Needs and implementation of preventive dentistry in China

Comparative assessment of plaque removal and motivation between a manual toothbrush and an interactive power toothbrush in adolescents with fixed orthodontic appliances: A single-center, examiner-blind randomized controlled trial

INTRODUCTION

The objective of this 2-arm parallel trial was to determine the plaque removal efficacy (main outcome) and the motivation assessment (secondary outcome) comparing a manual versus an interactive power toothbrush in orthodontic patients.

METHODS

Sixty adolescents with fixed orthodontic appliances in both arches were randomized in a 1:1 ratio in this parallel, randomized, examiner-blind controlled clinical trial. Eligibility criteria included at least 16 natural teeth, 1-6 "focus care areas," plaque score of ≥1.75, no severe caries, gingivitis and periodontitis, no dental prophylaxis, no smoking, no antibiotics, and no chlorhexidine mouth rinse. Subjects were to brush unsupervised with either an interactive power toothbrush (Oral-B Professional Care 6000, D36/EB20) with Bluetooth technology or a regular manual toothbrush (Oral-B Indicator 35 soft). Focus care areas were each brushed for 10 additional seconds. Plaque removal was assessed with the use of the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) to determine change from baseline at 2 and 6 weeks. Supervised brushing at screening and post-treatment visits recorded actual brushing times. Subject-reported motivational aspects were recorded at screening and week 6.

RESULTS

Fifty-nine subjects aged 13-17 years completed the study. The interactive power toothbrush provided significantly (P <0.001) greater plaque reduction versus the manual toothbrush at 2 and 6 weeks according to the whole-mouth TMQHPI. The treatment difference in adjusted mean plaque change from baseline was 0.777 (95% CI 0.614-0.940) at week 2 and 0.834 (0.686-0.981) at week 6. Mean reductions in the number of focus care areas were also significantly greater (P <0.001) in the power brush group at weeks 2 and 6. Brushing times increased significantly at weeks 2 and 6 (P ≤0.013) versus baseline in the interactive power brush group only. Subject-reported motivation was significantly increased in the interactive power brush group at week 6 versus screening (P ≤0.005).

CONCLUSIONS

An interactive power toothbrush generated increased brushing times and significantly greater plaque removal versus a manual brush.

A comparative assessment of plaque removal and toothbrushing compliance between a manual and an interactive power toothbrush among adolescents: a single-center, single-blind randomized controlled trial

BACKGROUND

Many adolescents have poor plaque control and sub-optimal toothbrushing behavior. Therefore, we compared the efficacy of an interactive power toothbrush (IPT) to a manual toothbrush (MT) for reducing dental plaque and improving toothbrushing compliance.

METHODS

In this randomized, parallel single-blind clinical study, adolescents brushed twice daily with either a MT (Oral-B® Indicator soft manual toothbrush) or an IPT (Oral-B® ProfessionalCare 6000 with Bluetooth). Subjects brushed for 2 min, plus an additional 10 s for each 'Focus Care Area'. At screening and Week 2, afternoon pre-brushing plaque was assessed via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI), and supervised brushing duration was measured.

RESULTS

Sixty subjects were randomized; 98% completed. At Week 2, the mean reduction in whole mouth plaque relative to baseline was 34% (p < 0.001) for the IPT versus 1.7% (p = 0.231) for the MT. For Focus Care Areas, the IPT yielded a 38.1% mean TMQHPI reduction (p < 0.001) versus 6.2% for the MT (p < 0.001). Mean brushing time versus baseline increased 34 s in the IPT group (p < 0.001) while remaining flat in the MT group (p = 1.0).

CONCLUSIONS

Over 2 weeks, adolescents using an IPT experienced superior plaque reduction and increased overall brushing time versus those using a MT.

TRIAL REGISTRATION

This trial was retrospectively registered ( ISRCTN10112852 ) on the 18th, June 2018.

Programme guidelines for promoting good oral health for children in Nigeria: a position paper

BACKGROUND

The objective of this paper is to draw attention to the oral health needs of children in Nigeria, and promote the use of appropriate interventions for disease prevention in the population. It also evaluates the value of the ongoing twice-daily tooth brushing campaign, which focuses on promoting good periodontal health and its relevance for children in Nigeria.

DISCUSSION

The main oral health burden for children in Nigeria is untreated dental caries, attributable to low utilization of oral health facilities. While there is a strong association between oral hygiene status and caries occurrence, no research had established an association between frequency of tooth brushing and caries in children in Nigeria. Prevalence of caries and gingivitis is low, despite the fact that a majority of children brush once a day and most of them have fair oral hygiene. Campaigns that promote twice daily brushing to prevent chronic periodontitis in children are not driven by evidences supporting the local epidemic, and therefore cannot be considered as efficient use of the limited resources available.

SUMMARY

Existing evidences show that the main oral health need of children in Nigeria is the management of untreated caries. Promoting the treatment of caries should be the primary focus of oral health programmes for children in Nigeria, as this would reduce further risks of developing new carious lesions. Public health campaigns should focus efforts at creating demand for oral health care services, for both preventive and curative purposes.

Position paper: periodontal diseases of children and adolescents

Children and adolescents are subject to several periodontal diseases. Although there is a much lower prevalence of destructive periodontal diseases in children than in adults, children can develop severe forms of periodontitis. In some cases, this destructive disease is a manifestation of a known underlying systemic disease. In other young patients, the underlying cause for increased susceptibility and early onset of disease is unknown. These diseases are often familial, suggesting a genetic predisposition for aggressive disease. Current modalities for managing periodontal diseases of children and adolescents may include antibiotic therapy in combination with non-surgical and/or surgical therapy. Since early diagnosis ensures the greatest chance for successful treatment, it is important that children receive a periodontal examination as part of their routine dental visits.

Dental caries and periodontal status of 12-year-old school children in rural Qinghai, China

OBJECTIVES

To describe the dental caries and periodontal status of 12-year-old children in rural Qinghai and to compare the oral health status between the Han and ethnic minority children.

METHOD

Children aged 12-years in three primary schools in Hexi Townships, Guide County, Hainan Tibetan Autonomous State, Qinghai Province, China, were invited to participate in the survey conducted during July 2001. Each child was interviewed and clinically examined in the schools, using portable equipment. World Health Organization (WHO) examination procedures and diagnostic criteria were used. SPSS 11.0 was used for data compilation and statistical analysis.

RESULTS

All 196 12-year-olds (118 Han and 78 from ethnic minorities, i.e. Muslims and Tibetans) were surveyed. 48% of the children reported never brushing their teeth, while 12% brushed only every 2-3 days. Over ninety per cent (n=182) of the children had never visited a dentist. The DMFT scores in Han and in minority groups were found to be 0.12 and 0.23 respectively. A larger proportion of children in Han group (94%) had no caries experience (DMFT = 0) than that of Muslim and Tibetan (82%) groups (p<0.01). None of the children had healthy gingiva (i.e. highest CPI score=0) and 85% had calculus.

CONCLUSION

The prevalence of caries experience in Han children is significantly lower than that in Muslim and Tibetan children in rural Qinghai. Dental caries and caries treatment needs of Han and minority rural schoolchildren in Qinghai are low but their periodontal health status is unsatisfactory. Basic dental health care and preventive education for the children in this part of China is needed.

Experiences from a school-based oral health promotion programme in Wuhan City, PR China

OBJECTIVES

To evaluate the effect of a six-year oral health promotion programme for school children of Wuhan City, PR China.

METHODS

The programme group (P-group) comprised 233 children who had just entered grade 1 (1989). The programme provided an oral health promotion programme, and 215 12-year-old children from three schools participated as a control group (C-group). After the 6-year period of the programme (1995), all of the children had a clinical examination according to the criteria of the WHO and responded to a structured questionnaire on dental health behaviour.

RESULTS

The results showed that attitudes to dental care, regular tooth brushing habits, use of fluoridated toothpaste, gingival health and dental visits, frequencies of consuming sugary drinks/foods were improved in the p-group when compared with the C-group.

CONCLUSION

The school-based oral health promotion programme should be expanded.

Oral health status and oral health behaviors in Chinese Children

The objectives of the study were to describe the oral health status and treatment needs of the 5- to 6-year-old and 12-year-old children in Southern China; to describe the patterns of oral health behaviors, knowledge, and attitudes among the 12-year-olds; and to assess the effects of socio-behavioral factors on the 12-year-old children's dental caries experiences. The study sample was comprised of 1,587 5- to 6-year-old and 1,576 12-year-old urban and rural schoolchildren living in Guangdong Province. Three calibrated dentists clinically examined the children, and trained interviewers interviewed the 12-year-olds. Caries prevalence of the 5- to 6-year-old children was high (urban 78% vs. rural 86%); the mean dmft of the urban and rural children was 4.8 and 7.0, respectively. The caries prevalence and mean DMFT score of the 12-year-olds were 41% and 0.9 (urban) and 42% and 0.9 (rural). Only 2% of the 12-year-olds exhibited no calculus or gingival bleeding, while more than 70% had calculus. In conclusion, there is an urgent need for establishing caries-preventive activities for preschool children. The prevalence of caries among the 12-year-olds was not high, but their periodontal condition was unsatisfactory. Knowledge about gum bleeding and the use of fluoride was low. More oral health education activities should be organized, especially for the rural children.

Attachment loss in rural Chinese children over a 3-year period

OBJECTIVES

The periodontal condition of 84 children (9-14 years old, 38 males and 46 females) in a rural area of China was monitored over a 3-year period in order to determine the clinical parameters that act as risk factors for attachment loss.

METHODS

Plaque and calculus accumulation (PSS and CI), modified gingival index (MGI), pocket depth (PD) and attachment level (AL) of two quadrants of each child were examined in 1993 and 1996. Following calculation of the mean of each of these parameters and statistical analysis of the change in each of the clinical parameters over the 3-year period, the relationship between attachment loss and clinical parameters was analyzed using multiple regression analysis.

RESULTS

At the beginning of this study, the mean values for males and females were 3.66 and 3.58 for PSS, 1.22 and 1.17 for MGI, 1.07 and 0.90 for CI, 2.21 and 2.22 for PD, and both 0.02 for AL respectively. No significant difference between males and females was observed. After 3 years, all except mean PSS had increased significantly. Multiple regression analysis indicated that AL correlated only to age (P<0.01). In 1993, although the AL was > or =1 mm for at least one site in 21 children, none had an AL> or =3 mm. In 1996, the number of children with an AL> or =1 mm had increased to 63, and nine of these children exhibited 3 mm AL (one to six sites per child). No other significant differences were observed between the clinical data of these nine children and those of the other children.

CONCLUSION

Although attachment loss tended to increase with age, no clinical parameters correlated with attachment loss in children.

Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits

Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. Removal of subgingival plaque and calculus remains the cornerstone of periodontal therapy. Calculus formation is the result of petrification of dental plaque biofilm, with mineral ions provided by bathing saliva or crevicular fluids. Supragingival calculus formation can be controlled by chemical mineralization inhibitors, applied in toothpastes or mouthrinses. These agents act to delay plaque calcification, keeping deposits in an amorphous non-hardened state to facilitate removal with regular hygiene. Clinical efficacy for these agents is typically assessed as the reduction in tartar area coverage on the teeth between dental cleaning. Research shows that topically applied mineralization inhibitors can also influence adhesion and hardness of calculus deposits on the tooth surface, facilitating removal. Future research in calculus may include the development of improved supragingival tartar control formulations, the development of treatments for the prevention of subgingival calculus formation, the development of improved methods for root detoxification and debridement and the development and application of sensitive diagnostic methods to assess subgingival debridement efficacy.

Strategies for application of scientific findings in prevention

Dental research in the last 50 years has accomplished numerous significant advances in preventive dentistry, particularly in the area of research in fluorides, periodontal diseases, restorative dentistry, and dental materials, as well as craniofacial development and molecular biology. The transfer of scientific knowledge to clinical practitioners requires additional effort. It is the responsibility of the scientific communities to transfer the fruits of their findings to society through publications, conferences, media, and the press. Specific programs that the International Association for Dental Research (IADR) has developed to transmit science to the profession and the public have included science transfer seminars, the Visiting Lecture Program, and hands-on workshops. The IADR Strategic Plan also has a major outreach goal. In addition, the Federation Dentaire Internationale (FDI) and the World Health Organization (WHO) have initiated plans to celebrate World Health Day and the Year of Oral Health in 1994. These are important strategies for the application of scientific findings in prevention.

Dental caries in developing countries in relation to the appropriate use of fluoride

Although it is widely believed that caries prevalence in developing countries is increasing rapidly, a review of studies from Africa and China provides equivocal evidence. Data from child and adult populations indicate that the disease is almost ubiquitous but with a slow rate of progression. Theoretically, administration of fluoride in such populations should result in reducing caries progression rates, but too little is known about the magnitude of the effect, and therefore about the cost-effectiveness of different methods of fluoride administration. The lack of a developed infrastructure and of trained personnel in many developing countries limits the applicability of many strategies. Methods of fluoride administration that minimize systemic exposure are to be recommended where affordable or practical. In the light of economic constraints and slow caries lesion progression rates, however, improvements in oral hygiene practices may be the most important method of controlling the disease whether or not fluoride is available or accessible.

Dental caries in adult and elderly Chinese

This paper reports on a study of dental caries conducted among 1744 urban and rural Chinese (from 20 to 80 years old), who were selected by means of a systematic stratified sampling procedure. The prevalence of one or more decayed or filled teeth ranged from 48 to 90% in urban residents, and from 51 to 97% in rural residents, depending on age. The mean number of decayed or filled teeth ranged from 1.2 (+/- 1.9) among 20-29-year-olds, to 6.2 (+/- 5.5) among 70+-year-olds, and was highest among rural residents. Among 20-29-year-olds, the main components of the DFT were enamel lesions and fillings. Among 30-49-year-olds, the DFT consisted mainly of enamel lesions and filled teeth, as well as teeth with lesions involving the pulpal tissues. In subjects over the age of 50 years, lesions involving pulpal tissues were the predominant type, followed by root-surface lesions. In subjects below the age of 50 years, most of the caries experience derived from coronal surfaces, particularly occlusal surfaces. Root-surface caries was predominantly a feature of persons aged 50 years and above. Despite a large number of surfaces being at risk of root-surface caries, less than 10% of the surfaces were so affected. Although cross-sectional in nature, these data indicate that when the oral hygiene standards are poor, caries lesions continue to develop and progress throughout life. With age, dental caries becomes a substantial oral health problem in this population of adult and elderly Chinese, despite the availability of some dental services.

Tooth mortality and prosthetic treatment patterns in urban and rural Chinese aged 20-80 years

The study describes tooth mortality levels and pattern of prosthetic treatments in a sample of 1744 Chinese aged 20-80 yr who are residents of Beijing area. Complete edentulousness was rarely seen before the age of 60 yr. Beyond this age up to 26% were edentulous, depending on age and sex. The mean number of teeth present ranged from 10.0 to 29.7 depending on age, sex, and area of residence. Below the age of 60 yr very few persons had experienced extensive loss of teeth but thereafter the number of teeth missing was substantially increased. Prosthetic treatments in the form of partial dentures, crowns, and bridges were frequently observed even in the younger age groups. In all age groups the number of teeth exhibiting caries lesions involving the pulp was much higher than the number of teeth exhibiting extensive mobility. Although many people retain a high number of teeth even late in life our findings indicate a substantial need for, in particular, relief of pain services. Concurrently, emphasis must be placed on preventive programs aiming at interfering with ongoing disease.

Periodontal disease prevalence in different age groups in Japan as assessed according to the CPITN

A CPITN survey was conducted involving 12,832 Japanese subjects from 7 to 64 years of age. Subjects under 18 were schoolchildren, and 18-year-old and older subjects represented various social backgrounds, having been randomly selected from both urban and rural Japan. Fifty percent of the 7-yr-old children had signs of periodontal disease, and this percentage increased with increasing age. In those under 14, this increase in periodontal disease was mainly due to an increase in the proportion of children developing dental calculus. Subjects with 6 mm or deeper pockets were observed starting from the 20-29-yr-old age group. In subjects over this age, the prevalence of periodontal disease was higher in men than in women. The percentages of subjects having pathologic pockets had increased remarkably in the 30-44-yr-olds. In the 45-64-yr-old group, almost all subjects had some sign of periodontal disease, and the percentage of those with 4 or 5 mm pockets and 6 mm or deeper pockets were 37% and 21%, respectively.