Periodontal status among 12-year-old schoolchildren: a population-based cross-sectional study in Quito, Ecuador

This study aimed to estimate the prevalence and extent of bleeding on probing and calculus in 12-year-old schoolchildren of Quito, Ecuador, and evaluate the associated factors. We conducted an epidemiological survey with a representative sample of 1,100 12-year-old schoolchildren from public schools in the urban area of Quito, Ecuador. We assessed the periodontal health using the Community Periodontal Index (CPI). The prevalence and extent of the periodontal condition was based on the presence of at least one site with bleeding on probing (BOP), and the presence of dental calculus was also evaluated. We used univariate and multiple multilevel Poisson regression analyses to verify the association between the independent variables and the number of sextants with BOP and calculus. The prevalence of BOP and calculus was 92% and 69.9%, respectively. The adjusted mean of the affected sextants was 4.3 and 2.2 for BOP and calculus, respectively. The mother's schooling and malocclusion were associated with the number of sextants with bleeding. The mother's schooling and dental caries experience were associated with calculus. Gingival bleeding and the presence of dental calculus are highly prevalent in 12-year-old schoolchildren from Quito. Gingival bleeding is associated with maternal education and malocclusion, and dental calculus is associated with maternal education and dental caries.

Oral Health Status of Disabled Children and Adolescents in China

OBJECTIVE

To investigate the dental caries status and periodontal status of disabled children and adolescents aged 0 to 18 years in China and provide suggestions for future policies.

METHODS

The cross-sectional survey included disabled children and adolescents aged 0 to 18 years in welfare institutions across 10 provinces in eastern, central and western regions in China, between November 2013 and May 2015. Oral health examination included dental caries status and periodontal status. The mean score for decayed, missing and filled teeth (dmft/ DMFT) due to caries in primary/permanent dentition, gingival bleeding rate and calculus rate were recorded and statistically evaluated. Data analysis was performed using SPSS 24.0 software (IBM, Armonk, NY, USA), and the level of statistical significance was P < 0.05.

RESULTS

The mean dmft/DMFT values of for groups aged 0 to 5, 6 to 12 and 13 to 18 years were 1.48 ± 3.00, 2.19 ± 2.94 and 1.78 ± 2.93, respectively. The mean scores for the groups aged 0 to 5 (P < 0.05) and 13 to 18 years (P < 0.01) showed a significant difference among different disability types. A significant difference between sexes was found only in the group aged 0 to 5 years (P < 0.05). Gingival bleeding rates were 13.70% for the group aged 0 to 5 years, 24.81% for the group aged 6 to 12 years and 42.06% for the group aged 13 to 18 years, and calculus rates were 5.48%, 22.41% and 47.62% for the three age groups, respectively. The gingival bleeding rate for all three age groups showed a significant difference between different disability types (P < 0.01), whereas calculus rates a showed significant difference only in the groups aged 6 to 12 and 13 to 18 years (P < 0.01).

CONCLUSION

The prevalence of dental caries, gingival bleeding and calculus in disabled children and adolescents in China is high. Disability type was strongly associated with oral health status. Specially designed oral health education and training are necessary for clinical professionals and caregivers.

Recall intervals for oral health in primary care patients

BACKGROUND

There is ongoing debate about the frequency with which patients should attend for a dental check-up and the effects on oral health of the interval between check-ups. Recommendations regarding optimal recall intervals vary between countries and dental healthcare systems, but 6-month dental check-ups have traditionally been advocated by general dental practitioners in many high-income countries. This review updates a version first published in 2005, and updated in 2007 and 2013.

OBJECTIVES

To determine the optimal recall interval of dental check-up for oral health in a primary care setting.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 17 January 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; in the Cochrane Library, 2019, Issue 12), MEDLINE Ovid (1946 to 17 January 2020), and Embase Ovid (1980 to 17 January 2020). We also searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. We placed no restrictions on the language or date of publication when searching.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) assessing the effects of different dental recall intervals in a primary care setting.

DATA COLLECTION AND ANALYSIS

Two review authors screened search results against inclusion criteria, extracted data and assessed risk of bias, independently and in duplicate. We contacted study authors for clarification or further information where necessary and feasible. We expressed the estimate of effect as mean difference (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RR) with 95% CIs for dichotomous outcomes. We assessed the certainty of the evidence using GRADE.

MAIN RESULTS

We included two studies with data from 1736 participants. One study was conducted in a public dental service clinic in Norway and involved participants under 20 years of age who were regular attenders at dental appointments. It compared 12-month with 24-month recall intervals and measured outcomes at two years. The other study was conducted in UK general dental practices and involved adults who were regular attenders, which was defined as having attended the dentist at least once in the previous two years. It compared the effects of 6-month, 24-month and risk-based recall intervals, and measured outcomes at four years. The main outcomes we considered were dental caries, gingival bleeding and oral-health-related quality of life. Neither study measured other potential adverse effects. 24-month versus 12-month recall at 2 years' follow-up Due to the very low certainty of evidence from one trial, it is unclear if there is an important difference in caries experience between assignment to a 24-month or a 12-month recall. For 3- to 5-year-olds with primary teeth, the mean difference (MD) in dmfs (decayed, missing, and filled tooth surfaces) increment was 0.90 (95% CI -0.16 to 1.96; 58 participants). For 16- to 20-year-olds with permanent teeth, the MD in DMFS increment was 0.86 (95% CI -0.03 to 1.75; 127 participants). The trial did not assess other clinical outcomes of relevance to this review. Risk-based recall versus 6-month recall at 4 years' follow-up We found high-certainty evidence from one trial of adults that there is little to no difference between risk-based and 6-month recall intervals for the outcomes: number of tooth surfaces with any caries (ICDAS 1 to 6; MD 0.15, 95% CI -0.77 to 1.08; 1478 participants); proportion of sites with gingival bleeding (MD 0.78%, 95% CI -1.17% to 2.73%; 1472 participants); oral-health-related quality of life (MD in OHIP-14 scores -0.35, 95% CI -1.02 to 0.32; 1551 participants). There is probably little to no difference in the prevalence of moderate to extensive caries (ICDAS 3 to 6) between the groups (RR 1.04, 95% CI 0.99 to 1.09; 1478 participants; moderate-certainty evidence). 24-month recall versus 6-month recall at 4 years' follow-up We found moderate-certainty evidence from one trial of adults that there is probably little to no difference between 24-month and 6-month recall intervals for the outcomes: number of tooth surfaces with any caries (MD -0.60, 95% CI -2.54 to 1.34; 271 participants); percentage of sites with gingival bleeding (MD -0.91%, 95% CI -5.02% to 3.20%; 271 participants). There may be little to no difference between the groups in the prevalence of moderate to extensive caries (RR 1.05, 95% CI 0.92 to 1.20; 271 participants; low-certainty evidence). We found high-certainty evidence that there is little to no difference in oral-health-related quality of life between the groups (MD in OHIP-14 scores -0.24, 95% CI -1.55 to 1.07; 305 participants). Risk-based recall versus 24-month recall at 4 years' follow-up We found moderate-certainty evidence from one trial of adults that there is probably little to no difference between risk-based and 24-month recall intervals for the outcomes: prevalence of moderate to extensive caries (RR 1.06, 95% CI 0.95 to 1.19; 279 participants); number of tooth surfaces with any caries (MD 1.40, 95% CI -0.69 to 3.49; 279 participants). We found high-certainty evidence that there is no important difference between the groups in the percentage of sites with gingival bleeding (MD -0.07%, 95% CI -4.10% to 3.96%; 279 participants); or in oral-health-related quality of life (MD in OHIP-14 scores -0.37, 95% CI -1.69 to 0.95; 298 participants).

AUTHORS' CONCLUSIONS

For adults attending dental check-ups in primary care settings, there is little to no difference between risk-based and 6-month recall intervals in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period (high-certainty evidence). There is probably little to no difference between the recall strategies in the prevalence of moderate to extensive caries (moderate-certainty evidence). When comparing 24-month with either 6-month or risk-based recall intervals for adults, there is moderate- to high-certainty evidence that there is little to no difference in the number of tooth surfaces with any caries, gingival bleeding and oral-health-related quality of life over a 4-year period. The available evidence on recall intervals between dental check-ups for children and adolescents is uncertain. The two trials we included in the review did not assess adverse effects of different recall strategies.

Perception of Gingival Bleeding by People and Healthcare Professionals: A Multicentre Study in an Adult French Population

Gingival bleeding (GB) is a common sign of gingival inflammation, which indicates the presence of periodontal diseases. This study aimed to describe the perception of French adults about their self-reported GB and answers of healthcare professionals regarding the GB reported by these interviewees. A questionnaire administered by one investigator in each of three public settings of four cities in France from September 2016 to November 2017. Among 794 adults interviewed, 502 (63.2%) reported a GB. Among them, 414 (82.5%) believed that GB is benign, and 309 (61.6%) declared one or more responses. The three main responses were to use mouthwash (29.3%), to change to a soft-bristle toothbrush (20.1%) and to modify the brushing technique (19.3%). Almost half (49.0%) questioned at least one healthcare professional concerning their GB: a dentist (43.0%), a physician (14.1%), and a pharmacist (8.0%). The main response of each healthcare professional was: for dentists: a "prescription of mouthwash", for physicians to say "gingival bleeding is not serious"; and for pharmacists: "to sell a mouthwash". Most of the participants considered their GB as benign and had inappropriate responses, which indicates their lack of knowledge regarding periodontal health. The same conclusions can be drawn for healthcare professionals, as reported by interviewees.

Gingival bleeding and calculus among 12-year-old Chinese adolescents: a multilevel analysis

BACKGROUND

Gingivitis is a common oral health problem, and untreated gingivitis can progress to periodontitis. The objectives of this study were to (1) explore associated factors of gingival bleeding and calculus among 12-year-old adolescents; (2) find predictive models for gingivitis management.

METHODS

Four thousand five hundred twenty-five subjects aged 12 in Sichuan Province were investigated. The questionnaire and clinical examination were applied in schools, and two-level logistic regression models were constructed to interpret the effect of individual and contextual factors on Chinese adolescents' gingival bleeding and calculus.

RESULTS

46.63% (95%CI: 40.71, 51.60) and 66.94% (95%CI: 56.85, 67.45) of the subjects presented gingival bleeding and calculus, respectively. For the gingival bleeding cases, the model showed the significant associated indicators were hukou (OR = 0.61, 95% CI: 0.52-0.72), family size (OR = 1.41, 95% CI: 1.19-1.68), parental educational level (father: OR = 0.53, 95% CI: 0.45-0.63; mother: OR = 0.71, 95% CI: 0.59-0.86), tooth-brushing frequency (OR = 0.35, 95% CI: 0.26-0.48), dental floss use (OR = 0.58, 95% CI: 0.41-0.83), sugar-containing drink consumption (OR = 2.11, 95% CI: 1.80-2.49), and dental visit (OR = 1.44, 95% CI: 1.19-1.74). It also confirmed that gender (OR = 1.32, 95% CI: 1.13-1.54), hukou (OR = 0.69, 95% CI: 0.59-0.82), family size (OR = 1.34, 95% CI: 1.12-1.59), parental educational level (father: OR = 0.46, 95% CI: 0.39-0.54; mother: OR = 0.65, 95% CI: 0.59-0.82), tooth-brushing frequency (OR = 0.57, 95% CI: 0.42-0.78), dental floss use (OR = 0.66, 95% CI: 0.48-0.90) and sugar-containing drink consumption (OR = 1.30, 95% CI: 1.11-1.53) were associated factors for dental calculus.

CONCLUSIONS

Gingival bleeding and calculus were common in western Chinese adolescents. Socio-demographic factors including gender, hukou and family factors are strong determinants of gingival health in Chinese adolescents. In addition, health-related lifestyle behaviors such as healthy diet, good hygiene care and more dental visits are good predictors of better gingival status.

Periodontal Status of Chinese Adolescents: Findings from the 4th National Oral Health Survey

OBJECTIVE

To investigate the periodontal health status and associated factors of adolescents aged 12 to 15 years old in China.

METHODS

A cross-sectional national oral health survey was conducted in 2015-2016. The multi-stage stratified cluster sampling was used to select participants in all 31 provinces, autonomous regions and municipalities in the mainland of China. Each participant received a clinical assessment including periodontal bleeding and calculus, and 15-year-old adolescents received additional examinations including for periodontal pocket depth and attachment loss, using the latest criteria from the Oral Health Survey Basic Methods, as recommended by the World Health Organization (WHO). A self-answered structured questionnaire was designed to collect the data of background information and associated risk factors.

RESULTS

A total of 118,514 adolescents (14.0 ± 1.09 years old) completed all the oral examinations and the questionnaire. The prevalence of periodontal bleeding and calculus was 61.0% and 67.3% respectively. In the group of 15 year olds, 6.5% adolescents had periodontal pocket and 0.5% had attachment loss. Molars were often involved and, furthermore, calculus also occurred on lower incisors. The periodontal status of adolescents became worse as they grew up. The condition of girls was significantly better than boys.

CONCLUSION

This survey illustrated a brief picture of periodontal status of adolescents in China showing that gingival bleeding and calculus were very common and frequent. Further actions on oral health education were necessary, especially for those in lower socio-economic classes.

Oral Health Knowledge, Attitudes, Behaviour and Oral Health Status of Chinese Diabetic Patients Aged 55 to 74 Years

OBJECTIVE

To understand the oral health knowledge, attitude, behaviour and oral health status of Chinese diabetic patients so as to facilitate the development of oral health education programmes for diabetic patients in China.

METHOD

A face-to-face questionnaire was conducted for 1,024 diabetic patients and 8,030 non-diabetic people aged 55 to 74 years old in order to understand their oral health knowledge, attitudes, and behaviour. Oral health examination was implemented including caries, gingival bleeding, dental calculus, periodontal attachment loss, etc. according to the Oral Health Surveys Basic Methods 5th Edition.

RESULTS

Compared with non-diabetic patients, those with diabetes had more oral health knowledge and more positive attitudes. The proportion of people who formed toothbrushing habits was higher in diabetic patients, but that of regular scaling and flossing is as low as that in non-diabetic people. The detection rate of deep periodontal pockets in diabetic patients was higher than that in non-patients, while the caries situation was better than that in non-patients.

CONCLUSION

This study has shown that the oral health knowledge, attitude, behaviour and oral health status of the 55 to 64-year-old diabetic population are not optimistic. There is a great need for a systematic oral health education programme in China. The contradiction between a large number of diabetes patients and limited health resources requires us to give priority to the improvement of oral health behaviours, such as educating patients to develop toothbrushing and flossing habits.

Utilisation of Oral Health Services and Economic Burden of Oral Diseases in China

OBJECTIVE

To evaluate the use of oral health services, the economic burden of oral diseases and related influential factors in China.

METHOD

Using the multistage, stratified, equal proportion, random sampling method in the 4th National Oral Health Survey of China conducted in 2015 to 2016, residents aged 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years respectively were recruited, clinically examined and answered a questionnaire. Utilisation of oral health services were assessed in all the age groups and the economic burden of oral diseases in the past 12 months were assessed in the 3 to 5 years and 35 to 74 year-old groups. Chi-squared tests, t tests, correlation analysis and a one-way ANOVA were used to determine the relationships of different factors with utilisation of oral health services and the economic burden of oral diseases.

RESULTS

In the subject groups - 3 to 5 years, 12 to 15 years and 35 to 74 years - the prevalence of the utilisation of oral health services in the past 12 months was 14.6% (5,876/40,353), 23.6% (27,936/118,592), and 20.1% (2,708/13,461), respectively. In all three groups, receiving dental treatment was the most common reason for subjects' recent dental visit. The average dental cost in the past 12 months was 403.43 CNY (median = 100) for 3 to 5-year-old children and 850.83 CNY (median = 300) for adults aged 35 to 74 years old. Area, education and annual household income per person were the socio-economic influential factors. Oral health status, oral hygiene and attitudes to and knowledge of oral health affected the utilisation of oral health services and the economic burden of oral diseases.

CONCLUSION

The percentage of dental service utilisation was relatively low, and the economic burden was high. The related factors for both utilisation of oral health services and the economic burden of oral diseases included living in area, educational attainment, household income, perceived oral health status, and oral hygiene.

The Prevalence and Associated Factors of Periodontal Disease among 35 to 44-year-old Chinese Adults in the 4th National Oral Health Survey

OBJECTIVE

To assess the current periodontal status of 35 to 44-year-olds from the Chinese population and to analyse potential influence factors on periodontal disease.

METHODS

The data of subjects were collected from both urban and rural areas of all 31 provinces, autonomous regions and municipalities of the mainland of China, as part of the 4th National Oral Health Survey. All subjects were aged 35 to 44 years old. In total, 4,410 subjects were enrolled in the present study. Each subject was asked to undergo a professional oral examination and to fill in a questionnaire. Periodontal health status was evaluated by probe bleeding, calculus, periodontal pocket depth and clinical attachment loss. The data were analysed using the chi-square test and binary logistic regression analysis.

RESULTS

The prevalence of probe bleeding and calculus was 87.4% and 96.7% respectively among the 35 to 44-year-old population. Prevalence of shallow pockets (4 mm ≤ PD < 6 mm) and deep pockets (PD ≥ 6 mm) was 45.8% and 6.9% respectively among 35 to 44-year-old people. In addition, prevalence of clinical attachment loss (CAL > 3 mm) was 33.2%. Gender, educational level, smoking, teeth brushing frequency, dental floss and toothpick use were found relevant to periodontal condition.

CONCLUSION

Periodontal disease was highly prevalent among 35 to 44-year-old Chinese adults. Gender, educational level, smoking, teeth brushing frequency, toothpick and dental floss use could be potential influence factors of periodontal health status.

Prevalence of Functional Dentition in a Group of Mexican Adult Males

OBJECTIVE

To determine the prevalence of functional dentition and associated periodontal variables in a sample of Mexican adult males.

METHODS

A cross-sectional study of 161 policemen in Campeche, Mexico, was carried out. A clinical examination using an electronic probe was used to collect variables (dental plaque, periodontal pockets, gingival recession, suppuration, and bleeding on probing) on 6 periodontal sites (a maximum of 168 sites, excluding third molars). Sociodemographic, socioeconomic, and behavioral variables were collected through a self-administered survey. Functional dentition was defined as having 21 or more natural teeth. Data were analyzed with STATA 11.0, using logistic regression models.

RESULTS

Mean age was 38.3 (±10.9) years. The prevalence of having a functional dentition was 83.8% in the sample. The odds of having a functional dentition declined with age (odds ratio [OR] = 0.93), having diabetes (OR = 0.27) and with having a high percentage of sites with plaque (OR = 0.77), with bleeding on probing (OR = 0.97), and with gingival recession (OR = 0.82).

CONCLUSION

While a large proportion of subjects had a functional dentition in this community-dwelling sample of adult Mexican males, the likelihood of their having a functional dentition decreased with age, with their having been diagnosed with diabetes, and with assorted negative indicators of periodontal/gingival status.

Retrospective analysis of the prevalence of peri-implant diseases in non-smoking patients rehabilitated with a fixed full-arch restoration, supported by two mesial axial and two distal tilted implants

BACKGROUND

The objective of the study was to evaluate the prevalence of peri-implant mucositis and peri-implantitis in non-smoking patients rehabilitated with a fixed prosthesis supported by two axial and two tilted implants.

METHODS

Forty-three patients with a total of 49 rehabilitations were included in the study. Each patient was included in a follow-up schedule consisting in a visit every six months during the first two years and every year thereafter in which professional oral hygiene was performed and data about bleeding on probing, probing depth and bone resorption were collected. Diagnoses of peri-implant mucositis (Bleeding Index>1) and peri-implantitis (Bleeding Index>1, probing depth >4, bone resorption radiographically detectable) were made.

RESULTS

The considered observational time was from 1 to 10 years. The prevalence of peri-implant mucositis detected ranged from 0 to 12.2% of patients (8.7% of implants), while that of peri-implantitis varied between 0 and 9.1% of patients (6.8% of implants) in the different follow-up considered.

CONCLUSIONS

The prevalence of peri-implant mucositis and peri-implantitis was lower than in most of the studies in literature suggesting the feasibility of this kind of rehabilitation, in combination with a strict hygiene recall protocol, in preventing the onset of these diseases.

Self-Reported Periodontitis and Incident Type 2 Diabetes among Male Workers from a 5-Year Follow-Up to MY Health Up Study

AIMS

The purpose of this study was to examine whether periodontitis is associated with incident type 2 diabetes in a Japanese male worker cohort.

METHODS

The study participants were Japanese men, aged 36-55 years, without diabetes. Data were extracted from the MY Health Up study, consisting of self-administered questionnaire surveys at baseline and following annual health examinations for an insurance company in Japan. The oral health status of the participants was classified by two self-reported indicators: (1) gingival hemorrhage and (2) tooth loosening. Type 2 diabetes incidence was determined by self-reporting or blood test data. Modified Poisson regression approach was used to estimate the relative risks and the 95% confidence intervals of incident diabetes with periodontitis. Covariates included age, body mass index, family history of diabetes, hypertension, current smoking habits, alcohol use, dyslipidemia, and exercise habits.

RESULTS

Of the 2895 candidates identified at baseline in 2004, 2469 men were eligible for follow-up analysis, 133 of whom were diagnosed with diabetes during the 5-year follow-up period. Tooth loosening was associated with incident diabetes [adjusted relative risk = 1.73, 95% confidence interval = 1.14-2.64] after adjusting for other confounding factors. Gingival hemorrhage displayed a similar trend but was not significantly associated with incident diabetes [adjusted relative risk = 1.32, 95% confidence interval = 0.95-1.85].

CONCLUSIONS

Tooth loosening is an independent predictor of incident type 2 diabetes in Japanese men.

Oral health status among 6- and 12-year-old Jordanian schoolchildren

PURPOSE

No nationwide oral health survey has previously been carried out in Jordan. The aims of the study were to assess the burden of dental caries and gingival health among children aged 6 and 12 years in relation to sociodemographic factors and to ascertain the trend over time in the occurrence of caries and the need for dental care.

MATERIALS AND METHODS

A cross-sectional epidemiological survey was carried out which included 2496 children aged 6 years and 2560 children aged 12 years selected by stratified cluster sampling. Children were examined in schools and data comprised information about caries and gingival health status. WHO methodology and criteria were applied. Structured questionnaires were used to collect information about oral hygiene, dental visits, consumption of sugars and parents' level of education.

RESULTS

The caries prevalence rates were 76.4% in 6-year-olds and 45.5% in 12-year-olds, and caries experience was 3.3 dmft and 1.1 DMFT, respectively. The prevalence of caries varied significantly by sex and geographical region. In both age groups, children of the social low and middle groups had significantly higher levels of caries experience, more untreated decayed teeth and fewer filled teeth than did children of the upper socioeconomic group. Multivariate regression analysis showed that social class was the most important independent variable for caries. The results from 2005 were compared with similar data collected in the capital, Amman, in 1993. For all social classes, the mean caries experience and the amount of untreated dental caries increased over time. Moreover, 17.7% of 6-year-old children and 49.1% of the 12-year-olds had gingival bleeding. Significant differences in gingival health were found by sex, location, geographical areas and socioeconomic group.

CONCLUSION

Oral disease is a significant public health problem in Jordan. Strengthening of the school oral health programme is needed for effective prevention and control of caries and promoting gingival health. A systematic school oral health programme including oral health promotion should be established.

Dietary intake of calcium, vitamins A and E and bleeding on probing in Sri Lankan preschoolers

OBJECTIVE

To determine the prevalence of gingival bleeding on probing and the associations between dietary intake of calcium, vitamins A and E and gingival bleeding on probing in Sri Lankan preschool children.

BASIC RESEARCH DESIGN

A cross-sectional study.

PARTICIPANTS

784 children aged 48-72 months attending preschools in the Kegalle district and their mothers/carers.

RESULTS

The prevalence of gingival bleeding on probing was 52.9%. A Poisson logistic regression model revealed that children with a high daily dietary intake of calcium were less likely to have gingival bleeding on probing than those with low intake (PR=0.80; 95%CI 0.64,0.98). Also prevalence of gingival bleeding was higher in children: with plaque on their teeth; whose mothers were not employed; or, were from families with three or more children.

CONCLUSIONS

The prevalence of gingivitis was high in the children and the findings suggest that high levels of dietary calcium intake are associated with reduced gingival bleeding in preschool children.

Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda

BACKGROUND

Literature reports have indicated an increase in research evidence suggesting association between periodontal disease and the risk of pre-term birth (PTB) and low birth weight (LBW). Periodontal diseases in Uganda have been documented as a public health problem, but their association to adverse pregnancy outcomes is unknown. This study was conducted to assess the association between periodontital diseases in postpartum mothers and PTB and LBW of babies in Mulago and Mbarara referral hospitals.

METHODS

This was a cross sectional study using medical records, clinical examination and oral interview of mothers at the two tertiary health facilities. Mothers with singleton babies from Mulago (n = 300) and Mbarara Hospital (n = 100) were recruited for the study. The women were clinically examined for periodontal disease by 2 trained and calibrated dentists. Data on PTB and LBW were retrieved from medical records. The data were analyzed to determine the relationship between the four parameters for periodontal disease (bleeding gingiva, periodontal pockets, gingival recession and calculus with plaque deposits) and the adverse pregnancy outcomes. Frequency distribution was used to describe the data. Bivariate and multivariate analyses were used to study the association between the periodontal diseases and adverse pregnancy outcomes.

RESULTS

Approximately 26% and 29% of the postpartum mothers examined had bleeding gingiva and periodontal pockets of 4 mm or more deep, respectively. Advanced periodontitis i.e. pocket depth ≥ 6 mm was recorded in 13 (3.6%) of the mothers. Calculus with plaque deposits were recorded in 86% (n = 343) of the mothers. Gingival recession was recorded in 9.0% of the mothers and significantly and directly related to birth weight (p < 0.05).

CONCLUSION

Periodontal conditions of postpartum mothers in this study were found to be better than previously reported amongst the Ugandan population. Bivariate analysis showed a significant association only between gingival recession and low birth weight. However, this finding should be interpreted with caution as it could have occurred by chance.

Dental and periodontal status of 12-year-old Bulang children in China

BACKGROUND

Bulang is an ethnic minority group living in Yunnan in the southwestern part of China. There is little information pertaining to the oral health of Bulang children. This study aims to examine the dental caries and periodontal status of 12-year-old Bulang children in China and the factors affecting their oral-health status.

METHODS

12-year-old Bulang school children in Yunnan, China, were recruited through a multi-stage cluster sampling method. Following the recommendation of the World Health Organization, caries experiences were recorded using the DMFT index and periodontal status with the CPI index. A self-completed questionnaire was used to collect information on the background and oral health-related behaviours of the children.

RESULTS

A total of 900 children in primary schools were invited, and 873 (97%) joined the survey. Their caries prevalence was 35%. Their caries experience in mean DMFT (±SD) score was 0.6 ± 1.1, and 94% of the carious teeth had no treatment. Most children (71%) had bleeding gums, and 58% of them had calculus. Girls and those who had visited a dentist in the previous year had higher caries risk.

CONCLUSIONS

Dental caries was common among the 12-year-old Bulang children in China. Most of the carious teeth were left untreated. Caries prevalence was associated with gender and dental attendance. Their periodontal condition was poor, and more than half of them had calculus.

Aspects related to a periodontal home prevention program for disabled patients: a clinical trial

AIM

The aim of the present study was to highlight the relationship between the level of oral hygiene and the context in which the patient receives dental treatment, demonstrating that home service is essential and effective to decrease the incidence of periodontal diseases.

METHODS

The study was initially conducted on a heterogeneous sample of patients including 48 individuals with psycho-motor deficits. The study included 28 males (58.3%) and 20 females (41.7%) aged between 18 and 50 years, coming from two different sites ("Fa.Di.Vi… e oltre" and "Dentistry Unit, Istituto G. Gaslini" in Genoa). The patients were evaluated during the period 2008-2009. After this first pilot study, a clinical trial was conducted within the educational center "Il Granello", with the participation of 20 patients with disabilities.

RESULTS

This study demonstrates that home assistance is essential and effective to decrease the incidence of those periodontal diseases induced by bacterial dental plaque accumulation, and associated with aggravating factors like the repeated use of drugs, such as benzodiazepines, phenylhydantoin, and cyclosporin A, that cause gingival hypertrophia.

CONCLUSION

This study was proposed to demonstrate that the availability of a dental service within institutions could improve not only the dental-periodontal conditions of the participants, but also decrease the admission of these subjects to hospitals, contributing to the reduction of public expenditure by the Health Care System.

The influence of different factors on the oral health status of smoking and nonsmoking adults

AIM

The aim of this study to determine the influence of smoking on self-reported oral health status among university students.

MATERIALS AND METHODS

Voluntary sample of 669 adults of 18 to 26 years old were invited to participate in the study. They were asked to read a self-designated questionnaire and a covering letter which explained the purpose of the study. The questionnaire addressed self-reported demographics, oral hygiene and smoking habits; knowledge about smoking and its effects on oral health. Data were statistically analyzed using Chi-square test to determine statistically significant differences across the oral health status.

RESULTS

The sample included 340 (56.7%) males and 240 (43.3%) females; 56.8% of the subjects were nonsmokers; 43.2% were current smokers, and 17.5% smoke argileh. Almost 24.7% of subjects started smoking because of emotional effects; 66.9% did not smoke because of its harm to health. The percentage of subjects with dental plaque on their teeth was 27.1%, and with calculus was 27.9%, and with stains was 26.9%. About 35.5% of the subjects brushed their teeth once daily. Statistically, significant association was proven between smoking and gender (p < 0.01); and smoking and halitosis (p < 0.01).

CONCLUSION

Smoking is significantly related to esthetics, calculus, tooth stains, halitosis, gingival bleeding, and gender with p < 0.01, p < 0.01, p < 0.01, p < 0.01, p = 0.05, and p < 0.01 respectively.

Social determinants of health and periodontal disease in Brazilian adults: a cross-sectional study

BACKGROUND

Recently, increasing importance has been placed on the social determinants of health and disease. The present study aimed to determine the prevalence of periodontal disease in Brazilian adults and identify possible relationships with social determinants.

METHODS

A cross-sectional study was performed using a sample of 743 adults (aged 35-49 years) living in an urban area of a large city in southeastern Brazil. The condition of the periodontium was assessed using the Community Periodontal Index (CPI) according to the diagnostic criteria established by the World Health Organization (WHO). The variables related to social determinants were collected using a structured questionnaire. A descriptive analysis of all study variables was performed. Multiple correspondence analysis was subsequently performed to identify relationships between periodontal disease and the social determinants of health.

RESULTS

The periodontal exams showed that 36.5% of adults had a healthy periodontium, 2.0% had gingival bleeding, 47.1% had calculus and 9.5% had periodontal pockets of 4-5 mm. Periodontal pockets of 6 mm or more were the worst periodontal condition found (affecting only 2.1% of the participants). The correspondence analysis enabled us to form three groups with different profiles. The first group was distinguished by the presence of bleeding (gingivitis) or a healthy periodontium. The members of this group were typically aged 35 to 39 years and had 9-12 years or more than 12 years of education. The second group consisted of subjects with calculus and periodontal pockets of 4-5 mm. The members of this group were typically white men aged 40-44 years with incomes greater than $ 300.00. The third group was distinguished by the presence of periodontal pockets of 6 mm or more. The members of this group were typically adult females, black and mixed individuals who had 8 years or less of schooling, individuals with incomes ≤ $ 300.00 and widowers.

CONCLUSION

The results suggest that periodontal health is worse in the group for which the social indicators are worse. Therefore, the social determinants of health also affect the severity of periodontal disease in adults Brazilian society.

Dental care among young adults with intellectual disability

Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer young adults with ID (45%) visited a dentist at least once per year, compared with those without ID (58%). ID severity and the presence of co-occurring developmental disabilities predicted dental care use. Sociodemographics, daily functioning, societal participation, dental services, and dental health factors were examined as predictors of dental care frequency. Our findings can help focus efforts toward improving the frequency of dental care visits among young adults with ID.

Socio-behavioral variables effecting oral hygiene and periodontal status of 12 year-old schoolchildren of Udaipur district

AIM

To assess the effect of various socio-demographic in addition to oral hygiene variables on the oral hygiene and periodontal status.

METHODS

A combination of multi stage and cluster sampling procedure was followed to collect a representative population of 831, 12 year-old schoolchildren of Udiapur district. Oral Hygiene Index Simplified (OHI-S) and Community Periodontal Index (CPI) were used to evaluate oral hygiene and periodontal status respectively. Along with the clinical examination, each subject was interviewed to collect the socio-demographic information and oral hygiene practices.

RESULTS

The overall mean OHI-S was 1.42 and debris component of the oral hygiene index was dominant. Unpaired 't' test showed significantly higher DI-S (p = 0.0001) and OHI-S (p = 0.007) among boys than girls. The overall prevalence of periodontal disease was 89.9% and gingival bleeding was widespread. Chi square test demonstrated significant differences (p = 0.0001) with 14.6% urban children having healthy periodontium in comparison to 5.6% rural residents. Oral hygiene scores were dependent on the father's occupation (p = 0.046), father's (p = 0.002) and mother's level of education (p = 0.0001).

CONCLUSIONS

Oral hygiene status was poor, more among boys with debris contributing a major part for oral hygiene index. Periodontal status was poor with bleeding being most prevalent indicator. The multivariate analysis of oral hygiene status confirmed the existence of socio-behavioural determinants for oral hygiene.

Dental conditions among competitive university athletes in Nigeria

OBJECTIVE

To assess the oral health practices and the prevalence of dental problems among competitive university athletes in Nigeria.

MATERIALS AND METHODS

A cross-section of athletes that participated at the 2011 Nigerian university games in Benin-city, Nigeria, was studied. The tool of data collection was self-administered questionnaire. The information sought included demographics of the respondents and the sports they are involved in. Other information included prevalence of dental problem, cigarette smoking and alcohol consumption, history of toothache, gingival bleeding and mouth ulcer as well as their care seeking behaviour and pattern of oral health utilization.

RESULTS

The response rate was 75.3%. The prevalence of oral health problem among the respondents was 28.3% and dental caries was the commonest reported oral health problem among the respondents. A total of 106 (46.9%), 82 (36.3%) and 92 (40.7%) of the respondents had experienced toothache, gingival bleeding and mouth ulcer respectively. Less than half (40.7%) of the respondents have ever visited the dentist. Among the respondents, 108 (47.8%) reported taking alcohol while 16 (7.1%) indulged in cigarette smoking. Consumption of soft drink always and sometimes were reported by 64 (28.3%) and 98 (43.4%) of the respondents respectively. Respondents who had experienced dental problem during competitions made up 15.9% of the respondents and 66.7% of this group reported that the dental problem affected their performance in the competition.

CONCLUSION

The prevalence of dental conditions among respondents was high and it had adverse impact on performance in competitions.

Marginal bone loss in the adult population in the county of Skåne, Sweden

The aim of this study was to investigate the prevalence and extent of periodontal disease registered as marginal bone loss and subject characteristics in the adult population in the county of Skåne in Sweden. One thousand individuals, 20-89 years old, were randomly selected and 451 subjects agreed to participate in the study. They answered a questionnaire and in conjunction with the clinical and radiological examination the subjects answered questions about their medical history. The examiners were co-ordinated regarding the diagnostic criteria through comprehensive written instructions, practice and discussions of clinical cases. One observer estimated marginal bone loss around the teeth on digital panoramic radiographs and bitewings. The individuals were classified regarding periodontal disease experience according to the following criteria: PD- = loss of supporting bone tissue < 1/3 of the root length, PD = loss of supporting bone tissue > or = 1/3 of the root length in < 30% of the teeth and PD+ = loss of supporting bone tissue > or = 1/3 the root length in > or = 30% of the teeth. Subjects with no or minor bone loss, i.e. PD- constituted 69% of the population. Twenty percent of the study population had marginal bone loss corresponding to localised periodontal disease (PD) and 11% exhibited generalised periodontal bone loss (PD+). The periodontal treatment need, defined as probing pocket depth > or = 6 mm and bleeding on probing > or = 20%, was 53% in the PD+ group. An interesting result was that there were no differences in periodontal disease experience between the genders.

CONCLUSIONS

The prevalence and extent of periodontal disease in this study correlates well with recent other studies. Eleven percent of the population has experienced generalised periodontal disease, and 53% of them have a periodontal treatment need defined as 1 or more site with PPD > or = 6 mm and BoP > or = 20%.

Oral health status of 12-year-old school children in Yemen. A cross- sectional survey

AIM

This study aims to describe the oral hygiene practices and the oral health status of 12-year-old school children of Aden, Yemen.

STUDY DESIGN

Multistage stratified cross-sectional survey.

MATERIALS AND METHODS

A cross- sectional survey of randomly selected schools in the city was performed. Four hundred 12-year-old students were recruited in the study from both private (N. 200) and government schools (N. 200). In total 219 boys (54.8%) and 181 girls (45.2%) participated in this study. Scoring of decayed, missing, filled teeth (DMFT) and the Community Periodontal Index (CPI) scores were computed according to the WHO recommendations.

RESULTS

Mean DMFT was 2.22±1.56 and DMFT >0 was seen in 90.2% of the study subjects. The D component of the caries index was dominant and it was clinically evident in 84.7% of the students. Children having high cariogenic food consumption had significantly (P<0.001) higher mean DMFT, DT, MT and FT. Children who used only toothbrush were found to have significantly (P<0.001) lower caries experience as compared to those who used only miswak or those who used both. About 63% of the students has CPI=2 and less than 20% had CPI=0. Children who brushed regularly were found to have better CPI scores. Multivariate analysis showed that diet (ORa = 1.56; 95% CI= 1.82-2.44) was significantly associated with dental caries.

STATISTICS

data were analysed with Statistical Package for Social Sciences for Windows 17.0 (SPSS Inc., Chicago, IL, USA).

CONCLUSION

The overall oral health of the 12-year-old school children is poor. More emphasis has to be given school based and community based oral health promotion and preventive programmes.

Dental health of homeless adults in Toronto, Canada

OBJECTIVES

This study aimed to assess the oral health status of the Toronto adult homeless population; to learn how they perceive their own oral health; and to correlate the presence of oral disease with length of homelessness and unemployment.

METHODS

This cross-sectional descriptive study collected data from 191 homeless adults who were randomly selected using a stratified cluster sample at 18 shelters. A questionnaire and clinical oral examination were conducted with participants.

RESULTS

The mean Decayed/Missing/Filled Teeth (DMFT) score of the subjects was 14.4 (SD = 8.1). Only 32% of them had visited a dentist during the last year, 75% believed that they had untreated dental conditions, and 40% had their last dental visit for emergency care. The clinical oral examination observed that 88% needed fillings, 70% periodontal, 60% prosthodontic, and 40% emergency treatment.

CONCLUSION

Homeless adults in Toronto have poor oral health, significant oral health treatment needs, and a lack of access to dental care.

Prevalence of necrotizing ulcerative gingivitis and associated factors in Koranic boarding schools in Senegal

BACKGROUND

Necrotizing ulcerative gingivitis is the most common clinical syndrome preceding noma. It is found in developing countries and in malnourished children and especially in deprived groups such as children at Koranic boarding schools. The objective of this study was to determine the prevalence of necrotizing ulcerative gingivitis and factors associated with its occurrence in a boarding school population.

METHODS

This was a cross-sectional study of children in Koranic boarding schools in the city of Touba, Senegal. A multistage sampling strategy was used and 8 out of 17 schools were selected. The variables collected were gender, age, oral hygiene habits, duration of residence, presence of ulcerative gingivitis and plaque, and gingival bleeding index. A logistic regression analysis with R software using the manual procedure down was used to identify factors associated with the dependent variables.

RESULTS

There were 501 participants and boys made up 92% of the study group. The mean age was 9.3 (sd 4.0) years. The mean of duration residence was 3.4 (sd 1.5) years. The prevalence of necrotizing ulcerative gingivitis was 37% and 81% of children did not use a toothbrush or a chewing-stick. The length of residence, school size, hygiene habits and plaque and bleeding indices were significantly associated with necrotizing gingivitis after adjustment for other variables.

CONCLUSION

It is necessary to develop oral hygiene programs, to establish policies to manage the oral health of children and to improve health and nutrition at Koranic boarding-schools.

Oral health status of a group of illicit drug users in Delhi, India

OBJECTIVES

To assess the oral health and related practices of a group of illicit drug users in Delhi, India; to compare with that of non-drug users; and to assess the impact of illicit drug use on oral health.

DESIGN

Cross-sectional study. Comparison was made with non-drug users to investigate any differences in oral health between illicit drug users and general population.

SETTING AND PARTICIPANTS

Illicit drug users attending a drug dependence treatment clinic in Delhi (n=126). Equal number of non-drug users attending other outpatient departments in the same setting.

OUTCOME MEASURES

Oral health practices assessed using structured questionnaire; dental caries, periodontal status and oral mucosa assessed using World Health Organization 2004 criteria; oral hygiene assessed using OHI-S.

RESULTS

Mean DMFT and OHI-S scores amongst the drug users were 3.48 and 3.80, respectively. Bleeding, shallow pockets and deep pockets were found as the highest CPI finding in 42%, 44% and 12% of drug users respectively. Premalignant states of leukoplakia and OSMF were diagnosed in 13% and 4% of drug users respectively. Significant differences were found between drug users and non-drug users with respect to oral hygiene practices; DMFT, OHI-S, CPI scores; and leukoplakia. In multivariate analysis, illicit drug use was significantly associated with CPI highest score (OR = 2.21, 95% CI 1.08-4.52).

CONCLUSION

The illicit drug users had significantly poorer oral hygiene practices, oral hygiene and periodontal health; higher caries experience; and higher prevalence of leukoplakia as compared to non-drug users. The findings of the study suggest that illicit drug use is independently associated with poor periodontal health.

Validity of partial protocols to assess the prevalence of periodontal outcomes and associated sociodemographic and behavior factors in adolescents and young adults

BACKGROUND

Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination.

METHODS

Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated.

RESULTS

Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors.

CONCLUSION

Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.

Caries experience in 14-year-olds from Northeast Italy. Is socioeconomic-status (SES) still a risk factor?

AIM

Prevalence and severity of dental caries in 14-year-olds of Northeast Italy were estimated, evaluating the dependence to SES.

MATERIALS AND METHODS

An epidemiological survey was performed among a randomised cluster sample of 560 (290 M and 270 F) 14-year-olds attending secondary schools, to evaluate DMFS following WHO indications. Association between caries occurrence and SES was evaluated in a logistic regression model. To account for high proportion of zero scores (DMFS and DS distribution highly positively skewed) data was moreover modelled with negative binomial regression and zero-inflated models.

RESULTS

Caries prevalence was 63.4% with a mean DMFS of 3.0 ± 3.8. A significant trend between means was observed regarding DS in the different SES levels: z = 2.22 p = 0.03 (occupational level) and z = 3.45 p<0.01 when SES was based on educational level. The Negative Binomial Regression model resulted more appropriate than the Poisson model because the dispersion parameter was significantly different from zero (alpha=1.5, 95% CI=1.3-1.8). Working class status showed significant association with DMFS (p=0.04) while using DS as dependent variable, working class subjects and subjects with medium-low and low educational level, showed a statistically significant association.

CONCLUSION

Socioeconomic status is still a predictor for dental decay in the Italian 14-year-olds.

Dental health of children with autism spectrum disorders: a population-based study

Data from the 2007 National Survey of Children's Health were used to investigate how autism spectrum disorder (ASD) symptom severity and comorbidity are associated with the dental health needs of children. The results of this study help provide insights into the greater oral needs of the increasing population of children with ASD that reside in our communities and their dependency upon local practitioners for treatment.

Relationship between periodontal status and levels of glycated hemoglobin

The objective of this study was to assess whether there is a bi-directional relationship between periodontal status and diabetes. Study 1 included 5,856 people without periodontal pockets of ≥ 4 mm at baseline. Relative risk was estimated for the 5-year incidence of periodontal pockets of ≥ 4 mm (CPI scores 3 and 4, with the CPI probe), in individuals with glycated hemoglobin (HbA1c) levels of ≥ 6.5% at baseline. Study 2 included 6,125 people with HbA1c < 6.5% at baseline. The relative risk was assessed for elevation of HbA1c levels in 5 years, with baseline periodontal status, assessed by CPI. Relative risk of developing a periodontal pocket was 1.17 (p = 0.038) times greater in those with HbA1c of ≥ 6.5% at baseline, adjusted for body mass index (BMI), smoking status, sex, and age. Relative risks for having HbA1c ≥ 6.5% at 5-year follow-up in groups with periodontal pockets of 4 to 5 mm and ≥ 6 mm at baseline were 2.47 (p = 0.122) and 3.45 (p = 0.037), respectively, adjusted for BMI, alcohol consumption, smoking status, sex, and age. The risk of developing periodontal disease was associated with levels of HbA1c, and the risk of elevations of HbA1c was associated with developing periodontal pockets of more than 4 mm.

Risk indicators for increased periodontal probing depth in subjects attending a public dental school in Brazil

PURPOSE

To assess the prevalence, extent and severity of periodontal probing depth (PD) and their association with sociodemographic and behavioural parameters in subjects attending a public dental school in Brazil.

MATERIALS AND METHODS

Five hundred and fifty-nine consenting participants (18 to 77 years of age) were submitted to full-mouth periodontal clinical examination and anamnesis questionnaires. The data were analysed by multivariable models using logistic regression analyses. The dependent variables were moderate (≥ 5 mm in ≥ 10% of sites) and deep (≥ 7 mm in at least one site) PD.

RESULTS

The prevalence of individuals with at least one site with PD ≥ 5 mm or ≥ 7 mm was 69% and 54%, respectively. Mean PD ranged from 2.86 to 3.08 mm, and the mean frequency of sites with moderate and deep PD ranged from 10.74% to 14.99%, and from 4.60% to 5.36%, respectively, according to age. Multivariate analyses identified a higher risk for having PD ≥ 5 in ≥ 10% of sites and 7 mm in at least one site in smokers (odds ratio [OR] = 10.56 and 9.10, respectively), and the presence of >10% of sites with bleeding on probing (BOP) (OR = 6.37 to 20.91, and 6.94 to 26.19, respectively). Age 36 to 50 years (OR = 1.95) and >50 years (OR = 3.15), presence of >30% of sites with supragingival biofilm (SB) (OR = 2.80), and ≥ 4 missing teeth (OR = 2.26) were risk indicators for PD ≥ 7 mm in at least one site.

CONCLUSION

This particular Brazilian population presented high prevalence and extent of increased periodontal probing depth. Age, smoking, BOP, SB, and tooth loss were risk indicators associated with probing depth in these individuals.

Oral hygiene and periodontal status among detainees in a juvenile detention center, India

PURPOSE

To assess the oral hygiene and periodontal status and analyse the influence of age, education, institutionalization, type of visit and oral health behaviour on oral hygiene and periodontal status among detainees in juvenile detention center in Udaipur city, Rajasthan, India.

MATERIALS AND METHODS

The total sample comprised 223 subjects (67.7% male and 32.3% female) aged 6 to 18 years. Clinical examination included assessment of oral hygiene and periodontal status using OHI-S (Oral Hygiene Index-Simplified) and CPI (Community Periodontal Index), respectively. Analysis of variance (ANOVA), chi-square, Student t-test and stepwise multiple linear and multiple logistic regression analysis were carried out to find the relation between oral hygiene/ periodontal status and different independent variables.

RESULTS

The results showed that the oral hygiene status of detainees was poor, with only 28.1% of the subjects having good oral hygiene. Mean OHI-S scores were significantly associated with all independent variables. Overall periodontal disease prevalence was 80.2% with bleeding and calculus contributing a major part (71.9%). Stepwise multiple linear and logistic regression analysis revealed that oral hygiene practice and type of visit in the detention center were the best predictors for the oral hygiene index, and for periodontal disease it was oral hygiene practice alone.

CONCLUSION

The findings confirmed that detainees in the juvenile detention center have poor oral hygiene and an increased prevalence of periodontal disease compared to that of similarly ages in the general population.

Periodontal condition of the elderly in Finland

OBJECTIVE

To describe the periodontal condition of the elderly in Finland and its association with sociodemographic factors.

MATERIAL AND METHODS

The study was based on a subpopulation of 1460 persons (748 dentate persons) aged > or =65 years who participated in a nationally representative Health 2000 Survey in Finland. The data for this study were collected by means of an interview and a clinical oral examination.

RESULTS

Seventy-three percent of the participants in this study had gingival bleeding in at least one sextant. The proportion of participants with no teeth with deepened periodontal pockets > or =4 mm deep was 31%. Twenty-eight percent of the participants had one to three teeth with deepened periodontal pockets > or =4 mm deep, 15% had four to six and 26% had > or =7. At the individual level, a high number of teeth with deepened periodontal pockets was associated with sociodemographic factors such as high age, intermediate or higher education, and living in a rural area.

CONCLUSION

At a national level, the greatest need for periodontal treatment presently derives from persons aged 65-74 years and/or those with low education, due to their high representation in the elderly population.

Periodontal diseases in Greek adults between 1985 and 2005--risk indicators

AIM

This study provides data on the periodontal status of Greek adults aged 35-44-years-old in relation to socio-demographic and behavioural parameters and compares these data with those of 1985.

MATERIAL AND METHODS

A stratified cluster sample was selected according to WHO guidelines for national pathfinder surveys. Periodontal and oral hygiene status were assessed using the CPI index and the OHI-S index respectively. Socio-demographic and behavioural data were collected through face-to-face interviews.

RESULTS

In 2005, 9.5% of the participants had healthy periodontium, 16.2% bleeding on probing, 46.8% calculus, 24.2% shallow pockets and 3.3% deep pockets. Half of the individuals (52.1%) had good oral hygiene status, 39.8% fair and 8.1% poor. Most of them (79%) brushed their teeth at least once a day, but only 25.4% used dental floss. Higher CPI scores were associated with living in rural areas, having a lower educational attainment and brushing and flossing teeth less frequently. Better oral hygiene status was associated with having a higher educational attainment and income, as well as brushing and flossing teeth more frequently. Comparisons with the 1985 findings indicate that severe periodontal diseases may be declining in Greece, whereas gingivitis may be increasing.

CONCLUSIONS

The prevalence of severe periodontal diseases in Greek adults is not high and their periodontal health has improved since 1985. As long as their oral hygiene status and preventive dental behaviour cannot be considered as satisfactory, there is room for further improvement.

Periodontitis in 65-74-year-old victims in Wenchuan, China post-earthquake: implications for service provision

OBJECTIVES

One year after the Wenchuan, Southwest China earthquake, a cross-sectional study was conducted as a preliminary assessment of the periodontitis of 65- to 74-year-old victims and to compare it with survey data from before the earthquake.

METHODS

A temporary housing, community-based study was conducted. A total of 1495, 65-74-year-old subjects, 740 county and 755 rural, 753 men and 742 women, were included in the study. The data were collected by means of an interviewer-administered questionnaire and an oral examination.

RESULTS

The calculus and gingival bleeding were distinctly increased, and the prevalence of Attachment Loss at 4-5 mm of 77.3%, at 6-8 mm of 44.8%, at 9-11mm of 13.6% and at > or =12 mm of 2.7%, were also much higher than the findings before the earthquake. Additionally, oral hygiene practice, stress, tobacco abuse and nutritional intake had gone into an adverse trend after the earthquake.

CONCLUSION

The changes caused by the earthquake exacerbated periodontitis in older people. Therefore, consistently superior oral prevention and treatment service programmes for elderly victims should be constituted and encouraged throughout the temporary housing community.

Relationship between periodontitis and hepatic abnormalities in young adults

OBJECTIVE

Obesity has been implicated as a risk factor for periodontitis and non-alcoholic fatty liver disease (NAFLD). In NAFLD, elevated alanine aminotransferase (ALT) is associated with obesity. Although a possible interrelationship between liver function and periodontitis has been reported among the middle-aged population, the correlation in young adults is little known. This study was designed to investigate the relationship between ALT and the presence of periodontitis in university students in Japan.

MATERIAL AND METHODS

Medical and oral health data were collected in a cross-sectional examination conducted by the Health Service Center of Okayama University. Systemically healthy, non-smoking students aged 18 and 19 years old (n = 2225) were included. The protocol of the United States National Health and Nutrition Examination Survey was applied. Subjects with probing pocket depth >or= 4 mm were defined as having periodontitis. Logistic regression analysis was used to estimate the association between ALT, body mass index and periodontitis.

RESULTS

The number of subjects with periodontitis was 104 (4.7%). In males, having periodontitis was significantly associated with an increased level of ALT (>or= 41 IU/l) in logistic regression analysis (adjusted odds ratio 2.3; 95% confidence interval 1.0-5.2; p < 0.05). However, there was no significant association between periodontitis and ALT in female students.

CONCLUSIONS

Elevated ALT could be a potential risk indicator for periodontitis among young males. Monitoring hepatic abnormalities to prevent periodontitis must be better understood, even in the young adult population.

Comparison between two methods for periodontal risk assessment

AIM

Risk assessment is increasingly important in periodontology. The aim of this article was to propose a new objective method (UniFe) in order to simplify the risk assessment procedures. UniFe was compared with a computer-based risk assessment tool (PAT(R)).

METHODS

Risk scores for both UniFe and PAT(R) were calculated for 107 patients, randomly selected among patients seeking care at a specialist periodontal clinic. For UniFe risk calculation, the ''parameter scores'' assigned to smoking status, diabetic status, number of sites with probing depth 5 mm, bleeding on probing score (BoP) and bone loss/age, were added and the sum was referred to a ''risk score'', ranging from 1 (low risk) to 5 (high risk). PAT(R) generated a risk score on a scale from 1 (lowest risk) to 5 (highest risk).

RESULTS

The mean UniFe and PAT(R) risk scores were 4.5+/-0.9 and 4.6+/-0.7, respectively. Cohen k-statistics amounted to 0.7, suggesting a good agreement between methods. Difference in risk score between methods was significantly explained by the parameter scores of BoP and bone loss/age (adjusted R2=0.378).

CONCLUSION

The comparison between UniFe and PAT(R) demonstrated a good level of agreement between methods in a randomly selected population referred to a periodontal clinic.

Differences in oral health among Italian adolescents related to the type of secondary school attended

PURPOSE

The aim of the present study was to evaluate the possible interaction between the type of secondary school attended, oral clinical data and self-perceived oral health (SPOH) behaviour among Italian adolescents.

MATERIALS AND METHODS

A total of 913 adolescents living in Milan (Italy), attending two different types of secondary schools, grammar and technical secondary schools, were examined regarding dental caries and gingival conditions. Oral health behaviour data were collected using an anonymous questionnaire. The presence of caries was recorded using the decayed missed filled tooth (DMFT) index, gingival conditions with community periodontal index (CPI) following World Health Organization recommendations. Stepwise logistic regression was applied to determine whether the type of school attended was associated with the clinical outcome variables and subjects' SPOH and with oral health or lifestyle behaviour.

RESULTS

The prevalence of caries was 59.8% (95% CI = 41.3 to 76.8); a third of participants showed a CPI = 0, whereas 34.9% had bleeding at probing and 37.9% had calculus. Caries distribution was significantly related to the type of school attended in each score of the DMFT categorisation (P < 0.01). Experience of tooth discomfort was claimed by 23.6% of subjects from grammar schools and 35.3% from technical schools (P < 0.01). In males, CPI > or = 1 was associated with the type of school, OR = 1.6 (95% CI = 1.1 to 2.5), the highest DMFT score and experience of self-perceived tooth discomfort, OR = 1.6 (95% CI = 1.2 to 2.0) and OR = 1.2 (95% CI = 1.4 to 2.6), respectively. In females, only CPI > or = 1 and highest DMFT score were associated with the type of school, OR = 2.1 (95% CI = 1.3 to 3.3) and OR = 1.6 (95% CI = 1.2 to 2.0), respectively.

CONCLUSIONS

The type of school is a sensitive indicator of oral health status among adolescents.

Smoking and periodontal disease: clinical evidence for an association

PURPOSE

The aim of the present study was to assess the periodontal condition and smoking status, according to dose and duration information, and to estimate the percentage of subjects with periodontitis attributable to cigarette smoking in a representative adult rural population in southern Brazil.

MATERIALS AND METHODS

Bivariate statistical analysis was used to evaluate the association of smoking status with periodontitis in a cross-sectional study comprising 165 dentate individuals, aged 35 to 66 years, subjected to oral clinical examination of six sites per tooth in all sextants.

RESULTS

The prevalence of periodontitis (having > or = 1 pocket of > or = 4 mm around the index teeth) in the population was 35.2%. Overall, 13.9% had a cumulative loss of attachment > 4 mm; 35.7% of subjects were current smokers, classified as heavy (average 25.3 pack years), moderate (average 14.6 pack years) and light smokers (average 3.1 pack years). Statistical analysis showed that current smokers had an 11 times (95% confidence interval [CI] = 4.69 to 26.62) and former smokers had a nine times (95% CI = 3.29 to 25.96) greater probability of having established periodontitis compared with non-smokers. The number of pack years (P = 0.0004) and years of smoking exposure (P = 0.0013) were associated with an increased prevalence of periodontitis. The number of current smokers with periodontitis might be reduced by 80%, had they not smoked cigarettes. Of the subjects with periodontitis, 64% could be prevented among current smokers by eliminating tobacco consumption.

CONCLUSIONS

Cigarette smoking was strongly associated with periodontitis, and there was a relationship with dose and duration of smoking. These findings contributed to the evidence of smoking as a risk factor for periodontal disease and support the importance of dose-response analysis on determining the strength of this association.

Association of the metabolic syndrome with severe periodontitis in a large U.S. population-based survey

CONTEXT

Metabolic syndrome and periodontitis both have an increasing prevalence worldwide; however, limited information is available on their association.

OBJECTIVE

The objective of the study was to assess the association between periodontitis and the metabolic syndrome in a cross-sectional survey of a nationally representative sample of the noninstitutionalized civilians in the United States.

DESIGN, SETTING, AND PARTICIPANTS

Data analysis from the Third National Health and Nutrition Examination Survey on 13,994 men and women aged 17 yr or older who received periodontal examination were studied.

MAIN OUTCOME MEASURES

Association of diagnosis and extent of periodontitis (gingival bleeding, probing pocket depths) with the metabolic syndrome and its individual component conditions (central obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol, hypertension, and insulin resistance) were measured. Adjustment for age, sex, years of education, poverty to income ratio, ethnicity, general conditions, and smoking were considered.

RESULTS

The prevalence of the metabolic syndrome was 18% [95% confidence interval (CI) 16-19], 34% (95% CI 29-38), and 37% (95% CI 28-48) among individuals with no-mild, moderate, and severe periodontitis, respectively. After adjusting for confounders, participants aged older than 45 yr suffering from severe periodontitis were 2.31 times (95% CI 1.13-4.73) more likely to have the metabolic syndrome than unaffected individuals. Diagnosis of metabolic syndrome increased by 1.12 times (95% CI 1.07-1.18) per 10% increase in gingival bleeding and 1.13 times (95% CI 1.03-1.24) per 10% increase in the proportion of periodontal pockets.

CONCLUSIONS

Severe periodontitis is associated with metabolic syndrome in middle-aged individuals. Further studies are required to test whether improvements in oral health lead to reductions in cardiometabolic traits and the risk of metabolic syndrome or vice versa.

Pyogenic granuloma, peripheral giant cell granuloma and peripheral ossifying fibroma: retrospective analysis of 138 cases

AIM

The present study examined retrospectively the clinical and radiographic characteristics of pyogenic granuloma (PG), peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma (POF), located in the gingiva and alveolar ridge.

METHODS

Biopsy records of the Stomatology Service of São Lucas Hospital-PUCRS were reviewed between 1980 and 2006. The medical charts of patients with histopathologic diagnosis of PG, PGCG and POF were selected. The data obtained were evaluated by means of descriptive statistics, analysis of variance (ANOVA), and the chi-squared test (chi-squared), considering the 5% level of significance.

RESULTS

Of the 138 cases analyzed, 57.2% corresponded to PG, 22.5% to PGCG and 20.3% to POF. PG and POF exhibited a predilection for females and PGCG for males. PG occurred in younger individuals and showed a greater tendency for bleeding (P=0.018). PG showed a greater frequency of reddish color (P<0.001), PGCG purplish (P<0.001) and POF pinkish (P<0.001). In the radiographic examination, the presence of radiopaque foci was greater in POF (P<0.001), and resorption of the subjacent alveolar bone was found more often in PGCG (P<0.001). POF exhibited a longer evolution. There was no difference in lesions with respect to local irritating factors, ulceration, size, site and recurrence. Pregnancy was a factor linked to PG.

CONCLUSION

Despite the lesions investigated exhibit similar clinical characteristics, the present study demonstrated that aspects such as age of the patient and evolution, color, bleeding and radiographic characteristics can help in the differential diagnosis of these lesions.

Immediate loading in the fully edentulous maxilla without bone grafting: the V-II-V technique

AIM

The aim of this prospective study was to evaluate a new surgical approach for the immediate rehabilitation of fully edentulous maxilla without any type of bone grafting.

METHODS

The technique named ''V-II-V'' consists of an immediately loaded full-arch bridge supported by six implants. Two distal implants engage the posterior wall of the maxillary sinus, being tilted 30-45 degrees relative to the occlusal plane. Two other tilted implants engage the anterior wall of the sinus, and finally two axial implants are inserted in the anterior maxilla. An acrylic provisional restoration is delivered within 4 hours of implant placement. At each follow-up, plaque and bleeding indexes were scored, marginal bone level change around tilted and axial implants were evaluated, and a questionnaire was compiled to assess patient's satisfaction for function and aesthetics.

RESULTS

Twenty-one patients were rehabilitated. A total of 126 implants were inserted. Nineteen prostheses were in function for more than 12 months. The average follow-up was 20 months (range 4-35 months). No implant failure occurred to date, leading to 100% survival rate and 100% prosthesis success. No complication was recorded. Peri-implant bone loss at axial and tilted fixtures was similar at one year, being 0.8 mm (SD 0.4, N.=28) and.0.9 mm (SD 0.5 mm, N.=56) respectively (P>0.05).

RESULTS

The ''V-II-V'' technique is a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, avoiding bone grafting or sinus augmentation. Long-term evaluation is needed to confirm these encouraging preliminary

[Evaluation of stomatognathic system in BRCA1 gene mutation carriers before and after prophylactic adnexectomy--part II: evaluation of stomatognathic system in BRCA1 gene mutation carriers after prophylactic adnexectomy]

INTRODUCTION

Prophylactic adnexectomy is widely used for cancer risk reduction in women with BRCA1 gene mutations. Adnexectomy significantly reduces ovarian/ salpinx/peritoneum cancer risk to 5% and breast cancer risk to 30-40%. The aim of the study was evaluation of influence of prophylactic adnexectomy in BRCAI gene female mutation carriers on stomatognathic system.

MATERIAL AND METHODS

Thirty BRCA1 gene female mutation carriers aged 43-56 years, patients of the Hereditary Cancer Center in Szczecin, one year after prophylactic adnexectomy have been studied. The control group consisted the same patients, but had been studied before adnexectomy. Females with BRCA1 gene mutations have not received any hormone replacement therapy since the adnexectomy. They were divided into 2 subgroups: Y--women before menopause and Z--women aftermenopause. The complete dental exam was performed in all patients. Additionally, panoramic radiograms were performed.

RESULTS

Patients after prophylactic oophorectomy revealed higher rates of periodontal pockets 4-5 mm deep and increase of complaints such as: gingival bleeding following brushing, oral dryness and burning.

CONCLUSIONS

In conclusion, especially premenopausal women with BRCA1 gene mutations after surgical menopause should use short-term hormone replacement therapy to alleviate oral discomfort. Short-term hormone replacement therapy use does not negate the protective effect of prophylactic adnexectomy on breast cancer risk reduction in BRCA1 gene mutation carriers.

Profile of periodontal conditions in a Brazilian adult population

PURPOSE

To evaluate the periodontal condition of adult patients attending public health centres in the city of Recife, Brazil, and to investigate whether periodontal conditions are associated with socioeconomic and demographic variables.

MATERIALS AND METHODS

This cross-sectional study included 13 randomly selected public health centres. Sample size was calculated using 5.0% standard error and a confidence interval of 95%. The minimum sample size was 461 subjects, and a total of 505 subjects participated in this study. Each participant completed a questionnaire and underwent periodontal examination. Periodontal conditions were based on the Community Periodontal Index (CPI). Bivariate analysis of frequencies and means was performed with SPSS, version 11.0. The chi-square and likelihood ratio statistical tests were used to calculate the level of statistical significance of the associations tested. The level of statistical significance was set at P < 0.05.

RESULTS

Calculus was the highest CPI score in 61.8% of the subjects, and shallow pockets (4-5 mm) were the highest score in 15.2% of them. A healthy periodontium was observed in 10.7%, while gingival bleeding and deep pockets (> or = 6 mm) were found as the highest CPI score in 10.3% and 2.0% of the sample, respectively. Periodontal conditions showed significant association with the socioeconomic and demographic variables analysed (P < 0.05).

CONCLUSIONS

Findings indicate a high prevalence of periodontal alterations in the sample. Periodontal conditions were worse in men, married individuals, older subjects and individuals with low socioeconomic class and poor education.

Chemotherapy-induced oral complications in leukemic patients

The adverse effects of chemotherapy frequently involve the oral cavity, but the severity of oral complications caused by different chemotherapy protocols is unknown.

OBJECTIVE

To compare the frequency of oral complications in patients with acute lymphoblastic leukemia treated with the GBTLI-93 and BFM protocols.

PATIENTS AND METHODS

Twenty patients ranging in age from 2 to 13 years were submitted to visual and tactile examination of the teeth, periodontium and soft tissues on the day of admission and over the 3 weeks following the first phase of chemotherapy.

RESULTS

No significant difference in the proportion of patients with complications was observed between the two protocols over the 3 weeks. Complications were more frequent immediately after administration of the chemotherapeutic agents, with a gradual decline over the following 3 weeks.

CONCLUSIONS

Oral complications occur in patients with acute lymphoblastic leukemia irrespective of the chemotherapy protocol used for treatment, with a higher frequency being observed in the first week after the beginning of antineoplastic therapy.

Reactive hyperplasia of the oral cavity in Kerman province, Iran: A review of 172 cases

The purpose of this study was to present the clinical features of reactive hyperplasia among Iranian people. A series of 172 consecutive confirmed cases were studied using the database available at the Department of Oral Medicine, Kerman School of Dentistry. Reactive hyperplasia was classified into five groups: traumatic fibroma, peripheral fibroma with calcification, pyogenic granuloma, peripheral giant cell granuloma, and hyperplasia caused by dentures. Age, sex, site, clinical and radiographic findings, and outcome of treatment were recorded. Ages ranged from 5 to 79 years (mean 36). More women were affected than men (M/F 1:1.5). Pyogenic granuloma (M/F 1:2.2, chi(2)=6.4, p=0.011) and hyperplasia caused by dentures (M/F 1:3.7, chi(2)=10.9, p=0.001) were significantly more common among women. Peripheral giant cell granuloma was more common among men (M/F 1.4:1). Of the 172 cases, 111 (64%) involved the gingiva. Pyogenic granuloma more often affected the maxillary gingiva, while traumatic fibroma, peripheral fibroma with calcification, and peripheral giant cell granuloma, were more common in the mandibular gingiva. Twenty peripheral giant cell granulomas and 23 pyogenic granulomas had ulcers on the surface. A tendency to bleed was common among patients with pyogenic granuloma (n=31) and peripheral fibroma with calcification (n=12). We have confirmed that the clinical features of reactive hyperplasia among Iranians are, for the most part, similar to those reported by other investigators.

Prevalence and risk variables for peri-implant disease in Brazilian subjects

OBJECTIVES

The aim of this study was to verify the prevalence of peri-implant disease and analyse possible risk variables associated with peri-implant mucositis and peri-implantitis. The study group consisted of 212 partially edentulous subjects rehabilitated with osseointegrated implants.

MATERIAL AND METHODS

The implants placed were examined clinically and radiographically to assess the peri-implant status. The degree of association between peri-implant disease and various independent variables was investigated using a multinomial regression analysis.

RESULTS

The prevalence of peri-implant mucositis and peri-implantitis were 64.6% and 8.9%, respectively. In univariate modelling, healthy peri-implant subjects presented lower plaque scores, less periodontal bleeding on probing, and less time elapsed since placement of supra-structures. In multivariate analyses, the risk variables associated with increased odds for having peri-implant disease included: gender, plaque scores, and periodontal bleeding on probing. Presence of periodontitis and diabetes were statistically associated with increased risk of peri-implantitis. The only two factors, which did not contribute to the presence of the disease, were the time elapsed since placement of supra-structures and the frequency of visits for maintenance care.

CONCLUSION

Our data suggest that subjects with periodontitis, diabetes, and poor oral hygiene were more prone to develop peri-implantitis.

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants

OBJECTIVE

To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis.

MATERIAL AND METHODS

For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms.

RESULTS

The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant.

CONCLUSION

Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

Oral health status of homeless people in Hong Kong

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT = 3.2, MT = 5.2, FT = 0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.