Factors influencing the caries experience of a group of children at the ages of 11-12 and 15-16 years: results from an ongoing epidemiological survey

The oral health of secondary school pupils: baseline data from the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial

Background This paper describes the sociodemographics and oral health of UK secondary school pupils. They were participants of the BRIGHT trial, which was designed to evaluate the effectiveness of a toothbrushing intervention to reduce dental caries.Methods Overall, 4,680 pupils aged 11-13 years attending 42 secondary schools in England, Scotland and Wales with above average proportion of pupils eligible for free school meals, were recruited to the trial. Sociodemographic data were collected. Participants had a clinical assessment for caries, plaque and bleeding and completed measures of oral and general health-related quality of life and oral health behaviours (frequency of toothbrushing, dental attendance and cariogenic food/drinks consumed). Regression analyses were performed.Results Over one-third (34.7%) of participants had caries experience, with 44.5% reporting their oral health had an impact on their daily lives. Factors associated with a statistically significant increased likelihood of caries experience were older age, being female, eligibility for free school meals, worse oral health-related quality of life, higher cariogenic diet, less than twice-daily toothbrushing, living in a more deprived area and lower school attendance.Conclusions The prevalence and impact of dental caries on the lives of pupils remains high, with further oral health promotion activities needed in targeted secondary schools.

Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study

Background

In the present state of knowledge regarding the etiology of dental caries, it is unacceptable for studies addressing factors associated with this outcome to disregard oral hygiene. Simple, valid methods are needed for the assessment of oral hygiene in adolescents to allow this condition to be properly investigated in epidemiological studies on caries and assist in the establishment of health promotion measures. The aim of the present study was to test the hypothesis that the self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices in epidemiological studies on dental caries in adolescents.

Methods

A cross-sectional study was conducted with a representative sample (n = 589) of 12-year-old school children in a medium-sized city in southern Brazil. A detailed questionnaire addressing socio-demographic and economic characteristics was sent to primary caregivers. Adolescents answered a brief self-administered questionnaire on behavioral characteristics, including toothbrushing frequency and sugar intake. Samples of stimulated saliva were collected from the adolescents and evaluated for levels of mutans streptococci and lactobacilli using Dentacult kits I and II, respectively. Examiners who had undergone a training and calibration exercise (kappa > 0.81) performed the clinical examination of the adolescents. Caries experience was assessed using the decayed, missing and filled teeth index. Oral hygiene was determined using the Simplified Oral Hygiene Index and the Visible Plaque Index.

Results

When the oral hygiene variables were used alone in the multiple models, significant associations with dental caries were found. When Simplified Oral Hygiene Index and/or Plaque Index were used together with toothbrushing frequency in the same model, only the latter was significantly associated with dental caries. A significant association was also found between self-reported toothbrushing frequency and the clinical indices.

Conclusion

Based on the present findings, self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices, which facilitates data collection in epidemiological studies addressing dental caries in adolescents.

Prevalência de cárie dentária em escolares de 12 e 15 anos de Salvador, Bahia, 2001

OBJETIVOS: determinar a prevalência e severidade da cárie em escolares aos 12 e 15 anos de idade em Salvador, segundo distrito sanitário. MÉTODOS: desenvolveu-se um estudo transversal com uma amostra probabilística, pré-estratificada pelos 12 distritos. Equipes calibradas examinaram 3313 escolares (CPO-D). Dados sobre acesso e cobertura dos serviços de saúde foram obtidos através de questionário. Para a análise utilizaram-se: teste do qui-quadrado, t de Student, análise bivariada e de regressão logística com nível de significância de 5%. RESULTADOS: 49,6% da amostra teve acesso ao dentista no último ano e quase 40% aos 12 anos e 27,7% aos 15 anos relataram ter participado de programas coletivos nos últimos dois anos. Observou-se um CPO-D de 1,44 e 49% das crianças livres de cárie aos 12 anos, e um índice de 2,66 aos 15 anos. Os distritos com menor prevalência de cárie foram o de Pau da Lima, Cajazeiras e Subúrbio Ferroviário. CONCLUSÕES: foi baixa a prevalência de cárie, e são encontradas iniqüidades na distribuição da cárie em áreas geográficas distintas, reforçando a necessidade de vigilância à saúde.

Oral hygiene instructions and dietary sugar advice received by adolescents in 1989 and 1997

OBJECTIVES

The aim of this study was to find out how commonly adolescents receive oral hygiene instructions and dietary sugar advice in the Finnish public oral health care system and whether there have been any changes between 1989 and 1997.

METHODS

The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey. Since 1977, a questionnaire has been sent every second year to a representative sample of 12-, 14-, 16- and 18-year-old Finns eligible for free comprehensive oral health care. The sample size was 3105 in 1989 and 8390 in 1997.

RESULTS

Almost all adolescents (95-96%) had visited a dentist during the last 2 years. In all age groups, boys reported having received tooth cleaning instructions during their dental visit more often than girls did (40%/35%). There was only a minor decrease in instructions received between 1989 and 1997. Boys and those who brushed their teeth once a day or less often were the most likely to receive instructions in 1997. Only one-fifth of adolescents reported having received dietary sugar advice, and there was a slight decrease between 1989 and 1997. In 1997, the groups of adolescents most likely to be advised were 12-16-year-old-boys, those using sweets daily and those living in Central Finland.

CONCLUSIONS

Oral health instructions were only given to a minority of adolescents. The targeting of adolescents with health-damaged behavior is therefore important.

Frequent use of sugar products by schoolchildren in 20 European countries, Israel and Canada in 1993/1994

The aim of this study was to describe the daily use of certain between-meal sugar products (soft drinks and sweets) of schoolchildren in 20 European countries, Israel and Canada as a part of the Cross-National Survey on Health Behaviour in School-Aged Children--a WHO Collaborative Study. The data were collected using standardised anonymous questionnaires in school classrooms during the 1993/1994 school year. In each country nationally or regionally representative samples of about 1,300 schoolchildren (450 in Greenland) were targeted. Use of sugar products was analysed according to sex, age, country, self-reported school performance and self-reported family economy. One third to one half of the children (30-48 per cent) drank coke or other soft drinks more than once a day in Israel, Northern Ireland, Scotland, the Slovak Republic and Flemish-speaking Belgium. Use of soft drinks was very uncommon in Finland, Sweden, Norway, Denmark, Latvia and Estonia. The strongest association (odds ratios) was between the use of soft drinks and good family economy; in Russia (20.3), in Lithuania (11.3), in Latvia (10.0), in Poland (8.5) and in Estonia (8.0). In Israel, Scotland, Northern Ireland, Russia and French-speaking Belgium 41-29 per cent of the children ate sweets more than once a day. Boys drank soft drinks and ate sweets slightly more often than girls did. In conclusion, large differences were found between the different countries in the frequency of use of soft drinks and sweets. This should be considered when developing the content of oral health promotion programmes.

A plaque index for occlusal surfaces and fissures. Measurement of repeatability and plaque removal

Plaque indices have largely been developed for buccal and lingual tooth surfaces. There has been minimal interest in plaque accumulation on occlusal surfaces despite the predilection for caries at these sites. A numerical plaque index (0-5) is described based on the presence and distribution of plaque in the fissures and over the occlusal surfaces of permanent molar and premolar teeth. The repeatability of a single examiner in scoring the index was performed using 4 groups of 10 subjects. Each group of volunteers suspended tooth cleaning for 48 h and the index scored after disclosing plaque deposits. The index was rescored 60-90 min later. Plaque area was also determined by drawing the outline of plaque onto grids. Except for one condition of repeatability for one group, the 4 conditions of repeatability in scoring the index were met for all 4 groups of subjects. The sensitivity of the index and area recordings to detect plaque removed by brushing was then evaluated. A group of 10 subjects had plaque scored by index and area after suspending toothcleaning for 48 h. Subjects were then randomly allocated to brush or not brush their teeth and plaque rescored. The experiment was then repeated and brushing or not brushing crossed over. Highly significant differences between brushing and no brushing plaque indices and areas were determined. In conclusion, the occlusal fissure plaque index was easy to apply, repeatable and sufficiently sensitive to detect plaque removed by brushing. The index could find use as an additional measure of oral hygiene, in clinical trials on plaque control and possibly epidemiological studies relating to caries.

Factors affecting caries experience in French adolescents

Three hundred French 14-15-yr-old adolescents were randomly selected. They were examined clinically and caries experience was determined by using the DMFS index. The aim of this investigation was to evaluate children's habits using a self-administered questionnaire, to clarify the actual influence of well-known factors such as fluoride exposure, diet, oral hygiene and socioeconomic factors on caries experience and to stress those factors of primary importance. A multiple regression analysis revealed the variables which significantly contributed to explain DMFS scores in a final model: Age, sex, frequency of sweet consumption, use of standard or high fluoride toothpastes, bleeding during toothbrushing, living in St Yorre (F- = 0.45 mg/l). At a time when caries experience is decreasing, it seems that fluoride supply, snacking and oral hygiene are still independent and significant determinants of caries experience in French adolescents.

Factors influencing the initiation of carious lesions in specific tooth surfaces over a 4-year period in children between the ages of 11-12 years and 15-16 years

An analysis of factors influencing the initiation of carious lesions on specific tooth surfaces over a 4-year period in children between the ages of 11-12 years and 15-16 years is presented. Approximately 1000 children, resident in the County of South Glamorgan, Wales, were assessed for caries status and oral cleanliness in 1980 when aged 11-12 years and again in 1984 when aged 15-16 years. On both occasions, the children completed detailed questionnaires on dental health-related topics. Surfaces which were sound when the children were 11-12 years were identified and subsequently awarded a score of zero if they remained sound at 15-16 years or a score of one if they had developed carious lesions or had been filled. For each child, a mean mouth caries initiation score was computed for specific groups of surfaces, namely pit and fissure surfaces in posterior teeth, approximal surfaces in posterior teeth, buccal and lingual smooth surfaces of all teeth and approximal surfaces of anterior teeth. One-way analysis of variance and multiple regression techniques revealed that a number of factors had a significant influence on the initiation of caries. The factors and their level of significance varied between the surfaces. However, relatively little (less than 6 per cent) of the total variance in caries initiation score could be explained by the identified factors. Overall, more lesions developed in pit and fissure surfaces in posterior teeth than in the other surfaces included in the analyses.