Oral Health and Preventive Dentistry, 04/2011

Purpose: To assess paediatricians' knowledge, attitude and awareness towards dental and oral health and treatment needs of their patients. Materials and Methods: Eighty-four paediatricians practicing in four cities of North Karnataka, India, were randomly selected for the study and were requested to fill out an objective questionnaire without providing any oral health information. Results: The present study shows that paediatricians who were surveyed had poor knowledge regarding dental and oral health and treatment needs in children. Conclusion: Paediatricians need to update themselves on recent recommendations regarding dental and oral health so as to ensure that all their patients receive timely preventive and restorative dental care. Keywords: awareness, oral health, paediatricians, survey

Purpose: To assess the tooth mortality and prosthetic treatment needs among the urban and rural adult population of Dharwad district. Materials and Methods: A total of 1223 subjects (685 urban and 538 rural) were selected using multi-stage cluster random sampling. A form was prepared and data were collected on sociodemographic factors, tooth mortality and its causes and prosthetic treatment needs by the interview method and clinical examination. Results: The rural population compared to urban, increased age and females compared to males had higher tooth mortality rates, which was demonstrated by the multiple logistic regression model. Dental caries and periodontal diseases were the two reasons for increased tooth mortality in the population studied. A proportion of 50.01% of the population required some form of prosthetic treatment. Conclusion: Age, gender and location were positive predictors of tooth mortality. Greater prosthetic treatment needs were observed among the rural population. Keywords: dental caries, periodontal disease, prosthetic treatment needs, tooth mortality

Purpose: The aim of the present investigation was to determine the degree of anxiety and fear in patients treated at the dental school clinics of the Universidade Federal de Pernambuco (Brazil) regarding the different types of treatment offered. Materials and Methods: The sample was made up of 400 patients from both genders over 18 years of age treated between July and October 2007. Data collection was carried out through the administration of validated questionnaires by a calibrated researcher. The Modified Dental Anxiety Scale (MDAS) and Gatchel's Scale were used to evaluate the degree of anxiety and fear among the patients. Results: There was a 23.0% prevalence of dental anxiety; 9.5% were very anxious, 13.5% were anxious and 77.0% were not anxious. Women were more anxious than men (20.7% and 11.3%, respectively, P = 0.995). The age group that exhibited the highest prevalence of anxiety was 30 to 39 years (29.3%). Regarding fear, 13.5% felt extreme fear; 30.5% felt moderate fear and 56% felt no fear. Schooling was the only significant socioeconomic factor for both anxiety and fear. In the association between fear and anxiety, 38.9% of the patients with extreme fear were classified as very anxious. Conclusion: The majority of individuals were classified as non-anxious and without fear regarding dental procedures. Keywords: anxiety, dentistry, fear

Purpose: To verify the aesthetic impact of mild and moderate dental fluorosis on young adult students from the UFMG using pictures with different fluorosis levels simulated in a computer program. Materials and Methods: The sample consisted of 396 university students, randomly selected from various courses (except dentistry). These participants were shown three mouth pictures with different rates of dental fluorosis (TFO, TF2 and TF4) according to the Thylstrup-Fejerskov Index (TF). The volunteers gave an individual assessment of the pictures and graded them (from 1 to 10) based on their aesthetics. In addition, they answered if they would feel uncomfortable smiling and if they would seek dental treatment in each case. The results were submitted to a chi-square test (P 0.05). Results: The students preferred the TF4 picture to the TF2. The picture which presented no fluorosis was more often preferred than the pictures which presented some form of change due to fluorosis. Higher scores were recorded by men for the TF2 picture than by women (P 0.05). As for the TF0 and TF4 pictures, the scores were similar among males and females. Furthermore, women reported more discomfort in smiling (P = 0.001) and a greater desire to seek out dental treatment than did men. Only 27.5% of all students stated that they knew what dental fluorosis was. Conclusion: Mild and moderate dental fluorosis had a negative aesthetic effect on the studied population, leading to a strong desire to seek dental treatment to change the appearance of affected teeth. Keywords: aesthetic perception, dental aesthetics, dental fluorosis

Purpose: To evaluate the knowledge and practice of the American Heart Association (AHA) 2007 guidelines among dentists in Hyderabad city, India, for the prevention of infective endocarditis (IE). Materials and Methods: A survey questionnaire was mailed to the dentists to assess their knowledge with regard to the antibiotic prophylaxis needed for specific cardiac conditions and the prophylaxis reasonable before various dental procedures in high-risk patients and the first-line and second-line antibiotic regimen prescribed. Results: Of the 190 registered dentists, 169 (88.94%) completed the questionnaire. The mean age of the population was 39.17 ± 8.23 years. The majority of the respondents correctly identified that having prosthetic cardiac valves, a previous history of IE illness and cardiac transplantation with subsequent cardiac valvulopathy are cardiac conditions requiring antibiotic prophylaxis. Prescription of first-line antibiotic drugs and second-line drug regimens corresponding to the current guidelines was correctly answered by only 56.21% dentists and 60.95% dentists, respectively. Conclusion: A relatively low level of knowledge of the new guidelines was reported among dentists, reflecting the need for more continuing dental education programmes. Keywords: antibiotic prophylaxis, dental procedures, dentists, infective endocarditis

Purpose: To review major mechanisms of dentine hypersensitivity and the treatment approaches offered. Materials and Methods: Medline was used to find relevant literature published up to December 2006. Based on abstracts and full articles, studies (in human and in animals) were identified describing mechanisms and management of dentine hypersensitivity. Additional information was also obtained by using manual library search for relevant topics in standard texts and journals of dentistry. Results: Discussion about the sensitivity of dentine started over a century ago, but it was not until sixty years later that a possible theory was posited. The so-called hydrodynamic theory became popular and was applied to understand the mechanism responsible for hypersensitive dentine. Nevertheless, because of the discrepancies in the pattern by which the dentine responds to various stimuli, several theories of dentine hypersensitivity were proposed which include the hydrodynamic theory, odontoblast transducer mechanism and direct innervation theory. None of these mechanisms was said to fully explain dentine hypersensitivity, thus indicating that as-yet unexplained mechanisms were possibly responsible. A multitude of products were tried and reported to be effective. The efficacy of many was not clearly established and their mechanisms of action were inadequately elucidated. The potential of gene therapy to reduce the burden of dentine hypersensitivity in the future is being examined. Conclusions: Considerable effort has been made to precisely explain dentine hypersensitivity, but doubt still exists whether any one theory can be applied to understanding this condition. This has led to a constant increase in therapeutic approaches worldwide, but with no conclusive evidence of reliable, successful treatment regimens. Keywords: dentine hypersensitivity, mechanisms, review, treatments

Purpose: To assess the current situation of white enamel lesions on vestibular surfaces of permanent maxillary incisors, diagnosed 6 years ago, without clinical intervention. Materials and Methods: The prospective study reassessed 53 students of both sexes, aged between 13 and 18 years old, all attending the public school system in Natal, Brazil. Data collection was performed by calibrated examiners, and a clinical chart consisting of demographic data on dental caries, oral hygiene and gingival condition was prepared. A tactile-visual examination was conducted using a clinical mirror and periodontal probe. Data compilation and analysis were carried out using SPSS software. In this analysis, the chi-square test was used for qualitative independent variables. To identify the net effect of treatment, multiple logistic analysis with forward stepwise model selection was performed. Results: The final sample was composed of 106 lesions in the 53 individuals, with mean age of 15.02 years, visible plaque index (VPI) of 23.34%, and gingival blood indices (GBI) of 25.92%. A statistically significant relationship (P = 0.003) was found between initial DMFS and the prognosis of white enamel lesions. Conclusion: It was observed that past caries experience and dental plaque were the main predictive factors for negative lesion outcomes, demonstrating the need for oral hygiene control through continuing preventive measures. Keywords: dental caries, dental enamel, prospective studies

Purpose: To assess the caries prevalence in 3- to 5-year-old children and determine whether urbanisation and income are associated with the dental decay status of these preschool children residing in the district of Lahore, Pakistan. Materials and Methods: Multistage random sampling was done to collect the sample of children from urban and rural areas. A list of children 3 to 5 years of age was prepared, and every 2nd child on the list was randomly selected until a total of 700 children were enrolled in the study. Lady Health Workers (LHWs) were trained to conduct this survey after permission from the pertinent authorities. The data of the children and their mothers regarding their age, gender, socioeconomic status (SES) and area of residence were collected. The caries status of children was recorded using the dmft index as per WHO criteria. Results: The prevalence of dental caries in preschool children of Lahore was found to be 40.5%. Within this group, caries prevalence was 33.3% in 3-year-old children, 47.6% in 4-year-old children and 75% in the 5-year-old children. The mean dmft score for the entire child population was 1.85 ± 3.26. A significant association was found between caries prevalence, low socioeconomic status, female gender and rural residence. Conclusion: Preschool children in Lahore, Pakistan have average dmft scores of 1.85 (± 3.26), which are mostly related to untreated carious lesions. Lower caries experience was found to be associated with rural residence and low family income. Keywords: dental caries, Pakistan, preschool children

Purpose: This study evaluated sealants placed on permanent molars in first-grade students in Shiraz primary schools during 2008 under a school oral health programme. Materials and Methods: A total of 420 sealed first permanent molar teeth in 179 students (mean age 8 years, 6 months) were evaluated for fissure sealant retention, occlusal caries status and Feigal criteria. All teeth were examined 1.5 years after application. The fissure sealants (Conceal F, SDI) were placed on occlusal surfaces after traditional acid etching. Statistical analysis was done with the chi-square test (P 0.05). Results: 57.5% of the seals were completely retained, 29.6% partially lost and 12.9% completely lost. There were no signs of carious lesions in 77.1% of the teeth. According to the Feigal criteria, success rates based on marginal integrity, marginal discolouration and anatomical form were 98.2%, 95.5% and 58.6%, respectively. The overall success rate with all three criteria was 54.14%. There were no significant relationships between the results and patient gender or tooth position in the arch. Conclusion: Although fissure sealants are an effective method for preventing tooth caries, the results of this study indicate that public oral health programmes need to be implemented more carefully and that follow-up programmes are advisable. Keywords: caries prevention, community dentistry, pit and fissure sealant, preventive dentistry, public health dentistry

Purpose: Triphala is an ayurvedic preparation with known antimicrobial action. This study was carried out to assess the antibacterial efficacy of triphala against salivary mutans streptococci in comparison with the 'gold standard' chlorhexidine. Materials and Methods: A double blind randomised control trial was conducted among 57 volunteers who were assessed to be in the high caries risk category. They were randomly allocated into three study groups: 1) 15 ml of 6% triphala mouthwash; 2) 15 ml of 0.2% chlorhexidine (active control); 3) no mouthwash (passive control). Mouthwashes were given twice a day for 15 days. Unstimulated saliva samples were collected at baseline and at 15 and 45 days. Mutans streptococci (MS) were cultured on MSB agar and colony counts obtained. The α error was fixed at 5%. ANOVA and post-hoc LSD tests were performed using SPSS version 14. Results: After using mouthwash for 15 days, an 83% and 80% reduction and at 45 days a 67% and 65% reduction in salivary MS colony count was observed in the triphala and chlorhexidine groups, respectively (P = 0.0001). The control group showed an increase of 3% in MS colony count at 15 days and a reduction of 7% at 45 days. (P = 0.116). Conclusion: The antimicrobial action of triphala against mutans streptococci closely parallels that of chlorhexidine. It does not have the side effects commonly associated with chlorhexidine and is cost effective. Keywords: chlorhexidine, dental caries, mutans streptococci, triphala

Purpose: To investigate the relationship between the type and material of dental restorations and periodontal health in a sample of Jordanians. Materials and Methods: Patients attending the Dental Teaching Clinics of Jordan University of Science and Technology with restored teeth were examined. For every patient, the plaque index, gingival index, probing depth and clinical attachment level were recorded on restored and non-restored tooth surfaces. The restoration types were Classes II, III and V, in addition to crowns and bridge abutments. The restorative materials included amalgam, tooth-coloured materials (resin composite and glass ionomer), non-precious alloys, porcelain and acrylic. Results: Class III restorations were associated with the lowest plaque index (0.62), gingival index (1.13), probing depth (1.62 mm) and clinical attachment level (0.31 mm). Class II restorations had the highest plaque index (0.99) and probing depth values (2.27 mm). Crowns and bridge abutments had the highest gingival index (1.65 and 1.61, respectively), high probing depth (2.01 and 2.15 mm), but a low plaque index (0.69 and 0.66). Class V restorations demonstrated the highest attachment loss (0.92 mm). Resin composite and glass ionomer restorative materials demonstrated the lowest gingival index (1.21) and probing depth (1.75 mm), whereas porcelain demonstrated the lowest plaque index (0.51) and clinical attachment level (0.14 mm). Amalgam was associated with the highest plaque index (1.01) and probing depth (2.29 mm). Non-precious alloys and acrylic covered castings demonstrated the highest gingival index (1.73 and 1.72, respectively) and clinical attachment level (1.00 and 0.88 mm). Conclusions: Crowns, bridge abutments (especially acrylic and non-precious metals) and Class II amalgam restorations appear to be associated with periodontal breakdown. Keywords: Jordan, periodontal disease, periodontal health, restoration, restorative material

Purpose: To assess the relationship of child oral health-related quality of life and socioeconomic backgrounds to traumatic dental injuries in schoolchildren. Materials and Methods: This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren, representative of Santa Maria, a city in southern Brazil. The participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14), their parents or guardians answered questions on socioeconomic status, and a dental examination provided information on the prevalence of dental trauma. The assessment of association used Poisson regression models. Results: The prevalence of TDI was 9.7%. The maxillary central incisors were the most frequently traumatised, and the most commonly observed traumatic dental injury was enamel fracture. No association was observed among child oral health-related quality of life and socioeconomic factors with traumatic dental injuries after the adjustment. Conclusion: Socioeconomic indicators are not associated with dental trauma in schoolchildren and this oral health condition has no negative impacts on children's quality of life. Keywords: quality of life, socioeconomic factors, traumatic dental injuries