Oral Health and Preventive Dentistry

Purpose: To compare the oral health-related quality of life (OHRQoL) of children (8- to 10-year-olds) and preadolescents (11- to 14-year-olds) with different oral conditions and to identify concepts associated with their perceptions of oral health (OH) and overall well being (OWB). Materials and Methods: A cross-sectional study was conducted with 264 students who were distributed into four groups: caries, with the sum of the decayed, missing and filled teeth in the primary (dmft) and permanent dentitions (DMFT) ≥ 1 (n = 72); malocclusion, with the Dental Aesthetic Index (DAI) ≥ 26 (n = 40); temporomandibular disorders (TMD) with at least one sign and one symptom of TMD (n = 89); control, with dmft/DMFT = 0, DAI 26 and without signs and symptoms of TMD (n = 63). OHRQoL was measured using Portuguese versions of Child Perceptions Questionnaires (CPQ) for children (CPQ8-10) and preadolescents (CPQ11-14). Differences in CPQ scores and in the frequency of responses to global ratings were assessed using Kruskal-Wallis and chi-square/Fisher's exact tests. Multiple linear regression analyses were used to identify items associated with CPQ and global scores. Results: The OHRQoL of the TMD group was statistically different from controls. The malocclusion group reported more oral symptoms and social impacts compared to controls. The variables associated with CPQ scores varied according to clinical condition. Conclusions: OHRQoL was significantly different between clinical groups and controls for both age groups. However, when comparing clinical groups, TMD and caries differed only for preadolescents. The items associated with higher OHRQoL scores were mainly psychosocial for caries and TMD groups, and physical/functional and psychosocial for children and preadolescents with malocclusions, respectively. Keywords: lifestyle, oral diseases, pediatric dentistry, self-concept

Purpose: To evaluate the knowledge of signs, symptoms and risk factors associated with oral cancer amongst undergraduate dental students and members of the general public. Materials and Methods: This study was open for a period of six months (Jan-June, 2013) to all undergraduate dental students in the 4th and 5th year of the dental science programme and dental patients attending the School of Dentistry, Griffith University, Australia. The survey evaluated the knowledge and awareness of clinical signs and symptoms and risk factors of oral cancers. Results: A total of 100 undergraduate students and 150 patients provided informed consent and participated in this survey study. Both patients and dental students were aware of the importance of early detection of oral cancer. With the exception of smoking and persistent ulceration, this study indicated that the knowledge about oral cancer, its signs, symptoms and risk factors was limited amongst participants. Conclusion: This study highlights the need to raise awareness and knowledge pertaining to oral cancer, not only in the general community but also amongst those in the dental field. Specific points of concern were the common intraoral sites for oral cancer, erythroplakia as a risk factor, the synergistic action of smoking and alcohol, and HPV (human papilloma virus) as risk factors for oral cancer. Keywords: dental students, oral cancer, oral cancer screening, public awareness

Purpose: To examine the association between sociodemographic, economic and health-related lifestyle factors and receipt of pre-pregnancy dental cleaning in West Virginia. Materials and Methods: A population-based secondary data analysis was conducted using the 2009-2010 West Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) dataset. The study population consisted of 3050 women who answered the survey question about pre-pregnancy dental cleaning. Results: Approximately 47% of the participants visited a dentist during the 12 months before pregnancy. Results from the logistic regression model showed that pre-pregnant Non-Hispanic white women were more likely to get their teeth cleaned compared to women from other racial/ethnic backgrounds (OR = 1.75; 95% CI: 1.01-3.04). Women with more than a high-school education (OR = 1.79; 95% CI: 1.22-2.62), young women 20 years of age (OR = 2.75; 95% CI: 1.86-4.06), women with private health insurance (OR = 2.65; 95% CI: 1.98-3.55) and women who had intended pregnancy (OR = 1.3; 95% CI: 1.04-1.64) were more likely to have dental cleaning before pregnancy compared to women with less than a high-school education, women between the ages of 20-29, uninsured women and women who had unintended pregnancy, respectively. Conclusion: Identifying factors associated with dental cleaning can aid healthcare providers and policy makers in developing approaches to promoting oral care among women of childbearing age. Keywords: dental, pregnancy, tooth cleaning, PRAMS, West Virginia

Purpose: To assess oral hygiene and the gingival and periodontal disease status in subjects scored under the modified Mallampati classification (MMC) of the oropharynx. Patients and Methods: The clinical parameters included recording MMC scores, simplified oral hygiene index (OHI-S), modified gingival index (MGI), tongue coating index (TCI) and periodontal status of the subjects. Eight additional parameters, which included percentage of sites with bleeding on probing (BOP), sites with probing depth (PD) ≥ 5 mm, tooth loss, attachment loss (AL):age ratio, diabetic status, smoking, the interplay of dental status and systemic factors (DS-SFI), and background characteristics (socioeconomic status and stress) were also assessed. Results: Class IV MMC group showed the highest mean scores for OHI-S, periodontal status, AL:age ratio, diabetic status, background characteristics, PD ≥ 5 mm and DS-SFI when compared to other groups. In measures of OHI-S, periodontal status, PD > 5 mm, AL:age ratio and background characteristics, Class IV MMC group showed significant intergroup differences over MMC class I. Regression analysis revealed a highly significant but low degree of correlation (R2 = 0.079; p ≤ 0.001) between the predictors and the dependent values. Conclusion: The results suggest that increasing MMC scores can be a possible determinant in identifying gingival and periodontal disease. Any dental professional dealing with a multifactorial disease such as periodontitis can use this classification as a basic screening tool in identifying the modifiable factors of periodontitis. Keywords: Mallampati score, oral hygiene, oropharynx, periodontitis

Purpose: To evaluate general dental practitioners' (GDPs) and dental hygienists' (DHs) assessment of prognosis, suggested treatment goals, and estimated number of treatment sessions in patients with varying severity of periodontal disease. Materials and Methods: Seventy-seven GDPs and fifty DHs in a Swedish county participated in a questionnaire study, based on three patient cases: a patient with generalised bone loss but no clinical signs of inflammation (well-maintained); a patient with clinical signs of inflammation and generalised bone loss (periodontitis); and a patient with clinical signs of inflammation but no bone loss (gingivitis). In open-ended questions, the clinicians assessed the prognosis in case of no treatment and proposed treatment goals. Furthermore, based on given fixed-alternative options, they estimated the number of treatment sessions needed for successful management of the condition. Results: Based on a response rate of 94%, the majority of clinicians expected a worsening of the periodontal condition in all three patients (well-maintained: 80%; periodontitis: 94%; gingivitis: 60%). The most common treatment goal in all 3 cases was to improve oral health awareness. The majority of clinicians estimated that the periodontitis case needed slightly more treatment sessions (mean: 3.04, 95% CI: 2.83-3.24) compared to the gingivitis (mean: 1.93, 95% CI: 1.75-2.11) or well-maintained patient case (mean: 1.84, 95% CI: 1.60-2.07). Conclusions: The majority of included clinicians did not perform an individualised risk assessment and did not individually match the number of appointments to the actual periodontal treatment needs of the patient. This may result in overtreatment in some cases and in undertreatment in others, and possibly in suboptimal use of resources. Keywords: clinical decision making, periodontal diseases, periodontitis, prognosis, treatment goals

Purpose: To compare the total and differential leukocyte counts in the peripheral blood of generalised aggressive periodontitis patients with that of periodontally healthy subjects in a central Indian population. Materials and Methods: Seventy-five patients with generalised aggressive periodontitis and 63 periodontally healthy subjects were enrolled for the purpose of the study. All participants received a full-mouth periodontal examination in which probing depth and clinical attachment level were recorded. The haematological variables analysed included total leukocyte count, neutrophil count, lymphocyte count, monocyte count, neutrophil percentage, lymphocyte percentage, monocyte percentage and platelet count. Results: The patient group showed a significantly higher total leukocyte count (7.62 ± 1.70 x 109 cells/l, p = 0.008), neutrophil count (5.06 ± 1.47x109 cells/l, p 0.001) and neutrophil percentage (70.61 ± 8.73, p 0.001), as well as a significantly lower lymphocyte count (1.82 ± 0.65 x 109 cells/l, p = 0.002) and lymphocyte percentage (26.55 ± 8.05, p 0.001) compared to the control group. Logistic regression analyses showed significant associations between aggressive periodontitis and elevated total leukocyte (p = 0.012) and neutrophil counts (p = 0.001). Conclusion: The findings of the present study suggest that patients with generalised aggressive periodontitis might also demonstrate a systemic inflammatory response, as evidenced by increased leukocyte counts. This systemic inflammatory response observed in patients with generalised aggressive periodontitis may be associated with an increased risk for cardiovascular diseases. Keywords: aggressive periodontitis, cardiovascular diseases, inflammation, leukocyte count, neutrophils

Purpose: To assess the prevalence of dental trauma (DT) and its associated factors in 9- to 14-year-olds. Subjects and Methods: A cross-sectional survey was carried out through clinical examination of the permanent incisors and canines of 907 schoolchildren (9 to 14 years old, average age = 11 ± 0.5 [SD] years, 55% female and 45% male) enrolled in 20 public schools in Isfahan, Iran. The demographic data, history and cause of trauma were recorded during patient interviews and with a structured questionnaire filled in by their parents. The overjet, lip coverage, and visible signs of DT (permanent incisors only, similar to the classification used by the US National Health and Nutrition Examination Survey 1988-1994, NHANES III) were recorded. DT in permanent canines were also recorded. Results: Approximately 36% (n = 325) recalled the occurrence of dental trauma, but only 23.8% (n = 216) of children had visible signs of dental trauma to the permanent incisors (girls [18.8%], boys [29.9%], OR = 0.54; 95% CI 0.40- 0.74; p = 0.000). The maxillary central incisors were commonly injured (69.5%). The most frequent types of injuries were the enamel fracture (59.0%), craze lines (16.3%), and enamel and dentin fracture (13.4%). Tooth avulsion was seen in 0.7%. No significant association was found between dental trauma and increased overjet of > 3 mm (p = 0.328), but a tendency was identified for overjet > 5 mm (OR = 1.51; 95% CI 0.89-2.58; p = 0.060). The relationship between DT and lip coverage was statistically significant (OR = 1.63; 95% CI 1.18-2.25; p = 0.003). Violence (30%) and fall (22.7%) were the main causes of DT. Conclusion: The prevalence of DT in permanent incisors was high (23.8%) and significantly lower in girls. The association between DT and lip coverage was significant. There was no association between DT and increased overjet of > 3 mm. Keywords: dental trauma, lip competence, oral epidemiology, overjet, permanent incisors

Purpose: To measure the xylitol content in sugar-free chewing gums available on the market in Gulf Cooperation Council (GCC) countries in the Middle East, in order to identify those products that can provide the recommended daily dose of xylitol for caries prevention (6-7 g). Acid production from chewing gums was also measured in vitro and in vivo. Materials and Methods: Twenty-one chewing gums containing xylitol were identified and collected from the GCC market (Kuwait, Bahrain, Qatar, Saudi Arabia, UAE and Oman). Xylitol was extracted and its concentration was analysed using a special enzymatic kit. The pH of extracts was measured during 30-min incubation with Streptococcus mutans. Changes in saliva and plaque pH were noted in four subjects after the consumption of highly concentrated xylitol gums. Results: The xylitol content in grams was clearly mentioned only on one product's label. Twelve products stated the percentage of xylitol (3.5% to 35%). The rest did not specify the amount. The mean measured weight of one piece of gum was 1.67 ± 0.38 g. The mean measured xylitol content/piece was 0.33 ± 0.21 g. Xylitol content was 0.3 g/ piece in 9 products, 0.3-0.5 g in 7 and > 0.5 g in 5 products. None of the highly concentrated xylitol gums showed a pH drop in vitro or in vivo. One chewing gum, containing xylitol and glucose, resulted in a low pH level ( 5.5) when tested in vitro. Conclusion: The majority of xylitol chewing gums sold on the GCC market do not provide the consumers with the recommended daily dose of xylitol for caries prevention. Clear, accurate labeling is recommended. Keywords: caries, chewing gums, preventive dentistry, sugar-free, xylitol

Purpose: The first large-scale epidemiological survey on dental caries in the Republic of Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008 and 2013, using the same methodology. The aim of the study was to describe the trend of caries in 12-year-olds in Slovenia from 1987 to 2013. Materials and Methods: The method applied in all six surveys was the National Oral Pathfinder Survey using WHO combined oral health and treatment need assessment forms. The surveys were performed in ten towns in all nine geographical regions of Slovenia. One randomly selected primary school in each town participated in the surveys. In each subject selected from the respective class of 12-year-old children, the caries experience and sealant data were recorded, using artificial light, a plane mirror and a sharp explorer. For statistical analysis of the results, the Statistical Package for Social Sciences (SPSS) was used. Results: The mean DMFT decreased significantly from 5.1 in 1987 to less than 1.7 in 2008 (p 0.0001), but afterwards began to increase and reached a mean value of almost 1.9 in 2013 (p > 0.05). The percentage of sealed teeth increased from 6% in 1987 to 92% in 2013. Conclusion: The substantial caries decline in 12-year-olds was evaluated as being due to the preventive measures implemented. However, in the last survey, the caries decline had stopped. Keywords: caries, children, DMFT, epidemiology, fissure sealing