Attitudes to fluorosis and dental caries by a response latency method

Does dental appearance impact on employability in adults? A scoping review of quantitative and qualitative evidence

Background The importance of physical appearance in social and professional situations has been well studied. It has been suggested that improving dental appearance may increase employment prospects. This scoping review aims to map the current literature regarding the impact of dental appearance on employability.Methods A scoping review was carried out in accordance with guidance from the Joanna Briggs Institute. Inclusion and exclusion criteria were developed iteratively, databases were searched and decisions on inclusion made in duplicate. Data were charted in Excel and synthesised using a visual map, study summary table and narrative description.Results We identified 16 relevant articles: ten experimental simulation studies, two qualitative studies, one cross-sectional survey, one pre-/post-dental treatment survey, one retrospective cohort study and one narrative systematic review. Experimental simulations support the notion that visible dental conditions can negatively impact appraisals of employment-related personal characteristics. Negative impacts on job-seeking self-efficacy and willingness to apply for jobs have also been documented.Conclusions The applicability of this evidence base to the UK health system context is uncertain and demonstration of real-life impact on employment is lacking. Further research is needed before programmes to improve dental appearance could be justified on the basis of improving employment outcomes.

Impact of dental fluorosis on the oral health related quality of life among 11- to 14-year-old school children in endemic fluoride areas of Haryana (India)

OBJECTIVE

This study investigates the impact of dental fluorosis on the oral health-related quality of life (OHRQoL) among 11- to 14-year-old school children in endemic fluoride areas of Haryana (India).

MATERIALS AND METHODS

A cross-sectional survey was conducted among 2,200 school children in endemic fluoride areas of Haryana. Using cluster random sampling, three districts out of 14 endemic fluoride districts were selected, and children 11-14 years of age were examined. A child perception questionnaire (CPQ_11-14 ) (Hindi version) evaluated the impact of dental fluorosis on OHRQoL. The Thylstrup-Fejerskov index (TFI) was used for assessing dental fluorosis. The data were analysed using SPSS version 18, and non-parametric tests were used to assess the significance. The regression analysis was used to determine the effect of change in CPQ scores with dental fluorosis at P < 0.05.

RESULTS

The study participants included 45.3% males and 54.7% females among which mild to moderate level of dental fluorosis was identified with mean mean TFI Scores being 3.19 ± 1.55. Children without dental fluorosis had 1.17 times more odd of percieving their oral health as excellent/good when compared to children with dental fluorosis (P < 0.05). Study subjects with dental fluorosis did not have higher mean CPQ_11-14 domain and total scores when compared with subjects without dental fluorosis.

CONCLUSION

It can be concluded that mild dental fluorosis did not affect the OHRQoL of the children in the endemic fluoride areas of Haryana in India.

The Untold Story of Fluoridation: Revisiting the Changing Perspectives

The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.

The Effect of Dental Fluorosis on the Quality of Life of Female High School and Precollege Students of High Fluoride-Concentrated Area

Aims and Objectives:

Colored and deformed fluorotic teeth may affect the quality of life (QOL). The present study, therefore, evaluates the effect of dental fluorosis on the QOL of female high school and precollege students of Behbahan district in 2014.

Materials and Methods:

One hundred 15–18-year-old female students with dental fluorosis were selected from the high schools of Behbahan district by random cluster sampling technique. Dental fluorosis was measured clinically using Dean's index after analyzing the drinking water of the affected district. The effect of dental fluorosis on the QOL was then evaluated through a questionnaire. The data from Dean's index, condition-specific oral impact on daily performance (CS-OIDP) questionnaire, and the mean score of QOL questionnaire were analyzed in SPSS version 20 using Pearson's and Spearman's correlation analyses (α = 0.05).

Results:

The mean values of age and the QOL regarding appearance were 16.5 years and 61.5 ± 20.8 from 100, respectively. Spearman's correlation showed a positive correlation between CS-OIDP total score and the severity of fluorosis (P = 0.0001, r = 0.342). Spearman's correlation also showed a negative correlation between the QOL and the severity of fluorosis (P < 0.001, r = −0.496) so that by increasing the severity of fluorosis, the QOL was decreasing.

Conclusions:

Increasing the severity of fluorosis is associated with increasing the dissatisfaction and decreasing the QOL.

Assessing the relationship between dental appearance and the potential for discrimination in Ontario, Canada

Poor oral health is influenced by a variety of individual and structural factors. It disproportionately impacts socially marginalized people, and has implications for how one is perceived by others. This study assesses the degree to which residents of Canada's most populated province, Ontario, recognize income-related oral health inequalities and the degree to which Ontarians blame the poor for these differences in health, thus providing an indirect assessment of the potential for prejudicial treatment of the poor for having bad teeth. Data were used from a provincially representative survey conducted in Ontario, Canada in 2010 (n=2006). The survey asked participants questions about fifteen specific conditions (e.g. dental decay, heart disease, cancer) for which inequalities have been described in Ontario, and whether participants agreed or disagreed with various statements asserting blame for differences in health between social groups. Binary logistic regression was used to determine whether assertions of blame for differences in health are related to perceptions of oral health conditions. Oral health conditions are more commonly perceived as a problem of the poor when compared to other diseases and conditions. Among those who recognize that oral conditions more commonly affect the poor, particular socioeconomic and demographic characteristics predict the blaming of the poor for these differences in health, including sex, age, education, income, and political voting intention. Social and economic gradients exist in the recognition of, and blame for, oral health conditions among the poor, suggesting a potential for discrimination amongst socially marginalized groups relative to dental appearance. Expanding and improving programs that are targeted at improving the oral and dental health of the poor may create a context that mitigates discrimination.

Straight, white teeth as a social prerogative

A distinguishing feature of North American society is preoccupation with self-image, as seen in the ritualistic nature of bodily practices aimed at constantly improving the body. Nowhere is this more apparent than in the prevailing fixation with straight, white teeth. While there is an ever-expanding literature on the sociology of body, very little has been written on teeth in this context. Using literature from anthropology, biology, dentistry, sociology and social psychology, this study attempts to answer: (1) Why have straight, white teeth become a beauty ideal in North American society? (2) What is the basis for this ideal? (3) How is this ideal propagated? It demonstrates that dental aesthetic tendencies are biologically, culturally and socially patterned. Concepts from the works of Pierre Bourdieu and Michel Foucault are used to illustrate how straight, white teeth contribute towards reinforcing class differences and how society exercises a disciplinary power on individuals through this ideal. It is concluded that modified teeth are linked to self and identity that are rooted in social structure. Moreover, teeth demonstrate the ways in which class differences are embodied and projected as symbols of social advantage or disadvantage. Implications on professional, public health, sociological and political levels are considered.

The effect of dentists' body-weight size on student social judgments of dental skill and patients' behavioural intentions: a vignette study

OBJECTIVES

Where previous work has suggested that over-weight individuals may be subject to negative social judgments, a finding also seen in judgments applied to healthcare professionals (HCPs), this study investigated whether these findings extend to judgments made about dental practitioners.

METHODS

A photo of a normal weight male and one of a normal weight female dentist were digitally modified to reliably show them as overweight, giving a total of 4 conditions. In a single-blind quasi-randomised controlled study of 302 undergraduate and postgraduate student participants used a 5 point Likert scale to appraise a single, gender-matched colour photograph as to whether they thought the dentist depicted was competent, professional, caring, had patients' best interests at heart, and was a good dentist. They further rated their future intentions to follow behavioural advice (reduce snacking and take-up flossing) given by the depicted dentist.

RESULTS

The data were analysed using independent sample t-tests. There were no differences in outcomes as a function of the weight status of the depicted dentist in any of the variables explored with the exception of the normal-weight images being rated as more caring than the overweight ones (p<.04).

CONCLUSIONS

Images of overweight dentists do not receive lower social judgement ratings than images of normal-weight dentists. Previous research in medicine reporting adverse social judgments made of over-weight HCPs does not apply to dental practitioners. Future research should focus on factors that may explain these findings.

CLINICAL SIGNIFICANCE

Dentists appear to be protected from the adverse effect of overweight on social judgments of their personal characteristics and on their health-promoting advice.

The aesthetic impact of enamel fluorosis on Irish adolescents

OBJECTIVES

To assess the impact of differing degrees of enamel fluorosis on dental aesthetics according to Irish adolescents. The same participants also aesthetically rated other variations in dental appearances including a carious lesion, bleached teeth and a demarcated opacity.

METHODS

One hundred and fifty adolescents examined seven identical template photographs of an attractive dental smile displaying varying levels of enamel fluorosis (TF1, TF2, TF3), a demarcated opacity, no fluorosis (TF0), anterior caries and very white or bleached teeth. By indicating their level of agreement or disagreement with five statements on a five-point Likert scale, the participants rated the aesthetic acceptability of each of the photographs.

RESULTS

Using paired t-tests with the Bonferroni correction, it was found that the photographs depicting the very white teeth and anterior caries were rated as the most and least aesthetically pleasing images, respectively. There was no significant difference in the ratings of the photographs displaying TF0, TF1 and TF2 levels of fluorosis indicating that these photographs were viewed similarly (P>0.002). The remaining two photographs (TF3 and the demarcated opacity) were rated similarly and significantly worse (P<0.002) than the photographs showing no or low grades of fluorosis (TF0, TF1 and TF2).

CONCLUSIONS

TF3 level of fluorosis represented the break point at which enamel fluorosis became aesthetically objectionable to these participants. Low grades of fluorosis (TF1 and TF2) were rated similarly to the photograph depicting no fluorosis (TF0).

Dental providers' attitudes regarding the application of fluoride varnish by pediatric health care providers

OBJECTIVES

To ascertain what proportion of dental hygienists and dentists in Indiana, United States, support the application of fluoride varnish in medical offices, and to determine if support differed by dental provider characteristics, practice characteristics, a limited assessment of knowledge about fluoride, or use of fluoride.

METHODS

Practicing dental hygienists and dentists in 2005 were asked to fill out a mail questionnaire. Logistic regression models tested the association of independent variables with support for medical providers applying varnish.

RESULTS

Response rates were 36% (dental hygienists) and 37% (dentists); median year of graduation was 1988 and 1981. Sixty-six percent of respondents were in solo practices, 82% of dentists in general practice, 5% in dental pediatrics, and 13% were other specialists. While 51.2% of dental professionals agreed that medical practices could apply fluoride varnish, 29% responded "none" should be allowed, and 19% were undecided. In the multivariable logistic regression for support of medical practices applying fluoride versus not supporting it, three practice characteristics and two measures of fluoride use were significant. Provider characteristics and a limited assessment about knowledge about fluoride were not significant.

CONCLUSIONS

Half of dental professionals felt that it was appropriate for medical providers to apply fluoride varnish; pediatric dental professionals were less supportive. A few dental practice characteristics were associated with acceptance of the use of fluoride varnish by medical care providers: targeting messages to dental hygienists and those with practices in mixed rural-urban areas may be a useful approach to garner greater support for this medical/dental partnership.

A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life

Aesthetic perceptions and oral health-related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published.

OBJECTIVE

To assess the relationships between perceptions of dental appearance/oral health-related quality of life (OHRQoL) and dental fluorosis.

METHODS

The PubMed database was searched using the Medical Subject Headings (MeSH) for English-language studies from 1985 to March 2009. Thirty-five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subject's teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact.

RESULTS

There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL.

CONCLUSION

Because dental fluorosis in the United States and other nations without high levels of naturally-occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.

Perceptions of adolescents and young people regarding endemic dental fluorosis in a rural area of Brazil: psychosocial suffering

Severe dental fluorosis is endemic in some rural areas of Brazil. This paper describes the psychosocial consequences of this condition and how it has affected the self-esteem of adolescents and young people in a rural area in Brazil. Semi-structured, face-to-face interviews were carried out with 23 adolescents and young people affected by severe dental fluorosis and 14 of their teachers. The study revealed the affected individuals were embarrassed to smile at strangers due to a presumed association between fluorosis and a lack of dental hygiene. Further findings include conflicts between affected and non-affected students at school, problems in pursuing a romantic relationship and uncertainties regarding a professional future. Disbelief and scepticism were observed regarding the ethical position that science can offer a solution to the problems stemming from the disease. Lesions from severe dental fluorosis appear to be a stigmatizing factor and have contributed toward suffering and self-exclusion among an entire generation of adolescents and young people.

Fluoride distribution in groundwater and survey of dental fluorosis among school children in the villages of the Jhajjar District of Haryana, India

Fluoride concentration of groundwater reserves occurs in many places in the world. A critical area for such contamination in India is alluvial soil of the plain region, consisting of five blocks (Jhajjar, Bahadurgarh, Beri, Matanhail, and Sahalawas) of the Jhajjar District adjacent to the National Capital Territory of India, New Delhi. The purpose of this study was to assess the association between water fluoride levels and prevalence of dental fluorosis among school children of the Jhajjar District of Haryana, India. The fluoride content in underground drinking water sources was found to vary in villages. Hence, the villages were categorized as high-fluoride villages (1.52-4.0 mg F/l) and low/normal-fluoride villages (0.30-1.0 mg F/l). The source of dental fluorosis data was school-going children (7-15 years) showing different stages and types of fluorosis who were permanent resident of these villages. The fraction of dental fluorosis-affected children varied from 30% to 94.85% in the high-fluoride villages and from 8.80% to 28.20% in the low/normal-fluoride villages. The results of the present study revealed that there existed a significant positive correlation between fluoride concentration in drinking water and dental fluorosis in high-fluoride villages (r = 0.508; p < 0.001) and insignificant correlation in low-fluoride villages.

Oral Health-Related Quality of Life of Children by Dental Caries and Fluorosis Experience

OBJECTIVE

To evaluate the oral health-related quality of life (OHRQoL) of children by dental caries and fluorosis status.

METHODS

A random sample of South Australian 8- to 13-year-old children was selected. Caries data were collected from school dental service records to group children by combined deciduous and permanent tooth caries experience. Children were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index to form groups by fluorosis scores on maxillary central incisors. Occlusal traits were recorded using the Dental Aesthetic Index. Children and their parents completed the Child Perception Questionnaire (CPQ) and the Parental Perception Questionnaire (PPQ) and a global rating of oral health (OH). OHRQoL indicators, rating OH as Excellent/Very good, and mean overall CPQ/PPQ scores were compared between groups by fluorosis scores and caries experience. Multivariate models were generated for both OH and CPQ/PPQ indicators.

RESULTS

Two hundred forty-two children (43.0 percent) had 0 decayed, missing, and filled primary and permanent tooth surface (dmfs/DMFS), while 170 (23.9 percent) had 5+ dmfs/DMFS. The prevalence of TF scores 1, 2, and 3 were 14.5, 9.5, and 1.9 percent, respectively. The proportion of children/parents rating OH as Excellent/Very good was significantly associated with children's caries experience. That proportion increased when fluorosis severity increased from a TF score of 0 to 2, but decreased with a TF of 3. Having low caries experience and better dental appearance were associated with parents' perception of good OH. Having mild fluorosis and more acceptable appearance were significant factors for children's perception of good OH. Caries and malocclusion were associated with lower OHRQoL, while having a TF score of 2 was associated with better OHRQoL in multivariate models for overall CPQ/PPQ scores.

CONCLUSION

Caries and less acceptable appearance showed a negative impact, while mild fluorosis had a positive impact on child and parental OHRQoL.