Showing papers in "Community Dentistry and Oral Epidemiology in 1997"

Derivation and validation of a short form oral health impact profile

Abstract: Growing recognition that quality of life is an important outcome of dental care has created a need for a range of instruments to measure oral health-related quality of life. This study aimed to derive a subset of items from the Oral Health Impact Profile (OHIP-49)-a 49-item questionnaire that measures people's perceptions of the impact of oral conditions on their well-being. Secondary analysis was conducted using data from an epidemiologic study of 1217 people aged 60+ years in South Australia. Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (OHIP-14) questionnaire and its validity was evaluated by assessing associations with sociodemographic and clinical oral status variables. Internal reliability of the OHIP-14 was evaluated using Cronbach's coefficient alpha. Regression analysis yielded an optimal set of 14 questions. The OHIP-14 accounted for 94% of variance in the OHIP-49; had high reliability (alpha = 0.88); contained questions from each of the seven conceptual dimensions of the OHIP-49; and had a good distribution of prevalence for individual questions. OHIP-14 scores and OHIP-49 scores displayed the same pattern of variation among sociodemographic groups of older adults. In a multivariate analysis of dentate people, eight oral status and sociodemographic variables were associated (P < 0.05) with both the OHIP-49 and the OHIP-14. While it will be important to replicate these findings in other populations, the findings suggest that the OHIP-14 has good reliability, validity and precision.

Prevalence of perceived symptoms of dry mouth in an adult Swedish population - relation to age, sex and pharmacotherapy

Abstract: The aim of the study was to evaluate the prevalence of subjective perception of dry mouth in an adult population and to determine the prevalence of pharmacotherapy in this population. An additional aim was to assess a possible co-morbidity between symptoms of dry mouth and continuing pharmacotherapy. Four-thousand-two-hundred persons were selected at random from the national census register of the adult population of the southern part of the province of Halland, Sweden. The sample was stratified according to age and sex, and 300 men and an equal number of women aged 20, 30, 40, 50, 60, 70 and 80, were included. A newly developed questionnaire was mailed to each individual. In addition to questions about subjective perception of dry mouth, the subjects were asked to report on present diseases and continuing pharmacotherapy. Three-thousand-three-hundred and thirteen (80.5%) evaluable questionnaires were returned. The estimated prevalence of xerostomia in the population was 21.3% and 27.3% for men and women, respectively. This difference between the sexes was statistically significant. In non-medicated subjects, women tended to report a higher prevalence of xerostomia compared with men, 18.8% vs. 14.6%, and also among medicated subjects the estimated prevalence of dry mouth was higher for women than for men, 32.5% vs. 28.4%. There was a strong association between xerostomia and increasing age and also between xerostomia and continuing pharmacotherapy. The average prevalence of dry mouth among medicated and non-medicated subjects was 32.1% and 16.9%, respectively, the difference being statistically significant. There was also a strong association between xerostomia and the number of medications. In a logistic regression, the probability of reporting mouth dryness was significantly greater in older subjects and in women, and the probability increased with the number of medications taken. In conclusion, this epidemiological survey of an adult population has demonstrated that women, independent of age, do report a higher prevalence of xerostomia than men and that the symptom of dry mouth is strongly associated with age and pharmacotherapy. It is, however, not possible to discriminate between disease and pharmacotherapy as causal factors.

Concepts of dental caries and their consequences for understanding the disease

Abstract: The way in which we conceptually consider dental caries determines our choice of preventive and treatment strategy. In this paper the definition of dental caries is discussed and the related problems concerning causality are addressed. Dental caries reflects symptoms of ongoing and past disease--not the disease itself. As such, it is important to record early stages of signs of the disease, i.e. non-cavitated stages of lesion development. The dynamic nature of the processes leading to net loss of mineral (hence a lesion) is emphasized, and appreciating that caries is ubiquitous in populations around the world and initiation and progression of lesions continues lifelong leads to the logical conclusion that we can control dental caries through a variety of measures--but not truly prevent the disease. We can prevent cavities by controlling the patho-physiological events which may result in a net loss of mineral. The relative role of dental plaque in caries control is discussed in relation to the role of the many determinants which influence the likelihood for lesion development. It is concluded that several paradigms about the nature of dental caries should be reconsidered to provide the most cost-effective dental services.

Gender and age differences in attitudes to dental pain and dental control

Abstract: In the literature, it is usual to find women and younger subjects reporting higher levels of dental anxiety than men and older subjects. Fear of pain was found to be the most important predictor of dental anxiety and issues of control were also related to such anxiety. Therefore, it was predicted that gender and age differences would be reflected in attitudes to pain and control. Subjects were randomly selected from the voters' list in metropolitan Toronto and mailed a questionnaire with a request for cooperation in a study of their thoughts, feelings, and behaviour regarding dental treatment. The questionnaire included demographic data, measures of dental anxiety and painful experiences as well as the Pain Anxiety Symptoms Scale and the Iowa Dental Control Index. The results supported the main predictions. In addition, attitudes to pain and control were found to be complex phenomena with characteristic gender differences.

Salivary parameters of relevance for assessing caries activity in individuals and populations

Abstract: A review of the non-microbial salivary parameters with respect to their possible association with caries activity is presented. The parameters are limited to those which already are or at least in the near future will obviously be simple enough, also for clinical purposes. Salivary flow rate is undoubtedly the most important single parameter since the cariostatic activity or efficacy of practically all other salivary parameters depends on the flow rate. Flow rate as such has no linear association with dental caries but there seems to exist an individual "threshold" limit which is decisive for enhanced caries activity. This threshold limit varies among different individuals and therefore the so-called normal values for unstimulated or stimulated flow rate are more reliable on a population level than among individuals for screening purposes. In any individual a regular and longitudinal follow-up of the flow rate is of higher clinical value than only a single cross-sectional measurement. Salivary buffer effect has only a weak negative association with caries activity and again, this effect is of greater clinical significance on a population level. Since the decisive processes in caries attack occur within or under the dental plaque, the buffering effect of saliva is limited and obviously more important to screen for erosion-than caries-prone individuals. Although important for dental health, none of the salivary antimicrobial agents as such has shown any strong association with caries activity. The only ones with some evidence of a regulatory role are secretory IgA antibodies, hypothiocyanite ions, and agglutinins. However, the data are controversial and it seems that instead of measuring individual parameters, the assessment of saliva's functional properties (such as the ability to aggregate bacteria, prevent their adhesion to hydroxyapatite or sugar metabolism etc.) is more important for clinical purposes. Of the parameters involved in de- and remineralization process, only salivary fluoride content has some association with caries susceptibility but its diagnostic or predictive value is questionable.

Caries prediction – state of the art

Abstract: This paper considers the question of whether, by using the currently available measures for assessing caries risk, one can identify with sufficient accuracy the high caries-risk susceptible individuals who need individual protection to avoid having an unacceptably high number of new cavities. In addition, the outline of a typical caries prediction study is presented with an example, Finally, the accuracy of an actual caries prediction is compared with the accuracy of predicting the onset of acute myocardial infarction in order to point out the fact that the risk of any disease is difficult to assess accurately.

Assessing the stage of caries lesion activity on the basis of clinical and microbiological examination

Abstract: The dynamic nature of caries lesion progression may require that classification of caries lesions makes distinctions in activity status. The aim of the present review was to compile and discuss the literature which pertains to clinical assessment of caries lesion activity, and to examine whether recent developments in microbiological research may justify the use of microbiological methods for evaluation of caries activity. Clinical observations suggest that caries lesion progression can be arrested at any stage of lesion development, provided that clinically plaque-free conditions are obtained. However, there is no universal level of oral hygiene to be recommended. The diagnoses "active" and "inactive/arrested" caries have been validated by a range of histological and chemical methods which have supported a separation into distinct clinical categories. Simple microbiological methods have so far not been useful in differentiating between active and inactive caries lesions. Very few studies have evaluated the inter- and intraexaminer reliability of caries diagnostic criteria based on assessment of the activity state of lesions, but recent data indicate that active and inactive caries lesions can be diagnosed with a high degree of reliability. A decision-making tree for dental caries is presented by means of which it is possible to associate the assessment of caries lesion activity with an appropriate treatment modality. It is concluded that research into better methods of assessing caries lesion activity clinically should be stimulated.

Diagnostic tools and measurements--impact on appropriate care.

Abstract: The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice.

A national epidemiological survey of oral mucosal lesions in Malaysia.

Abstract: The prevalence of oral mucosal lesions in Malaysia was determined by examining a representative sample of 11 707 subjects aged 25 years and above throughout the 14 states over a period of 5 months during 1993/1994. A two-stage stratified random sampling was undertaken. A predetermined number of enumeration blocks, the smallest population unit in the census publication was selected from each state. With the selected enumeration block, a systematic sample of living quarters was chosen with a random start. The survey instrument included a questionnaire on sociodemographic characteristics and a clinical examination. The clinical examination was carried out by 16 specially trained dental public health officers and the diagnosis calibrated with a final concordance rate of 92. The age in the sample ranged from 25 to 115 years with a mean of 44.5+14.0. The sample comprised 40.2 males and 59.8 females; 55.8. were Malays, 29.4 Chinese,10.0 Indians and 1.2 other ethnic groups. Oral mucosal lesions were detected in 1131 (9.7.) subjects. 5 (0.04) had oral cancer, 165 (1.4) had lesions or conditions that may be precancerous (leukoplakia. erythroplakia, submucous fibrosis and lichen planus) and 187 (1.6) had betel chewer's mucosa. The prevalence of oral precancer was highest amongst Indians (4.0) and other Bumiputras (the indigenous people of Sabah and Sarawak) (2.5) while the lowest prevalence was amongst the Chinese (0.5).

Clinical diagnosis of precavitated carious lesions

Abstract: During the 20th century, dental caries was usually diagnosed using tactile-visual criteria that detected the presence of cavitation rather than measured the disease process as a continuum that starts from the appearance of microporosity, as a result of demineralization, to the occurrence of cavitation. With increasing understanding of the dental caries process and the role of primary and secondary prevention in arresting it, sensitive and specific diagnostic systems are needed that could enable dentists to detect signs of early demineralization and possible progression of precavitated carious lesions before the occurrence of cavitation. In this review of the literature, published validity studies of diagnosis of precavitated lesions were reviewed. Overall, the current clinical diagnostic systems have low sensitivity and moderate specificity. Good reliability of diagnosing precavitated carious lesions could be obtained for diagnosing pits and fissures but for smooth tooth surfaces the reliability is poor. As our diagnostic capability of precavitated lesions improves, there is a need for a significant change in dental education, dental insurance, and dental practice to reward dentists for promoting oral health and preserving tooth structure. In this paper, a new model for classifying carious lesions based upon the type of intervention strategies is proposed to assist in this new approach of caries management.

Current trends of sugar consumption in developing societies

Abstract: This paper reviews recent data on sugar consumption in developing countries that may lead to a potential increase in caries prevalence. A search of the business, dental and nutritional literature was conducted through May 1995. There is evidence that sugar (sucrose) use was increasing in China, India, and Southeast Asia. In South and Central America (except Haiti) sugar use was either equivalent to or higher than that in most developed societies. In the Middle East, average sugar use was higher than that of other developing areas. However, it was either lower than or equivalent to the levels reported by other developed countries. Many central African countries consumed less than 15 kg of sugar/ person/year. Of particular concern is a rise in the consumption of sugar-containing carbonated beverages in a number of developing societies: China, India, Vietnam, Thailand, and other Southeast Asian countries are currently major growth markets for the soft drink industry. Consumption of high-sugar desserts and snacks may also be increasing in urban centers in some developing countries. To counteract the potential increase in the prevalence of dental caries in some developing countries, preventive and oral health promotion programs should be planned and implemented. We contend that taxation of sugar-containing products as well as efforts to reduce the level of sugar consumption to "safe" levels may be impractical, and in most countries, cannot be supported for political, economic, or health reasons. Instead, we recommend that collaboration be established between public health authorities and manufacturers/distributors of soft drinks and sweets in developing countries to establish a dental health fund that could be used to support caries preventive programs. The fund could be supported through donations from manufacturers based on the principle of the "milli-cent" (1 cent for every 1000 cents of sales). This minimal contribution would provide enough financial support for planning and implementing dental preventive and restorative programs in developing countries.

What do we know about how dentists make caries-related treatment decisions?

Abstract: A conceptual model of dentists' treatment decision-making is discussed. The model suggests that dentists do not use a hypothetico-deductive process for the diagnosis of caries. Rather, caries is identified through a process of pattern recognition that in most instances is inextricably linked to intervention decisions. Individual dentists have inventories of caries scripts that, when matched by a particular clinical presentation, lead to decisions to treat. The scripts comprise salient factors that are dependent on individual dentist's characteristics and biases, and thus vary substantially across dentists. The scripts tend to be complex, highly visual, and difficult to describe. All of these characteristics suggest that efforts to improve dentists' caries-related treatment decisions should acknowledge this knowledge structure and be designed to change the salient factors or interpretations of salient factors within the context of the caries script.

Incidence of tooth loss and dental caries in 60-, 70- and 80-year-old swedish individuals

Abstract: The retention of natural teeth among the elderly is increasing and, in recent studies, dental caries has been identified as the main reason for teeth being extracted. The 5-year incidence of tooth loss and dental caries and the most crucial dental factors for tooth extraction were studied in a random sample of 60-. 70- and 80-year-old inhabitants of Gothenburg, Of the 208 persons examined at baseline, 148 (71%) participated in the follow-up examination: 69, 51 and 28 respectively in the different age groups. In all. 110 teeth had been extracted during the period in 40% of the participants. Only 9 persons had lost three or more teeth. The mean numbers of remaining teeth were 22, 18 and 15 respectively in the 60-, 70- and 80-year age groups and the mean numbers of teeth lost during the 5-year period increased with age from 0.4 in the 60-year-olds to 0.8 and 1.4 in the 70- and 80-year-olds (P<0.05). The major reason for tooth extraction was dental caries and it was found in 60% of all cases and at a higher rate of 77%i in the oldest age group. Fifty-one per cent had developed new coronal carious lesions and 61% had new root carious lesions, while 27% had not developed caries during the period. The mean 5-year increment in decayed and filled coronal surfaces increased with age from 2.3 in the 60-year-olds to 3.7 and 5.3 in the 70- and 80-year-olds (N.S.). The increment in decayed and filled root surfaces was higher in women than men, 3.4 compared with 1.8 (N.S.), which also increased with age from 1.4 in the 60-year-olds to 2.4 and 5.5 in the 70- and 80-year-olds (P<0.0001). It was concluded from this study that few teeth had been lost during the 5-year period but that dental caries still appeared to be a serious problem among some very elderly people.

Oral health condition of 12-year-old handicapped children in Flanders (Belgium)

Abstract: The dental condition of 626 12-year-old handicapped children with mild mental or moderate to severe mental retardation or learning impairment, being 25% of the population of each of these groups, was examined in Flanders. An evaluation of oral cleanliness showed poor oral hygiene in 31.8% of the children. No significant differences were found in oral cleanliness among types of handicapping conditions, The mean DMFT score was 2.9 (s: 2.6) and DMFS score was 5.4 (s: 5.6). Almost 21% of the children were free of caries or fillings. No significant differences were found among groups of handicapped children. Handicapped children presented a low level of restorative care (restorative index score: 48.7%). Mildly mentally retarded children demonstrated the lowest restorative index (43.9%). The caries experience of first permanent molars represented the largest part of the DMFT score (64.1%). Sealants were present in 7.9% of children examined. A considerable percentage of mildly mentally retarded children and learning impaired children did not brush daily (22.1% and 20.9%) and did not receive help with toothbrushing from their parents or carers (91.0% and 94.7%, respectively).

Two-year incidence of tooth loss among South Australians aged 60+ years.

Abstract: UNLABELLED Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss. OBJECTIVES The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia. METHODS Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation. RESULTS Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers. CONCLUSIONS The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.

Impact of dental treatment on the incidence of dental caries in children and adults

Abstract: A review of the literature on the impact of dental care on the incidence of dental caries in children and adults suggests that the effect is small. Dental services were relatively unimportant in explaining the recent decline in caries in 5- and 12-year-olds. An important contribution of the dental services to the decline in caries was a change in the diagnostic and treatment criteria. The role of dentistry in reducing dental caries may lie mainly in the non-personal health services. Knowledge of the life history and patterns of caries attack rates within populations and individuals could be used as a benchmark against which interventions can be assessed. Different teeth and tooth sites are affected differentially at different levels of dental caries. This truism may appear obvious but it is not used to evaluate the effectiveness and quality of dental treatment. A working rule is that "As caries prevalence falls, the least susceptible sites (proximal and smooth surfaces) reduce by the greatest proportion, while the most susceptible sites (occlusal) reduce by the smallest proportion." There is a specific relationship between the mean DMFT and mean DMFS, and the percentage of caries-free subjects and the frequency distribution of subjects with different levels of caries. Further more, the best predictor of caries at older ages is DMFT at a younger age. Caries levels follow trend lines for each level of caries. As the mean DMFT declines so post-eruptive time increases for initiation of caries and the progression rates of caries through enamel decreases. This is true regardless of the presence of fluoride.

Clinical factors related to reported satisfaction with oral function amongst dentate older adults in England

Abstract: This paper aims to identify the features of a natural dentition, specifically the number and distribution of teeth, which are important for oral satisfaction and freedom from eating problems in the elderly. Data were gathered on the dental condition, satisfaction and function of 1211 dentate adults aged 60 years or over, randomly sampled from three areas in England. Multiple logistic regression was used to identify the clinical factors which contribute to satisfaction with aesthetics and the ability to bite and chew. Satisfaction with biting and chewing was influenced by specific reported eating problems, dry month and increasing age. The presence of these eating problems was related to a complex series of factors describing the number and distribution of teeth and dentures, and some variables describing symptoms and disease. Having 21 or more natural teeth and no removable partial dentures (odds ratio 3.2), 2 or more posterior contacting pairs of teeth (odds ratio 1.7), and few anterior spaces were important factors related to the absence of eating problems. Unfilled anterior spaces (odds ratio 3.9), and widespread caries and periodontal disease were associated with aesthetic dissatisfaction. Many of the principles of shortened dental arch are consistent with good function and satisfaction in the elderly.

Antecedents of dental anxiety: learned responses versus personality traits.

Abstract: The origins of dental fear and anxiety are numerous and complex The purpose of the present study was to evaluate the relative effects of learned responses and subjective personality traits on the development of dental anxiety The study was carried out in kibbutzim (closed homogeneous societies) in Israel where all subjects had received dental treatment from the same dentist since childhood with no choice of dentist Subjects were requested to fill out questionnaires concerning their dental anxiety (DAS) in the past and at present, an evaluation of their dentist in the past and at present, and a psychopathologic symptom survey (SCL-90) The results show that dental anxiety at present correlates significantly with the evaluation of the present dentist; with dental anxiety as remembered from childhood; and with the following SCL-90 scales: interpersonal sensitivity, anxiety, phobic anxiety and Positive Symptom Distress Index The best predictors of dental anxiety at present were the evaluation of the present dentist and past dental anxiety (as remembered from childhood) The results suggest that the level of the subject's dental anxiety is affected by environmental factors (evaluation of the present dentist, memories of anxiety from childhood), and by personality traits as evaluated by the SCL-90 questionnaire

Does assessment of microbial composition of plaque/saliva allow for diagnosis of disease activity of individuals?

Abstract: Microbiological tests are limited in their applicability in the assessment of caries activity and in caries prediction. They can be effective in groups of persons with high or low caries experience. The reasons for the limitation of microbiological tests rests with unique characteristics of the microflora and local environments of the oral cavity, which will modify the cariogenicity of plaque in an individual. Thus, high numbers of S. mutans may be associated with the development of a lesion at a site, while a second susceptible site with high levels of this organism in the same subject will remain caries free. This paper identifies some aspects of oral bacteria which can contribute to the unique nature of the microflora associated with plaque in an individual. Firstly, the range of bacteria potentially involved in caries has widened and now includes, for example, ‘low pH’ non-mutans streptococci. The presence of such organisms in plaque in an individual may influence early enamel demineralization. Most significantly. Streptococcus mutans, Streptococcus mitis and Actinomyces naeslundii have been shown to be comprise many distinct clones, with different distribution among subjects. Little is known of the impact of clonal diversity on caries activity but in some bacterial diseases particular clones are associated with virulence. Therefore, possession of a particular clone or clones by an individual could be related to caries activity. Also, the extent of clonal diversity may reflect the nature of the oral environment. Recent studies suggest that cells are released from biofilms during adherence and growth, i.e. the early phases of development. Thus, determination of the numbers of a given species in non-stimulated saliva may indicate whether it is actively growing in plaque. Microbiological tests on the oral flora should perhaps be used to monitor the status of the oral cavity, after establishing a norm for the individual patient. Research on species and clonal diversity of oral bacteria among human populations; diversity and its role in the caries process; and the liberation of biofilm cells could provide data to allow better appreciation and evaluation of the results of microbiologiocal testing.

Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample.

Abstract: The aim of this study was to validate the Kleinknecht's Dental Fear Scale and the Getz's Dental Belief Survey in a Norwegian sample by 1) testing their ability to discriminate between fearful (n = 151) and regular (n = 160) patients, and 2) correlating them. Both instruments were highly reliable (Cronbach's alpha > 0.90). Between 81% and 95% of the fearful and regular patients were correctly assigned to their appropriate groups with both instruments. It may thus be concluded that both instruments are valid. Also, the correlation between the instruments was 0.68, indicating that they to a large extent seem to measure the same concept. The most important predictor items for both instruments were related to avoidance of dental treatment.

How useful are cross-sectional data from surveys of dental caries?

Abstract: Surveys are projects involving systematic data collection without a specific hypothesis to be tested and hence without a specific research design. This paper reviews their uses, and some of the issues involved with measuring dental caries in surveys. The principal benefits of surveys are in (a) monitoring trends in oral disease when the surveys are repeated periodically; and (b) giving dental health a visibility to might otherwise not gel among policy-makers. On the other hand, they are of limited use in determining treatment needs for a population, evaluating treatment outcomes, and evaluating prevention programs. Some major issues in caries surveys today include difficulties with the DMF index; the use of exclusively visual versus visual-tactile criteria; “hidden” caries; and the appropriate role for early, non-cavitated carious lesions. The DMF index suffers from its mixing of disease and treatment, and more research is needed to determine the most appropriate role for exclusively visual criteria in surveys. Trade-offs, such as weighing the benefits of exclusively visual criteria against the probable greater difficulty in finding “hidden” caries, have not been determined. Inclusion of non-cavitated lesions in a survey will increase its cost. Organizers should therefore be clear before the survey on how this additional information will be used to justify the additional expense.

Epidemiological survey of oral submucous fibrosis in Xiangtan City, Hunan Province, China

Abstract: Oral submucous fibrosis is a high risk precancerous condition and is suggested to be caused by areca nut chewing. Areca nut chewing is popular in Hunan Province of China, and is more concentrated in Xiangtan City. Two and nine cases of oral submucous fibrosis (OSF) were first noticed in 1984 and 1985 respectively, and an epidemiologic survey was subsequently performed in 1986. The epidermiologic method of cluster sampling was used. The Yuhu District, one of the five urban districts of the Xiangtan City with a population of 100,000 was selected as a whole body in the survey, 57 independent units of various professions were randomly selected as group samples and more than 70% of subjects in each unit were examined. Definite fibrous band on palpation was used as a main diagnostic criterion for OSF. A total of 11046 individuals were examined; among them were 3907 areca nut chewers (35.37%) and 7139 non-chewers (64.63%). 335 cases of OSF were found, comprising a prevalence rate of 3.03%. The disease involved mainly the middle third of the oral cavity. All of the OSF cases were areca nut chewers. No case had been found in non-chewers. Four cases of oral carcinoma were found on the basis of OSF, the malignant transformation rate was 1.19%. The high prevalence of OSF may be due to areca nut chewing plus extensive and heavy use of hot pepper in Xiangtan people. The result supports the role of the areca nut as an etiologic factor in the development of OSF. The low malignant transformation rate of 1.19% compared with the 7.6% in an Indian report may be because Xiangtan people chew areca nut without tobacco.

Effect evaluation of an oral health education programme in primary schools in Tanzania

Abstract: This study aimed to assess the clinical oral health outcome effects among schoolchildren participating in a school-based oral health education (OHE) programme. Local social, cultural and environmental conditions were determinants of the school-based OHE programme, which was compiled on the basis of prevailing beliefs and on what teachers and educational authorities considered to be important for the oral health of schoolchildren. Consequently, the practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of oral health education. The teachers were prepared to carry out weekly supervised toothbrushing sessions and monthly lessons on aspects of oral health for the school year in grade 4. Eight participating schools were selected for the clinical effect evaluation and four non-participating schools served as the control. In total, 309 children from the participating schools and 122 children from the non-participating schools were available for the evaluation. Their ages varied between 9 and 14 years. The mean plaque score, calculus score and gingival bleeding score at baseline and at follow-up examinations 3, 8, 15 and 36 months later were not significantly different for participating schools and controls. The mean DMFT value at baseline was 0.4 and 3 years later 0.9 in both the participating and control schools. In conclusion, the present study shows that the implemented school-based OHE programme did not result in significant reductions of the clinical parameters measured.

Development of oral hygiene self-efficacy and outcome expectancy questionnaires.

Abstract: In order to measure social cognitive constructs in the oral hygiene domain, questionnaires containing self-efficacy and outcome expectation items were developed. Items were generated to measure personal beliefs in brushing and flossing ability under a variety of circumstances, and expected outcomes from performing oral hygiene behaviors that might be positive, negative, primary and secondary. In the first study, factor scales were developed on the basis of the responses from 90 subjects awaiting dental treatment. Principal components analyses with varimax rotation revealed two self-efficacy and four outcome expectations dimensions that explained 73% and 51% of the variance, respectively. A second study that utilized 103 government employees was conducted to evaluate the psychometric properties of the questionnaires. All scales demonstrated good internal consistency and test-retest stability. Correlations with extra test measures provided preliminary evidence for the validity of the instruments.

Dental fluorosis in 12–15-year-old rural children exposed to fluorides from well drinking water in the Hail region of Saudi Arabia

Abstract: To investigate the relationship between fluoride levels in well drinking water, severity of dental fluorosis and dental caries in the Hail region of Saudi Arabia, 2355 rural children aged 12-15 years were examined. Over 90% of the children had fluorosed teeth and chi-square tests showed a strong association (P < 0.001) between fluoride level (0.5-2.8 ppm) in well drinking water and severity of dental fluorosis. Although regression analysis showed a statistically significant relationship (P < 0.001) between fluoride concentration and caries experience, the amount of variation explained was very low (R2 = 0.9%). Since fluoride in well water had little influence on caries experience and is causing dental fluorosis, it should be removed by defluoridation or the rural population should be provided with an alternative source of drinking water with lower fluoride concentration.

Oral disadvantage among dentate adults.

Abstract: Oral disadvantage can be defined as the avoidance of certain daily activities because of decrements in oral health. These decrements include oral disease and tissue damage, pain, and functional limitation. The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least 1 tooth, were 45 years old or older, and who participated for an interview and clinical examination. Three objectives of the FDCS are: (1) to describe selected psychometric properties of the measurement of oral disadvantage; (2) to describe oral disadvantage in a diverse sample of dentate adults; and (3) to describe the relationship between disadvantage and other aspects of oral health, such as disease/tissue damage, pain, and functional limitation. The prevalence of oral disadvantage within the previous 6 months, using eight self-reported measures, ranged from 5% to 25%, depending upon the measure. Factor analysis suggested that oral disadvantage is best described as three factors: disadvantage due to (1) oral disease/tissue damage, (2) oral pain, and (3) oral functional limitation. Irregular dental attenders, poor persons, and blacks had the highest prevalence of oral disadvantage. Clinical measures of oral disease/tissue damage, self-reported measures of oral disease/tissue damage, oral pain, and oral functional limitation were strongly associated with the presence of oral disadvantage. In multivariate analyses that accounted for differences in clinical measures of disease/tissue damage, self-reported disease/tissue damage, oral pain, and oral functional limitation, females were more likely to report disadvantage due to disease/tissue damage, and middle-aged persons and irregular dental attenders were more likely to report oral disadvantage due to pain. In these same regressions, differences in disadvantage due to race, poverty status, socioeconomic status, and rural/urban area of residence were not evident. These results have implications regarding the use of oral disadvantage to assess the long-term effectiveness of dental care.

Predictors of tooth loss over 10 years in adult and elderly Chinese.

Abstract: This study describes the incidence of tooth loss over a 10-year period in a population of rural Chinese, initially aged between 20 and 80 years. Among the 587 persons who participated in a baseline examination in 1984, 440 persons were available for a follow-up study in 1994. A total of 31 persons, mainly aged 50+ years at baseline, had become completely edentulous. Between 45% and 96% of the persons lost at least one tooth, and the average number of teeth lost ranged between 1.0 and 7.2. The distribution of the number of teeth lost was skew, indicating that a minor group of subjects had a substantially higher risk of tooth loss than the majority. Logistic regression analysis identified six significant predictors of tooth loss among those who remained dentate: age, a high number of teeth with dentinal caries lesions, a high number of teeth with caries lesions of any type, presence of teeth with attachment loss > or = 7 mm, presence of mobile teeth, and a low percentage of sites with subgingival calculus deposits. At the subject level, caries variables and periodontal disease variables seemed equally important predictors of the incidence of tooth loss over 10 years, but at the tooth level caries was a predominant cause of tooth loss in all age groups.

Skewed distributions--new outcome measures.

Abstract: The traditional measure of caries, the DMF index, either as prevalence or incidence of disease, has become highly positively skewed among children and young adults. Most discussion of skewed distributions has focused on the properties of statistical analyses using such data or the implications for sample sizes and subject selection in clinical trials. This paper examines the full range of epidemiologic studies, their aims and constitutive interest in order to identify the measurement problems associated with skewed DMF index data. Constitutive interests include: description; documentation; explanation and prediction; evaluation; advocacy; and, experimentation. ‘New’ outcome measures that would assist in reaching the aims and constitutive interests of the epidemiology of caries include caries severity grading, variants of prevalence, extent and severity and their combination into case definitions, and weighting of the components of the DMF index. Research questions for each area of ‘new’ outcome measures are identified as steps in the codifying of their use in the epidemiology of caries.

Risk factors associated with fluorosis in a non-fluoridated population in Norway.

Abstract: In Norway, there is no water fluoridation and little naturally occurring fluoride in drinking water. Fluoride toothpaste is used by 95% of the population and there is a long tradition of fluoride supplement use. The purpose of this study was to record the prevalence and severity of dental fluorosis in 8-year-old children and relate this to systemic fluoride exposure (supplements and toothpaste). All children (n = 551, born 1988) in a municipality in Norway were invited to participate. Dental fluorosis on the buccal surface of the upper permanent incisors was recorded according to the Thylstrup-Fejerskov index (TF). Parents provided data on use of supplements and toothpaste. Complete data were obtained from 383 children. Sixty-seven percent of the children had used fluoride supplements regularly during childhood. At 8 months or earlier, the teeth of 26% of the children, and at age 14 months or earlier the teeth of 82%, were being brushed. Among children who used fluoride supplements regularly, periodically, seldom and not at all, 45%, 21%, 10% and 0%, respectively, had dental fluorosis. The dental fluorosis was mild (TF = 1) in 87% of the cases. Bivariate and multivariate analyses showed that, in addition to use of fluoride supplements, starting toothbrushing at an early age was associated with higher prevalence of dental fluorosis. The child's birth weight and liking for or swallowing of toothpaste did not influence the prevalence of fluorosis. Risk factors for fluorosis were use of toothpaste before the age of 14 months and regular use of fluoride supplements during childhood.