Oral Health Knowledge, Perceptions, and Habits of Adolescents from Portugal, Romania, and Sweden: A Comparative Study

The Impact of Mobile Applications on Improving Oral Hygiene Knowledge and Skills of Adolescents: A Scoping Review

Background/Objectives: During adolescence, dental caries, erosions, and gingival diseases can significantly impact quality of life. Currently, mobile applications are widely used in health promotion, especially among teenagers, as they offer a modern approach to oral health education. This scoping review aims to evaluate the effectiveness of mobile health (mHealth) applications in improving adolescents' behavior and knowledge regarding oral hygiene. Methods: Searches were conducted in the Medline/PubMed, Scopus, Web of Science, Embase, and Google Scholar databases. Both randomized and non-randomized clinical trials published between 2015 and 2024 were analyzed. Selected studies evaluated oral hygiene behavior (knowledge and skills), as well as Plaque Index and gingival health indicators, by comparing a control group receiving traditional education with an intervention group using mobile applications for education. Results: Out of 738 articles found, only 21 met the eligibility criteria. Of the total number of included studies, 14 (66.6%) reported that adolescents in the intervention group utilizing mobile applications demonstrated superior plaque control and reduced gingival bleeding compared to those in the control group. Notably, this outcome was observed even in studies employing a single-group design. In contrast, five studies (23.8%) found no statistically significant differences between groups, while two studies (9.6%) indicated that traditional educational methods were more effective than modern methods. Conclusions: The analyzed studies indicate that mobile health applications can be valuable tools for improving adolescents' oral health. However, some findings also demonstrate that traditional education methods yield similar positive effects.

Effectiveness of a School-Based Oral Health Promotion Program on Dental Caries Among Iraqi School Children: A Cluster Randomised Controlled Trial

AIM

To assess the effectiveness of a school-based oral health promotion program on dental caries of permanent dentition among Iraqi children.

METHODS

A cluster randomised controlled trial was conducted with a parallel study group, comprising 8-10-year-old schoolchildren, 186 in each group. At the beginning of the study, subjects in the intervention group received oral health education and a single dose of 5% sodium fluoride varnish for all teeth surfaces while the control group only received oral health education. The primary outcome data in this study were caries increment and incidence after six months. The secondary outcome data was any change in oral health behaviors in the students of both groups after 3 months. The caries status was recorded according to International Caries Detection and Assessment System (ICDAS). Statistical analyses included the Chi-square test, McNemar test, independent t-test, simple and multiple logistic regression models.

RESULTS

Study participants included 372 children with no significant difference in baseline characteristics between intervention and control groups. An increase was evident in the mean scores of DMFS, DMFT, number of children with DMFT > 0, and DS > 0 for both control and intervention groups at six-month follow-up but this increase was significantly higher for the control than intervention group (P < .001). Among all variables included in the multiple logistic regression model, just being in the intervention group showed a significant effect in which children in the control group had a 4.2-fold (95% CI: 2.36-7.54) greater chance for developing new caries than children in the intervention group. There was a statistically significant increase in the percentage of children with favourable levels of behaviors between baseline and 3-month follow-up (P < .05, P < .001).

CONCLUSION

Providing access to oral health services such as oral examination, fluoride varnish application, and oral health education to reduce dental caries and improve oral health practices seems to be effective among primary schoolchildren.

Dietary and Hygiene-Related Knowledge Versus Reported Behaviors of Eighteen-Year-Olds: A Nationwide Cross-Sectional Study

Background/Objectives: The aim of the present study was to examine eighteen-year-olds' self-assessed knowledge about diet and hygiene, behaviors that they report, and education they receive during dental appointments. Methods: Questionnaires distributed among 1611 subjects included questions concerning sociodemographic factors, dietary and hygiene knowledge and behaviors, and dental visits. Spearman's rank correlation and a bivariate and multivariate logistic regression analysis was conducted; odds ratios (ORs) and adjusted odds ratios (AORs) were calculated (p ≤ 0.05). Results: Respondents self-assessed their oral health knowledge; 63.1% of them considered it to be limited, and 40.7% understood the cariogenic effect of frequent snacking. Dentists and a dental team (DT) were the main source of information (55.7%). Dietary advice was recommended by 10.8% of dentists and the DT, while check-up appointments were advised by 49.2%. Parents' higher education contributed to a lower intake of cariogenic food. This effect was stronger for the mother's education. Dental appointments scheduled twice a year increased the chances of consuming healthy food (A2OR = 1.21 (1.07-2.11); p = 0.0028). Being informed increased the chances of toothbrushing ≥ 2 times (OR: 1.21, CI 1.10-1.46), using fluoridated toothpaste (OR: 1.26 CI1.05-1.55), and the frequency of appointments (A1OR: 1.56 CI 1.21-1.87; A2OR: 1.78 CI 1.54-1.91). Conclusions: Knowledge and oral health related behaviors, as well as the involvement of the dental team in education, are inadequate. Education and instruction in the dental office has a favorable influence on oral-health-related behaviors. It is, therefore, necessary to undertake systemic solutions so that dental practitioners are more involved. Providing oral health knowledge should be the standard of care.

Factors associated with the dental service utilization by enrollees on the Lagos State health insurance scheme, Nigeria

BACKGROUND

Despite assumptions that insurance coverage would boost oral healthcare utilization in Nigeria, there is insufficient evidence supporting this claim. This study investigates the associations between residential location, awareness of the oral health insurance scheme, history of dental service utilization, and acceptance of oral health insurance among individuals benefiting from the Ilera Eko Scheme; a scheme that integrates preventive and curative oral health care into the state health insurance scheme.

METHODS

A cross-sectional survey was conducted from July to November 2023 recruiting from a database of 1520 enrollees aged of 18 and 72-years-old who had been on the scheme for at least three months. An interviewer-administered questionnaire was used to collect the data from participants living in five regions of Lagos State. The dependent variable was dental service utilization. The independent variables were awareness about Ilera Eko health insurance scheme, history of oral health problem, residential location of the respondents (Lagos Island, Badagry, Epe, Ikorodu and Ikeja), and perception about the scheme. The confounding variables were the age at last birthday, sex at birth (male or female), educational level (no education, primary, secondary, and tertiary education), level of income (< 50,000, 50,000-10000, 150,000-200,000, > 200,000), employment status (employed, self-employed and unemployed), marital status (single, married, divorced. widow/widower) and duration on the scheme (< 6 months, 6-12 months, > 12 months). A binary logistic regression analysis was conducted to determine the associations between the dependent and independent variables, controlling for confounders.

RESULTS

The study recruited 485 participants of which 31 (6.4%) had used the oral health care services. Respondents with oral health problems had higher odds of using the scheme (AOR:21.065; p < 0.001). Residents in Ikeja had significantly lower odds of using the scheme when compared with residents in Lagos Island (AOR: 0.174; p = 0.005).

CONCLUSION

Respondents with oral health problems had higher odds of using the oral health insurance scheme. Innovative approaches are needed to drive the utilization of free dental service packages on health insurance schemes in Lagos State, especially for preventive care.

Factors Influencing Adolescents' Knowledge, Practices, and Attitudes Towards Oral Health in the Rupa-Rupa District, Peru

Aim

This study aimed to identify factors associated with adolescents' knowledge, practices, and attitudes (KPA-OH) regarding oral health in the Rupa-Rupa district, a high jungle region of Peru.

Materials and Methods

An analytical study was conducted with a sample of 408 adolescents (aged 13-17 years) from seven public schools in the Rupa-Rupa district (elevation: 649 meters above sea level). The sample was stratified by sex, age, and school. Data were collected using a 49-item questionnaire, which included sections on knowledge (10 items), practices (10 items), and attitudes (13 items) toward oral health, as well as 16 sociodemographic variables. The reliability of the questionnaire was confirmed (KMO ≥ 0.537, Bartlett's test: P < 0.001, ω ≥ 0.7). Multiple linear regression models were used to analyze associations, with significance set at P < 0.05, using Jamovi software.

Results

Correct knowledge regarding oral health was highest for understanding the functions of teeth (speech, chewing), the link between caries and bacteria-sugar interaction, the relationship between gingivitis and gum inflammation, fluoride as a remineralizing agent, and the use of dental floss for cleanliness (73.3%-99.8%). Appropriate oral health practices, such as using an individual toothbrush, replacing it quarterly, and brushing twice a day for 2 minutes (89.8%-99.8%), were associated with being the only child and not having reading difficulties (P ≤ 0.03). Positive attitudes toward brushing and dental visits for caries and gingivitis prevention were more prevalent in females (P < 0.001). Multiple regression analyses revealed that demographic factors explained 21.4% of the variance in oral health knowledge (F = 2.05, P < 0.001), but had no significant predictive value for oral health practices (P = 0.127) or attitudes (P = 0.230). Significant predictors of better knowledge included being female (β = 0.3257, P = 0.026), aged 15-17 years (β = 0.6477-0.8246, P ≤ 0.006), and having part-time employed parents (β = 0.5097, P = 0.007). Negative associations with knowledge were observed in adolescents with reading difficulties (β = -0.6376, P = 0.018) and comorbidities (β = -0.5405, P = 0.031).

Conclusion

Factors such as sex, age, sibling position, general health, reading abilities, and parental employment status were found to influence adolescents' oral health knowledge, practices, and attitudes. Clinically, these findings suggest that targeted oral health education programs should consider these demographic factors, especially for adolescents with reading difficulties and comorbidities, to improve oral health outcomes in underserved populations. The results also highlight the need for interventions that emphasize preventive oral health practices, particularly among younger adolescents and those from lower socioeconomic backgrounds.

Comparison of Fracture Resistance Force (Load-to-fractured Test) and Failure Type of 3D-printed Stainless Steel Crowns and Preformed Stainless Steel Crowns in Primary Molars: An In Vitro Study

Aims and background

This study aims to compare the fracture resistance force (FRF) and failure types of three-dimensional (3D)-printed stainless steel crowns (SSCs) and preformed SSCs in primary molars.

Materials and methods

Forty-eight over-retained and extracted mandibular second deciduous molars were divided into two groups: one receiving 3D-printed crowns and the other preformed crowns. Fracture resistance testing was performed using a universal mechanical testing machine, and failure types were analyzed post-testing.

Results

Fracture resistance testing revealed a significant difference between 3D-printed and preformed SSCs (p < 0.05), with 3D-printed crowns exhibiting a mean FRF of 3953.82 N compared to 742.94 N for preformed crowns. Additionally, Mann-Whitney U tests and Chi-squared tests were utilized to examine variations within and across the groups. Analysis of shear bond strength showed that 3D-printed crowns demonstrated superior adhesive performance compared to preformed crowns, with mean shear bond strength values of 3953.82 N and 742.94 N, respectively. Both groups A and B showed unrepairable failure modes.

Conclusion

The study concludes that 3D-printed SSCs offer distinct advantages over preformed options, including tailored fit, enhanced mechanical properties, and improved longevity. These findings underscore the potential of 3D printing technology to revolutionize pediatric dental restoration practices.

Clinical significance

Integrating 3D printing into pediatric dental practice holds promise for optimizing treatment outcomes and improving long-term oral health in children. The superior fracture resistance and adhesive performance of 3D-printed crowns suggest their potential to enhance restoration viability and reduce the need for subsequent interventions.

How to cite this article

Giridharan DL, Gopal S. Comparison of Fracture Resistance Force (Load-to-fractured Test) and Failure Type of 3D-printed Stainless Steel Crowns and Preformed Stainless Steel Crowns in Primary Molars: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(10):1129-1134.

Oral Mucositis in Adult Cancer Patients Undergoing Chemotherapy: Six-Month On-Treatment Follow-Up

Objectives. Oral mucositis (OM) is a common adverse reaction associated with chemotherapy. We conducted a six-month longitudinal study to estimate the cumulative incidence of OM during the first six months of chemotherapy in adult patients with cancer other than head and neck cancer. Secondary objectives were as follows: (a) to scrutinize the oral health status of these patients and its evolution during chemotherapy, as assessed by oral health indices; (b) to estimate adherence to prescribed oral hygiene protocol during chemotherapy; and (c) to analyze ulceration-free survival in these patients. Methods. Sixty-four patients participated. Dental health and oral hygiene were assessed at baseline and at the end. Every month, blood tests were performed and oral lesions were recorded. This study was observational, with the only intervention being instruction in the hygiene protocol. The cumulative incidence of OM was estimated with the patient as the unit of analysis. A repeated measures ANOVA was applied to analyze the monthly blood test results. Ulceration-free survival analysis was conducted with adherence to the oral hygiene protocol as a grouping factor, followed by Cox proportional-hazards regression. Results. The six-month cumulative incidence rate was 43.75%, 95%CI (31.58-56.67%) for OM grade 2 or higher. The hazard ratio of ulceration associated with adherence to the hygiene protocol was 0.154, 95%CI (0.049-0.483), adjusted for age, sex, baseline hygiene index, and class of treatment. Conclusions. Compliance with hygiene recommendations would decrease the OM risk by more than six times, compared to non-compliance.

Oral Hygiene Profile of Schoolchildren from Bucharest, Romania-How It Can Be Used and Improved for Better Prevention of Oral Diseases

BACKGROUND

Oral hygiene is essential for low caries or gingivitis prevalence in children. This study aimed to determine the oral hygiene profile of children from secondary schools (10-17 years) in Bucharest, Romania, and to explore options for preventing their future oral diseases.

METHODS

The study was cross-sectional, with a sample of n = 1595 pupils. The sample was stratified by clusters in city areas, grades, and the criterion of the presence/absence of in-school dental service. Dental check-ups were performed by using a commune dental examination kit. The oral hygiene simplified index (OHI; Silness and Löe) was used to assess the children's oral hygiene status. Five questions were used to determine oral hygiene habits.

RESULTS

The mean value of the OHI was 1.04. Some differences in oral hygiene scores were found for different socioeconomic variables, such as parents' education (p < 0.05): parents with vs. without a university degree-0.95/0.94 (male/female) vs. 1.06. Most of the children used manual toothbrushes (88%).

CONCLUSIONS

The analysis of objective data (OHI) revealed a good level of oral hygiene, with many socioeconomic disparities.

Status of Healthy Choices, Attitudes and Health Education of Children and Young People in Romania-A Literature Review

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic's overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania.

Oral Health Knowledge, Self-Assessed Oral Health Behavior, and Oral Hygiene Practices among the Adult General Population in Croatia

OBJECTIVES

Emphasizing the significance of optimal oral health for enhancing overall well-being, this study aimed to investigate oral health knowledge, self-assessed oral health behaviors, and oral hygiene practices within the Croatian general population.

MATERIALS AND METHODS

A cross-sectional observational study was conducted online, utilizing a questionnaire collecting sociodemographic characteristics and inquiring about respondents' oral health knowledge, self-assessed oral health status, oral hygiene habits, and use of oral hygiene products. Collected data underwent both descriptive and regression analyses to unveil patterns and relationships within the dataset.

RESULTS

The respondents showed a high level of knowledge about oral health (median score 9, IQR 7.00-10.00, maximum possible score 10), with significant factors for higher knowledge being engaged in dental professions; above-average socioeconomic status; and the use of an electric brush, dental floss, and interdental brushes (p ˂ 0.05). Insufficient knowledge, on the other hand, was associated with bleeding gums and daily smoking (p ˂ 0.05). Although 69.4% of respondents considered their oral health to be very good, 32.5% reported tooth decay, and 38.2% reported tooth sensitivity. The majority (62.0%) cited regular check-ups as the reason for their last visit to the dentist, with 74.1% feeling no anxiety or discomfort during these visits. Daily toothbrush use was widespread (97.8%), but only 34.1% and 19.1% of respondents reported using floss and/or interdental brushes daily. A remarkable 69.0% of respondents indicated that low oral health literacy and low prioritization contribute to suboptimal oral health.

CONCLUSIONS

While respondents demonstrated commendable oral health knowledge, the prevalence of reported issues suggests a potential gap between perception and actual oral health status. To address this, targeted educational interventions focusing on comprehensive oral hygiene practices and debunking misconceptions should be prioritized in Croatia.

Effect of Toothbrush Bristle Stiffness and Brushing Force on Cleaning Efficacy

PURPOSE

This study investigated the effect of toothbrush bristle stiffness and brushing force on the cleaning efficacy in vitro.

MATERIALS AND METHODS

Eighty bovine dentin samples were allocated to eight groups (n=10). Two custom-made toothbrushes of different bristle stiffness (soft and medium) were tested at four different brushing forces (1, 2, 3 and 4 N). Dentin samples were stained in black tea and brushed (60 strokes/min) for a total of 25 min in a brushing machine with an abrasive solution (RDA 67). Photographs were taken after 2 and 25 min of brushing time. Cleaning efficacy was measured planimetrically.

RESULTS

After 2 min of brushing, the soft-bristle toothbrush did not cause statistically significantly different cleaning efficacy at different brushing forces, while the medium-bristle toothbrush cleaned statistically significantly less efficaceously only at 1 N. Comparing the two different toothbrushes, higher cleaning efficacy was observed only at 1 N for the soft-bristle brush. At 25 min brushing time, the soft-bristle cleaned statistically significantly better at 4 N compared to 1 N and 2 N and at 3 N compared to 1 N. Using the medium-bristle, cleaning efficacy increased with increasing brushing force. After 25 min of brushing, no statistically significant difference was observed between the two different toothbrushes.

CONCLUSION

Irrespective the brushing force, the use of a soft or medium toothbrush results in comparable cleaning efficacy. At 2 min brushing time, increasing the brushing force does not increase the cleaning efficacy.

The Impact of the COVID-19 Pandemic on the Dental Emergency Service from Oradea, Romania: A Retrospective Study

The COVID-19 pandemic affected the daily lives of the global population, not only in terms of social interaction but also in terms of access to medical and dental care. Non-urgent dental treatments could not be continued during the lockdown and only a small number of dental centres addressed patients with dental emergencies. The aim of this study was to evaluate the socio-demographic characteristics (age, gender, and living environment) of the individuals that accessed the dental emergency centre in Oradea (North-West Romania) and the main causes for accessing the dental emergency service among the population of Oradea (North-West Romania), during the COVID-19 lockdown, between March and May 2020 and, furthermore, to compare the results obtained in the lockdown timeframe (March–May 2020), with the results obtained in the corresponding timeframe in the pre-lockdown year (March–May 2019) and post-lockdown year (March–May 2021). The retrospective study was carried out by analysing the medical records of the patients who were treated in the dental emergency service of the Oradea County Emergency Clinical Hospital in the following periods: March–May 2019, March–May 2020, and March–May 2021. Most patients were treated in 2020, during the lockdown (n = 784), predominantly in April (n = 308). Most patients treated in April 2020 were male patients (43.7%, n = 205) and were aged between 30 and 39 years (19.4%, n = 74). The most frequent types of dental emergencies were acute apical periodontitis and acute pulpitis in all the months and years investigated. During the lockdown months of 2020, acute pulpitis was the most frequent type of emergency in March (42.2%, n = 100) and May (45.6%, n = 109), while in April, acute apical periodontitis was the most frequent type of emergency (43.5%, n = 166). The COVID-19 lockdown led to an increase in the number of patients that required emergency treatments and impacted all groups of people investigated.

The Effect of Changing the Toothbrush on the Marginal Gingiva Microcirculation in the Adolescent Population—A Laser Doppler Flowmetry Assessment

It is well-known that proper tooth brushing has the effect of stimulating microcirculation in a healthy gingiva. The aim of this study was to evaluate the microcirculation dynamics at the level of healthy marginal gingiva in adolescents after changing their toothbrush. Three evaluation instruments were employed to assess and quantify the effects on the marginal gingiva: the periodontal probing depth (PD), gingival index (GI) and laser Doppler flowmetry (LDF). A total of 12 adolescents, aged between 15 and 20, were enrolled in the study, resulting in a total of 72 frontal upper teeth for PD and GI and 48 gingival interdental sites for LDF assessment. For each measurement, the pulp blood flow signal was recorded for 1 min and represented as a pulsatory signal. Data were collected in four moments: before the toothbrush changed and 24 h, 7 days and 14 days after. For the statistical analysis, the nonparametric Friedman test was applied for comparisons between more than two pair numeric series and for comparisons between two sets of pair values without Gaussian distribution, the Wilcoxon signed-rank test was applied. The paired t test was used for two sets of normally distributed paired values. The results showed that using a new toothbrush in the adolescent population with healthy gingiva can induce statistically significant increases in gingival blood flow, which remain at a high level even at two weeks. The GI also increases significantly at 7 days and 14 days, while the periodontal PD does not change significantly.

Oral Hygiene in Adolescence: A Questionnaire-Based Study

Oral health is fundamental to our well-being, especially in adolescence. The aim of this study is to investigate oral hygiene knowledge through a questionnaire in a sample of adolescents, paying particular attention to those wearing orthodontic braces. The study was designed as a descriptive report of a local survey. An anonymous questionnaire was distributed to individuals born between 2000 and 2005, both on paper and online. Among 213 adolescents answering the questionnaire, 206 went to the dentist at least once (most of them between 5 and 9 years old), and 144 experienced at least one session of professional oral hygiene. Approximately 83% of the sample brushed their teeth at least twice a day, while only 7% used dental floss daily. Only 54% of respondents wearing orthodontic braces were advised to undergo professional oral hygiene during their orthodontic treatment. Education on oral hygiene at home came only from their parents for 61% of the whole sample. Most respondents had their first visit to the dentist apparently too late. Flossing was rare, whether the adolescents wore orthodontic braces or not. In many cases, professional oral hygiene was not common during orthodontic treatment. Adolescents did not learn about oral hygiene from a dental specialist.

Title Cross-Sectional Study to Evaluate Knowledge and Attitudes on Oral Hygiene of Romanian Students

Background and Objectives: the purpose of this study was to evaluate students’ level of knowledge and attitude towards oral hygiene. Materials and Methods: the evaluation was carried out by a questionnaire, with 30 Q (questions) as follows: demographic data (Q1–Q5), oral hygiene knowledge data (Q6–Q23) and oral hygiene attitude data (Q24–Q30). The study included students from Romanian schools and the selection of the study group was made following selection criteria in accordance with ethical issues. A descriptive statistical analysis was performed and a value of p ≤ 0.05 was considered statistically significant. Results: the study included a number of 718 subjects with a mean age of 14.54 (±2.22), male 250 (34.8%) and female 468 (65.2%), MS (middle school students) 354 (49.4%) and HH (high school students) 364 (50.6%). Most of the subjects 292 (MS = 160; HS = 132) know a toothbrushing technique, p = 0.009, r = 0.091 and 587 (MS = 278; HS = 309) know that brushing removes the bacterial plaque p = 0.027, r = −0.082 but only 147 (MS = 71; HS = 76) know that (by) brushing can re-mineralize hard dental structures. The duration of the toothbrushing is variable, for 2- or 3-min p = 0.058, r = 0.043. Criteria for choosing the toothbrush were based mainly on the indications of the dentist, respectively, for toothpaste on its properties. The frequency of toothbrushing is mainly twice a day 428 (MS = 234; HS = 248), p = 0.079, r = 0.037, 73 (MS = 33; HS = 40) after every meal. p = 0.099, r = 0.095. Mouthwash is used by 421 (MS = 199; HS = 222) p = 0.111, r = −0.048, and 228 (MS = 199; HS = 222) after each brushing. Dental floss is used by 240 (MS = 106; HS = 134), p = 0.031, r = −0.073 and only 74 (MS = 41; HS = 33) after each brushing. Conclusions: there are differences in the level of knowledge and attitudes regarding the determinants of oral hygiene depending on the level of education.

Oral Hygiene Practices and Knowledge among Adolescents Aged between 15 and 17 Years Old during Fixed Orthodontic Treatment: Multicentre Study Conducted in France

The aims of this study were to assess oral health knowledge, attitudes, and practices among orthodontic patients between the ages of 15 and 17 years old compared to adolescents without orthodontic treatment. This cross-sectional study included 392 adolescents drawn from various French teaching hospitals. A closed-ended questionnaire was used to collect data. Adolescents undergoing orthodontic treatment had a higher knowledge of oral health than adolescents without orthodontic treatment. The majority of adolescents for both groups (69%) claimed to brush their teeth twice a day. Regarding complimentary dental material, 81.9% of adolescents without orthodontic treatment never used an interdental brush and 78.8% never used dental floss. For those undergoing orthodontic treatment, 48.5% never used an interdental brush. Only 4% of adolescents without and 3% of adolescents with orthodontic treatment never consumed fizzy drinks, 4.9% and 3% never consumed sweets, and 4% and 8.4% never ate fast-food. Adolescents without treatment consumed more sodas (p = 0.048) and more fast food (p = 0.029). Adolescents had insufficient knowledge of oral health. Health education programmes should be implemented to improve adolescents’ knowledge and individual oral prophylaxis with interdental brushes.

Oral self-care behavior and its influencing factors in a sample of school children from Central Iran

BACKGROUND

Oral health is an important part of public health and crucial to health promotion and enhancing the quality of life. This research examined childhood oral self-care behavior and their related factors using extended Theory of Planned Behavior (TPB).

METHOD

This cross-sectional study was conducted on 368 sixth-grade elementary school students in Saveh city, Iran, in 2019. The students were selected using a random multi-stage sampling method. The instrument included the socio-demographic questions, TPB constructs, and action and coping plan items. Data were analyzed by SPSS software (Version 21) at alpha level p ≤ 0.05.

RESULT

Overall, 24 (6.6%) students have never used toothbrushes, 222 (62.7%) have never used dental floss, and 298 (82.7%) students have never used mouthwash. The stepwise multiple linear regression analysis results indicated that the TPB with action and coping planning constructs had better predictive power than the original model. In the final model, coping planning (β = .28), intention (β = .24), action planning (β = .23), and perceived behavior control (β = .15) were the most important predictors of oral self-care behavior.

CONCLUSION

The results indicated that the oral self-care behavior status in Iranian elementary students was not favorable, and the extended model of the TPB with action and coping plan constructs were significant predictors of self-care behavior. Therefore, these findings emphasize the need for expanding educational interventions based on the extended model of the TPB to improve the oral self-care behavior of students.

Saliva pH and Flow Rate in Patients with Periodontal Disease and Associated Cardiovascular Disease

BACKGROUND Periodontal disease, a frequent oral health problem, is connected with cardiovascular morbidity and mortality. This study aimed to assess the unstimulated saliva flow rate and saliva pH as markers of the severity of periodontal disease in patients with cardiovascular disease. MATERIAL AND METHODS A cohort of 155 patients (78 men and 77 women, aged 30-92 years) was included, and a structured questionnaire obtained information about their health status, oral healthcare behaviors, and eating habits. An oral examination was performed to assess periodontal status and presence of dental calculus. The unstimulated whole salivary flow rate and salivary pH were measured. An oral hygienization was performed, and 3 months later, salivary flow rate and pH were reevaluated. RESULTS A severe form of periodontal disease was found in 22.4% of patients. Disease severity was strongly correlated with low pH values (6.25 in stage IV periodontal disease), lower salivary flow rate (0.28 mL/min), smoking, poor oral hygiene habits and obesity, with no significant differences by sex. We observed a significant increase of pH (up to 6.30±0.17) in patients with severe periodontal disease (P=0.001) and salivary flow rate values (0.29±0.07 mL/min; P=0.014) 3 months after oral hygienization. There was a strong association between the severity of periodontal disease and presence of cardiovascular disease (P=0.001). CONCLUSIONS Our study suggests that the decrease of salivary flow rate and pH level might be associated with the severity of periodontal disease.

Perception and Knowledge of Patients from Different Regions in the Kingdom of Saudi Arabia towards Oral Hygiene and Oral Hygiene Aids

Aim: The present study aims to evaluate the perception and awareness of interdental aids in different regions of Saudi Arabia. Methods: A cross-sectional questionnaire-based study was conducted, in order to evaluate the perception and knowledge of patients towards oral hygiene products among the population of the Kingdom of Saudi Arabia. In total, 812 out of 1124 participants responded and completed the survey (response rate 72.2%). The data were collected using a self-administered structured questionnaire in English and Arabic. All statistical analyses were carried out using the SPSS 20 software. p < 0.05 was used to indicate statistical significance. Results: A total of 812 participants responded, of which 486 participants (60%) declared using a toothpaste and toothbrush for cleaning their teeth. The cohort consisted of 274 (34%) females who brushed twice daily, while 96 (33%) males brushed their teeth once a day and 18% of the participants did not even brush once a day. The results indicated that 332 (64%) female participants and 174 (60%) male participants had perception and knowledge of the use of dental floss or any other device to clean between their teeth, while 174 (48.50%) male participants and 174 (49.10%) female participants cleaned their tongue with the same brush, rather than using a tongue scrubber or any other aids. Conclusion: The total awareness of interdental aids in Saudi Arabia is unsatisfactory, as demonstrated by the participants not being conscious or informed about the maintenance of their oral health. A majority of participants did not report adopting basic techniques, such as tongue brushing. This study reveals that no interdental aids were used by 16% of the participants. Thus, it is crucial to develop an effective educational program which emphasizes oral healthcare in this population.

Correlation of Caries Prevalence, Oral Health Behavior and Sweets Nutritional Habits among 10 to 19-Year-Old Cluj-Napoca Romanian Adolescents

Background and objectives: The primary oral disease during adolescence is dental caries. Less is known about the caries prevalence, oral health behavior, and sweets nutritional habits in Romanian adolescents. The objective of this study was to assess the actual caries prevalence among Romanian adolescents in a representative area of Romania, Cluj, and to correlate with oral hygiene behaviors and dietary sugary foods intake. Materials and methods: We have done a cross-sectional study of 650 adolescents aged 10 to 19-years-old (average age 15.3 ± 2.8). We performed the oral dental examination according to the WHO methodology, calculated the number of decayed, missing (due to caries), and filled teeth (DMFT index), assessed the oral hygiene and dietary behaviors using a two-section valid questionnaire and statistically analyzed the interrelation between DMFT, oral hygiene and eating behaviors by multivariate statistical analysis. Results: (a) The caries prevalence in the adolescent population enrolled in the study was 95.5%; (b) the mean DMFT was 3.13 ± 2.0, without significant differences between the urban and rural adolescents (p = 0.253); lower in females than males (p < 0.050), (c) more than one third (33.7%, n = 219) of teenagers are seldom or never brush their teeth in the evening; (c) 40.6% of adolescents are missing the regular annual dental check-ups leading to an increased DMFT as shown in the multivariate analysis (p = 0.038); and (d) there is an increased prevalence of caries with age (p = 0.020), and with sugary sweetened beverages consumption (p = 0.028). Conclusions: Our study evidenced a persistent high caries prevalence in Romanian teenagers. Their dietary habits and irregular dental check-up were associated with the occurrence of dental conditions.

Dentin Abrasivity and Cleaning Efficacy of Novel/Alternative Toothpastes

PURPOSE

To investigate dentin abrasivity and cleaning efficacy of novel/alternative toothpastes containing diamond particles, active carbon, sea salt or organic oils.

MATERIALS AND METHODS

Seventy-two bovine dentin samples (for measuring abrasivity) and 60 human dentin samples (for assessing cleaning efficacy) were used in this study. Samples were divided into six groups as follows: group 1: Elmex Kariesschutz (hydrated silica); group 2: Lavera Neutral Zahngel (sea salt); group 3: Curaprox Black is White (active carbon); group 4: Swiss Smile Diamond Glow (diamond powder); group 5: Ringana Fresh Tooth Oil (hydrated silica); and group 6: artificial saliva. Samples were brushed for a total of 26 min at 120 strokes/min, replacing slurries (1 part respective toothpaste and 2 parts artificial saliva) every 2 min. Finally, abrasive dentin wear was measured profilometrically and cleaning efficacy planimetrically.

RESULTS

The highest abrasivity values were observed for Lavera Neutral Zahngel (sea salt 9.2 µm) and Elmex Kariesschutz group (hydrated silica 6.0 µm). The lowest abrasivity value was observed for Ringana Fresh Tooth Oil group (hydrated silica 1.3 µm). The highest cleaning efficacy was observed for Elmex Kariesschutz group (86.7%) and the lowest cleaning efficacy was observed for Ringana Fresh Tooth Oil group (31.3%).

CONCLUSION

The addition of diamond powder or active carbon to toothpastes could offer high cleaning efficacy with low dentin abrasivity. The addition of sea salt to traditional abrasives might cause high abrasive dentin wear without adding further cleaning benefit.

Knowledge and Practice of Preventive Measures for Oral Health Care among Male Intermediate Schoolchildren in Abha, Saudi Arabia

The aims of this study were to evaluate oral health knowledge and assess the practice of preventive measures for oral health care among intermediate schoolchildren in Abha, Saudi Arabia. Information about oral health was collected through a questionnaire containing closed-ended questions, which was distributed to children of six randomly selected intermediate schools. Most (82.3%) of the schoolchildren were aware that good oral health is important for general health. The priority for oral health information was given to dentists (31.6%), whereas teachers were given the least priority (19.1%). About half (53.5%) of the schoolchildren reported that sweets are the cause of dental caries, and 47.1% of them related pain with dental caries. More than half (58.8%) took sweets between meals. Most of them (69.6%) visited a dentist because of pain. Two-thirds (66.9%) of the children did not brush their teeth daily, and most (78%) did not use dental floss. A large number (62.7%) of the schoolchildren stated that rinsing with water after each meal is the best way to keep their gums healthy. For boys in intermediate schools, properly designed oral health educational programs should be implemented to improve their knowledge and behavior toward oral health.