Oral Health and Preventive Dentistry, 01/2008

Purpose: To describe the use of dental care services in an urban sample of adults from Porto, and to quantify the association between dentist visits and social, demographic, clinical and lifestyle factors. Materials and Methods: Participants were selected by random digit dialling, and interviewed with a structured questionnaire to obtain information on socio-demographic, clinical and lifestyle variables. Crude, and age- and education-adjusted Odds Ratios (ORadj) were computed by unconditional logistic and multinomial logistic regression to quantify the association between the use of dental care and each exposure. Results: In the year preceding the interview, 51.1% of the subjects visited a dentist at least once. Dental visits were less frequent in subjects aged >= 70 years compared to those aged 18-29 years (ORadj = 0.66, 95% Confidence Interval [CI]: 0.45-0.98), and increased with education (from 23.8% in subjects with 0-3 school years to 67.9% in those with > 12 years of education, p 0.001 for trend). The use of dental care services at least once in the previous year was more frequent in white-collar workers (ORadj = 0.69, 95% CI: 0.52-0.91), when a private doctor was the usual source of medical care (ORadj = 1.38, 95% CI: 1.06-1.79) and in those who visited a medical doctor in the previous year (ORadj = 1.96, 95% CI: 1.57-2.45). Diabetics were less likely to seek dental care (ORadj = 0.67; 95% CI: 0.48-0.93). Conclusion: Nearly half the adults from Porto had not visited a dentist in the previous year. Education was the factor most strongly associated with dentist attendance. No differences were observed regarding the determinants of one or two or more dental visits in the previous year. Keywords: dental care, epidemiology, oral health, Portugal

Purpose: 1) To evaluate trends in dental caries of children and adolescents of Hubei Province and Wuhan Municipality over the last two decades. 2) To conduct a situational analysis of existing oral health care and to recommend changes to improve this care for children. Materials and Methods: An analysis was performed on data from national oral health surveys carried out in China at the provincial level, and data on 12-year-old children of Wuhan Municipality. A review of the literature was conducted on available and utilised oral health care facilities by children. Results: In 1983, the mean decayed, missing and filled teeth (DMFT) of 12-year-olds in Hubei Province was 1.0, and in 1995 it was 0.6. The studies in Wuhan Municipality in 1993-1995 among 12-year-olds reported DMFT values ranging from 0.7-1.5, however different methods of caries assessment were performed in the various studies making comparisons difficult. The caries prevalence and the mean dmft score of 5-year-old children in 1995 in Hubei Province were 69% and 3.6, respectively. The percentage of untreated caries for all age groups in Hubei Province was very high. Conclusions: Analysis of epidemiological information over the last two decades does not provide any conclusive evidence supporting either an increasing or decreasing trend of dental caries in the child and adolescent population of Hubei Province and Wuhan Municipality. There is, however, a clear need to prevent the incidence of dental caries from increasing and to provide care to address the treatment needs of pre-school and school-age children. The promotion of twice-daily tooth brushing with fluoride toothpaste at maternal and child health care centres, and the establishment of daily tooth brushing with pea-size amounts of fluoride toothpaste in the pre-school and primary school setting are recommended preventive strategies. Establishment of school-based oral health promotion should be accompanied with the provision of Atraumatic Restorative Treatment (ART) sealants and ART restorations which can be provided by dental nurses at dramatically lower costs than the traditional high-tech approach. Keywords: epidemiology, Hubei Province, oral health care, oral health status, Wuhan Municipality

Purpose: To compare caries experience and periodontal status between two US populations that lived a century apart. Materials and Methods: The University of Pittsburgh, School of Dental Medicine possesses a collection of skulls that was organised in the first half of the 20th century. Those individuals are likely to have lived in the northeast United States during the late 19th century and the early 20th century. The present study measured caries and periodontal disease morbidity in the collection of skulls and compared the data with current prevalence rates of these diseases in the United States (from the third National Health and Nutrition Examination Survey 1988-94). Results: Periodontal health appears to have improved since this population resided, over 150 years ago. On the other hand, Americans between the ages of 16 and 39 appear to have the same prevalence of caries as a group of individuals that lived 150 years ago. Conclusions: The periodontal health of Americans has probably improved in the last 100 years. The individuals identified that were free of caries and periodontal disease among the group that lived during the 19th century may have some protective factor against these diseases. Keywords: dental caries, epidemiology, periodontitis

Purpose: This study evaluated the agreement between clinical and photographic assessment of dental fluorosis (DF) in 73 children during a field study, using portable equipment and a standardising device. Materials and Methods: A dental exam was performed using the Tooth Surface Index of Fluorosis (TSIF). Photographs of the facial aspects of front teeth and from the occlusal aspect of the mandibular posterior teeth were taken. All photographs were taken following a standard operating procedure. Photographs of anterior and posterior teeth were coded and assigned a random study number. Examiners scored photographs as fluorosis cases or non-cases. Results: Agreement among the clinical examiners ranged from good to excellent. Agreement was also good for the repeated photographic evaluations. In total, 22% of the children were diagnosed with DF during a clinical exam, and 19% were diagnosed with DF using the photographs. Conclusions: Development of this method aided in the photographic assessment of DF. The photographs obtained were a useful tool for documenting DF, to re-train examiners, and to determine intra- and inter-examiner agreement. Keywords: dental fluorosis, fluoride, photography, TFI, TSIF

Purpose: The present study was undertaken to evaluate the oral health status and oral hygiene habits of dialysis patients. Materials and Methods: A total of 145 patients on dialysis were evaluated in two centres. Evaluation included oral examination of soft and hard tissues and completion of a questionnaire that was used to gather information about demographic, socioeconomic, medical and dental status and oral hygiene attitudes of patients. Awareness of the importance of oral health was also determined by four yes/no questions within this questionnaire. Results: Of the 145 patients, 89 (61.4%) were presently candidates for renal transplantation. Nineteen patients (13.1%) were edentulous and nearly half of the patients (n = 69, 47.6%) had 15 or fewer remaining teeth. Dentate patients who regularly brushed twice a day and flossed were few (n = 18, 14.3%; n = 3, 2.4%, respectively). In addition, plaque score was more than 50% in most of the dentate patients (93.7%). Gingival bleeding was reported by about two thirds of dentate patients (67.5%). None of the patients were referred to a dentist or were attending regular dental care. The percentage of patients who were aware of oral cavity-related infections and importance of oral hygiene following renal transplantation was very low (20.7% and 9.7%, respectively). Conclusions: Poor oral health, unsatisfactory daily oral hygiene habits and insufficient awareness of the importance of oral health is frequent among Turkish dialysis patients. Dentists and nephrologists should work in close cooperation in order to raise awareness and encourage regular dental controls. Keywords: chronic renal failure, dialysis, oral health

Purpose: To assess smoking, tooth brushing and oral cleanliness and their relationships among 15-year-olds in Tehran, Iran. Materials and Methods: A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out in autumn 2004 among 15-year-olds (n = 502) in Tehran. Data were based on a self-administered questionnaire and a clinical dental examination. Results: Smokers comprised 5% of the boys and 2% of the girls (p = 0.02). Smoking was more common among students of less-educated parents (50% vs. 30%, p 0.05). Of all students, 26% reported twice-daily tooth brushing; those of higher socio-economic backgrounds and girls did so more frequently. Of the smokers, 11% reported no tooth brushing compared to 6% of the non-smokers. Oral cleanliness was good for 13%, moderate for 32%, and poor for 55%; the rates associated positively with female gender (p = 0.002), having higher-educated parents (p = 0.03), and reporting a higher frequency of tooth brushing (p 0.001). Those students reporting twice-daily tooth brushing had less dental plaque and gingival bleeding (p = 0.01) on both anterior and posterior teeth. In multivariable analyses, the best predictors for a good level of oral cleanliness were female gender (OR = 2.0) or twice-daily tooth brushing (OR = 1.7). Conclusion: Oral cleanliness and tooth brushing among 15-year-olds were at poor levels, particularly among boys. Such poor levels call for intensive attempts to enhance rates of twice-daily tooth brushing and to improve its quality. For this age group, anti-smoking purposes should be combined into school-based oral health promotion programmes as well. Keywords: adolescents, oral cleanliness, smoking, tooth brushing

Purpose: To study risk-based preventive practice among Iranian dentists. Materials and Methods: A questionnaire survey was conducted at two annual dental meetings in 2004 and 2005 in Tehran. Using a five-point Likert scale, respondents indicated their level of agreement with taking preventive measures including oral hygiene, use of fluoride, diet and dental check-up for a high- and a low-risk (HR and LR, respectively) hypothetical patient case. Respondent's smoking and activity in smoking cessation were enquired about as well. Of 1033 responding dentists, 980 (64% men) were eligible for this study. Statistical evaluation was by the chi-square test and logistic regression. Results: The top four of the eight measures were instructions on tooth brushing and flossing, advice related to fluoridated toothpaste, and regular dental check-ups, with the choice 'fully agree' being more prevalent for the HR (74%-58%) than for the LR case (59%-41%). For the HR case, 45% of the respondents fully agreed with applying chair-side tooth cleaning, 41% with advice on diet modification, and 38% with advice on home-use of sodium fluoride mouthwash. Of all respondents, 76% were nonsmokers and 56% reported that they always recommend their smoking patients to quit. Female gender and activity in professional reading were associated with higher levels of agreement for applying preventive measures to the HR case. Non-smoking was the strongest explanatory factor (OR = 3.6, 95% CI = 2.6-5.1) of dentist's higher involvement in smoking cessation. Conclusion: Risk-based preventive dental care should be emphasised and applied in order to maximise efficient use of resources. Keywords: dentist's characteristics, preventive treatment, risk-based practice, smoking cessation

Purpose: The purpose of this study was to evaluate the amount of dentifrice applied to the toothbrush by school children using a liquid dentifrice (drop technique), when compared to toothpaste. Materials and Methods: A total of 178 school children (4-8 years old) from two cities in Brazil (Bauru and Bariri) participated in the present two-part crossover study. Children from Bauru received training regarding tooth-brushing techniques and use of dentifrice before data collection. In each phase, the amount of toothpaste or liquid dentifrice applied by the children to the toothbrush was measured, using a portable analytical balance (± 0.01 g). Data were tested by analysis of covariance (Ancova) and linear regression (p 0.05). Results: The mean (± standard deviation) amounts of toothpaste and liquid dentifrice applied to the toothbrushes for children from Bauru were 0.41 ± 0.20 g and 0.15 ± 0.06 g, respectively. For children from Bariri, the amounts applied were and 0.48 ± 0.24 g and 0.14 ± 0.05 g, respectively. The amount of toothpaste applied was significantly larger than the amount of liquid dentifrice for both cities. Children from Bariri applied a significantly larger amount of toothpaste, when compared to those from Bauru. However, for the liquid dentifrice, there was no statistically significant difference between the cities. A significant correlation between the amount of toothpaste applied and the age of the children was verified, but the same was not found for the liquid dentifrice. Conclusion: The use of the drop technique reduced and standardised the amount of dentifrice applied to the toothbrush, which could reduce the risk of dental fluorosis for young children. Keywords: fluorides, fluorosis, preventive dentistry, toothpaste, topical

Purpose: To examine the risks for being overweight (Ow) or obese (Ob) in subjects with elevated Periodontal Screening and Recording™ (PSR™) Codes (>= 1) (with smoking as a modifier) in a population of dental school patients located within a region with a high incidence of Ow, Ob, diabetes mellitus (Db), and cardiovascular disease (CVD). Materials and Methods: 1098 patient files were studied and data were grouped by average PSR™ Codes, smoking history, and body mass index (BMI). Data were compared by factorial ANOVA, the Mann-Whitney U test, and chi-square analysis using PSR™ Code as an exposure for BMI, Db, or CVD, with smoking as the effect modifier. Data were then analysed by adjusted multivariate logistic regression to determine the risks for being Ow or Ob. Results: Subjects with an average PSR™ Code >= 1 and a smoking history did not have a significantly increased risk for either Db or CVD. Non-smoking subjects with an average PSR™ Code = 3 had a significantly higher risk for being Ow; those with an average PSR™ Code of 2-4 had a significantly higher risk for being Ob (p 0.05). In contrast, only smokers with an average PSR™ Code = 4 had a significant risk for being either Ow or Ob. Conclusion: Our data suggest that smoking may not directly increase the risk factors for Db or CVD in subjects with an average PSR™ Code > 1 (confirming the 'Smoker's Paradox'), but could be an indirect risk factor for these diseases as a consequence of its effect on body weight. Keywords: cardiovascular disease, diabetes mellitus, obesity, overweight, PSR™ Code, smoking

Purpose: Our aim was to evaluate the expression of interleukin-18 (IL-18), interleukin-1-beta (IL-1ß) and the amount of elastase activity in gingival crevicular fluid (GCF) from inflamed gingival sites in patients with juvenile systemic lupus erythematosus (JSLE), and compare these to the expression in GCF from inflamed sites in generally healthy controls. In addition, the local inflammation in periodontal tissues was related to systemic inflammation by the assessment of IL-18 levels in plasma. Materials and Methods: GCF from 16 patients with JSLE and 14 controls were collected using a washing device. Elastase activity was measured with a specific substrate, and IL-18 and IL-1ß were measured by ELISA. Results: The percentage of visible plaque index, gingival bleeding index and attachment level were similar in JSLE and controls, while the percentage of probing depth greater or equal to 3 mm was significantly higher in the controls. The total amount of IL-1ß and IL-18 in GCF were significantly decreased in JSLE, while the total amount and the percentage of free elastase activity were significantly higher in JSLE when compared with the controls. The plasma levels of IL-18 and the erythrocyte sedimentation rate were significantly higher in JSLE patients. Conclusion: We found more active elastase in GCF from inflamed sites in JSLE patients even in the presence of significantly lower levels of IL-18 and IL-1ß. The increased elastase activity suggests a hyperactivity of neutrophils in JSLE, possibly generated by a priming effect caused by the higher plasma levels of IL-18 found in these JSLE patients. Keywords: elastase, IL-18, IL1-ß, juvenile systemic lupus erythematosus, periodontitis