Dental cleanliness and chronic periodontal disease. Studies on populations in Britain

Evaluation of the Effectiveness of Probiotic Mouthwashes in Reducing Dental Plaque in Primary and Permanent Teeth: A Randomized Clinical Trial

Background: Due to the disadvantages of chemical mouthwashes, the search for an effective and safe anti-plaque agent has led to the emergence of probiotics.

Aim: To compare the effectiveness of nonchemical mouthwashes (probiotic) with chemical mouthwashes (fluoride) on plaque accumulation in orphan children after seven, 14, and 30 days of use.

Materials and methods: The present study was a triple-blind randomized controlled trial with two parallel groups (A and B), which included 30 healthy children. Each group included 15 children aged between eight and 10 years from Dar Al-Rahma Orphanage in Damascus, Syrian Arab Republic. Group A used 10 ml of probiotic mouthwash (ProbioClean) and group B used 10 ml of fluoride mouthwash (Colgate) for 60 seconds for 30 days. Turesky Modified Quigley-Hein (TMQH) plaque index was used in this study to record the values of plaque accumulation on days seven, 14, and 30.

Results: Mann-Whitney U test showed statistical significance between probiotics and fluoride mouthwashes on days 14 (p < 0.001) and 30 (p = 0.001), and there was no statistical significance on day seven (p = 0.934).

Conclusion: According to the results of this study, probiotic mouthwashes are considered an effective solution for maintaining oral health. However, probiotics are more effective in reducing plaque accumulation after a month of use.

Trends in toothbrushing in 20 countries/regions from 1994 to 2010

BACKGROUND

For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010.

METHODS

Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling.

RESULTS

Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03-2.10). However, the increasing trend was stronger among boys (OR(2010 vs. 1994) for boys 1.60; for girls 1.48), and among the younger adolescents (OR(2010 vs. 1994) for 11-year-olds 1.64; for 15-year-olds 1.45).

CONCLUSION

Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004-2010.

Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours

AIM

The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents.

MATERIALS AND METHODS

Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses.

RESULTS

At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4).

CONCLUSION

Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Do life- or school-satisfaction and self-esteem indicators explain the oral hygiene habits of schoolchildren?

OBJECTIVES

The aim of this study was to ascertain how frequently toothbrushing and flossing are practiced among schoolchildren in Kuwait and whether life- and school-satisfaction and self-esteem indicators are associated with oral hygiene habits.

METHODS

A sample of 2312 schoolchildren between 11 and 13 years old filled out a structured questionnaire anonymously in school classrooms during 2002 and 2003. For this study, nationally representative samples of children were drawn from all six governorates of Kuwait. Only government schools were included. The questionnaire of the Health Behaviour in School-Aged Children Study was used in this study after it was modified to suit Kuwait. A chi-squared test and logistic regression model were used for analyzing the data.

RESULTS

Over half of the pupils reported brushing their teeth more than once a day; girls reported brushing more frequently than boys did. One-fifth of the pupils did not brush their teeth even on a daily basis. The life- and school-satisfaction and self-esteem indicators were associated with more-than-once-a-day toothbrushing frequency. The strongest predictors for recommended brushing were: feeling very happy (OR 2.0, 95% CI 1.38-2.77), feeling that other pupils always accept him/her (1.5; 1.16-2.02), never/sometimes feeling lonely and feeling that it is very easy to make friends (1.4; 1.06-1.94). The summary variables of life-satisfaction, school-satisfaction and self-esteem seemed to be strongly associated with brushing. Dental floss was never used by 45% of the children, weekly by 18% and daily by 17%; 20% did not even know what dental floss was.

CONCLUSIONS

Among intermediate schoolchildren in Kuwait, oral hygiene practices were far behind the international recommendations. Special emphasis should be placed on children who have personal problems with their life, school and self-esteem.

Periodontal diseases: current and future indications for local antimicrobial therapy

The microbial etiology of gingivitis and periodontitis provides the rationale for use of adjunctive antimicrobial agents in the prevention and treatment of periodontal diseases. Although mechanical removal of supra- and subgingival calcified and non-calcified plaque deposits has been proved effective to control the gingival inflammatory lesions as well as to halt the progression of periodontal attachment loss, some patients may experience additional benefits from the use of systemic or topical antimicrobial agents. Such agents are able to significantly affect supra- and subgingival plaque accumulation and/or suppress or eradicate periodontal pathogenic microflora. Currently, properly selected local antiseptic and systemic antibiotic therapies can provide periodontal treatment that is generally effective, low-risk and affordable. This paper will briefly review the host-related conditions in which the periodontal preventive and therapeutic approaches may be effectively assisted by a local antimicrobial regimen. Potential future indications for adjunctive local antimicrobial therapy will also be discussed.

Dental health knowledge, attitudes and behaviour among students at the Kuwait University Health Sciences Centre

OBJECTIVE

The aim of the study was to determine the extent of dental health knowledge among students at the Kuwait University Health Sciences Centre (HSC), as well as their attitudes toward dental health and their oral hygiene habits.

METHODS

A structured questionnaire was distributed to 450 of the 800 students enrolled in 3 faculties of the HSC from March to April 2000. The questionnaire was completed anonymously by the students.

RESULTS

Four hundred and ten students (91.1%) completed the questionnaire. Of these, 64.6% believed that the main cause of tooth decay was 'not brushing properly'. Only 19.3% of the students believed that sugar could cause dental decay. Half of the students did not know if sugar-free drinks are harmful to their teeth, and 29.5% did not know about any measures to prevent gums from bleeding. Self-assessment questions showed that 84.5% of the students were satisfied with their dental health. A large majority of the students (94.8%) brushed their teeth at least once a day. Female students brushed their teeth more frequently than male students, as did those students who had visited a dentist in the past 6-12 months and those who rated their dental health to be very good. The main reason given for a dental visit was toothache (70.0%). Coffee was consumed daily by 68.9% of students, 76.6% of whom added sugar to their coffee.

CONCLUSIONS

The findings indicate that although most of the students at the HSC seem to be satisfied with their dental health, they did not have correct knowledge about the causes and prevention of dental diseases. In general, female students were more aware and concerned about dental health issues and more engaged in dental behaviour than male students.

Dental erosion in a group of British 14-year-old, school children. Part III: Influence of oral hygiene practises

OBJECTIVES

The aims of this study were firstly to describe the dental history and oral hygiene practises in a cluster random sample of 14-year-old children in Birmingham, UK. The second aim was to determine whether the oral hygiene practises are associated with dental erosion.

METHOD

A total of 418, 14-year-old schoolchildren from a cluster random sample in Birmingham, UK were assessed for dental erosion (209 males and 209 females). Data on the dental history and oral hygiene practises were obtained from a self-reported questionnaire supplemented by a structured interview. The data were analysed using SPSS with Mann-Whitney U analyses and odds ratios.

RESULTS

74% of the teenagers claimed to attend the dentist on a six-monthly basis; 60% brushed their teeth twice a day ie before breakfast and last thing at night, 25% once a day, 12% three times or more a day and 3% less than once a day. It was a so found that 28% of the children brushed their teeth after meals; 92% of the children used a manual toothbrush and 56% of them replaced their toothbrush every three-months. The most common technique used by the children was a circular brushing movement; 44% of them used a mouthwash and 40% used other interdental cleaning. Girls brushed their teeth more frequently than boys. Associations were found between dental erosion and brushing teeth last thing at night, after meals, techniques of brushing teeth, and type of toothbrush and frequency of brushing. It was concluded that reported oral hygiene practises in teenage schoolchildren in Birmingham, UK complied with generally recommended guidelines. However, there was an association between dental erosion and some of these oral hygiene practises. Advice concerning the impact of some oral hygiene procedures needs to be given to those who are susceptible to dental erosion.

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.

A cluster randomized controlled trial testing the effectiveness of a school-based dental health education program for adolescents

OBJECTIVES

This trial investigated the value of a school-based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores.

METHODS

A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school-based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six-month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six-month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior.

RESULTS

The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P < .001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P < .05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P = .043). This difference was sustained at 12 months (P = .037).

CONCLUSION

This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.

Therapeutic effects of supervised chlorhexidine mouthrinses on untreated gingivitis

AIM

The aim of the present study was to test the presumptive therapeutic effect of chlorhexidine digluconate in a population with untreated gingivitis and presence of abundant calculus. SETTING AND STUDY DESIGN: Sixty subjects (approximately mean age of 23.4) were recruited from a knitting factory in the Province of Guangdong, People's Republic of China. By applying a double-blind clinical trial design the participants were divided into two groups (Test and Control) and matched according to their mean GI scores. The Test group (n = 20) was assigned to two daily mouthrinses for 6 days per week using 0.12% chlorhexidine digluconate (Peridex). The Control group (n = 40) rinsed twice daily with a placebo solution. All the rinsings were supervised and timed for 45 s. No attempt was made to influence the oral hygiene habits of the participants. Prior to and after 3 months of the supervised rinsing, plaque was scored using the Plaque Index system (PII), and gingivitis was assessed using the criteria of the Gingival Index system (GI). Calculus was scored according to the Calculus Surface Severity Index system (CSSI), and stain was also graded by the Discoloration Index system (DI).

RESULTS

After 3 months, the Test group (n = 13) showed significant reduction in mean PII, GI and percentage of gingival bleeding (GB%), while significant increases in mean DI were observed. The improvement in gingival health was observed at all regions with marked reduction in mean GI (from GI = 1.40 to 1.08) and GB% reduction by 24-52%. The proportion of GI = 2 was also reduced significantly from 50-36%. The Control group (n = 23) also showed a decrease in mean PII but significant increases in the mean GI and GB%. Intergroup comparison showed statistically significant differences between mean GI, percentage of gingival bleeding (GB%) and mean DI for the test and control groups after 3 months of supervised rinsing. However, there were no significant intergroup differences for mean PII.

CONCLUSION

In conclusion, there was a significant effect of chlorhexidine on gingivitis, although the effect may be too limited to assure prognostic benefits in the prevention of future disease progression.

Changes in dental knowledge and self-efficacy scores following interventions to change oral hygiene behavior

One hundred twenty-three male veterans were randomly assigned to control, education, and psychological groups to improve oral hygiene behavior. The educational group received four 40-min sessions designed to increase knowledge of the causes and prevention of dental disease. The psychological intervention also consisted of four 40-min sessions. However, a psychologist provided the intervention using a Stage of Change intervention. The control group received pre- and post-testing only. There were no significant changes in dental knowledge for the control group while the increases in dental knowledge in the educational and psychological groups were similar and statistically significant. Pre-Post change scores for flossing self-efficacy scores showed significant changes for all groups. The magnitude of changes was similar when the control and educational groups were compared. In contrast, the psychological intervention group demonstrated significantly greater flossing self-efficacy changes when compared to either the control or the educational groups. These results suggest that increases in self-efficacy may be an important component of interventions designed to change health behavior and may serve a role in evaluating and comparing the efficacy of these interventions.

Periodontitis in the baboon: a potential model for human disease

Advances in periodontics with respect to disease activity, microbiology and immunology have demonstrated the multifactorial nature of periodontal diseases. This serves to underscore the need for an ideal animal model for periodontal research. Non-human primates are most similar to man in comparison to other animal models. The baboon is an Old World monkey that has infrequently been used in periodontal research. Periodontal exams were accomplished on 116 baboons (Papio anubis, P. cynocephalus) ages 5 to 30 years with one baboon year being roughly equivalent to 3 to 4 human years. The study population consisted of 29 males and 87 females. Clinical parameters including probing depth, attachment level, mobility, plaque index and gingival index were collected. Radiographs were taken on 25 animals and correlated to clinical findings. Results showed a significant increase in mean probing depth and mean attachment level with age (p = 0.0001). Disease prevalence and severity were not significantly different between genders. Mobility was uncommon; however, the prevalence and severity of furcation involvement increased with age. Radiographs suggested horizontal and isolated vertical bone loss. Plaque and gingival indices were at sustained high levels for all age groups and showed a statistically significant increase with age. Some baboons were found to develop a naturally-occurring periodontitis that increased in severity with age. This primate may be a suitable model for studies in human periodontal disease.

Association of lifestyle with periodontal health

All the 1012, 55-yr-old citizens of Oulu (a medium-sized Finnish town) were invited to a clinical examination, and 780 of them participated. The associations of lifestyle with periodontal health were analyzed in the 527 dentate subjects. Periodontal pockets deeper than 3 mm were recorded as a percentage of the surfaces at risk. Lifestyle was measured by questions about dietary habits, smoking habits, alcohol consumption and physical activity. Lifestyle had an independent association with periodontal health. Periodontal pocketing increased with an unhealthier lifestyle. Lifestyle could explain some of the social and sex differences in periodontal health.

Oral hygiene status and necrotizing ulcerative gingivitis in Nigerian children

This study was designed to determine the association between oral hygiene status and necrotizing ulcerative gingivitis (NUG), as well as the severity of NUG in Nigerian children. The study cohort was made up of 438 children under 12 years attending the Dugbe Dental Centre in Ibadan, Nigeria. A dental history and intra-oral examination using probe and mirror were taken. A slightly modified Green and Vermillion index was used to determine oral hygiene status. An index was also developed for NUG severity. The result showed that only 2.4% of the children with good oral hygiene had NUG, compared with: 24.6% of those with fair oral hygiene; 62.8% of those with poor oral hygiene; and 66.7% of those with very poor oral hygiene. The prevalence of the more severe stages of the disease showed an increasing trend as the oral hygiene status became poorer. This study thus demonstrated that the prevalence of NUG was significantly higher and more severe in children with poor oral hygiene status compared with those having good oral hygiene status. (P < 0.001).

A 6-month home usage trial of a 1% chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining

Research and development has been aimed towards the development of toothpastes for oral hygiene and gingival health benefits. The most effective antiplaque agent to date, chlorhexidine, is difficult to formulate into active toothpaste products. Despite some encouraging findings for experimental chlorhexidine toothpastes, there are to date no commercially available products. Based on positive findings from an experimental gingivitis study, this investigation evaluated 2 chlorhexidine toothpastes, one with fluoride, as adjuncts to oral hygiene. The study was a double-blind controlled, parallel, balanced group design, extending over 6 months. A total of 297 volunteers commenced the study after screening for a minimum acceptance level of gingivitis. At baseline, 6, 12 and 24 weeks, stain, gingival, bleeding and plaque indices were recorded, together with a calculus index at 6, 12 and 24 weeks. After a baseline prophylaxis, volunteers used the allocated product 2 x per day, with no other oral hygiene instructions given. Plaque, gingival and bleeding scores improved in all 3 groups, but to an overall significantly greater extent in the active groups. However, staining and calculus indices were significantly increased in the active compared to the control group. If the local side-effects of chlorhexidine are considered to be acceptable, these chlorhexidine toothpastes could be recommended for the same clinical applications as other chlorhexidine products. The apparent compatibility of fluoride with chlorhexidine in the one product may be pertinent to caries prevention.

Self-esteem as a predictor of toothbrushing behaviour in young adolescents

A survey of 4075 14-year-old children from secondary schools throughout England was made to obtain information about toothbrushing frequency, motivation for mouth care, and self-esteem. Subjects completed a questionnaire, anonymously, in class. Toothbrushing frequency was found to increase significantly with increasing self-esteem in males (P less than 0.0001) and females (P less than 0.05). However, there was no consistent variation with self-esteem in those brushing 3 or more times per day, in either sex. There was a significant variation in the main reason given for mouth care between the sexes (P less than 0.0001); proportionately more females (67%) than males (57%) gave cleanliness or cosmetic effect as the principal reason for mouth care. A variation was observed in the mean reason given for mouth care with self-esteem in females (P less than 0.05), but not in males. However, in both sexes, as self-esteem improved, there was a consistent increase in the proportions of individuals who brushed their teeth to make them feel clean. These findings suggest there may be a positive relationship between self-esteem and toothbrushing behaviour and motivation for mouth care in adolescents.

The effects of 0.5% chlorhexidine and 0.2% triclosan containing toothpastes on salivary bacterial counts

A number of antimicrobial compounds could be incorporated into toothpastes to enhance plaque inhibitory effects. However, the number of possible formulations is immense and makes clinical testing in plaque and gingivitis studies difficult. In this study, the effects on salivary bacterial counts of a number of chlorhexidine and triclosan toothpastes was evaluated as a predictor of persistence of antimicrobial action in the mouth. The study was a supervised, randomised 15-way crossover study employing 10 healthy human volunteers. All toothpastes were brushed for 1 min and comparison made with a 0.2% chlorhexidine rinse. The latter produced a large drop in salivary bacterial counts to the end of the 7-h study period. The toothpastes decreased salivary bacterial counts and all but two had notably more effect than a water brushing. No toothpaste showed a significant persistence of antimicrobial effect beyond 5 h. In the light of available plaque inhibition data for the toothpastes, persistence of antimicrobial activity beyond 5 h will be necessary for a clinical effect on plaque and gingival health. The method appears to be a simple and rapid screening technique for products formulated to enhance plaque inhibition mediated through an antimicrobial action.

Dental health behaviors and periodontal disease indicators in Danish youths. A 10-year epidemiological follow-up

The purpose of the present study was to analyse the epidemiologic relationship between dental health behaviors and periodontal disease. Indicators of periodontal disease in terms of bleeding and calculus were measured dichotomously (absence/presence). Periodontal pockets were as follows: normal pockets (0-3 mm), shallow pockets (4-5 mm), and deep pockets (6+ mm). The indicators were measured on 4 surfaces on 6 index teeth (16, 11, 26, 36, 31, 46) in 1984-85. The highest value for each tooth of bleeding (0/1), calculus (0/1) and pockets (0/1/2) was used for calculation of the bleeding index, the calculus index and the pocket index. The participation rate in 1984-85 was 86%, and the study population involved 368 males and 388 females. Information concerning dental health behavior was obtained both in childhood (1974) when the individuals were 9-10 years of age, and in adulthood (1984-85) when the individuals were 20-21 years of age. Information concerning dental health behaviors in adulthood, i.e., regularity of dental visits, frequency of tooth brushing, and regular use of interdental aids, was obtained through a self-administered questionnaire (1984-85). Dental health behaviors in childhood (1974) was operationalized as level of plaque, gingivitis, and dmfs. The results showed that dental health behaviors in childhood and in adulthood were together responsible for 9.4-13.8% of the variance in level of periodontal disease indicators. Determinants of early dental health behaviors in terms of plaque and dmfs at age 9-10 years were significant predictors in pocket index at age 20-21.(ABSTRACT TRUNCATED AT 250 WORDS)

Toothbrushing frequency in relation to family size and bedtimes in English schoolchildren

Data from a survey of 3727 14-yr-old children from 31 secondary schools in England in 1984-85 were analysed to obtain information about toothbrushing frequency, social group, number of siblings, and time of going to bed. Subjects completed a questionnaire, anonymously, in class. One third of respondents cleaned their teeth once or less per day. Toothbrushing frequency was found to increase significantly with improvement in social status in males (P less than 0.05), while a similar non-significant trend was found in females. Toothbrushing frequency decreased significantly as the number of siblings increased (P less than 0.01) and a trend towards decreasing brushing frequency as bedtimes became later was observed. These findings indicate that family factors do influence toothbrushing practice in adolescents. These factors need to be understood more thoroughly if toothbrushing habits in school-age children are to be improved.

A new measure of teeth-cleaning efficiency and periodontal disease

This paper presents a new measure of teeth-cleaning efficiency based on information from a random sample of 400 factory employees and a separate (non-random) sample of some 400 skilled manual workers and their wives. Regression analysis showed that only 1/3 of the variance in calculus levels in the random sample was explained by age, frequency of visits to a dentist, socioeconomic group and smoking habits (other variables tested--gender, date of last dental visit, frequency of teeth-brushing and sugar consumption--were not significant). The corresponding regression for the skilled manual sample gave a broadly similar result, though the proportion of explained variance (1/5) was lower than for the random sample. These results indicated the presence of one or more additional factors, of which teeth-cleaning efficiency is likely to be the most important. A new measure of cleaning efficiency was then constructed by expressing the actual calculus level as a proportion of the level estimated from the regression equation, and deducting this proportion from unity. If this new measure is, indeed, a genuine indicator of teeth-cleaning efficiency, then one should expect it to be an important element in an explanation of the level of periodontal disease, but not of dental caries (which is a resultant essentially of dietary habits). This hypothesis was tested and confirmed by multiple regression analysis. Though the new measure of teeth cleaning efficiency is essentially experimental, and has yet to be validated by clinical testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of age on the periodontium

It is generally known that the degree of periodontal breakdown increases with increasing age. The extent to which aging of periodontal tissues plays a part in this respect poses a question which is yet to be answered. Aging proves to be accompanied by a variety of periodontal changes. The periodontal tissues themselves show evidence of aging, there are indications that the composition of the plaque changes, and the reaction of the periodontium to the presence of plaque probably changes as well. There is as yet no sufficient evidence of a physiological apical migration of the epithelial attachment in human subjects. It seems plausible that periodontal breakdown can occur only in the presence of plaque with consequent inflammation of the periodontium, or as a result of trauma. Whether changes in plaque composition with age exert any influence on the course of periodontal breakdown is uncertain: the data available are not yet sufficient to warrant definite conclusions. The same applies to the influence which a changing reaction of the periodontium to the presence of plaque may have on the course of periodontal breakdown. Research findings do suggest that the degree of periodontal breakdown increases with age, that with increasing age inflammation of the periodontium tends to develop more rapidly and that in the process of aging the periodontium shows a slower rate of wound healing. However, these phenomena are overshadowed by the patients' susceptibility to periodontal disease. This implies that (1) the susceptibility to periodontal disease is more significant for the rate of periodontal destruction than the length of time plaque is present (the age effect) and (2) the greater the susceptibility to periodontal disease, the slower the rate of wound healing and the more rapidly inflammation of the periodontium tends to develop.

Toothbrushing efficiency in smokers and non-smokers

The present study was conducted to determine whether smokers have more plaque than non-smokers, and whether higher plaque scores subsequently found in smokers could be explained by differences in toothbrushing time, efficiency and frequency. Plaque was scored from photographs, before and after toothbrushing, in 64 smokers and 64 non-smokers, aged 20-40 years, matched for age and sex. The results showed that in both sexes smokers had more plaque than non-smokers. Male smokers brushed for a shorter time, and had more plaque after toothbrushing, than male non-smokers. A similar, though non-significant trend was found in females. There was no association between tobacco consumption and frequency of toothbrushing. It was concluded that the poorer oral cleanliness found in smokers both before and after toothbrushing may be explained, in part at least, by their shorter toothbrushing time.

Oral health survey in Haitian and Hamburg children aged 12-15

Oral hygiene, dental caries and periodontal diseases surveyed in 1743 children aged 12-15. Of these 879 of Black origin resided in Haiti (West Indies) and 864 of White origin in Hamburg (West Germany). Oral hygiene was assessed using the Greene & Vermillion's OHI-S, periodontal status using Ramfjord's PDI and Mühlemann's SBI and the caries rate using the DMFT and DMFS indices. Boys of all age groups showed significantly poorer oral hygiene than girls. In the Hamburg children the mean OHI-S was 1.28, in Haitians 1.14. Periodontal diseases showed equal prevalence in Haiti and Hamburg when expressed in PDI, namely 0.59, while SBI was slightly higher in the Haitians, namely 2.58 against 2.21 in the Hamburg Children. Hamburg girls showed lower PDI and SBI scores than all boys and Haitian girls. Same degrees of OHI-S caused more severe periodontal diseases among Haitian than among German children. In general, scores of OHI-S, PDI and SBI increased with age except in Haitian girls, who showed a decrease. The DMFT and DMFS of the Haitian children averaged 3.65 and 4.80 respectively, and those of the Hamburg children 8.35 and 21.09.

Oral hygiene and gingival health in Greek airforce cadet candidates

A broad epidemiologic investigation on oral hygiene and gingival health in Greece has been undertaken since 1978. Part of our findings are presented in this study. 1291 male airforce cadet candidates aged 17-22 years were interviewed first concerning brushing habits and gingival bleeding and subsequently using the Russell Index. The mean P. I. score of the group was 0.71, ranging from 0 to 2.13. The highest P. I. was found in the molars (0.82) followed by the anterior teeth and the premolars (0.75 and 0.63, respectively). Statistically significant correlation was found between P. I. and frequency of brushing (P. I. = 0.92 in never brushing, P. I. = 0.69 in twice or more daily brushing). The effect of brushing techniques and bristle stiffness on the P. I. was statistically not significant. As expected the presence of calculus decreased as the frequency of brushing increased. Finally a strong correlation existed between the P. I. and gingival bleeding.

An analysis of factors affecting compliance with tooth-cleaning recommendations

A study was undertaken on a group of patients who have had periodontal treatment in an attempt to test some of the predictions of the "Health Belief Model" (Rosenstock et al. 1966). This present study set out to test whether (1) persons who knew they had periodontal disease (hence considered themselves susceptible) (2) thought the condition serious and (3) had a knowledge of how to prevent the disease (4) were effectively complying with a previously prescribed oral hygiene regimen. The study was conducted at a school of dental hygiene, providing a source of patients attending specifically for periodontal care and where the format of hygiene instruction and treatment is largely standardized. A questionnaire was designed to assess (1) attitudes and beliefs (2) knowledge of the disease (3) reported behavior. Gingival health was measured using Gingival Index (Löe & Silness 1963) and patients actual behavior was measured using the Plaque Index (Silness & Löe 1964). The majority of the highly motivated patients in the study were concerned with their susceptibility to, the seriousness of, and the benefits of treatment for periodontal disease. They were stimulated to take action by a cue, bleeding gums. These findings confirm the predictions made in the Health Belief Model. However, none of the factors in the Health Belief Model were significantly associated with the gingival health status of the patients, indicating that other factors were important for patients to clean their teeth effectively. It was also shown that information is not necessary followed by a change in behavior.

Application of the periodontal treatment need system (PTNS) in a group of young Israeli adults

The Periodontal Treatment Need System (PTNS) was applied to a group of young Israeli adults, 18-25 years of age, to test the system in the field. A total of 830 persons were examined. Their periodontal treatment needs were assessed. One of the aspects investigated was that of treatment needs according to distribution by sex. Only 2.7% of young adults studied were free of plaque, calculus and gingival inflammation. All the rest (97.3%) needed some kind of periodontal treatment. The time required for treatment needed was also calculated. It was found that on the average 2.4 h per person would be required to deliver the periodontal treatment needs of the group. A close association between sex and PTNS was established in this study.

Periodontal disease and oral hygiene in a group of blind and sighted Israeli teenagers (14--17 years of age

The purpose of the present study was to obtain up-to-date information on periodontal disease and oral hygiene status in Israel among 9th to 12th grade non-blind students and among the inmates of six schools for the blind aged 14--17 years. 460 sighted and 434 blind students participated in the study. The examination was for periodontal status and oral hygiene only. Periodontal status was recorded according to Russell's Periodontal Index (PI). Oral hygiene was assessed according to Greene & Vermillion's Simplified Oral Hygiene Index (OHI-S). Mean PI for the non-blind group was found to be 0.23, and for the blind students 0.79. Partially blind students were found to have a lower mean PI value than the totally blind. PI values did not increase significantly with age. Blind students exhibited a fair-to-poor level of oral hygiene (according to Greene & Vermillion's categorization). Relatively healthier levels of oral hygiene were found in the partially blind as compared with the totally blind. Mean OHI-S did not vary with age in either group.

The epidemiology of dental caries and periodontal disease

Dental caries and periodontal disease are common in industrialized countries and caries is increasing in non-industrialized countries. The predominant method of coping with the disease problem has been to treat rather than prevent the diseases, an approach which has obviously failed to cope with the problem as shown by the results of the International Collaborative Study of Dental Manpower Systems (58). Epidemiological evidence suggests that a food policy directed at lowering the refined sugar consumption level to about 10 kg per person per year in conjunction with fluoride supplementation of the diet would virtually eliminate dental caries in industrialized countries. Health education to improve the effectiveness of toothbrushing will reduce the progression of periodontal disease to a rate compatible with keeping teeth for a life-time.

Effect of age and removable partial dentures on gingivitis and periodontal disease

The periodontal disease variables manifested in the individuals with partial dentures were more severe, which suggests that the contribution of denture status is significant. Age, while related to increased bone loss, did not appear to be of significance. Common sense suggests that poor oral hygiene in persons wearing removable partial dentures also is a contributing factor.

Periodontal disease and oral hygiene in Israeli youth (14-17 years of age)

The purpose of the pesent study was to obtain current information regarding periodontal disease and oral hygiene status. The survey was conducted in Israel amon 9th-12th grade students, 14-17 years of age. A total of 1,320 schoolchildren were examined. During the examination only periodontal status and oral hygiene were checked. Periodontal status was recorded according to Russell's Periodontal Index (PI). Oral cleanliness was assessed according to GREENE & VERMILLION'S Simplified Oral Hygiene Index (OHI-S). The mean PI found was 0.22. The results indicated an increase in the mean PI with age. No difference was found in average PI values between girls and boys. On the other hand, significantly lower mean OHI-S values were recorded for girls as compared with boys in the total study population and within the different age groups. Mean OHI-S decreased with age, indicating improvement.

A radiographic study of the prevalence of chronic periodontitis in 14-year-old English schoolchildren

The prevalence of chronic periodontitis was investigated in six hundred and two 14-year-old English schoolchildren using a standardised radiographic technique. The interproximal spaces on the mesial and distal aspects of the first molar teeth were examined. Oral cleanliness and gingivitis for the anterior teeth and caries prevalence were also recorded. Radiographic evidence of chronic periodontitis was detected in 51.5% of the children examined. No significant relationship was demonstrated between bone loss associated with the first molars and any of the other parameters measured.

Prevention and the developing child

The changing problems of the developing child are considered in relation to the action and advice which should be given by the dentist to the child and his parent. Seven stages are distinguished in the dental development of the individual and guidance and techniques appropriate to each stage, based on recent evidence are tabulated. The hazards to oral health which may result from orthodontic treatment are discussed and methods of avoiding or minimizing these effects are summarized in four simple rules.