Oral Health and Preventive Dentistry, 03/2007

Purpose: To evaluate the prevalence and aetiological factors involved with wear of deciduous teeth. Materials and Methods: A convenience sample of 356 children (aged 6 years old) was selected at Bauru, SP (Brazil). Clinical examinations were carried out by 1 examiner (Kappa = 0.87), using the Tooth Wear Index (G0-G4). A questionnaire addressing the aetiological factors of tooth wear was applied to parents. Results: Wear on the incisors was diagnosed in 34.8% of children (91.1% G1 and 6.4% G2); 78.1% presented wear in canines (64.7% G1 and 33.1% G2); and 40.7% in molars (89.6% G1 and 9.0% G2). No significant correlation was observed between gastro-oesophageal reflux, toothbrushing habits, or consumption of citrus fruits/soft drinks and the presence of tooth wear for all groups of teeth. The wear showed correlation with the presence of bruxism for canines and with the habit of holding drinks in the mouth before swallowing for incisors (Chi-square test, p0.05). Conclusions: The findings indicate that the wear of incisors could be considered physiological for this age. Further longitudinal studies should be conducted in order to measure the wear in canines and molars in the period close to their replacement by permanent teeth. Keywords: deciduous, tooth abrasion, tooth attrition, tooth erosion

Purpose: To assess psychological, individual and maternal factors related to dental anxiety among pre-adolescents in the different cultural settings of Turkey and Finland. Materials and Methods: A cross-sectional study of Finnish (n = 338) and Turkish (n = 611) pre-adolescents aged 10-12 years old by paired matching of questionnaires for the subjects and their mothers. These questionnaires, along with modified dental anxiety scales, were designed to collect data on the pre-adolescents' and their mothers' oral and dietary behaviours in relation to psychosocial factors. Multiple linear regression and factor analyses as well as descriptive and correlation statistics were applied. Results: The Turkish pre-adolescents (TP) reported poorer dental health (50%) and more frequent gingival bleeding (26%) than did the Finnish pre-adolescents (FP) (26%, 0%), (p 0.05). A similar trend occurred for reported toothache (70% and 17% for TP and FP respectively [p = 0.00]). Mean dental anxiety (DA) for TP and their mothers, and Finnish counterparts respectively were 9.64 ± 6.01, 8.70 ± 4.53 and 7.39 ± 4.51, 6.02 ± 5.50 (p 0.05). Among TP, those with low DA reported high levels of toothbrushing and dietary self-efficacy (DSES) and self-esteem (p 0.05); FP showed similar trends for DSES and self-esteem. Principal component analysis revealed that maternal DA and regular dental visits largely accounted for primary associations with DA among TP. Conclusions: Appreciating the impact of various psychosocial factors may provide a better understanding of DA among preadolescents, and thus may reduce dental avoidance and behavioural management problems for the overall improvement of young patients' oral health. Keywords: culture, dental anxiety, maternal influence, pre-adolescents, psychosocial

Purpose: To investigate knowledge of and attitudes towards prevention of dental caries among Iranian dental educators in relation to their personal and academic background. Materials and Methods: Of the 15 Iranian state dental schools, 7 were selected by stratified random sampling to serve as clusters. All the present educators (n = 363) were individually asked to voluntarily complete a pre-tested anonymous questionnaire. A total of 291 educators completed the questionnaire (response rate of 80%). The questionnaire requested information on educators' knowledge of caries prevention and attitudes towards preventive dentistry. The educator's age, gender, highest academic degree, department of teaching, and familiarity with the discipline of dental public health (DPH) served as background factors. Chi-square test and a logistic regression model served in statistical analyses. Results: Educators working in paedodontics, operative dentistry or periodontology departments had more extensive knowledge of caries prevention than did the others (p 0.05). Women, as well as those familiar with DPH, reported more positive attitudes towards prevention than did the others (p = 0.05). In the regression model, having a more positive attitude towards prevention was associated with female gender (OR = 2.2, 95% CI: 1.2-4.1), more extensive knowledge of caries prevention (OR = 2.4, 95% CI: 1.1-5.6), and greater familiarity with DPH (OR = 2.0, 95% CI: 1.1-4.1). Conclusions: Dental educators seem to have different knowledge of and attitudes towards prevention based on their disciplines. This may reflect negatively in preventive practice among both the educators and students. Continuing education activities and placing emphasis and support on prevention-related research are recommended. Keywords: attitude, dental education, knowledge, preventive dentistry

Objective: To assess the effect of sound produced in a dental clinic on the hearing of dentists in a dental school. Materials and Methods: Thirty-two dentists were evaluated for changes in their hearing thresholds at the Speech and Audiology Department, Manipal College of Allied Health Sciences, Manipal, India. Middle Ear Analyser (MEA), Pure Tone Audiometry (PTA) and Oto-Acoustic Emission (OAE) were used to evaluate changes in the hearing thresholds. Results: There was a change in distortion product (DP) amplitude (temporary shift) in all frequencies. Statistically significant changes were found in the 6 kHz and 4 kHz ranges in the left ear and 6 kHz in the right ear. There was a larger DP shift in the left ear than in the right ear. A comparison of the hearing thresholds of males and females showed a significant difference of 3 kHz in the left ear, where males had a higher hearing loss. Conclusion: There were shifts of hearing threshold at 6 kHz and 4 kHz. The danger to hearing from dental clinic working environment in a dental school cannot be underestimated. Keywords: dentists, hearing loss, India, noise-induced hearing loss

Purpose: To investigate the sources of information on oral self-care and the content of professional guidance received on it as reported by dentate elderly patients in Lithuania, and to relate such guidance to their self-assessed knowledge of oral self-care. Materials and Methods: A cross-sectional questionnaire study was carried out at two public dental offices, among dentate patients aged >=60. In total, 174 dentate elderly responded; mean age was 69.2 years (SD = 6.6). The self-administered questionnaire covered sources of information on and self-assessed knowledge of oral self-care, and the content of professional guidance received. Age, gender, education, and number of teeth served as background information. Statistical evaluation was by Chi-square test, correlation analysis, ANOVA, and logistic regression. Results: Most of the elderly (82%) named the dentist as the source of information. For the professional dental guidance received, 53% of our elderly reported being told how to brush, and 31% how to floss their teeth. Furthermore, 44% assessed their knowledge of oral self-care as poor, 22% as moderate, and 34% as good. At least a moderate level of knowledge of oral self-care was associated with a greater extent of professional guidance (OR 1.3; 95% CI 1.2-1.5; p 0.001), a better dental state (OR 1.9; 95% CI 1.1-3.2; p = 0.03), and a higher level of education (OR 1.9; 95% CI 1.0-3.5; p = 0.04) in the logistic regression model, controlling for background information. Conclusions: To increase the awareness of oral self-care among the elderly, dentists play an important role as providers of versatile and regular professional guidance. Keywords: dentate elderly, knowledge of oral self-care, Lithuania, oral health education

Purpose: To evaluate the effect of CO2 laser treatment through topically applied amine fluoride solution on demineralised enamel. Materials and Methods: Sixty extracted human molar crowns were selected and cut longitudinally into half. One half was subjected to a 10-day pH-cycling procedure to create caries-like lesions, whereas the other was left non-demineralised. The following treatments were randomly assigned (one treatment per tooth, on respective non-demineralised and demineralised matched specimens): exposure to a 1% amine fluoride solution for 15 s without irradiation (group I), irradiation for 15 s with a continuous-wave CO2 laser (group II), or laser-treatment for 15 s through the amine fluoride solution applied immediately beforehand (group III). Fluoride uptake (n = 30) and acid resistance (n = 30) were determined after treatment. Enamel surface alterations after laser irradiation were monitored using scanning electron microscopy. Results: In groups I and III, an increased fluoride uptake was detected (p = 0.05). Laser irradiation through topical fluoride resulted in an increased acid resistance of sound and demineralised enamel specimens in deeper layers (p = 0.05). In addition, less surface alterations were observed in SEM examination of specimens irradiated through the amine fluoride solution compared with counterparts treated with laser only. Conclusions: CO2 laser light application through an amine fluoride solution may be instrumental in enhancing acid resistance of sound and demineralised enamel. Keywords: acid resistance, CO2 laser, demineralisation, enamel, fluoride uptake

Purpose: To assess the risk factors involved for active white enamel lesion in public schoolchildren, aged 7 to 12 years, in Natal, Brazil, using a case-control study. Materials and Methods: A total of 273 cases of active white enamel lesion and 325 controls (lesion-free) were matched by age, gender and school. The independent variables were: age; gender; visible plaque index (VPI); gingival bleeding index (GBI); decayed, missing and filled surfaces (DMFS); decayed, extracted or filled surfaces (dmfs); DMFS-dmfs; and the number of carious surfaces. Results: There was no statistical significance for age (p = 0.57), gender (p = 0.428) and dmfs (p = 0.06). Univariate analysis revealed an increased risk of developing active white enamel lesions in individuals with high VPI (OR = 15.5, CI 95% 10.35-23.2), GBI (OR = 2.86, CI 95% 2.05-3.99), DMFS (OR = 18.91, CI 95% 12.51-28.59), DMFS-dmfs (OR 10.22, CI 95% 7.01-14.91) and number of carious surfaces (OR = 5.47, CI 95% 3.85-7.78). Logistic regression analysis identified that GBI (OR = 2.14, CI 95% 1.41-3.25) and DMFS (OR = 17.3, CI 95% 11.39-26.27) were independent risk factors for active white lesions. Conclusions: The results reaffirm the importance of mechanically controlling biofilm to prevent caries development in its initial stage (white lesion). Keywords: case-control study, dental caries, enamel demineralisation

Aim: To investigate existing caries risk factors in preschool children and to illustrate their caries risk profiles graphically with aid of a computer-based program. Materials and Methods: All 2-year-old children from a small town in northern Sweden were invited and 87% (n = 125) accepted to participate. Data was collected with a questionnaire concerning the child's normal diet and sugar consumption. Special care was taken to note the intake of sweet drinks and sugary between-meal products. Questions on general health and medication, toothbrushing frequency with parental help and use of fluorides were also included. The caries prevalence was recorded with mirror and probe and the level of oral mutans streptococci was enumerated with a chair-side technique. The obtained data were computerised in a risk assessment program (Cariogram) and a graphical profile of each child was constructed. Results: The caries prevalence was 6%, and 18% had detectable levels of oral mutans streptococci. The sugar consumption was strikingly high with 82% and 97% having ice cream and sweets once a week or more often. In 22% of the families, toothbrushing with parental help was not a daily routine. Of the children, 51% displayed a low chance (0-20%) of avoiding caries in the future. The frequency of sugar consumption was the most pertinent factor in the children's caries risk profiles. Conclusions: Half of the subjects exhibited a low chance of avoiding caries in the near future and the strongest single factor was frequent sugar consumption. Thus efforts to limit and reduce the sugar intake in young children are important measures for primary caries prevention. Keywords: caries risk, children, mutans streptococci, oral hygiene, sugar

Purpose: The aim of the present investigation was to study the effect of daily use of fluoride dentifrices containing various antimicrobial agents on mutans streptococci (MS) in saliva and approximal dental plaque. Materials and Methods: Fifty-nine healthy adolescents, 12-14 years old, undergoing orthodontic treatment with fixed appliances and harbouring high levels of MS in saliva and preferably also in interdental plaque, were randomly distributed into four groups, using dentifrices with: 1) zinc lactate (n = 16), 2) amine fluoride-stannous fluoride (n = 13), 3) triclosan (n = 15), and 4) no antimicrobial agent (control; n = 15). Changes of MS scores versus baseline were determined after 1, 3 and 6 months, using the Dentocult® SM Strip mutans test. Results: At the 6-month sampling occasion, the subjects using dentifrice with either amine fluoride-stannous fluoride or triclosan showed a tendency to lower MS scores in interdental plaque (p 0.05). In saliva and in the 1- and 3-month plaque samples, no changes of MS were detected in any of the four groups. Conclusion: This 6-month clinical study showed that dentifrices with various antimicrobial agents only result in small or no changes of the MS scores in saliva and approximal dental plaque in orthodontic patients. Keywords: amine fluoride, caries prevention, dentifrice, mutans streptococci, stannous fluoride, triclosan

Purpose: To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate (CPP-ACP) and fluoride mouthwashes on the regression of white spot lesions (WSL). Materials and Methods: The study group consisted of 26 healthy adolescents (mean age 14.6 years) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances. After bracket removal, professional tooth cleaning and drying, a visual scoring (0-4) and laser fluorescence (LF) readings were carried out. The patients were randomly assigned to two different treatment protocols with the aim of remineralising the lesions: A) daily topical applications of a dental cream containing CPP-ACP (Topacal) for 3 months followed by a 3-month period of daily toothbrushing with fluoridated dentifrice, or B) daily 0.05% sodium fluoride mouthwash combined with fluoridated dentifrice for 6 months. The registrations were repeated after 1, 3, 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests. Results: A significant improvement of the clinical WSL-scores was found over time in both groups, but there was a statistically significant difference (p0.01) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime, 63% compared with 25% respectively. The clinical registrations were mirrored by a statistically significant decrease (p0.05) in the LF readings at the 6- and 12-month follow-ups compared with baseline. No significant differences were displayed between the groups. Conclusions: Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances. The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments. Keywords: lesion regression, milk derivate, orthodontics, sodium fluoride mouthwash, white spot lesions

Purpose: The aim of the present study was to investigate the oro-facial health of patients with end stage renal disease, focusing on their periodontal conditions. Material and Methods: A total of 51 patients (33 men) between the ages of 22 and 81 years with different types of chronic kidney disease that needed renal dialysis, underwent a full dental examination including a panoramic radiograph. A blood sample was collected from the subjects to investigate the levels of pro-inflammatory biomarkers. Results: A large proportion of patients had oral health problems. A total of 35% claimed that they suffered problems of the oral cavity and 51% had periapical osteitis around one or more teeth. A high number of patients also suffered from gingivitis (46%), severe periodontitis (35%) and 37% had cavities due to caries. On average the patients had 22.9 (SD 7.3) teeth and 14% had complete or partial dentures. Although periodontitis influenced the C-reactive protein level and oral pathology was significant within this specific population, the correlation between inflammatory biomarkers and dental parameters was weak. Conclusions: This study indicates that a substantial number of patients who suffer from advanced chronic kidney disease, close to the start of dialysis treatment, have dental problems that require attention. Keywords: dialysis, kidney disease, oral health, periodontitis, risk factors

Purpose: To evaluate knowledge of betel quid (BQ) vendors in relation to traditional chewing and smoking habits in Northern Thailand. Materials and Methods: Interviews of vendors selling BQ and other traditional chewing and smoking items were conducted. Questions related to side effects of BQC were included, as well as questions focusing on why traditional chewing and smoking habits were on the decline. Results: Nineteen stalls in 10 markets were visited and 18 vendors were interviewed (16 women, 2 men, average age 55.0 years, range 28-75 years). Vendors had been present for an average of 21.8 years (range 2-60 years). The number of customers buying BQ regularly was 2-3 per day. More elderly women than men bought BQ. Side effects of BQ on the oral mucosa were largely unknown to vendors. Most respondants thought BQ to be good for teeth. Reasons why young people have given up the BQ habit were black teeth. Miang (fermented tea leaves) and khi yo (traditional cigar) were rarely sold and were considered vanishing habits. Conclusions: BQ vendors had poor knowledge of the side effects of BQC. BQ vendors unanimously considered traditional habits such as chewing of BQ, miang and smoking of traditional cigars to be on the decline. Nowadays, most of these items are bought to be offered during ceremonies. Generally, traditional habits seem to be replaced by 'modern' lifestyle habits such as cigarette smoking and alcohol consumption. With these changes, general and oral disease patterns will eventually occur. Keywords: areca nut, betel quid chewing, tobacco, oral cancer