Showing papers in "Community Dentistry and Oral Epidemiology in 2011"

Impact of oral diseases and disorders on oral health-related quality of life of preschool children.

Abstract: BACKGROUND The presence of oral diseases and disorders can produce an impact on the quality of life of preschool children and their parents, affecting their oral health and well-being. However, socioeconomic factors could confound this association, but it has not been yet tested at this age. OBJECTIVE To assess the impact of early childhood caries (ECC), traumatic dental injuries (TDI) and malocclusions on the oral health-related quality of life (OHRQoL) of children between 2 and 5 years of age adjusted by socioeconomic factors. METHODS Parents of 260 children answered the Early Childhood Oral Health Impact Scale (ECOHIS) (six domains) on their perception of the children's OHRQoL and socioeconomic conditions. Two calibrated dentists (κ>0.8) examined the severity of ECC according to dmft index, and children were categorized into: 0=caries free; 1-5=low severity; ≥6=high severity. TDI and malocclusions were examined according to Andreasen & Andreasen (1994) classification and for the presence or absence of three anterior malocclusion traits (AMT), respectively. OHRQoL was measured through ECOHIS domain and total scores, and poisson regression was used to associate the different factors with the outcome. RESULTS In each domain and overall ECOHIS scores, the severity of ECC showed a negative impact on OHRQoL (P 0.05). The increase in the child's age, higher household crowding, lower family income and mother working out of home were significantly associated with OHRQoL (P<0.05). The multivariate adjusted model showed that the high severity of ECC (RR=3.81; 95% CI=2.66, 5.46; P<0.001) was associated with greater negative impact on OHRQoL, while high family income was a protective factor for OHRQoL (RR=0.93; 95% CI=0.87, 0.99; P<0.001). CONCLUSIONS The severity of ECC and a lower family income had a negative impact on the OHRQoL of preschool children and their parents.

Equity, social determinants and public health programmes – the case of oral health

Abstract: The WHO Commission on Social Determinants of Health issued the 2008 report 'Closing the gap within a generation - health equity through action on the social determinants of health' in response to the widening gaps, within and between countries, in income levels, opportunities, life expectancy, health status, and access to health care. Most individuals and societies, irrespective of their philosophical and ideological stance, have limits as to how much unfairness is acceptable. In 2010, WHO published another important report on 'Equity, Social Determinants and Public Health Programmes', with the aim of translating knowledge into concrete, workable actions. Poor oral health was flagged as a severe public health problem. Oral disease and illness remain global problems and widening inequities in oral health status exist among different social groupings between and within countries. The good news is that means are available for breaking poverty and reduce if not eliminate social inequalities in oral health. Whether public health actions are initiated simply depends on the political will. The Ottawa Charter for Health Promotion (1986) and subsequent charters have emphasized the importance of policy for health, healthy environments, healthy lifestyles, and the need for orientation of health services towards health promotion and disease prevention. This report advocates that oral health for all can be promoted effectively by applying this philosophy and some major public health actions are outlined.

Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial.

Abstract: Indigenous1 Australians experience lamentable rates of death and disease. Life expectancy at birth is 59 years for men and 65 years for women, some 17–18 years below the corresponding figures for non-Indigenous Australians (1). The poor health of Indigenous Australians is attributed to risk behaviors in individuals (e.g. use of tobacco, alcohol and other substances) and to broader societal factors such as the organization of health care and quality of housing. There are less tangible but equally pervasive effects of disempowerment that arise through welfare dependency, loss of traditional roles and feelings of hopelessness (2). Australia's Indigenous children also experience disproportionately high rates of dental disease. Indeed, during the last 15 years, caries rates have increased among Indigenous Australian children and declined in non-Indigenous children (3). Today's disparities between Indigenous and non-Indigenous Australians are particularly pronounced in the preschool years (4) and in geographically remote areas (5–7). It is noteworthy that these disparities in dental caries are not fully explained by the lower socioeconomic status (SES) of Aboriginal children (6). Higher rates of dental caries in Indigenous children have broader health consequences. In 2002-03, the rate of hospitalization for dental treatment among Aboriginal preschool children was 1.4 times the rate seen in non-Aboriginal preschoolers (8). When planning this study, we knew that fluoride varnish was effective in reducing levels of decay (9). We also knew that fluoride varnish and parent counseling in diet and oral hygiene could be provided by nondental personnel in primary care settings (10). We saw this as an important prerequisite for the sustainability of any new intervention in remote Aboriginal communities, where routine health care for preschool children is provided by primary health care workers. To achieve similar benefits in our setting, we felt a preventive dental program should also target families and communities. Researchers attribute disparities in dental caries to behavioral risk factors, such as frequent sugar consumption as well as community-level characteristics, including suboptimal levels of fluoride in drinking water and poor access to dental care (7). Another study cited broader social influences, concluding ‘it could be that factors concerning the social history of Indigenous people contribute more to oral health outcomes than SES per se, which could explain why Indigenous children had worse oral health than non-Indigenous children’ (3). The views of Indigenous Australians themselves are reported less commonly in the scientific literature. When we consulted with communities prior to starting this project, the ‘old people’ said ‘we never had this problem’ and began sharing stories of traditional health practices and a way of life. We were told some Indigenous Australians still practice a degree of ‘Traditional Medicine’ and they see health as a way of life, encompassing their land, law and culture, spirituality, economic, social, physical, mental and environmental well-being of its people. This was supported by Miriam-Rose Ungunmerr, a respected elder from one of our participating communities, who has described Aboriginal people as ‘Food Gatherers’. She writes ‘These “Food Gatherers”, as well as physical, drew spiritual sustenance from nature and the land. It was this spiritual sustenance that gave them their real strength and the power for such long endurance. They celebrated the land and their closeness to it, even oneness with it, through various ceremonies (11).’ These accounts, together with evidence from the scientific literature, motivated us to develop a program to prevent dental caries that targeted communities, families and children themselves.

Determinants of oral hygiene behavior: a study based on the theory of planned behavior.

Abstract: Objective: The aim of this study was to develop an index for oral hygiene behavior (OHB) and to examine potential predictors of this actual behavior based on the theory of planned behavior (TPB) Measures of oral health knowledge (OHK) and the expected effect of having healthy teeth on social relationships were included too Material and methods: Using an Internet questionnaire, 487 participants were asked about actual OHB, attitudes (ATT), social norms (SN), perceived behavioral control (PBC), OHK, and expected social outcomes (ESO) Based on a Delphi method involving oral health professionals, a new index for OHB was developed, including tooth brushing, interdental cleaning, and tongue cleaning Results: Regression analysis revealed that the TPB variables (ATT, SN, and PBC) and OHK explained 323% of the variance in self-reported OHB Conclusion: The present findings indicate that socio-psychological consequences play a role in oral health care

To what extent do oral disorders compromise the quality of life

Abstract: Locker D, Quinonez C. To what extent do oral disorders compromise the quality of life? Community Dent Oral Epidemiol 2011; 39: 3–11. © 2010 John Wiley & Sons A/S Abstract – Objective: Most measures of ‘oral health-related quality of life’ assess the presence and frequency of functional and psychosocial impacts rather than explicitly documenting their impact on the quality of life. The aim of this study was to evaluate Prutkin and Feinstein’s suggestion for addressing the issue of quality of life in health outcome research by the use of global ratings. Methods: Data were collected from a national sample of Canadian adults by means of a telephone interview survey based on random digit dialing. Participants completed the OHIP-14. Those reporting one or more impacts in the previous year were asked three questions concerning the extent to which these impacts bothered them, affected their life as a whole, and affected their quality of life. These items were scored on a scale ranging from ‘Not at all’ to ‘A great deal’. All participants were asked to rate the quality of their life using a six-point scale ranging from ‘Very poor’ to ‘Excellent’. Results: Interviews were completed with 2027 participants, and 2019 were included in the analysis. Overall, 19.5% reported one or more impacts ‘fairly often’ or ‘very often’. Of these, 48.3% reported being bothered by these impacts, 40.3% that their life overall was affected, and 36.0% that their quality of life was affected. These individuals represent 9.4%, 7.8%, and 6.9% of the sample as a whole. Among those reporting impacts, there was a significant association between OHIP-14 extent and severity scores and the three ratings. Those with impacts that bothered them, that affected their life overall or affected their quality of life, rated their overall quality of life less favorably than those with impacts that did not. Analysis by household income indicated that low-income participants were more likely to be OHIP-14 ‘cases’. Moreover, among the ‘cases’, low-income participants were more likely to report an impact on the quality of life. Conclusions: The addition of global ratings of oral health-related quality of life and quality of life provides information of use in understanding the negative consequences of oral disorders.

Evaluation of a brief tailored motivational intervention to prevent early childhood caries.

Abstract: Objectives This pragmatic randomized trial evaluated the effectiveness of a tailored educational intervention on oral health behaviors and new untreated carious lesions in low-income African-American children in Detroit, Michigan.

Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland

Abstract: Objectives: To investigate the psychological health - in particular, levels of burnout and engagement, job demands, job resources, and general psychological distress - among dental staff in Northern Ireland. Methods: Three hundred questionnaires were administered to all dental offices in the western part of Northern Ireland. The questionnaire consisted of ‘Maslach Burnout Inventory (MBI)’, ‘Job Demands in Dentistry measure’, ‘Utrecht Work Engagement Scale (UWES)’, ‘Job Resources in dentistry measure’, and ‘General Health Questionnaire (GHQ)’. Results: Overall response rate among all staff members was 45% (for general dental practitioners: 65%). Burnout mean scores were unfavourable when compared with MBI manual norm scores, 26% had scores in the ‘high’ categories of both emotional exhaustion (EE) and depersonalization (DP). This is an indication of severe burnout risk. Time pressure, financial worries, and difficult patients appeared to be the most prominent work demands (mean scores >3). All job demands’ scales correlated significantly (P r 3 as a cut-off point, 25% of the subjects have to be considered cases. Conclusion: Burnout is a serious threat for the dental team in this region of Northern Ireland, especially among general dental practitioners. One-quarter of the dentists were categorized as having a serious burnout risk. Dentists appeared to have most trouble with the work environment aspects: time pressure and financial worries. Furthermore, the proportion of those suffering from psychological distress was unusually high. In contrast to these findings, encouraging levels of engagement were identified. It is recommended that attention for burnout risk is given priority by dental associations.

Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro.

Abstract: Castro RAL, Portela MC, Leao AT, Vasconcellos MTL Oral health–related quality of life of 11- and 12-year-old public school children in Rio de Janeiro Community Dent Oral Epidemiol 2011; 39: 336–344 © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to assess the association between oral health–related quality of life (OHRQoL), measured through the Child-OIDP, and demographic characteristics, self-reported oral problems, and clinical oral health measures, among 11- to 12-year-old school children in the city of Rio de Janeiro, Brazil Methods: A cross-sectional study was conducted, having as its target population 11- and 12-year-old students of both sexes, formally enrolled in 6- and 7-year school classes at public schools A probabilistic sample with complex design was used OHRQoL was assessed by the Brazilian version of Child-OIDP Oral exams were conducted, and the presence of dental biofilm, gingival bleeding, DMFT, fluorosis, enamel defects, dental trauma, and malocclusion were recorded Results: A total of 571 school children participated with a mean age of 120 years and 95% confidence interval (95% CI) from 119 to 121 A total of 887% of the school children presented the impact of oral problems in at least one of the eight daily performances The activities that had most impacts were eating (813%), cleaning mouth (405%), and smiling (322%) The mean Child-OIDP index was 71 with 95% CI from 62 to 81 The highest scores were in relation to eating (mean = 250; 95% CI from 224 to 276), cleaning mouth (mean = 120; 95% CI from 91 to 149), and smiling (mean = 100; 95% CI from 75 to 125) In the logistic regression model, the Child-OIDP was associated with dental caries experience and with the perception of sensitive teeth, perception of gingival bleeding, and perception of inadequate position of the teeth In the multinomial regression, we found that the odds of having higher levels of Child-OIDP were positively associated with dental caries experience Self-reported dental caries, mobile milk teeth, tooth position, bleeding gums, and bad breath were associated with worst OHRQoL Conclusions: It can be concluded that there is an association between dental caries experience and the Child-OIDP index This association indicates the impact of this condition on the quality of life of school children Moreover, the Child-OIDP index is explained more by self-reported oral problems than by clinical normative measures

Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people.

Abstract: Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 39: 276–288. © 2010 John Wiley & Sons A/S Abstract – Objective: To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. Methods: Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community-dwelling elderly aged 65–95. Results: Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta-blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. Conclusions: In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.

Caries prevalence and severity, and quality of life in Brazilian 2- to 4-year-old children

Abstract: Gradella CMF, Bernabe E, Bonecker M, Oliveira LB. Caries prevalence and severity, and quality of life in Brazilian 2- to 4-year-old children. Community Dent Oral Epidemiol 2011; 39: 498–504. © 2011 John Wiley & Sons A/S Abstract – Objective: The purpose of this study was to assess the impact of caries and severe caries on preschool children’s quality of life. Methods: Data from 765 2- to 4-year-old children attending a statutory National Day of Children’s Vaccination in Macapa (Northern Brazil) were analysed. Caries and severe caries were indicated by the dmfs and pufa indices, respectively. Parents completed a questionnaire including questions on socioeconomic factors and the impact of oral conditions on their children’s quality of life using the Brazilian version of the Parental Perceptions Questionnaire for preschool children. Logistic regression was used to test the unadjusted and adjusted associations of caries and severe caries with different aspects of children’s quality of life. Results: Sixty-two and five per cent of children had dental caries (dmfs index > 0) and severe caries (pufa index > 0), respectively. In the adjusted models, having caries was significantly related to toothache and problems eating certain foods as well as to be absent from school and ashamed to smile, whereas having severe caries was significantly related to toothache and problems eating certain foods only. Neither caries nor severe caries was related to stop playing with other children. Conclusions: This study shows that caries and severe caries may have a considerable impact on some aspects of preschool children’s quality of life.

Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age.

Abstract: Wigen TI, Espelid I, Skaare AB, Wang NJ. Family characteristics and caries experience in preschool children. A longitudinal study from pregnancy to 5 years of age. Community Dent Oral Epidemiol 2011; 39: 311–317. © 2010 John Wiley & Sons A/S Abstract – Objective: The purpose of the study was to explore associations between family status, family income, family size, mother’s age at child birth, mother’s education and parents’ national background and caries experience in 5-year-old children. Method: This study is based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and the Public Dental Services. A total of 1348 children were followed from pregnancy to the age of 5 years. Questionnaires were completed by mothers twice during pregnancy and when the children were 3 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. Results: Caries experience in the 5-year-old children was low; 89% had no caries experience (d3–5 mft = 0). In multiple logistic regression having one or both parents of non-western origin (OR 3.4, CI 1.6–7.3), having had a change in family status from pregnancy to 5 years of age (OR 2.0, CI 1.1–3.4) and having mother with low education (OR 1.9, CI 1.3–2.8) were statistically significant risk indicators for having caries experience at the age of five. Conclusion: Family characteristics in pregnancy and early life were associated with caries experience in 5-year-old children. Primary care personnel meeting young children with one or several of these characteristics should consider referring the child to dental personnel to enable early initiation of health-promoting activities.

Paying for the wrong kind of performance? Financial incentives and behaviour changes in National Health Service dentistry 1992–2009

Abstract: Tickle M, McDonald R, Franklin J, Aggarwal VR, Milsom K, Reeves D. Paying for the wrong kind of performance? Financial incentives and behaviour changes in NHS dentistry 1992-2009. Community Dent Oral Epidemiol 2011; 39: 465-473. � 2011 John Wiley & Sons A/S Abstract?-? Background:? There is a tension between financial incentives and professional codes and norms, both of which are believed to influence the behaviour of health care professionals. This study examined the impact of changes to financial incentive structures on the behaviour of dentists working in the English National Health Service (NHS) as a result of a new national contract. Methods:? Comparison of six reference treatments delivered by all NHS dentists in England for the period 1992-2009. Results:? Large and abrupt changes in the provision of the reference treatments coincided with the introduction of changes in the incentive structure in 2006. Treatments which can be provided in the least amount of time (and therefore costs to dentists) such as extractions increased and treatments which are time consuming or have significant additional materials costs such as bridgework, crowns, root fillings and radiographs reduced substantially. Conclusions:? Changes to financial incentive structures can produce large and abrupt changes in professional behaviours. In the context of multiple and conflicting goals, greater thought needs to be given to policies to change incentive structures to mitigate their unintended consequences.

The association between neighborhood social capital and self-reported dentate status in elderly Japanese - The Ohsaki cohort 2006 study

Abstract: Aida J, Kuriyama S, Ohmori-Matsuda K, Hozawa A, Osaka K, Tsuji I. The association between neighborhood social capital and self-reported dentate status in elderly Japanese – The Ohsaki Cohort 2006 Study. Community Dent Oral Epidemiol 2011; 39: 239–249. © 2010 John Wiley & Sons A/S Abstract – Objectives: Little is known about the influence of social capital on dental health. The aim of the present cross-sectional study was to determine the association between neighborhood social capital, individual social networks and social support and the number of remaining teeth in elderly Japanese. Methods: In December 2006, self-administered questionnaires were sent to 31 237 eligible community-dwelling individuals (response rate: 73.9%). Included in the analysis were 21 736 participants. Five neighborhood social capital variables were calculated from individual civic networks, sports and hobby networks, volunteer networks, friendship networks and social support variables. We used multilevel logistic regression models to estimate the odds ratio (OR) of having 20 or more teeth according to neighborhood social capital variables with adjustment for sex, age, individual social networks and social support, educational attainment, neighborhood educational level, dental health behavior, smoking status, history of diabetes and self-rated health. Results: The average age of the participants was 74.9 (standard deviation; 6.6) years, and 28.5% of them had 20 or more teeth. In the univariate multilevel model, there were statistically significant associations between neighborhood sports and hobby networks, friendship networks and self-reported dentate status. In the multivariable multilevel model, compared with participants living in lowest friendship network neighborhoods, those living in highest friendship network neighborhoods had an OR 1.17 (95% confidence interval, 1.04–1.30) times higher for having 20 or more teeth. Conclusions: There is a significant association between one network aspect of neighborhood social capital and individual dentate status regardless of individual social networks and social support.

An appraisal of the quality of published qualitative dental research.

Abstract: Masood M, Thaliath ET, Bower EJ, Newton JT. An appraisal of the quality of published qualitative dental research. Community Dent Oral Epidemiol 2011; 39: 193–203. © 2010 John Wiley & Sons A/S Abstract – Objectives: To appraise the quality of published qualitative research in dentistry and identify aspects of quality, which require attention in future research. Methods: Qualitative research studies on dental topics were appraised using the critical appraisal skills programme (CASP) appraisal framework for qualitative research. The percentage of CASP criteria fully met during the assessment was used as an indication of the quality of each paper. Individual criteria were not weighted. Results: Forty-three qualitative studies were identified for appraisal of which 48% had a dental public health focus. Deficiencies in detail of reporting, research design, methodological rigour, presentation of findings, reflexivity, credibility of findings and relevance of study were identified. Problems with quality were apparent irrespective of journal impact factor, although papers from low impact factor journals exhibited the most deficiencies. Journals with the highest impact factors published the least qualitative research. Conclusions: The quality of much of the qualitative research published on dental topics is mediocre. Qualitative methods are underutilized in oral health research. If quality guidelines such as the CASP framework are used in the context of a thorough understanding of qualitative research design and data analysis, they can promote good practice and the systematic assessment of qualitative research.

Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia

Abstract: Lee GHM, McGrath C, Yiu CKY, King NM Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia Community Dent Oral Epidemiol 2011; 39: 372–377 © 2011 John Wiley & Sons A/S Abstract – Objective: This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA) Methods: A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12-month period Caregivers self-completed the ECOHIS prior to and 3 months following their child dental treatment under GA In addition, caregivers rated the change in their child’s overall health condition compared to before treatment on a global transition scale Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size Results: Following treatment under GA, there was significant changes in ECOHIS scores (P < 001) and many of its sub-domains The magnitude of change (effect size) of the total ECOHIS following treatment was 089 and among sub-domains ranged from −029 to 133 There was an observed gradient in the changes of ECOHIS scores (and effect sizes) in relation to global transition judgement of oral change following treatment, supporting the responsiveness of the measure Conclusions: The Chinese version of ECOHIS is sensitive and responsive to dental treatment of ECC under GA

Evaluation of the implementation of an ‘oral hygiene protocol’ in nursing homes: a 5‐year longitudinal study

Abstract: De Visschere L, de Baat C, Schols JMGA, Deschepper E, Vanobbergen J. Evaluation of the implementation of an ‘oral hygiene protocol’ in nursing homes: a 5-year longitudinal study. Community Dent Oral Epidemiol 2011; 39: 416–425. © 2011 John Wiley & Sons A/S Abstract – Objectives: To explore the long-term effects of the implementation of an oral hygiene protocol in nursing homes. Methods: Out of 14 nursing homes (Flanders) seven nursing homes were randomly allocated to the intervention group and confirmed to implement an ‘oral hygiene protocol’. The remaining nursing homes (the control group) continued to perform oral hygiene as usual. Oral hygiene levels were scored and factors related to plaque levels were recorded. Mixed model analysis with random institution effect, were performed to explore differences in oral hygiene levels owing to the intervention, and the predictive value of explanatory variables. Results: At baseline, no significant differences were found between plaque levels in both study groups. In an unadjusted analysis, different effects were observed on denture and dental plaque. The lowest denture plaque levels were found 2 years after the start of the study, while the lowest dental plaque levels were found at the end of the study. The effect of the intervention could not be confirmed in an adjusted mixed model, where significant indicators for dental plaque were resident’s dependency (P < 0.01) and presence of mouth rinse (P < 0.01). Capacity of the nursing home (P < 0.05) and the presence of toothpaste (P < 0.01) were dominant influencing factors for denture plaque. Conclusions: After 5 years of implementation obtained plaque levels were unsatisfactory. A lot of uncertainties remained on the impact of characteristics of individual nursing homes. Obtaining adequate oral hygiene levels in nursing homes remain an important ongoing challenge and needs further research.

Socioeconomic and clinical factors associated with caregivers’ perceptions of children’s oral health in Brazil

Abstract: Piovesan C, Marquezan M, Kramer PF, Bonecker M, Ardenghi TM. Socioeconomic and clinical factors associated with caregivers’ perceptions of children’s oral health in Brazil. Community Dent Oral Epidemiol 2011; 39: 260–267. © 2010 John Wiley & Sons A/S Abstract – Objectives: We assessed how socioeconomic and clinical conditions could affect parents’ perceptions of their child’s oral health. Methods: A cross-sectional study was conducted in a sample of 455 children, aged 1–5 years, representative of Santa Maria, a southern city in Brazil. Participants were randomly selected among children attending a National Day of Children’s Vaccination. Clinical examinations provided information on the prevalence of caries, dental trauma, and occlusion. The caregivers’ perception of children’s oral health and socioeconomic status were assessed by means of a questionnaire. A Poisson regression model using robust variance (Prevalence ratio: PR; 95% CI, P ≤ 0.05) was performed to assess the association between the predictor variables and outcomes. Results: Parents were more likely to rate their child’s oral health as ‘poor’ if the former earned a lower income and the latter had anterior open bite and dental caries. Parents of black children with anterior open bite and dental caries were more likely to rate their child’s oral health as ‘worse than that of other children’. Conclusions: Clinical and socioeconomic characteristics are significantly associated with parents’ perceptions of their child’s oral health. Understanding the caregivers’ perceptions of children’s oral health and the factors affecting this could be useful in the planning of public health polices, in view of the inequity in the oral health pattern.

The risk of temporomandibular disorder in patients with depression: a population-based cohort study.

Abstract: Liao C-H, Chang C-S, Chang S-N, Lane H-Y, Lyu S-Y, Morisky DE, Sung F-C. The risk of temporomandibular disorder in patients with depression: a population-based cohort study. Community Dent Oral Epidemiol 2011; 39: 525-531. � 2011 John Wiley & Sons A ⁄ S Abstract - Objectives: This study used a population-based retrospective cohort design to examine whether depression is a risk factor of temporomandibular disorder (TMD). Methods: From a universal insurance database, we identified 7587 patients who are newly diagnosed individuals with depression in 2000 and 2001. A total of 30 197 comparison subjects were randomly selected from a nondepression cohort. Both groups were followed until the end of 2008 to measure the incidence of TMD. Results: The incidence of TMD was 2.65 times higher in the depression cohort than in the nondepression cohort (6.16 versus 2.32 per 1000 person-years). The hazard ratio (HR) measured by multivariate Cox's proportional hazard regression analysis of TMD for the depression cohort was 2.21 (95% confidence interval (CI) 1.83-2.66), after controlling for socio- demographic factors and other psychiatric comorbidities. Women had higher risk to develop TMD than men (HR 1.61, 95% CI 1.36-1.92 for women without depression; HR 3.54, 95% CI 2.81-4.45 for women with depression). Conclusions: This study demonstrates that patients with depression are at an elevated risk of developing TMD.

Sense of coherence and its relationship with oral health-related behaviour and knowledge of and attitudes towards oral health

Abstract: Objective: To investigate the relationship between sense of coherence (SOC), oral health–related behaviour, knowledge of and attitudes towards oral health in an adult Swedish population.Methods: ...

Trends in oral health from childhood to early adulthood: a life course approach

Abstract: Lu HX, Wong MCM, Lo ECM, McGrath C. Trends in oral health from childhood to early adulthood: a life course approach. Community Dent Oral Epidemiol 2011; 39: 352–360. © 2011 John Wiley & Sons A/S Abstract – Objectives: The aims of this study were to investigate trends in oral health in a cohort from late childhood through adolescence to early adulthood and to describe how the oral health of young adults was affected by their family sociodemographic characteristics, oral health status, and utilization of dental services during adolescence using life course approach. Methods: A cohort of 638 students was followed from late childhood (12 years old) through adolescence (15 years old) to early adulthood (18 years old) in Hong Kong. Dental examinations included the assessment of caries experience (DMFT score) and periodontal conditions (Community Periodontal Index, CPI) according to WHO criteria. Information on utilization of dental services, parental education attainment, and monthly household income was collected. Path analyses were performed to investigate oral health trends and the relationships between oral health (DMFT scores and highest CPI values) at age 18 years and the sociodemographic characteristics at age 12 years, oral health, and utilization of dental services during adolescence. Results: In 2004 and 2007, 395 (62%) and 324 (51%) subjects of the original sample were followed up when they reached the age of 15 and 18 years, respectively. The mean DMFT score gradually increased from 0.62 at age 12 to 1.52 at age 18 (P 0.29, P 0.12, P 0.05). However, parental education attainment had no significant effect on either DMFT score or highest CPI value (P > 0.05). Conclusions: Oral health status had become worse from childhood to early adulthood in the study cohort. Economic circumstance of the subjects was found to be positively related to their utilization of dental services and through this contributed to the subjects’ caries experience. Oral health at younger ages was positively associated with succeeding oral health conditions.

Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network.

Abstract: Riley JL, Gordan VV, Ajmo CT, Bockman H, Jackson MB, Gilbert GH, for The Dental PBRN Collaborative Group. Dentists’ use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2011; 39: 564–573. © 2011 John Wiley & Sons A/S Abstract – Objectives: Few studies have examined dentists’ subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP). Methods: Data were collected as part of a questionnaire entitled ‘Assessment of Caries Diagnosis and Caries Treatment’, completed by 547 practitioners who belong to The Dental Practice-Based Research Network (DPBRN), a consortium of participating practices and dental organizations. Results: Sixty-nine percent of DPBRN dentists perform CRA on their patients. Recently graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and individualized prevention was weaker than expected (r = 0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use CRA appear to use this information in restorative decisions. Conclusion: A substantial percentage of DPBRN dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care.

Abstract: care da Silva AN, Mendonca MH, Vettore MV. The association between low- socioeconomic status mother's Sense of Coherence and their child's utilization of dental care. Community Dent Oral Epidemiol 2011; 39: 115-126. � 2010 John Wiley & Sons A ⁄ S Abstract - Objectives: The objective of this study was to investigate the relationship of low-socioeconomic status mother's Sense of Coherence (SOC) and their child's utilization of dental care services in a city of Southeast Brazil. Methods: A cross-sectional study was conducted on a sample of 190 schoolchildren aged 11-12 and their mothers in Sao Joao de Meriti-RJ, Southeast Brazil. The outcome variables were children's use of dental care services and visiting dentists mainly for check-ups. Demographic and socioeconomic characteristics and data regarding children's dental care use were collected through interviews with mothers. Children's oral health-related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother's SOC was assessed through the validated short version (13-item) of Antonovsky's scale. Multiple logistic regression was used in the data analysis. Results: Of the mothers, 81.1% reported on their child's utilization of dental care services. Of them, 42.9% considered check-ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR = 2.08 95%CI = 1.17-3.64) and visit a dentist mainly for check-ups (except for dental treatment) (OR = 2.02 95%CI = 1.06-3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children's oral health-related behaviours and oral health measures. Conclusions: Mother's SOC was a psychosocial factor associated with their child's pattern of use of dental care services in low-socioeconomic status families.

Association between periodontal pathogens and risk of nonfatal myocardial infarction.

Abstract: Andriankaja O, Trevisan M, Falkner K, Dorn J, Hovey K, Sarikonda S, Mendoza T, Genco R. Association between periodontal pathogens and risk of nonfatal myocardial infarction. Community Dent Oral Epidemiol 2011; 39: 177–185. © 2011 John Wiley & Sons A/S Abstract – Background: The direct effect of periodontal pathogens on atherosclerotic plaque development has been suggested as a potential mechanism for the observed association between periodontal disease and coronary heart disease, but few studies have tested this theory. Objectives: (i) To assess the association of periodontal pathogens in periodontal pockets with the risk of myocardial infarction (MI) and (ii) to assess whether an increase in the number of periodontal bacterial species increases the risk of MI. Methods: A total of 313 cases and 747 controls, consisting of Caucasian men and women from Western New York, aged 35 to 69 years, were recruited for this study. The presence of microorganisms was assessed by indirect immunofluorescence microscopy, using species-specific polyclonal and monoclonal serodiagnostic reagents. The presence of six periodontal pathogens, Porphyromonas gingivalis (Pg), Tannerella forsythensis (Tf), Prevotella intermedia (Pi), Campylobacter recta (Cr), Fusobacterium nucleatum (Fn), and Eubacterium saburreum (Es), and their co-occurrence (0–6) was compared with the odds of having myocardial infarction. Results: Univariate analyses revealed a higher percentage of the presence of each bacterium in cases compared to controls. In multivariate analyses, only Tf and Pi were statistically associated with an increase in the odds of having MI [Odds ratio OR = 1.62; 95% CI (1.18–2.22); and 1.40; 95% (1.02–1.92), respectively] after adjusting for age, gender, education, cholesterol, high blood pressure, diabetes, and total pack-years of cigarette smoking. An increase in the number of different periodontal bacteria in pockets was also found to increase the odds of MI [adjusted OR = 1.14; 95% CI (1.03–1.26)]. Participants who had three species or more of periodontal pathogens had about 2-fold increase in odds of having nonfatal MI than those who did not have any type of bacterial species [OR = 2.01 (1.31–3.08)]. Conclusion: The presence of periodontal pathogens, specifically Tf or Pi, and an increase in total burden of periodontal pathogenic species were both associated with increased odds of having MI. However, further studies are needed to better assess any causal relationship, as well as the biological mechanisms underlying this association.

Quality of life and psychosocial outcomes after fixed orthodontic treatment: a 17‐year observational cohort study

Abstract: Arrow P, Brennan D, Spencer AJ Quality of life and psychosocial outcomes after fixed orthodontic treatment: a 17-year observational cohort study Community Dent Oral Epidemiol 2011; 39: 505–514 © 2011 John Wiley & Sons A/S Abstract – Background: There is little evidence to suggest that orthodontic treatment can prevent or reduce the likelihood of dental caries or of periodontal disease or dental trauma and temporomandibular disorders, but there is a modest association between the presence of malocclusion/orthodontic treatment need and quality of life However, little is known of the long-term outcomes of orthodontic treatment This study reports on the longitudinal follow-up of quality of life and psychosocial outcomes of orthodontic treatment among a cohort of adults who were examined as adolescents in 1988/1989 Materials and Methods: Children who were examined in 1988/1989 were invited to a follow-up in 2005/2006 Respondents completed a questionnaire, which collected information on quality of life, receipt of orthodontic treatment and psychosocial factors, and were invited for a clinical examination Oral health conditions including occlusal status using the Dental Aesthetic Index were recorded Analysis of variance and multiple linear regression were used to examine the relationship between the measured factors Results: There was no statistically significant association between occlusal status at adolescence and quality of life at adulthood Those individuals who had orthodontic treatment but did not need orthodontic treatment had higher self-esteem (231, SD 52) and were more satisfied with life (185, SD 37) than other treatment groups (self-esteem range, 200–227; life satisfaction range, 164–181), anovaP < 001 and P < 005, respectively Occlusal status at adulthood was significantly associated with quality of life, P < 001 Multivariate analyses showed a statistically significant association between occlusal status at adolescence (‘Desirable treatment’β = 070, P = 004) and adulthood (‘Desirable treatment’β = 166, P < 001) with quality of life Orthodontic treatment was negatively associated with psychosocial factors (life satisfaction; fixed orthodontic treatment (FOT) β = −091, P = 002 and self-esteem; FOT β = −139, P < 001) Conclusions: Occlusal status appears to have limited association with quality of life and psychosocial factors Receipt of fixed orthodontic treatment does not appear to be associated with oral health-related quality of life but appears to be negatively associated with self-esteem and satisfaction with life

Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities.

Abstract: Hopcraft MS, Morgan MV, Satur JG, Wright FAC. Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities. Community Dent Oral Epidemiol 2011; 39: 378–384. © 2011 John Wiley & Sons A/S Abstract – Objective: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are commonly dependent on others for their daily oral hygiene care and often display high levels of plaque and calculus. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. The aim of this study was to investigate the ability of a dental hygienist to undertake a dental examination for residents of aged care facilities, devise a periodontal and preventive treatment plan and refer patients appropriately to a dentist. Methods: A total of 510 residents from 31 Victorian RACFs were examined, with 275 dentate residents included in this study. Between May 2005 and June 2006, residents were examined by a single experienced dental epidemiologist and one of four dental hygienists using a plane mouth mirror and periodontal probe. Results: A total of 510 residents from 31 RACFs had a dental examination from a dentist and one of four dental hygienists. The treatment needs of residents examined were high, with nearly all of the 275 dentate residents requiring preventive and periodontal treatment, and three-quarters requiring referral to a dentist for treatment. There was excellent agreement between the dentist and hygienists regarding the decision to refer residents to a dentist for treatment, with high sensitivity (99.6%) and specificity (82.9%). Only 8.0% of residents were referred by a hygienist to a dentist when the dentist considered that no referral was required. Conclusions: Dental hygienists have the skills and knowledge necessary for undertaking a dental examination for residents, correctly identifying the majority of residents who require a referral to a dentist. They are capable of formulating appropriate dental hygiene treatment plans for residents of aged care facilities. It is recommended that there should be greater utilization of hygienists in the provision of dental care to residents of aged care facilities, as a safe, efficient and effective use of health resources.

Associations between orthodontic treatment need and oral health-related quality of life among young adults: does it depend on how you assess them?

Abstract: Liu Z, McGrath C, Hagg U. Associations between orthodontic treatment need and oral health-related quality of life among young adults: does it depend on how you assess them? Community Dent Oral Epidemiol 2011; 39: 137–144. © 2011 John Wiley & Sons A/S Abstract – Objective: To determine the association between orthodontic treatment need (OTN) and oral health-related quality of life (OHRQoL). Methods: A cross-sectional study involving 273 young adults seeking orthodontic care. OHRQoL was assessed by the short-form Oral Health Impact Profile (OHIP-14) and United Kingdom oral health-related quality of life measure (OHQoL-UK). Study casts were assessed for OTN by: Dental Aesthetic Index (DAI), Index of Orthodontic Treatment Need (IOTN)-Aesthetic Component (IOTN-AC) and Dental Health Component (IOTN-DHC) and Index of Complexity, Outcome and Need (ICON). Variations in OHIP-14 and OHQoL-UK were determined with respect to OTN, and the magnitude of differences was calculated (effect size: ES). Results: There were significant but weak correlations between occlusal indices scores and OHIP-14 scores (P < 0.05, r < 0.3) and between occlusal indices scores and OHQoL-UK scores (P < 0.05, r < 0.4). The magnitude of the statistical difference in OHQoL-UK scores was moderate to large with respect to OTN (ES: 0.36–0.87) and largest when DHC (ES = 0.87) and ICON (ES = 0.74) were used. The magnitude of the statistical difference in OHIP-14 scores was relatively lower (ES: 0.21–0.69), but also greatest when DHC and ICON were used to determine OTN (ES 0.69 and 0.50, respectively). Conclusion: Orthodontic treatment need was associated with OHRQoL. The magnitude of the statistical difference between those with and without an orthodontic treatment need was larger when OHRQoL was assessed using OHQoL-UK compared to OHIP-14. DHC and ICON were more useful indices in identifying greater differences in OHRQoL with respect to orthodontic treatment need.

Temporomandibular disorder patients' journey through care.

Abstract: Temporomandibular disorders (TMDs) are a common group of chronic disorders (illnesses) that health care providers can find difficult to diagnose and explain. Similar difficulties in the diagnosis of other chronic conditions have been shown to have a negative impact on health. An understanding of TMD patients’ experiences and journey through care could indicate time points and strategies to help patients. Objective: To develop a robust empirically derived map of TMD sufferers’ journey through care. Methods: A qualitative study using semi-structured interviews was undertaken using a purposive sample of patients with TMDs. Analysis followed the principles of the constant comparative method where data collection and thematic analysis occurred concurrently and continued until data saturation (n = 29). Results: The experiences of patients could be grouped into three key stages: genesis of problem, seeking help in primary care and secondary care intervention. A wide variety of negative effects were described throughout these stages. An empirically derived map of the patients’ reported journey through care emerged. Conclusions: The experiences of patients with TMDs mirror experiences of other types of chronic illness. Mapping the journey through care for TMDs highlights the potential for interaction between the stages of the journey and the individual’s illness. It may be possible to target interventions at specific stages on the map to help minimize the psychosocial effects of TMDs.

Self-rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors

Abstract: Borrell LN, Baquero MC. Self-rated general and oral health in New York City adults: assessing the effect of individual and neighborhood social factors. Community Dent Oral Epidemiol 2011; 39: 361–371. © 2011 John Wiley & Sons A/S Abstract – Objective: This study investigates the independent and joint effects of individual and neighborhood socioeconomic characteristics on self-rated general and oral health before and after controlling for selected characteristics in adults aged 18 years and older in New York City. Methods: Data for 1168 individuals who participated in the 2004 Social Indicators Survey were linked to neighborhood data from the 2000 US Census. Log-binomial regression models fitted using generalized estimating equations were used to calculate prevalence ratios (PR) and 95% confidence intervals (CI). sudaan was used to accommodate the complex sampling design of the survey and the intra-neighborhood correlation of outcomes of individuals residing within the same neighborhoods. Results: After adjusting for selected characteristics, survey participants with 12 years of education or less were almost twice more likely to rate their general health as fair/poor than counterparts with more than 12 years of education [PRs 1.86 (95%CI: 1.16, 3.00) and 1.82 (95%CI: 1.18, 2.82)]. Participants earning <$20 000 (PR: 2.29; 95%CI: 1.23, 4.29) or between $20 000 to $39 999 yearly (PR: 2.24; 95%CI: 1.11, 4.53) were more than twice as likely to rate their general health as fair/poor compared to their counterparts earning over $40 000 yearly. When compared to participants with more than 12 years of education and those reporting an annual income ≥$40 000, the probability of rating oral health as fair/poor was at least 50% greater in participants with <12 years of education (PR: 1.58; 95%CI: 1.11, 2.26) and in participants earning an annual income of <$20 000 (PR: 1.55; 95%CI: 1.10, 2.19). No association was found between neighborhood characteristics for either self-rated general or oral health. Conclusions: Individual socioeconomic characteristics may be important for both self-rated general and oral health by affecting individuals’ behaviors and access to resources.

Development of the two-stage rapid estimate of adult literacy in dentistry.

Abstract: Objective: This work proposes a revision of the 30 item Rapid Estimate of Adult Literacy in Dentistry (REALD-30), into a more efficient and easier-to-use two-stage scale. Methods: Using a sample of 1405 individuals (primarily women) enrolled in a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the present work utilizes principles of item response theory and multi-stage testing to revise the REALD-30 into a two- stage test of oral health literacy, named Two-Stage REALD or TS-REALD, which maximizes score precision at various levels of participant ability. Results: Based on the participant's score on the five-item first-stage (i.e., routing test), one of three potential stage-two tests is administered: a four-item Low Literacy test, a six-item Average Literacy test, or a three-item High Literacy test. Conclusions: The reliability of scores for the TS-REALD is >0.85 for a wide range of ability. The TS-REALD was found to be predictive of perceived impact of oral conditions on well-being, after controlling for educational level, overall health, dental health, and a general health literacy measure. While containing approximately one-third of the items on the original scale, the TS-REALD was found to maintain similar psychometric qualities.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

Abstract: Vered Y, Soskolne V, Zini A, Livny A, Sgan-Cohen HD. Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia. Community Dent Oral Epidemiol 2011; 39: 145–153. © 2010 John Wiley & Sons A/S Abstract – Objectives: To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. Methods: Three hundred and forty immigrants, aged 18–75 years, with a mean age of 38.4 ± 13.5 years, comprised the study population and were followed over a 5- year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. Results: Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004–2005, since baseline (1999–2000), was 3.52 ± 0.19 when compared to 0.35 ± 0.15 among subjects with no psychological distress (P < 0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P < 0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psycholog-ical distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deeppockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. Conclusions: This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.