the annual reports of municipal dental health centers. The mean annual proportion of children participating in the care increased from 27% in 1974 to 71 % in 1979. A clear improvement was noticed in each county, especially in areas where the earlier situation was poor. During the study period an average proportion of entirely caries free children increased from 24% at the beginning lo 57% at the end of the study. The mean annual proportion of children recorded to be in need of restorative care decreased from 61% at the beginning to 32% at the end of the study period. The mean dmft value decreased from 3.7 in 1974 to 1.7 in 1979. A strong inverse relationship existed between the dental health at the beginning of the study period and the extent of changes in dental health during the 6-year-period. Thus regional differences have greatly diminished since the introduction of the public dental care system.

The number of teeth remaining in adults was evaluated with specific reference to the frequency of tooth-brushing. The sample consisted of 5028 dentate subjects, representing the Finnish population aged 30 years and older. Their mean age was 47.5 years. The presence or absence of each individual tooth was recorded. A total of 91,332 teeth was registered. Forty-eight per cent of the women had retained no fewer than 21 teeth, 20% had 20-11 teeth, and 32% had 10-1 teeth. For men the percentages were 52%, 23%, and 25%, respectively. The number of a subject's remaining teeth was strongly related to the frequency to tooth-brushing (p less than 0.001). The more frequent it had been, the more teeth the subjects, both women and men, had retained. This trend was also seen for the teeth in each jaw, and even for type of tooth. The trend was also present when the number of teeth was analyzed in accordance with a subject's income.

In the present study the association between the occurrence of retained roots and several oral status factors was studied using a representative sample of 8,000 Finnish adults 30 yrs of age and over. The overall prevalence rate of dentate subjects with roots was 21%, a rate consistently higher among men. In the age category 65+ yrs, the prevalence rate was 35%. Among subjects with at least one root the average number of roots was 2.7. Those having removable denture(s) and a number of filled teeth showed a decreased probability of having root(s). Among those having root(s) the greater number of roots was associated with increasing age and with increasing number of remaining and decayed teeth.

The purpose of this study was to evaluate the reproducibility of the Periodontal Treatment Need System (PTNS), when plaque retentions were examined separately. A sample of 8000 persons was drawn to represent the Finnish population aged 30 yr and over. The first clinical examination (total sample) was made by a specially trained expanded-duty dental auxiliary (EDDA). During the second examination (2-6 months later), 20% of the total sample was reexamined by a dentist, and of those, every 6th patient was examined by the EDDA. Reproducibility of the PTNS was assessed as intra- and interexaminer agreement and was calculated using Cohen's kappa and weighted kappa. The intraexaminer weighted kappa values were 0.67 +/- 0.05 for the PTNS and 0.48 +/- 0.15 for plaque retentions. The interexaminer weighted kappa values between the PTNS registrations were 0.77 +/- 0.05 and 0.74 +/- 0.12 in plaque retentions when examinations were made within 1 day, and 0.53 +/- 0.05 and 0.37 +/- 0.07, respectively, when the interexaminer registrations were made with an interval of 2-6 months between them. The kappa values for intra- and interexaminer reliability reflect quite high reproducibility.

Nyyssönen V (Institute of Dentistry, University of Kuopio, PO Box 138, 70101 Kuopio 10, Finland), Pauniol, Rajala M and Vehkalahti M. Dental caries in the adult population in Finland. International Journal of Epidemiology 1984, 13: 486–490. The aim of this study was to describe the prevalence of untreated dental caries in the adult population aged 30 years and over in Finland according to sex, age, region of living, and socioeconomic status. The level of untreated caries per subject also was studied and population estimates were made for prevalence and level of untreated caries. The representative sample used in this study included 5028 dentate subjects. Data were collected using interviews and clinical examination. The prevalence of untreated caries was 55% in women, and the figure for men was 67%. In eastern Finland the figures for women and men differed significantly. The mean number of decayed teeth was 2.5 per person. Men had more decayed teeth per person than women did. The number decreased significantly with increasing socioeconomic status. The data presented in the study provide a reliable picture of the occurrence of untreated dental caries in Finnish adults arid form the basis for further analyses.

A representative sample of Finnish denture wearers (n = 3875) aged 30 or over were examined clinically and interviewed about their oral hygiene habits, use of dental services and possible prosthetic treatment during last visit to a dentist. Of these denture wearers, over 80% brushed their dentures at least once a day, and 16% visited a dentist at least once in 2 yr. For denture stomatitis the age-standardized risk ratio decreased with brushing frequency in women and increased in men. For frequency of dental visits the prevalence of denture stomatitis increased in both men and women when visits were made over 2-yr intervals. The prevalence of denture stomatitis was higher in the group with dentures over 1 yr old. It seems that the oral hygiene measures as they are generally carried out and regular dental visits are not effective enough methods in preventing denture stomatitis.

Of a representative sample of 8000 persons aged 30 and over living in Finland, 3875 users of removable dentures were examined. The condition of the oral mucosa was recorded during clinical examinations. The prevalence of oral mucosal lesions associated with removable dentures was analyzed according to age, sex, place of residence, geographical region of living, and type and location of prosthesis. Lesions were found in about 50% of the denture wearers. Women were affected more often than men. The prevalence of lesions decreased with age and differed slightly according to region of living and place of residence. Compared with the wearing of partial dentures, wearing complete dentures increased the risk of lesions. Only one of the 72 denture users who wore a denture with metallic base plate had oral mucosal lesions associated with wearing a denture.

The need for complete denture treatment was compared to utilization of complete denture services. To estimate the need for complete denture treatment we used data from the Mini-Finland Survey which included 3620 persons who were edentulous in one or both jaws. Data about utilization of services was obtained through questionnaires sent to samples of dentists and special dental technicians. Utilization of services was 21.8% of the need assessed with professional criteria and 17.7% of the subjective need. Compared to the subjectively assessed need, utilization of complete denture services was highest among young women and lowest among men aged 60-69 yr. Subjective need for denture services was highest in older groups. From these results we conclude that certain barriers prevent patients from seeking care; and as these barriers are reduced, use of complete denture services may increase.

To develop the functions of a health care system it is essential to compare and evaluate the systems of different countries. The World Health Organization (WHO) has emphasized the importance of collaborative studies in the field of epidemiology. In countries with similar social systems the basis for health care is usually the same. Comparison of health care in such countries is relatively easy because in most cases the criteria for functions, diagnosis, etc. are similar. Comparison of countries having different bases for health care and different philosophies of research is much more complicated and time-consuming. Soviet health care, including oral health care, is based on community responsibility and has complex prophylaxis as its main emphasis. In the USSR there are no private dentists. All dental services are available at polyclinics located either near the place of residence or at the work place. In Finland there are two separate systems for oral health care. Children up to the age of 18 and some special groups of the adult population (pregnant women, military recruits, and students) are treated in municipal polyclinics (called health centres in Finland). Otherwise, the adult population is treated mainly by private dentists. The study will be carried out in three towns in Finland and six towns in the USSR. The aim of this study is to describe the causal epidemiology of dental caries among children 6 to 7, 9 and 12 years old in Finland and the Soviet Union. In addition, certain measures and compounds for caries prevention will be tested during 3 years of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to analyze the present state of occupational dental care in Finland. In addition, the viewpoints of employees and employers concerning possibilities for developing occupational dental care were evaluated. Five percent of employers had arranged dental services for their employees. Twenty-four firms either had their own dentist or had made an agreement with a dentist about dental care for their employees. Most of these dentists delivered all kinds of dental treatment to employees, and the costs of treatment were usually paid from the worker's sickness benefit funds. Many such funds also subsidized the costs of dental treatment delivered in other dental offices. In 1978 about 49% of the workers covered by such funds received subsidies for their dental expenses. The most important means of developing adult dental care in Finland was considered to be widening the scope of public dental care. The second means was widening the scope of the national health insurance system. In third place, the employers supported development of private dentistry. Employees, however, preferred to include dental care in agreements made by collective bargaining.