Oral health among residents of publicly supported housing in Boston

Tooth loss in adults diminishes quality of daily life, affecting eating, speaking, appearance, and social interactions. Tooth loss is linked to severe periodontitis and caries; and to risk of stroke, cardiovascular disease, rheumatoid arthritis, and dementia. At the national (USA) level, poverty and African-American race have been linked to lower utilization of dental services, suggesting that the 7.5 million residents of publicly supported housing may be at risk of tooth loss and poor overall oral health. We assessed whether residence in publicly supported housing in Boston was associated with four oral health-related indicators. Compared to residents of nonpublicly supported housing, after adjusting for covariates residents of both public housing developments (PHDs) and rental assistance units (RAUs) had significantly lower odds of having had a dental cleaning in the past year (PHD, OR = 0.64 (95 % CI, 0.44-0.93); RAU, OR = 0.67 (95 % CI, 0.45-0.99))-despite parity in having had a past year dental visit. Further, residents of RAUs had double the odds of having had six or more teeth removed (OR = 2.20 (95 % CI, 1.39-3.50)). Associations of race/ethnicity and housing type with dental insurance were interrelated. Unadjusted results document a deficit in oral health-related indicators among public housing residents, taken as a group, giving a clear picture of an oral health care gap and identifying a defined real-world population that could benefit from services. Existing public housing infrastructure could provide both a venue and a foundation for interventions to reduce oral health disparities on a broad scale.

Smiles over time: an older adult oral health survey in Illinois

PURPOSE

The purpose of the project was to identify the oral health status and needs of the older adult population ≥60 years old in Illinois for policy decisions and to help identify possible need for oral health interventions. No baseline data has previously been collected on this population in Illinois.

METHODS

A public/private collaboration was formed, which included the Illinois Department of Public Health, the IFLOSS Coalition and dental and dental hygiene schools in Illinois. The screening tool was developed based on methods outlined by Association of State and Territorial Dental Directors for Basic Screening Surveys. Questionnaires and in-mouth screenings were conducted at selected sites statewide. Data was collected by dental and dental hygiene students and faculty at onsite clinics and community outreach sites.

RESULTS

A total of 437 seniors were screened statewide. Of this population, 81% had no dental insurance, 13% were edentulous and 58% claimed to have had a dental visit in the last year.A total of 26% rated their oral health as fair or poor, while 29% had untreated caries. Suspicious oral lesions were present in 14% (n=308 for the oral lesions indicator), 19% needed immediate dental care and 41% required referral.

CONCLUSION

This study revealed that surveillance can be accomplished by the collaboration among entities with focus on a specific population. Additional surveillance efforts are warranted among older adults in Illinois in an effort to plan and to implement appropriate interventions for addressing the oral health needs of this population.

Comparison of chewing ability, oral health related quality of life and nutritional status before and after insertion of complete denture amongst edentulous patients in a Dental College of Pune

BACKGROUND

The relationship between tooth loss and nutritional intake is important. As people age, their diminished physical capacity and decreased income adversely affect their ability to maintain their teeth. The aim of the study was to assess and compare the chewing ability, oral health related quality of life and nutritional status before and after fabrication and insertion of complete denture amongst edentulous participants in a dental college.

MATERIAL AND METHODS

Non Randomized Intervention study. The study population consisted of 42 participants (16 females and 26 males), aged 50 years and above. Prior to commencement of the study, informed consent was obtained and validation and reliability test of the questionnaire were done. The data for chewing ability, GOHAI and nutritional status assessment was recorded at baseline, 3(rd), 6(th) and 12(th) month after denture fabrication and insertion. The statistical comparisons were performed by repeated measure ANOVA and Chi-square test. P value<0.05 was considered as statistically significant.

RESULTS

Chewing ability, GOHAI, BMI (Body Mass Index) and data from Food-intake questionnaire showed statistically significant improvement from baseline to 6(th) month but no statistically significant improvement was observed from 6(th) month to 12(th) month. Nutritive value of food (protein, energy and fat) showed no significant difference over a period of 12 months (p<0.05).

CONCLUSION

Thus, it was concluded that the intervention (denture insertion) was effective in increasing the chewing ability, body weight, food-intake, and oral health related quality of life.

Oral characteristics of children with visual or auditory impairments

PURPOSE

The purposes of this study were to: (1) describe the demographics and oral characteristics of deaf or blind children and adolescents receiving dental treatment at an institution for the deaf and blind (DBC); (2) compare this information to children and adolescents with no systemic disease or impairments attending a dental university clinic (UC); and (3) compare the oral characteristics between visually or auditorily impaired children and adolescents.

METHODS

The demographics and oral characteristics of 120 DBC patients and 119 UC patients and between 35 visually impaired and 85 auditorily impaired were compared using analysis of variance, chi-square, Fisher's exact, and multiple regression analyses.

RESULTS

When controlling for age, there was no statistically significant difference between the UC and the DBC patients regarding caries prevalence. A significantly higher proportion of DBC children had gingival inflammation. Visually impaired patients had a statistically higher level of dependence on caretakers and higher gingivitis and plaque scores than the auditorily impaired.

CONCLUSIONS

Under oral health supervision, children and adolescents with or without hearing or visual impairment develop similar dental caries prevalence. Oral hygiene and resulting gingival inflammation are a challenge for the visually impaired and, to a lesser degree, the auditorily impaired.

[Social determinants and adult oral health in Brazilian state capitals]

OBJECTIVE

To assess the correlation between the social determinants of oral health (SDOH) index and social indicators, indicators of oral health, and intermediary social determinants expressed by the indicators of the Government of Brazil's National Oral Health Policy.

METHODS

This ecological study included 5 915 adults aged 35 to 44 years from 27 Brazilian capitals. Indicators of oral health outcomes-tooth loss, restored teeth, and dental care index (DCI)-were extracted from the 2010 National Oral Health Survey. Social indicators (structural social determinants) and indicators of the National Oral Health Policy were obtained from census data and from the Ministry of Health.

RESULTS

A moderate Pearson correlation (r) was observed between SDOH and DCI (r = 0.580), restored teeth (r = 0.545), and tooth loss (r = - 0.490). The social equity component was strongly correlated to DCI (r = 0.856), restored teeth (r = 0.822), and tooth loss (r = - 0.665). These oral health outcomes were not statistically associated with the components related to primary and secondary oral health care. The social equity component explained 44% of the variance in tooth loss, 68% of the variance in the number of restored teeth, and 73% of the variance in DCI.

CONCLUSIONS

A significant correlation was observed between SDOH and the social equity component with oral health outcomes in adults in Brazilian capitals. Therefore, equity policies should prioritize actions focused on the SDOH, such as increased sanitation coverage and water fluoridation, and on reducing poverty and regional inequities.

Oral cancer from a health promotion perspective: experience of a diagnosis network in Ceará

The aim of this study is to share the experience of implementing a network for the diagnosis of oral cancer by integrating primary, secondary, and tertiary oral health care centers and identifying the possible weaknesses of the process. The study also investigated the risks of exposure to the main risk factors for oral and lip cancer and their most common potentially malignant lesions (PML). A quantitative cross-sectional study was conducted in two different regions, with patients seen at a primary health care facility from August 2010 to July 2011. Patients with oral lesions were referred to dental specialty centers for biopsy. Patients with PML were treated in dental specialty centers, and patients with squamous cell carcinoma (SCC) were referred to tertiary health care facilities. The dentists' knowledge of PML and SCC was assessed by an objective questionnaire. A total of 3,965 individuals were examined, 296 lesions were found, and 73 biopsies were performed, of which 13.7% were diagnosed as PML and 9.6% as SCC. Tobacco use and sunlight exposure were associated with SCC (85.7%) and PML (80%), respectively. In total, 55 dentists were assessed. The lesions most commonly recognized as PML were leukoplakia (74%), erythroplakia (57%), and actinic cheilosis (56%). Most dentists (74%) felt incapable of performing biopsies, most likely because of an anxiety towards oral cancer, and 57% had never performed one. The integration of primary and secondary health care enables the diagnosis of PML and SCC and establishes a diagnosis network. However, the inability of most primary care dentists to identify PML and perform biopsies is a weakness of the diagnostic process.

Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden

BACKGROUND

Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.

METHODS

In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.

RESULTS

Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p < 0.05). Stratified analysis revealed that the mean OIDP frequency score worsened in participants who became dissatisfied- and improved in participants who became satisfied with oral health. Compared to participants who maintained all teeth, those who lost teeth were more likely to experience improvement and worsening of OIDP across both countries. The two-way interaction between country and tooth loss was not statistically significant.

CONCLUSIONS

Changes in OIDP at the individual level were more pronounced than the percentage distribution of OIDP at each point in time would suggest. The OIDP frequency score showed promising evaluative properties in terms of acceptable longitudinal validity, responsiveness and reproducibility among older people in Norway and Sweden. This suggests that the OIDP instrument is able to detect change in the oral health status that occurred over the 5 year period investigated. Norwegian elderly were more likely to report worsening in OIDP than their Swedish counterparts. Disease prevention should be at focus when formulating the health policy for older people.

Oral health conditions affect functional and social activities of terminally ill cancer patients

PURPOSE

Oral conditions are established complications in terminally ill cancer patients. Yet despite significant morbidity,the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions.

METHODS

This was an observational clinical study including terminally ill cancer patients (2.5–3-week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures.

RESULTS

Of 104 participants, most were ≥50 years of age,female, and high-school educated; 45 % were African American, 43 % Caucasian, and 37 % married. Oral conditions frequencies were: salivary hypofunction (98 %), mucosal erythema (50 %), ulceration (20 %), fungal infection(36 %), and other oral problems (46 %). Xerostomia, taste change, and orofacial pain all had significant functional impact; p <.001, p =.042 and p <.001, respectively. Orofacial pain also had a significant social impact (p <.001). Patients with oral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p =.003). Erythema was significantly associated with fungal infection and with mucosal ulceration (p <.001).

CONCLUSIONS

Oral conditions significantly affect functional and social activities in terminally ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration.

Methods of estimating or accounting for neighborhood associations with health using complex survey data

Reasons for health disparities may include neighborhood-level factors, such as availability of health services, social norms, and environmental determinants, as well as individual-level factors. Investigating health inequalities using nationally or locally representative data often requires an approach that can accommodate a complex sampling design, in which individuals have unequal probabilities of selection into the study. The goal of the present article is to review and compare methods of estimating or accounting for neighborhood influences with complex survey data. We considered 3 types of methods, each generalized for use with complex survey data: ordinary regression, conditional likelihood regression, and generalized linear mixed-model regression. The relative strengths and weaknesses of each method differ from one study to another; we provide an overview of the advantages and disadvantages of each method theoretically, in terms of the nature of the estimable associations and the plausibility of the assumptions required for validity, and also practically, via a simulation study and 2 epidemiologic data analyses. The first analysis addresses determinants of repeat mammography screening use using data from the 2005 National Health Interview Survey. The second analysis addresses disparities in preventive oral health care using data from the 2008 Florida Behavioral Risk Factor Surveillance System Survey.

Do health provider-patient relationships matter? Exploring dentist-patient relationships and oral health-related quality of life in older people

BACKGROUND

patient experience is now a key parameter in health care. Yet, very little is known about the possible impact of dentist-patient relationships on patient-centred outcomes including older peoples' oral health-related quality of life (OHRQoL).

OBJECTIVE

this study assessed the relationship between OHRQoL and dentist-patient relationships related to perceived unmet dental needs; shared decision-making; time spent discussing oral health problems; respect and confidence and trust.

PARTICIPANTS

older people aged 65 years and over living in East London, U.K. in 2011.

METHODS

a cross-sectional study using stratified random sampling recruited a representative sample of older people (n = 772). PARTICIPANTS completed an oral examination and a structured questionnaire including the Oral Health Impact Profile-14 (OHIP-14) measuring OHRQoL and five dentist-patient relationship questions taken from the U.K. 2009 Adult Dental Health Survey. Multivariate Poisson regressions modelled the association between OHRQoL and dentist-patient factors adjusting for socio-demographic factors, clinical oral indicators, and dental attendance.

RESULTS

having a perceived unmet need for dental treatment (PRR = 1.84; 95% CI: 1.32, 2.56) and expressing a lack of trust and confidence in one's dentist (PRR = 1.74; 95% CI: 1.01, 2.98) were significant predictors of poor OHRQoL among older people.

CONCLUSIONS

these findings suggest that older people with unmet dental needs and those who expressed a lack of trust and confidence in their dentist were more likely to experience poor OHRQoL reinforcing the importance of the dental patient experience in healthy ageing and well-being.

Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: results of the AMEL study

OBJECTIVES

This study aimed to assess the nutritional status, measured by MNA, and its association with socio-demographic indicators and health related characteristics of a representative sample of community dwelling elderly subjects.

DESIGN

Cross-sectional study.

SETTING

Community dwelling elderly individuals living in rural communities in Lebanon.

PARTICIPANTS

1200 elderly individuals aged 65 years or more.

MEASUREMENTS

Socio-demographic indicators and health related characteristics were recorded during a standardized interview. Nutritional status was assessed through Mini Nutritional Assessment (MNA). The 5-item GDS score and the WHO-5-A score were used to assess mood, whereas Mini Mental Status (MMS) was applied to evaluate cognitive status.

RESULTS

The prevalence of malnutrition and risk of malnutrition was 8.0% respective 29.1% of the study sample. Malnutrition was significantly more frequent in elderly subjects aged more than 85 years, in females, widowed and illiterate people. Moreover, participants who reported lower financial status were more often malnourished or at risk of malnutrition. Regarding health status, poor nutritional status was more common among those reporting more than three chronic diseases, taking more than three drugs daily, suffering from chronic pain and those who had worse oral health status. Also, depressive disorders and cognitive dysfunction were significantly related to malnutrition. After multivariate analysis following variables remained independently associated to malnutrition: living in the governorate of Nabatieh (ORa 2.30, 95% CI 1.35 -3.93), reporting higher income (ORa 0.77, 95% CI 0.61-0.97), higher number of comorbidities (ORa 1.22, 95% CI 1.12-1.32), chronic pain (ORa 1.72, 95% CI 1.24-2.39), and depressive disorders (ORa 1.66, 95% CI 1.47-1.88). On the other hand, better cognitive functioning was strongly associated with decreased nutritional risk (ORa 0.27, 95%CI 0.17-0.43).

CONCLUSION

Our results highlighted the close relationship between health status and malnutrition. The identification of potential predictive factors may allow better prevention and management of malnutrition in elderly people.

[Bucco-dental health in the elderly]

Whether they live at home or in institutions, the elderly generally have a poor bucco-dental health. The proportion of totally toothless patients is almost always higher than 50% and, among the others, the average number of remaining teeth is no more than ten. In the aged, this condition has several consequences on the quality of life, nutrition, cardiovascular diseases and pneumopathies. Maesures should be taken to improve this appaling state of affairs.

Dental and periodontal status of 12-year-old Bulang children in China

BACKGROUND

Bulang is an ethnic minority group living in Yunnan in the southwestern part of China. There is little information pertaining to the oral health of Bulang children. This study aims to examine the dental caries and periodontal status of 12-year-old Bulang children in China and the factors affecting their oral-health status.

METHODS

12-year-old Bulang school children in Yunnan, China, were recruited through a multi-stage cluster sampling method. Following the recommendation of the World Health Organization, caries experiences were recorded using the DMFT index and periodontal status with the CPI index. A self-completed questionnaire was used to collect information on the background and oral health-related behaviours of the children.

RESULTS

A total of 900 children in primary schools were invited, and 873 (97%) joined the survey. Their caries prevalence was 35%. Their caries experience in mean DMFT (±SD) score was 0.6 ± 1.1, and 94% of the carious teeth had no treatment. Most children (71%) had bleeding gums, and 58% of them had calculus. Girls and those who had visited a dentist in the previous year had higher caries risk.

CONCLUSIONS

Dental caries was common among the 12-year-old Bulang children in China. Most of the carious teeth were left untreated. Caries prevalence was associated with gender and dental attendance. Their periodontal condition was poor, and more than half of them had calculus.

Sociodemographic disparities and behavioral factors in clinical oral health status during pregnancy

OBJECTIVES

Although oral health (OH) problems are common during pregnancy, little is known about individual characteristics or behaviors relating to clinically assessed OH during pregnancy. This cross-sectional study describes the clinical OH status of a sample of pregnant women, examines relationships between sociodemographic factors and OH, behavioral factors and OH, and the influence of behavior on the relationships between sociodemographic clusters and OH. Baseline data were utilized from a pilot intervention study promoting OH during pregnancy.

METHODS

Participants (n = 99), recruited from CenteringPregnancy(®) prenatal care groups completed questionnaires addressing race/ethnicity, income, education, dental insurance, oral hygiene practices, and dental care utilization; and clinical examinations for periodontal probing depths (PD), bleeding on probing (BOP), plaque assessment, and visual detection of untreated decay. Chi-squares and one-way anovas with Tukey's studentized range test of planned comparisons were conducted to examine bivariable relationships between both sociodemographic and behavioral characteristics to OH status. Multivariable logistic regression analyses tested whether the effects of sociodemographic variables on OH status might be mediated by behaviors, including self-reported oral hygiene and recent dental visits.

RESULTS

Forty-five percent of the sample had untreated decay and the mean percentage of sites with BOP = 18%. Bivariable analyses of sociodemographic factors indicated that compared with Whites, Hispanic women had greater % of sites with: BOP, PD ≥5 mm plus BOP, and Plaque Index (PI) scores of ≥2, all P = 0.05; and greater untreated decay (Chi-square 13.3, P < 0.001). Lower income was related to greater untreated decay (Chi-square 7.6, P < 0.01). Compared with the highest education level, the lowest level group had higher % BOP, P < 0.05. Public dental insurance (versus private) was associated with greater % BOP, PD ≥5 mm plus BOP, both P < 0.05, and greater untreated decay (Chi-square 16.9, P < 0.001). Regarding behaviors, lacking a past 6-month dental visit was related to greater: BOP, PD ≥5 mm plus BOP, and PI ≥2 (F range 6.2-8.7, P < 0.01-0.05); and greater untreated decay (Chi-square 12.0, P < 0.001). Self-reported optimal oral hygiene was related to lower % BOP and PD ≥5 mm plus BOP (F range 4.5-6.7, both P < 0.05). Mediation analyses indicated that there were significant indirect effects of racial/ethnic differences on OH outcomes via having a recent dental visit (OR range 1.2-1.9). However, significant differences between the Hispanic and White groups remained.

CONCLUSIONS

This study highlights sociodemographic disparities in clinical OH during pregnancy, the importance of dental care, and provides useful findings for tailoring interventions for expectant mothers and their infants.

Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?

OBJECTIVES

The aim of this study was to analyse inequalities in the use of dental care services according to socioeconomic position (SEP) in individuals aged ≥50 years in European countries in 2006, to examine the association between the degree of public coverage of dental services and the extent of inequalities, and specifically to determine whether countries with higher public health coverage show lower inequalities.

METHODS

We carried out a cross-sectional study of 12 364 men and 14 692 women aged ≥50 years from 11 European countries. Data were extracted from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE 2006). The dependent variable was use of dental care services within the previous year, and the independent variables were education level as a measure of SEP, whether services were covered to some degree by the country's public health system, and chewing ability as a marker of individuals' need for dental services. Age-standardized prevalence of the use of dental care as a function of SEP was calculated, and age-adjusted indices of relative inequality (RII) were computed for each type of dental coverage, sex and chewing ability.

RESULTS

Socioeconomic inequalities in the use of dental care services were higher in countries where no public dental care cover was provided than in countries where there was some degree of public coverage. For example, men with chewing ability from countries with dental care coverage had a RII of 1.39 (95%CI: 1.29-1.51), while those from countries without coverage had a RII of 1.96 (95%CI: 1.72-2.23). Women without chewing ability from countries with dental care coverage had a RII of 2.15 (95%CI: 1.82-2.52), while those from countries without coverage had a RII of 3.02 (95%CI: 2.47-3.69).

CONCLUSIONS

Dental systems relying on public coverage seem to show lower inequalities in their use, thus confirming the potential benefits of such systems.

Oral health in Libya: addressing the future challenges

Libya is a vast country situated in North Africa, having a relatively better functioning economy with a scanty population. This article is the first known attempt to review the current state of oral health care in Libya and to explore the present trends and future challenges. Libyan health system, oral health care, and human resources with the present status of dental education are reviewed comprehensively. A bibliographic study of oral health research and publications has been carried out. The results point toward a common indicator that oral health-related research is low. Strategies have to be developed to educate the medical and dental professionals, to update the current curriculum and enable the system to be competent in all aspects of oral health care management.

A systematic review of the impact of parental socio-economic status and home environment characteristics on children's oral health related quality of life

Childhood circumstances such as socio-economic status and family structure have been found to influence psychological, psychosocial attributes and Oral Health Related Quality of Life (OHRQoL) in children. Therefore, the aim of this study was to conduct a systematic review of the published literature to assess the influence of parental Socio-Economic Status (SES) and home environment on children's OHRQoL. A systematic search was conducted in August 2013 using PubMed, Medline via OVID, CINAHL Plus via EBSCO, and Cochrane databases. Studies that have analysed the effect of parental characteristics (SES, family environment, family structure, number of siblings, household crowding, parents' age, and parents' oral health literacy) on children's OHRQoL were included. Quality assessment of the articles was done by the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative studies. Database search retrieved a total of 2,849 titles after removing the duplicates, 36 articles were found to be relevant. Most of the studies were conducted on Brazilian children and were published in recent two years. Early Childhood Oral Health Impact Scale and Children's Perception Questionnaire were the instruments of choice in preschool and school aged children respectively. Findings from majority of the studies suggest that the children from families with high income, parental education and family economy had better OHRQoL. Mothers' age, family structure, household crowding and presence of siblings were significant predictors of children's OHRQoL. However, definitive conclusions from the studies reviewed are not possible due to the differences in the study population, parental characteristics considered, methods used and statistical tests performed.

Oral health-related risk behaviours and attitudes among Croatian adolescents--multiple logistic regression analysis

The aim of this study was to explore the patterns of oral health-related risk behaviours in relation to dental status, attitudes, motivation and knowledge among Croatian adolescents. The assessment was conducted in the sample of 750 male subjects - military recruits aged 18-28 in Croatia using the questionnaire and clinical examination. Mean number of decayed, missing and filled teeth (DMFT) and Significant Caries Index (SIC) were calculated. Multiple logistic regression models were crated for analysis. Although models of risk behaviours were statistically significant their explanatory values were quite low. Five of them--rarely toothbrushing, not using hygiene auxiliaries, rarely visiting dentist, toothache as a primary reason to visit dentist, and demand for tooth extraction due to toothache--had the highest explanatory values ranging from 21-29% and correctly classified 73-89% of subjects. Toothache as a primary reason to visit dentist, extraction as preferable therapy when toothache occurs, not having brushing education in school and frequent gingival bleeding were significantly related to population with high caries experience (DMFT > or = 14 according to SiC) producing Odds ratios of 1.6 (95% CI 1.07-2.46), 2.1 (95% CI 1.29-3.25), 1.8 (95% CI 1.21-2.74) and 2.4 (95% CI 1.21-2.74) respectively. DMFT> or = 14 model had low explanatory value of 6.5% and correctly classified 83% of subjects. It can be concluded that oral health-related risk behaviours are interrelated. Poor association was seen between attitudes concerning oral health and oral health-related risk behaviours, indicating insufficient motivation to change lifestyle and habits. Self-reported oral hygiene habits were not strongly related to dental status.

Comparison of oral health among older people with and without dementia

Older people with dementia are very dependent on nursing, and caregivers are frequently confronted with oral-care-resistant behaviour which may lead to shortcomings in oral health.

OBJECTIVE

To compare oral hygiene and health status of institutionalised older people suffering, or not, from dementia.

BASIC RESEARCH DESIGN

Prospective cohort study (single-blind).

CLINICAL SETTING

Institutionalised older population in south-west Germany.

PARTICIPANTS

Ninety-three, allocated to two groups: dementia (n = 57) and non-dementia (n = 36) based on a mini mental state examination.

MAIN OUTCOME MEASURES

Target variables were plaque control record (PCR), gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN), and denture hygiene index (DHI). Differences between the dementia and non-dementia groups were evaluated by univariate testing of all target variables.

RESULTS

Univariate analysis revealed the amount of plaque in the dementia group was significantly higher than in the non-dementia group (p = 0.004). Mean CPITN of participants in the dementia group was significantly worse than those of participants in the non-dementia group (p < 0.001). All participants in the dementia group had periodontitis in at least one of the sextants, compared with 74% in the non-dementia group (p < 0.001). For DHI (p = 0.198) and GBI (p = 0.275) no differences were found between the groups.

CONCLUSIONS

Some aspects of oral hygiene and health seem to be worse for the institutionalised older people with dementia. Permanent specially adapted intervention for residents suffering from dementia in long-term care homes, and training for caregivers, is desirable to maintain life-long oral hygiene and health.

Development and psychometric validation of a Health Literacy in Dentistry scale (HeLD)

BACKGROUND

Oral health literacy is emerging as a new public health challenge and poor oral health literacy is increasingly seen as an important predictor of poor oral health outcomes. Within Indigenous populations, there may be benefits to research in using a culturally acceptable, internally consistent and valid instrument to assess oral health literacy. We translated a general health literacy measure, the Health Literacy Management (HeLM) scale to make a dentally relevant scale; Health Literacy in Dentistry (HeLD).

OBJECTIVE

This study describes the development and assessment of the reliability and validity of the HeLD in an Indigenous Australian population.

DESIGN AND METHODS

The 29 item HeLD scale assesses the components of oral health literacy. The reliability and validity of the seven HeLD subscales were evaluated in a convenience sample of 209 Indigenous Australians with mean age 35 years (range 17-81) and of which 139 were female.

RESULTS

The scale was supported by exploratory factor analysis and established seven distinct and internally consistent domains of oral health literacy: Communication, Access, Receptivity, Understanding, Utilisation, Support and Economic Barriers (Cronbach's alpha = 0.91). Discriminative ability was confirmed by HeLD associations with socio-demographic variables and self-reported health ratings in the expected direction. The convergent validity and predictive validity were confirmed by HeLD scores being significantly associated with toothbrush ownership, use of a toothbrush, time since last dental visit and knowledge of the effect of cordial on the teeth.

CONCLUSIONS

The HeLD appears to be an internally valid and reliable instrument and can be used for measuring oral health literacy among rural Indigenous Australian adults.

Caries prevalence, oral hygiene, and oral health habits of Kuwaiti infants and toddlers

OBJECTIVE

The purpose of this study was to describe the oral health, oral hygiene, and oral health habits of Kuwaiti infants and toddlers.

SUBJECTS AND METHODS

This cross-sectional study of a convenience sample included 336 infants and toddlers (156 females and 180 males). The teeth of the infants and toddlers were examined using a mirror and a light source. Oral hygiene was recorded, and then all teeth were cleaned with gauze and examined for caries. Parents were interviewed regarding their children's feeding habits, brushing or tooth cleaning, and night feeding. The evaluation criteria for caries were sound teeth, noncavitated lesions, cavitated lesions, filled teeth, and missing teeth.

RESULTS

The mean age was 11.1 ± 2.4 months (range 2-23). Of the 336 subjects, 247 (73%) had good oral hygiene, 64 (19%) had parents who brushed or cleaned their infants' and toddlers' teeth; 288 (86%) were bottle-fed, and 290 (86%) were also night fed. The mean number of teeth upon examination was 4.6 ± 2.7 (range 2-8). Three percent of the infants and toddlers had caries. Cavitated lesions were present in 6 patients (1.8%), while 4 (1.2%) had noncavitated lesions. The mean d1d2t (caries teeth: noncavitated lesions and cavitated lesions) was 0.03 ± 0.3, and the mean d1d2s (carious surfaces) was 0.07 ± 0.5.

CONCLUSION

The caries prevalence and severity was low in infants and toddlers. However, poor oral health practices and habits as well as unhealthy feeding practices that could affect the future caries prevalence were noted.

Caries and oral health related behaviours among homeless adults from Porto, Portugal

PURPOSE

To describe caries prevalence and oral-health-related behaviours in a sample of homeless adults from the city of Porto, Portugal.

MATERIALS AND METHODS

Subjects attending any of two temporary shelters or two institutions that provide meal programmes were consecutively invited (n = 196); 42 (21.4%) refused to participate. Trained interviewers applied a structured questionnaire to obtain sociodemographic, behavioural, health and oral health status data. An oral examination was conducted to evaluate the past and present history of caries (Decayed Missing Filled Teeth [DMFT] index) and the presence of oral lesions. Those classified as houseless were considered for the present analysis (n = 141). The association between homelessness, sociodemographic and behavioural characteristics and oral health indexes was quantified through crude β coefficients and β coefficients adjusted for age, gender, education, nationality and duration of homelessness, as well as the respective 95% confidence intervals (CI).

RESULTS

The median age of the participants was 45 years, most were male (86.3%), reported having less than a 9th grade education (80.1%) and were unemployed (82.1%). The median duration of homelessness was 24 months. The mean (SD) DMFT index, number of decayed, lost and filled teeth were 12.8 (7.9), 4.2 (4.4), 8.0 (7.6) and 0.6 (1.9), respectively. Older subjects and those homeless for longer periods presented higher DMFT index scores (β = 3.4, 95% CI: 0.0 to 6.8) and higher number of decayed teeth (β = 2.8, 95% CI: 0.4 to 5.2). Filled teeth were more frequent among the more educated (>9 vs ≤4 years: β = 1.6, 95% CI: 0.7 to 2.6).

CONCLUSIONS

This population of homeless subjects showed poor oral health, particularly with respect to caries and missing teeth, resulting in high oral treatment needs.

Influence of diet on oral health in young adults--pilot study

INTRODUCTION

Diet is a factor that can modify, among others, the course of caries, dental erosive lesions and periodontal disease. It is important to know the influence of diet on the clinical oral condition in young adults.

MATERIAL AND METHODS

20 women and 20 men aged 19-21 participated in the study. During a clinical examination of the patients the following clinical indices were estimated: Ap- proximal Plaque Index (API), Bleeding on Probing (BOP) and DMFT indices. The frequency and quality of food products consumed were noted in a special questionnaire. Results with p ≤ 0.05 were considered statistically significant.

RESULTS

The average API value for the female participants was 77.37%, BOP--23.84% and DMFT--9.9. The t-test results for independent samples showed that women who consumed meat and meat products two times a week or more, had statistically higher API (p = 0.01) and BOP (p = 0.05) values, than the mean value for these indexes. Women who consumed grain products and grain-based products two times a week or more, had higher API values compared to the mean value for this index (p = 0.02). The average API value for the male participants was 34.25%, BOP--10.15% and DMFT--9.05, respectively. Men who consumed milk and dairy products three times a week or less had statistically lower API (p = 0.05) and BOP values (p = 0.02), relative to the mean index values.

CONCLUSIONS

The chemical composition and texture of the food intake can affect oral health. Besides instruction in oral hygiene, doctors and dentists should also assess the eating habits of their patients.

Dental status of junior high school students in Łódzkie voivodeship

OBJECTIVE

Dental caries still constitutes a serious health problem in Łódzkie voivodeship. The aim of the article was to evaluate the dental status of 15-year-old adolescents living in Łódzkie voivodeship based on epidemiological studies conducted in 2011.

MATERIAL AND METHODS

The study group was comprised of 177 students at the age of 15 years living in Łódzkie voivodeship, selected on the basis of stratified cluster sampling method. The study was conducted pursuant to WHO recommendations. The dental caries prevalence and intensity among students were calculated as well as the components values (DMFT), dental caries severity, treatment index and SiC index. The study results were analyzed using the statistical methods.

RESULTS

From the study results transpires that dental caries was observed in 93.8% of students. The dental caries severity amounted to 6.18. Having compared urban and rural areas, the statistically higher number of teeth subject to treatment was observed in the latter. The SiC and treatment index were 8.20 and 0.54, respectively.

CONCLUSIONS

On the basis of gathered data, the deterioration of dental status in adolescents aged 15 years from Łódzkie voivodeship was observed. Furthermore, it is strictly related to the place of residence.

Oral health and access to dental care: a qualitative exploration in rural Quebec

INTRODUCTION

We sought to explore how rural residents perceive their oral health and their access to dental care.

METHODS

We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation.

RESULTS

Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities.

CONCLUSION

Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.

Oral health and prophylactic-therapeutic needs of children aged 6 years in Poland in 2012

BACKGROUND

Irrespective of the fact that in developed countries, a reduction of dental caries incidence is observed, it still remains the most common chronic disease affecting children in Poland.

OBJECTIVES

In the paper, the results of nationwide epidemiological studies conducted in Poland in 2012 within the framework of the Nationwide Dental Health Monitoring Programme were presented.

MATERIAL AND METHODS

The children aged 6 years were enrolled into the study. Clinical assessment of oral health status of children was made in accordance with WHO recommendations.

RESULTS

The percentage of healthy children aged 6 years, who did not have any signs of dental caries manifested with cavity, tooth filling or tooth loss was only 14.4%. On average, only one tooth per child was filled due to dental caries and four out of five teeth affected by dental caries required invasive treatment. Index of conservative treatment was very low and amounted to 0.23 +/- 0.24.

CONCLUSIONS

The results demonstrate high caries prevalence and significant prophylactic-therapeutic needs.

Polish public programme of dental caries prevention in children aged 6, 12 and 18 years in 2012

INTRODUCTION

Studies conducted within the framework of "Monitoring of oral health in Polish population", adapted by Ministry of Health, determined the percentage of children aged up to 18 years who were involved in prophylactic programme in schools.

OBJECTIVE

The study aimed at analyzing the prophylactic programme conducted in 2012 in Poland, combined with the procedure of sealing of primary and permanent lateral teeth in 3 age groups.

MATERIAL AND METHODS

A total of 5,723 children aged 6, 12 and 18 years living in 7 voivodeships were involved in epidemiological study. The study was conducted pursuant to WHO recommendations (Oral Health Surveys).

RESULTS

The percentage of children in particular age groups involved in prophylactic programme was: 34.8% and 97.3%, while the 18-year-olds were not subject to prophylaxis. Taking into account the completion status of prophylactic programmes, considerable differences between voivodeships were observed. A minor percentage of children aged 6 years had primary and permanent teeth sealed with their respective share being 0.6% and 7.1%. The percentage of children aged 12 years with sealed teeth amounted to 33%. The noticed disprities in the percentage of sealed teeth in particular voivodeships ranged from 1.4 to 56.0%. Less than 1% (0.8%) of examined 18-year-olds required sealing of teeth as generally lateral teeth in this age were filled or affected by dental caries.

CONCLUSIONS

1. Having analyzed the place of residence (urban, rural area) in relation to the number of children involved in prophylactic programme, no differences were observed in children aged 6 years. However, considerable disparities were present between particular voivodeships. A minor percentage of 6-year-olds had sealed permanent teeth, its value was less regarding primary teeth. 2. Nearly all children aged 12 years were subject to fluoride prophylactic programme, while in four voivodeships it amounted to 100%. The percentage of sealed teeth was 33%. From the analysis of number of sealed teeth in examined children transpires that more than 67% of children had no sealing of teeth, while 13% of them had from 4 to 6 teeth with sealants.

[A comparison of self assessment of dental status regarding dental anxiety among combat and non-combat soldiers]

The objective of the study was to evaluate the difference in the level of self dental assessment between different groups of soldiers: 115 combats and 115 non-combats. All the solders in this study where male, Jewish, with a service record of 12-48 months, ages 18-22 and born in Israel. The data was summarized, evaluated and tested by x2 - chi square and logistic regressions analysis. In the following parameters no significant differences were found regarding time past from last visit to the dentist, self assessment of dental condition, self assessment of need of dental treatment and the frequency of tooth brushing and sugar consumption. Significant differences were found in the percentage of smokers (59.1% among non-combat vs. 31.9% among combat), and in the dental anxiety level (55.3% among non-combat vs. 38% among combat). The main difference between these two groups is the nature of the social support and society surrounding them, a society that strengthens them and gives the feeling they can deal with fears and difficulties. An additional study should be done in which the soldiers self assessment should be compared to clinical examination. The importance of this study is that the non-combat group should be defined as a high risk population regarding dental anxiety.

Oral health promotion in early childhood: age of joining preventive program and behavioral aspects

OBJECTIVE

To analyze the interference of age in the entrance into a public dental care program for infants as well as family behavioral aspects about tooth decay experience in children 0 to 4 years old.

METHODS

Cross-sectional study involving 465 children who were divided into 3 groups: infants whose mothers joined the program during pregnancy (n=50); infants enrolled in the program during the first year of life (n=230); and infants enrolled in the program between 13 and 18 months old (n=185). The χ(2) and Kruskal-Walis tests (95% confidence interval) were used to assess the relationship among variables.

RESULTS

There was an association between the age of entrance in the programs and dental caries (p<0.001). A lower prevalence was seen in infants whose mothers joined the program during pregnancy, and among those infants enrolled in the program during the first year of life. The same low prevalence occurred in relation to mothers' commitment to attend follow-up visits with their infants, cariogenic diet, nighttime oral care, duration of night feeding and parents' educational level (p<0.001). Unfavorable socioeconomic conditions (p>0.05) and daily oral care (p=0.214) were common variables in the groups with 99% of occurrence. Commitment to attend follow-up visits, nighttime oral care and parents' educational level (p>0.05) were considered protective factors for dental caries. Cariogenic diet and night feeding were determinant factors to the appearance of dental caries.

CONCLUSION

To promote children oral health it is essential to enroll children in oral health programs and adopt healthy habits as early as possible, besides the adherence of the child to their parents' advice.

Changes in children's oral health status and receipt of preventive dental visits, United States, 2003-2011/2012

INTRODUCTION

Oral health represents the largest unmet health care need for children, and geographic variations in children's receipt of oral health services have been noted. However, children's oral health outcomes have not been systematically evaluated over time and across states. This study examined changes in parent-reported children's oral health status and receipt of preventive dental visits in 50 states and the District of Columbia.

METHODS

We used data from the 2003 and the 2011/2012 National Survey of Children's Health. National and state-level estimates of the adjusted prevalence of oral health status and preventive dental visits were calculated and changes over time examined. Multivariable logistic regression was used to compare outcomes across all states and the District of Columbia for each survey year.

RESULTS

The percentage of parents who reported that their children had excellent or very good oral health increased from 67.7% in 2003 to 71.9% in 2011/2012. Parents who reported that their children had preventive dental visits increased from 71.5% in 2003 to 77.0% in 2011/2012. The prevalence of children with excellent or very good oral health status increased in 26 states, and the prevalence of children who received at least 1 preventive care dental visit increased in 45 states. In both years, there was more variation among states for preventive dental visits than for oral health status.

CONCLUSIONS

State variation in oral health status and receipt of preventive dental services remained after adjusting for demographic characteristics. Understanding these differences is critical to addressing the most common chronic disease of childhood and achieving the oral health objectives of Healthy People 2020.

Oral health, oral pain, and visits to the dentist: neighborhood influences among a large diverse urban sample of adults

The objective of this study was to assess the association between oral health and individual-level characteristics as well as both socioeconomic position (SEP) and service provision characteristics at the neighborhood level. Multilevel logistic analysis was undertaken of data from the Neighbourhood Effects on Health and Well-being Study in Toronto comprising 2,412 participants living in 47 neighborhoods and 87 census tracts. Three oral health outcomes were investigated: last dental visit, self-rated oral health, and self-rated oral pain. Results indicated that SEP was significantly associated with no dental visits in the last year, poor self-rated oral health, and experiencing oral pain after adjusting for age, gender, and immigrant status. Lack of dental insurance was associated with no visits to the dentist in the last year and poor self-rated oral health; however, no association was observed with oral pain. In adjusted regression models, few neighborhood level variables were significantly associated with dental visits and self-rated oral health and no neighborhood variables were associated with oral pain. Based on these results, SEP appears to be important in evaluating oral health outcomes. While insignificant in this study, neighborhood factors are important when considering the impact of service provision on oral health.

Promoting oral health of children through schools--results from a WHO global survey 2012

This paper reviews the range of school-based approaches to oral health and describes what is meant by a Health Promoting School. The paper then reports the results of a World Health Organization global survey of school-based health promotion. Purposive sampling across 100 countries produced 108 evaluations of school oral health projects spread across 61 countries around the globe. The Ottawa Charter for Health Promotion noted that schools can provide a supportive environment for promoting children's health. However, while a number of well-known strategies are being applied, the full range of health promoting actions is not being used globally. A greater emphasis on integrated health promotion is advised in place of narrower, disease- or project-specific approaches. Recommendations are made for improving this situation, for further research and for specifying an operational framework for sharing experiences and research.

[The relationship between the oral health and socioeconomic characteristics of chronic kidney disease patients undergoing haemodialysis treatment or kidney transplant]

OBJECTIVE

Characterising the oral health of patients undergoing different types of dialysis or kidney transplant.

MATERIALS AND METHODS

This was a descriptive study which involved multivariate analysis of information taken from an initial database regarding 336 patients; 49 % were receiving haemodialysis, 34 % peritoneal dialysis, 7 % pre-dialysis and 10 % kidney transplant. Illustrative variables were age, gender, marital status, occupation, education, oral hygiene and gingival indexes, flossing, decayed, missing, and filled teeth (DMFT) index, renal disease aetiology and type of dialysis being received. A hierarchical clustering method was used.

RESULTS

Four groups of patients were identified. Class 1 (37.8 %) consisted of unmarried men having had secondary education and having good oral hygiene, very high DMFT, with haemodialysis but no stomatological pathology. Class 2 (20.24 %) included haemodialysis patients who had received elementary education, were unemployed, had inadequate oral hygiene, severe gingivitis, very high DMF rate and high Candida frequency. Class 3 (31.2 %) included women undergoing peritoneal dialysis who were over 70 years old, had received elementary education, were housewives, edentulous and who had loss of vertical dimension. Class 4 (10.7 %) included men who had received renal transplant, secondary education and were employees; one third of them were edentulous and had soft tissue alterations.

CONCLUSION

Multivariate analysis indicated a possible relationship between the type of dialysis received and patients' socioeconomic characteristics regarding oral health status.

Oral health status and oral hygiene habits among children aged 12-13 years in Yangon, Myanmar

We conducted a cross sectional study among children aged 12-13 years in Yongon, Myanmar to assess the oral health status and oral hygiene habits. The studied 220 students were from two high schools, one urban and the other rural. We conducted an oral health examination following WHO criteria and used a self-administrated questionnaire. The prevalence rate of dental caries among the study population was 53.2%. The mean number of decayed, missing and filled teeth (DMFT) was 1.7 +/- 2.1 teeth per person (decayed, 1.5 +/- 1.9); missing 0.0 +/- 0.2; filled, 0.1 +/- 0.4). Multivariate analysis revealed significant risk factors for dental caries were: the geographical location of the school (adjusted OR=2.24; 95% CI: 1.01-4.94), occupational status of the father (adjusted OR=2.83; 95% CI: 1.05-7.62) and the child's attitude about dental caries (adjusted OR=2.35; 95% CI: 1.18-4.67). Knowledge and oral hygiene habits were not associated with dental caries. The results of this study suggest the need to change from restoration orientated dentistry to dental public health care services, to reduce of the high level of dental caries in this age group.

Association between parity and dentition status among Japanese women: Japan public health center-based oral health study

BACKGROUND

Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men.

METHODS

A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model.

RESULTS

Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects.

CONCLUSION

Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.

Mobile primary healthcare services and health outcomes of children in rural Namibia

INTRODUCTION

In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia.

METHODS

Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed.

RESULTS

For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001).

CONCLUSION

Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.

[Dental health status of 15 year-old schoolchildren in Comoros]

The epidemiological situation of decay evolves differently in the world. In industrialized countries, prevalence has declined significantly due to preventive measures, while in developing countries many studies have shown that caries was increasing. The aim of this study was to assess the state of dental health of schoolchildren aged 15 in Grand Comore (Comoros). This was a descriptive cross-sectional study on 15 year-old schoolchildren in colleges in Grande Comore who agreed to be examined. Four hundred schoolchildren were chosen by a stratified sampling weighted according to the area of living. Three groups of indicators of dental caries were used: the components D, M and F, the average DMFT and prevalence. The WHO modified questionnaire for the assessment of dental health was used to collect data; continuous data were compared by Student t test and qualitative ones by Chi-square test. Fifty two percent of schoolchildren were male and 63.5% lived in urban area. From the 888 teeth bearing the stigmata of decay, 83.2% were decayed, 12.5% missed and 4.3% filled. These components of DMF were associated with sex (p = 0.039) and not with area (p = 0.12). The 2.22 DMFT average was not associated with sex (p = 0.58) neither with area (p = 0.57). The caries prevalence was higher in rural than in urban areas (p = 0.001) and was not associated with sex (p = 0.61). These results suggest that schoolchildren need decay treatments. The dental programs will have much more success when they will be integrated into more comprehensive programs to promote schoolchildren health.

Gingival evaluation of the pediatric cardiac patient

PURPOSE

Children with congenital cardiovascular diseases (CCDs) who suffer from dental diseases have an increased risk of infective endocarditis. In the light of recent evidence, oral inflammatory diseases may also increase the severity of their cardiovascular condition. The purpose of this study was to evaluate the gingival status of children with congenital cardiovascular diseases in comparison to healthy children.

METHODS

Fifty 7- to 13-year-old children were included. The test group comprised 25 CCD children subdivided into three groups: (1) unrepaired ventricular septal defect; (2) aortic valve stenosis; and (3) coarctation of the aorta. The control group consisted of 25 healthy age- and gender-matched children. Gingivitis, plaque, calculus, and recession were measured on six sites per tooth on 12 teeth.

RESULTS

CCD children had significantly more gingivitis (P<.001), plaque (P<.001), recession (P>.02), and calculus (P<.001) than controls. Among the CCDs groups, no statistically significant differences were found for gingivitis, plaque, or recession.

CONCLUSIONS

Children with congenital cardiovascular diseases had a higher prevalence of periodontal disease, evidenced by gingivitis, plaque, calculus, and recession. These children should be evaluated periodontally and their oral health monitored on a 3-month basis to prevent disease development, benefit cardiovascular condition, prevent endocarditis, and improve quality and longevity of life.

The influence of different factors on the oral health status of smoking and nonsmoking adults

AIM

The aim of this study to determine the influence of smoking on self-reported oral health status among university students.

MATERIALS AND METHODS

Voluntary sample of 669 adults of 18 to 26 years old were invited to participate in the study. They were asked to read a self-designated questionnaire and a covering letter which explained the purpose of the study. The questionnaire addressed self-reported demographics, oral hygiene and smoking habits; knowledge about smoking and its effects on oral health. Data were statistically analyzed using Chi-square test to determine statistically significant differences across the oral health status.

RESULTS

The sample included 340 (56.7%) males and 240 (43.3%) females; 56.8% of the subjects were nonsmokers; 43.2% were current smokers, and 17.5% smoke argileh. Almost 24.7% of subjects started smoking because of emotional effects; 66.9% did not smoke because of its harm to health. The percentage of subjects with dental plaque on their teeth was 27.1%, and with calculus was 27.9%, and with stains was 26.9%. About 35.5% of the subjects brushed their teeth once daily. Statistically, significant association was proven between smoking and gender (p < 0.01); and smoking and halitosis (p < 0.01).

CONCLUSION

Smoking is significantly related to esthetics, calculus, tooth stains, halitosis, gingival bleeding, and gender with p < 0.01, p < 0.01, p < 0.01, p < 0.01, p = 0.05, and p < 0.01 respectively.

Knowledge, attitude and practice of mothers regarding their own and children's dental health--a tertiary care hospital based study

BACKGROUND

Mothers play a basic role in the dental health of children. They decide whether their children need dental treatment or not. The aims of this study were to assess mothers' knowledge and practices regarding children's dental health and to determine association of mothers own attitude and their attitude towards children's dental health.

METHODS

A cross sectional study was conducted in the Aga Khan University Hospital (AKUH), Karachi, Pakistan in which 207 mothers completed a self-administered structured questionnaire. Inclusion criteria were respondents having children between 2 and 5 years of age and exclusion criteria were respondents having physical or mentally handicapped children. SPSS-16 was used for data analysis. Chi Square test was used to determine association between maternal own dental attitude and their attitude and knowledge about children dental health with p < or = 0.05 as statistically significant.

RESULTS

Majority of the mothers used to visit dentists for themselves in the case of problems and they thought the same for their children (p < 0.001). A statistically significant association also existed between mothers and children tooth brushing frequency (p < 0.001).

CONCLUSIONS

Mothers visiting Aga Khan University Hospital, lack sufficient knowledge regarding timings of the children's first dental visit and the importance of limiting frequency of in-between meals snacks consumed by their children.

Oral health practices of adult inhabitants of a traditional community in Ibadan, Nigeria

BACKGROUND

Although, the association between oral health care practices and sociodemographic characteristics of populations have been documented, information is sparse on sociodemographic indices influencing oral health practices of residents of traditional communities. The study aimed to describe the oral health practices of adult inhabitants of a traditional community in Nigeria.

METHODS

A descriptive, cross-sectional study involving adult residents in randomly selected houses in Idikan, Ibadan, Nigeria. Data on their oral health care practices was obtained with the use of structured interviewer administered questionnaires. Data was analysed with SPSS and test of association carried out using Chi square.

RESULTS

A total of 390 adult residents participated in the study, of which 56.2% were males. A total of 196 (50.3%) participants used toothbrush solely to clean their teeth, 72 (18.5%) used chewing sticks alone while 119 (30.5%) used both tooth brush and chewing stick. Older residents of the community, those with no formal education and in lower occupational classes were more likely to use chewing stick (p < 0.05). The majority (68.7%) cleaned their teeth once daily, 30% cleaned twice while 1.3% cleaned infrequently. Educational level attained and occupational class were significantly related to frequency of oral hygiene. Nearly all (95.4%) of the participants knew that oral health services are available in most hospitals, yet only 35.9% had ever visited a dental centre with a significantly higher proportion being males (p < 0.05).

CONCLUSION

The study showed that the oral health practices of a typical traditional community in Nigeria are highly influenced by socioeconomic considerations.

Association of the oral health impact profile with malnutrition risk in Spanish elders

The objective of this study was to determine any relationship between oral health-related quality of life (OHR-QoL) and malnutrition risk in the elderly using the oral health impact profile (OHIP). We studied 250 institutionalized elderly people, 162 females and 88 males, with and without teeth. Data were gathered on: general health; oral health; malnutrition risk, measured with the Mini Nutritional Assessment (MNA); and OHR-QoL, evaluated with the OHIP. A multivariate binary logistic regression model was constructed with malnutrition presence/risk as dependent variable. Mean age was 82.7 ± 8.2 years. Malnutrition or malnutrition risk was shown by 36.8% of the sample. OHIP was associated with malnutrition/risk after adjustment for age, sex, functional status, and mild dementia diagnosis. Malnutrition/risk was 3.43-fold more likely in participants with OHIP-reported "problems" than in those with none. The conclusion of the study was that OHIP-measured OHR-QoL is associated with malnutrition risk.

Oral health behaviours in relation to caries and gingivitis in primary-school children in Tehran, 2008

The objectives of this cross-sectional study were to determine the prevalence of caries, severe caries and gingivitis in Tehran primary-school children and to analyse the relationship between children's oral hygiene habits and prevalence of these oral health diseases. Data were collected on the oral hygiene habits of 1271 Tehran schoolchildren (637 boys, 634 girls) aged 9-13 years. Clinical examinations were performed to determine the decayed, missed and filled teeth (DMFT) and the presence of gingivitis. Total DMFT > or = 1 was observed in 83.3% of children; 55.5% had tDMFT > or = 4 and 87.7% had > or = 1 site affected by gingivitis. Dental visits of 48.2% of children were limited to toothache occasions and parents' lack of belief in the importance of oral health was the most commonly cited reason (P < or = 0.05). The source of oral health education had the strongest independent association with severe dental caries (OR= 2.35; 95% CI: 1.80-2.60); dental flossing frequency was the strongest predicting factor correlated with gingivitis (OR = 3.51; CI: 1.46-8.44).

[Prevention of oral diseases]

Oral health is essential to general health and quality of life. Ever more people are affected with oral diseases. Dental caries, gingivitis and periodontitis are the most common oral diseases and they can be prevented. Oral health promotion and oral disease prevention programs should be incorporated in national health strategies. Inability to understand health information can be a profound disadvantage to patients when asked to take responsibility for their health. Increasing the level of oral health literacy and improvement of communication between patients and dentists by avoiding the usage of professional dental terminology should be included in each oral prevention program.

Factors related to oral health related quality of life in TMD patients

The aims of the study were to determine the impact of temporomandibular disorders (TMD) on self-percieved oral health related quality of life (OHRQoL) and to compare OHRQoL of patients with TMD with a control group. A total of 81 TMD patients participated in a study group and 400 adults served as the control group. The mean OHIP summary scores were computed for all patients with the same diagnosis and the same subgroup of axis I according to the RDC/TMD exam form. The mean OHIP subscores for all seven domains of the OHIP questionnaire were compared between the study and the control group. The hierarchical linear regression model was used to assess the most important variables according to the RDC/TMD protocol that contribute to OHRQoL in TMD patients with the OHIP summary score as dependent variable. According to this study, TMD had a high association with reduced OHRQoL (p < 0.001). More diagnoses of axis I according to the RDC/TMD protocol (p < 0.001), higher age of TMD patients (p < 0.001) and diagnoses associated with limited jaw movements contributed to more impaired OHRQoL (p = 0.008 and p = 0.030, respectively). Female TMD patients had no significantly different OHRQoL compared to male patients (p = 0.436). According to regression analysis, higher age (p < 0.001), more physical diagnoses (p = 0.018) and diagnosis Ib (p = 0.169) explained 39.1% of the variability (p < 0.001) of the OHIP summary score in TMD patients.

Georgian version of the "Oral Health Impact Profile"

The aim of the present study was to survey the validation of the Georgian version of "Oral Health Impact Profile" (OHIP). Initial testing of questionnaire showed that the all questions are understood by the patients. Survey, which was conducted with the help of the Georgian version of quality of life questionnaire, showed that received results are directed related to the progress of chronic parodontitis; during the aggravation period there is the worse quality of life than those in remission. It was confirmed that the Georgian version of the questionnaire reflects the objective side of the disease. The influence of the objective and subjective parameters on the quality of life show the average power ratios of positive correlation received by us between the quality of life and main clinical index, which is typical for parodontitis progress (CPI). During improving the clinical picture of the disease there is revealed the reduction of both, the CPI and the number of scores. Numerous studies have shown that the OHIP questionnaire was tested and accepted in different countries of the world, but until recently there were no Georgian version of the questionnaire. Questionnaire (OHIP) contains only 14 questions, which gives the patient an opportunity to quickly complete it, and the doctor - to quickly assess the results of the application. The data obtained can be used as a treatment planning, as well as during provided examination of the quality of the medical services. Based on the obtained data, we can plan not only therapeutic measures, but also to identify the need of psychological help of patients.

Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case-control study

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women. The findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth, showing that osteoporosis/osteopenia has had an influence on the progression of periodontitis.

INTRODUCTION

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women and explored the effects of use of osteoporosis medication and tooth loss on this association.

METHODS

This case-control study involved 521 postmenopausal women, with minimum age of 50 years, in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions/medications, and lifestyle habits were recorded. A complete periodontal examination was performed and periodontitis was diagnosed. Bone mineral density was evaluated through lumbar spine and femoral bone densitometry, obtained using dual-energy X-ray absorptiometry. Logistic regression was used to calculate the strength of association between the occurrences of osteoporosis/osteopenia and periodontitis.

RESULTS

Women with osteoporosis/osteopenia were twice as likely to present periodontitis, as were those with normal bone mineral density, even after adjusting for smoking, age, family income, and last visit to dentist (odds ratios (OR)adjusted=2.24, 95% CI [1.24-4.06], p=0.008). Among nonusers of osteoporosis medication (ORadjusted=2.51, 95% CI [1.33-4.73], p=0.004) and women with at least 10 remaining teeth (ORadjusted=2.50 95% CI [1.18-5.27], p=0.02), the odds ratio was higher and statistically significant.

CONCLUSIONS

These findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth.

Including oral health training in a health system strengthening program in Rwanda

OBJECTIVE

Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH) Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda.

DESIGN

In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined 'vertical' direct patient care training with 'horizontal' interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability.

RESULTS

The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed.

CONCLUSIONS

Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come.

Synergism between obesity and poor oral health associated with diabetes in an elderly human population

We investigated associations between type 2 diabetes (DM) and several variables, including poor oral health and overweight/obesity, among a group of elderly Hmong subjects (60 years and older) who emigrated to the United States following the Vietnam conflict. Each subject was interviewed and their weight, height and waist circumference were measured. Each subject had an oral health examination. Each subject's saliva was analyzed for seven components related to inflammation. The presence of DM was correlated with poor oral health (POH) and overweight/obesity (OW) separately. There was a strong correlation between concurrent POH and OW and the presence of DM: all subjects with both POH and OW had DM. Logistic multivariate analysis of OW, POH, age, years of residence in California, and stress level revealed a significant association between the presence of DM and concurrent OW and POH. A change in diet after immigration was excluded as an explanatory variable. Subjects with DM and concurrent OW and POH had significantly elevated salivary levels of five analyses related to chronic inflammation. The association between POH and OW and the presence of DM needs further study.