Oral Health and Preventive Dentistry, 03/2012

Purpose: To assess whether adolescents with periodontitis presented with higher scores for non-psychotic psychosocial disorders than control subjects without periodontitis. Materials and Methods: A case control study (n = 160) nested in a well-defined adolescent population (n = 9,163) was performed using the 28-item Spanish version of the General Health Questionnaire. The inclusion criterion for being a case was a clinical attachment level of >= 3 mm in at least two teeth. Multiple logistic regression analyses were used to assess the association between periodontitis and psychosocial distress. Results: The response rate was high and 94% of the participants answered all the items of the questionnaire. Similarly, the internal consistency of the instrument was high (Cronbach's = 0.91). The results of multiple logistic regression analyses, adjusted for age and gender, suggested an association between case status and higher total scoring for psychosocial distress (OR = 1.69). Among the four subdomains of the General Health Questionnaire, the dimensions 'somatic symptoms' and 'severe depression' appeared positively associated with periodontal case status, albeit not significantly. Conclusion: The findings of this study suggest that the association between periodontitis and dimensions of psychosocial distress can be documented early in life. This calls for awareness on the part of healthcare providers attending adolescents. Keywords: adolescents, coping, depression, periodontitis, stress

Purpose: To evaluate the efficacy of plaque removal of four different toothbrushes in visually disabled children. Three manual toothbrushes with different bristle designs (Oral-B CrossAction 40-regular, Oral-B ShinyClean 40-soft, Oral-B Advantage 40-soft) were compared with an electric toothbrush with an oscillating rotating head (Colgate Motion). Materials and Methods: Forty visually impaired children in a professional education center participated in the study and were divided into 4 groups of 10 participants each. To obtain a plaque-free condition at baseline, professional toothcleaning was performed on each participant. After instructions on how to use the toothbrushes, each group started the experiment using a differently designed toothbrush. After 1 week of application, the Quigley Hein plaque index (QHI) was used to assess the oral hygiene status of each participant. Student's t-test was chosen for comparing brushes. P 0.01 was considered as the significance level. Results were presented as mean ± standard deviation. Results: The QHI values obtained with the electric Colgate Motion brush were the lowest (0.088 ± 0.051) and Advantage (0.801 ± 0.132) the highest. Although the QHI values with the manual Oral-B CrossAction (0.439 ± 0.094) were lower than those with the Oral-B shiny clean (0.503 ± 0.098), there was no statistical difference between the two. Conclusion: The electric toothbrushes are still the most effective in the visually disabled group. However, because of cheaper cost, easier availability and use, the Oral-B CrossAction toothbrush with criss-cross bristles could be a suitable alternative. Keywords: plaque, toothbrush, visually impaired

Purpose: To investigate the effect of different milk formulas on dental plaque pH. Materials and Methods: Six commercial infant milk formulas were selected, with 10% sucrose solution as the positive and deionised water as the negative control, and tested among ten children aged 7-10 years. The plaque pH changes were recorded by using a combination electrode. Results: Mouth rinsing with all infant formulas significantly reduced the plaque pH (Tukey's multiple comparison test, P 0.05) to levels below the pre-rinse pH value for sucrose solution and also below the pH obtained after rinsing with water. Each milk formula had a significant but variable buffering effect or tendency to decrease the pH. The formula with the least buffering effect was Nestogen (9.21%) followed by Nan (11.92%), and the highest buffering effect was shown by Lactodex (20.13%). The pH drop ranged from 0.72 for Farex to 0.98 for Nan. Conclusion: The results of this study underscore the need for parents and clinicians to be fully aware of the potential harm of various infant formulas and their major role in the etiology of ECC. These findings may help in creating a new generation of foods which, if not 'friendly to teeth', may be thought of as 'friendlier' than their predecessors. Keywords: baby bottle tooth decay, early childhood caries, infant milk formulas, plaque pH

Purpose: To investigate the association between dental caries, obesity and socioeconomic status (SES) in 6-and 13-yearold school children in Davangere city, Karnataka, India. Materials and Methods: Data were obtained from a cohort of 1,550 children. Dental caries detection was performed according to the World Health Organization criteria and the medical evaluation assessed the body mass index (BMI). With appropriate sample weighting, relationships between dmft/DMFT, obesity and socioeconomic status were assessed using the Kruskal-Wallis H test and multivariate logistic regression. Results: The prevalence of dental caries was 28.9%. The mean dmft and DMFT scores for 6-year-olds were 2.1 ± 3.75 and 0.16 ± 0.59, respectively, and corresponding values for 13-year-olds were 0.03 ± 0.19 and 0.91 ± 2.04. Of the total sample, the mean BMI was 16.56 ± 2.8. Approximately 63.4% of the children were classified as normal weight, 18.1% as overweight and 7.5% as obese. When adjusted for covariates, the logistic regression model showed that there was a significant association between overweight children (P 0.001), obese children (P 0.05) and caries prevalence. Conclusion: This study demonstrated a significant association between caries frequency and obesity in school children. In future preventive programmes, the importance of obesity should not only be emphasised with respect to general diseases but also with regard to carious lesions. Keywords: body mass index, dental caries, obese, overweight, socioeconomic status

Purpose: The present study was conducted to determine the patterns of tooth loss among subjects with different tobacco- related habits and compare it with non-users of tobacco. Materials and Methods: A total of 1075 patients over the age of 14 years attending the Department of Periodontics, People's College of Dental Sciences and Research Centre, Bhopal, India from May to September 2009 were included in the study. Besides name, age and gender, information regarding tobacco habits was recorded through interviews. Based on the tobacco habits, the patients were grouped into 4 categories: group 1 (non-users of tobacco), group 2 (smokers only), group 3 (smokeless tobacco users only) and group 4 (users of both smoking and smokeless tobacco). Tooth loss was determined by clinical examination of all permanent teeth excluding the third molars. Tooth loss included missing or extracted teeth as well as teeth indicated for extraction due to periodontal disease, dental caries or wasting diseases. Prevalence and mean tooth loss for whole dentition, maxillary and mandibular arches were compared between the 4 groups. The chi-square test and one-way ANOVA were used for comparing the prevalence and mean tooth loss, respectively, between different groups. Results: The overall prevalence and mean tooth loss, respectively, for different groups were as follows: group 1: 28.3% and 0.85; group 2: 56.1% and 1.97; group 3: 58.7% and 2.38; group 4: 56.7% and 2.48 (P 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the maxillary arch for the different groups were: group 1: 15.3% and 0.32; group 2: 43% and 1.24; group 3: 34.3% and 0.91; group 4: 45.4% and 1.26 (P 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the mandibular arch for the different groups were: group 1: 22.3% and 0.52; group 2: 33.6% and 0.73; group 3: 50.9% and 1.48; group 4: 48.5% and 1.23 (P 0.001 for both prevalence and mean tooth loss). Conclusion: When compared to non-users of tobacco, tooth loss was greater among subjects who consumed tobacco. In India, where consumption of tobacco in different forms is very common, public health programmes need to be implemented to increase public awareness regarding the adverse effects of tobacco on oral health. Keywords: periodontitis, smokeless tobacco, smokers, tooth loss

Purpose: To investigate teachers' knowledge and attitudes about emergency management of traumatic dental injuries (TDIs) in children. Materials and Methods: A total of 764 teachers from 13 elementary schools were included in the study. Data were collected using a self-reporting questionnaire in which teachers were asked about demographic information, previous experience with dental trauma, first-aid training, knowledge of emergency management and how they would respond to two hypothetical TDI cases. Results: Of the 764 participants, 550 (71.4%) returned the questionnaire; of these, 309 (56.2%) were female and 241 (43.8%) were male. While 297 teachers reported having had first-aid training, only 13 (4.4%) of them reported emergency management of TDIs being covered in this training. Less than half of respondents (47.5%, n = 261) correctly answered the question on the appropriate response to a TDI involving a fractured tooth and only one-quarter of respondents (25.4%, n=140) correctly answered the question on the appropriate response to a TDI involving an avulsed tooth. Conclusion: The results of this study demonstrated teachers' low level of knowledge about the emergency treatment of TDIs in schoolchildren, suggesting that educational programmes are needed to improve proper emergency management of TDIs by teachers. Keywords: children, dental trauma, emergency, knowledge, teacher

Purpose: To test the value of submerging vital roots for the preservation of the residual ridge. Materials and Methods: The study sample consisted of 10 patients whose bone height on both submerged and control sites was measured with the help of OPG tracings and the use of grids, from the immediate post-operative period to 3 months, 6 months and 9 months post-operatively. Statistical analysis was performed using the t-test and one-way ANOVA. Results: The amount of bone loss was significantly greater in the control area in comparison to the submerged area from the immediate post-operative period to 3 months, 6 months and 9 months post-operatively. Conclusion: Although the retained roots do not prevent the resorption of residual ridge, they aid in decreasing the resorptive pattern, thereby preserving the residual ridge to some extent. This may be an expedient and inexpensive way to preserve residual ridge, requiring minimal specialised training. Keywords: prosthetic factors, residual ridge, surgical technique, vital roots

Purpose: To determine the prevalence and pattern of dental caries among public primary school children in Lagos State, Nigeria. Materials and Methods: A cross-sectional survey of pupils in randomly selected public primary schools in Lagos State Nigeria was conducted. Dental examinations were carried out on 2835 children and caries diagnosis was based on the WHO diagnostic criteria (1999). Results: Overall caries prevalence in the study population was 13.1% with the highest caries prevalence recorded among eight-year-old children (17.7%), boys (13.5%) and those of the Hausa tribe (15.0%). The DMFT score ranged between 0 and 11 with a mean score and standard deviation of 0.344 ± 0.937. Children aged 5-10 years had slightly higher caries prevalence (14.8%) than those aged 11-16 years (10.6%). The first molars were the worst affected teeth in both the deciduous and permanent dentitions. The mandibular left first molar had the highest caries prevalence (4.7%) in the deciduous dentition, while the right mandibular first molar had the highest tooth-specific caries prevalence (3.5%) in the permanent dentition. The restorative index for the study population was 0.3% while the treatment index was 5.7%. Conclusion: While the caries prevalence in the study population is very low, the treatment and restorative indices are unacceptably low. There is a need for early preventive strategies and treatment services in terms of restorative care for this important age group. Keywords: dental caries, prevention, school children, treatment needs

Purpose: The objectives of this in-vitro study were to investigate the effect of theobromine, which is the principle xanthine species in Theobroma cacao, at two concentrations on the surface hardness and topography of human enamel. Materials and Methods: Twenty-four freshly extracted human third molars were collected and stored in distilled water with 0.1% thymol solution at room temperature prior to the experiments. The enamel specimens were treated with one coat of theobromine at two concentrations (100 mg/l or 200 mg/l in distilled water) for 5 min. Enamel surfaces in the control group received no theobromine. They were then kept in distilled water for 1 week and subjected to SEM analysis. The specimens were demineralised by storing them in acidic hydroxyethylcellulose for three days. After baseline microhardness measurements, they were incubated either in 100 or 200 mg/l theobromine for 5 min. The control group was kept in distilled water. After washing the specimens under distilled water, they were kept in a remineralising solution for 18 h. Microhardness of the enamel surface was initially determined for each specimen before artificial demineralisation. After demineralisation, the experimental groups were incubated in 100 mg or 200 mg theobromine and control-group specimens were placed in remineralising solution. Results: Enamel surfaces of the untreated control group presented a generally smooth and slightly hummocky surface with small lines of pits. Specimens treated with theobromine showed differences between the two concentrations. The group treated with 200 mg/l solution for 5 min showed a greater quantity of globules on enamel than did specimens treated with 100 mg/l solution. Conclusion: As shown by the microhardness values, a consistent and remarkable protection of the enamel surface was found with the application of theobromine. Keywords: enamel, fluoride, SEM, Theobroma cacao, theobromine

Purpose: To investigate whether feeding and oral hygiene practices of preschool children are associated with the risk and prevalence of Early Childhood Caries (ECC). Materials and Methods: A cross-sectional study comprising 1250 children aged 3 to 5 years from Belgaum was designed. On the first day, validated questionnaires along with parental informed consent forms were distributed to the children and were collected after a week. Validated questionnaires consisted of 20 close-ended questions pertaining to feeding and oral hygiene practices. Consent was obtained from parents of the 1116 children who were examined for ECC. Data analysis included correlation coefficients and logistic regressions. Results: Among the children studied, 97.3% were breastfed, of which 41.25% were breastfed until 2 years of age. Seventyfive percent of children who were breastfed beyond 2 years were affected by ECC. Exclusive bottle feeding was practiced in 46.15%; 64.85% of them suffered from ECC. Burping was not practiced in 25.18%, and 68.68% of these were affected by ECC. ECC was more prevalent in 89% of children who were weaned later than 12 months of age. Parental assistance for oral hygiene was not seen in 37.27% and 67.22% of these suffered from ECC. Overall, 63.17% of the children were affected by ECC. Conclusion: Prolonged breastfeeding, absence of burping the child, delay in starting oral hygiene practices and lack of parental assistance with the same were shown to be significant determining factors for ECC. Health education and proper guidelines on feeding and oral hygiene practices can substantially reduce the risk and prevalence of ECC. Keywords: burping, early childhood caries, feeding practices, oral hygiene practices, preschool children

Purpose: To compare the efficacy of alcohol-free chlorhexidine mouthrinse to chlorhexidine with alcohol and a placebo (water) in controlling plaque and reducing gingival inflammation in patients with gingivitis. Materials and Methods: This was a single-blind, parallel-group study with 30 gingivitis patients in whom the plaque index (Silness and Löe) and gingival index (Löe and Silness) were recorded prior to treatment with 0.2% chlorhexidine mouthrinse with alcohol (group I, n = 10; CHX-A), 0.2% chlorhexidine mouthrinse without alcohol (group II, n = 10; CHXNA) or a placebo (water) (group II, n = 10; P). The plaque and gingival indices were recorded again at days 14 and 28 after the start of treatment. Results: There were significant differences in plaque and gingival indices with both chlorhexidine rinses compared to the placebo. The gingival index showed a greater clinical change in group II (CHX-NA) than in group I (CHX-A). Conclusion: The alcohol-free rinse was as effective as the one containing alcohol in controlling plaque and reducing gingival inflammation. Therefore, its use can be recommended in all periodontal patients, but especially in those for whom the use of alcohol may lead to side effects. Keywords: alcohol, alcohol free, chlorhexidine, dental plaque, mouthrinse

Purpose: To examine the possible association between the presence of apical periodontitis (AP) and the quality of endodontic treatment and coronal restoration over a time period of 14 years. Materials and Methods: 1781 panoramic radiographs of freshmen cadets, taken between the years 1995-2008 were included in this study. The periapical status was evaluated using the Periapical Index (PAI) scoring system. The chisquare test and logistic regression analysis were used to examine associations between apical disease and the quality of both the root filling and the coronal restoration. Results: 62.3% of the examined teeth demonstrated AP. The number of root-filled teeth and the prevalence of AP were found to be higher in OPGs taken between 1995 and 2001 than those taken between 2002 and 2008. Both the quality of the coronal restoration and the quality of the root filling (length and lateral seal) were found to be correlated with the presence of AP, but the factor most significantly associated seemed to be the coronal restoration (OR = 0.404, 95% CI: 0.174-0.940). Conclusion: The quality of the endodontic treatment in young Greek adults was poor but improved over the years. Both the quality of the endodontic treatment and coronal restoration appeared to affect the periapical status of the treated teeth. The factor that probably most determined the periapical health was the quality of the coronal restoration. Keywords: apical periodontitis, coronal restoration, root filling, quality