Oral Health and Preventive Dentistry, 02/2013

Purpose: To assess a) whether the quality of reporting of randomised controlled trials (RCTs) has improved since the formulation of the Consolidated Standards of Reporting Trials (CONSORT) statement and b) whether there is any difference in reporting of RCTs between the selected public health dentistry journals. Materials and Methods: A hand search of the journals of public health dentistry was performed and four journals were identified for the study. They were Community Dentistry and Oral Epidemiology (CDOE), Community Dental Health (CDH), Journal of Public Health Dentistry (JPHD) and Oral Health and Preventive Dentistry (OHPD). A total of 114 RCTs published between 1990 and 2009 were selected. CONSORT guidelines were applied to each selected article in order to assess and determine any improvement since the publication of CONSORT guidelines. The chi-square test was employed to determine any statistical significant difference in quality of reporting of RCTs before and after the publication of the CONSORT guidelines. A comparison was also done to determine any statistically significant difference in quality of reporting of RCTs between the selected journals. Results: Title, abstract, discussion and conclusion sections of the selected articles showed adherence to the CONSORT guidelines, whereas the compliance was poor with respect to the methodology section. Conclusion: The quality of reporting of RCTs is generally poor in public health dentistry journals. Overall, the quality of reporting has not substantially improved since the publication of CONSORT guidelines. Keywords: CONSORT, public health dentistry, reporting of RCTs

Purpose: To assess the prevalence and related factors of traumatic dental injuries (TDI) among 12-year-old Jordanian schoolchildren. Materials and Methods: For this cross-sectional study among schoolchildren, a sample of 2560 schoolchildren (1209 boys, 1351 girls) aged 12 years were randomly selected. The epidemiological classification adopted by the World Health Organization (WHO) and modified by Andreasen et al was used to record TDI on incisors. Results: Of the children examined, 5.5% showed TDI. The difference in prevalence between boys and girls was statistically significant (P 0.01). Maxillary central incisors were the most affected and the most common type of crown injury was enamel/dentin fracture. The relationship between dental injuries and geographic location, area, and socioeconomic indicators was not statistically significant. Most of the TDI occurred at home, followed by school; the most frequent cause was falls. No statistically significant association was found between TDI and dental caries experience (P > 0.05). There was a tendency for boys (P 0.01), children with an incisal overjet > 3 mm (P 0.01) and incompetent lip closure (P 0.001) to have experienced dental injuries. Treatment need due to dental injuries was very high. Conclusion: The prevalence of traumatic injuries to permanent incisors in 12-year-old Jordanian schoolchildren was relatively low. TDI was associated with gender, overjet and lip competence, but was not influenced by dental caries experience. There was a great unmet treatment need. Keywords: children, epidemiology, Jordan, prevalence, risk factors, traumatic dental injuries, treatment need

Purpose: To investigate the prevalence and severity of dental caries in children with a history of asthma in addition to their salivary characteristics, flow rate and buffering capacity, as well as the salivary level of Mutans streptococci (MS) and lactobacilli present. Materials and Methods: The study sample was composed of 30 cases and 30 controls with an age range from 5 to 13 years. The cases involved children with a past history of asthma, while the controls were medically fit children. The study was conducted from 2010 to 2011 and patients were randomly selected through the electronic filing system at King Abdul-Aziz University Hospital (R4 system), Jeddah, Saudi Arabia. Interviews and questionnaires were completed by the parents of the children involved and dental examinations were performed. Stimulated salivary samples were collected to determine the salivary flow rate, buffering capacity and salivary levels of MS and lactobacilli. Results: No significant differences were found in the DMFT, dmft scores or community periodontal index (CPI) scores between the cases and controls. However, there was a positive correlation between DMFT and dmft scores (r = 0.83, P 0.0001) in both the cases and controls. In asthmatic patients who took their medication 3 times a day or more, the level of MS and lactobacilli was significantly higher (P = 0.014 and P = 0.008, respectively) compared with other asthmatic patients. Patients with severe asthma had significantly lower salivary flow rate levels than other asthmatic patients (P = 0.040), while patients taking a combination therapy of anti-asthmatic drugs with corticosteroids had higher levels of lactobacilli compared with patients using other medications (P = 0.02). Conclusions: The frequency of taking asthma medication, the severity of asthma and the use of combination therapy can significantly alter the salivary characteristics in asthmatic children. Keywords: asthma, caries, children, saliva

Purpose: To evaluate the impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults. Subjects and Methods: Subjects comprised dentate patients (mean age, 60.0 ± 9.9 years) in Taiwan. Information on demographic data, oral health behaviours, oral habits and self-perceived health status was collected via self-administered questionnaires and dentition status was assessed by oral examination. Multiple logistic regression analyses were used to determine variables correlated with the low dentition group (subjects with less than 20 natural teeth or 8 functional tooth units). Results: The analysis showed that the low dentition group was more likely to be older and to exhibit low educational levels, less frequent use of dental floss, more common smoking habits, poor self-perceived dental health and to be exbetel- nut chewers. In addition, the low dentition group was less likely to be current betel-nut chewers. Conclusions: These results underscore the importance of the use of dental floss and confirm the adverse effects of smoking on dental health. Hence, the dental profession should continue to encourage proper oral health behaviours and oral habits. Keywords: functional tooth units, natural tooth, oral habit, oral health behaviour, tooth retention

Purpose: To find the differences in patient satisfaction related to dental services among three ethnic groups - Chinese, Indian and Malay - at AIMST University Dental Centre and analyse them with an importance-performance grid, identifying the weak and strong points, in order to provide better service. Materials and Methods: This questionnaire-based study consisted of convenience samples of 174 patients of Chinese, Indian and Malay ethnicity. Importance-performance analysis for 20 attributes were compared using Likert's scale. The data obtained were statistically analysed using the Kruskal-Wallis test. Results: Chinese and Indians both emphasised low performance on the interpersonal relationship attribute in terms of the receptionist's courtesy, whereas the Malay participants were concerned with convenience attributes. All the ethnic groups favoured maintaining existing major attributes towards technical competency, interpersonal relationship and facility factors. This study demonstrated priority differences between the ethnic groups' perception of the quality of dental services, where ethnic Chinese showed the highest gap (measure of dissatisfaction) between importance and performance compared to ethnic Malays, followed by ethnic Indians. Conclusion: The patients from the three major ethnic groups of Malaysia were generally well satisfied. Perhaps more priority should be placed on improving the interpersonal relationship attribute, especially with the receptionists. Keywords: ethnicity, expectation, health care, importance-performance analysis, perception, quality service

Purpose: To investigate the level of dental fear and anxiety of children who have cleft lip and palate (CLP). Materials and Methods: The study was performed at Cukurova University, Faculty of Dentistry. A total of 32 7- to 12-yearold children, 17 of them with CLP (8 girls and 9 boys) and 15 of them without CLP (7 girls and 8 boys) participated in the study. The children were evaluated by using the Facial Image Scale (FIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) methods. The anxiety state of the children was assessed twice using FIS: first in the dental hospital waiting room (FIS-WR) and after, while sitting in the dental chair (FIS-DC). CFSS-DS was administered to all participants in order to assess the dental anxiety while they were sitting in the dental chair. Results: According to the FIS results, there was no difference between CLP and control group in the waiting room (P = 0.682). However, the CLP group showed lower scores than the control group while they were sitting in the dental chair (P = 0.030). The FIS scores of the CLP group were significantly higher in the waiting room than while sitting in the dental chair (P = 0.007). In the control group, there was no significant difference between FIS-WR and FIS-DC values (P = 0.664). The total CFSS-DS scores of children with CLP were lower than those of the control group, but these differences were not statistically significant (P > 0.05). Conclusion: Children with CLP showed more anxiety in the FIS-WR than in the FIS-DC, but they showed lower scores than the control group in the FIS-DC. The positive previous experience of meetings with dentists of the CLP children could explain these results. Positive previous experiences with dentists and a short time in the waiting room could be key elements in the care of CLP children. Keywords: CFSS-DS, children, CLP, dental anxiety, FIS

Purpose: To evaluate the psychometric properties of an oral-health related quality of life (OHRQoL) instrument for application in the population of Iranian adolescents and to assess the discriminate and convergent validity and reliability of the Persian version of the Child Oral Health Impact Profile (COHIP) in a representative sample of this population. Materials and Methods: Using multistage stratified sampling, 597 schoolchildren aged from 13 to 18 years living in the city of Isfahan were recruited to complete the Persian COHIP questionnaire. They were also examined for dental caries and malocclusion by two trained, calibrated examiners. Results: Overall COHIP scores ranged from 15 to 135 (mean ± SD: 103.6 ± 18). Sixty-six percent of the students experienced at least one frequent oral health-related impact over the past three months. The Cronbach alpha coefficient was 0.89 for the overall score. Discriminate validity was supported by the significant difference between COHIP scores in the caries-free group and the others (P = 0.01). In addition, the questionnaire was able to differentiate among the groups by various degrees of need for orthodontic treatment (P 0.01). Convergent validity was confirmed by significant association between the quality of life scores, the self-perceived health and oral health ratings and the self-perceived treatment need (r = 0.36, 0.57, -0.40). Conclusion: The Persian COHIP demonstrated acceptable psychometric properties for the descriptive purposes. Some discrepancies observed between the clinical data and quality of life status were confirmed by the perceptual identity of such indices influenced by several overt and covert variables. Keywords: adolescents, child oral health impact profile, construct validity, oral health-related quality of life

Purpose: The aim of this retrospective study was to assess the prevalence of taurodont molars among an Indian population. The goal was also to determine sexual dimorphism, distribution of taurodontism as well as any association between taurodontism and simultaneously occurring syndromes and anomalies. Materials and Methods: Full-mouth periapical radiographs of a total of 1360 patients were screened. A total of 9792 molars (including third molars) were evaluated. The relative incidence and the correlations regarding the location of taurodonts (right versus left side and maxillary versus mandibular) were analysed using the Z test. Results: The overall incidence of subjects with taurodont molars among this Indian population was 2.5% (34/1360). Sexual distribution showed female dominance (21 females, 13 males), but this was statistically insignificant (P > 0.05). Maxillary second molars (35/118) were the most commonly involved teeth, followed by mandibular second molars (32/118). No significant differences were obtained for distribution by side (right vs left; P > 0.05) or interarch distribution (maxillary vs mandibular; P > 0.05). Out of 34 subjects with taurodonts, 50% (17/34) were associated with pyramidal molars and 32.35% (11/34) had impacted molars. Conclusions: Taurodontism is not uncommon in the Indian population and it might be associated with other conditions, such as pyramidal molars and impaction. Further larger scale studies are required to assess its prevalence in the general population and to establish any associations. Keywords: anomalies, association, prevalence, pyramidal molars, taurodont

Purpose: To assess the knowledge of dental decay among pregnant women and its relationship with sociodemographic characteristics and caries experience in rural India. Materials and Methods: A cross-sectional study was conducted among 381 pregnant women in southern India. Variables and knowledge of dental decay were recorded using a structured self-administered questionnaire. Dental caries was recorded by a calibrated examiner as per WHO guidelines. Results: The majority of the respondents were under 30 years of age (91.6%), utilised a public health-care delivery system (57.2%), were primigravid (63%), had a pre-universtiy diploma (64.8%) and were in the 3rd trimester (63%). Overall, poor knowledge was expressed by 12% to 37% of the women. The mean (±SD) DT (decayed teeth), MT (missing teeth), FT (filled teeth) and DMFT (decayed, missing and filled teeth) were 3.08 (±2.6), 0.93 (±2.23), 0.39 (±1.14) and 4.4 (±3.56), respectively. There were no significant differences in the responses to the knowledge of caries with respect to age and trimester. Educational status, health-care delivery system and number of pregnancies had a significant association with knowledge of caries. Conclusion: This study highlighted the limited knowledge of dental decay among pregnant, rural, southern Indian women. Preventive programmes for pregnant women should be designed based upon a thorough interview including an informative session on the specific risks during this period, in order to motivate the patient towards oral health and implement the needed prophylactic measures. Keywords: dental caries, India, knowledge, pregnancy

Purpose: To assess halitosis and determine the relationship between halitosis and tongue scores, periodontal status and DMFT among dental students. Materials and Methods: The study comprised 268 (178 female, 90 male) dental students. Halitosis was measured using a Halimeter and the organoleptic method. Halitosis was diagnosed with a mean volatile sulphur compounds (VSC) level of >=125 ppb and an organoleptic measurement of >= 2 on a 0- to 5-point scale. Tongue scores were obtained using a tongue coating index (TCI), periodontal status was measured and assessed using the Community Periodontal Index of Treatment Needs (CPITN) and DMFT indices were calculated. Results: Halitosis occurred at higher rates among male students than female students (83% vs 71%, P = 0.02). No differences were found in halitosis rates among students in different academic years (P = 0.6) or age groups (P = 0.6). A relationship was found between halitosis and tongue scores (P 0.001) and between halitosis and mean CPITN scores (P = 0.004). The mean DMFT was 4.02 (SD = 3). No relationship was found between halitosis and DMFT index (P = 0.5). Conclusion: Halitosis was prevalent among dental students. Given their responsibilities for diagnosing and improving oral health, they may benefit from increased awareness of the problem and encouragement to improve their own oral hygiene, especially male students. Keywords: CPITN, dental students, DMFT, Halimeter, halitosis, tongue scores

Purpose: The objective of this study was to assess the opinion of dental patients who use tobacco towards receiving tobacco cessation counseling and services in a dental college and hospital setting. Materials and Methods: A cross-sectional descriptive survey method using a structured questionnaire was used in this study. Participants were patients attending The Oxford Dental College, Hospital, and Research Center, Bengaluru, India. Each patient in the clinic waiting room was asked by the investigator to complete a 29-item self-administered questionnaire. Descriptive statistics and bivariate analysis using Fisher's exact tests were used for statistical analysis of the data. Results: Ninety-six percent (n = 770) of tobacco users had previously attempted to quit tobacco and 95.7% were willing to quit. Sixteen percent (n = 132) of respondents reported that they currently used tobacco. About 83% of tobacco users agreed that the student dentist should ask patients whether or not they use tobacco, 79.4% agreed that the student dentist should advise tobacco users to quit, and 81.4% agreed that student dentists should offer information on quitting tobacco to patients who want to quit. Only 12.5% (n = 100) of the patients who use tobacco were aware of the community resources available to quit tobacco. Conclusion: This study shows that patients expect and felt comfortable with receiving tobacco cessation counseling services by oral health professionals in a dental hospital setting. Keywords: oral health, patient opinion, student dentist, tobacco cessation

The biochemical definition of dental caries is reasonably understood and generally agreed upon, but there is no consensus on a clinical definition among dentists. There are many proposed diagnostic criteria of dental caries in the dental literature. The recently developed International Caries Detection and Assessment System (ICDAS II) has been constructed to allow data comparison between studies. It can be used in epidemiological studies, public health research, clinical research, clinical practice and dental education. A good study evaluating a caries detection method should contain information on caries prevalence of the study sample and other measures, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). It is noteworthy that measuring sensitivity and specificity provides no quantitative information on how likely a tested tooth is to be carious because the true caries status of the tooth is not known in a clinical situation. Moreover, the study design for caries detection should address the interpretation of predictive values because PPV and NPV are affected by the caries prevalence. The study design should also measure patient-oriented outcomes, address allocation concealment and avoid lead-time bias to generate valid and clinically relevant studies. Prudent evaluation of caries detection methods is the standard of care. This paper reviews current diagnostic criteria for caries detection and discusses proper ways to evaluate new diagnostic methods. Keywords: assessment, caries, demineralisation, detection, diagnosis, research

Purpose: To evaluate the efficacy of 10% casein phosphopeptide amorphous calcium phosphate complex (CPP-AC P) used alone or with fluoride as compared to fluoride mouthrinse for the remineralisation of occlusal white spot lesions in an in vivo pilot study. Materials and Methods: Forty-five subjects with occlusal white spot lesions (WSL) determined by visual examination and confirmed with Diagnodent were randomly divided into 3 groups: group 1: 10% CPP-AC P + 0.2% NaF; group 2: 10% CPPAC P; group 3: 0.5% NaF mouthrinse for 30 days. The pre-treatment and post-intervention Diagnodent values were tabulated and subjected to statistical analysis. Results: Among the groups, the remineralising potential of 10% CPP-AC P + 0.2% NaF (group 1) and 10% CPP-AC P (group 2) were similar, however, both groups were superior to 0.5% NaF mouthrinse (group 3). Conclusions: The CCP-AC P technique is highly beneficial for the remineralisation of non-cavitated occlusal white spot lesions when compared to 0.5% NaF mouthrinse. Keywords: casein phosphopeptide amorphous calcium phosphate complex (CPP-AC P), diagnodent, fluoride, remineralisation, white spot lesion