Showing papers in "Community Dental Health in 2009"

Oral health in German children, adolescents, adults and senior citizens in 2005.

Abstract: Objective The aim of this field study (the "Fourth German Oral Health Study") was to obtain representative data on caries (DMFT index), periodontitis (CPI) and prosthetic status in the German population and to evaluate changes in the oral health of the German people as compared with the findings of the Third German Oral Health Study conducted eight years previously Basic research design The study took the form of a population-representative cross-sectional survey with random samples, and was complemented by a questionnaire to reveal sociological as well as behavioural data Participants The age cohorts in the present study were 12-year-olds (children), 15-year-olds (adolescents), 35- to 44-year-olds (adults) and 65- to 74-year-olds (senior citizens) Results All age groups showed considerable improvements in oral health with respect to caries Of the children, 701% were free of dentine caries and the mean DMFT value was 07 In adults and senior citizens both the DMFT value and the number of missing teeth and edentulousness declined With regard to periodontal conditions, increasing prevalence of moderate and severe findings was recorded in adults and senior citizens, owing probably to the larger number of natural teeth remaining in the oral cavity Conclusion The study documents a distinct improvement in oral health in the German population Interrelated with the higher numbers of remaining natural teeth a higher prevalence of moderate and severe periodontal conditions in German adults and senior citizens was observed

Sense of coherence associates with oral and general health behaviours.

Abstract: Objective: Our aim was to investigate the mutual relationship between oral and general health behaviours and oral and general subjective health among adults, and to explore whether sense of coherence (SOC) could be a common health-promoting correlate for them. Participants: The present study included data for 4,096 30- to 64-year-old dentate adults (2,177 females and 1919 males). Basic research design: In the nationally representative, cross-sectional sample including 8,028 persons aged 30, or more, 88% were surveyed. The questionnaire and home interview included information about socio-economic and demographic factors, behavioural and psycho-social variables. Chisquare test and logistic regression models were used in the data analysis. Main outcome measures: The main outcome measures were oral health behaviours (regular dental attendance, twice a day tooth-brushing frequency), general health behaviours (non-smoking habits, physical activity at least twice a week), subjective oral and general health and the SOC (12-item) scale. Results: Among females, positive health behaviours tended to occur together significantly more often than among males. Thus, 83 % of females with more than once a week physical exercise frequency, and 79 % of the non-smoking females, brushed their teeth at least twice a day, while the corresponding figures for the males were merely 55 % and 50 %. A strong SOC was associated with uniformly positive health behaviours and subjective oral and general health. Conclusions: Our results suggest that a strong SOC has a universal positive association with several health behaviours and subjective health measures, also concerning oral health. Thus, the role of psycho-social factors should not be underestimated in health promotion.

Relationships between patient characteristics and reasons for tooth extraction in Japan.

Abstract: OBJECTIVES The purpose of this study was to examine the relationships between patient characteristics and reasons for extraction of permanent teeth. METHODS 5131 dentists were selected from the list of the membership directory of the Japan Dental Association by systematic random selection. The dentists were asked to record the reason for each extraction of permanent teeth during a period from February 1 to 7, 2005. Reasons for tooth extraction were assigned to five groups: caries, fracture of teeth weakened by caries or endodontics, periodontal diseases, orthodontics and other reasons. We used cross tabulation and multiple logistic regression analysis to estimate the relationships between patient characteristics and reasons for tooth extraction. RESULTS 2001 dentists (response rate of 39.0%) returned the forms, and complete information on 7333 patients was obtained. A total of 3,196 (43.6%) patients underwent tooth extraction due to caries and its sequela, and 2721 (37.1%) patients underwent tooth extraction due to periodontal disease. Multiple logistic regression analysis showed that denture wearers were more likely to undergo tooth extraction due to periodontal disease in all age groups (p < 0.05). Males tended to undergo tooth extraction due to periodontal disease than did females in all age groups (p < 0.05) except for age group 30-49. Subjects with 19 or less teeth were more likely to undergo tooth extraction due to periodontal disease in the age groups 30-49 (p < 0.001) and 50-69 (p < 0.001). In the age group of 50 years or older, female (p<0.01) and the possession of 20 or more natural teeth (p < 0.05) were related to caries extraction. However, there was no clear relationship between caries extraction and patient characteristics under 50 years old. CONCLUSION There was a significant relationship between denture wearing and periodontal extraction. In the middle aged population, patients with 19 or less teeth lost their teeth mainly due to periodontal disease.

Childhood growth and dental caries.

Abstract: Objectives: The aim of the study was to examine whether the removal of carious teeth affected children's growth relative to that of a standard population. Design: Longitudinal prospective observational study. Setting: Manchester Dental Hospital (MDH), UK. Participants: Five and six year- old children who attended for extraction of carious teeth under general anaesthesia. Main outcome measure: Change in height, weight and BMI standard deviation scores during the six months after extraction of carious teeth. Methods and materials: The children's dental caries levels, weight and height were measured prior to extraction using standard criteria and a single trained examiner and they were then re-measured six months later. The body mass index of the children was calculated and all measurements were converted to standard deviation scores (SDS) using the UK 1990 growth reference. Changes in growth SDS during the six months subsequent to the extractions were then calculated. Results: Two hundred and eighteen children, mean (range) age 5.9 (5-6) were examined initially, of whom 131 were successfully followed up a mean 7.1 (0.13) months later. The participants had a mean dmft of 7.18 (SD 3.27) at baseline and were not shorter than expected (8.3% <10 th percentile), or more underweight (6.9% <10 th percentile for weight). At follow up children showed a statistically significant gain in BMI SDS (mean (SD) 0.26 (37) p<0.001) and a small gain in height SDS (0.05 (0.38) p=0.05). Conclusion: This study suggests that the extraction of carious teeth in five and six year old children promotes weight gain and possibly growth.

Dental caries prevalence and distribution among preschoolers in Singapore.

Abstract: Objective To describe the prevalence, severity and distribution of dental caries among preschoolers in Singapore Basic research design population-based, cross-sectional study Setting 13 randomly selected People's Action Party Community Foundation (PCF) Education Centers, the main provider of preschool education in Singapore Participants 1782 children aged 3-6 years Main outcome measures The caries status was evaluated by using WHO examination procedures and diagnostic criteria Results About 40% children (26%, 37%, and 49% for 3-4, 4-5, and 5-6 year-olds, respectively) were affected by caries The mean (SD) deft and defs were 154 (275) and 330 (749), respectively About 90% of the affected teeth were decayed teeth A significantly skewed distribution of caries lesions was revealed, indicating that 16% children with high caries activity (deft > or =4) were carrying 78% lesions Rampant caries, defined as caries affecting the smooth surfaces of two or more maxillary incisors, was found in 165% of children About 61% of affected surfaces were smooth surfaces Malays and boys tended to have more rampant caries Higher caries severity and treatment need were found among Malays and children in the low socio-economic group Conclusions Caries is a severe oral health problem for Singaporean preschoolers, especially in the Malay community and among children with low economic status

Opportunities and challenges to promoting oral health in primary schools.

Abstract: Inequalities in oral health in areas of socio-economic disadvantage are well recognised. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. However, to what extent schools are able to do this is unclear. The aim of this study was therefore to investigate opportunities and challenges to promoting oral health in primary schools. METHODS: A purposive sample of 20 primary schools from socially and economically disadvantaged areas of Cardiff, UK were selected to participate in this qualitative study. Data were collected through semi-structured interviews conducted with head teachers or their nominated deputies. RESULTS: General awareness of health and oral health was good, with all schools promoting the consumption of fruit, water and milk and discouraging products such as carbonated drinks and confectionaries. Health promotion schemes wereimplemented primarily to improve the health of the children, although schools felt they also offered the potential to improve classroom behaviour and attendance. However, oral health was viewed as a separate entity to general health and perceived to be inadequately promoted. Successful health promotion schemes were also influenced by the attitudes of headteachers. Most schools had no or limited links with local dental services and, or oral health educators, although such input, when it occurred, was welcomed and highly valued. Knowledge of how to handle dental emergencies was limited and only two schools operated toothbrushing schemes, although all expressed an interest in such programmes. CONCLUSION: This study identified a positive predisposition to promoting health in primary schools. The challenge for the dental team, however, is to promote and integrate oral health into mainstream health promotion activities in schools. The paper also makes recommendations for further research.

Prevalence of enamel defects related to pre-, peri- and postnatal factors in a Brazilian population.

Abstract: Objectives The aim of this paper is to evaluate the prevalence of enamel defects in infants from a socially and economically poor population and the possible association of these defects with disturbances occurring in the pre-, peri- and postnatal periods of human development. Participants 117 infants aged between 16 and 18 months old were included in four groups based on gestational age and whether part or full term pregnancy. Method The data were collected in two stages: hospital-based, where gestational and birth records were examined, and home-based, where dental examinations and nutrition were evaluated. The teeth were cleaned and dried with gauze and examined in the open air, avoding direct sunlight in the knee-to-knee position. The enamel defects were coded according to the modified Developmental Defects of Enamel Index. Besides this, body weight and height were considered as anthropometric measures for the evaluation of nutritional status by the National Center for Health Statistics standards. Main outcome measures The data were analyzed using the chi-square and Fisher Exact tests. Besides these tests, logistic regression models were used. Results The prevalence of enamel defects was 49.6%, higher in the group of male infants (p<0.001). The most frequent type of defect and the most affected surface were, respectively, diffuse opacity (9.5%) and the buccal surface (83.3%), located in the gingival half (6.7%). The logistic regression model showed that educational level, gestational age and intrauterine growth retardation (IUGR), besides a lack of breastfeeding, increased the probability of enamel defects up to level of 5%. Conclusions The association between enamel defects and the etiologic factors shown in this study suggest the existence of social influences regarding oral health and teeth development.

Early childhood caries and related risk factors in Mongolian children.

Abstract: Objectives: The aims of this study were to investigate the dental caries experience among 1-5 year-old children in the two areas of Ulaan- baatar city, and to examine the relationship of dental caries experience with socioeconomic status, eating behaviors, oral hygiene habits, dental plaque accumulation and Mutans Streptococci level. Methods: In 2004/2005, 670 children from the two areas were examined and a questionnaire survey was conducted. Mutans streptococci (MS) levels in the children's and mothers' dental plaque were evaluated using Dentocult® SM. Results: Dental caries prevalence (72%) and mean dmft (4.4) were very high in both areas, however, children in the central area showed higher caries severity than those in the suburban area in 3-5-year olds (p<0.05). Higher family income and education level of the mothers were significantly associated with children's higher caries experience. Furthermore, dental caries showed a significant positive relationship with sweets intake and a negative relationship with tooth brushing habits of the children. The children's caries experience was significantly and positively associated with modified debris index (m-DI) scores, and the MS levels in their own and their mothers' dental plaque. Area, sweets intake, prolonged breastfeeding, and high MS level in the dental plaque resulted in significant odds ratios for the development of caries. Conclusions: The prevalence of dental caries amongst 1-5 year-old children in Ulaanbaatar City, Mongolia was found to be high and was associated with socioeconomic, demographic and behavioural factors.

Rural Mexican immigrant parents' interpretation of children's dental symptoms and decisions to seek treatment.

Abstract: Objective: Mexican-origin children have higher rates of decay and lower dental utilization rates than children from all other racial/ethnic groups. Different cultural groups' interpretations of dental symptoms illuminate their different decision-making process about seeking care. Through ethnography in a small rural U.S. city, we examined low-income Mexican immigrant caregivers' interpretations of their children's dental symptoms and evaluations of the need for treatment. Basic Research Design: We conducted 49 in-depth interviews with 26 Mexican immigrant caregivers about their perceptions of their children's dental symptoms, and observations of five such caregivers' help-seeking episodes and 30 other caregivers' presentation of their children's symptoms at dental clinics. All interviews and fieldnotes were analyzed qualitatively through a series of readings and codings. Results: A conceptual model of caregivers' decision-making processes was developed. Most caregivers deduced the health of teeth from visible appearance, and thus children's complaints of pain alone were often ineffective in triggering a dental visit. Caregivers often delayed treatment because they viewed their children's oral disease as mere "stains" requiring cleaning rather than as bacterial infections requiring restorative treatment. Parents appeared to confuse carious "stains" with fluorosis stains common in rural Mexico. Conclusions: Even when Mexican immigrant caregivers recognize a dental problem, they often misinterpret it as a "stain." Caregivers' interpretations of decay were shaped by their lack of experience with children's decay in rural Mexico. Oral health education programs should help rural immigrant caregivers distinguish between "stains" and "cavities," and understand the heightened oral hygiene requirements of the cariogenic diet in industrialized countries.

Differences in oral health behaviour between children from high and children from low SES schools in the Netherlands

Abstract: 4Objective To identify the determinants of dental caries in relation to socio-economic status (SES) within oral health, children’s eating habits and parental attitudes towards oral health Basic research design Dental screening data were collected from 6- and 10- year old schoolchildren from low and high SES schools in the Netherlands in this cross-sectional study Methods The clinical examination was performed by trained dental hygiene students who collected the data on dental caries, dental plaque and duration of brushing The paper questionnaire completed by the parents included 18 questions about oral health behaviour, eating habits and parental attitudes towards oral health Results Two of the six parameters of oral health behaviour were statistically associated with the high caries prevalence in the low SES group (brushing frequency (p = 0028) and age at the first visit to the dentist (p = 0044)) High intake of fruit juices and/or soft drinks (p = 0043) and low calcium intake (p = 0028) were identified as risk determinants for caries with low SES All parameters of parental attitudes towards oral health were associated with caries, but not with SES Conclusions This study confirmed that the high caries prevalence in children from low SES schools was associated with oral health behaviour and eating habits The role of parents was indirectly associated with the occurrence of dental caries Therefore, it is important to include parents in all intervention programmes in order to reduce the prevalence of caries

Orthodontic treatment need and oral health-related quality among children

Abstract: Objectives: To determine the association between the impact of oral health on quality of life (OHQoL) among children and their need for orthodontic treatment. Methods: Children (217) were screened for orthodontic treatment need using a number of professionally derived indices: Index of Orthodontic Treatment Need (IOTN) - Aesthetic Component (AC) and Dental Health Component (DHC); Index of Complexity, Outcome and Need (ICON) and the Dental Aesthetic Index (DAI). In addition, all children self-completed the 37-item Child Perception Questionnaire (CPQ), a measure of OHQoL, to assess Oral Symptoms (OS) experienced, Functional Limitation (FL), Emotional Well Being (EWB) and Social Well Being (SWB). Results: Different prevalence of orthodontic treatment need was observed depending on occlusal indices used (ranged from 31.6% to 85.9%). However, there were significant correlations between the different occlusal indices (p<0.01). Significant differences in overall CPQ scores existed between those with and without an orthodontic treatment need irrespective of occlusal indices used to categorize treatment need (p<0.05); Effect sizes ranged from 0.24 to 0.51. However no single index's categorization of treatment need could identify variations in all of CPQ domain scores (OS, FL, EWB and SWB). Conclusion: Different occlusal indices (AC, DHC, ICON and DAI) prescribe a different prevalence of orthodontic treatment need. Those categorized as having an orthodontic treatment need by AC, DHC, ICON and DAI criteria had poorer overall OHQoL compared to those ascribed as not having a treatment need. None of the occlusal indices could comprehensively differentiate poorer OHQoL across all its domains.

Hopelessness, depression and oral health concerns reported by community dwelling older Australians.

Abstract: Objectives The purpose of this analysis was to explore whether, and if so to what extent, there is an association between self-reported oral and mental health problems, and if this association exists after controlling for self-rated physical health and age. Research design A large cross-sectional population-based telephone health survey with participants selected using random stratified sampling. The response rate was 71%. Survey weights were used for estimating proportions and for all statistical inferences. Setting and participants Participants (n=8,881) were community-dwelling older people (65+ years) living independently in New South Wales, Australia. Measures and analysis The following measures were used in the analysis: physical health (1 item); oral health (5 items), mental health (2 items). Trends in prevalences across groups were analysed using the Cochrane-Armitage trend test. Logistic regression modelling was conducted to account for the main confounders of age and self-rated physical health, and attributable fractions calculated. Results Both measures of mental health, feeling hopeless and feeling depressed, were significantly and positively associated with increased reporting of oral health concerns in both males and females. Logistic regression modelling showed that most of the oral health items remained strongly associated with mental health after controlling for self-rated physical health and age. The attributable fractions demonstrated that a proportion of the mental health problems identified in older people would be reduced if oral health concerns were adequately addressed. Conclusions The findings highlight the association between oral and mental health, and provide evidence to support the expansion of publicly funded dental health services.

Association of urgent dental care with subjective oral health indicators and psychosocial impact.

Abstract: UNLABELLED Pressures on public dental services require new approaches to managing demand. OBJECTIVE To identify possible predictors of urgency of clinically assessed emergency dental care using self-reported oral health indicators. DESIGN AND METHODS This study was a prospective study examining associations between patient reports of oral health indicators and psychosocial impact of oral disorders and a clinical determination of a hierarchy of urgency of emergency dental care. The data set comprised a random sample of 839 eligible adults presenting to nine public dental clinics across South Australia and New South Wales for emergency dental care. All participants held a government health concession card and were aged 18+ years and had a minimum of six natural teeth. Significant associations between self-reported oral health indicators and psychosocial impacts and a normative clinical assessment of urgency of emergency dental care were examined by means of binary logistic regression analysis in order to develop prediction models. Prediction of the urgency of emergency dental care was based on the assessment of two models--Model 1: urgency of care = <48 hours vs. 2+ days, Model 2: urgency of care = 2-7 days vs. 8+ days. RESULTS Some 35.8%, 34.8% and 29.4% of respondents were classified by the assessing dentist as requiring dental care within 48 hours, 2-7 days and 8+ days respectively. For Model 1, difficulty sleeping all the time (OR = 4.8, CI = 3.0-8.0), pain in the jaw when opening wide (OR=2.4, CI=1.6-3.7), having a broken filling (OR = 1.7, C1 = 1.1-2.4), having a loose tooth (OR = 2.4, CI = 1.5-3.8), bleeding gums (OR = 0.7, CI = 0.5-1.0) and being dentally anxious (OR = 1.5, CI = 1.0-2.3) had a statistically significant association with needing to be seen within 48 hours. For Model 2, factors significantly associated with an urgency of care in the period 2-7 days included experience of toothache (OR = 2.6, CI = 1.6-4.3), pain in teeth with hot food or fluids (1.9, CI = 1.2-2.9), bleeding gums (OR = 2.0, CI = 1.3-3.2), having a broken filling (OR = 2.1, CI = 1.2-3.5), difficulty sleeping all the time (OR = 2.9, CI=1.4-6.4), and being concerned about the appearance of teeth or mouth very often (OR=0.3, CI = 0.1-0.7). CONCLUSION This study has identified a pertinent set of self-reported oral health indicators that can be used to predict the urgency of emergency dental care.

The prevalence and severity of dental fluorosis in the high and low altitude parts of Central Plateau, Nigeria.

Abstract: Objective To compare the prevalence and severity of dental fluorosis in the high and low altitude parts of the Central Senatorial District of Plateau State. Basic research design The study was cross-sectional and descriptive. Setting The community based study was carried out in Central Plateau Nigeria, in 2005. Participants The study subjects were 12-15 year old life long residents selected using the multistage sampling technique. One Local Government Area each was randomly selected from the high and low altitude parts of the district and from each selected Local Government Area two health districts were randomly selected with probability proportional to size. From each of the selected health Districts two major settlements were selected again with probability proportional to size. 12-15 year old life long residents of the selected settlements were studied. Each respondent completed an interviewer administered questionnaire after which he/she was clinically examined to ascertain his/her fluorosis status. Samples of water were collected from water sources consumed by the respondents in each settlement. Main outcome measures The main outcome measures were presence and severity of dental fluorosis as measured by the Thylstrup and Fejerskov index. (TF score). Results One thousand one hundred children were studied, 554 (50.4%) from the high altitude part of the district and 546 (49.6%) from the low altitude part. Fluorosis prevalence was 12.9% in the district, but significantly higher (22.2%) in the high altitude areas compared to the low altitude ones (3.5%). The severest form of fluorosis in the district was TF 6 for tooth 14 and TF 5 for tooth 11. Conclusion The prevalence and severity of dental fluorosis is significantly higher in the high altitude parts of the District compared to the low altitude ones. Efforts are needed to further investigate and control the problem.

Deprivation and access to dental care in a socially diverse metropolitan area.

Abstract: BACKGROUND Primary Care Trusts (PCTs) in England have a responsibility to ensure that the oral health needs of their residents are addressed. This will involve monitoring the uptake of primary dental care and developing services to address local needs and demands. OBJECTIVE To examine the relationship between dental registration, age, gender and deprivation at ward and borough level within a socially diverse metropolitan area. METHODS This retrospective, cross-sectional ecological study was conducted using ward level registration data for residents of south east London from the Dental Practice Board, population data from the Office of National Statistics and the Index of Multiple Deprivation (IMD) from the Office of the Deputy Prime Minister. Registration rates were calculated at ward level for the population as a whole and for specific age bands. The correlation with deprivation was examined using Pearson's correlation co-efficient and the data mapped. RESULTS Registration varied by gender (40% females registered compared with 35% males) and age (children aged 6-12 years (62%) were most likely to be registered and 0-2-year-olds least likely (11%). There was a strong negative correlation between deprivation (IMD) and registration in the 0-5 year (r = -0.82; p < 001) and 6-17 year (r = -0.81; p < 0.001) age-bands across the sector and similarly within each borough. The negative correlation was most marked in the most affluent borough (r = -0.87; p < 0.001). CONCLUSION Analysis of registration for dental care across a socially diverse area reveals a strong negative correlation between NHS service uptake and deprivation status amongst children only. Inequalities in service utilisation by children were most marked within affluent boroughs, compared with deprived boroughs.

Factors influencing the need for dental care amongst the elderly in the Republic of Ireland.

Abstract: Objective To identify the socio-economic, demographic and behavioural determinants of dental treatment needs of those aged 65 and over in the Republic of Ireland. Design The treatment needs data is based on detailed clinical oral examinations in the NSAOH carried out between October 2000 and June 2002. To determine factors influencing treatment needs, three measures are used: a dichotomous variable expressing the need for any dental treatment, a dichotomous variable expressing the need for dentures, and a dichotomous variable expressing a Community Periodontal Index of Treatment Need (CPITN) score of three or greater representing a need for periodontal treatment. Methods Factors such as age, gender, dental services eligibility status, fluoridation, employment status, educational attainment, anxiety about dental visits, frequency of brushing, and attendance patterns were regressed on a dichotomous version of prevalence of Decayed Missing Filled Surfaces, DMFS including the visual component, and CPITN scores. Associations were estimated using multivariate logistic regression and expressed as odds ratios (OR) with 95% confidence intervals (CI). Goodness of fit was evaluated by estimating sensitivity, specificity, positive/negative predictive values and accuracy. Results Being female, smoking, frequent snacking and anxiety about dental visits increased the odds of having a periodontal treatment need. Having primary education only, and being a smoker increased the odds of having a need for any treatment including dentures, whereas being female, regular usage of dental services, and access to fully fluoridated water supplies reduced the odds. Conclusions Socio-economic factors such as lower levels of educational attainment, demographic factors such as age and gender and not having access to fully fluoridated water supplies, and behavioural factors such as smoking, frequent snacking, anxiety about dental visits, influence above average treatment needs amongst the elderly in the Republic of Ireland.

Quality of life in patients with dental conditions: comparing patients' and providers' evaluation

Abstract: Objective To measure the agreement between patients and their caregivers in evaluating patients' oral quality of life. Basic research design Cross-sectional study. Clinical setting Data collected in four Swedish dental clinics in 2004. Participants Consecutive patients. Data were completed for 444 patients. Fifteen dentists and 12 dental hygienists agreed to participate. Interventions For each patient, the patient him/herself and his/her caregiver completed the 14-item Oral Health Impact Profile (OHIP-14), a specific instrument used to measure quality of life in oral conditions, with higher scores indicating a worse quality of life. Information on personal and clinical characteristics of patients were also collected. Main outcome measures Median OHIP-14 scores given by caregivers and patients were calculated and compared in different subgroups of patients. Cohen's kappa was calculated to measure the agreement between the evaluation of patients and caregivers. Results OHIP-14 scores median values were 3.0 among patients and 9.0 among caregivers. Caregivers always gave a higher score than patients, especially in older patients and patients with lower education. The concordance between patients' and caregivers' evaluation was very low (for different OHIP-14 cutoffs: Cohen's kappa from 0.10 to 0.15). Conclusions In this study, great discrepancies were observed between patients and caregivers in the evaluation of patients' oral quality of life, with caregivers overestimating the burden of dental conditions on patients. It is important to improve patient-caregiver communication, in order to increase patient satisfaction and provide better care. A good patient-caregiver relationship is essential for the patients' well-being and their adherence to treatment.

Evaluation of the direct and diffusion methods for the determination of fluoride content in table salt.

Abstract: Objective: The aim of this study was to assess methods currently used for analyzing fluoridated salt in order to identify the most useful method for this type of analysis Basic research design: Seventy-five fluoridated salt samples were obtained Samples were analyzed for fluoride content, with and without pretreatment, using direct and diffusion methods Element analysis was also conducted in selected samples Fluoride was added to ultra pure NaCl and non-fluoridated commercial salt samples and Ca and Mg were added to fluoride samples in order to assess fluoride recoveries using modifications to the methods Results: Larger amounts of fluoride were found and recovered using diffusion than direct methods (96%-100% for diffusion vs 67%-90% for direct) Statistically significant differences were obtained between direct and diffusion methods using different ion strength adjusters Pretreatment methods reduced the amount of recovered fluoride Determination of fluoride content was influenced both by the presence of NaCl and other ions in the salt Conclusion: Direct and diffusion techniques for analysis of fluoridated salt are suitable methods for fluoride analysis The choice of method should depend on the purpose of the analysis

Caries prevalence and fluoride use in low SES children in Clermont-Ferrand (France).

Abstract: Objective To evaluate the association between dental caries experience and preventive behaviours of children residing in a deprived area in Clermont-Ferrand (France) Participants and methods All 4-5 yr-olds attending nine schools in deprived areas of the city were invited to participate and 81% (n=282) consented and were examined Dental caries was recorded at the dentine threshold Parents completed a questionnaire concerning family demographics and the child's use of fluoride Non-parametric tests and logistic regression assessed the relative importance of SES and fluoride variables on dental status (dt>1) Results Fifty four (19%) of the examined children were living in families with an immigrant background, 33% were fully covered by the national health insurance programme for deprived families Caries experience was high; mean dft was 194 (331) and 30% of the children had >1 carious teeth Thirty percent of the families reported using fluoridated salt Tooth brushing once daily was reported for 39% and twice daily for 26% Parents declared supervising tooth brushing for 60% Two thirds of the children, according to their parents, used fluoride supplement between birth and two years Supervised tooth brushing was significantly correlated with lower mean dt scores Systemic fluoride use was poorly related to dental caries Immigrant background, family size, type of health insurance and mother's unemployment were significantly correlated with caries prevalence In multivariate analysis, immigrant status, supervised tooth brushing and parental knowledge about fluoride in toothpastes were significant caries predictors Conclusions The majority of low SES children did not practice effective caries prevention; few reported twice daily brushing with fluoride toothpaste Caries experience was very high and much was untreated Immigrant status, supervised tooth brushing and parental knowledge about fluoride in toothpastes were significant caries predictors

Fluoride toothpaste utilization behaviour among preschool children in Perlis, Malaysia.

Abstract: Background Very mild fluorosis is quite prevalent in children and one of the sources may be attributed to poor fluoride toothpaste utilization habits. Aim To investigate the frequency of toothbrushing, parental supervision, the person who usually applied the toothpaste, toothpaste swallowing and spitting habits, size of toothbrush, type of toothpaste used and amount of toothpaste used by shape and weight. Methodology Observational cross-sectional study of a representative random sample of 373 children aged 5-6 year-old. The children were interviewed using a structured close ended questionnaire. Direct observations were made on their toothpaste dispensing habit during a toothbrushing exercise. Results All children reported practising toothbrushine with 90 on a daily basis. Almost all used fluoridated toothpaste (91.4). About one-half (50.7) reported that their parents never supervised them. More than one-third of children used adult toothpaste and 60.1 of the toothpaste was flavoured. Most (92) used toothbrush meant for children. About 40 applied a pea-sized amount of toothpaste. The mean weight of toothpaste applied was 0.43g (SD+0.35g). Conclusions The majority used the recommended child-sized toothbrush and toothpaste that contained fluoride but less than one-half of the parents supervised their children. Most children used flavoured children's toothpaste but a sizable proportion used toothpastes meant for adults. The amount applied by shape and weight exceeded the amount recommended by experts.

The prevalence of dental caries and fissure sealants in 12 year old children by disadvantaged status in Dublin (Ireland).

Abstract: OBJECTIVE The aim was to record dental caries levels and the presence of fissure sealants in 12-year-old schoolchildren whose domestic water supply had been fluoridated since birth in Dublin (Ireland). RESEARCH DESIGN Cross-sectional study. Participants A representative, random sample of 12-year-old schoolchildren in north-west Dublin. OUTCOME MEASURES Dental caries levels were recorded using WHO criteria and fissure sealant was recorded when sealant was detectable on a permanent molar tooth. Medical card ownership, as a surrogate for disadvantage, was recorded by use of a questionnaire. RESULTS Three-hundred and thirty-two (332) children were examined. The mean DMFT was 0.80 (SD 1.24). Analysis (Mann-Whitney U test) based on stratification of the sample according to medical-card status revealed no statistically significant difference between DMFT median scores of children of medical-card holders (i.e., social disadvantage background) and non medical-card holders (p-value = 0.23). However, the data revealed a social gradient in the presence of at least one fissure sealant. Approximately 10% more children in the group of medical-card holders had no fissure sealants present. Fisher's exact test was used to examine the association between the absence of fissure sealants and at least one fissure sealant between the two groups and was considered to be statistically significant (p-value = 0.04). CONCLUSION This study demonstrated a social gradient in the presence of fissure sealants, but no such gradient in dental caries levels. This demonstrates the importance of population-based measures in the prevention of dental caries, such as water fluoridation, in reducing oral health inequalities.

Higher-order exploratory factor analysis of the Dental Subscale of Children's Fear Survey Schedule in a Taiwanese population.

Abstract: Objectives: The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is extensively used to assess the level of child dental anxiety. The present study aimed to explore the higher-order factor structure of the parental Chinese version of the CFSS-DS with a large sample of young children in Taiwan. Design: The parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5 to 8- year-old children at kindergartens and elementary schools in Kaohsiung city, Taiwan. Subjects were selected by stratified random sampling. The stratification was done by geographic district, age group, and gender. Participants: The sample was 1,819 children aged 5 to 8 years old. Main outcome measures: A first-order factor analysis was performed using the principal components method with promax rotation, and a second-order factor was obtained by applying the Schmid-Leiman solution (SLS). Results: The present study found three first-order factors, defined as: (1) fear of dental aspects, (2) fear of medical aspects, and (3) fear of potential victimization. The second-order factor defined as "dental fear" accounted for most of the variance in the second-order factor structure. The results of higher-order factor analysis according to different gender or age levels were identical. Conclusions: A higher-order factor structure consisting of a single second-order factor and three first-order factors was extracted, giving a fuller understanding of the CFSS-DS. The second-order factor structure of Chinese version CFSS-DS was stable and reliable.

Racial and ethnic differences in a regular source of dental care and the oral health, behaviors, beliefs and services of low-income mothers.

Abstract: Objective In a racial/ethnically-diverse sample of low-income mothers of children aged 3-6, we determine: (1) whether a regular source of dental care (RSDC), self-rated oral health, beliefs and behaviors differ by racial/ethnic group; (2) estimate whether a RSDC is associated with oral health, beliefs and behaviors, and whether these associations differ by racial/ethnic group; and (3) examine these relationships for mothers' dental utilization. Basic research design Cross-sectional survey. Participants From a population of 108,151 Medicaid children aged 3-6 in Washington state, U.S., 10,909 eligible children were sampled stratified by racial/ethnic group. Eligible mothers completed a mixed-mode survey in the following groups: Black (n=818), Hispanic (n=1310), or White (n=1382). Main outcome measures Measures were mothers' RSDC, personal characteristics, self-rated dental health, appearance of teeth, dental problems, brushing duration, flossing frequency, use of toothpicks or whiteners, belief that cleaning prevents cavities or loose teeth, and self-reported services at last dental visit. Results About 38-40% of mothers had a RSDC. For Black, Hispanic and White mothers, having a RSDC was associated consistently with better oral health, greater likelihood of a dental cleaning and less likelihood of tooth extraction. RSDC was not associated generally with oral health beliefs and behaviors. Oral health behaviors differ by racial/ethnic group. Conclusions Relationships between RSDC and self-reported oral health, health behaviors, beliefs and dental services are similar for Black, Hispanic and White low-income mothers of young children. Oral health behaviors differ across racial/ethnic groups, which may have implications for mother and child oral health.

Predicting relative need for urgent dental care

Abstract: OBJECTIVE: To develop prediction models of the relative need for care to differentiate between urgent and not urgent individuals presenting for emergency dental care. DESIGN AND METHODS: Data were collected from 839 adults presenting to public dental clinics across South Australia (SA) and New South Wales (NSW) for emergency dental care. Prediction of the urgency of emergency dental care was based on the assessment of two binary logistic regression models - Model 1: urgency of care= or =0.40 and > or =0.50 for Model 1 and Model 2 respectively. These cut-off values were chosen as they produced test results that were consistent with the proportions of patients falling into various urgency categories derived from dentist's assessment of urgency. Model 1's sensitivity was 58%, specificity 77% and positive predictive value (PPV) 59%. Model 2's sensitivity was 75%, specificity 65% and PPV 71%. CONCLUSIONS: These models of relative need may be useful tools for the screening of urgent dental care and for allocating priority among patients presenting for emergency dental care.

Development of a psychometric scale to assess satisfaction with dental care among Sri Lankans.

Abstract: Objective: To develop and validate a psychometric scale to assess dental satisfaction among Sri Lankans Design: A population based cross sectional study, where the data were collected by a postal questionnaire A 22-item scale was developed to measure dental satisfaction Participants: 1,000 Sri Lankans aged 18-75 years, selected by cluster sampling with probability proportionate to size technique, using National Voters' register Outcome measures: Reliability of the scale was assessed by internal consistency using Cronbach's alpha and corrected item-total correlations Construct validity was determined by factor analysis and acceptability was assessed by percentage of item-specific non-response Results: The overall response rate was 309% Among respondents, analysis was limited to dental care users within two years (n=117) Item-specific non-response was low, ranging from 34% to 94% Four (negatively worded) items were removed from the scale due to poor internal consistency (corrected item-total correlations <02) After removal, corrected item-total correlations of remaining 18 items were improved, ranging from 023 to 076 Factor analysis revealed a four factor solution, interpreted as: "outcome of care/clinic context" (8-items), "factors related to treatment process" (7-items), "convenience" (2-items) and "cost of care" (single item) Identified factors explained 6456% of the variance of the scale The Cronbach's alpha values for the first three dimensions were 090, 087 and 060 respectively and for the overall construct it was 091 Conclusions: The present scale appeared to be a valid and reliable instrument for measuring dental satisfaction among Sri Lankans, but merits further refinements to explore detailed aspects of it

The contributions of Edward H. Angle to dental public health.

Abstract: The genius of Edward Hartley Angle, (1855-1930), the founder of the dental specialty of orthodontics, to create order from chaos in the study and treatment of positional discrepancies of the teeth, jaws and face advanced greatly the cause of dental public health. Angle's innovations that had the most public health impact were (1) his identification of dental occlusion, not simply tooth irregularity, as a prime concern, (2) his development of an uncomplicated classification system for occlusal conditions, (3) his introduction of prefabricated orthodontic appliances and (4) his framing of orthodontics as a dental specialty by organizing the world's first educational program to train orthodontists.

Measurement of attitudes of UK dental practitioners to core job constructs.

Abstract: OBJECTIVES To develop a measure to identify dental practitioner attitudes towards core job dimensions relating to job satisfaction and motivation and to test this against practice characteristics and provider attributes of U.K. practitioners. RESEARCH DESIGN an 83-item questionnaire was developed from open-ended interviews with practitioners and use of items in previously used dentist job satisfaction questionnaires. This was subsequently sent to 684 practitioners. Item analysis reduced the item pool to 40 items and factor analysis (PCA) was undertaken. RESULTS 440 (64%) dentists responded. Factor analysis resulted in six factors being identified as distinguishable job dimensions, overall Cronbach's alpha = 0.88. The factors were: 'restriction in being able to provide quality care (F1)', 'respect from being a dentist (F2)', 'control of work (F3)', 'running a practice (F4)', 'clinical skills (F5)', and 'caring for patients (F6)'. All six factors were correlated with a global job satisfaction score, although F1 was most strongly related (r = 0.60). Regression model analysis revealed that 'whether the dentist worked within the National Health Service or wholly or partly in the private sector' (p < 0.001), 'time since qualification' (p = 0.009), and the position of the dentist within the practice (whether a practice owner or associate dentist), (p = 0.047) were predictive of this factor. CONCLUSIONS Six core job constructs of U.K. practitioners have been identified, together with several practice characteristics and practitioner attributes which predict these factors. The study demonstrates the importance of refining measures of dentists' job satisfaction to take account of the culture and the system in which the practitioner works.

The periodontal health of Nepalese schoolchildren.

Abstract: Objectives: To report on the periodontal status of schoolchildren in urban and rural Nepal and to identify possible risk indicators of poor periodontal health. Design: Cross-sectional 'pathfinder' survey using the stratified cluster sampling technique included seven urban and nine rural sites representing the three geographic divisions and five political regions of Nepal. Second stage sampling involved the random selection of 25 schools (18 government and seven private). Subjects: Final study population consisted of three age groups: 5-6-years (n = 1025), 12-13-years (n = 1037) and 15-16-years (n = 1053). Outcome measures: Periodontal data was collected using CPI based on WHO methodology and criteria by trained examiners. A structured questionnaire was administered to collect information on oral health behavior and socio-economic status. Results: A gradual decline in the mean number of healthy sextants was noted with an increase in age among the schoolchildren. Males and females within a specific school and area showed no statistical significant difference when assessed for differences in score 0 (healthy periodontium) among all age groups except for 15-16-year-olds studying in government-urban schools. Multivariate logistic regression analyses showed that children 5 to 6 years of age studying in government urban (Adjusted Odds Ratio = 1.5, 95% Confidence Interval = 1.1-2.1) and government rural schools (Adj OR = 2.8, 95% CI 1.9-4.1) were at higher risk of having periodontal conditions (CPI scores > 0) when compared to those in private urban schools. The probability of poorer periodontal status increased for 12 to 13 (Adjusted OR = 1.9, 95% CI 1.3-2.9) and 15 to 16-year-old children (Adjusted OR = 1.7, 95% CI 1.1-2.5) who studied in government rural schools. Conclusions: A steady increase in periodontal conditions was observed with increasing age. The main risk indicator for unhealthy periodontal status at 5-6 years was studying and residing in government rural and urban schools; while the indicator of unhealthy periodontal status for children 12 to 13 and 15 to 16 years of age was studying in rural government schools.

Changing dental caries levels in the 1980's, 1990's and 2005 among children of a Jerusalem region.

Abstract: Objective To study caries levels and related variables among first grade and fourth grade schoolchildren in one Jerusalem geographic region in 2005, and possible changes in caries levels over three decades: the 1980s, 1990s and finally in 2005. Methods Dental caries was examined, within schools, employing the DMFS and defs indices, for permanent and deciduous teeth respectively. Results Data indicate a consistent decline in disease: a reduction from 1.64 to 0.32 to 0.16 for DMFS, and 13.95 to 8.09 to 5.07 for defs (1983, 1992, 2005, respectively), among first grade children; and from 3.50 to 2.50 to 1.07 for DMFS, and 13.88 to 7.26 to 4.16 for defs, (1983, 1992, 2005, respectively), among fourth grade children. Conclusions A consistent decrease in caries has been detected over three decades. Specific causal factors were not ascertained.