Oral Health and Preventive Dentistry, 01/2016

Purpose: To assess the practice of self-medication for oral health problems in Uttar Pradesh, India. Materials and Methods: This multiregional cross-sectional questionnaire-based study was conducted in four towns; Moradabad, Meerut, Ghaziabad and Bareilly over a 2-month period on 352 subjects. The questionnaire consisted of a demographic profile, questions related to problems of oral health for self-medication, substances used, source of the substance, duration, reason and source of advice for self-medication. The data were analysed using the chi-square test with significance set at p 0.05. Results: The prevalence of self-medication was 72%. The source of substances in most of the cases was a pharmacy shop (62.5%). The most frequent self-medicated oral health problem was toothache (55.6%), followed by other problems, and the most frequently used substance was analgesics (59%). 49.8% self-medicated due to lack of money for consulting a doctor and 45% of the population received advice from the pharmacist for self-medication. Conclusion: The majority of those surveyed practiced self-medication using an array of drugs, e.g. analgesics, native herbs, antibiotics, etc, either alone or in combination. The main reason identified for self-medication was motivation from relatives and friends. Keywords: dental problems, self-medication, Uttar Pradesh

Purpose: To determine Portuguese dentists' role in addressing obesity. Materials and Methods: For this pilot study, the original version of the Dentists' Role In Addressing Obesity questionnaire was translated from English into Portuguese and validated to ensure that it was culturally adapted for Portuguese dentists. The questionnaire was distributed to a random sample of 400 Portuguese dentists. SPSS Statistics 20 was used to analyse the survey sampling design and assess respondents' attitudes and opinions, outcome expectations and self-efficacy both as ordinal and dichotomised variables. The analysis was a descriptive statistic based on frequencies, without symmetry test. Results: In all, 141 dentists responded. Overall, 22.0% of respondents offered a form of counseling services and 58.9% reported that they were interested in offering obesity-related services. A paucity of trained personnel (58.9%) was cited by the respondents as a major barrier, followed by patients' rejection of weight-loss advice (32.6%) and fears of offending patients (29.1%). 92% of respondents agreed that dentists would be more willing to intervene if obesity were linked to oral disease. Conclusion: Healthcare providers must coordinate prevention and interventional efforts for maximum effect. Given the positioning of dentists willing to assist in such an effort, it appears reasonable for experts in obesity intervention in conjunction with dental educators to develop intervention models to be implemented within the scope of the dental practice. Keywords: obesity, questionnaire, survey, translation, validation

Purpose: To assess the behaviour of the elderly with regard to hygiene procedures for and maintenance of removable dentures. Materials and Methods: 243 elderly people were interviewed using a semi-structured questionnaire, which was applied in the coverage area of Family Health Strategy in Urlandia district in the city of Santa Maria, Brazil. Results: The majority of those interviewed were 60 to 69 years old, with a prevalence of women and incomplete primary school education. In general, the dentures had been worn for more than 10 years and 43.7% of them had been made by a dental prosthetic technician. More than half the study population had not received instructions on hygiene and maintenance of the dentures. Conclusion: This population was not aware of the importance of hygiene and maintenance of the removable dentures. It is worrying that a considerable number of elderly have sought dental prosthetic care from technicians who were not trained to promote and maintain health. Keywords: denture, elderly, hygiene

Purpose: To compare the social impact of malocclusion on quality of life between adult patients with Angle Class I, II and III malocclusion. Materials and Methods: A total of 222 adult patients (139, 42 and 41 with Angle Class I, II and III malocclusion, respectively) were recruited voluntarily from those attending the Orthodontic Clinic of Khyber College of Dentistry in Pesh awar, Pakistan. Participants were asked to complete the Urdu version of the short form of the Oral Health Impact Profile (OHIP-14), which was previously validated for this study. Multivariate analysis of variance (MANOVA) was used to compare the seven OHIP-14 domains scores and the total score between patients with malocclusion Class I, II and III. Results: Adults with Class III malocclusion had a significantly higher OHIP-14 total score than those with Class I malocclusion (a mean difference of 5 units between groups), but there were no differences between other Angle malocclusion groups. In addition, adults with Class III malocclusion reported greater impacts on the three OHIP-14 disability domains (physical, psychological and social) than those with Class I malocclusion. No significant interactions with sex and age were found. Conclusion: These findings suggest that adult patients with Class III malocclusion had a poorer quality of life than those with Class I malocclusion. Differences were mainly found in the physical, psychological and social disability domains of the OHIP-14 instrument. Keywords: adults, malocclusion, quality of life

Purpose: To determine whether family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over a 13-year period in a city in southern Brazil. Materials and Methods: A comparison of two household surveys was carried out where mothers of the family were interviewed using a structured questionnaire in order to obtain demographic, behavioural and socioeconomic information. In total, 852 and 984 households were included in 1996 and 2009, respectively. Self-reported use of dental floss was assessed dichotomously (yes/no). Poisson regression models were fitted to study the association between sociodemographic variables with the use of dental floss. Proportion ratios (PR) and 95% confidence intervals (95% CI) were reported. Results: The proportion of dental floss use increased from 48% to 59% over 13 years. The probability of dental floss use increased 1.23 times from 1996 to 2009 (PR = 1.23; 95% CI 1.13-1.34). Households with mothers ≥50 years old presented a 28% lower probability of using dental floss than households with mothers ≤35 years old. In households with higher family income and higher educational level of the mother, probabilities of flossing were 90% and 97% higher. Conclusion: Family income, age and educational level of the mother of the family are associated with self-reported use of dental floss over 13 years. Keywords: dental floss, oral hygiene, risk factor

Purpose: To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants. Materials and Methods: A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients. Results: Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic. Conclusion: The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia. Keywords: clinical practice, oral infections, pregnancy, questionnaire

Purpose: To evaluate the oral health of children who were beneficiaries of a promotion and preventive programme for more than 6 years and to estimate the factors relating to their oral condition. Materials and Methods: In this case-control study, the total population comprised all 7- to 13-year-old children who attended the Paediatric Dentistry Centre of Reference Simón Bolívar (CROSB), a programme for students of the community of Viña del Mar, Chile. The case group was treated from the age of 7 to 13 years and controls were only seen at the age of 13 (had not been previously enrolled in the programme). The compilation of data was carried out through examination of clinical records. Statistical analysis included Fisher's Exact Test, the chi-square and Mantel-Haenszel tests to determine odds ratios, log-linear models to study some types of relationships between the different qualitative variables and Mood's Median Test for quantitative variables. Finally, a logit-type generalised linear model (GLM) was adjusted to estimate the probability of a caries-free child according to the different variables under study. Results: The main finding is that this programme does not successfully control the local risk factors of caries. The factors that jointly explain the presence of caries-free children were: non-participation in the programme, attending public school and the presence of sealed teeth. Conclusion: Even though the evaluated programme creates equity in the indicators of oral health among its beneficiaries, it does not reach the levels of oral health of the non-vulnerable population. It is recommended that this programme seek more effective tools. Keywords: children, oral health, preventive dentistry, programme evaluation

Purpose: The aims of this study were to: 1) determine the oral health status of Campanian (Italy) 5- and 12-year-old schoolchildren; 2) establish an oral health baseline prior to introducing promotion and prevention strategies and appropriate healthcare for specific groups; 3) provide the starting point for monitoring changes over time according to the World Health Organization 2020 global goals for oral health. Materials and Methods: A cross-sectional observational study was performed on schoolchildren from public schools. 828 children were clinically evaluated, recording DMFT, dmft and SiC (Significant Caries Index). A questionnaire investigating demographic and oral health behaviour was completed by parents. Results: 56.6% of the 5-year-old children were caries free (deciduous dentition) and the mean dmft value was 1.44 ± 2.13. In 12-year-old children, caries prevalence was 35.8%. The mean DMFT value was 1.17 ± 1.96, while the SiC was 3.42 ± 1.97. There were significant relationships between dmft/DMFT (caries experience) and family income level (p 0.001), mother's educational level (p 0.001) and history of recent dental visits (p 0.01). Conclusion: Information drawn from this study can be helpful to describe future and specific dental prevention programmes in order to reduce caries incidence and promote better oral health in the Campania region of Italy. Keywords: caries prevalence, oral health, sociobehavioural factors

Purpose: To evaluate the psychological impact and effect on academic performance of untreated gross dental malocclusion in adolescents. Materials and Methods: A total of 366 (181 girls and 185 boys) adolescents with gross dental malocclusion were selected for the study group. A modified oral aesthetic subjective impact scale questionnaire was applied in face-to-face interviews. Similar data were collected from parents, schoolteachers and one friend of each adolescent selected for the study. Academic performance was evaluated from school records and compared with a control group of 400 adolescents (200 girls and 200 boys) having normal occlusion and an aesthetically pleasing facial appearance. The Kruskal-Wallis H and chi-square tests were used to analyse the data. The correlation between the academic performance of adolescents and the psychological impact of malocclusion was assessed using the Spearman rank correlation. Results: Significant numbers of adolescents (81.1%) were concerned about the appearance of their teeth, with significant gender variation (0.02). 88.5% of the adolescents received comments from others about their appearance. The results differed significantly by gender for 'avoiding smiling' (p = 0.02) and 'participation in social activities' (p = 0.02). The evaluation of academic performance showed that 42.1% of the adolescents with gross dental malocclusion performed below average; this also differed statistically significantly by gender (p = 0.04). Conclusion: Untreated gross dental malocclusion significantly affects the psychosocial well-being of adolescents, who may avoid participating in social activities and tend to underperform in school. Keywords: adolescents, malocclusion, psychological impact

Purpose: Because the relationship between childhood obesity and periodontal diseases has rarely been studied, this study investigated the potential association between obesity and periodontitis among Chinese school-age children and its underlying mechanisms. Materials and Methods: The periodontal status of normal and obese Chinese children was examined and the expression of several inflammatory factors was compared between the normal and obese group. The periodontal status, including the sulcus bleeding index (SBI), plaque index (PI), bleeding on probing percentage (BOP%) and probing depth (PD) of normal and obese children was recorded. A correlation analysis between obesity degree and periodontitis was performed. The plasma levels of tumor necrosis factor-α (TNF-α) and soluble intercellular adhesion molecule-1 (sICAM-1) in gingival crevicular fluid (GCF) samples were examined using ELISA. Results: No obvious correlation was observed between obesity and the four clinical periodontal indices SBI, PI, SBI and BOP% was observed, which is in contrast to the contribution of obesity to periodontitis in adults. However, the concentration of serum TNF-α was significantly elevated in the obese group (219.91 ± 24.57 pg/ml, n = 30) when compared with the normal group (169.31 ± 23.62 pg/ml, n = 23) (t = 2.844, p 0.05), indicating that obesity still reinforces the inflammation responses in the periodontium. Conclusion: Among the Chinese school-age children, obesity leads to the accumulation of TNF-α in the gingival crevicular fluid, which occurs much earlier than and may contribute to the development of periodontitis associated with obesity. Keywords: children, obesity, periodontitis, TNF-α

Purpose: To investigate the association between sociobehavioural variables and the pattern and severity of early childhood caries in Brazilian infants and toddlers ages 0-3 years. Materials and Methods: This was a cross-sectional study with 768 children who attended 58 public nursery schools. Five previously calibrated teams (Kappa = 0.842) performed oral examinations, using the decayed, missing, filled teeth (dmft) index according to the WHO methodology. A pretested, self-administered questionnaire was given to the subjects' parents or guardians to obtain sociobehavioural information. Results: Caries was observed in 134 of the 768 (17%) children. Caries and rampant caries were significantly more prevalent in low-income families (p = 0.0121) and the incidence of caries was associated with access to dental services (p 0.05). The percentages of children who were caries free in the age groups of 0-11 months, 12-23 months, 24-35 months and 36-47 months were 100%, 96%, 88% and 76%, respectively. Conclusion: Programmes for prevention and oral health education should be instituted, preferably during the first year of life, especially for those in the most socioeconomically deprived groups. Keywords: dental caries, epidemiology, primary dentition

Purpose: To evaluate the caries prevalence and experience in primary molars in Polish 6- to 7-year-old children using the Caries Assessment Spectrum and Treatment index. Materials and Methods: This cross-sectional study was carried out on a sample of 332 out of 468 invited children (140 6- and 192 7-year-olds). Cluster sampling was used to select the participating schools. Dental status was evaluated according to the criteria dedicated to CAST. The means of the individual CAST scores were assessed. Data were statistically analysed using the Mann-Whitney U-test (p 0.05). The percentage of children according to the highest CAST score was calculated. The mean values of the dmft index, based on three different caries thresholds - CAST codes 3 to 7 (d3-7t), 4 to 7 (d4-7t) and 5 to 7 (d5-7t) - were calculated. Results: The response rate was 70.9%. One-fifth of the participants showed a healthy, functional dentition (CAST codes 0-2). The highest percentage of children had at least one carious tooth with pulpal involvement (26.2%), followed by children having an obvious dentin caries lesion (20.8%). The means for CAST codes 3, 4 and 5 were 0.61 ± 1.0, 0.19 ± 0.53 and 1.23 ± 1.61, respectively. The means of molars with pulpal involvement was 0.83 ± 1.32 and with dental sepsis 0.07 ± 0.33. Apart from filled teeth, no age-dependent differences were observed. The d3-7mft, d4-7mft and d5-7mft were as follows: 5.18, 4.61 and 4.41, respectively. Conclusion: The surveyed Polish children showed high caries prevalence and severe caries experience in the primary molars. The CAST index was a useful tool for the epidemiological analysis of primary molars. Keywords: CAST, children, dental caries, epidemiology, primary molars