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Faculty of Health Sciences, University of Copenhagen

School of Dentistry


Department of Cariology and Endodontics


 

 
 

(Nexø Public Dental Health Clinic)
 

 
 

A Non-Operative Caries Treatment Program
NOCTP 

(NEXODENT    -   the Nexø Method)

Primary Dentition

Permanent Dentition

Permanent First Molar

Individualized non-operative caries treatment - Flowcharts
Primary teeth    Permanent teeth

Permanent Second Molar

References

Outcome Data 1978/79 - 2004 Data

 
 



Kim Ekstrand,    Department of Cariology and Endodontics,   School of Dentistry
Faculty of Health Sciences, University of Copenhagen

20 Nørre Alle, DK-2200 Copenhagen N, Denmark


E-mail
: kim@odont.ku.dk    Tel: +4535326813      Fax: +4535326505


Nexø Public Dental Health Clinic:

The NOCTP   


A dental health care program based on
individualized non-operative caries treatment of children and adolescents
aged 0-18.

The aim of the program is to maintain sound teeth using the fewest
resources possible.


The treatment program is based on 3 principles - dosed at
individually assessed recalls according to diagnosis and risk assessment:
 
. Education of parents, children and adolescents in understanding
dental caries as a localized disease.
. Intensive training in home-based plaque control.
. Early professional non-operative intervention.


Successful implementation of the treatment program requires that the dental staff possesses thorough knowledge and understanding of the localized nature of dental caries according to these principles:

Caries is caused by bacteria present in the oral cavity. Changes in conditions of growth leading to accumulations of undisturbed bacteria on teeth initiate decalcification due to excessive acid production.


Mechanical forces prevent caries progression because of disturbance of plaque, whereas fluoride may only decelerate the progression process. Carbohydrates on the other hand may accelerate caries progression rate underneath undisturbed plaque.


Therefore prevention or early treatment means disturbance of bacteria accumulations in order to prevent acid production from reaching a level resulting in net loss of mineral from the tooth.


This is the philosophy behind the education of patients: To undertake the balance between bacteria and teeth by means of mechanical disturbance.


As a general recommendation patients are advised to brush their (child's) teeth before breakfast and before bedtime using fluoridated toothpaste stressing the importance of quality of the plaque removal. This is underlined during critical periods such as erupting periods for molars, due to facilitated possibilities for plaque accumulations and hence increased caries progression rate. Therefore the following tooth brushing technique is recommended: Hold the brush in bucco-lingual direction and rotate with small movements on the occlusal surface.



NOCTP

 

 
 

PRIMARY DENTITION   
 


Aim
To keep caries progression at a level where no fillings will be needed.
 


Method
Education
of parents starts when the child is 8 months old and called to the clinic for the first time.

Training in home based plaque control:
Demonstration of plaque.
Education in plaque removal.

Early professional non-operative intervention:
Plaque removal by means of toothbrush or rubber cup and dental floss.
Surface drying.

Diagnosing:
Visual examination for indications of caries progression.

In case of progression:
Further education and training in plaque removal.
Topical application of fluoride.

Assessment of recall interval.
 


Principles for individual assessment of recall intervals
based on diagnosis and risk assessment:
 
Cooperation of parents Inadequate
Good

2 points
1 point

Caries progression within the dentition Yes
No

2 points
1 points

4

  points: 1-3 months' interval

3

  points: 4-8 months' interval

2

  points: 8-12 months' interval



Parents are made aware of their responsibility on the dental health of their child.
The education in plaque removal focuses on quality rather than frequency.



 

 
  NOCTP:
 
 
 

PERMANENT FIRST MOLAR   


Aim

To keep caries progression at a level where no fillings and as few fissure sealants as possible will be needed.
 


Method

 
 

 
Education
is given to parents’ right after the emergence of permanent first molars. Additional education is given at meetings for parents of 6-yr-olds. The children are given lectures involving them in the subject of the permanent first molars.

Training in home based plaque control:
Demonstration of plaque.
Education and training in plaque removal focusing on erupting molars.

Early professional non-operative intervention:
Plaque removal by means of rubber cup, rotating tuft and dental floss.
Surface drying.

Diagnosing:
Visual examination for indications of caries progression. Radiographic examination, if required.

In case of progression:
Further education and training in plaque removal.
Topical application of fluoride.

Assessment of recall interval.
 


Principles for individual assessment of recall intervals
based on diagnosis and risk assessment:
 

Cooperation of parents

Inadequate
Good

2 points
1 point

Caries progression within the dentition

Yes
No

2 points
1 points

Stage of eruption of permanent first molars

Partly erupted
Full occlusion

2 points
1 point

Occlusal surfaces of permanent first molars

Caries progression
Caries free or
arrested lesions
 

2 points

1 point
 

 
 
8 points: 1 months' interval
7 points: 2 months' interval
6 points: 3 months' interval
5 points: 4 months' interval
4 points: 6-12 months' interval
 

 
 
NOCTP:
 
 

PERMANENT SECOND MOLAR   


Aim
To keep caries progression at a level where no fillings and as few fissure sealants as possible will be needed.
 


Method
 

 
  Education is given to the child right after the emergence of permanent second molars.
Additional education is given at lectures for school classes (12-yr old children) providing them with basic understanding of dental caries.

Training in home based plaque control:
Demonstration of plaque.
Education and training in plaque removal focusing on erupting molars.

Early professional non-operative intervention:
Plaque removal by means of rubber cup, rotating tuft and dental floss.
Surface drying.

Diagnosing:
Visual examination for indications of caries progression.Radiographic examination, if required.

In case of progression:
Further education and training in plaque removal.
Topical application of fluoride.

Assessment of recall interval.
 


 
 
 

Principles for individual assessment of recall intervals
based on diagnosis and risk assessment:

 
   

Cooperation

Inadequate
Good

2 points
1 point

Caries progression within the dentition

Yes
No

2 points
1 points

Stage of eruption of permanent second molars

Partly erupted
Full occlusion

2 points
1 point

Occlusal surfaces of permanent second molars

Caries progression
Caries free or
arrested lesions

2 points

1 point

 
 
 
8 points: 1 months' interval
7 points: 2 months' interval
6 points: 3 months' interval
5 points: 4 months' interval
4 points: 6-12 months' interval
 

 

 
 


 

 
 

Arrows indicate the emergence of the permanent second molars.
The figure shows the difficulty in reaching them with a toothbrush.

 
NOCTP
 

PERMANENT DENTITION    
 


Aim
The adolescents should have achieved knowledge that enables them to keep caries progression at a level, that requires minimal use of dental materials, and gingiva free of inflammation.
 


Method

 
 
Education
is continued at the clinic.

Training in home based plaque control:
Demonstration of plaque.
Education and training in toothbrushing and the use of dental floss where needed.

Early professional non-operative intervention:
Plaque removal by means of rubber cup, rotating tuft and dental floss.
Surface drying.
Diagnosing: Visual examination for indications of caries progression and gingival inflammation. Radiographic examination, if required.
In case of caries progression or gingival inflammation: Further education and training in plaque removal.
In case of caries progression: Topical application of fluoride.
Assessment of recall interval.
 


 
 

Principles for individual assessment of recall intervals based on diagnosis and risk assessment:

 
 

Cooperation

Inadequate
Good

2 points
1 point

Caries progression within the dentition

Yes
No

2 points
1 points

 
 
 
4 points: 1-3 months' interval
3 points: 4-8 months' interval
2 points: 8 months' interval-->
 
 
 

 
 


Adolescents are made aware of their responsibility
for their own dental health.

 
  NOCTP:
 
 
 

Individualized non-operative caries treatment:  
 


 

Primary teeth, 0 to 5-yr-olds
Clinical process

 

 
 


 

Permanent teeth
Clinical process

 

 
 


Nexø Public Dental Health Clinic

 
 



Outcome Results - Caries Data    

 
 


Caries D
ata comprise all   0 - 15-yr-olds  and about  86% of the 16 - 18-yr-olds  in the former Nexø Municipality (2003)
Caries data from Nexø and Denmark (National Board of Health)
D
ata for 5-yr-olds, 15-yr-olds and 18-yr-olds

 

 
 

Caries data 5-yr-olds - Nexø and Denmark

Table 1 Table 2 Table 3
%Children, def-s=0 mean def-t mean def-s
Year Nexø DK Year  Nexø DK Year Nexø DK
1978/79 29,2         1978/79 6,2  
. . . . . . . . .
1980/81 42,3         1980/81 3,4  
                 
1982/83 34,8 50,2       1982/83 3,2 3,5
                 
1984/85 48,3 55,2 1984/85 1,97   1984/85 3 3
                 
1986/87 57,5 58,5 1986/87 1,57   1986/87 2,1 2,8
                 
1989 68,75 65,87 1989 0,61  1,28 1989 0,75 2,09
                 
1991 66,67 63,15 1991 0,81 1,39  1991 1,14 2,27
                 
1993 71 63,38 1993 0,71 1,38  1993 0,85 2,24
                 
1995 74,76 66,77 1995 0,56 1,17 1995 0,61 1,85
                 
1997 80,65 69,44 1997 0,4 1,02 1997 0,44 1,61
                 
1999 80,61 71,16 1999 0,52 0,96 1999 0,61 1,52
2000 86,49 70,46       2000 0,51 1,59
2001 80 70,89       2001 0,69 1,59
2002 79,52 69,86       2002 1,00 1,64
                 
2004 75,95 71,77       2004 0,62 1,53
                 
Graph:

Outcome 5-yr:
Fig 1

        Graph:

Outcome 5-yr:
Fig 2

 
 

Caries data 15-yr-olds - Nexø and Denmark

Table 3 Table 4 Table 5
%Adolescents, DMF-S=0 mean DMF-T mean DMF-S
Year Nexø DK Year  Nexø DK Year Nexø DK
1980/81 0,7         1980/81 16,9  
                 
1982/83 1,4         1982/83 14,5  
                 
1984/85 1,7   1984/85 7,64   1984/85 12  
                 
1986/87 8,5 9,6 1986/87 5,04   1986/87 7,7 7,5
                 
1989 25,5 19,96 1989 2,26 3,51 1989 3,22 4,96
                 
1991 45,93 25,23 1991 1,6 3,08  1991 2,38 4,38
                 
1993 47,97 27,84 1993 1,31 2,91  1993 1,76 4,2
                 
1995 65,49 29,73 1995 0,7 2,73 1995 1,03 4,01
                 
1997 60,75 30,67 1997 0,78 2,59 1997 0,98 3,85
                 
1999 71,29 32,68 1999 0,68 2,42 1999 0,88 3,58
2000 74,58 34,65       2000 0,72 3,34
2001 80,34 35,44       2001 0,49 3,24
2002 77,05 36,98       2002 0,62 3,11
                 
2004 79,29 39,79       2004 0,56 2,85
                 
Graph:

Outcome 15-yr:   Fig 3

        Graph:

Outcome 15-yr:    Fig 4

 

Caries data 18-yr-olds - Nexø and Denmark

Table 6 Table 7 Table 8
%Adults, DMF-S=0 mean DMF-T mean DMF-S
Year Nexø DK Year  Nexø DK Year Nexø DK
1989 6,41 8,89 1989 5,54 5,43 1989 8,76 8,27
                 
1991 18,52 12,4 1991 3,73 4,8  1991 5,65 7,29
                 
1993 28,43 15,31 1993

2,57

4,5  1993 3,93 6,9
                 
1995 42,68 17,34 1995 1,87 4,33 1995 2,62 6,81
                 
1997 44,74 19,56 1997 1,5 4,12 1997 2,3 6,53
                 
1999 55,41 19,00 1999 0,95 3,97 1999 1,23 6,33
2000 56,25 20,12       2000 1,25 6,14
2001   21,74       2001   5,75
2002   21,85       2002   5,73
                 
2004 55,26 22,94       2004 1,34 5,43
                 
Graph:

Outcome 18-yr:

Fig 5

        Graph:

Outcome 18-yr:

Fig 6

 

Nexø Public Dental Health Clinic

Outcome Data - Caries Data 5-yr-olds    
 

                                                                                   
                                                                                         


Nexø Public Dental Health Clinic

Outcome Data - Caries Data 15-yr-olds
 

                                                                                      
                                                                                           

Nexø Public Dental Health Clinic

Outcome Data - Caries Data 18-yr-olds
 

                                                                                       
 

 

Nexø: 15-yr-olds, DMF-S and S-S (Sealed Surfaces)   

1985/86 - 2003
 

NOCTP

REFERENCES     

ÅRTUN J, THYLSTRUP A. Clinical and scanning electron microscopic study of surface changes of incipient caries lesions after debonding. Scan J Dent Res 1986; 94: 193-201.

ÅRTUN J, THYLSTRUP A. A 3-year clinical and SEM study of surface changes of carious enamel lesions after inactivation. Am J Orthod Dentofac Orthop 1989; 95: 327-33.

CARVALHO J C, EKSTRAND K R, THYLSTRUP A. Dental plaque and caries on occlusal surfaces of permanent first molars in relation to stage of eruption. J Dent Res 1989; 68: 773-779.

CARVALHO J C, EKSTRAND K R, THYLSTRUP A. Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol 1991; 19: 23-28.

CARVALHO J C, THYLSTRUP A, EKSTRAND K R. Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol 1992; 20: 187-92.

CHRISTIANSEN J, CHRISTIANSEN M E C, VINTHER D, THYLSTRUP A. A dental health care program based on individualized treatment of children and adolescents. Proceedings of 13th Congress of International Association of Dentistry for Children. Kyoto, Japan, September 27-30, 1991.

EKSTRAND K R, CARVALHO J C, THYLSTRUP A. A Longitudinal 5-year Study on Caries in Relation to Groove-Fossa System Morphology on Permanent First Molars. Abstracts of Papers Presented at the 42nd ORCA Congress. Caries Res 1995; 29: 320.

EKSTRAND K R, QVIST V, THYLSTRUP A. Light microscope study of the effect of probing in occlusal surfaces. Caries Res 1987; 21: 368-374.

EKSTRAND K R, BRUUN G, BRUUN M. Plaque and Gingival Status as Indicators for Caries Progression on Approximal Surfaces. Caries Res 1998; 32: 41-45.

EKSTRAND K R, RICKETTS D N J, KIDD E A M, QUIST V, SCHOU S. Detection, Diagnosing, Monitoring and Logical Treatment of Occlusal Caries in Relation to Lesion Activity and Severity: An in vivo Examination with Histological Validation. Caries Res 1998; 32: 247-254.

EKSTRAND K R, KUZMINA I N, KUZMINA E, CHRISTIANSEN M E C, Two and a Half-Year Outcome of Caries-Preventive Programs offered to Groups of Children in the Solntsevsky District of Moscow. Caries Res 2000, 34:8-19.

EKSTRAND K R, CHRISTIANSEN J, CHRISTIANSEN M E C. Time and duration of eruption of first and second permanent molars: a longitudinal investigation. Community Dent Oral Epidemiol 2003; 31: 344-50.

EKSTRAND K R, CHRISTIANSEN M E C, QVIST V. Influence of  Different Variables on the Inter-Municipality Variation in Caries Experience in Danish Adolescents. Caries Res 2003; 37:130-141.

EKSTRAND K R, CHRISTIANSEN M E C. Outcomes of a Non-Operative Caries Treatment Programme for Children and Adolescents. Caries Res 2005; 39:

HOLMEN L, THYLSTRUP A. Natural caries development and its arrestment. In: Leach S A, ed. Factors relating to demineralisation and remineralisation of the teeth. Oxford: IRL Press. 1986: 139-52.

HOLMEN L, THYLSTRUP A, ÅRTUN J. Surface changes during the arrest of active enamel caries lesions in vivo. A scanning electron microscope study. Acta Odontol Scand 1987; 45: 383-390.

HOLMEN L, THYLSTRUP A, ÅRTUN J. Clinical and histological features observed during arrestment of active enamel carious lesions in vivo. Caries Res 1987; 21: 546-554.

HOLMEN L, MEJARE I, MALMGREN B; THYLSTRUP A. The effect of regular professional plaque removal on dental caries in vivo. Caries Res 1988; 22: 250-256.

THYLSTRUP A, FEJERSKOV O, eds. Textbook of Clinical Cariology. 1994 Munksgaard, Copenhagen. 2nd edition.

THYLSTRUP A, QVIST V. Principal enamel and dentine reactions during caries progression. In: Thylstrup A, Leach S A, Qvist V, eds. Dentine and dentine reactions in the oral cavity. Oxford: IRL Press. 1986.

THYLSTRUP A. Clinical evidence of the role of pre-eruptive fluoride in caries prevention. J Dent Res 1990; 69: 742-750.

THYLSTRUP A, BRUUN C. The use of dentifrices in the treatment of dental caries. In: Embery G, Rølla G, eds. Clinical and biological aspects of dentifrices. Oxford: Oxford University Press, 1992: 131-43.

THYLSTRUP A, BRUUN C, HOLMEN L. In vivo caries models-mechanisms for caries initiation and arrestment. Adv Dent Res, 1994; 8: 144-57.

THYLSTRUP A, VINTHER D, CHRISTIANSEN J. Promoting changes in clinical practice. Treatment time and outcome studies in a Danish public child dental health clinic. Community Dent Oral Epidemiol, 1997; 25: 126-34.

THYLSTRUP A. When is Caries Caries, and What Should We do About it? How Should We Manage Initial and Secondary Caries In Current Topics in Dentistry. Quintessence International Vol 29 No 9 (September 1998).

VINTHER D, CHRISTIANSEN J, CARVALHO J C; EKSTRAND K R, THYLSTRUP A. Experience with a non-operative occlusal caries treatment program after 3 years. Proceedings of the 3nd World Congress on Preventive Dentistry, June 14-17, 1991. Fukuoka, Japan.


 

Nexø Public Dental Health Clinic and NOCTP

SUPPLEMENTARY LITERATURE:    
 

CARVALHO J C. Ph.D-Thesis at Department of Cariology and Endodontics, Royal Dental College, Copenhagen, Denmark, 1992: Clinical studies on the influence of eruption stage on occlusal plaqe formation and caries development in children.

CHRISTIANSEN J, VINTHER D. Skandynawski model profilaktyki próchnicy zebów. Czasopismo Stomatologiczne.
Tom XLVII , 1994, nr 6: 389-392

DJAHJAH C, ALMEIDA E, Do VALLE E V. O MÉTODO DE NEXØ. Um Programa para Atencão em Saúde Bucal. Jornal ABOPREV, 1994: jan/fev/mar: 6-8.

Do VALLE E V. O Método DE NEXØ. UM PROGRAMA PARA ATENCÃO EM SAÚDE BUCAL. NEXØ PUBLIC DENTAL HEALTH SERVICE. October 1996: 5 edicão.

EKSTRAND K, CHRISTIANSEN C, FORSS H; JOKELA J. Teoriasta käytäntöön - kaksi menestyksekästä organisoidun karieshoidon mallia.
Finnish Dental Journal: Suomen Hammaslääkärilehti, 5.97, 1.3.1997. N.s. Vol IV: 206-209, 261

EKSTRAND K, CHRISTIANSEN C, FORSS H, JOKELA J. To nordiske modeller for organiseret cariesbehandling.
The Journal of the S.D.A: Tandläkartidningen, Årgång 89, April 1997, nr 6: 19-24.

EKSTRAND K, CHRISTIANSEN C, FORSS H, JOKELA J. To nordiske modeller for organiseret cariesbehandling. The Journal of the N.D.A: Den Norske Tandlegeforenings Tidende 1997; 107 nr 3 : 114-8

FRONING N. Dissertation zur erlangung des Doktorgrades der Zahnheilkunde der Medizinischen Fakultät der Westfälischen Wilhelms-Universität Münster Deutschland 1987: Entwicklung der Karies bei Kindern in Nexoe Kommune ( Bornholm/Dänemark) seit Einrichtung der Schulzahnklinik von 1976 bis 1985.

GONZÁLEZ C. M C, VALBUENA M. L F, ZARTA A. O L, MARTIGNON B. S, ARENAS A. M, LEAÑO M. CARIES DENTAL - Guías de Práctica Clínica Basadas en la Evidencia - . PROYECTO ISS - A.C.F.O. (INSTITUTO DE SEGUROS SOCIALES - ASOCIACIÓN COLOMBIANA DE FACULTADES DE ODONTOLOGIA) Primera Edición, Diciembre de 1998

KUZMINA I N, KUZMINA E, EKSTRAND K R. Dental caries among children from Solntsevsky - a district in Moscow, 1993.
Community Dent Oral Epidemiol. 1995; 23: 266-70

KUZMINA I N. Ph.D-Thesis at Department of Cariology and Endodontics, School of Dentistry - Faculty of Health Sciences, University of Copenhagen, Denmark, 1997: A CARIES PREVENTIVE PROGRAM AMONG CHILDREN IN A DISTRICT OF MOSCOW, planing, implementing and outcome.

THYLSTRUP A. Diagnose und Therapie beginnender Karies. Philip Journal für restaurative Zahnmedizin, Teil 1: 4 Jahrgang, August 87: 228-235. Teil 2: 3 Jahrgang, Oktober 86: 304-308


 

Nexø Public Dental Health Clinic


 

ACTIVITIES    

National lectures and courses

Courses in cooperation with experts from the Department of Cariology, University of Copenhagen:
The dentists Dorte Vinther and Jette Christiansen have together with associate professor Kim Ekstrand, Department of Cariology, University of Copenhagen given 37 courses "How to handle occlusal caries". Associate professor Carsten Bruun, Department of Cariology, University of Copenhagen was a co-lecturer 7 times.

The courses have been given in the period 1988-93 all over Denmark and at the Faroe Islands. The target group has been dentists, dental hygienists and dental assistants employed in the Public Dental Health Service. The course has also been given to teachers at the Department of Pedodontics, University of Copenhagen.

On these courses the experts from the Department of Cariology have presented a modern understanding of the caries disease and the dentists from Nexø have presented how to implement these modern principles.

Dorte Vinther has together with professor Anders Thylstrup given courses in Cariology:

1993, Frederiksværk Public Dental Health Service
1995, County of Frederiksborg

Jette Christiansen has together with associate professor Kim Ekstrand given courses in "Evidence based prevention and caries treatment of children and adolescents"

2002, County of Århus

Courses/Lectures given by the Nexø dentists:
1990, Hvidovre Public Dental Health Service (JC)
1992, Hørsholm Public Dental Health Service (JC)
1992, Hillerød Public Dental Health Service (JC)
1994, Herning Public Dental Health Service (JC+DV)
1995, Fuglsø, Counties of Jylland (JC)
1996, Viborg Public Dental Health Service (JC)
1996, County of Frederiksborg (DV+BM)
1996, Municipality of Trehøje, Private Practice for children (JC)
1996, Counties of Vejle and Ribe (JC)
1997, Public Dental Health Services in Djursland (JC)
1997, Brædstrup, Ry and Them Public Dental Health Services (JC)
1997, Køge Public Dental Health Service (JC)
1997, Nibe, Sejlflod, Skørping, Støvring Public Dental Health Services (DV+BM)
1997, Brovst, Fjerritslev, Pandrup, Åbybro Public Dental Health Services (DV+BM)
1997, Skive and Struer Public Dental Health Services (JC)
1999, Ringkøbing Public Dental Health Service (JC)
1999, County of Storstrøm (JC)
1999, Horsens Public Dental Health Service (JC) 
2000, Vordingborg Public Dental Health Service (JC)
2001, Brande and Aaskov Public Dental Health Services (JC)
2001, Holstebro Public Dental Health Service (JC)
2001, Søllerød and Rødovre Public Dental Health Services (JC)
2002, Municipalities of EastFyn (JC)

Lecture, Danish Association of Quality Assurance:
1995, Fåborg (DV)
Lecture, interdisciplinary:
1995, Nexø. Annual Meeting of county health persons (DV)

International congresses and courses

Brazil (Kim Ekstrand + CC)
2000, ORCA SUMMER SCHOOL, Sardinia, Italy (JC) 

Presentations of papers at international congresses:
1990, NFP = Nordisk Forening for Pædodonti, Ålborg, Denmark (DV)
1991, WCPD = World Congress on Preventive Dentistry, Fukuoka, Japan (DV)
1991, IADC = International Association of Dentistry for Children, Kyoto, Japan (JC)
1993, Nordic Conference on Social Medicine, Kuopio, Finland (DV)
1993, WCPD = World Congress on Preventive Dentistry, Umeå, Sweden (JC+DV)
1993, IAPD = International Association of Paediatric Dentistry, Chicago, USA (JC)
1994, EUPHA = European Public Health Association, Copenhagen, Denmark (JC)

1995, ORCA = European Organisation for Caries Research, Netherland (A. Thylstrup)
1995, IAPD = International Association of Paediatric Dentistry, Göteborg, Sweden (JC)
1995, NOF = Nordisk Odontologisk Forening, Oslo, Norway (JC)
1997, IAPD= International Association of Paediatric Dentistry, Buenos Aires, Argentina (JC)
1999, IAPD= International Association of Paediatric Dentistry, London, United Kingdom (JC)
2000, ORCA = European Organisation for Caries Research, Sardinia, Italy (K.R. Ekstrand)
 
2001, IAPD=International Association of Paediatric Dentistry, Paris, France (JC)
2001, NFP=Norsk Forening for Pedodonti, Tromsø, Norway (KE)

Lectures/courses at annual meetings/conferences/congresses of dentists:
1991, I. Annual Meeting of Bulgarian Dentists, Varna, Bulgaria (JC)
1992, 2. Annual Meeting of Bulgarian Dentists, Plovdiv, Bulgaria (JC)
1995, 8. Innsbrucker Zahn-Prophylaxetage, Innsbruck, Austria (JC)
1997, International Conference on Prophylaxis and Biomaterials, Poznan, Poland (JC)
1997, Conselho Regional de Odontologia de Minas Gerais, Belo Horizonte, Brazil (JC)
1998, STOMA´98 Scientific Conference, Moscow, Russia (Kim Ekstrand+CC)

1998, IV CONFIO, Belo Horizonte, Brazil (JC)
1999, STOMATOLOGIYA 99 International scientific forum, Moscow, Russia (JC)
2000, III CIOMAR-CONGRESSO INTERNATIONAL DE ODONTOLOGIA, Maringa,


2000, 7. Jahrestagung - Greifswald; Gesellschaft für Kinderzahnheilkunde und  Primärprophylaxe in der DGZMK und Deutsche Gesellschaft für Zahnerhaltung e. V. (JC)
2000, Primer Simposio de Cariologia y Prevention, Santafé de Bogota, Colombia (Kim Ekstrand + CC)


Lectures /courses at Dental Schools/Institutes:
1993, Moscow Medical Stomatological Institute, Moscow, Russia (Kim Ekstrand+JC)
1994, Institute of dentistry, Poznan, Poland (JC+DV)
1995, The Baltic School of Public Health, Karlskrona, Sweden (JC)
1997, Ernst-Moritz-Arndt-Universität, Greifswald, Germany (DV+JC)
1997, Universidade Federal do Rio de Janeiro, Brazil (JC)
1998, Faculdade Medicina Dentaria, Universidade de Lisboa, Portugal (JC)
1998, "Prev Acao" Faculdade Odontologia, Universidade Federal de Juiz de Fora, Brazil (JC)
1998, Universidad El Bosque, Santafé de Bogota, D.C. -Colombia (CC)
2001, ACTA, Amsterdam, Netherland (JC)

Presentation in relation to Quality in Health Award:
1994, Golden Helix Award, Stockholm, Sweden (DV)

Lectures/courses given to dentists/dental teams:
1993, Moscow, Russia (Kim Ekstrand+JC)
1994, Poznan, Poland (JC)
1994, Karlstad, Sweden (DV+JC)
1995, Rio de Janeiro, Brazil (DV)
1995, Linköping, Sweden (JC)
1995, Marijampole, Lithuania (JC+DV)
1996, County of Östergötland, Sweden (JC)
1997, County of Östergötland, Sweden (JC)
1998, County of Värmland, Sweden (JC)
1998, ABO/JF, Juiz de Fora, Minas Gerais, Brazil (JC)

International courses and visits in Nexø.              

International courses in Nexø Public Dental Health Service:
1996: 10 days "Course in caries prevention and treatment-strategies" for 9 chief dental officers in charge of caries prevention programmes at national and county level in Lithuania, in collaboration with the County of Bornholm
1997: 5 days "Course in caries prevention and treatment strategies" for 3 chief dental officers from the child dental Health Service in Kaliningrad, Russia
1997: 3 days "Course in caries prevention and treatment strategies" for 5 dentists from "Akademia Medyczna, Instyitut Stomatologii", Poznan, Poland
1998: 2 days "Pregraduate course in non-operative caries treatment strategies" for 5 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.
1999: 2 days "Pregraduate course in non-operative caries treatment strategies" for 2 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.
2000: 2 days "Pregraduate course in non-operative caries treatment and caries treatment strategies" for 9 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.

2000: 2 days "Postgraduate course in Caries Prevention and Treatment Strategies" for 6 dental teachers from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.
2001: 2 days "Pregraduate course in non-operative caries treatment strategies" for 10 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.
2002: 2 days "Pregraduate course in non-operative caries treatment strategies" for 8 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.

2003: 2 days "Pregraduate course in non-operative caries treatment strategies" for 9 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland.

2004: 2 days "Pregraduate course in non-operative caries treatment strategies" for 9 students and a dental teacher from Ernst-Moritz-Arndt-Universität Greifswald, Deutschland. 

 

International visits:
Dentists from different countries have made study visits to Nexø Public Dental Health Service. The programme have included: "Presentation of a modern understanding of dental caries. Non-operative caries treatment Observations of clinical procedures with patients". The study visits have lasted from 1 to 14 days during the period 1987-02 including dentists from following countries:

Austria, Brazil, Colombia, Costa Rica, Cyprus, Finland, Georgia, Germany, Lithuania, Nepal, Netherlands, Poland, Portugal, Russia, Scotland, Sweden, Syria, USA

Dissertations.

Dissertations dealing with Nexø public Dental Health Service:
1987: Norbert Frohning, University of Münster, Germany. Doctor dissertation: "Entwicklung der Karies bei Kindern in Nexoe Kommune (Bornholm/Dänemark) seit Einrichtung, der Schulzahnklinik (Boernetandpleje) von 1976 bis 1985".
1992: Joana Carvalho, The Dental School, University of Copenhagen, Denmark: Dissertation PhD: "Clinical studies on the influence of eruption stage on occlusal plaque formation and caries development in children".
1997: Irina Kuzmina, Department of Cariology and Endodontics, School of Dentistry - Faculty of Health Sciences,University of Copenhagen: Ph.D-Thesis: "A Caries preventive program among children in a district of Moscow. Planning, Implementing and outcome".

Awards:
1994: Nexø Public Dental Health Service received the Danish "Colgate Award 1994" as an "acknowledgement of the entusiasm shown by the dental team in the work of transforming caries research results to practical work for the benefit of the dental health of the population."
1997: Nexø Public Dental Health Service received a "Certificate of Recognition" from The International Association of Paediatric Dentistry: "for a distinguishing contribution to the field of pediatric dentistry and the public awareness of good oral health in children".

Jette Christiansen(JC) Dorte Vinther(DV)
Christian Christiansen(CC) Birte Mortensen(BM)