Oral Health and Preventive Dentistry, 03/2013

Purpose: To compare reproducibility of marginal bone measurements in conventional film and digitised radiographs and to assess whether variations in reproducibility occurred in measurements taken in a longitudinal, epidemiological survey. Materials and Methods: Triplicate measurements of the marginal bone level and of remaining bone were obtained from film and digitised full-mouth radiographic surveys from 20 individuals who were examined three times at five-year intervals in a longitudinal study design. The digitalisation of the films was conducted by scanning the film with a flatbed scanner. The standard deviation (SD) of the triplicate measurements served as the statistic for reproducibility. The time spent for recording one radiographic survey, which consisted of 14 periapicals and 2 bitewings, was documented. Results: Statistically significant differences existed in the reproducibility of marginal bone level measurements obtained at the first examination and the two subsequent examinations both for film and digitised radiographs (P 0.05). The difference in marginal bone level measurements (film vs digitised) was 0.16 mm (SD = 0.45 mm). Similarly, the overall difference in measurements of the remaining bone was 0.12 mm (SD = 0.61 mm). Recording of a digitised survey lasted on average 5 min (SD = 1.5 min), while the recording of a film survey lasted on average 14 min (SD = 1 min). Conclusions: Digitising film is an acceptable method for the purpose of assessing the marginal bone level and will save time in longitudinal, epidemiological studies. Keywords: conventional, digitised, marginal bone level, radiographs

Purpose: To compare normative methods of orthodontic treatment need with the sociodental approach in 12-year-old students and correlate the normative measures of malocclusion with the impact of oral health on daily activities. Materials and Methods: A cross-sectional study of 201 12-year-old students was conducted in the city of Manaus, Brazil. The normative orthodontic treatment need was determined by oral clinical examination using two occlusal indices, the Index of Orthodontic Treatment Need (IOTN), comprising the Dental Health Component (DHC) and Aesthetic Component (AC ), and the Dental Aesthetic Index (DAI). The sociodental approach combined normative measures (IOTN and DAI), the impact of malocclusion on daily activities (Child-Oral Impacts on Daily Performances index, Child-OIDP) and propensity- related orthodontic treatment assessment. The normative method and the sociodental approach of orthodontic treatment needs assessment were compared using the McNemar test. The association between the impact of malocclusion on daily activities and normative orthodontic need was tested using χ2 and Kruskal-Wallis tests. Results: The frequency of individuals with normative need according to IOTN/DHC (24.9%) and DAI (42.3%) was statistically higher when compared with the sociodental approach (= 4.5%) (P 0.001). The sociodental approach provided different results using IOTN/DHC (1.5%) and DAI (4.5%) (P 0.001). The magnitude of normative need was associated with the impact of malocclusion on children's daily activities. Conclusion: Substantial reductions in normative need estimates for orthodontic treatment were observed using the sociodental approach. The sociodental approach for orthodontic treatment needs can optimise the use of resources in oral health services. Keywords: health services needs and demand, malocclusion, needs assessment, orthodontics, quality of life

Purpose: Saliva is considered to be critical for the maintenance of healthy oral mucosa, and oral fluids provide an easily available, non-invasive medium for the diagnosis of a wide range of diseases and clinical situations. The purpose of this study was to estimate the thiocyanate (SCN) level in saliva of cigarette smokers and compare it with that of nonsmokers. Materials and Methods: The present study comprised 100 subjects, of which 50 had a habit of tobacco smoking. The other 50 neither smoked nor chewed tobacco and comprised the healthy control group. The age and sex (all males) of both groups of subjects were matched. All the patients were in the age group of 25 to 40 years. The group of smokers was divided into subgroups according to duration and frequency of smoking. Duration group 1: smoking for a period of 4-7 years; duration group 2: smoking for a period of 8-15 years; duration group 3: chronic smokers, smoking for a period of more than 15 years. Frequency group 1: patients smoked half pack of cigarettes, i.e. 4-6 per day; frequency group 2: patients smoked one pack of cigarettes, i.e. 7-11 per day; frequency group 3: patients smoked more than one pack, i.e. >11, per day. Saliva was collected by the spitting method. Unstimulated whole saliva was refrigerated at 4°C and processed within 24 h. The estimation of thiocyanate in saliva was done according to Densen et al (1967). Results: The present study clearly indicates a significant increase in salivary thiocyanate level in tobacco smokers as compared to nonsmokers (P 0.0001). Comparing salivary SCN in different duration groups, the salivary SCN level was significantly lower in group 1 vs groups 2 and 3, with P 0.0001. In terms of smoking frequency, the salivary SCN level was significantly lower in group 1 vs group 3, P 0.0001. It is also evident that there was an increase in salivary thiocyanate levels with increased duration and frequency, thus showing a positive correlation between them. Conclusion: The findings of this study suggest that salivary thiocyanate can be used as a safe and acceptable prevalence measurement for cigarette smoking behaviour. Keywords: saliva, salivary thiocyanate, tobacco smoking

Purpose: Some evidence implicates a role of hydroxychloroquine (HQ) in the management of Sjögren's syndrome. This study evaluated the effect of HQ on saliva B-cell activating factor (BAFF) levels as well as health related quality of life (QoL) in patients with primary Sjögren's syndrome (pSS). Materials and Methods: Ten pSS patients who had been treated with HQ for at least 2 years and 15 healthy controls (HC) were included in the study. First, HQ was withdrawn for 12 weeks, then baseline evaluation was performed. Subsequently, HQ was restarted and further evaluations were carried out after 12 and 24 weeks of HQ treatment. Oral infection foci were eliminated by dental and periodontal treatments in both groups before enrollment. BAFF levels were evaluated with ELISA in serum and unstimulated mixed saliva. Salivary flow rates of patients and the control group were measured as well. Oral health quality of life (QoL) was evaluated by an oral health impact profile-14 (OHIP-14) questionnaire. Results: Salivary BAFF levels (median: 12.39 ng/ml) were significantly decreased by using HQ both at 12 (2.78 ng/ml, P = 0.008) and 24 weeks (0.54 ng/ml, P = 0.011). Similarly, decreases in serum BAFF levels (5.23 ng/ml) were seen at 12 and 24 weeks after HQ treatment (2.18 ng/ml, P = 0.008 and 0.0 ng/ml, P = 0.012, respectively). Serum and salivary BAFF levels were significantly lower in healthy controls (0.37 ng/ml and 0.0 ng/ml, resp.) compared to those of pSS before HQ therapy (P = 0.006 and P = 0.001, resp.). Unstimulated salivary flows were similar in patients treated with HQ after 12 (0.38 ml/min) and 24 weeks (0.50 ml/min) (P = 0.51) but higher than the patients' rate at baseline (0.04 ml/min) (P = 0.008). Conclusion: Salivary and serum BAFF levels were lowered in patients with pSS when treated with HQ. In addition, decreased disease activity and increased salivary flows can be achieved with HQ in pSS patients. Keywords: BAFF level, hydroxychloroquine, Sjögren's syndrome

Purpose: To obtain a valid Romanian version of the OHIP-14 for use among Romanian adults, either in Romania or abroad. Materials and Methods: The Romanian version of the OHIP-14 was obtained through the back translation technique and pre-tested in a pilot study. Subsequently, it was self-administered to 187 adults who also underwent a clinical examination. Cronbach alpha was used to check the internal consistency and reliability analysis and validity tests were used to determine the psychometric properties of the questionnaire. Results: The Cronbach alpha coefficient obtained was 0.88. Inter-item correlation coefficients were between 0.01 and 0.74; item-total correlation values ranged between 0.25 and 0.77. There were statistically significant associations (p = 0.001) between the respondents' self-perceived oral health (r = 0.41), the dental treatment need (r = 0.35) and the mean of the OHIP-14 total scores. Similar statistically significant associations (p = 0.001) existed between the OHIP-14 total scores mean and the clinical data - the number of decayed (D) and of missing (M) teeth and the prosthetic treatment need - proving the construct validity of the questionnaire. The subscales 'physical pain' and 'psychological disability' have the most important impact on the overall OHIP-14 score. The subscales 'social disability' and 'handicap' seem to make the least contribution to the overall OHIP-14 score. Conclusion: The Romanian version of the OHIP-14 is a valid and reliable questionnaire that can be used in future studies. Keywords: linguistic and cultural validation, OHIP-14, oral-health related quality of life

Background and purpose: Child abuse has serious physical and psychosocial consequences which adversely affect the health and overall well-being of a child. However, in a developing country like India there has been no knowledge of the extent, magnitude and trends of the problem. This study reviews the overall scenario of child abuse in India as well as the role of the dentist in recognising and thereby combating this problem. Results: Among health professionals, dentists are probably in the most favourable position to recognise child abuse, with opportunities to observe and assess not only the physical and the psychological condition of the children, but also the family environment. The high frequency of facial injuries associated with physical abuse places the dentist at the forefront of professionals to detect and treat an abused child. Screening for maltreatment should be an integral part of any clinical examination performed on a child. Although many injuries are not caused by abuse, dentists should always be suspicious of traumatic injuries. The dental professional's role in child abuse and neglect is to know the current state law regarding reporting child abuse and to follow the law. Awareness, identification, documentation and notification should be carried out by the dentist. Conclusion: Paediatric dentists can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. Such efforts will strengthen the ability to prevent and detect child abuse and neglect and enhance care and protection for the children. Keywords: child abuse, dentist, neglect

Purpose: The aim of this retrospective investigation was to examine the occurrence of periodontal disease in patients referred to a specialist clinic for neurosurgery and to explore possible associations between common systemic disorders and periodontal disease in an adult population in Greece. Materials and Methods: The study sample consisted of 1,652 individuals, 760 males and 892 females, aged 40 to 68 years, with a mean age of 57.3 ± 4.7 years. Data were collected by means of an oral clinical examination and a selfadministered questionnaire. Statistical analysis of questionnaire items was performed by using a multiple linear regression analysis model in order to estimate correlations between systemic disorders as independent variables, and the relative frequency of periodontal pockets of 5 mm or more and the frequency of clinical attachment loss of 6 mm or more as dependent variables. Results: The relative frequencies of periodontal pockets >= 5.0 mm and clinical attachment loss >= 6.0 mm as expressed in terms of mean values were 76% and 70.2%, respectively, for individuals who suffer from cardiovascular disease and 62.3% and 52.9% respectively, for those who suffer from respiratory disease. The depth of periodontal pockets was significantly and positively correlated to the presence of respiratory diseases (P = 0.0001) and diabetes mellitus (P = 0.0001) after adjustment for age, gender and smoking, whereas clinical attachment loss was significantly and positively correlated to the presence of diabetes mellitus (P = 0.0001) and cardiovascular diseases (P = 0.037). Conclusion: Based on the clinical criteria for established periodontitis, the current study supports associations between periodontal disease and systemic disorders such as diabetes mellitus, cardiovascular and respiratory diseases. Keywords: cardiovascular diseases, diabetes mellitus, health questionnaire, periodontitis, systemic disorders

Purpose: To conduct a questionnaire-based survey of pregnant women with particular reference to their knowledge, attitudes and practices in relation to oral care and adverse pregnancy outcomes and also to identify the various risk indicators for gingival bleeding during pregnancy. Materials and Methods: This was a cross-sectional questionnaire-based survey using interviewer-administered, structured questionnaires at three maternity care centres. The study group comprised 359 pregnant women who were assessed for their knowledge, attitudes and practices regarding oral health care during pregnancy and adverse pregnancy outcomes. Results: There were deficits in various areas of the knowledge, attitudes and practices of the pregnant women. The majority (87.2%) were not aware of the importance of oral hygiene and its probable association with adverse pregnancy outcomes. None of the respondents ever used dental floss and only a few (1.4%) had heard about it. Risk indicators that were identified in our study for gingival bleeding during pregnancy were: poor knowledge regarding various parameters, brushing only once daily and infrequent visits to the dentist. Conclusions: Most pregnant women need more information about oral health and disease prevention. It would be prudent to compile and consider their knowledge, attitudes and practices along with sociocultural characteristics, so that health education programmes are customised to different sectors of the population. Keywords: gingival bleeding, KAP, pregnancy outcomes, sociocultural factors

Purpose: Caries is a prevalent condition in Saudi Arabia. At present, knowledge regarding caries risk factors in Saudi Arabia is limited. The present study aimed to identify characteristic features of Saudi preschoolers at high risk for caries, using the American Academy of Pediatric Dentistry caries risk assessment tool (CAT ) and to report the most significant caries risk predictors. Materials and Methods: A sample of 407 children aged 4 and 5 years was selected randomly from private and public nursery schools. Their parents answered a questionnaire prepared using the CAT . Each child was examined for the presence of caries and his/her oral hygiene status. Results: According to the CAT , almost all children (89%) were considered to be at high risk. Caries was significantly more prevalent among children attending public than private schools. All CAT variables were significantly related to the presence of caries except general health condition and water fluoridation. Logistic regression analysis showed previous caries experience, enamel demineralisation, and socio-economic status to be the most significant caries risk factors. Conclusion: Most of the Saudi children are considered to be at high risk for caries. Previous caries experience, enamel demineralisation and socioeconomic status are the most significant caries risk predictors. These groups should be targeted for inclusion in caries prevention programmes. Keywords: assessment, caries risk, children, Saudi Arabia

Purpose: To evaluate the relative performance of fluoride (F) dentifrices to promote remineralisation and enamel F acquisition using an in vitro pH-cycling model. Enamel surface morphology was investigated. Materials and Methods: Thirty-six white spot lesions and 36 sound enamel sections from extracted premolars and molars were randomly assigned to 8 experimental groups and a placebo group. Eight commercially available brands of Fdentifrices were used: A. 0.8% monofluorophospate (MFP)-silica; B. 0.8% MFP-calcium carbonate and calcium phosphate; C. 0.8% MFP-calcium carbonate and calcium phosphate; D. 0.76% MFP-aluminium hydroxide; E. 0.24% sodium fluoride (NaF)-silica and sodium pyrophosphate; F. 0.24% NaF-silica and sodium pyrophosphate; G. 0.76% MFP and 0.10% NaF-dicalcium phosphate and sodium pyrophosphate (1450 ppm F); H. 0.76% MFP and 0.33% NaF-silica (2500 ppm F). The placebo (I) contained non-fluoridated silica. The cycling regimen comprised the following: three 2-min and one 4-min daily treatments with dentifrice slurries, rinsed with water and stored in fresh whole saliva at 37°C until the next experimental day, when specimens were activated in acid buffer solutions prior to each dentifrice treatment. This pH cycling continued for 21 consecutive days. Lesion depths and size were measured using a polarising microscope and enamel F uptake was determined using the acid-etch biopsy technique. The morphology of enamel surfaces was examined using scanning electron microscopy. The data were statistically analysed using Student's t-test, analysis of variance (ANOVA) and Pearson's correlation coefficient (r). Results: All tested fluoride dentifrices significantly enhanced remineralisation by reducing the lesion depths from 6.4 to 17.1 µm and lesion sizes by 10% to 34% relative to the pre-cycling measurements. Overall, the degree of remineralisation was as follows: NaF-silica-pyrophosphate dentifrices (1000 ppm F) averaged 41%; NaF/MFP-silica (1500/1000 ppm F) 38%; MFP/NaF-dicalcium phosphate (1000/450 ppm F) 30%; MFP dentifrices (1000 ppm F) ranged from 15 to 23%. Enamel F uptake by NaF and NaF/MFP was significantly greater than MFP dentifrices (P 0.05 to P 0.001), with the area under the depth curve being 2.4 and 2.2 times greater, respectively. At all enamel depths, fluoride dentifrices significantly increased F concentrations relative to the control (P 0.001). A strong correlation was found between ionic F levels in dentifrices and their efficacy. Dentifrices produced different enamel surface morphologies. Conclusions: The present study demonstrates that commercially available dentifrices vary in their degree of effectiveness and mode of action depending on formulations. Keywords: carious lesion, dentifrices, enamel, fluoride, fluoride uptake, pH cycling, remineralisation