Oral Health and Preventive Dentistry, 02/2008

Purpose: To survey an adult population in a deprived district of Karachi, with reference to factors influencing perceived oral health. Materials and Methods: Of 1000 questionnaires distributed to households, 994 were returned. The respondents were aged between 30 and 50 years old. Women comprised 49% of the sample. Results: Pan and betel nut chewing had a strong influence on the perceived oral health of the respondents. Pan chewers, 32% of the respondents, had a greater risk of oral problems, odds ratio 3.63. In contrast to other oral problems, dental caries was significantly less frequent among pan chewers (odds ratio 0.63). Betel nut chewing (28%) was less deleterious to oral health: the only significant effects were a higher risk for dental caries, odds ratio 4.51, and more gingival bleeding. While most of the respondents used a toothbrush for oral hygiene, a substantial proportion (27%) used their fingers. The oral hygiene method had no influence on the perceived oral health, nor did consumption of sweets and tea with sugar. Over 80% of the participants seldom or never visited a dentist. Cleaning frequency was significantly associated with oral health: those who cleaned their teeth at least daily had fewer oral problems. Almost all participants considered that eating sweets, smoking, and chewing pan and betel nuts endangered oral health. Conclusions: In this population, typical of deprived urban areas of Pakistan, betel nut habits and frequency of oral hygiene have a strong influence on perceived oral health, while cleaning method and sugar intake do not. Keywords: betel nuts, dental care, oral health, oral hygiene

Purpose: The aim of the present study was to investigate whether self-consciousness, self-reported oral health status and oralhealth-related behaviours were associated. Material and Methods: The present study sample consisted of 253 first year medical students in Romania. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status and three selfconsciousness subscales (Private Self-Consciousness, Public Self-Consciousness, and Social Anxiety). Results: Significant differences were found in Public Self-Consciousness and Social Anxiety according to several variables: anxiety, stress, depression and current non-treated caries. There were significant differences in Social Anxiety for the variables of gender, smoking, perceived dental health, self-reported gum bleeding and reason for dental visit (p 0.05). A significant difference was found in Public Self-Consciousness for the reason for dental visits (p 0.05). Total Self-Consciousness is correlated with anxiety, stress, depression, current non-treated caries, gingival bleeding and reason for dental visit. Oral health behaviours such as tooth brushing, flossing, mouth washing and last dental visit were not influenced by each of the self-consciousness subscales. Conclusions: The results suggest that self-consciousness might be a psychosocial risk marker that influences self-reported oral health status. Keywords: oral health behaviour, perceived oral health status, self-consciousness

Purpose: To study oral health conditions, diabetic medical complications and their association in type 2 diabetes mellitus (DM). Materials and Methods: Cross-sectional survey of 364 type 2 DM patients (63.6 ± 10.1 years, 54% female) and 161 controls (64.1 ± 10.6 years, 53% female) with or without essential hypertension, predominantly low-income, attending a hospital were recruited. Periodontal disease (Community Periodontal Index [CPI]) and dental status (decayed, missing and filled teeth [DMFT]) were recorded. Fasting plasma glucose and, for DM patients, HbA1C and DM complications were recorded on enrolment and follow up, respectively. Results: Many DM subjects had fair diabetic control. Both groups (control/DM) had poor oral health: DMFT = 14.5/16.8, CPI 4 = 36%/50%, (P 0.02) while DM subjects had less DT(adjusted) = 2.1/1.4 (P 0.01). Of the follow-up DM individuals, 294 (81%) had medical complication(s). Regression analyses showed association between advanced periodontal attachment loss (ALoss) and age, male gender, smoking and DM; MT and DMFT were associated with age, female gender, smoking, DM and hypertension. ALoss and DMFT were not associated with DM complications. Conclusions: The oral health of the surveyed Chinese subjects was poor. Type 2 DM subjects were affected more by ALoss and MT but less DT. Subjects with hypertension had higher odds for MT. Keywords: dental caries, diabetes complications, diabetes mellitus, DMF index, periodontal disease, type 2 diabetes mellitus

Purpose: To know the prevalence of malocclusal traits and their correlation in Italian mixed dentition children. Materials and Methods: A sample of 1,198 children 7 to 11 years old, who had never undergone orthodontic treatment, were included in the Italian Oral Health of Schoolchildren of the Abruzzo Region (OHSAR) Survey. Canine and molar classes, overbite, overjet, dental crowding, maxillary midline diastema, crossbite and scissorbite were recorded. The canine and molar classes were considered as dependent variables, and their separate correlations with all of the other occlusal traits were analysed by multivariate methods. Results: Over 90% of the children showed at least one malocclusal trait; the mean ± SD of malocclusal traits was 3.5 ± 1.8. Gender did not affect the prevalence of any malocclusal traits. Dental class II was correlated with increased overbite and overjet, and negatively correlated with the maxillary midline diastema; dental class III was correlated with decreased overbite and overjet, and crossbite. Asymmetrical dental class was correlated with increased overjet and crossbite. Dental crowding showed very little correlation. Conclusions: The prevalence of malocclusal traits in Italian children is very high, and more effort is needed to implement early interventions, including close monitoring and modifications of lifestyle. Keywords: children, correlation, epidemiology, Italy, malocclusion/malocclusal trait, mixed dentition, OHSAR survey

Purpose: To identify the risk indicators of gingivitis among socioeconomic, clinical and gender variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005. Materials and Methods: The sample consisted of 728 subjects attending 22 public (n = 428) and 18 private (n = 300) preschools. A previously calibrated examiner performed the clinical examination in an outdoor setting, under natural light, using a dental mirror, Community Periodontal Index probe and air-drying. Gingival status was measured using the gingival alteration index for 5-year-olds according to the national survey carried out in 2002 in Brazil (Health Ministry of Brazil, 2004). Socioeconomic variables (monthly family income, number of people living in the household, parents' educational level, home ownership and car ownership) were collected by means of a parental semi-structured questionnaire. Results: The prevalence of gingivitis was 16.6%. Monthly family income (p 0.0001), father's education (p 0.0007), mother's education (p = 0.0004), type of school (p 0.0001), car ownership (p = 0.0854), gender (p = 0.0087), initial lesion (p 0.0001), dental caries (p = 0.0008), crowding (p = 0.0054) and spacing (p = 0.0019) were associated with gingival bleeding at p 0.15 and were selected for the regression analysis. By means of multiple logistic regression analyses, monthly family income of up to 4 Brazilian minimum wages, presence of initial lesion, presence of crowding and male gender were found to be risk indicators of gingivitis. Conclusion: The prevalence of gingivitis in 5-year-old preschool children in Piracicaba was 16.6%. Also, family income of up to 4 minimum wages, male gender, the presence of initial caries lesion and crowding were risk indicators of gingivitis. Keywords: gingivitis, preschool, risk indicator

Purpose: To evaluate the periodontal condition of adult patients attending public health centres in the city of Recife, Brazil, and to investigate whether periodontal conditions are associated with socioeconomic and demographic variables. Materials and Methods: This cross-sectional study included 13 randomly selected public health centres. Sample size was calculated using 5.0% standard error and a confidence interval of 95%. The minimum sample size was 461 subjects, and a total of 505 subjects participated in this study. Each participant completed a questionnaire and underwent periodontal examination. Periodontal conditions were based on the Community Periodontal Index (CPI). Bivariate analysis of frequencies and means was performed with SPSS, version 11.0. The chi-square and likelihood ratio statistical tests were used to calculate the level of statistical significance of the associations tested. The level of statistical significance was set at P 0.05. Results: Calculus was the highest CPI score in 61.8% of the subjects, and shallow pockets (4-5 mm) were the highest score in 15.2% of them. A healthy periodontium was observed in 10.7%, while gingival bleeding and deep pockets (>= 6 mm) were found as the highest CPI score in 10.3% and 2.0% of the sample, respectively. Periodontal conditions showed significant association with the socioeconomic and demographic variables analysed (P 0.05). Conclusions: Findings indicate a high prevalence of periodontal alterations in the sample. Periodontal conditions were worse in men, married individuals, older subjects and individuals with low socioeconomic class and poor education. Keywords: adults, periodontal condition, prevalence

Purpose: This study aimed to describe the periodontal condition of children, adolescents and young Saudi adults and to investigate its relationship with salivary variables and oral hygiene status. Materials and Methods: A sample of 114 children, 99 adolescents and 99 young adults were randomly selected from patients attending dental clinics at the school of dentistry. Clinical examination of oral health status included using WHO Community Periodontal Index and Green and Vermillion oral hygiene index. In addition, salivary flow rate, pH, buffering capacity and microbial flora were measured. Results: A healthy periodontal condition was found in 6.7% of the sample. Calculus was the most frequently encountered periodontal disease. Children had better periodontal condition than adolescents and adults. Males had higher plaque and gingival scores than females. The salivary flow rate and pH were significantly higher in individuals with good periodontal condition. The salivary level of fluoride and buffering capacity was not related to the periodontal condition. Yeast was the only microorganism related to periodontal condition. The relationship between poor periodontal condition and high plaque score was highly significant. Conclusions: Periodontal disease increased with age and was strongly related to salivary flow rate, pH value and yeast level, as well as plaque accumulation. Preventive efforts must be increased in order to achieve the WHO goal for the year 2010 of no more than one sextant showing bleeding or calculus at the age of 15. Keywords: community periodontal index, microbial flora, oral hygiene, saliva

Purpose: One of the recommended measures to prevent and control dental erosion is the oral rinse with sodium bicarbonate solution, which would neutralise the dietary acids. However, the prescription of this aqueous suspension has been made on an empirical basis. The aim of this in vitro study was to evaluate whether the demineralisation caused by erosive episodes could be controlled by the potential neutralising effect exerted by a sodium bicarbonate solution. Materials and Methods: Bovine enamel slabs were embedded in epoxy resin, ground/polished and tested for initial surface microhardness. Twice daily for 2 days, specimens were subjected to an erosive challenge with orange juice in an orbital shaker. Following each erosive episode, specimens (n = 15) were immersed for either 30 or 60 seconds in a sodium bicarbonate solution or deionised water. The negative control group was left untreated. For the remaining daily time, specimens were kept in artificial saliva. New microhardness indentations were then made as described for the initial measurements. Results: ANOVA applied to the percentage of surface microhardness change (%ΔSMH) showed no statistically significant difference among treatments (P = 0.5810). Conclusion: The use of sodium bicarbonate solution, at least under in vitro conditions, may not be a feasible strategy for managing enamel erosion. Keywords: dental enamel, erosion lesions, microhardness, sodium bicarbonate solution

Purpose: The aim of the study was to determine possible differences in decrease of pH-values of whole saliva, following the intake of different beverages. Materials and Methods: Twelve boys and 13 girls (4.9 ± 0.9 years old) participated in this study. A dental examination was performed (dmft). Orange juice (pH = 3.67), instant fennel tea (pH = 7.38), whole milk (pH = 6.84) and mineral water (pH = 5.88) were tested. All beverages were given at the same time of day. Salivary pH and buffering capacities of the beverages were determined with a portable pH-meter. Immediately after intake of a beverage, and 5, 10, 15 and 25 minutes later, whole saliva was collected, and the pH-value was measured again. The statistical evaluation was performed using the Wilcoxon test for paired samples. Results: Fifteen children had healthy dentitions. Ten subjects had a mean dmft of 1.1 ± 2.3. The mean base salivary pH was 7.09 ± 0.07, without differences between the children with and without dental decay. Mineral water led over the whole period of measurements to a significant rise in salivary pH (P 0.05). Orange juice caused a significant reduction in the salivary pH during the first 10 minutes. After intake of instant tea or milk, significant reductions were found in the period of 5 to 10 minutes. After the intake of instant tea, the reduction was still significant after 15 minutes. During the period of 5 to 10 minutes, the change in pH (ΔpH) in whole saliva differed significantly only between consumption of mineral water and other beverages (P 0.01). Conclusion: With regard to dental health, a regular consumption of orange juice or sweetened instant teas should be discouraged. Keywords: children, instant tea, milk, orange juice, salivary pH

Purpose: To evaluate if using the laser fluorescence (LF) device improves the detection of early or more advanced occlusal caries lesions in primary teeth. Materials and Methods: A total of 181 occlusal sites in primary teeth were assessed by one examiner using DIAGNOdent. The same examiner and a second examiner evaluated 72 of the sites again to assess intra- and inter-examiner reproducibility. After histological validation, lesions were divided at three thresholds according to the lesion depth: outer half of the enamel (D1), inner half of the enamel (D2) and dentine (D3). The sensitivity, specificity, accuracy and area under ROC curve were calculated for cut-off points for the sample considering the aforementioned thresholds. The parameters were compared using chi-square test and by comparison between unpaired ROC curves. Results: The overall LF performance was better at dentine threshold than at enamel threshold. The higher specificity was found at D3 and D2, and higher accuracy at D3 (P 0.001). The intra- and inter-examiner agreements were classified as good or excellent for all thresholds. Conclusions: The LF device performs better at the dentine threshold than at the enamel threshold. This method does not perform well in detecting initial enamel caries lesions. Keywords: dental caries, early detection, laser fluorescence, occlusal surface, primary teeth