Oral Health and Preventive Dentistry, 03/2011

Purpose: The aim of this study was to test the applicability of the Transtheoretical Model (TTM) to gain an understanding of interdental cleaning behaviour change in senior high school students (12th grade) in Iran. Materials and Methods: Multistage cluster sampling was employed to recruit 361 senior high school students from 8 schools in Yazd City, Iran. This cross-sectional study took place from November 2008 to March 2009. Appropriate instruments were used to identify the stages of interdental cleaning behaviour and psychological attributes, including interdental cleaning behaviour, decisional balance, and self-efficacy. The statistical analysis of the data included descriptive statistics, t-test and ANOVA. Results: Of the 361 students, nearly 12.5% were in the maintenance stage, while 49.6% were in the pre-contemplation stage, with the rest distributed among the other stages of interdental cleaning behaviour change. There was a statistically significant difference in the stages of interdental cleaning behaviour change by gender. Self-efficacy and decisional balance differed significantly across the stages of interdental cleaning behaviour change. Conclusion: The TTM was found to be useful in determining the stages of interdental cleaning behaviour change among students. This study suggests the development of theory-based and empirically supported intervention strategies and programs to improve interdental cleaning behaviour with an emphasis on improving students' self-efficacy in this area. Keywords: decisional balance, interdental cleaning behaviours, transtheoretical model, self-efficacy, students

Purpose: To compare the effectiveness of bacterial plaque removal of six denture hygiene procedures used by patients to clean their dentures. Materials and Methods: Fifteen students randomly divided into groups G1, G2, G3, G4, G5 and G6 used maxillary intraoral appliances for 24 h without cleaning them. Afterwards, the appliances were submitted to the following procedures: P1: washing under running water for 20 s; P2 and P3: cleaning with alkaline peroxide (Corega Tabs®) for 5 and 30 min, respectively; P4: brushing with water and liquid soap for 40 s; P5: alkaline hypochlorite for 10 minutes; P6: home use chlorine solution (Q'boa® at 0.45% for 10 min), throughout a period of 6 consecutive weeks. The procedures followed a circulating scheme, so that all the appliances were submitted to all the hygiene methods studied. After the hygiene procedures, the appliances were stained, photographed and submitted to the weighing method. Results: After ANOVA and Tukey's test, differences were observed: P5 = 0.73 ± 0.3 (b), P6 = 1.27 ± 0.4(b,c), P4 = 1.92 ± 0.5 (b,c), P3 = 2.24 ± 1.0 (b,c), P2 = 7.53 ± 2.5 (c) and P1 = 26.86 ± 15. 3 (a). Conclusion: From the results of the study, it could be concluded that the use of alkaline hypochlorite is the best way to remove bacterial plaque, followed by the home-use chlorine solution and brushing with water and liquid soap. Corega Tabs® must be used for 30 min of immersion to have a cleaning effectiveness similar to that of alkaline hypochlorite. Keywords: biofilm, denture cleaners, dental prosthesis

Purpose: The aim of this study was to assess the relationship between untreated malocclusions and oral health-related quality of life (OHRQOL) in male adolescents of Mashad (Iran) high schools. Materials and Methods: In this observational cross-sectional descriptive study, 120 male students were randomly selected among Mashad (Iran) high schools. These students filled out an oral health-related quality of life questionnaire (the modified version of CPQ), and then they were clinically examined to determine their malocclusions according to the Index of Complexity, Outcome and Need (ICON), and finally the relationship between these two variables was assessed with the Pearson correlation test. Results: There was a statistically significant relationship between ICON scores and the quality of life levels (P 0.01). The assessment of four sections of the questionnaire showed that among these four sections (oral symptoms, functional limitations, emotional well-being, social well-being), only oral symptoms were significantly correlated with the ICON score (P 0.05). Conclusion: Malocclusion plays an important role in the oral health-related quality of life. However, the relationship between emotional well-being, social well-being and malocclusions was not as strong as in previous studies. Keywords: adolescent, index of complexity, malocclusions, oral health-related quality of life, outcome and need (ICON)

Purpose: To assess: 1) awareness of diabetic patients about their increased risk for oral diseases, 2) attitudes of diabetic patients towards maintaining good oral health through oral self-care and regular dental visits and 3) their sources of information on oral health. Materials and Methods: A self-administered questionnaire was used to assess the main objectives of the study. Two hundred diabetic patients ranging in age from 17 to 78 years old participated in the study. Results: A majority of the participants had type 2 diabetes. The awareness of diabetic patients of their increased risk for oral diseases is low compared to their awareness of systemic diseases. Their attitude towards maintaining good oral health is poor. Of the participants, only 17% brush their teeth twice daily, 61% never use dental floss, and 67% had not visited a dental clinic within the last year. Regarding participants' sources of awareness, 53% learned from a dentist and 30% through other media sources. A significant association (P 0.05) was found between glycaemic control and oral infections and between duration of diabetes and denture problems. Conclusions: Diabetic patients were found to have little awareness of their increased risk for oral diseases. In order to promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to develop programs to educate the public about the oral manifestations of diabetes and its complications for oral health. Keywords: awareness, diabetes, oral health, oral self-care, periodontal disease

Purpose: Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. The objective of this study was to assess the tobacco cessation knowledge, attitudes and behaviours of dental practitioners in Kochi (Cochin), Kerala, India. Materials and Methods: A sampling frame of dentists enrolled in the Indian Dental Association (IDA), Kochi (Cochin) branch, practising in Ernakulam city, was obtained from the IDA. The letter describing the rationale for the study contained a 35-item pre-tested questionnaire and was personally delivered along with a stamped envelope. One hundred fourteen dentists returned a usable questionnaire. Data were entered and analysed using SPSS 12. Frequencies were calculated for all variables. Results: Based on the responding dentists' self-reports, 54.6% were not confident in tobacco cessation counselling, 10.6% never asked, 60.9% asked in 50% of their patients about tobacco use and 17.6% of the dentists surveyed were smokers themselves. Participating dentists perceived that they were interested in using tobacco cessation counselling, but were not sure of quitting rates in their patients. The average time spent counselling patients about tobacco cessation was less than 2 minutes. Conclusion: The dentists perceived that lack of formal training leads to less motivation about tobacco counselling and hence infrequently incorporated tobacco cessation into their dental practices. The cessation of tobacco habits among dentists is essential. Keywords: dental practitioners, tobacco cessation activity, tobacco cessation counselling

Purpose: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. Materials and Methods: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. Results: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.89/κinter = 0.84), VE2 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.88/κinter = 0.83), BW (D3: κintra = 0.95/κinter = 0.92; D1+D3: κintra = 0.99/κinter = 0.90) and FOTI (D3: κintra = 0.97/κinter = 0.93; D1+D3: κintra = 0.87/κinter = 0.83) exams and 'fair' for the DD exam (D3: κintra = 0.36/κinter = 0.35; D1+D3: κintra = 0.30/κinter = 0.32). Conclusion: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys. Keywords: dental caries, diagnosis, epidemiology

Purpose: The present study was undertaken to compare the relative antimicrobial efficacy of two commercially available mouthrinses, Hexidine (0.12% chlorhexidine mouthrinse) and S-Flo (0.2% sodium fluoride), and a laboratory-manufactured propolis mouthrinse (10%) tincture with a dilution of 1:5 with water and their combinations against Streptococcus mutans, lactobacilli and Candida albicans. Materials and Methods: Unstimulated saliva samples were obtained from the patients using the spitting method and the isolates of Streptococcus mutans, Lactobacillus and Candida albicans were obtained. The agar diffusion method was used to evaluate the antimicrobial activity of these test solutions and their combinations. Results: Hexidine (0.12% chlorhexidine gluconate mouthrinse) showed the best antimicrobial efficacy against all the tested microorganisms. The laboratory manufactured propolis mouthrinse showed an effective antimicrobial action only against Streptococcus mutans. The antimicrobial efficacy of propolis (P) against Streptococcus mutans was similar to that of chlorhexidine (CHX) and the combination of propolis with chlorhexidine (CHX+P). S-Flo mouthrinse (0.2% sodium fluoride) showed the least efficacy against Streptococcus mutans among all tested solutions, but had better efficacy than propolis against lactobacilli and Candida albicans. The antimicrobial efficacy of the combination of chlorhexidine and fluoride mouthrinse and the combination of chlorhexidine and propolis mouthrinse was less than chlorhexidine mouthwash alone. Among all the tested combinations, the combination of fluoride and propolis showed the least efficacy against all the tested microorganisms. Conclusion: The results of the study indicate that 0.12% chlorhexidine gluconate mouthrinse (Hexidine) has the best anti-microbial efficacy against all the tested microorganisms, with laboratory-manufactured propolis mouthrinse showing an equivalent efficacy against Streptococcus mutans only. No added advantage of using the tested mouthrinse combinations was observed. Keywords: Candida albicans, chlorhexidine mouthrinse, lactobacilli, propolis, Streptococcus mutans

Purpose: This in vitro investigation assessed whether different dentifrices would be capable of controlling the enamel erosion progression caused by HCl. Materials and Methods: Sixty bovine enamel slabs were covered with acid-resistant varnish, except for a 2.5-mm2 circular area on the labial surface. According to a complete block design, the experimental units were immersed in HCl solution (pH 1.2; 0.1M). After storage in artificial saliva for 1 h, specimens (n = 15) were exposed to different dentifrices: Sensodyne Cool Gel (1100 ppm F), Sensodyne ProNamel (1450 ppm F), and PrevDent 5000 (5000 ppm F). The control group was immersed in deionised water. Following five cycles of erosive challenge, the slabs were prepared for porosity evaluation using solutions of copper sulfate and rubeanic acid. Results: ANOVA demonstrated no difference in the enamel porosity as a function of the dentifrice employed (P = 0.5494). Conclusion: The damage caused by a simulated intrinsic erosive challenge seems unable to be controlled by fluoridated dentifrices, even when this ion is found in elevated concentrations. Keywords: dentifrices, prevention and control, tooth erosion

Purpose: The aim of this study was to compare the effect of polishing after scaling and root planing on supragingival plaque, calculus formation, and gingival bleeding. Materials and Methods: The study was designed as a split-mouth randomised clinical trial. Seventy-six patients were submitted to supragingival scaling on the six mandibular anterior teeth with manual curettes until a smooth surface was achieved. Subsequently, quadrants were randomly selected to be polished (test) or not (control) with a rubber cup and pumice. One, two and three weeks following treatment, a blinded examiner evaluated the visible plaque index, gingival bleeding index and the presence of supragingival calculus on the lingual tooth surfaces. Results: The results showed that unpolished surfaces exhibited higher mean percentages of visible plaque in the third week. No statistically significant differences were observed between unpolished and polished sites related to gingival bleeding. Calculus formation was higher on unpolished sites than on polished sites at 2 and 3 weeks. Dental polishing after supragingival scaling contributed to reducing plaque and calculus formation. Conclusions: Polishing exerts an inhibitory effect on plaque and calculus formation. Keywords: dental calculus, dental plaque, dental polishing, dental scaling

Purpose: To assess the oral hygiene and periodontal status and analyse the influence of age, education, institutionalization, type of visit and oral health behaviour on oral hygiene and periodontal status among detainees in juvenile detention center in Udaipur city, Rajasthan, India. Materials and Methods: The total sample comprised 223 subjects (67.7% male and 32.3% female) aged 6 to 18 years. Clinical examination included assessment of oral hygiene and periodontal status using OHI-S (Oral Hygiene Index-Simplified) and CPI (Community Periodontal Index), respectively. Analysis of variance (ANOVA), chi-square, Student t-test and stepwise multiple linear and multiple logistic regression analysis were carried out to find the relation between oral hygiene/ periodontal status and different independent variables. Results: The results showed that the oral hygiene status of detainees was poor, with only 28.1% of the subjects having good oral hygiene. Mean OHI-S scores were significantly associated with all independent variables. Overall periodontal disease prevalence was 80.2% with bleeding and calculus contributing a major part (71.9%). Stepwise multiple linear and logistic regression analysis revealed that oral hygiene practice and type of visit in the detention center were the best predictors for the oral hygiene index, and for periodontal disease it was oral hygiene practice alone. Conclusion: The findings confirmed that detainees in the juvenile detention center have poor oral hygiene and an increased prevalence of periodontal disease compared to that of similarly ages in the general population. Keywords: juvenile delinquency, oral hygiene, periodontal status, prisoners

Purpose: To assess the prevalence, extent and severity of periodontal probing depth (PD) and their association with sociodemographic and behavioural parameters in subjects attending a public dental school in Brazil. Materials and Methods: Five hundred and fifty-nine consenting participants (18 to 77 years of age) were submitted to full-mouth periodontal clinical examination and anamnesis questionnaires. The data were analysed by multivariable models using logistic regression analyses. The dependent variables were moderate (>=5 mm in >=10% of sites) and deep (>=7 mm in at least one site) PD. Results: The prevalence of individuals with at least one site with PD >= 5 mm or >= 7 mm was 69% and 54%, respectively. Mean PD ranged from 2.86 to 3.08 mm, and the mean frequency of sites with moderate and deep PD ranged from 10.74% to 14.99%, and from 4.60% to 5.36%, respectively, according to age. Multivariate analyses identified a higher risk for having PD >=5 in >=10% of sites and 7 mm in at least one site in smokers (odds ratio [OR] = 10.56 and 9.10, respectively), and the presence of >10% of sites with bleeding on probing (BOP) (OR = 6.37 to 20.91, and 6.94 to 26.19, respectively). Age 36 to 50 years (OR = 1.95) and >50 years (OR = 3.15), presence of >30% of sites with supragingival biofilm (SB) (OR = 2.80), and >=4 missing teeth (OR = 2.26) were risk indicators for PD >= 7 mm in at least one site. Conclusion: This particular Brazilian population presented high prevalence and extent of increased periodontal probing depth. Age, smoking, BOP, SB, and tooth loss were risk indicators associated with probing depth in these individuals. Keywords: epidemiology, multivariate analysis, periodontal diseases, probing depth, risk indicators

Purpose: To assess the prevalence of traumatic dental injuries (TDIs) among 12- to 15-year-old schoolchildren in the Ambala district of Haryana state, India. Materials and Methods: A study was carried out on 963 schoolchildren of 15 government schools in the Ambala district. The examiner was calibrated and a pilot study was conducted. Maxillary as well as mandibular anterior teeth were taken into consideration to assess the traumatic dental injuries. The teeth involved, place of and reason for injury and other demographic details were recorded in a structured format. Data were analysed using SPSS version 13.0. Results: Out of 963 subjects, 14.4% (139) had at least one tooth with TDI. Of these subjects, males and females accounted for 16.2% (77) and 12.7% (62), respectively. Permanent maxillary central incisors were the most commonly affected teeth. Enamel fracture was the most common (80% [111]) followed by enamel-dentin fracture (17.2% [24]). A higher number of children with incisal overjet greater than 3 mm had TDI than those with less than 3 mm, although this difference was not statistically significant. Subjects with Class III and Class II Div II malocclusion were more likely to have TDI, 16.2% and 17.7% respectively. Lip-closure incompetence was found to be more common in subjects having a TDI. Amongst the subjects having a TDI, only 83.4% (116) were aware of their injury, and falling was the reason most commonly reported. Conclusion: Traumatic dental injuries are highly prevalent among schoolchildren. Most of the TDIs involve only tooth enamel. Incompetent lip closure was significantly associated with TDIs and a fall was the major cause for TDIs in this age group. Keywords: dental injury, luxation, schoolchildren, trauma