Showing papers on "Oral hygiene published in 2008"

Erosion—diagnosis and risk factors

Abstract: Dental erosion is a multifactorial condition: The interplay of chemical, biological and behavioural factors is crucial and helps explain why some individuals exhibit more erosion than others. The erosive potential of erosive agents like acidic drinks or foodstuffs depends on chemical factors, e.g. pH, titratable acidity, mineral content, clearance on tooth surface and on its calcium-chelation properties. Biological factors such as saliva, acquired pellicle, tooth structure and positioning in relation to soft tissues and tongue are related to the pathogenesis of dental erosion. Furthermore, behavioural factors like eating and drinking habits, regular exercise with dehydration and decrease of salivary flow, excessive oral hygiene and, on the other side, an unhealthy lifestyle, e.g. chronic alcoholism, are predisposing factors for dental erosion. There is some evidence that dental erosion is growing steadily. To prevent further progression, it is important to detect this condition as early as possible. Dentists have to know the clinical appearance and possible signs of progression of erosive lesions and their causes such that adequate preventive and, if necessary, therapeutic measures can be initiated. The clinical examination has to be done systematically, and a comprehensive case history should be undertaken such that all risk factors will be revealed.

Association Among Rheumatoid Arthritis, Oral Hygiene, and Periodontitis

Abstract: Background: A limited number of studies suggest a higher prevalence of periodontal disease among individuals with rheumatoid arthritis (RA); however, results have been inconsistent. Further, it is unclear to what extent poor oral hygiene among patients with RA may account for this association.Methods: The association between RA and periodontitis was examined in 57 subjects with RA and 52 healthy controls, matched by age and gender. Oral examination included plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). Potential risk factors for periodontal disease, such as smoking, education, alcohol consumption, and body mass index (BMI), as well as chronic diseases associated with RA and periodontal disease were assessed through questionnaires.Results: In a stepwise logistic regression, including RA status, age, gender, education, smoking, alcohol consumption, and BMI, only RA status and age remained significant predictors of periodontal disease. Subjects with RA had a ...

A Systematic Review of the Preventive Effect of Oral Hygiene on Pneumonia and Respiratory Tract Infection in Elderly People in Hospitals and Nursing Homes: Effect Estimates and Methodological Quality of Randomized Controlled Trials

Abstract: The objective of this study was to investigate the preventive effect of oral hygiene on pneumonia and respiratory tract infection, focusing on elderly people in hospitals and nursing homes, by systematically reviewing effect estimates and methodological quality of randomized controlled trials (RCTs) and to provide an overview of additional clinical studies in this area. Literature searches were conducted in the Medline database, the Cochrane library databases, and by hand-searching reference lists. Included publications were analyzed for intervention (or topic) studied, main conclusions, strength of evidence, and study design. RCTs were further analyzed for effect magnitudes and methodological details. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were calculated. Fifteen publications fulfilled the inclusion criteria. There was a wide variation in the design and quality of the studies included. The RCTs revealed positive preventive effects of oral hygiene on pneumonia and respiratory tract infection in hospitalized elderly people and elderly nursing home residents, with ARRs from 6.6% to 11.7% and NNTs from 8.6 to 15.3 individuals. The non-RCT studies contributed to inconclusive evidence on the association and correlation between oral hygiene and pneumonia or respiratory tract infection in elderly people. Mechanical oral hygiene has a preventive effect on mortality from pneumonia, and non-fatal pneumonia in hospitalized elderly people and elderly nursing home residents. Approximately one in 10 cases of death from pneumonia in elderly nursing home residents may be prevented by improving oral hygiene. Future research in this area should be focused on high-quality RCTs with appropriate sample size calculations.

Mixed Candida albicans and Candida glabrata populations associated with the pathogenesis of denture stomatitis.

Abstract: Introduction: Oral yeasts are an important component of the resident microbial ecology of the oral cavity, but they are also associated with various forms of oral candidosis, such as denture stomatitis. Although Candida albicans is the predominant oral fungal pathogen, other species may also play an integral role in pathogenesis. The aim of this study was to examine the mycological ecology in patients with denture stomatitis, using an improved sampling technique, to determine whether species diversity and species quantity were related to oral pathology. Methods: Thirty-seven patients attending the Glasgow Dental Hospital were enrolled in this study following informed consent. A full clinical history was obtained, including details of their oral hygiene practices and the levels of erythema based on Newton’s classification scale. Oral rinse, denture sonicate, and swab samples were taken, which were processed for quantitative and qualitative analysis of oral yeasts. Results: The proportion of patients with no inflammation or Newton’s Types I, II, and III were 31, 33, 25, and 14%, respectively. Denture sonication was a superior sampling procedure, with statistically greater quantities of yeasts isolated using this methodology (P < 0.01). The predominant oral yeasts isolated were C. albicans (75%) and Candida glabrata (30%), which were isolated in higher proportions in patients with the highest grades of inflammation (100 and 80%), and in combination from 80% of these patients. Conclusions: This study has demonstrated that mixed C. albicans and C. glabrata biofilms may play an important role in the pathogenesis associated with severe inflammation in denture wearers.

Oral health during pregnancy.

Abstract: Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. Evidence-based practice guidelines are still being developed. Research suggests that some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. Other oral lesions, such as gingivitis and pregnancy tumors, are benign and require only reassurance and monitoring. Every pregnant woman should be screened for oral risks, counseled on proper oral hygiene, and referred for dental treatment when necessary. Dental procedures such as diagnostic radiography, periodontal treatment, restorations, and extractions are safe and are best performed during the second trimester. Xylitol and chlorhexidine may be used as adjuvant therapy for high-risk mothers in the early postpartum period to reduce transmission of cariogenic bacteria to their infants. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and decrease infant caries.

Tooth loss after active periodontal therapy. 1: patient‐related factors for risk, prognosis, and quality of outcome

Abstract: Objectives: Assessment of patient-related factors contributing (1) to tooth loss and (2) to the quality of treatment outcome 10 years after initiation of anti-infective therapy. Material and Methods: All patients who had received active periodontal treatment 10 years ago by the same examiner were recruited consecutively until a total of 100 patients were re-examined. Re-examination was performed by a second examiner and included clinical examination, test for interleukin-1 (IL-1) polymorphism, smoking history, review of patients' files (e.g. regularity of supportive periodontal therapy: SPT). Statistical analysis included Poisson and logistic regressions. Results: Fifty-three patients attended SPT regularly, 59 were females, 38 were IL-1 positive. Poisson regressions identified mean plaque index during SPT (p<0.0001), irregular attendance of SPT (p<0.0001), age (p<0.0001), initial diagnosis (p = 0.0005), IL-1 polymorphism (p - 0.0007), smoking (p = 0.0053), and sex (p = 0.0487) as factors significantly contributing to tooth loss. Additionally, mean plaque index during SPT (p = 0.011) and irregular SPT (p = 0.002) were associated with a worse periodontal status 10 years after initiation of therapy. Conclusion: The following risk factors for tooth loss were identified: ineffective oral hygiene, irregular SPT, IL-1 polymorphism, initial diagnosis, smoking, age and sex.

Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease.

Abstract: Aim: The present investigation presents findings of the prevalence and distribution of gingivitis and periodontitis in a Swedish population over the 30 years 1973–2003. Material and Methods: Four cross-sectional epidemiological studies in 1973, 1983, 1993, and 2003 were performed in Jonkoping, Sweden. Random samples of individuals aged 20, 30, 40, 50, 60, 70, and 80 years were examined clinically and radiographically. Diagnostic criteria were edentulousness, number of teeth, plaque, gingival status, probing pocket depth, gingival recession, alveolar bone level, and classification according to periodontal disease status. Results: In all age groups, the number of edentulous individuals decreased dramatically and the number of teeth increased. Oral hygiene improved considerably. Over the 30 years, the proportion of periodontally healthy individuals increased from 8% in 1973 to 44% in 2003 and the proportion of individuals with gingivitis and moderate periodontitis decreased. There was a non-significant trend for the proportion of individuals with severe periodontal disease experience (Group 4) to decrease, while the proportion of individuals with advanced periodontitis (Group 5) remained unchanged. Conclusion: Oral hygiene and periodontal health improved significantly in the 20–80-year age groups over the 30 years 1973–2003.

Efficacy of an oral health promotion intervention in the prevention of early childhood caries.

Abstract: – Objective: Despite a marked improvement in oral health of Australian children over the last 30 years, severe early childhood caries (S-ECC) affects up to 17% of 2- to 3-year-old children with some requiring hospitalization and invasive treatment. This provided a compelling rationale to develop and test an oral health promotion programme which aimed to reduce this unnecessary suffering. The purpose of this study was to test the efficacy of an oral health promotion programme for the parents of infants, starting during the pregnancy, using a randomized controlled trial. Methods: A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12 months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 20 ± 2.5 months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed. Results: Of 649 women enroled in the programme (test group 327, control group 322), 441 had their child examined at follow-up. The incidence of S-ECC in the test group was 1.7% and in the control group 9.6% (P < 0.001). Conclusion: An oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mother’s pregnancy was successful in reducing the incidence of S-ECC in these very young children.

Factors associated with prevalence and severity of caries experience in preschool children

Abstract: The aim of the present study was to examine the prevalence and severity of caries experience in the primary dentition of preschool children and to assess the association of disease distribution with oral hygiene levels, reported oral health behaviours and socio-demographic factors.

Tooth loss and lack of regular oral hygiene are associated with higher risk of esophageal squamous cell carcinoma

Abstract: We tested the association between tooth loss and oral hygiene and the risk of esophageal squamous cell carcinoma (ESCC) in people living in a high-risk area of Iran. We used a case-control study of pathologically confirmed ESCC cases (n = 283) and controls (n = 560) matched on sex, age, and neighborhood. Subjects with ESCC had significantly more decayed, missing, or filled teeth (DMFT) with a median (interquartile range) of 31 (23-32) compared with controls 28 (16-32; P = 0.0045). Subjects with ESCC were significantly more likely than controls to fail to practice regular oral hygiene (78% versus 58%). In multivariate-adjusted conditional logistic regression models, having 32 DMFT compared with < or = 15 conferred an odds ratio (95% confidence interval) of 2.10 (1.19-3.70). Compared with daily tooth brushing, practicing no regular oral hygiene conferred an odds ratio (95% confidence interval) of 2.37 (1.42-3.97). Restricting the analysis to subjects that had never smoked tobacco did not materially alter these results. We found significant associations between two markers of poor oral hygiene, a larger number of DMFT and lack of daily tooth brushing, and risk of ESCC in a population at high risk for ESCC where many cases occur in never smokers. Our results are consistent with several previous analyses in other high-risk populations.

Genetic Relationships between Respiratory Pathogens Isolated from Dental Plaque and Bronchoalveolar Lavage Fluid from Patients in the Intensive Care Unit Undergoing Mechanical Ventilation

Abstract: Ventilator-associated pneumonia (VAP) is an important infection in patients hospitalized in intensive care units (ICUs) who receive mechanical ventilation [1]. VAP occurs in such patients >48 h after intubation [2]. Common VAP pathogens include Staphylococcus aureus and gram-negative bacteria, including Pseudomonas aeruginosa and Enterobacteriaceae [3]. Gram-negative bacteria account for 60% of all hospital-acquired pneumonia [4]. The mortality rate associated with VAP can be as high as 76% [5], especially among patients with life-threatening illness. The prevalence of VAP is 10%–65% among patients who receive mechanical ventilation, with mortality rates of 24%–76%, depending on the study method, the patient population, and the mode of treatment [1, 6–8]. VAP can prolong the duration of mechanical ventilation by 14–32 days and the length of stay in the ICU by 11.7 days, resulting in an increase in total hospital charges of >$150,000 per patient [9]. Dental plaque is a complex and dynamic biofilm that forms on supragingival and subgingival tooth surfaces, oral mucosal surfaces (especially the tongue), and dental restorations [10]. Recent molecular studies have suggested that >700 species of bacteria colonize dental plaque [11]. It is well known that a lack of oral hygiene allows uninterrupted microbial ecological succession and, therefore, increased microbial diversity within dental plaque [12, 13]. Plaque formation is also fostered by reduced salivary function, which is often a sequelae of xerostomic medications in critical care patients [14]. Such conditions may favor colonization by respiratory pathogens. Indeed, several studies have suggested that dental plaque may serve as a reservoir for respiratory pathogens in patients in the ICU, but not in community-dwelling subjects [15–19]. In the present study, a molecular epidemiologic analysis was used to determine the genetic relationship between respiratory pathogen strains isolated from the oral cavity of patients in the ICU who underwent mechanical ventilation and strains isolated from tracheal secretions and bronchoalveolar lavage (BAL) fluid obtained from the same patient.

The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: a systematic review

Abstract: Aim: The aim of the study was to asses the effect of the use of interdental brushes (IDB) in patients as an adjunct to toothbrushing compared with toothbrushing alone or other interdental oral hygiene devices on plaque and the clinical parameters of periodontal inflammation. Material and methods: MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through November 2007 to identify appropriate studies. Clinical parameters of periodontal inflammation such as plaque, gingivitis, bleeding and pockets were selected as outcome variables. Results: Independent screening of the titles and abstracts of 218 MEDLINE-PubMed and 116 Cochrane papers resulted in nine publications that met the eligibility criteria. Mean values and standard deviations were collected by data extraction. Descriptive comparisons are presented for brushing alone or brushing and woodsticks; meta-analyses were also performed for the floss comparison. Conclusion: As an adjunct to brushing, the IDB removes more dental plaque than brushing alone. Studies showed a positive significant difference using IDB with respect to the plaque scores, bleeding scores and probing pocket depth. The majority of the studies presented a positive significant difference in the plaque index when using the IDB compared with floss.

Influence of mothers' oral health knowledge and attitudes on their children's dental health.

Abstract: Aim: This was to evaluate the influence of mothers’ oral healthrelated knowledge and attitudes on the tooth-brushing behaviour and dental health of their children and to compare the effect of these maternal aspects on child’s oral health. study design and methods: In 2005, an oral health study conducted among a random sample of 457 mother and child pairs in Tehran, Iran, used self-administered questionnaires to provide data on mothers’ oral health-related knowledge and attitudes and children’s tooth-brushing behaviour. Clinical data allowed assessment of dental status of the primary and permanent dentition. statistics: Chi-square test and binary logistic regression models were employed. Results: Generally, mothers had extensive knowledge of and positive attitudes towards oral health. Mothers’ higher level of oral health knowledge and better attitude scores were associated with children’s sound dentition (p<0.05), while only mothers’ better attitude was associated with children’s twice-daily tooth brushing (p=0.001). The multivariate analyses showed that children of mothers with higher attitude scores were more likely to brush their teeth twice daily (OR = 2.1; 95% CI 1.2–3.7) and have sound dentition (OR = 12.4; 95% CI 1.8–85.9). The models revealed that mother’s knowledge per se had no effect on children’s sound dental health, but showed an additive effect with mother’s attitudes. Conclusions: Because twice-daily tooth-brushing behaviour and sound dentition in 9-year-olds were associated with their mothers’ positive oral health-related attitudes, in developing oral health promotion programs for children and adolescents, the considerable potential of mothers should be a major focus of oral health professionals.

Halitosis: a review of associated factors and therapeutic approach

Abstract: Halitosis or bad breath is an oral health condition characterized by unpleasant odors emanating consistently from the oral cavity. The origin of halitosis may be related both to systemic and oral conditions, but a large percentage of cases, about 85%, are generally related to an oral cause. Causes include certain foods, poor oral health care, improper cleaning of dentures, dry mouth, tobacco products and medical conditions. Oral causes are related to deep carious lesions, periodontal disease, oral infections, peri-implant disease, pericoronitis, mucosal ulcerations, impacted food or debris and, mainly, tongue coating. Thus, the aim of the present review was to describe the etiological factors, prevalence data and the therapeutic mechanical and chemical approaches related to halitosis. In general, halitosis most often results from the microbial degradation of oral organic substrates including volatile sulfur compounds (VSC). So far, there are few studies evaluating the prevalence of oral malodor in the world population. These studies reported rates ranging from 22% to more than 50%. The mechanical and chemical treatment of halitosis has been addressed by several studies in the past four decades. Many authors agree that the solution of halitosis problems must include the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This could be achieved by therapy procedures that reduce the amount of microorganisms and substrates, especially on the tongue.

Discovering new treatments for sensitive teeth: the long path from biology to therapy.

Abstract: Tooth sensitivity is a common dental pain condition where sufferers experience brief episodes of sharp well-localized pain when their teeth are subjected innocuous stimuli such as cold, air-currents and probing with a metallic instrument. In this review, we will make no attempt to describe all the treatments that have been developed to treat tooth sensitivity. We will review the basic anatomic and physiological mechanisms responsible for sensitivity. The insights into the dental lesions responsible for tooth sensitivity, as well as the physiological processes linking stimuli and pain generation have suggested several treatments and preventive strategies. Unfortunately, many tooth sensitivity treatments fail to perform better than placebos in clinical trials that seek to assess the effect of agents on pain symptoms. In the case of the most commonly used self-applied desensitizing agent, potassium salts, the mechanism of action established by laboratory and animal models may not apply to clinical use. Thus results obtained with laboratory and animal models must be applied with care to clinical use. Clinical literature suggests that tooth sensitivity is the symptomatic manifestation of significant dental problems, such as wear and other forms of non-carious tooth structure loss. These conditions are increasing in frequency as people age, retaining their natural teeth longer. They are frequently the consequences of aggressive oral hygiene practices and diets rich in acids. Treatments directed at the underlying causes rather than the symptoms of tooth sensitivity would hinder the development of these lesions and provide researchers with objective targets for assessing therapeutic efficacy.

Noxious effect of cigarette smoking on periodontal health.

Abstract: Periodontal probing depth, furcation involvement and tooth mobility were compared in smokers and non-smokers. The study covered 242 subjects aged 21–60 yr, 76 of whom were smokers. Oral hygiene status and dental care habits were above average and of similar standard in both groups (Pll = 0.9). Probing depth was measured at 6 sites around all teeth and sites with a depth of 4 mm or more were regarded as diseased. Both number and probing depth of pockets were significantly greater in smokers than in non-smokers. On average, smokers exhibited 36.0 sites with a probing depth of 4 mm or more, in contrast to 21.8 sites in non-smokers. Probing depth was 2.59 ± 0.06 (mean ± SEM) and 2.36 ± 0.03 in smokers and non-smokers, respectively. The relatively greater occurrence of pockets in smokers remained even when allowance was made for age and oral hygiene. There were also significantly increased numbers of teeth with furcation involvement, pocket involvement and hypermobility in smokers. It is concluded that smoking is associated with a deterioration in periodontal health and that the influence of smoking may be independent of plaque exposure.

Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs

Abstract: The oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs. This study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters. Fifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years) and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7%) were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5) and parents' educational status (p = 0.43). The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6). Twenty-five (46.3%) had good oral hygiene, 17 (31.5%) had fair oral hygiene and 12 (22.2%) had poor oral hygiene, with no significant difference across gender (p = 1.11) and age groups (p = 0.07). Fifteen (27.8%) had gingivitis with no significant difference across age groups (p = 0.17). Forty-five (83.3%) had Angle's class I malocclusion, 6(11.1%) class II and 3 (5.6%) class III. Chronologic enamel hypoplasia was found in 9 (16.7%) of the total population. Up to 53.7% of the total population will require oral prophylaxis, 33.3% required restorations on their posterior teeth and 12.9% required veneers for labial facing of hypoplastic enamel. The subjects in this study had a high prevalence of dental caries and need for restorative care. They would benefit from parental education on diet modification, improvement of oral hygiene practices and regular dental visits.

Modification of the risk of mortality from pneumonia with oral hygiene care.

Abstract: OBJECTIVES: To investigate the associations between the assignment of an oral hygiene aide staff member and risk factors for mortality from pneumonia in a nursing home and to test the hypothesis that this care would affect the incidence of mortality from pneumonia. DESIGN: Electronic medical records. SETTING: Nursing home. PARTICIPANTS: One hundred forty-three residents of a Veterans Affairs Medical Center (VAMC) nursing home. METHODS: The electronic medical records of 143 residents of a VAMC nursing home were analyzed for risk factors for pneumonia. A certified nursing assistant had been assigned to provide oral hygiene care for residents on two of four nursing home wards. Researchers performed a longitudinal analysis of resident's medical records to investigate the association between the assignment of an oral hygiene aide with the risk of mortality from pneumonia. RESULTS: Initially, the group that received oral care, an older and less functionally able group, showed approximately the same incidence of mortality from pneumonia as the group that did not receive oral care, but when the data were adjusted for the risk factors found to be significant for mortality from pneumonia, the odds of dying from pneumonia in the group that did not receive oral care was more than three times that of the group that did receive oral care (odds ratio=3.57, P=.03). Modified risk factors included age, functionality, cognitive function, and clinical concern about aspiration pneumonia. CONCLUSION: Oral hygiene nursing aide intervention may be an efficient risk factor modifier of mortality from nursing home–associated pneumonia.

The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies.

Abstract: Background The authors conducted a systematic review of original studies that was designed to assess the impact of polyol-containing chewing gum on dental caries compared with the effect with no chewing gum. Review Methods The authors searched MEDLINE, The Cochrane Library and Google Scholar up to May 2008 to identify peer-reviewed articles that compared polyol-containing chewing gum with no chewing gum. The authors extracted study characteristics, data on incremental dental caries and quality by consensus. Data on prevented fraction (PF) were pooled across studies. Results The results of 19 articles with data from 14 study populations showed that the use of xylitol, xylitol-sorbitol blend and sorbitol were associated with mean PF (95 percent confidence interval) of 58.66 percent (35.42–81.90), 52.82 percent (39.64–66.00) and 20.01 percent (12.74–27.27), respectively. For the sorbitol-mannitol blend, it was 10.71 percent (−20.50–41.93), which was not statistically significant. Sensitivity analyses confirmed the robustness of the findings. Clinical Implications Although research gaps exist, particularly on optimal dosing and relative polyol efficacy, research evidence supports using polyol-containing chewing gum as part of normal oral hygiene to prevent dental caries.

Professional Oral Health Care Reduces the Number of Oropharyngeal Bacteria

Abstract: Silent aspiration of oropharyngeal pathogenic organisms is a significant risk factor causing pneumonia in the elderly. We hypothesized that regular oral hygiene care will affect the presence of oropharyngeal bacteria. Professional cleaning of the oral cavity and/or the gargling of a disinfectant liquid solution was performed over a five-month period in three facilities for the dependent elderly. Total oropharyngeal bacteria, streptococci, staphylococci, Candida, Pseudomonas, and black-pigmented Bacteroides species were monitored. The levels of these oropharyngeal bacteria decreased or disappeared after weekly professional oral health care, i.e., cleaning of teeth, dentures, tongue, and oral mucous membrane by dental hygienists. After lunch, gargling with povidone iodine was shown to be less effective than professional oral care. These findings indicate that weekly professional mechanical cleaning of the oral cavity, rather than a daily chemical disinfection of the mouth, can be an important strategy to prevent aspiration pneumonia in the dependent elderly.

Oral and dental health care practices in pregnant women in Australia: a postnatal survey

Abstract: The aims of this study were to assess women's knowledge and experiences of dental health in pregnancy and to examine the self-care practices of pregnant women in relation to their oral health. Women in the postnatal ward at the Women's and Children's Hospital, Adelaide, completed a questionnaire to assess their knowledge, attitudes and practices to periodontal health. Pregnancy outcomes were collected from their medical records. Results were analysed by chi-square tests, using SAS. Of the 445 women enrolled in the survey, 388 (87 per cent) completed the questionnaire. Most women demonstrated reasonable knowledge about dental health. There was a significant association between dental knowledge and practices with both education and socio-economic status. Women with less education and lower socio-economic status were more likely to be at higher risk of poor periodontal health compared with women with greater levels of education and higher socioeconomic status. Most women were knowledgeable about oral and dental health. Lack of knowledge about oral and dental health was strongly linked to women with lower education achievements and lower socioeconomic backgrounds. Whether more intensive dental health education in pregnancy can lead to improved oral health and ultimately improved pregnancy outcomes requires further study.

Oral manifestations of eating disorders: a critical review.

Abstract: Background: Eating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED. Methods: Mucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed. Results: Oral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances. Conclusion: Oral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.

Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia.

Abstract: Objectives: To assess the frequency ofconsumption of cariogenic foods, oral hygiene practices anddental health knowledge among Saudi male primary schoolchildren in relation to socio-demographics and to findthe possible predictors for dental caries among them. Subjectsand methods: The cross-sectional descriptive study included1115 Saudi male selected by multistage random sample from18 public primary schools. Subjects were interviewed byclosed ended questionnaire gathering data regardingfrequency consumption of some cariogenic foods, oral hygienepractices and dental health knowledge. Students weresubmitted to dental screening to detect the clinically evidentcaries lesion. Results: The clinically decayed tooth wasdiagnosed in 68.9% of the included children, more in urbanand younger students. Caries affected the subjects consumedcariogenic foods at greater frequency compared with caries-free children. Only 24.5% of the students brushing their teethtwice or more per day, and 29% of them never receivedinstructions regarding oral hygiene practices. Miswak as analternative and⁄or additional method of dental cleaning wasused by 44.6%. Stepwise logistic regression analysis revealedthat maternal working conditions, large family size and poororal hygiene practices were the chief predictors for dentalcaries among the included school children. Conclusion: Thepoor oral hygiene practices, lack of parental guidance andappropriatedental health knowledge with frequent exposure tocariogenic foods in addition to socio-demographics are the mainrisk factors for dental decay among the surveyed students.Key words: dental caries; dental knowledge; dietary habits;oral hygiene practice; Saudi Arabia; school children

Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study.

Abstract: Objective Oral health status is a risk factor for postradiation bone complications (also known as osteoradionecrosis [ORN]), and oral health care is an important element in the prevention of this condition. Some authors recommend extracting teeth with a questionable prognosis and either gross mobility or periodontal disease. However, the criteria for making such decisions remain to be elucidated. In addition, the specific details of the association between oral health status and ORN have not yet been clearly demonstrated. The purpose of this study was to clarify the relationship between oral health status and the development of ORN. Study design Thirty-nine head and neck cancer patients whose radiation fields included both the teeth and the mandible were followed for ≥3 years after radiotherapy. Among these patients, 6 suffered from ORN (ORN group), and the other 33 did not experience the condition (non-ORN group). We analyzed the patient factors, radiation factors, and oral health factors related to the complication. Results The onset of ORN occurred from 18 months to 51 months after radiotherapy. The radiation dose in the oral cavity and the oral health status before radiotherapy were not significant risk factors for ORN. However, the oral health status at 1 year or 2 years after radiotherapy was significantly associated with the development of ORN. The oral health conditions that increased the risk of ORN were >5 mm periodontal pocket depth, >40% dental plaque score, >60% alveolar bone loss level, and a grade 3 radiographic periodontal status. Conclusion This is the first report to show the changes in the oral health status before and after radiotherapy regarding the development of ORN. The results support the periodontal status that almost all clinicians agree on as indications for preradiation teeth extraction (namely, periodontal pockets of >5 mm) to prevent ORN. Good oral health status, especially after radiotherapy, is very important in the prevention of ORN, and we recommend periodical dental management and care by well trained dentists and dental hygienists to avoid the condition.

Self-reported oral hygiene habits, dental attendance and attitudes to dentistry during pregnancy in a sample of immigrant women in North London.

Abstract: Aims The aim of this study was to describe self-reported oral health, oral hygiene habits, frequency of visits to a dentist and factors associated with dental attendance among pregnant women at a North London Hospital, the majority of whom are immigrants.

Inequalities in Oral Health for Children with Disabilities: A French National Survey in Special Schools

Abstract: Background: Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available. Method: Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives. Results: DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25-4.86 for COHI; OR = 2.01, 95% CI = 1.77-2.28 for COCNI; OR = 5.25, 95% CI = 4.55-6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7-4.6 for COHI; OR = 1.52, 95% CI = 1.38-1.69 for COCNI; OR = 1.53, 95% CI = 1.39-1.69 for COPI). Conclusion: Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.

Pregnancy and oral health: a review and recommendations to reduce gaps in practice and research.

Abstract: This article presents a review of the research relevant to oral health during pregnancy and includes nursing practice recommendations for referral of women to a dentist for safe and effective dental care during pregnancy. In recent years, research linking periodontitis to the risk for adverse birth outcomes has resulted in increased interest in the topic of oral health during pregnancy. The achievement of optimal oral health in pregnant women as its own benefit, however, has in the past been hampered by myths surrounding the safety of dental care during pregnancy. Many women also lack access to dental care and dental insurance, which interferes with their ability to receive adequate oral care during pregnancy. Intraoral changes that occur with pregnancy because of hormonal changes, combined with lack of routine exams and delays in treatment for oral disease, place pregnant women at higher risk for dental infections.

Risk indicators and risk predictors of dental caries in schoolchildren

Abstract: The purpose of this study was to identify risk indicators of high caries level at baseline (HCLB) based on cross-sectional data and predictors of high caries increment (HCI) based on a 7-year-follow-up examination in 6-8-year-old schoolchildren Two hundred and six schoolchildren were examined in 1997 and in 2004 by the same two calibrated dentists, in Piracicaba, Brazil At baseline, dental caries, presence of sealants, fluorosis, and oral hygiene status were recorded The children's parents completed a questionnaire concerning socioeconomic level, fluoride use, dental service utilization, dietary and oral hygiene habits HCLB and HCI were defined considering the upper quartile of the total caries experience distribution (dmfs+DMFS) and caries increment distribution, respectively Logistic regression models were adjusted estimating the Odds Ratio (OR), 95% confidence intervals and p-values Having white spot lesions (OR=525) was found to be a risk indicator of HCLB Schoolchildren with dental fluorosis (OR=017) or those who brushed the teeth more than two times a day (OR=037) presented less probability of HCLB The predictors of HCI were: dmfs>0 (OR=268) and mothers' educational level up to 8 years of schooling (OR=287) Clinical and socioeconomic variables were found to be risk indicators and/or predictors of dental caries in schoolchildren