Why and when older people lose their teeth: A study of public healthcare patients aged 60 years and over in 2007-2015

OBJECTIVES

This register-based study on public sector patients aged 60 years and over assessed annual age-specific volume of and reasons for tooth extractions as well as changes in these across the period 2007-2015.

BACKGROUND

Alongside the rapidly ageing population, the demand for public oral healthcare services is growing. Damaged teeth may induce a long-lasting inflammation burden in old age.

MATERIALS AND METHODS

Data used the electronic documentation of oral healthcare procedures recorded according to healthcare regulation. The study population consisted of all patients over 60 years of age (n = 216 059) who were treated 2007-2015 in public oral health care available to all citizens of Helsinki, Finland. Data for the 9-year time series included reasons for tooth extractions and were aggregated by patient age into 5-year groups. Statistical analyses included rates and proportions, mean values, correlation coefficients and linear regression modelling.

RESULTS

Extraction patients (n = 48 623) were more likely in the older age groups: 21.8% in the age group 60-64 and 27.5% in the age group 90+. Mean number of tooth extractions among all patients was 0.4 per patient and 1.7 per extraction patient. Among all tooth extractions (n = 82 677), main reasons were caries 29.5%, apical periodontitis 19.4%, tooth remnant 19.4% and periodontitis 18.0%. Tooth remnant predominated as extraction reason in the oldest age groups, while apical periodontitis displayed an upward trend by calendar year.

CONCLUSION

Tooth extractions attributable to caries were common in all old-age groups, tooth remnant extractions were most common in older age groups, and apical periodontitis abounded as extraction reason during 2007-2015.

Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation

OBJECTIVE

Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults.

METHODS

Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention.

RESULTS

Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001).

CONCLUSIONS

The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.

Frequency and type of tooth extractions in adults vary by age: register-based nationwide observations in 2012-2017

OBJECTIVE

This register-based study assessed the frequency of and age-specified variation in tooth extractions in adults visiting private dentists in Finland in 2012-2017.

MATERIAL AND METHODS

Retrospective study design was used on the register-based data of private sector services. Data of the entire 6 years, 2012-2017, included records of a total of 6,252,039 patients. From among these, further detailed information was gathered in 2012 for 1,058,305 patients, and in 2017, for 985,043 patients. For each 6 years, the data were aggregated into patients' 5-year age groups that were observation elements. Proportions of patients undergoing oral surgical treatments were compared during the 6 years 2012-2017, and details of tooth extractions in 2012 and 2017. Linear regression modelling was used to analyse thinkable age- and year-related inclinations in oral surgical treatments.

RESULTS

Across the 6 years, a total of 848,362 patients (13.6%) underwent oral surgical treatments, and the rates varied by year 13.3-13.8%. By age group, the smallest rates (9-10%) were for 35-49-year-olds and greatest (20-22%) for those aged below 25 or over 84. The rates in same-age groups were stable. In 2012 and 2017, mean numbers of tooth extractions per patient by year were 0.17 and 0.18, and per patients undergoing oral surgical treatments, 1.29 and 1.27, respectively. Proportion of patients undergoing oral surgical treatments and mean number of tooth extractions per patient was greater in younger and older age groups.

CONCLUSIONS

Tooth extractions in adults are age-dependent and age-specified differences remain stable across the years.

Retained dental roots of adults: A nationwide population study with panoramic radiographs

The aim of this study was to assess the occurrence and nature of retained dental roots and their associations with demographics in the Finnish adult population. From the cross‐sectional nationwide Health 2000 Survey of the Finnish population aged 30 years and older, 6005 participants with clinical oral examination and panoramic radiographs were included. Occurrence and characteristics of all retained dental roots were examined. Statistical analyses included χ², Kruskal–Wallis and Mann–Whitney U tests, and SAS‐SUDAAN calculations. The mean age of the 6005 participants (46% men and 54% women) was 53 (SD 14.6) years. At least one retained dental root was observed in 13% (n = 754) of the participants. The 1350 retained roots included 461 (34%) roots retained entirely in bone and 889 (66%) partly in bone. The most common location of a retained dental root was the third molar region. Occurrence of retained roots partly in bone was associated with male sex and lower education. Occurrence of retained third molar roots entirely in bone was associated with female sex, younger age, higher education, and living in a city. Among all retained dental roots, the preponderance of third molars emphasized the demanding nature of extracting the third molar in women.

Compliance with Key Practices of Root Canal Treatment Varies by the Reward System Applied in Public Dental Services

INTRODUCTION

To assess clinical practices in root canal treatments (RCTs) performed by general dental practitioners under 2 different reward schemes applied in public dental services.

METHODS

This study used a retrospective design with tooth as the observation unit. The data included all teeth (n = 547) with nonsurgical primary RCT completed in 2016. Electronic documents included treatment details and radiographs. RCT assessment covered 4 key items: taking pre- and postoperative radiographs, using a rubber dam, measuring working length. Assessed dichotomies indicated whether practices were adequate. Dentists' reward schemes were "salaried" and "fee-for-service." Chi squared tests analyzed frequency differences.

RESULTS

RCTs formed 2 groups by the reward scheme: 305 RCTs were performed by salaried dentists and 242 by fee-for-service dentists. Preoperative radiographs were diagnosable for 76.1% and postoperative radiographs, for 95.1% of all RCTs. Rubber dam use was documented for 28.9% of the RCTs, more frequently when performed by salaried than by fee-for-service dentists (43.9% vs 9.9%, P < .001). Working length measurement was documented for 72.9% of the RCTs, more frequently for RCTs performed by salaried than by fee-for-service dentists (85.2% vs 57.4%, P < .001). All 4 key items were assessed as adequate in 19.0% of all RCTs, more frequently when performed by salaried than by fee-for-service dentists (29.5% vs 5.8%, P < .001).

CONCLUSIONS

Deficiencies in RCTs, particularly underuse of rubber dams call for further research to understand the reasons for noncompliance with good clinical practice guidelines.

Varying Manpower Alters Dental Health in a Developing Health Care System

OBJECTIVES

This study assessed relationships between oral health care workforce and dental health in 12-year-olds in a developing health care system in Iran from 1992 to 2014 and compared these findings with the most recent corresponding findings in selected countries.

METHODS

Data regarding oral health care workers from 1962 to 2014 were extracted from the comprehensive human resource data bank of the Shahid Beheshti Research Institute of Dental Sciences. Data regarding decayed, missing, and filled permanent teeth (DMFT) of 12-year-olds, extracted from official statistics, described dental health. Comparisons with other countries utilised the database of the World Health Organization. Changes in the DMFT index with fluctuations in the number of oral health care workers were investigated using exploratory data analysis methods. Associations of DMFT with the density of the oral health care workforce were evaluated using a multiple linear regression model.

RESULTS

The trend in supply of dental workforce in Iran began to expand in the 1970s and, after a reduction in 2003 to 2007, reached a peak by 2014. Means of DMFT indices of 12-year-olds in Iran fluctuated between 1.50 and 2.40 from 1992 to 2014. The relationship between the dentist to population ratio and the DMFT index of 12-year-olds showed a downwards trend (r = -0.994; P < .001) until 1998 and afterwards an upwards trend (r = 0.887; P < .001). Globally, the DMFT index decreased in countries with a preventively-oriented oral health care workforce.

CONCLUSIONS

Increased numbers of dentists have no significant impact on improving dental health in 12-year-olds. To promote dental health, the system providing health services should implement a preventively-oriented approach when planning for the oral health workforce.

Age- and Time-Related Trends in Oral Health Care for Patients Aged 60 Years and Older in 2007-2017 in Public Oral Health Services in Helsinki, Finland

BACKGROUND

Population aging will likely have an impact on oral health care trends. The aim of this study was to describe age- and time-related trends in oral health care in people ages 60 and older in Public Oral Health Services (POHS) in Helsinki, Finland.

MATERIALS AND METHODS

Material for the study comprised the electronic documentation of oral health care procedures performed on patients 60 years and older (N = 282,143) in POHS during 2007-2017. Patients were aggregated into 5-year age groups. The 5 most common treatment categories, restorations, periodontal treatment, extractions, endodontics, and prosthetics, were selected for analysis. Changes by time (calendar year) and differences by age group were shown as percentages and percentage points; corresponding trends were assessed by applying linear regression models to the data.

RESULTS

The attendance rate for these patients increased from 14.5% in 2007 to 23.1% in 2017, with the total number of visits increasing by 76.4% in the 11-year period. The average number of visits per patient decreased from 3.5 visits in 2007 to 3.0 visits in 2017. In 2007, 60.5% of patients received restorative treatment and 41.3% received periodontal care. In 2017, the corresponding figures were 55.5% and 49.8%, respectively. The older the patient, the fewer the visits and restorative, periodontal, and endodontic treatments and the greater the rate of tooth extractions and prosthetics.

CONCLUSION

A declining age group-related trend was recognized for restorative, periodontal, and endodontic treatments. Owing to ongoing population growth, POHS will be facing huge challenges in providing treatment for all individuals seeking services.

Radiographic outcome of root canal treatment in general dental practice: tooth type and quality of root filling as prognostic factors

OBJECTIVE

This study evaluated the radiographic outcome of root canal treatments (RCTs) performed by general dental practitioners (GDPs) with focus on tooth type and quality of root filling.

MATERIALS AND METHODS

The target population included all patients receiving root filling by GDPs in City of Helsinki in 2010-2011. Equal numbers of each tooth type (anteriors, premolars, molars) by jaw were included, resulting in 426 teeth. Pre- and post-operative periapical radiographs were assessed to evaluate periapical status and quality of root filling. Statistical evaluation utilized Chi-squared tests, Cohen's kappa and logistic regression modelling.

RESULTS

The overall success rate of RCT was 67.4%, being 76.8%, 69.7% and 55.6% (p < .001) for anteriors, premolars and molars, respectively. The quality of root fillings varied by tooth type (p < .001); optimal fillings were least frequent (43%) in molars. In multifactorial analysis, RCTs were more likely to succeed in non-molars (OR = 1.8), in teeth with optimal root fillings (OR = 3.6) and in teeth without apical periodontitis (OR = 3.2).

CONCLUSION

The quality of root fillings and radiographic outcome of RCTs varied considerably according to tooth type; success was least likely in molars. Improvement is needed in quality of RCTs by GDPs.

Age-related variation in volume and content of restorative private dental care for adults in Finland in 2012-2017: A nationwide register-based observation

OBJECTIVES

This study assessed age-related variation in the volume and content of restorative dental care performed by private dentists for adults in Finland in 2012-2017.

METHODS

This retrospective register-based observational study utilized the Social Insurance database of private dental services in 2012 and 2017, including all patients. The data were aggregated into 5-year age groups for 20-89-year-olds; those aged 90+ formed one group. A patient was one who had received at least one treatment, and a restoration patient one who received at least one restoration (direct/indirect), excluding prosthetic crowns. Attendance rate was the proportion of the population treated. Volume of restorative treatment was the proportion of restoration patients among all patients using private dental services. Content of restorative treatment was described as the number of teeth receiving restoration and the size of restoration (number of surfaces restored). Correlation coefficient demonstrated associations between age groups and numbers of restorations.

RESULTS

Rate of restoration patients was 64.8 % in 2012 and 61.1 % in 2017, the rate for individuals aged under 80 years in each calendar year being smaller than in previous years. Mean number of restorations received per patient was 1.59 in 2012 and 1.42 in 2017, increasing with age (r = 0.85 in 2012; r = 0.95 in 2017). Small restorations dominated; one to two surfaces were covered in 72.3 % and 75.5 % of restorations in 2012 and 2017, respectively.

CONCLUSIONS

Volume and content of restorative dental care for adults vary by age and have decreased slightly over time.

CLINICAL SIGNIFICANCE

Restorative treatments are a prominent part of dental care for adults. This paper sheds light on the entity of restorative dental care for adults visiting private dentists. Variation in restoration volume and content is shown according to patient's age group, and changes are assessed across six years.

Type and time of first re-intervention of posterior restorations - 13-year scenario at the public dental service

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

Age-specific findings on endodontic treatments performed by private dentists in Finland in 2012 and 2017: a nationwide register-based observation

AIM

To evaluate age-specific aspects and changes in volume and content of endodontic treatment for adults visiting private dentists in Finland in 2012 and 2017.

METHODOLOGY

This study utilized register-based data of private dental care. The observation unit of the aggregated macro-level data was age group, with 5-year age groups from 20 to 24 years onwards and the oldest group combining all patients aged 90 years and over. Data from years 2012 and 2017 included all the oral health care of 2.04 million patients receiving reimbursement for treatment by private dentists; a total of 183 932 patients received at least one endodontic treatment and were analysed. The number of teeth receiving endodontic treatment was counted separately as pulp cappings, pulpotomies and root canal fillings according to number of canals filled per tooth. Statistical associations were assessed as correlation coefficients.

RESULTS

The mean age of endodontic patients was 53.6 years in 2012 and 55.9 years in 2017. In both years, 38% were aged from 50 to 64 years. In 2012, 9.9%, and in 2017, 8.0% of patients received at least one endodontic treatment; the older the patients, the fewer received endodontic treatment (r = -0.9). From 2012 to 2017, numbers of all patients and treatments decreased, endodontic patients and treatments even more notably, and in all age groups. Per thousand patients in 2017, 62.1 teeth received root canal treatment and 14.9 pulp capping. Pulp capping comprised 19.2%, pulpotomies 0.8% and root canal fillings 80.0% of teeth receiving endodontic treatment. Of root filled teeth, 45.1% received filling in one canal, 17.0% in two and 37.9% in three or more canals, multi-canal options being less frequent in older patients (r = -0.94).

CONCLUSIONS

Endodontic treatment, received by 9% of adult patients visiting private dentists in Finland, was strongly age-dependent, showing a decreasing trend with age and time.

Prevalence of third molars determined by panoramic radiographs in a population-based survey of adult Finns

OBJECTIVES

The aim of the study was to examine the prevalence of third molars in panoramic radiographs in a population-based study of adults aged ≥30 years.

METHODS

Out of a sample of 8028 inhabitants of Finland, selected with two-staged stratified cluster-sampling method for the Health 2000 Survey, 5989 participated in clinical oral examination and panoramic radiography. Mean age was 52.5 years (SD 14.6; range 30-97 years). The following variables were included in the analysis: participant characteristics, clinical number of all teeth, and radiographic prevalence and characteristics of third molars. Statistics included chi-squared, Fisher's exact, and Kruskal-Wallis tests and SAS-SUDAAN calculations.

RESULTS

A total of 5912 third molars in 47.8% of the study population were recorded from panoramic radiographs. At least one impacted third molar was found in 21.9% of the study population. More than half (57.3%) of the remaining third molars were located in the mandible. A preponderance of participants with all third molars missing were observed in the oldest age group, women, those with lower education and those living in the countryside. Third molars or remnants thereof were observed radiographically in 3.9% of clinically edentulous study population.

CONCLUSIONS

The panoramic radiographs disclosed many remaining third molars in adult Finns aged ≥30 years. One-third of the third molars located impacted which may cause unexpected need for care.

Impact of Insurance Scheme on Adults’ Dental Check-Ups in a Developing Oral Health Care System

Objectives: To find out the relationship between dental insurance and demand for dental care, the present study evaluated impact of insurance scheme on adults’ dental check-ups in a developing oral health care system.

Methods: The target population included adults in the city of Tehran where the only telecommunication company provides 90% of the 1.9 million households with a fixed telephone. Of the 1531 subjects who answered the phone call, 224 were outside the target age (under 18), 67 said that they never had visited a dentist, and 221 refused to respond, leaving 1019 subjects in the final sample. Each interview lasted 15 minutes and was carried out using a structured questionnaire with fixed and open-ended questions.

Results: 71% of the subjects reported having dental insurance and 16% having visited a dentist for a check-up; 55%, more women than men, reported having had a dental visit within the past 12 months.

Conclusions: The present results revealed the positive relationship between insurance and demand for dental care. Those having dental insurance were more likely to go to check-ups despite their generally low rate found in this country with a developing oral health care system. In such countries, health insurance schemes should therefore include obligatory regular dental check-ups to emphasize prevention-oriented dental care. (Eur J Dent 2008;2:3-10)

Knowledge of and Attitudes towards Preventive Dental Care among Iranian Dentists

Objectives: To assess Iranian dentists’ knowledge of and attitudes towards preventive dental care

Methods: A questionnaire survey was conducted at two nationwide annual dental congresses in 2004 and 2005 in Tehran, Iran. Dentists’ level of knowledge was assessed based on their responses on a Likert scale (0-4) to nine statements on preventive dental care. Higher scores indicated more accurate knowledge. Dentists’ attitudes towards preventive dental care were rated based on responses on a Likert scale (1-7) to nine pairs of bipolar adjectives. The respondents were to choose the response which best described their opinion. Higher scores indicated more positive attitudes. Of 1033 responding dentists, 980 (64% men) were deemed eligible for this study. Statistical evaluation was by t-test and the Chi-square test

Results: Highest ratings were obtained for knowledge of the role of sugar consumption (Mean±SD: 3.73±0.60), sealants (3.58±0.68), and water fluoridation (3.35±0.81) in caries prevention; the lowest for their knowledge of the superiority of the use of fluoride toothpaste over technique of brushing (1.11±1.09). Dentists’ attitudes towards preventive dental care appeared most positive regarding its usefulness (Useful — Useless; 6.67±0.94), value (Valuable — Worthless; 6.59±0.98) to the community and for its status as a scientific (Scientific — Unscientific; 6.47±1.06) subject. Overall, female dentists had more favourable attitudes towards preventive dental care than male colleagues

Conclusions: Preventive dentistry should be emphasised in dental education in order to update dentists’ knowledge and attitudes regarding preventive dental care. (Eur J Dent 2007;1:222-229)

Impact of systemic diseases and tooth-based factors on outcome of root canal treatment

AIM

To investigate the impact of systemic health and tooth-based factors on the outcome of root canal treatment (RCT).

METHODOLOGY

The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008-2011. The inclusion criteria were diagnosable pre- and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically 'healthy' and 'healing' cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi-squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT.

RESULTS

The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10-83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow-up period was 6-71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P < 0.001), in teeth with optimal root filling quality (OR = 2.5; P < 0.001), in teeth restored with indirect restorations (OR = 3.7; P = 0.002) and in teeth with none/mild alveolar bone loss (OR = 2.4; P = 0.003).

CONCLUSIONS

DM diminished the success of RCT, especially in teeth with apical periodontitis. However, tooth-based factors had a more profound impact on the outcome of RCT. This should be considered in clinical decision-making and in assessment of RCT prognosis.

Frequent consumption of sugar-sweetened beverages and sweets starts at early age

OBJECTIVES

We aimed to investigate the habitual consumption of sugar-sweetened beverages (SSBs) and sweets in relation to mothers' behaviours and practices with their infants.

METHODS

We targeted mothers with children 1-24 months (N = 200) visiting Public Child Health clinics in Finland. During routine visits mothers (N = 179) volunteered to complete a self-administered anonymous questionnaire about their child's health-related behaviours (consumption of sweets and SSBs, tooth brushing frequency). The questionnaires also included questions about the mothers' background (age, education) and health-related behaviours (consumption of sweets, tooth brushing frequency and smoking habits). The children were categorised by age, and Chi-squared tests, Fischer's exact test, ANOVA and correlation coefficient served for the statistical analyses.

RESULTS

Of those under 6 months, almost half (44%) received SSBs, and 45% of them more than once a week. Their use gradually increased by age such that by 19-24 months, all received SSBs at least sometimes, and 56%, frequently. Fewer than half of the mothers (33-43%) gave sweets to their children between the ages of 10-15 months, but 92% by the age of 2 years. Children's twice-a-day tooth brushing increased from 14% to 33%. The child's age and tooth brushing frequency correlated with the consumption of sugar-sweetened products (r = 0.458).

CONCLUSIONS

Infants frequent consumption of sugar-sweetened products begins early in childhood. Thus, tackling these common risk factors in the first years of life is essential and calls for health-promoting actions in multiple areas that target primarily the parents of infants.

Education-related inequality in restorative dental treatment need over 11 years in two areas of Finland

OBJECTIVES

This study aimed to analyse education-related inequality in restorative dental treatment need among adults aged 30 years and older living in Northern and Southern Finland in 2000 and 2011.

METHODS

Data were taken from the Health 2000 and 2011 population-based follow-up surveys, including information gathered by interviews and clinical dental examination. Final effective sample sizes were 2423 people in 2000 and 1192 people in 2011. Restorative dental treatment need was measured with number of decayed and/or fractured teeth (DT + FrT). Education-related inequality in number of DT + FrT and factors explaining it were analysed using the Poisson regression analysis, relative index of inequality and slope index of inequality.

RESULTS

Average number of DT + FrT decreased from 2000 to 2011. Absolute and relative education-related inequalities in them decreased approximately 50% and 25% from 2000 to 2011, respectively. Tooth brushing frequency and time since last dental visit explained approximately 30%-40% of the education-related inequality. The contribution of time since last dental visit to the education-related inequality was smaller in 2011 than in 2000.

CONCLUSIONS

It seems that, from 2000 to 2011, the need for restorative dental treatment decreased simultaneously with the education-related inequality in it among adults aged 30 years and older living in Northern and Southern Finland.

Role of Employment in 11-Year Changes of Clinical Oral Health: A Multilevel Longitudinal Analysis

The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y ( n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health-related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health-related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health. Knowledge Transfer Statement: The findings of this study can help clinicians and oral health policy makers to reorient oral health services toward those who are unemployed as a risk group for poor oral health. The research highlights the role of employment in the longitudinal changes of clinically determined oral health, taking into consideration other socioeconomic factors. The study concluded that unemployment seemed to have a role in social inequalities of oral health.

Longevity of 2- and 3-surface restorations in posterior teeth of 25- to 30-year-olds attending Public Dental Service-A 13-year observation

OBJECTIVES

The aim of this patient document-based retrospective study among 25- to 30-year-old Finnish adults was to evaluate longevity of 2- and 3-surface posterior restorations according to type of tooth, size of restoration, and restorative material used.

METHODS

Data were extracted from electronic patient files of the Helsinki City Public Dental Service (PDS), Finland. A total of 5542 2- and 3-surface posterior composite and amalgam restorations were followed indirectly from 2002 to 2015. Longevity of restorations was illustrated using Kaplan-Meier curves. Annual failure rates (AFRs) of the restorations were calculated separately by type of tooth, size, and material. Differences in longevity were statistically tested with log-rank tests.

RESULTS

Composite restorations formed the majority (93%). The longest median survival times and the smallest failure rates were found for teeth in the upper jaw, for premolars, and for 2-surface restorations. Median survival time of all restorations was 9.9 years (95% CI 9.6, 10.2) and re-intervention of restorations occurred less often in the maxilla (AFR 4.0%) than in the mandible (AFR 4.7%). Median survival time of composite restorations was greater for 2-surface than for 3-surface restorations: in premolars 12.3 vs. 9.6 years (p<0.001) and in molars, 9.2 vs. 6.3 years (p<0.001); for molar amalgams the difference (8.0 vs. 6.3 years) was non-significant (p=0.38). Median survival time of 2- and 3-surface restorations in premolars exceeded that in molars (12.0 vs. 8.7 years; p<0.001).

CONCLUSIONS

Longevity of posterior composite multisurface restoration is comparable to amalgam longevity.

CLINICAL SIGNIFICANCE

Regarding material choices for posterior multisurface restorations, composite and amalgam perform quite similarly in molars, 3-surface restoration being challenge for both materials.

Use of oral health care services in Finnish adults - results from the cross-sectional Health 2000 and 2011 Surveys

Background

During the 2000s, two major legislative reforms concerning oral health care have been implemented in Finland. One entitled the whole population to subsidized care and the other regulated the timeframes of access to care. Our aim was, in a cross-sectional setting, to assess changes in and determinants of use of oral health care services before the first reform in 2000 and after both reforms in 2011.

Methods

The data were part of the nationally representative Health 2000 and 2011 Surveys of adults aged ≥ 30 years and were gathered by interviews and questionnaires. The outcome was the use of oral health care services during the previous year. Determinants of use among the dentate were grouped according to Andersen’s model: predisposing (sex, age group), enabling (education, recall, dental fear, habitual use of services, household income, barriers of access to care), and need (perceived need, self-rated oral health, denture status). Chi square tests and logistic regression analyses were used for statistical evaluation.

Results

No major changes or only a minor increase in overall use of oral health care services was seen between the study years. An exception were those belonging to oldest age group who clearly increased their use of services. Also, a significant increase in visiting a public sector dentist was observed, particularly in the age groups that became entitled to subsidized care in 2000. In the private sector, use of services decreased in younger age groups. Determinants for visiting a dentist, regardless of the service sector, remained relatively stable. Being a regular dental visitor was the most significant determinant for having visited a dentist during the previous year. Enabling factors, both organizational and individual, were emphasized. They seemed to enable service utilization particularly in the private sector.

Conclusions

Overall changes in the use of oral health care services were relatively small, but in line with the goals set for the reform. Older persons increased use of services in both sectors, implying growing need. Differences between public and private sectors persisted, and recall, costs of care and socioeconomic factors steered choices between the sectors, sustaining inequity in access to care.

Operator-related aspects in endodontic malpractice claims in Finland

OBJECTIVE

We analyzed operator-related differences in endodontic malpractice claims in Finland.

MATERIALS AND METHODS

Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses.

RESULTS

Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists.

CONCLUSIONS

Operator-related factors had no impact on endodontic malpractice claims.

Variation in fluorosis and caries experience among Lithuanian 12 year olds exposed to more than 1 ppm F in tap water

AIM

The aim of the present study was to analyze caries experience in relation to the occurrence of fluorosis in 12 year olds in a natural fluoride area.

METHODS

This cross-sectional study was conducted among 12-year-old lifetime residents (n = 301) of Klaipeda, Lithuania, where the natural fluoride content is 1.7-2.2 ppm F. Data collection included a clinical dental examination and an inquiry about toothbrushing habits. Dental caries was diagnosed according to the World Health Organization criteria and described in terms of decayed, missing, and filled teeth (DMFT)/decayed, missing and filled surfaces (DMFS) indices and decayed, filled surfaces (DFS) on selected proximal surfaces. Dental fluorosis was diagnosed according to the Thylstrup-Fejerskov (TF) index and categorized as none (TF = 0), mild (TF = 1-2), moderate (TF = 3-7), or severe (TF = 8-9). The χ(2)-, Kruskal-Wallis, and Mann-Whitney tests, Pearson's correlation, and linear regression served for statistical analyses.

RESULTS

A total of 34% of the 12 year olds studied had no signs of fluorosis, while the rest had mild (42%) or moderate (24%) fluorosis. Caries experience was negatively related to the presence of fluorosis. When present (TF > 0), the mean DMFT was 1.8 (standard deviation [SD]: 1.7) versus 2.6 (SD: 2.3) in the absence of fluorosis (TF = 0, P = 0.008). The corresponding mean DMFS values were 2.6 (SD: 3.1) versus 3.8 (SD: 4.3, P = 0.014).

CONCLUSION

The presence of fluorosis associates with lesser caries experience in 12-year-old lifetime residents of an area with moderately-elevated natural fluoride.

The Shape of the Dose-Response Relationship between Sugars and Caries in Adults

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults' Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

Oral health behaviors and bacterial transmission from mother to child: an explorative study

Background

Health behaviors play a major role in the prevention of the most common oral diseases. To investigate health behaviors related to the potential transmission of oral bacteria from mother to child using novel multiple correspondence analysis (MCA).

Methods

Mothers (n = 313) with children under three years attending two municipal child health clinics in Finland completed a self-administered questionnaire on health knowledge and behaviors such as sharing a spoon with their child, kissing on the lips, and the mothers’ tooth brushing, smoking, age, and level of education. We used MCA to reveal the relationships between the mothers’ behaviors and background factors, along with unconditional, binary, multivariable logistic regression models, odds ratios (OR) and their 95 % confidence intervals (95 %CI).

Results

Of the mothers, 38 % kissed their child on the lips and 14 % shared a spoon with their child; 11 % believed that oral bacteria cannot be transmitted from mother to child. Two-thirds (68 %) of them reported tooth brushing twice daily, and 80 % were non-smokers. MCA revealed two diverging dimensions of the mothers’ behaviors: a ‘horizontal’ one showing clear evidence of relationships between tooth brushing, smoking, age and education, whereas the ‘vertical’ one revealed the mothers’ habits of kissing the child on the lips and sharing a spoon related to each other. Spoon sharing was related to the kissing on lips (OR 10.3), a higher level of education (OR 3.1), and, inversely, older age (OR 0.1), whereas kissing on lips behavior was inversely related to a higher level of education (OR 0.5).

Conclusion

The study revealed two diverging dimensions of the mothers’ health behaviors. More emphasis in health education ought to be put to how to avoid bacterial transmission from caregiver to child during feeding.

The association of depression and anxiety with dental caries and periodontal disease among Finnish adults

OBJECTIVE

To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations.

METHODS

Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators.

RESULTS

Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated.

CONCLUSION

Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.

Satisfaction with dental care and its role in dental health-related behaviour among lithuanian university employees

PURPOSE

To assess factors related to satisfaction with dental care and its role in dental health-related behaviour among Lithuanian university employees.

MATERIALS AND METHODS

Our cross-sectional survey collected data on respondents' satisfaction with dental care using 24 statements. The self-administered questionnaire also inquired about dental attendance, dental health-related behaviour and attitudes, self-assessed dental status and background details. All 35- to 44-year-old employees (n = 862) of four universities in Lithuania were invited to participate; 64% (n = 553) responded, 78% of them were women. Statements on satisfaction with technical, personal and organisational dimensions of the dental surgery were assessed using a five-point scale, ranging from entirely agree to entirely disagree, with higher scores indicating stronger agreement. Overall satisfaction scores were summed and subjects divided into tertiles to evaluate dental health-related behaviour. For the logistic regression model, subjects were divided into two groups of satisfaction level (below and above the mean of the sum score).

RESULTS

Subjects were highly satisfied with dental care, with the mean sum score being 99.5 (SD = 12.62, range 59-120). Stronger satisfaction was reported by those visiting private practices (p < 0.001) and the same dentist longer (p = 0.006) and by those who entirely agreed with the statements on dental health-related attitudes (p ≤ 0.001). The logistic regression model showed that higher satisfaction with dental care level was more likely for those who indicated check-up-based regular dental attendance (OR = 1.7) and brushing their teeth at least twice daily (OR = 1.6).

CONCLUSIONS

Satisfaction with dental care is positively related to individuals' dental health-related attitudes and behaviour among highly-educated subjects in particular.

Five-year follow-up of children receiving comprehensive dental care under general anesthesia

Background

Dental general anesthesia (DGA) is part of public dental care in Finland, but the intention is to return the patient to routine dental care. The aims of this study were to describe the details of treatments under DGA given to generally healthy children and to explore the outcome of their dental care during a 5-year follow-up, with special focus on preventive care. In particular, we examined the return of the patients to routine dental care, of which, to our knowledge, little is known.

Methods

Our prospective 5-year follow-up of generally healthy children (aged 0–13 years) treated under DGA by the Helsinki Public Dental Service in 2004 was based on official dental and general anesthesia documents. The statistical analyses employed chi-square tests, t-tests, Pearson’s correlation coefficient (r), Fisher’s transformation to test r ≠ 0, and logistic regression modeling.

Results

The most common reason for DGA was uncooperation (82%), followed by dental fear (56%). Filling therapy predominated in the treatments given under anesthesia, and the mean number of treatments per patients was 9.5 (SD = 4.2). Throughout the follow-up, 54% of the patients continued to have co-operation problems and 53% expressed dental fear; 11% of the patients received repeat DGA. The mean follow-up time was 48 (median 52) months. The postoperative review visit was actualized within 1.5 (SD = 0.8) months and the first visit to the home dental clinic of the patients in 12.0 (SD = 11.8) months for the 0–5-year-olds and in 7.2 (SD = 5.9) months for the 6–13-year-olds (p < 0.001). The mean time elapsed to the first need for treatment was 18.5 (SD = 14.1) months. During the follow-up, the mean number of treatments per patient was 5.3 (SD = 4.9); almost all patients (97%) received preventive treatment at one of two visits, but the control of dental fear remained rare.

Conclusions

To return to routine dental care after DGA, most of the generally healthy children in our study still needed special attention due to their uncooperation and dental fear, thus calling for a renewal of practices to treat these patients.

The Role of Behaviour in Inequality in Increments of Dental Caries among Finnish Adults

Background: Evidence from cross-sectional studies implies that dental behaviours partially explain inequalities in oral health. Objective: To assess whether dental behaviours completely eliminate inequality in increments of dental caries in a sample of Finnish adults. Methods: The baseline data were collected from the Health 2000 survey, a nationally representative survey of 8,028 individuals aged 30 years or older living in mainland Finland. Four years later, 1,248 subjects were invited for oral re-examination, and 1,049 agreed to participate (84% response rate). At baseline, participants provided information on demographics, education and dental behaviours (dental attendance, tooth brushing with fluoride toothpaste, sugar consumption and daily smoking). Oral examinations at baseline and follow-up were identical. Results: Adults with basic education had significantly greater increments of DMFT (incidence rate ratio 1.41, 95% CI 1.07-1.85) and DT (incidence rate ratio 2.23, 95% CI 1.27-3.90) than those with high education. Adjusting for single behaviours attenuated but did not eliminate education inequality in DMFT and DT increments, tooth brushing having the greatest impact on inequality. Simultaneous adjustment for all behaviours eliminated the significant relationship between education and caries increment. Conclusions: Accounting for important dental behaviours appears to explain all education inequality in dental caries in Finnish adults. The results should be interpreted with caution when applied to less egalitarian populations.

Do self-assessed oral health and treatment need associate with clinical findings? Results from the Finnish Nationwide Health 2000 Survey

OBJECTIVE

To associate self-assessed oral health and treatment need with clinically determined findings.

MATERIALS AND METHODS

As part of the Finnish nationwide comprehensive Health 2000 Survey, the present cross-sectional study included dentate participants aged 30-64 years who self-assessed their oral health and treatment need in an interview and who underwent a clinical oral health examination (n = 4385). Self-assessed oral health and treatment need were used as subjective indicators. Clinically determined dental and periodontal status described objective dental and periodontal health and treatment need. The evaluation of relationships between subjective and objective findings was based on two-by-two tables and multivariate analyses.

RESULTS

The better the self-assessed oral health, the better the objective dental and periodontal health. Those reporting need for treatment more often had the objective need in terms of dental or periodontal treatment, also when controlling for background factors. Of the subjective indicators, good self-assessed oral health best reflected the absence of clinically determined dental or periodontal treatment need. Those who reported a need for treatment were mainly adults with an objective dental and periodontal treatment need.

CONCLUSIONS

Self-assessed good oral health is a fairly good estimate for the absence of clinically determined dental and periodontal treatment need. As implication for practice, self-assessed data could be used for screening purposes for oral health service planning and for priority allocation in large adult populations.

Improvements in the Behaviour of Mother-Child Pairs Following Low-cost Oral Health Education

PURPOSE

To determine changes in oral health behaviour following low-cost oral health education among mother-child pairs.

MATERIALS AND METHODS

In this controlled trial, interviews were conducted in a random sample of mothers of 12- to 15-month-olds (N = 242) attending the vaccination offices of public health centres in Tehran, Iran, and the vaccination staff provided oral health education for the mothers belonging to two intervention groups (A and B) and a control. Groups A and B received health education, but group A additionally received two reminders during the 6-month follow-up. The control group received no health education. The mothers' oral health behaviour and practices with regard to their children were scored at baseline and at the end. Changes in these scores were recorded separately for the mothers and the children and grouped into the categories prominent, minor or no improvement. Statistical evaluation was performed with the chi-square test, ANOVA and logistic regression.

RESULTS

Prominent improvement in oral health behaviour was evident in 45% of the mothers and 66% of the children in group A, 29% of the mothers and 31% of the children in group B and in 11% of the mothers and 21% of the children in the control group (P < 0.001). A prominent improvement in the mothers' practices with regard to their children was related to the mother's own behavioural improvement (OR = 1.3). The intervention was most successful in group A (OR = 5.1).

CONCLUSION

Improvement in mothers' oral health behaviour can lead to improved health practices with regard to their children. Oral health education combined with external motivation is a valuable tool for promoting oral health behaviour in mother-child pairs.

Oral mucosal health in liver transplant recipients and controls

Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n = 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P < 0.001), and the use of steroids raised the prevalence to 53%. Drug-induced gingival overgrowth was the single most common type of lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P = 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P = 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated.

Reasons for replacement of restorations: dentists' perceptions

OBJECTIVE

This study aimed at evaluating dentists' perceived reasons for replacement of restorations and ascertaining the differences arising from dentists' gender, time since graduation and working sector (salaried vs private).

MATERIALS AND METHODS

A postal questionnaire was sent to a total of 592 working-age general dental practitioners in Finland, 57% (n = 339) responded. The dentists were asked to rank in order of priority the six most common reasons for replacement of composite in the incisors and posterior teeth and amalgam in the posterior tooth from a list of 12 reasons. Ranking order 1 was worth six points and order 6 one point; the non-ranked reasons were equal to zero. Differences in the means of the summed scores of caries-related (RC), fracture- and failure-related (RF) and miscellaneous (RO) groups were evaluated by ANOVA. The level of significance was set at p = 0.05.

RESULTS

For each of three restorations, the RF group comprised 48-56% of the sum-scores. Of the single reasons, secondary caries predominated (20-24%). For composite restorations in the incisors, the mean sum-score of the RO group was greater for private-sector dentists (p = 0.04). For composite restorations in the posterior teeth, the mean sum-score of RF group was higher for male than female dentists (p = 0.009). For amalgam, mean score for RF was 10.2, followed by RC (8.5) and RO (1.1).

CONCLUSION

Secondary caries and various fractures and failures predominate as dentists' perceived reasons for replacement of restorations. Private dentists included miscellaneous reasons as one of their six reasons more often than did the salaried dentists. The complex process of treatment planning and decision-making is influenced by many as of yet unknown factors, calling for emphasis on investigating of perceptions.

Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

BACKGROUND

Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients' overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care.

METHODS

The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (<6, 6-12, 13-17, 18-68), gender, immigration, previous conscious sedation and previous DGA; medical background; reasons for DGA and treatments provided. Chi-square tests, Fisher's exact test, and logistic regression modelling were employed in the statistical analyses.

RESULTS

The DGA patients (n=349) were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p<0.001) and medically compromised patients among the adults (p<0.001) relative to the other age groups. The main reason for DGA was extreme non-cooperation (65%) followed by dental fear (37%) and an excessive need for treatment (26%). In total, 3435 treatments were performed under DGA, 57% of which were restorations, 24% tooth extractions, 5% preventive measures, 5% radiography, 4% endodontics and the remaining 5% periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given.

CONCLUSIONS

Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

A community-randomized controlled trial against sugary snacking among infants and toddlers

OBJECTIVES

We evaluated the impact of educational interventions on sugary snacking in infants and toddlers in Tehran, Iran.

METHODS

A 6-month intervention was integrated into health staff duties. We assigned 12- to 15-month-olds (n = 242) and their mothers attending the vaccination offices of 18 randomly selected public health centers into the following groups: pamphlet and reminder (A), pamphlet only (B), and one control group (C). The mothers were interviewed at baseline and after follow-up. We recorded the frequency of sugary snacking for both the children and their mothers and calculated changes over 6 months. A reduction in the children's snacking frequency indicated a positive outcome. The family's residential area (affluent/nonaffluent) indicated its socioeconomic level. Associations between the children's and their mothers' snacking frequency were assessed by means of Spearman correlation. The outcomes of each intervention group were compared separately to those of the control group by means of the Mann-Whitney test. In addition, we performed intention to treat analysis. Factors related to a positive outcome were explained by means of logistic regression models.

RESULTS

In all groups, the child's and mother's snacking at baseline correlated (r = 0.4). A positive outcome was found for 62% of the children in group A and for 49% and 32% in groups B and C, respectively. In group A, a reduction in the children's snacking frequency was found despite their residential area (P < 0.05). Controlling for intervention effects, the logistic regression model showed that residential area was unrelated to the positive outcome.

CONCLUSIONS

Oral health education with reminders provided to mothers by general health staff is a valuable tool for reducing sugary snacking in infants and toddlers in a country with developing oral health systems.

Radiographic assessments on prevalence and technical quality of endodontically-treated teeth in the Finnish population, aged 30 years and older

OBJECTIVE

To assess the prevalence and technical quality of endodontic treatment (ET) in Finland by panoramic radiography.

MATERIALS AND METHODS

As part of the Finnish nationwide Health 2000 Survey, panoramic radiographs of 5244 dentate subjects, aged 30-95 years, were analyzed. The criterion for a technically adequate ET was a distance from the root filling to the root apex of ≤3 mm.

RESULTS

Sixty-one per cent of subjects had one or more teeth with ET. ET was more prevalent in older subjects and among women. Of all teeth (n = 120 250), 7% had had ET, the percentages being greatest for molars and premolars. Technical quality was adequate in 47% of all ET, in 71% of anterior teeth, in 51% of premolars and in 25% of molars.

CONCLUSIONS

Prevalence and technical quality of endodontic treatment in Finland are comparable to that reported elsewhere, but are still calling for improvement in endodontic treatment, especially regarding molars.

Factors related to gender differences in toothbrushing among Lithuanian middle-aged university employees

BACKGROUND AND OBJECTIVES. Many previous studies showed clear gender differences in the percentages of adults reporting toothbrushing more than once a day. This study evaluated the factors determining gender differences in toothbrushing among Lithuanian middle-aged university employees. MATERIAL AND METHODS. A questionnaire survey was anonymously conducted among 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data covered toothbrushing frequency, habitual dental attendance, dental health attitudes and knowledge, and subject's background information. RESULTS. Of all respondents, 68% reported brushing their teeth more than once a day (73% of women and 49% of men, P<0.001) and 51% indicated checkup-based habitual dental attendance (54% of women and 41% of men, P=0.012). The majority reported good dental status as being important to them and poor oral health as injurious to general health. Of all respondents, 44% indicated that "Lack of time is the main reason for incomplete oral self-care" (61% of men and 40% of women, P<0.001). Logistic regression models showed that the strongest factor affecting toothbrushing frequency was the importance of good dental health to them (OR, 1.6; 95% CI, 1.1-2.4; P=0.02) among women and statement that "Poor oral health can be injurious to general health" (OR, 2.6; 95% CI, 1.2-5.5; P=0.01) and checkup-based habitual dental attendance (OR, 2.4; 95% CI, 1.0-5.9; P=0.06) among men. CONCLUSIONS. Due to different determinants affecting toothbrushing frequency among men and women, different oral health motivation programs by gender should be developed.

Does dental insurance make a difference in type of service received by Iranian dentate adults?

OBJECTIVES

To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system.

METHODS

A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression.

RESULTS

Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3).

CONCLUSIONS

In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported.

Education level and oral health in Finnish adults: evidence from different lifecourse models

AIM

To assess the relationship between education level and several oral health outcomes in Finnish adults, using three conceptual lifecourse models.

MATERIALS AND METHODS

This study analysed data from 7112 subjects, aged 30 years or over, who participated in the nationally representative Finnish Health 2000 Survey. Parental and own education levels were the childhood and adulthood socioeconomic measures, respectively. Oral health was indicated by edentulousness, perceived oral health and levels of dental caries and periodontal disease. Three conceptual lifecourse models, namely critical period, accumulation and social trajectories, were separately tested in regression models.

RESULTS

In line with the critical period model, parental and own education levels were independently associated with oral health after mutual adjustment. There was also a graded linear relationship between the number of periods of socioeconomic disadvantage and oral health, corresponding to the accumulation model. Gradual declines in oral health were evident between social trajectories from persistently high to upwardly mobile, downwardly mobile and persistently low groups.

CONCLUSION

There was similar support for the lifecourse models of critical period, accumulation and social trajectories. They collectively contribute to a better understanding of oral health inequalities.

Patterns of oral cleaning habits and use of fluoride among dentate adults in Finland

PURPOSE

The aim of the present study was to identify the underlying patterns of oral cleaning habits and the use of fluoride, and to investigate their variations by studying the socioeconomic characteristics among Finnish dentate adults aged 30 to 64 years.

MATERIALS AND METHODS

Participants of the nationwide Health 2000 survey who were dentate, aged 30 to 64 years, and underwent a health interview and a clinical oral examination, were included in the present study (n = 4419).

RESULTS

In total, 79% of the women and 46% of the men reported to have brushed their teeth twice or more daily; 16% of the women and 14% of the men reported daily use of an electric toothbrush and 14% of the women and 5% of the men reported daily use of dental floss or an interdental brush. Factor analysis revealed five oral cleaning habit patterns, which were named modern, rational, before-breakfast, social and irrational. The modern cleaning pattern was associated with higher levels of education, and the rational cleaning with younger age, female gender and higher levels of education. The before-breakfast cleaning pattern was associated with male gender and lower levels of education, and the social cleaning with older age, female gender and higher levels of education. The irrational cleaning pattern was associated with older age.

CONCLUSIONS

Adults have various oral cleaning habit patterns, each of which is associated with the subjects' socioeconomic characteristics.

Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care?

OBJECTIVE

To investigate patients' reasons for selecting a dental clinic given their choice of free or highly-subsidized dental services.

METHODS

The study was based on cross-sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly-subsidized dental services (n = 726). The data covered the patients' awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly-subsidized (FHS) or fully out-of-pocket paid (FOP) services. Free format answers about the subjects' reasons for selecting a particular clinic were later sub-grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio-demographic status was based on background. Data analysis included the chi-square test and logistic regression model.

RESULTS

Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects' mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP.

CONCLUSIONS

Despite the opportunity to use highly-subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.

The T-Health index: a composite indicator of dental health

The aim of this study was to determine the most appropriate set of weights with which to calculate the number of sound-equivalent teeth (T-Health index) against perceived oral health, which was used as a proxy of oral health status. This study used data from 5,057 dentate subjects, > or = 30 yr of age, who ere participating in the Finnish Health 2000 Survey. Subjects provided information on socio-demographic characteristics, behaviours and perceived oral health, and had a clinical examination. The T-Health index was calculated by assigning different weights to missing, decayed, filled, and sound teeth. Thirty-six alternative sets of weights were evaluated. The most appropriate set of weights was judged by the strength of the adjusted association between the T-Health index and levels of perceived oral health in ordinal logistic regression models and by the invariance of this association according to the extent of restorative treatment (non-significant statistical interaction). Among the 36 sets of weights used to calculate the T-Health index, assigning twice the weight of a decayed tooth to a filled tooth whilst keeping the weight for a filled tooth < or = 0.20 provided the strongest association with levels of perceived oral health and did not vary according to the extent of restorative treatment.