Social gradients in periodontal diseases among adolescents

Unveiling Oral Health Differences: Gingival Health and Hygiene in Children With and Without Cleft Lip and Palate

OBJECTIVE

To compare the oral hygiene and gingival health of children with and without cleft lip and palate.

DESIGN

Cross-sectional comparative study.

SETTING

Institutional tertiary referral hospital.

PATIENTS/PARTICIPANTS

This study was conducted on 108 children aged 6 to 12 years, divided into 3 groups: Group 1 = children with cleft lip and alveolus with or without cleft palate, unilateral or bilateral (n = 36, 22 boys and 14 girls, aged 8, 39 ± 1.61 years), Group 2 = children with isolated cleft palate (n = 36, 8 boys and 28 girls, 8.11 ± 1.88 years); and Group 3 = children without clefts (n = 36, 18 boys and 18 girls, 8.53 ± 1.33 years).

MAIN OUTCOME MEASURES

The clinical parameters evaluated were Gingival Index (GI) and Patient Hygiene Performance (PHP) Index. analysis of variance and Kruskal-Wallis tests were used to evaluate intergroup differences. Correlations between the variables age, PHP Index and GI were assessed by the Spearman correlation (P < .05).

RESULTS

The results demonstrated no statistically significant difference between the three groups for the PHP index (P = .126). There was also no intergroup difference for GI (P = .418).

CONCLUSIONS

No difference for the gingival status was observed between children with cleft lip and palate and with isolated cleft palate. Children with oral clefts present adequate gingival status compared to noncleft children.

Inequalities in dental services use by older adults in Chile according to eligibility for a national dental programme

OBJECTIVES

The objectives of this study were to determine the prevalence and trends in dental service use among Chilean older adults (60+ years) between 2006 and 2017; to assess the association between socioeconomic factors and dental service use and type (public/private) in 2017 and whether these differ by eligibility to a national dental programme (GES-60).

METHODS

This study involved secondary data analysis of five nationally representative cross-sectional surveys between 2006 and 2017. Trends were assessed for use of dental services and types of services used among 60-79-year-olds. Logistic regression models examined the association between use of dental services in 2017 and socioeconomic variables (income and education), accounting for covariates (age, gender, residence, ethnicity, cohabiting status, employment and disability). Estimated marginal means and odds ratios (ORs) were calculated to assess the association between socioeconomic variables and the outcomes by GES-60 eligibility.

RESULTS

Across surveys, the average prevalence of use of dental services in the last 3 months was 5.0%. There was a slight increase in dental visits between 2006 and 2017. This trend was higher among GES-60 eligible individuals using public dental services. Inequalities were observed in regression analyses. Compared to the poorest quintile and those with no formal education respectively, the ORs were 2.36 (95% confidence interval (CI) 1.79-5.68) for the richest quintile and ranged from 2.91 (95% CI 1.49-5.68) to 6.43 (3.26-12.68) for each higher level of educational attainment. Inequalities were wider among GES-60 non-eligible than GES-60 eligible older adults for both outcomes.

CONCLUSIONS

Socioeconomic inequalities were present among older adults regardless of GES-60 eligibility. However, these inequalities were more pronounced among non-eligible individuals. Our findings suggest a limited impact of GES-60 only among eligible older adults. Policies considering the needs of the whole older adult population are likely to have a stronger impact.

Direct relations between sense of coherence and oral health-related quality of life in adolescents

OBJECTIVE

To verify the relations between sense of coherence (SOC) and dental caries on oral health-related quality of life (OHRQoL) of adolescents.

SUBJECT AND METHODS

A cross-sectional sample of 768 adolescents nested in a cohort study was evaluated. SOC was measured using Antonovsky's scale. Dental caries was collected considering the decayed, missing, and filled teeth index (DMFT). OHRQoL was collected through the Child Perception Questionnaire. Demographic, socioeconomic, and use of service variables were also collected. The mediation effects between variables were tested by structural equation modeling.

RESULTS

The average age of the individuals was 17.5 years. Individuals with high SOC scores had a positive impact on OHRQoL (β-coefficient = -0.573, p < 0.00). Individuals with high DMFT (β-coefficient = 0.080, p = 0.034) and dental pain (β-coefficient = 0.079, p = 0.039) negatively impacted OHRQoL. Still, adolescents who had dental pain (β-coefficient = 0.112, p = 0.005), mothers with lower education levels (β-coefficient = -0.114, p = 0.004), lower household income (β-coefficient = -0.131, p = 0.003), and those who visited the dentist (β-coefficient = 0.109, p = 0.005) exhibited a higher DMFT index.

CONCLUSIONS

SOC and dental caries had a direct effect on OHRQoL, indicating that oral conditions and psychosocial characteristics are important contributors to OHRQoL.

Reflections on oral health inequalities: Theories, pathways and next steps for research priorities

Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.

Detection of soluble urokinase type plasminogen activator receptors in children with gingivitis and normal subjects

BACKGROUND

Gingivitis is a reversible condition; however, if left untreated, it progresses to periodontitis, which a serious infection that leads to bone destruction. Soluble urokinase-type plasminogen activator receptor (suPAR) measurement may be of value in the early assessment of gingivitis in children, thereby minimizing risk of tooth loss.

OBJECTIVES

In this observational study, we assessed salivary and serum concentrations of suPAR for the diagnosis of gingivitis and correlation of salivary suPAR with the periodontal clinical parameters.

METHODS

Ninety children participated in the study, with 20 healthy subjects as controls and 70 patients with gingivitis. The gingivitis group was divided into mild, moderate, and severe cases. According to the gingival index (GI), salivary and serum samples were analyzed for the suPAR and C-reactive protein levels using an enzyme-linked immunosorbent assay.

RESULTS

The salivary suPAR was significantly higher in patients with gingivitis (10.8 ± 2.9 ng/mL) than in the control group (7.0 ± 1.1 ng/mL) as P < 0.001. SuPAR was correlated with gingivitis severity. It was 7.7 ± 1.5 1 ng/mL in mild cases, 10.9 ± 1.2 ng/mL in moderate cases, and 14.4 ± 0.9 ng/mL in severe cases. The difference was significantly high (P < 0.001) between the groups; however, the difference between the mild cases and the control was nonsignificant as P < 0.066. The salivary suPAR was correlated with periodontal clinical parameters, which included GI and simple oral hygiene index (SOHI). Conversely the serum suPAR was not correlated with the salivary suPAR or the periodontal clinical parameters.

CONCLUSION

The results of the present study demonstrated that the salivary suPAR is increased in proportionate with the degree of severity of gingivitis in children. Moreover, salivary suPAR was correlated with the periodontal clinical parameters.

Illegal drugs and periodontal conditions

In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.

Prevalence of periodontal disease in young moroccans. A national survey

BACKGROUND

There are few large surveys of periodontal disease in young age cohorts, and national surveys in Africa do not existent. This study assessed the prevalence and severity of periodontal disease in a national survey of adolescents and young adults in Morocco.

METHODS

A multi-stage probability sampling design was used to draw a sample of 14,667 students 12-25 years old attending 87 schools. The sample was representative of approximately 3 million Moroccan students in this age group.

RESULTS

27.9%, 11.9%, and 7.7% of the subjects had ≥1 teeth with ≥4 mm, ≥5 mm, and ≥6 mm probing depth, and the population estimates were approximately 822, 350, and 226 thousand affected subjects, respectively. For attachment loss the prevalences were: 11.6%, 9.5%, and 6.9% (or ≈ 342, 281, and 204 thousand affected subjects) for ≥4 mm, ≥5 mm, and ≥6 mm, respectively. The rates of probing depth and attachment loss increased significantly with the increase in age (p<0.01, p<0.001). Gender and urban status did not show significant effects on the prevalence of periodontal disease (p>0.05). Similarly, the relationship between the occupation status and periodontal status was modest and not statistically significant (p>0.05).

CONCLUSIONS

Children and young adults attending public schools in Morocco have a high prevalence and severity of periodontal disease compared to other populations of similar age. The rate of periodontal disease reported here may be used as baseline population estimates in the surveillance of disease status in this population. This article is protected by copyright. All rights reserved.

Orthodontic Status and Orthodontic Treatment Need of 12- and 15-Year-Old Greek Adolescents: A National Pathfinder Survey

The purpose of this research was to assess the orthodontic status and orthodontic treatment needs of 12- and 15-year-old schoolchildren in Greece, in relation to sociodemographic factors and parental education level. A total of 1102 12-year-old children and 1131 15-year-old adolescents across Greece were assessed using the Modified Dental Health component (DHC) of the Index of Orthodontic Treatment Need (IOTN). An amount of 38.7% of 12-year-olds and 33.7% of 15-year-olds were in definite need of orthodontic treatment. The most common etiologic factors were tooth eruption and position anomalies. A higher rate of orthodontic treatment need was recorded among subjects with lower parental education level. Class I malocclusion was found in 50.9%, Class II in 38.4% and Class III in 10.8% of the total sample. A higher incidence of dental trauma was found in the 12-year-olds presenting with a Class II molar relationship and >3 mm overjet. The need for orthodontic treatment in Greece was higher, in comparison to other European countries, with one out of two children presenting a severe overjet associated with a high incidence of dental trauma. One out of three adolescents were still judged as having a need for orthodontic treatment by the age of 15.

Association Between Sense of Coherence and Periodontal Outcomes: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to evaluate the association between sense of coherence (SOC) and periodontal outcomes. Electronic searches were performed in 6 databases. Seventeen studies that evaluated the association between SOC and periodontal outcomes were included. The included studies demonstrated that individuals with a stronger SOC were more likely to present improved periodontal outcomes. The meta-analysis showed that individuals with a lower SOC were 3.31 times more likely to present bleeding on probing. Sons/daughters of mothers with a lower SOC were 3.22 times more likely to present gingival bleeding. Individuals with a stronger SOC have better periodontal health.

The Effect of Socio-Economic Status on Health Information Literacy among Urban Older Adults: Evidence from Western China

The present study aimed to observe the effect of socio-economic status on health information literacy and to identify whether there is a social gradient for health information literacy among urban older adults in Western China. This study employed a cross-sectional research design, and 812 urban participants aged 60 and older were enrolled in Western China. In the current study, only 16.7% of urban older adults reported having adequate health information literacy. Binary logistic regression analysis showed that socio-economic status factors including educational attainment, ethnicity, and financial strain were significantly and tightly associated with health information literacy. Additionally, other factors including suffering from chronic diseases, information-seeking activity, reading magazines and books, and watching television were also significantly linked to health information literacy. Consistent with existing studies, the findings indicate the health information literacy deficit and demonstrate the crucial impact of socio-economic status on health information literacy, which implies a social gradient in health information literacy. The importance of other factors related to health information literacy are discussed as well. The results suggest that reducing the health information literacy deficit and social gradient in health information literacy must be considered as an important priority when developing public health and health education strategies, programs, and actions among urban older adults in Western China.

Assessing the Association Between Nutritional Status, Caries, and Gingivitis in Schoolchildren: A Cross-Sectional Study

Objective. To evaluate if nutritional status is associated with caries and gingivitis in Brazilian schoolchildren. Material and methods. Children of both genders, age ranging from 8 to 11 years old, were included in this study. Caries was diagnosed using ICDAS (International System for Detection and Assessment of Carious Lesions) and gingivitis was diagnosed using the Community Periodontal Index. The nutritional status of each child was defined by BMI Z-score calculation. Data on oral health behavior and dietary habit were collected through parent's questionnaires. Parametric analyzes were performed to compare the groups. The established alpha was 5%. Results. The sample consisted of 353 schoolchildren: 16 underweight children, 247 eutrophic children, 64 overweight children, and 26 were obese children. Overweight, Obese and Overweight + Obese children presented less cavitated caries lesion than Eutrophic children (P < .05). Gingivitis was not associated with nutritional status (P > .05). Conclusion. Caries was associated with overweight and obesity in Brazilian schoolchildren.

Effect of individual and neighborhood social capital on gingival bleeding in children: A 7-year cohort study

BACKGROUND

Social capital incorporates contextual and individual levels of interactions, which influence human health. The aim of this study was to evaluate the influence of individual and contextual social capital in early childhood on gingival bleeding in children after 7 years.

METHODS

This 7-year cohort study was conducted with a randomized sample of 639 children (1 to 5 years old) evaluated in 2010 (T1) in Santa Maria, southern Brazil. Gingival bleeding was recorded during follow-up (T2). Contextual (social class association and number of churches) and individual (religious practice, volunteer networks, and school involvement) social capital variables were collected at baseline, along with demographic, socioeconomic, and oral health variables. A multilevel Poisson regression model was used to investigate the influence of individual and contextual variables on mean gingival bleeding. The incidence rate ratio (IRR) and 95% confidence interval (95% CI) were calculated.

RESULTS

A total of 449 children were reassessed after 7 years (70.3% cohort retention rate). Children living in areas with a larger number of churches at baseline had lower mean gingival bleeding at follow-up. Regarding individual social capital, children whose parents did not attend school activities were more likely to have gingival bleeding. Additionally, low maternal education, poor parents' perception of oral health, non-use of dental services, and low frequency of tooth brushing were related to higher mean gingival bleeding at follow-up.

CONCLUSION

The presence of more churches in neighborhoods and parents' involvement in a child's school activities positively influenced children's oral health, and these individuals had lower mean gingival bleeding.

Does the national dental scaling policy reduce inequalities in dental scaling usage? A population-based quasi-experimental study

BACKGROUND

In 2013, the national dental scaling insurance policy was introduced in South Korea. The purpose of this study is to determine the impact of the policy on inequalities in dental scaling usage.

METHODS

Data of a nationally representative sample of 1,517,097 people over the age of 20 were obtained from the 2010-2016 Community Health Survey. Respondents who reported that they had not received dental scaling in the past year were defined as dental scaling non-users. The excess prevalence and relative prevalence ratio of dental scaling non-users were calculated for the pre-policy (2010-2012) and post-policy periods (2014-2016) using monthly household income levels. Additionally, trends of dental scaling inequalities were shown as concentration indexes.

RESULTS

The prevalence of dental scaling non-users declined from 58.0 to 48.7% in the highest income group and from 86.3 to 78.8% in the lowest income group. However, the adjusted excess prevalence for the lowest income group compared with the highest had increased from 11.9 (95% CI: 11.9-11.9) to 15.5 (95% CI: 15.5-15.5)%, and the adjusted prevalence ratio increased from 1.19 (95% CI: 1.19-1.20) to 1.29 (95% CI: 1.29-1.30). Absolute and relative concentration indexes of dental scaling non-users increased after policy implementation.

CONCLUSIONS

The national dental scaling insurance policy has increased socioeconomic inequalities in dental scaling usage. Because dental care access generally requires high individual agency, expanded dental coverage may have had limited effects in attenuating inequalities and inadvertently widened the gap. To reduce dental care inequalities, universal access with universal dental coverage should be considered.

Prevalence and predictors of early periodontal disease among adolescents

Background

Periodic estimation of periodontal disease burden is essential for formulating new treatment strategies, for evaluating preventive strategies, and for framing of new policies. The previous national-level survey among adolescents was held 15 years ago. The objective of this study was to estimate the prevalence of periodontal disease among older adolescent students and to analyze its predictors as part of an oral health assessment survey conducted in Kerala.

Materials and Methods

A multistage cluster sampling was employed among five districts of Kerala to examine 1065 students in the age group of 15-18 years from government and private schools of selected urban and rural areas. Sociodemographic and oral health behavioral data, modified Community Periodontal Index, Oral Hygiene Index Simplified, and Dental Aesthetic Index were taken. Descriptive statistics and bivariate and multivariate logistic regression analyses were done to identify the predictors of gingival bleeding and periodontal pockets.

Results

The prevalence of gingival bleeding, periodontal pockets, and loss of attachment was 42%, 13.4%, and 2.7%, respectively. In the adjusted multivariate model for predictors of gingival bleeding, rural location of residence, studying in government schools, high mother's education and their working status, orthodontic treatment need, oral hygiene frequency, and poor oral hygiene status emerged as significant predictors of gingival bleeding. In the multivariate model for periodontal pockets, bleeding on probing emerged as the strongest predictor with an odds ratio of 12.85 when adjusted to poor oral hygiene.

Conclusion

The prevalence of early periodontal disease among adolescents is significant. Sociodemographic factors, poor oral hygiene, and malocclusion are significant predictors for periodontal disease among adolescents.

Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland

Objectives

Although adolescence is a sensitive developmental period in oral health, the social equalization hypothesis that suggests health inequalities attenuate in adolescence has not been examined. This study analyses whether the socioeconomic gap and ethnic disadvantage in oral health among children aged 5 reduces among adolescents aged 15.

Methods

Data from the cross‐sectional Children's Dental Health Survey 2013 were analysed, comprising of 8541 children aged 5, 8, 12 and 15 attending schools in England, Wales and Northern Ireland. Oral health indicators included decayed and filled teeth, plaque, gingivitis and periodontal health. Ethnicity was measured using the 2011 UK census ethnic categories. Socioeconomic position was measured by family, school and residential deprivation. Negative binomial and probit regression models estimated the levels of oral health by ethnicity and socioeconomic position, adjusted for demographic and tooth characteristics.

Results

The predicted rate of decayed teeth for White British/Irish children aged 5 was 1.54 (95%CI 1.30‐1.77). In contrast, the predicted rate for Indian and Pakistani children was about 2‐2.5 times higher. At age 15, ethnic differences had reduced considerably. Family deprivation was associated with higher levels of tooth decay among younger children but not among adolescents aged 15. The influence of residential deprivation on the rate of tooth decay and filled teeth was similar among younger and older children. Moreover, inequalities in poor periodontal health by residential deprivation was significantly greater among 15‐year‐old children compared to younger children.

Conclusions

This study found some evidence of smaller ethnic and family socioeconomic differences in oral health among British adolescents compared to younger children. However, substantial differences in oral health by residential deprivation remain among adolescents. Community levels of deprivation may be particularly important for the health of adolescents.

Socioeconomic inequalities in self-perceived oral health among adults in Chile

BACKGROUND

This paper studies the socioeconomic disparities in self-perceived oral health among Chilean adults and in the perceived physical, functional, psychological and social consequences of oral health.

METHODS

In February 2011, 1,413 residents of Metropolitan Area of Santiago, Chile, were interviewed using a standardized questionnaire and examined by dentists for dental status and oral health conditions. Only adults 18 to 60 years old affiliated with the public healthcare system were eligible to participate. We estimate socioeconomic gradients in self-perceived oral health and its distinct dimensions. We use the Heckman two-step procedure to control for selection bias given the non-random nature of the sample. In addition, we use a two-equation ordered response model given the discrete nature of the dependent variable.

RESULTS

There is a non-linear socioeconomic gradient in self-perceived oral health even after controlling for oral health status. The gradient is steep at the lower end of the income distribution and constant at mid-income levels. These socioeconomic disparities are also found for the psychological and social dimensions of self-perceived oral health, but not for the functional limitations and physical pain dimensions.

CONCLUSIONS

The findings are consistent with inequities in the access to oral health services due to insufficient provision in the public sector and costly options in the private sector.

Multimorbidity patterns of oral clinical conditions, social position, and oral health-related quality of life in a population-based survey of 12-yr-old children

The aim of this study was to describe the patterns of multimorbidities of oral clinical conditions in children. The association between social position and number of oral clinical conditions, and the relationship of social position and number of oral clinical conditions with oral health-related quality of life [OHRQoL, measured using the Brazilian Child-Oral Impacts on Daily Performance (Child-OIDP)] were also investigated. The study analysed data on 7,208 children, 12 yr of age, from the Brazilian Oral Health Survey (SBBrasil Project). Cluster analysis based on the observed/expected (O/E) ratios identified six significant clusters of oral clinical conditions: (i) dental caries and missing teeth; (ii) dental caries and dental trauma; (iii) dental trauma and gingivitis; (iv) dental caries, missing teeth, and dental trauma; (v) dental caries, dental trauma, and gingivitis; and (vi) all oral clinical conditions. Ordinal regression showed that poor social position was associated with a large number of oral clinical conditions. Poisson regression demonstrated that low social position and greater number of oral clinical conditions increased the likelihood of poor OHRQoL (Child-OIDP extent). The four oral clinical conditions clustered into six distinct clusters among Brazilian children. Multimorbidity of oral clinical conditions predicted poor OHRQoL. Social position was of high relevance to multimorbidity of oral clinical conditions and children's OHRQoL.

Epidemiology of gingivitis in schoolchildren in Bucharest, Romania: a cross-sectional study

BACKGROUND AND OBJECTIVE

Gingivitis is the most prevalent oral disease in children, being strongly associated to social gradients. Many studies have reported different results concerning the extent and intra-oral distribution of gingivitis in children. The aim of this study was to investigate the epidemiologic parameters and socio-related risk factors of gingivitis in the 10-17-year-old Bucharest schoolchildren population and to analyze its intra-oral distribution.

MATERIAL AND METHODS

Cross-sectional data were obtained from 1595 schoolchildren, social condition being assigned using a simple questionnaire. Classes of students were used as clusters in a single-stage cluster sampling method. An intra-oral exam was performed for all the children included in this study. Silness and Löe scores, prevalence and the extent of gingivitis were calculated.

RESULTS

The gingival scores showed a mild inflammation and the prevalence of gingivitis was 91%. Boys had a higher gingival (0.19 vs. 0.18; p < 0.05) and plaque scores (0.71 vs. 0.59; p < 0.01) than girls. Children who did not live in overcrowded households, whose parents had a better education and those who had direct access to school dental services displayed better gingival conditions (p < 0.05). Gingivitis was more severe on the upper teeth, with the maximum score being reached at the right upper lateral incisor (0.63 on distal surface).

CONCLUSIONS

Gingival condition in Bucharest schoolchildren population was associated to social gradients. School dental services are also another factor that seems to be related with gingivitis.

A cross-sectional survey to assess the effect of socioeconomic status on the oral hygiene habits

Background:

It is widely accepted that there are socioeconomic inequalities in oral health. A socioeconomic gradient is found in a range of clinical and self-reported oral health outcomes.

Aim:

The present study was conducted to assess the differences in oral hygiene practices among patients from different socioeconomic status (SES) visiting the Outpatient Department of the Sudha Rustagi College of Dental Sciences.

Materials and Methods:

A cross-sectional survey was conducted from June to October 2014 to assess the effect of SES on the oral hygiene habits. The questionnaire included the questions related to the demographic profile and assessment of the oral hygiene habits of the study population.

Results:

Toothbrush and toothpaste were being used significantly (P < 0.05) more by lower middle class (84.4%) and upper middle class (100.0%). A significantly higher frequency of cleaning teeth (twice a day) was reported among the lower middle class (17.2%) and upper middle class (21.5%). The majority (34.3%) of the study population changed their toothbrush once in 3 months. The cleaning of tongue was reported by patients belonging to the upper middle (62.0%), lower middle (52.1%), and upper lower class (30.0%). The use of tongue cleaner was reported to be significantly (P < 0.05) more among upper middle (10.1%) class patients. A significantly higher number of patients from the lower class (81.3%) never visited a dentist.

Conclusion:

The oral hygiene practices of the patients from upper and lower middle class was found to be satisfactory whereas it was poor among patients belonging to lower and upper lower class.

Health investment behaviours and oral/gingival health condition, a cross-sectional study among Swedish 19-year olds

OBJECTIVES

To test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents.

METHODS

Five hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents' education level.

RESULTS

In the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with 'tooth-brushing ≥ 2 times daily' as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators 'no/few missed dental appointments', 'no tobacco use' and 'weekly exercise', theoretical studies were statistically significant and positively associated. In the investment model with 'perceived oral health care attention' as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth.

CONCLUSIONS

Individual, environmental and lifestyle factors are associated with young individuals' oral health investment behaviours and gingival health conditions.

Prevalence and predictors for clinical attachment loss in adolescents in Latin America: cross-sectional study

AIM

To describe the prevalence, severity and extension of clinical attachment loss (CAL) and to study the predictors in 15- to 19-year-old adolescents from high schools in the Latin America.

MATERIALS AND METHODS

A cross-sectional, epidemiological study was performed. The sample included 1070 high school adolescents 15-19 years of age from Santiago de Chile (Chile), Buenos Aires, Córdoba, Mendoza (Argentina), Montevideo (Uruguay), Quito (Ecuador) and Medellín (Colombia). Calibrated examiners performed full mouth, six sites per tooth clinical examination.

RESULTS

There was a response rate of 100%. The prevalence of CAL ≥3 mm in ≥1 site was 32.6%, probing pocket depth ≥4 mm was 59.3% and bleeding on probing (BoP) ≥25% was 28.6%. The logistic regression analysis adjusted for cities revealed that smoking (OR = 1.6), attending public school (OR = 2.3) and having a BoP ≥25% (OR = 4.2) were positively associated with CAL ≥3 mm in ≥ 1 site.

CONCLUSION

Clinical attachment loss was prevalent in Latin America adolescents and it is associated with smoking, attendance public school and BoP.

Factors related to number of present teeth in Korean elderly adults aged 55-84 years

OBJECTIVES

The aim of this study was to determine the associations between the number of present teeth (NT) and socio-economic, demographic and oral health behavioural factors among Korean adults aged 55-84 years.

METHODS

The total subjects comprised 3767 individuals who were examined and who answered the questions on socio-economic status and oral health behaviour from the fourth Korean National Health and Nutrition Examination Survey conducted from 2007 to 2009. The dependent variable was NT, with binary status divided by the median. Socio-economic and demographic factors included gender, educational level, parent's educational levels, region of residence, household income, type of health insurance and mother's economic activity. Oral health behaviours were as follows: daily toothbrushing frequency, smoking status, recent dental visit and illegal dental treatment. Multivariate logistic regression models were applied to explain the associations between NT and other variables.

RESULTS

In a model adjusted by socio-economic, demographic and oral health behavioural variables, subjects who lived in urban areas were more likely to have larger NT compared to those in suburban areas (OR: 1.22, P = 0.025). Males were more likely to have larger NT (OR: 1.90, P < 0.001), and daily toothbrushing frequency was associated with NT (OR = 1.25, P = 0.023). Non-smokers (OR: 2.44, P < 0.001) and past smokers (OR: 1.70, P < 0.001) were more likely to have lager NT compared to current smokers. Subjects without illegal dental treatments were more likely to have lager NT compared to those with illegal dental treatments (OR = 2.21, P < 0.001).

CONCLUSIONS

Interventions aiming to preserve present teeth in elderly adults should consider socio-economic, demographic and oral health behavioural factors.

Assessment of gingival health among school children in Sharjah, United Arab Emirates

Objectives:

The present study evaluated the gingival condition among school going children in Sharjah, United Arab Emirates and determined its relationship with tooth brushing frequency, diet and dental caries.

Materials and Methods:

Four hundred and five children participated in the study. There were 232 boys (57%) and 173 (43%) girls. Children were grouped based on age as ≤6 years (n = 84) mean age 4.72 ± 0.50 and >6 years (n = 321) mean age 8.47 ± 1.65. The amount of dental plaque and gingival condition were assessed on the inner and outer surface of six index teeth using Silness and Loe and Loe and Silness criteria. Dental caries status was assessed using WHO 1997 criteria. Dental examination, tooth brushing frequency and 24 h diet chart were recorded by calibrated dentists. Logistic regression analysis was used to determine the predictors of gingivitis.

Results:

Increase in decayed, missing, and filled teeth values corresponds to increase in plaque index and gingival index scores (P ≤ 0.05). A logistic regression analysis of the predictors of gingivitis showed that males were 2.11 times less likely to have gingivitis compared with females (odds ratio [OR]: 0.47,95% confidence interval [CI]: 0.24-0.93, P = 0.03) and children aged ≤6 years were 3.06 times less likely to have gingivitis than those aged >6 years (OR: 0.33, 95% CI: 0.17-0.62, P = 0.00). Tooth brushing frequency and diet were not significant predictors.

Conclusion:

Current study clearly demonstrated that female gender and children more than 6 years were more likely to have gingivitis.

The Interplay between socioeconomic inequalities and clinical oral health

Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age are fundamental if we are to understand and address inequalities.

Early life-course socioeconomic position, adult work-related factors and oral health disparities: cross-sectional analysis of the J-SHINE study

OBJECTIVES

We examined the association between socioeconomic position (SEP) and oral health, and the associations of economic difficulties in childhood and workplace-related factors on these parameters.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 3201 workers aged 25-50 years, living in and around Tokyo, Japan, from the J-SHINE (Japanese study of Stratification, Health, Income, and Neighborhood) study. The response rate was 31.6%.

OUTCOME MEASURES

Self-rated oral health (SROH)-A logistic regression model was used to estimate ORs for the association between poor SROH and each indicator of SEP (annual household income, wealth, educational attainment, occupation and economic situation in childhood). Multiple imputation was used to address missing values.

RESULTS

Each indicator of SEP, including childhood SEP, was significantly inversely associated with SROH, and all of the workplace-related factors (social support in the workplace, job stress, working hours and type of employment) were also significantly associated with SROH. Compared with professionals, blue-collar workers had a significantly higher OR of poor SROH and the association was substantially explained by the workplace-related factors; ORs ranged from 1.44 in the age-adjusted and sex-adjusted model to 1.18 in the multivariate model. Poverty during childhood at age 5 and at age 15 was associated with poorer SROH, and these two factors seemed to be independently associated with SROH.

CONCLUSIONS

We found oral health disparity across SEP among workers in Japan. Approximately 60% of the association between occupation and SROH was explained by job-related factors. Economic difficulties during childhood appear to affect SROH in adulthood separately from sex, age and the current workplace-related factors.

Socioeconomic position and subjective oral health: findings for the adult population in England, Wales and Northern Ireland

Background

The objective of this study was to assess socioeconomic inequalities in subjective measures of oral health in a national sample of adults in England, Wales and Northern Ireland.

Methods

We analysed data from the 2009 Adult Dental Health Survey for 8,765 adults aged 21 years and over. We examined inequalities in three oral health measures: self-rated oral health, Oral Health Impact Profile (OHIP-14), and Oral Impacts on Daily Performance (OIDP). Educational attainment, occupational social class and household income were included as socioeconomic position (SEP) indicators. Multivariable logistic regression models were fitted and from the regression coefficients, predictive margins and conditional marginal effects were estimated to compare predicted probabilities of the outcome across different SEP levels. We also assessed the effect of missing data on our results by re-estimating the regression models after imputing missing data.

Results

There were significant differences in predicted probabilities of the outcomes by SEP level among dentate, but not among edentate, participants. For example, persons with no qualifications showed a higher predicted probability of reporting bad oral health (9.1 percentage points higher, 95% CI: 6.54, 11.68) compared to those with a degree or equivalent. Similarly, predicted probabilities of bad oral health and oral impacts were significantly higher for participants in lower income quintiles compared to those in the highest income level (p < 0.001). Marginal effects for all outcomes were weaker for occupational social class compared to education or income. Educational and income-related inequalities were larger among young people and non-significant among 65+ year-olds. Using imputed data confirmed the aforementioned results.

Conclusions

There were clear socio-economic inequalities in subjective oral health among adults in England, Wales and Northern Ireland with stronger gradients for those at younger ages.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-827) contains supplementary material, which is available to authorized users.

Changes in the oral-health-related quality of life of Brazilian children after an educational preventive programme: an 1-month longitudinal evaluation

OBJECTIVE

This 1-month longitudinal study assessed whether the oral status and the oral-health-related quality of life (OHRQoL) of children changed after four sessions of an educational preventive programme.

STUDY POPULATION AND METHODS

Fifty Brazilian students (11-12 year old) were examined for signs and symptoms of gingivitis using the Community Periodontal Index and two questions about gingival bleeding. The OHRQoL was measured using the Brazilian Portuguese version of the Child Oral Impacts on Daily Performances (Child-OIDP). Higher scores indicated worse OHRQoL. The results were analysed using the Shapiro-Wilk, Chi-square, Wilcoxon signed-rank and Mann-Whitney tests. The magnitude of the mean change was calculated using the effect size.

RESULTS

Twenty-four percentage of children had more than six sites with bleeding at follow-up compared with 58% at baseline. There was a significant decline in the intensity and extension of impacts at follow-up. A significant improvement in the clinical status and oral hygiene was observed for both transitional categories. There was a significant decline in the Child-OIDP scores of those reporting 'much improved'. A significant improvement in the global ratings of oral health was observed at follow-up.

CONCLUSIONS

In the studied sample, an improvement occurred with respect to the severity of disease, intensity and extension of impacts and global ratings of oral health after 1-month follow-up. These results suggest that improving the global transition in health by enhancing coping and management skills while inducing slight changes in the clinical status and the specific aspects of health compromised by the disease is possible.

Progression of attachment loss is strongly associated with presence of the JP2 genotype of Aggregatibacter actinomycetemcomitans: a prospective cohort study of a young adolescent population

AIM

To assess the progression of attachment loss (AL) during a 2-year period according to the presence of JP2 and non-JP2 genotypes of Aggregatibacter actinomycetemcomitans in a Ghanaian adolescent population.

METHODS

A total of 500 adolescents (mean age 13.2 years, SD ± 1.5) were enrolled in the study. After 2 years, 397 (79.4%) returned for a periodontal re-examination, including the measurement of AL. The carrier status of the JP2 and non-JP2 genotypes of A. actinomycetemcomitans was evaluated in a baseline examination 2 years earlier.

RESULTS

Individuals who carried the JP2 genotype of A. actinomycetemcomitans had a significantly increased risk [relative risk (RR) = 7.3] of developing AL ≥ 3 mm. The mean AL at the follow-up and the mean 2-year progression of AL were significantly higher in the JP2 genotype-positive group (n = 38) compared with the group positive for the non-JP2 genotypes of A. actinomycetemcomitans (n = 169), and the group of A. actinomycetemcomitans-negative individuals (n = 190). The JP2 genotype was strongly associated with the progression of AL ≥ 3 mm (OR = 14.3). The non-JP2 genotypes of A. actinomycetemcomitans were also, however, less pronounced, associated with the progression of AL ≥ 3 mm (OR = 3.4).

CONCLUSION

The JP2 genotype of A. actinomycetemcomitans is strongly associated with the progression of AL.

Are obesity and overweight associated with gingivitis occurrence in Brazilian schoolchildren?

AIM

This cross-sectional study aimed to assess the relationship between weight status and gingival inflammation in Brazilian schoolchildren aged 8- to 12-year old, when controlling for potential confounders.

METHODS

Overall, 1211 children aged 8- to 12-year old from public and private schools in Southern Brazil were selected by a two-stage cluster method. Questionnaires were used to assess socio-demographic data and oral hygiene habits. Oral examination evaluated presence of plaque and gingival bleeding. Anthropometric measures were collected to obtain body mass index. Multivariate Poisson regression was used for data analysis (Prevalence Ratio/95% Confidence Interval).

RESULTS

Prevalence of gingivitis was 44.0%. Mean and median values of gingival bleeding sites were 3.10 and 2.0 respectively. Obese/overweight children totalized 34.6%. In multivariate adjusted analysis, sex (PR 0.86; 95%CI 0.75;0.98), maternal schooling (PR 1.09; 95% CI 1.01;1.18), plaque (PR 1.37; 95% CI 1.26;1.50), dental caries experience (PR 1.16; 95% CI 1.01;1.36) and bleeding during tooth brushing (PR 1.27; 95% CI 1.11;1.48) were associated with the outcome. In the sex-stratified analysis, overweight/obese boys presented a greater risk for gingivitis (PR 1.22 95% CI 1.01;1.48).

CONCLUSIONS

Gingivitis was not associated with obesity/overweight in the total sample. Gender differences seem to influence the relationship between gingivitis and obesity/overweight; a stronger association was noted among boys than girls.

Periodontal health through public health--the case for oral health promotion

Periodontal diseases are highly prevalent, particularly amongst socially disadvantaged populations, impact on quality of life and are costly to treat. Clinical treatments and chairside preventive approaches alone will never adequately address this problem. Indeed in many parts of the developing world clinical care and chairside prevention are both unaffordable and inappropriate for the control of periodontal diseases. A paradigm shift away from the individualized treatment approach to a population public health model is needed to promote periodontal health and, in particular to address social inequalities in periodontal status. Public health measures need to focus on the underlying determinants of periodontal diseases. Poor hygiene, tobacco use, psychosocial factors and related systemic diseases are the main risk factors for periodontal diseases. Public health interventions need to tackle these factors but also must recognize and act upon the distal underlying influences that determine and pattern these identified risks. Recognition also needs to be placed on the interlinking and common risk factors shared by periodontal diseases and other chronic conditions. A complementary range of public health policies acting at local, regional, national and international levels need to be implemented to achieve sustainable improvements in oral health. To be effective these policies need to link across the broader public health agenda and require public engagement and support. Clinicians, public health practitioners, commercial organizations and professional groups all have an important role to play in promoting periodontal health.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey

AIM

To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters.

METHODS

A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance.

RESULTS

The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds.

CONCLUSIONS

The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Income-related inequalities in denture-wearing by Europeans aged 50 and above

BACKGROUND

Despite its importance for the planning of future treatment needs and an optimised allocation of health care resources, only little is known about socio-economic inequalities in denture-wearing by late middle-aged and elderly generations.

OBJECTIVES

To describe income-related inequalities in denture-wearing by elderly populations residing in different European countries.

MATERIAL AND METHODS

Data from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 2) were used to assess income-related inequalities in denture-wearing by means of Concentration Indices (CI) for populations aged 50+ from 14 different European countries.

RESULTS

We could identify a significant disproportionate concentration of denture-wearing amongst the poor elderly populations in Denmark (CI = -0.3534, corresponding to the highest level of inequality), Sweden (CI = -0.3479), Switzerland (CI = -0.2013), Greece (CI = -0.1953), the Netherlands (CI = -0.1413), France (CI = -0.1339), Austria (CI = -0.0974), Czech Republic (CI = -0.0959), Belgium (CI = -0.0947), Germany (CI = -0.0762), Ireland (CI = -0.0575) and Spain (CI = -0.0482, corresponding to the lowest level of pro-poor inequality). Poland became evident as the only country in which individuals from the upper end of the income scale wear more dentures than their peers from the lower end of the income scale (CI = 0.0379). No significant income-related inequalities were observable in Italy.

CONCLUSIONS

There is considerable income-related inequality in denture-wearing by several elderly populations in Europe. Future resource planning for prosthetic care should, thus, specifically distinguish between the treatment needs of different socio-economic groups within elderly populations.

Subgingival microbial consortia and the clinical features of periodontitis in adolescents

This study aimed to investigate the association between microbial consortia and the clinical features of periodontitis using a multilevel modeling approach. A total of 958 sites in 87 adolescents with periodontitis (cases) and 73 controls were microbiologically sampled and clinically examined. Associations between each of the clinical parameters clinical attachment, probing depth, supragingival plaque, calculus, bleeding on probing, and each of 18 bacterial species; and between the same clinical parameters and each of two microbial consortia identified, were investigated using mixed-effects regression modeling. Higher counts of Tannerella forsythia, Campylobacter rectus, and Porphyromonas gingivalis were all statistically significantly associated with higher values of clinical attachment level, probing depth, and bleeding on probing in the sampled site, when both case status and between-subject variance were accounted for. Higher counts for the consortium comprising the putative periodontopathogens were statistically significantly associated in a dose-response manner with both higher clinical attachment levels and with increased pocket depth. The counts for the consortium predominantly comprising the early-colonizer species were statistically significantly negatively associated with the presence of supragingival calculus, but positively associated with the presence of supragingival plaque. The study demonstrates a relationship between the counts of putative periodontopathogens and clinical attachment levels and probing pocket depths, even for low levels of these clinical parameters.

Social gradients in oral health in older adults: findings from the English longitudinal survey of aging

OBJECTIVES

We examined prospective associations between socioeconomic position (SEP) markers and oral health outcomes in a national sample of older adults in England.

METHODS

Data were from the English Longitudinal Survey of Aging, a national cohort study of community-dwelling people aged 50 years and older. SEP markers (education, occupation, household income, household wealth, subjective social status, and childhood SEP) and sociodemographic confounders (age, gender, and marital status) were from wave 1. We collected 3 self-reported oral health outcomes at wave 3: having natural teeth (dentate vs edentate), self-rated oral health, and oral impacts on daily life. Using multivariate logistic regression models, we estimated associations between each SEP indicator and each oral health outcome, adjusted for confounders.

RESULTS

Irrespective of SEP marker, there were inverse graded associations between SEP and edentulousness, with proportionately more edentate participants at each lower SEP level. Lower SEP was also associated with worse self-rated oral health and oral impacts among dentate, but not among edentate, participants.

CONCLUSIONS

There are consistent and clear social gradients in the oral health of older adults in England, with disparities evident throughout the SEP hierarchy.

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.

Socio-behavioural factors influencing oral health of 12 and 15 year old Greek adolescents. A national pathfinder survey

AIM

To estimate the frequency in use of oral health services, oral health self-assessment, oral hygiene practices of 12- and 15-year-old Greek children and adolescents, to investigate possible influences of these factors and other socio-demographic parameters on oral health.

METHODS

A stratified cluster sample of 1224 12 year old and 1257 15 year old children and adolescents of Greek nationality were selected and examined by calibrated examiners. Clinical examination included recording of caries according to the British association for the study of community dentistry diagnostic criteria, while oral hygiene and periodontal status were assessed by means of the simplified debris and the community periodontal index. Subjects were interviewed to answer questions on socio-behavioural risk factors through a structured questionnaire. The student's t-test and ANOVA were used for statistical evaluation of the means and the chi-square test was applied for statistical comparison of the proportions. Multiple linear regression analysis was performed to assess the statistical association between variables.

RESULTS

Caries experience and untreated caries were significantly higher among children and adolescents who visited the dentist only when in pain or for restoring a tooth, compared to those visiting for check-ups or prevention and having more frequent application of topical fluorides. Tooth brushing, at least twice a day, and flossing were significantly associated with periodontal and oral hygiene status, but not with caries presence. The multivariate analysis revealed that parental educational status and reason for visiting a dentist were strong determinants for caries experience and oral hygiene status but not for periodontal health of children and adolescents.

CONCLUSIONS

This study has identified several socio-demographic and behavioural determinants for dental caries, oral hygiene and periodontal health of Greek children and adolescents.

Income-related inequalities in dental service utilization by Europeans aged 50+

The purpose of this study was to describe income-related inequalities in dental service utilization by the elderly populations residing in different European countries. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Wave 2), which contains information on utilization of dental services by 33,358 individuals aged 50+ years from 14 different countries. We assessed income-related inequalities in dental attendance and preventive and/or operative dental treatment by means of Concentration Indices (CI) and Slope Indices of Inequality (SII). We could identify a disproportionate concentration of access to treatment among the rich elderly populations in all 14 countries (relative inequality according to CI), as well as significantly higher access to treatment by individuals located in the highest in relation to the lowest income group for all countries except Italy and the Czech Republic (absolute inequality according to SII). Such differential utilization appears mainly attributable to inequalities in preventive dental visits, either alone or in combination with operative treatment. Persons' oral health status explains substantial proportions of absolute but not of relative inequalities. Overall, there is considerable income-related inequality in dental service utilization by several elderly populations residing in Europe. More research is needed to identify the exact causes of such disparities.

The relationship among educational achievement, career aspiration, and oral hygiene behaviours in Iranian adolescents

The objectives of this study were to examine: (i) the association between toothbrushing frequency and educational achievement; (ii) the influence of social status and career aspiration on this association; and (iii) whether educational achievement and career aspiration explain the gender difference in oral hygiene behaviours in Iranian adolescents in Mashhad. The sample population was sixth-grade adolescents in Mashhad, Iran. Participants completed a 37-item questionnaire with questions on socio-demographic variables, frequency of toothbrushing, educational achievement, and their career aspiration. The associations between toothbrushing frequency and other study-outcome variables were tested using binary logistic regression. The association between toothbrushing frequency and educational achievement was significant only after adjusting for the father's level of education and the child's career aspiration. Toothbrushing frequency was highly significantly associated with gender, and this association remained unaltered after adjusting for educational achievement and career aspiration. Career aspiration and toothbrushing frequency were significantly associated. In conclusion, educational achievement was not an independent indicator of reported toothbrushing frequency in Iranian adolescents in Mashhad. Father's educational level and child's career aspiration mediated the association between toothbrushing frequency and educational achievement. Educational achievement and career aspiration did not explain the gender difference in toothbrushing behaviours of Iranian adolescents.