Oral Health and Preventive Dentistry, 04/2008

Purpose: The objective of the present study was to compare the self-assessed and the clinically determined findings of oral health and their determinants 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 among the 15-year-olds (N = 509). The data were based on a self-administered questionnaire and a clinical dental examination. Results: Altogether 78% of the 15-year-olds assessed their oral health as good or better. Based on self-assessment, 46% reported gingival bleeding, 28% reported the need for a filling and 23% for teeth straightening. Clinical examinations showed that 40% of the students had sound dentition (decayed, missing or filled teeth, DMFT = 0), 40% had current caries (decayed teeth, DT > 0), 92% had gingival bleeding and 26% had a definite need for orthodontic treatment. Most of those with DMFT = 0 and DT = 0 assessed their oral health as good or better. Compared with clinical findings, sensitivity for self-assessed need for fillings, gingival bleeding and the need for teeth straightening were 42%, 49% and 37%, respectively, whereas the corresponding specificities were 82%, 80% and 81%, respectively. Good or better selfperceived oral health was more likely among those with sound dentition (odds ratio, OR = 2.1, P = 0.01), with no selfassessed need for fillings (OR = 2.1, P = 0.01), with a self-assessed absence of gingival bleeding (OR = 2.9, P 0.001) or with highly educated parents (OR = 1.2, P = 0.007). Conclusions: When compared with clinical evaluations, the students most accurately detected healthy conditions. Educating the students on the signs of dental diseases could increase the reliability of self-assessment to provide a useful method for reporting oral conditions, especially in countries with developing oral health care systems. Keywords: adolescents, self-assessment, sensitivity, specificity, validity

Purpose: This study investigated the role of mothers in their preadolescents' oral self-care (OSC) and oral health in Tehran, Iran. Materials and Methods: In 2005, two self-administered questionnaires provided data on a random sample of 9-year-old children (N = 416) and their mothers. Brushing frequency, use of fluoridated dentifrice and the number of sugary snacks between meals served as OSC assessment criteria for both children and their mothers. Supervision of the child's tooth brushing and control of the child's sugary snacking indicated the mother's role that was defined as either active or inactive. Decayed, missing or filled teeth (DMFT + dmft) values facilitated the assessment of children's dental status in a voluntary clinical examination for children. The child's twice-daily tooth brushing, sound dentition and good oral hygiene were taken as the outcome measures for evaluating the impact of the mother's role. The chi-square test and logistic regression model were used for the analyses. Results: Half of the mothers were assessed as active in the supervision of their children's tooth brushing. Supervision was clearly more frequently reported by the mothers whose own OSC was favourable. In the logistic regression model, the strongest factors contributing to the explanation of twice-daily tooth brushing were the child's female gender (odds ratio, OR = 1.6; 95% confidence interval, 95% CI = 1.1 to 2.4) and the mother's active supervision (OR = 1.5; 95% CI = 1.0 to 2.2). Having sound dentition was most strongly explained by the mothers' active supervision of their children's tooth brushing (OR = 2.4; 95% CI = 1.3 to 4.5). Conclusions: The mothers' supporting role positively reflects on twice-daily tooth brushing and sound dentition in preadolescents. More preventive efforts through mothers should be considered during the planning of promotion programmes for preadolescents. Keywords: behaviour, mother-child relationship, oral health, supervision

Purpose: To investigate the oral health behaviour and the smoking habits among diabetic adults with regard to diabetesrelated factors and their background information. Materials and Methods: In 2005, a questionnaire was conducted among diabetic adults (N = 299) in Tehran, Iran. The subjects were invited to the dental clinic and were asked to complete a self-administered questionnaire. In addition to their background information, the questionnaire requested information on smoking, oral self-care, dental attendance, year of onset of diabetes and organ complications related to diabetes. The data related to the type of diabetes and the latest value of glycosylated haemoglobin level (HbA1c) were obtained from the patient records at the diabetic clinic. Chi-square test and binary logistic regression model were used for statistical analyses. Results: Of all the subjects, 29% reported brushing their teeth on a twice-daily basis. Women (P = 0.05) reported higher frequencies of twice-daily tooth brushing. Subjects with moderate diabetic control (HbA1c = 7.6-8.5%) showed the highest rate for twice-daily tooth brushing (P 0.001). Of all the subjects, 47% reported having visited a clinician within the past 12 months; this rate was the highest among those without diabetes-related complications (52% versus 41%; P = 0.05). Subjects who had a physician referral were more likely to report having had a dental visit within the past 12 months (OR = 4.4; CI = 1.9-10.2). Conclusions: The present results call for improvement in the level of oral self-care and the regularity of dental checkups among diabetic adults to compensate for their increased risk for oral diseases. Keywords: diabetes mellitus, oral self-care, use of dental services

Purpose: The aim of this study was to assess the relative weights of each factor related to tooth retention identified in our previous study with an objective of developing a risk assessment tool that could be incorporated into a selfadministered oral salutogenic checklist. Materials and Methods: Oral health status and lifestyle were investigated in 777 subjects aged >= 20 years. Eleven items that had a statistically significant odds ratio of being related to the number of retained teeth in our previous study were identified. Discriminant analysis was used to calculate the scores for each item. Results: Based on the discriminant analysis, the variables affecting tooth retention, from the most to the least important, were 'gum swelling' (1.241), followed by 'toothache' (0.766) and 'do you have any hobbies' (0.691). Based on the above analysis, a total of 20 points were allocated in proportion to the ranges. The final oral salutogenic score (OSS) was swollen gums (4), toothache (3), frequency of between-meal snacks (3), having some hobbies (3), having a family clinician (2), consulting a clinician when having dental symptoms (1), bleeding gums (1), frequency of tooth brushing (1), having one's own toothbrush (1) and smoking (1). Conclusions: A self-administered checklist for the OSS was designed. The first part contains a list of questions for the participants to fill out. The second part offers comments depending on the range of score values. The suggestions include advice to decrease or to stop the behaviours for which the subject obtained zero points. Keywords: behaviours, checklist, salutogenic, tooth loss

Purpose: The aim of this study was to assess the impact of clinical oral health conditions, and the prevalence, intensity and the impact of dental pain on daily living among 5-year-old preschool children. Materials and Methods: A cross-sectional survey was carried out on a sample of 578 children attending preschools in Belo Horizonte, Brazil. Data were collected by means of a pretested questionnaire given to the parents and a visual analogue scale of faces applied to the children. The children underwent dental examinations. Results: According to the parents' reports, the lifetime prevalence of dental pain was 25.0% (95% confidence interval, 95% CI = 21.4 to 28.6), and dental pain caused crying in 16.8% (95% CI = 13.6 to 19.9) of the children; 10.7% (95% CI = 8.1 to 13.3) of children had dental pain in the 2 months prior to the dental examination. Among this group of children with dental pain, 59.3% experienced a negative impact as a result of pain. The following clinical conditions had mostly caused dental pain in the 2 months prior to the dental examination: root remnants, fistula and pulp caries. This recent pain resulted in a visit to the clinician in 13.6% of the children. Conclusions: Prevalence, intensity and the impact of dental pain in 5-year-old children were high in Belo Horizonte, Brazil. Dental pain assessed in the present study was associated with avoidable pathological factors. However, only few children were treated professionally for the dental pain they were experiencing. Public policies should be developed and implemented to promote fair, comprehensive treatment for the population. Keywords: cross-sectional study, dental pain, epidemiology, paediatric dentistry

Purpose: To compare the two non-surgical periodontal treatment methods with regard to socioeconomic aspects, treatment results and complications. Methods and Results: Twenty-five patients were randomly divided into two groups for non-surgical treatment consisting of scaling and root planing. One group had intensive treatment (InT) performed within 24 h and the other group received conventional treatment (CoT) with one treatment session a week for 4 weeks. All the patients rinsed their mouth with chlorhexidine 0.2% after each treatment session for 5 weeks. The investigation before and after the treatment was performed by the same clinician blinded to the treatment modalities, and all the treatments were performed by the same dental hygienist. Treatment had significantly reduced the number of pockets in both the treatment groups, but there was no difference between the two treatment modalities regarding pocket reduction or reported discomfort/pain graded on the visual analogue scale. Only one patient receiving the InT was not satisfied. However, in the CoT group six patients answered that they would have preferred the InT, whereas the remaining patients answered that it did not matter whether they received InT or CoT. The patients in the CoT group consumed more analgesics after the treatment. The mean total travelling time for the InT group was 113 min compared with 357 min for the CoT group. Conclusions: Most patients preferred the InT if they were to undergo the treatment again. Furthermore, InT resulted in a substantial socioeconomic gain with no difference in the treatment result and the complication rate compared with CoT. Keywords: full-mouth periodontal therapy, periodontal treatment, scaling and root planing

Purpose: To compare the efficacy of two types of interdental device, namely triangular woodstick and round toothpick, in the removal of interproximal dental plaque. Materials and Methods: This study had a split-mouth design and was conducted on 15 individuals. After 72 h of dental plaque accumulation, the dental plaque was quantified by the Quigley-Hein Plaque Index (QHPI). Two quadrants were then randomly assigned for the use of triangular woodstick and the other two for the use of round toothpick. After the use of toothpicks, the QHPI was re-evaluated by a calibrated examiner, blinded to the types of toothpick used. The mean values of QHPI were calculated for both types of toothpick, before and after use. Comparison within and between groups was performed by the paired t test, at a significance level of 0.05. Results: Both the toothpicks provided significant reduction of QHPI, without any statistically significant difference between the types of toothpick (from 3.31 ± 0.61 to 2.42 ± 0.60 using triangular woodsticks and from 3.19 ± 0.71 to 2.24 ± 0.54 using round toothpicks, in the initial and the final periods, respectively). Individual comparison of proximal aspects by observation from buccal proximal and palatal/lingual proximal aspects revealed that round toothpicks removed a greater amount of plaque than triangular woodsticks in areas that were analysed by observation from the palatal/lingual proximal aspect. Conclusions: No statistically significant differences were found between round toothpicks and triangular woodsticks in the removal of supragingival plaque. Keywords: dental plaque, dental plaque index, oral hygiene, oral and dental hygiene products

Although there has been a decrease in the prevalence and the severity of dental caries in children over the past few decades, the benefits have not been equally shared by many low-income or underserved children in many industrialised countries, or children in developing countries. Dental caries is still the most common and challenging dental disease in children for a clinician to treat. Silver diamine fluoride (SDF) has been in use to arrest dental caries in many countries. A 38% (44,800 ppm fluoride ions) SDF solution is commonly used to arrest caries in primary teeth of children, especially those children who are young and difficult to manage. Application of SDF to arrest dental caries is a non-invasive procedure that is quick and simple to use. However, it stains the carious teeth and turns the arrested caries black. It also has an unpleasant metallic taste that is not liked by patients, especially children. The low cost of SDF and its simplicity in application suggest that SDF is an appropriate therapeutic agent for use in community dental health projects. Reports of available studies found no severe pulpal damage after SDF application. The current literature suggests that SDF can be an effective agent in preventing new caries and in arresting dental caries in the primary teeth of the children. It can be used to arrest caries progression in very young children who are less cooperative, and it allows definitive restoration to be performed when they grow older and become more receptive to dental procedures. Keywords: arrested caries, children, silver diamine fluoride

Purpose: The aim of this study was to evaluate the solubility and the fluoride release of different materials used for orthodontic band cementation in different solutions and at different times. Materials and Methods: Three materials were selected: Ultra Band-Lok (UBL); RelyX (RLX) and Ketac-Cem (KTC). Sixteen standard samples from each material were prepared, according to the manufacturers' instructions. The samples were stored in two different solutions (n = 8): 0.9% saline solution (pH 7.0) and 0.1 mol/l lactic acid (pH 4.0). The storage solutions were changed after 24 h and after 7, 15 and 30 days. The fluoride release was determined with an ion-specific electrode (Analion). For the solubility evaluation, the formula Wsl = (m1 - m2)/V was used to determine the loss of mass. Data were submitted for statistical analysis using the non-parametric Kruskal-Wallis test. Results: With respect to the solubility, immersion in lactic acid increased the solubility when compared with saline solution (P 0.01). In both the solutions, there were differences among materials (P 0.01) with the following rankings: UBL RLX KTC for lactic acid and UBL RLX KTC for saline solution. The ranking of fluoride release was UBL KTC RLX. In the two tested solutions, RLX exhibited the highest fluoride release (P 0.01), whereas KTC showed more fluoride release than that of UBL (P 0.05). Fluoride release decreased over time and the storage solution influenced the fluoride-releasing capacity of some materials. Conclusions: It was found that fluoride release was influenced by storage solution, materials and immersion time. Materials and storage solution were the significant factors for solubility. Keywords: cementation, fluoride release, orthodontic bands, solubility

Purpose: Enamel defects are serious challenges because of their unaesthetic appearance, dentinal sensitivity and the subsequent susceptibility to dental caries. Apgar index (AI) is used for postnatal, general, neural and behavioural assessment of newborns. The aim of the present study was to investigate the correlation of AI with the enamel defects of primary dentition. Materials and Methods: A total of 181 subjects (95 females and 86 males) aged 3 to 5 years were randomly selected. Subjects with a history of systemic or debilitating diseases or local confounding factors, for example traumatic habits leading to enamel abrasion, were excluded. According to the modified index for developmental enamel defects, visual and tactile examinations of the entire primary dentition (buccal, lingual/palatal and incisal/occlusal) were performed. Teeth with caries lesions and restorations were excluded from the examination. After collection of the data regarding AIs of the subjects, statistical analysis was performed based on the Spearman and Mann-Whitney U tests. Results: Enamel hypoplasia and hypocalcification were negatively correlated with the AI (P 0.05). Moreover, the number of teeth exhibiting enamel defects was significantly lower in subjects with higher AI (P 0.05). The effect of gender on the distribution of enamel defects as a covariate was not statistically significant (P > 0.05). Conclusions: AI is inversely correlated with enamel defects of primary dentition. Both quality and quantity of enamel defects of primary dentition are higher in children with lower AI, delineating a high-risk group demanding more stringent preventive measures. Keywords: Apgar index, hypocalcification, hypoplasia, primary dentition

Purpose: The aim of the present study was to examine whether xylitol, at different concentrations, inhibits the formation of an experimental model of oral biofilm. Materials and Methods: Biofilms of six bacterial species (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus rhamnosus, Actinomyces viscosus, Porphyromonas gingivalis and Fusobacterium nucleatum) were prepared on hydroxyapatite (HA) discs according to the Zürich Biofilm Model. Xylitol was tested at two concentrations, 1% and 3%. At the end of their designated incubation times, some HA discs were destined for confocal laser scanning microscopy (CLSM) and the others were harvested using a sterile surgical instrument. Aliquots of harvested biofilms were diluted and plated onto specific media. After a 48-h anaerobic incubation at 37°C, the colony-forming units (CFUs) were counted. Results: CLSM images showed that only a small amount of isolated bacteria was observed on the surface of HA discs. Culture of harvested biofilms showed an inhibition in the growth of different species included in the biofilms. Conclusions: Xylitol has a clear inhibitory effect on the formation of the experimental biofilms. This study shows that xylitol is not only efficient in inhibiting the acid production of cariogenic bacteria, but also in preventing the formation of a multispecies biofilm; it confirms the relevance of the use of this polyol for the prevention of oral diseases caused by dental plaque. Keywords: adherence, biofilm, oral bacteria, xylitol

Purpose: To describe oral health status and to evaluate the effectiveness of a caries prevention programme in preschool children. Materials and Methods: A sample of 1656 3- to 7-year-old children were examined in kindergartens in 2002, and 411 3-year-old children were then selected to participate in the prevention programme. The test group A (n = 156), group B (n = 118), and the control group (n = 137) were defined for the study. For test group A, supervised toothbrushing was prescribed and for test group B, fluoride gel applications were used. For the control group, children did not undergo any of the aforementioned procedures. Dental caries was assessed according to the World Health Organization (WHO) criteria, and oral hygiene according to the Greene-Vermillion simplified oral hygiene index. Preventive programmes were based on oral hygiene instructions, supervised daily toothbrushing, and fluoride gel applications. The relationship between oral hygiene and severity of dental caries was determined by using Fisher's test. Results: The prevalence of dental caries varied between 39.7% and 90.8%, and the decayed, missing, and filled teeth (dmf-t) varied between 1.3 ± 0.16 and 5.0 ± 0.24. Oral hygiene was satisfactory in 43.2% of children. During the 3 years of the programme, a significant difference was found between the test and the control groups. The reduction in test group A was 45.4% and in test group B was 60.1%. Conclusions: The prevalence and severity of dental caries among the examined children increased with age, and was lower in both the test groups compared with the control group. The professional fluoride applications and proper oral hygiene showed the most effective results in caries prevention. Keywords: dental caries, kindergarten, oral hygiene, preschool children, preventive programme

Purpose: To investigate the influence of a number of variables regarding clinicians' gender, social class, length of time since graduation and the level of knowledge on their use of available preventive measures against hepatitis B and C. Materials and Methods: A cross-sectional questionnaire-based survey was carried out involving a random and representative sample (n = 319) of the clinicians working in Recife, Pernambuco, North-East Brazil. The participants were interviewed by means of a questionnaire, prepared and pretested by the researchers. Pearson's chi-square and Fisher's exact tests were used in the statistical analyses (significance level: 5%). Results: Female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks (P = 0.0357). With regard to lab coat use in relation to social class, it was seen that clinicians from social class B used it less (P = 0.0077). The length of time since graduation was seen to be connected with the use of scrub caps (P = 0.0003), coating of equipment with polyvinyl chloride plastic film (P = 0.037), use of alcohol for cleaning equipment (P = 0.0012), two-handed recapping of needles (P 0.0001) and immunisation (P = 0.003), showing that those who graduated most recently were more likely to take adequate infection control steps. The fact that clinicians had been informed about hepatitis B and C, and also their knowledge about its contagion, was positively associated with their levels of vaccination against HBV (P = 0.0313 and 0.0108, respectively). Conclusions: The adherence to preventive practices against hepatitis B and C was shown to be connected with the clinicians' socio-demographic, professional and educational variables. Keywords: clinicians, hepatitis B and C, knowledge, prevention, protection