Showing papers on "Oral hygiene published in 2000"

Saliva and dental caries.

Abstract: Caries is a unique multifactorial infectious disease. Our understanding of etiological factors, the progress of the disease, and the effectiveness of prophylactic procedures have led us to believe that we understand the disease. However, we still have too few answers to many questions: "Why can we not predict who will get the disease?" "Why do we not become immunized?" "How much saliva is enough?" or "Which salivary components are protective?" and "Which salivary components predispose for caries?" It is generally accepted, however, that saliva secretion and salivary components secreted in saliva are important for dental health. The final result, "caries to be or not to be", is a complex phenomenon involving internal defense factors, such as saliva, tooth surface morphology, general health, and nutritional and hormonal status, and a number of external factors-for example, diet, the microbial flora colonizing the teeth, oral hygiene, and fluoride availability. In this article, our aim is to focus on the effects of saliva and salivary constituents on cariogenic bacteria and the subsequent development of dental caries.

Examination, classification, and treatment of halitosis; clinical perspectives.

Abstract: Patients with halitosis may seek treatment from dental clinicians for their perceived oral malodour. In this article, an examination protocol, classification system and treatment needs for such patients are outlined. Physiologic halitosis, oral pathologic halitosis and pseudo-halitosis would be in the treatment realm of dental practitioners. Management may include periodontal or restorative treatment or both, as well as simple treatment measures such as instruction in oral hygiene, tongue cleaning and mouth rinsing. Psychosomatic halitosis is more difficult to diagnose and manage, and patients with this condition are often mismanaged in that they receive only treatments for genuine halitosis, even though they do not have oral malodour. A classification system can be used to identify patients with halitophobia. Additionally, a questionnaire can be used to assess the psychological condition of patients claiming to have halitosis, which enables the clinician to identify patients with psychosomatic halitosis. In understanding the different types of halitosis and the corresponding treatment needs, the dental clinician can better manage patients with this condition.

Dental caries and its relationship to bacterial infection, hypoplasia, diet, and oral hygiene in 6- to 36-month-old children.

Abstract: – Caufield et al. (1) have suggested that the acquisition of mutans streptococci in young children most likely takes place during a “window of infectivity” from 19 to 31 months of age. Objectives and Methods: This study determined the prevalence of dental caries and bacterial infection in a randomly selected sample of 199 children 6 to 36 months old from the island of Saipan in the Commonwealth of the Northern Mariana Islands, USA. The relationships between caries and Streptococcus mutans infection, hypoplasia, diet and oral hygiene behavior were investigated. Results and Conclusions: The overall estimated prevalence of caries was high: 46.8% of the children had white spot lesions and 39.1% had enamel cavitation. Colonization was seen in very young children; S. mutans was detected in 25% of the predentate children. The results of multi-variable modeling support the hypothesis that bacterial infection, diet, and hypoplasia are important in the etiology of dental caries in this population. Adjusted for age and ethnicity, children with a high level of S. mutans detected were 5 times more likely to have dental caries than children with a lower level of S. mutans detected. Hypoplasia and a high cariogenicity score (diet) were also significant independent predictors. The odds of having any white spot lesions or enamel cavitation were 9.6 times greater for children with any hypoplasia, and 7.8 times greater for children with high cariogenicity scores relative to those with lower scores after adjusting for level of S. mutans, age and ethnicity. Sleeping with a bottle, maternal sharing of utensils, and high snacking frequency were not significant predictors of caries in this population.

Dietary determinants of dental caries and dietary recommendations for preschool children.

Abstract: Objectives The purpose of this review, commissioned by the Administration for Children and Families, the Health Resources and Services Administration, the Health Care Financing Administration, and the Department of Agriculture's Food and Nutrition Service, was to update the evidence of the dietary factors that affect dental caries, and subsequently formulate dietary recommendations for preschool children based on principles of cariology. Methods Literature on the dental caries process, dietary factors affecting dental caries initiation and progression, and nutrition education and counseling were reviewed and synthesized. Dietary guidelines for children at various ages were then constructed based on the review. Results Dental caries in preschool children is due to a combination of factors, including colonization of teeth with cariogenic bacteria, type of foods and frequency of exposure of these foods to the cariogenic bacteria, and susceptible teeth. Caries risk is greatest if sugars are consumed at high frequency and are in a form that is retained in the mouth for long periods. Sucrose is the most cariogenic sugar because it can form glucan that enables firm bacterial adhesion to teeth and limits diffusion of acid and buffers in the plaque. There is emerging interest in the effects of tooth development and its role in the future dental caries risk of the child. Conclusions Nutrition education and counseling for the purposes of reducing caries in children is aimed at teaching parents the importance of reducing high frequency exposures to obvious and hidden sugars. Guidelines include: avoiding frequent consumption of juice or other sugar-containing drinks in the bottle or sippy cup, discouraging the behavior of a child sleeping with a bottle, promoting noncariogenic foods for snacks, fostering eating patterns consistent with the Food Guide Pyramid, limiting cariogenic foods to mealtimes, rapidly clearing cariogenic foods from the child's oral cavity either by toothbrushing or by consumption of protective foods, and restricting sugar-containing snacks that are slowly eaten (e.g., candy, cough drops, lollipops, suckers). Along with nutritional factors, a comprehensive approach to preventing dental caries in preschool children must include improved general dietary habits, good oral hygiene, appropriate use of fluorides, and access to preventive and restorative dental care.

The impact of dental anxiety on daily living.

Abstract: Aim To explore the impact of dental anxiety on daily living. Method Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audio-tape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis. Results The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships. Conclusion The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.

Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis

Abstract: Objective: To test the effectiveness of 3 mouthwashes used to treat chemotherapy-induced mucositis. The mouthwashes were as follows: salt and soda, chlorhexidine, and “magic” mouthwash (lidocaine, Benadryl, and Maalox). Study Design: A randomized, double-blind clinical trial was implemented in 23 outpatient and office settings. Participants were monitored from the time they developed mucositis until cessation of the signs and symptoms of mucositis, or until they finished their 12-day supply of mouthwash. All participants followed a prescribed oral hygiene program and were randomly assigned a mouthwash. Nurses used the Oral Assessment Guide for initial assessment and taught patients how to assess their own mouths, then phoned the patients every other day to gather status reports. Results: In 142 of 200 patients, there was a cessation of the signs and symptoms of mucositis within 12 days. No significant differences in time for the cessation of the signs and symptoms were observed among the 3 groups. Conclusions: Given the comparable effectiveness of the mouthwashes, the least costly was salt and soda mouthwash. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:39-47)

Oral hygiene, dentition, sexual habits and risk of oral cancer.

Abstract: In an Italian case-control study of oral cancer, number of missing teeth and other aspects of dental care were similar, but the general condition of the mouth, as indicated by gum bleeding, tartar deposits and mucosal irritation, was worse among oral cancer cases than controls. No differences were detected in sexual practices (including oral sex) and (previous) sexually transmitted infections. © 2000 Cancer Research Campaign

Caries and its association with infant feeding and oral health-related behaviours in 3-4-year-old Brazilian children

Abstract: –Objectives: To investigate the relationships between socio-demographic factors, infant feeding habits, oral hygiene and the prevalence and patterns of caries in Brazilian 3–4-year-olds. Methods: Systematic random sampling was used to select children enrolled in municipal nurseries in Araraquara, Brazil, in 1998. Clinical examinations were carried out by one examiner using dmft and dmfs indices and WHO criteria. Questionnaires for information related to the socio-demographic background, oral hygiene and dietary history of the children were completed by their mothers. Results: Caries was seen in 46% of the children; 17% of them had the more extensive pattern involving molars and incisors. Social class, mother’s education, and age at which breast-feeding terminated showed statistically significant associations with caries. Feeding bottles with added sugars were still being given to 80% of the children. When the significant variables were taken into account only age at which breast-feeding terminated showed a significant relationship to the pattern of disease. Children who were never breast-fed or were breast-fed beyond the age of 24 months had a higher prevalence of the more extensive pattern of caries. Conclusions: The association between the length of time a mother breast-feeds and extensive caries should be a consideration in any local infant feeding policies or health promotion strategies. The duration for appropriate breast- or bottle-feeding should be emphasised.

Oral health care among nursing home residents in Avon

Abstract: Objective: To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. Design: Descriptive survey, interview and clinical data. Setting: 22 randomly selected nursing homes in the Bristol area. Method: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. Results: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. Conclusions: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.

Effectiveness on oral health of a long-term health education programme for mothers with young children

Abstract: Aim To determine the effect of dental health education (DHE) on caries incidence in infants, through regular home visits by trained DH Educators over a period of 3 years. Method A randomly selected cohort of 228 children born between 1st January and 30th September 1995, in a low socio-economic/high caries suburb of Leeds (UK) were divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; and C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes at home every 3 months for the first 2 years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, once a year only. All children and mothers were examined for caries and oral hygiene. A fifth group E (control) received no DHE and were never visited but examined at 3 years of age only. Results In the groups of children visited regularly only two developed caries and three had gingivitis (all in group A). In group E, however, 33 % of children had caries and nine (16%) had gingivitis. The differences in caries levels and caries risk factors between study and control groups were statistically significant (P < 0.001). Mothers of the study groups also showed an improvement in their own levels of gingivitis, debris and calculus scores by the second and third examinations (P < 0.001). Conclusion Regular home visits to mothers with infants, commencing at or soon after the time of the eruption of the first deciduous teeth, was shown to be effective in preventing the occurrence of nursing caries.

Effects of an oral health program on the occurrence of oral candidosis in a long-term care facility.

Abstract: –Objectives: The aim was to evaluate the effectiveness of a preventive oral health program on the prevalence of oral candidosis in 237 frail or dependent residents in a long-term care facility. Half of the residents were included in an experimental group which benefited from a preventive oral hygiene program including instruction of the carers and implementation of a recall program for professional oral hygiene care. Methods: Intraoral examinations and yeast cultures from the oral mucosa and the fitting denture surface were carried out at baseline and 18 months later. The outgrowth of yeast was estimated on Oricult-N dip slides using the scale: no growth; 1–20 colonies; 21–100 colonies; >100 colonies. Results: At baseline (n=237) and at 18 months (n=159) the experimental and the control groups were similar with regard to the residents' distribution by age, sex, dental and prosthetic status and prevalence of denture stomatitis. The 78 residents lost had the same baseline characteristics as the survivors, except for being older. In the experimental group the severity of the inflammation of the palate decreased (P=0.005) as well as the prevalence of glossitis (P=0.005). At baseline high yeast scores from the mucosa (>20) were observed in about 50% of the residents in the experimental as well as the control group. At 18 months this figure was 23.4% for the experimental and 48.7% for the control group (P=0.001). There was also a reduction of the number of residents with positive cultures and the denture yeast scores at 18 months in the experimental group (P=0.05). Conclusions: This study has shown that the preventive program was effective in reducing the colonization of the oral mucosa and dentures by Candida and thereby improving the health of the oral mucosa.

Diabetes and oral health promotion: a survey of disease prevention behaviors

Abstract: Background Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health in a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. Methods As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. Results The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. Conclusions Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. Clinical Implications Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.

Effect of Cigarette Smoking on Periodontal Status of Healthy Young Adults

Abstract: Background: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population. Methods: The study population consisted of 304 young Caucasian males (average age 19.38 ± 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBl); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and nonsmokers. Results: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once...

Effect of an essential oil-containing antiseptic mouthrinse on plaque and salivary Streptococcus mutans levels.

Abstract: Background Clinical studies in which antimicrobial mouthrinses were shown to have significant antiplaque activity most frequently have used gingivitis as the clinically relevant endpoint. However, there is evidence to suggest that mouthrinses containing active agents effective against Streptococcus mutans, such as chlorhexidine, may also have a role in inhibiting dental caries. This clinical study was conducted to determine the effect of 2x-daily rinsing with an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic) on levels of recoverable S. mutans and total streptococci in supragingival interproximal plaque and in saliva. Additionally, a follow-up in vitro study is reported which determined whether a differential susceptibility to the antiseptic mouthrinse exists among different strains of streptococci. Method Following baseline saliva and plaque sampling for quantification of recoverable S. mutans and total streptococci, 29 qualifying subjects were randomly assigned either the essential oil mouthrinse or a sterile water control. They rinsed with 20 ml for 30s 2 x daily for 11 days and once on the 12th day, in addition to their usual oral hygiene procedures. On day 12, saliva and plaque samples were again collected and microbiological quantification performed. The procedures were repeated with the alternate rinse after a 1-week washout period. Results The essential oil mouthrinse produced respective reductions of 69.9% and 75.4% in total recoverable streptococci and in S. mutans in plaque, and corresponding reductions of 50.8% and 39.2% in saliva. The in vitro study revealed that streptococci from the mutans group were more susceptible to the bactericidal activity of the essential oil mouthrinse than streptococci from the mitis group. Conclusions As antimicrobial mouthrinses are most frequently recommended to patients whose mechanical oral hygiene procedures are not adequate for the control of supragingival plaque and gingivitis, this study provides an additional rationale for the inclusion of the essential-oil mouthrinse as an adjunct to daily oral hygiene procedures.

Clinical benefits of oral irrigation for periodontitis are related to reduction of pro‐inflammatory cytokine levels and plaque

Abstract: BACKGROUND Although a growing body of evidence indicates that oral irrigation with water has therapeutic benefits in periodontitis, the mechanisms of action have not been elucidated. The aims of this study were: (1) to analyze the effects of oral irrigation (Water Pik Oral Irrigator) on the clinical signs of adult periodontitis (AP) and on the levels of interleukin-1 beta (IL-beta), prostaglandin-E2 (PGE2), interleukin-10 (IL-10) and interferon-gamma (IFN-gamma) in GCF, and (2) to analyze the influence of the periodontitis-related IL-1 genotype (IL-1GT) on these variables. METHOD A single-center, blinded study in otherwise healthy humans (n= 52) with localized mild to moderate AP was carried out, using the following groups: group A (n= 12), no oral hygiene for 14 days; group B (n=20), routine oral hygiene (ROH) for 14 days; group C (n=20), supra-gingival oral irrigation plus ROH for 14 days. Group A patients were crossed-over to group C for 14 days (=day 28) after a professional prophylaxis. Group assignment was randomized by a coin toss, with the exception of group A subjects, who were self-selected as per recommendations of the internal review board for human subjects. GCF was sampled from 3 study teeth per patient and analyzed for IL-1 beta, PGE2, IL-10 and IFN gamma by ELISA on days 0, 7, 14 and 28. Probing pocket depths (PPD), clinical attachment levels (CAL), bleeding on probing (BOP), gingival index (GI) and plaque index (PI) were measured by a calibrated examiner (TWS) on days 0, 14 and 28. Analysis of covariance was performed using SAS 6.12 and Proc Mixed with group and IL-1GT as the factors and the baseline levels as the covariate, with output being least squares means and least significant difference (LSD). Significant differences were declared if the p-value for the F-statistic was < or =0.05. RESULTS Oral irrigation plus ROH resulted in a significant reduction in PPD, BOP, GI and PI, as well as IL-beta levels by 7 days and PGE2 levels by 14 days, relative to ROH or no oral hygiene. Interestingly, decreased IL-1 beta levels in patients using oral irrigation plus ROH was accompanied by a trend for increased levels of the "anti-inflammatory" cytokine IL-10. ROH reduced GI, BOP and PI, and PGE2 levels by 14 days, but had no effect on IL-1 beta or IL-10 levels relative to no oral hygiene. The effects of no oral hygiene were reversed by a prophy followed by oral irrigation plus ROH for 14 days. No clinical differences were evident between IL-1 GT (+) patients (n= 1) and GT (-) patients (n=40), but the former had significantly elevated levels of GCF IL-10 and borderline increases in IL-1 beta (p=0.07). CONCLUSIONS Oral irrigation with water for 14 days had an improved therapeutic benefit for AP over that of routine oral hygiene alone and this improvement was accompanied by a down-modulation of the pro-inflammatory cytokine profile in GCF.

Periodontal status of adult Sudanese habitual users of miswak chewing sticks or toothbrushes.

Abstract: Miswak chewing sticks are prepared from the roots or twigs of Salvadora persica plants. They are widely used as a traditional oral hygiene tool in several African and Middle Eastern countries. The ...

Oral health behavior and attitudes of adults in Lithuania

Abstract: In Lithuania, the oral health system is currently in transition and systematic data are needed for public oral health care planning. The objectives of this study were (i) to describe the self-assessment of oral health status in Lithuanian adults, the oral hygiene practices, and dental visiting habits; (ii) to assess the attitudes towards teeth and oral health, dental care and oral health services; (iii) to determine whether oral health attitudes and behavior are affected by socio-economic factors; and (iv) to analyse the association between self-care practices and use of oral health services. The study comprised random samples of 35-44-year-olds (n = 381) and 65-74-year-olds (n = 302). Data were collected during 1997 98 by means of self-administered questionnaires and the response rate was 53%. Nearly all persons of ages 35-44 had natural teeth, whereas 14% of 65-74-year-olds were edentulous. Among the dentate persons, 45% of the young adults against 36% of the elderly claimed having poor teeth, and 66% and 55%, respectively, had experience of pain from teeth or mouth during the past year. At ages 35-44, 33% of participants reported toothbrushing at least twice a day and this was the case for 21% of 65-74-year-olds. Dental visits within the past year were indicated by 60% of young adults and 43% of the elderly; 83% of all participants reported that their last visit to the dentist was due to acute oral symptoms. In general, the participants had positive dental knowledge and attitudes; however, 56% were unaware of any effect of fluoride. The bivariate analyses showed that perceived oral health status and oral self-care practices were related to use of dental services. The multivariate analyses of dental visiting habits revealed the effects of gender, urbanization, presence of natural teeth, experience of dental problems, attitudes to dental care and dentists, and education. In conclusion, preventive dental services should be introduced and the establishment of community-based oral health promotion programs is urgently needed for Lithuania.

Oral hygiene in 12-year-old disabled children in Flanders, Belgium, related to manual dexterity.

Abstract: – As part of a larger epidemiological survey of a stratified sample of 12-year-old handicapped children in Flanders, Belgium, the present study describes gingival health, gingival hypertrophy, oral cleanliness and the presence of calculus. Statistical analysis was performed with motor skills, brushing help, the use of chemical agents, the use of anti-epilectic drugs, the knowledge of parents and educators (or caregivers) and their opinion of the oral hygiene of their children/pupils as response variables. From this study, it became clear that mildly mentally retarded and learning-impaired children had significantly better manual dexterity skills than moderately and severely mentally retarded and physically impaired children. However, this was not reflected in improved oral hygiene. The use of chemical plaque controlling agents was found to be extremely low and, with the exception of children with gingival hyperplasia, the users of these agents did not have better oral hygiene. No difference was found between subtypes in the opinion of parents and educators on oral status. There was, however, a difference between their assessment and the clinical picture. It was concluded that there was a need for in-service training programmes in oral health care for educators as well as for parents.

Dental and periodontal status of Sjögren's syndrome.

Abstract: Background: Sjogren's syndrome (SS) is one of the most common systemic autoimmune diseases in middle-aged women. The present study had the aim to examine the dental and periodontal condition in patients with SS in comparison with disease controls and to evaluate the influence of reduced salivary flow in the periodontal tissues. Method: We examined 24 patients with primary or secondary SS in comparison with 27 patients who had another autoimmune disease but no signs or symptoms of SS, as well as with 29 subjects who had a subjective feeling of xerostomia or xerophthalmia without exhibing an underlying disease. The clinical evaluation included examination of the oral mucosa, determination of missing, decayed and filled teeth, fixed or removable prosthetic appliances, plaque index, gingival index, probing pocket depth, probing attachment level, oral hygiene habits and frequency of dental visits. Statistical analysis was performed using the 2-tailed Fisher exact and Kruskal-Wallis tests. Results: No significant difference was found in the dental or periodontal condition of the 3 groups. The number of teeth, feelings and distal or mesial decay lesions correlated negatively with age, while the number of fixed prosthetic appliances correlated positively. The salivary flow was statistically lower in patients with SS and exhibited a negative correlation with the number of cervical decay lesions. It was also found that SS patients had better oral hygiene habits than subjects of the control groups. Conclusions: No significant difference could be detected concerning the dental and periodontal status of SS patients, compared with that of patients with other immune diseases as well as with that of controls who had subjective xerostomia.

Root-dentin sensitivity following non-surgical periodontal treatment.

Abstract: BACKGROUND, AIMS Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops RDS. MATERIAL AND METHODS Alterations in RDS was followed in 35 patients (29-65 years of age) requiring non-surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow-up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10-cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra- and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow-up data included pain assessment after 1-3 weeks of OH alone, and 1-4 weeks post-instrumentation. RESULTS There was a statistically significant reduction in mean VAS scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p 2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4-week follow-up period after scaling and root planing, the percentage of sensitive teeth remained unchanged. CONCLUSION The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.

Behavior management and communication strategies for dental professionals when caring for patients with dementia.

Abstract: The impact of dementia and associated behavioral problems on the oral health of long-term-care-facility residents is increasing. The provision of oral hygiene care for these cognitively impaired residents is difficult and complex. Dental professionals and carers need good communication skills with cognitively impaired residents, and specific strategies for the management and prevention of their behavioral problems. Newer philosophies of dementia care enable dental professionals and carers to use more individualized and non-pharmacological approaches for dental treatment and preventive oral care provision. This paper reviews behavior management and communication strategies from the dental literature, and newer techniques and interventions from dementia research and literature.

Risk indicators associated with tooth loss in Jordanian adults.

Abstract: –Objectives: The purpose of this study was to evaluate the risk indicators of tooth loss in Jordanian adults. Methods: A sample of 509 Jordanian adults was randomly selected. The subjects were interviewed regarding demographics, social economic status, smoking habits, and oral hygiene practices and then clinically examined by a single examiner. Multiple regression analysis was performed to estimate the simultaneous impact of risk indicators on tooth loss. Results: The subjects’ mean age was 42.6 years with an average of 20.9 teeth remaining per person. The overall educational level of the subjects was low. More than 40% reported not brushing their teeth regularly and 56% had had no professional teeth cleaning during the last year. Monthly family income averaged JOD 231, and about a third of the subjects were smokers. The mean number of remaining teeth decreased significantly with age. Smokers, those who brushed irregularly, and those who had not had professional teeth cleaning in the last year had significantly fewer remaining teeth. Men also had significantly fewer remaining teeth. Education and income were also significantly associated with the number of remaining teeth. Age, income, brushing, prophylaxis, and gender collectively explain 75.1% of the variance in the number of remaining teeth. Conclusion: Modification of non-disease independent factors could reduce tooth loss and improve oral health in Jordanians.

Dental care access among individuals with Down syndrome in France

Abstract: The aim of this study was to compare levels of dental care utilization, receipt of dental services, and oral hygiene habits between a sample of individuals with Down syndrome (DS) and their siblings. Data were collected by means of a recently validated, French-language, questionnaire measured of oral health and its related problems for individuals with DS. A cross-sectional survey was undertaken of parents of children with DS attending a national meeting for families and carers of individuals with DS in France. Older individuals with DS were significantly more likely to visit a dentist regularly than their older non-DS siblings, but the group with DS was significantly less likely to have received any dental treatment. The group with DS was significantly more likely to have difficulty finding both medical and dental services. Parents were nearly twice as likely to report problems finding dental services for their child with DS as they were medical services. In a multiple logistic regression analysis within the DS group, it was found that older age, regular speech therapy and ophthalmology consultations, and reports of no difficulty finding a dentist were independently associated with increased odds for regular dental consultations. Analysis of the findings suggests that the parents of children with DS in France frequently encounter problems of access to oral health care and that individuals with DS are less likely to receive dental services than are their non-DS siblings.

Oral health status of patients 5–6 years after placement of cobalt–chromium removable partial dentures

Abstract: This study is a clinical survey of cobalt-chromium (Co-Cr) removable partial denture (RPD) wearers that aimed to investigate the effects of denture wearing on oral tissues. A random sample of patients who had received their dentures 5-6 years previously from a dental teaching hospital in Hong Kong was selected. Those who had been constantly wearing the RPDs were examined by one calibrated examiner under an optimal clinical setting. The patients' dental, periodontal and mucosal status were assessed. A total of 87 patients were examined. Mucosal lesions under the Co-Cr RPDs were uncommon in this study sample. However, there was a high prevalence of plaque, gingivitis and gingival recession, especially in dento-gingival surfaces in close proximity (within 3 mm) to the dentures. Thus, there is a special need for regular oral hygiene reinforcement, scaling and prophylaxis among RPD wearers. Despite a low caries incidence in the study sample, root caries were found to be associated with contact with the RPDs (P < 0.05) but coronal caries were not. It is recommended that coverage of the exposed root surfaces by RPD components should be avoided. Also, topical fluorides should be regularly applied onto exposed root surfaces as a preventive measure.

Evaluation of a long-term oral health program by carers of children and adults with intellectual disabilities.

Abstract: The oral health program presented here was undertaken in three French centers for persons with special needs. The program aimed to educate the carers about dental disease, to motivate them with regard to prevention, and to improve the oral hygiene and oral health of the residents. This study evaluated the impact of the program in terms of change in attitudes and behavior expressed by the carers by means of a questionnaire. Following demonstration of oral hygiene techniques on an individual basis, the number of residents who had their teeth cleaned more than once a day rose from 24% to 52% (p < 0.05). The percentage of carers able to clean both posterior and anterior teeth of their key residents increased from 24% to 60% (p < 0.05), and the percentage finding tooth cleaning easy increased from 36% to 60% (non-significant). The intervention was thus deemed moderately successful, although the carers continued to take better care of their own oral health than that of the residents. The need for ongoing training is emphasized, both for the carers of those with special needs and for the dental profession. The lack of a validated means of measuring the impact of such interventions on care providers for this population is discussed.

Dental care of elderly in nursing homes: perceptions of managers, nurses, and physicians.

Abstract: Epidemiologic studies have shown that the oral health of residents in nursing homes is poor. This can be due to their impaired ability to maintain appropriate oral hygiene or to a lack of interest in oral care among those responsible for the care. The purpose of this study was to assess the attitudes of managers, caregivers, and physicians with regard to oral health care issues of their residents. A questionnaire sent to the managers of the 65 nursing homes in Geneva was returned by 47 (69%). According to the managers, 85% of the nursing homes organized transportation for the residents to a dental office; dental care with follow-up treatment was organized in 79% of the facilities; 68% of the facilities organized treatment for dental emergencies. Another questionnaire was distributed to 169 caregivers in 13 nursing homes. A majority had received no education in oral hygiene care of the residents. The caregivers did accept responsibility for oral hygiene care, but preferred to share it with a dentist responsible for the oral health care of the residents. Only 33% of the physicians indicated that they carried out a systematic examination of the oral cavity, and 20% agreed that the oral cavity might be an integrated part of the body. The majority of the physicians were in favor of more information on oral diseases and regular visits by a dentist; however, close collaboration with a dentist on oral health issues had a low priority.

A Comparison Between Written, Verbal, and Videotape Oral Hygiene Instruction for Patients with Fixed Appliances

Abstract: The objective of the study was to compare the effectiveness of written, videotape, and one-to-one instruction upon the knowledge, oral hygiene standard, and gingival health of subjects undergoing o...