Oral Health and Preventive Dentistry, 04/2009

Purpose: The aim of the present crossover study was to evaluate professional toothbrushing as a method for diagnosing gingivitis in children. Materials and Methods: Thirty-four preschool children who had gingival bleeding >= 10% and without proximal restorations/carious lesions were included in the study. Examinations comprised two gingival indices recorded at a 15-min interval, in the following sequences: the Ainamo and Bay gingival bleeding index (GBI1) followed by the brushing index (BI2) and vice versa (BI1-GBI2). Half of the children started the study in the first sequence and the other half in the second. After a 3- to 4-day washout period, the indices were again recorded with individuals changing the sequences. Data analysis considered GBI as the gold standard, and sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were also calculated. Results: The overall mean value of gingival bleeding at the first examination was 18.85 ± 9.24%. Validation of toothbrushing performed after GBI (BI2) resulted in values for SE, SP, PPV and NPV of 0.59 (95% CI, 0.55 to 0.63), 0.92 (95% CI, 0.91 to 0.93), 0.64 (95% CI, 0.60 to 0.69) and 0.90 (95% CI, 0.89 to 0.92), respectively. BI performed before GBI (BI1) resulted in similar SE, SP, PPV and NPV. Percentage agreement of GBI1-BI2 and BI1-GBI2 was 83.5% and 85.9%, respectively. Conclusions: Professional toothbrushing can be suggested as a method for the diagnosis of gingival inflammatory status in children, especially as an indicator of gingival health. Keywords: children, diagnosis, gingivitis, periodontal index, primary dentition

Purpose: The aim of the present study was to evaluate the possible interaction between the type of secondary school attended, oral clinical data and self-perceived oral health (SPOH) behaviour among Italian adolescents. Materials and Methods: A total of 913 adolescents living in Milan (Italy), attending two different types of secondary schools, grammar and technical secondary schools, were examined regarding dental caries and gingival conditions. Oral health behaviour data were collected using an anonymous questionnaire. The presence of caries was recorded using the decayed missed filled tooth (DMFT) index, gingival conditions with community periodontal index (CPI) following World Health Organization recommendations. Stepwise logistic regression was applied to determine whether the type of school attended was associated with the clinical outcome variables and subjects' SPOH and with oral health or lifestyle behaviour. Results: The prevalence of caries was 59.8% (95% CI = 41.3 to 76.8); a third of participants showed a CPI = 0, whereas 34.9% had bleeding at probing and 37.9% had calculus. Caries distribution was significantly related to the type of school attended in each score of the DMFT categorisation (P < 0.01). Experience of tooth discomfort was claimed by 23.6% of subjects from grammar schools and 35.3% from technical schools (P < 0.01). In males, CPI >= 1 was associated with the type of school, OR = 1.6 (95% CI = 1.1 to 2.5), the highest DMFT score and experience of self-perceived tooth discomfort, OR = 1.6 (95% CI = 1.2 to 2.0) and OR = 1.2 (95% CI = 1.4 to 2.6), respectively. In females, only CPI >= 1 and highest DMFT score were associated with the type of school, OR = 2.1 (95% CI = 1.3 to 3.3) and OR = 1.6 (95% CI = 1.2 to 2.0), respectively. Conclusions: The type of school is a sensitive indicator of oral health status among adolescents. Keywords: adolescents, cross-sectional studies, epidemiology, oral health, socioeconomic status

Purpose: The objective of the present study was to assess the persistence of non-nutritive sucking habits and its relationship with breastfeeding, as well as to establish the influence of sociodemographic factors on these habits among children aged 3 to 5 years. Materials and Methods: A case-control study was conducted with 1107 children from public and private daycare centres in Natal, Brazil: 450 in the case group (312 pacifier suckers and 138 thumb suckers) and 657 in the control group (habitfree). Data regarding sociodemographic conditions and duration of breastfeeding were obtained using a structured questionnaire. Results: Breastfeeding for a duration of > 6 months (adjusted odds ratio = 0.311; 95% confidence interval = 0.226 to 0.428) was an independent protective factor against persistent pacifier sucking. The use of pacifiers was more frequent among 3-year-old children and among those from a higher income family and a higher level of schooling of parents. The relation between duration of breastfeeding and thumb sucking was not statistically significant (P = 0.087). There was an association between the thumb sucking habit with sex (female), low level of schooling of father and the child being born as the last male child in the birth order. No relation was found between breastfeeding and habit frequency (day/night and night) (P = 0.301). An association with habit frequency was found with the age of 3 years, female, the family income group that ranged between US $176 and US $875, and those attending private institutions. Conclusions: Breastfeeding for a duration of > 6 months was a protective factor against the persistence of pacifier sucking, but the subjectivity of the mother-child relationship must be investigated further. Keywords: bottle-feeding, breastfeeding, sucking habits

Purpose: The aim of this study was to examine the perceived barriers to preventive dental practice among Iranian dentists. Materials and Methods: A questionnaire survey was performed among the dentists who participated in two annual dental meetings (conducted in December 2004 and in July 2005) in Tehran, Iran. The dentists who attended the meeting completed the self-administered questionnaire anonymously. The questionnaire included 12 statements with answer alternatives rated on a 5-point scale to which the dentists were asked to indicate how much each of the 12 items, later classified as three barriers (practice-, dentist- and patient-related), impedes them from practising preventive care. The sum of the scores of the four items in each barrier served as an indicator of each dentist's perception of the strength of each barrier. The background data included dentists' personal and professional characteristics. In total, 1033 dentists completed the questionnaire, of whom 980 (64% men) were eligible. Statistical evaluation was performed using analysis of variance, t test and Pearson's correlation coefficient. Results: Of the respondents, 29% to 66% rated the items of the practice-related barrier as very strong impediments. Corresponding figures for the dentist- and the patient-related barriers were 20% to 54% and 70% to 77%, respectively. The highest mean of the score sum was for the patient-related barrier (11.9) and the lowest mean was for the dentistrelated barrier (7.9). For both practice- and dentist-related barriers, male dentists reported significantly higher scores than the female dentists (P < 0.001). Conclusions: The perceived barriers to the provision of preventive care should be meticulously explored and tackled to enhance oral health in Iran. Keywords: barriers against prevention, dental education, practice factors, preventive dental care

Purpose: The objective of the present study was to evaluate surface roughness and adherence of Candida albicans and to determine the effectiveness of denture cleansers in the disinfection of silicone-based soft lining materials. Materials and Methods: Two types of silicone-based soft lining materials (four room temperature polymerised soft lining materials [RTPSLM]: Ufi Gel P, Ufi Gel C, Mollosil and Soft-Liner; and two high temperature polymerised soft lining materials [HTPSLM]: Moloplast B and Luci Soft) and seven denture cleansers (Efferdent, Polident, Steradent, Corega, Denclen, Klorhex and Axion) were tested in the present study. For each soft lining material, 56 samples (10 mm x 10 mm x 3 mm) were prepared. Surface roughness measurements were made using a profilometer with an optical scanner probe. All samples were ultrasonically cleaned in water for 15 s, autoclave sterilised and contaminated with C. albicans solutions for adherence assay evaluation. After the evaluation, the samples were immersed in seven different denture cleansers. The results were expressed as the ratio of cells remaining after each cleanser in comparison with the control group. Results: HTPSLM showed a lower surface roughness value (2.21 ± 0.30 lm) than RTPSLM (2.39 ± 0.40 lm), but these differences were not statistically significant (P > 0.05). Also, HTPSLM showed lower adhesion of C. albicans (mean ranks 136.35) than RTPSLM (mean ranks 138.64), but the differences were not statistically significant (P > 0.05, one- or two-way analysis of variance). In the C. albicans removal test, all denture cleansers showed a strong effect on both silicone-based soft lining materials. HTPSLM showed lower removal activity (mean ranks 30.01) than RTPSLM (mean ranks 25.86), but these differences were not statistically significant (P > 0.05). Although there were no significant differences between disinfectants on both silicone-based soft lining materials, Axion was found to be the most effective disinfectant. Corega, Polident, Denclen, Steradent and Efferdent showed the most effective cleansing, respectively. Conclusions: RTPSLM and HTPSLM did not show significant differences in the surface roughness value; also they showed no significant differences in the adhesion rate of C. albicans. All tested silicone-based soft lining materials showed adherence of C. albicans after contamination procedures, and removal activity for C. albicans was observed in all tested silicone-based soft lining materials after disinfection procedures. Keywords: C. albicans, disinfections, silicone-based soft lining materials, surface roughness

Purpose: The aim of the present study was to identify the concerns and the influence of demographic factors on the social, psychological and health concerns of people living with HIV/AIDS (PLWHA) in a Nigerian population. Materials and Methods: A questionnaire survey was conducted among 141 consenting PLWHA in the Ife-Ijesa zone, Osun State, Nigeria. A 22-item questionnaire elicited information on PLWHA's concerns about social, psychological and health issues. Results: The main social concern was that of 'Feeling very lonely', whereas the major psychological concern was that of 'Lack of interest in things'. The most common health concern reported was 'Gradually getting thinner', whereas 'No cure for AIDS' was the least. 'Getting tired easily' was also a highly rated concern. Males had statistically significant fewer social concerns than females. Unemployed PLWHA had fewer social, health and psychological concerns when compared with the employed. There was a statistically significant relationship between age and health concerns (P < 0.05). Conclusions: PLWHA in the present study reported that they were concerned about social, psychological and health issues, despite the fact that they were attending support group meetings. Efforts on care should not only focus on health and medical issues but also on social and psychological issues. Keywords: HIV/AIDS, social, psychological and health factors

Purpose: The objective of the present study was to determine oral health knowledge, attitude and practice among National Cadet Corps (NCC) Navy Cadets and their correlation with oral hygiene in South India. Materials and Methods: A questionnaire study was conducted among 412 high school students who were voluntary participants of an NCC unit in South India. Knowledge, attitude and practice scores were calculated, and then were correlated with Simplified Oral Hygiene Index (OHI-S) values. Spearman's correlation test was used to measure the correlation. The significance value was set at P < 0.05. Statistical analysis was performed using the Statistical Package for Social Sciences software for Windows, version 13. Results: NCC Cadets' knowledge about gum diseases and the use of fluoride-containing dentifrice was found to be low, dental visits were infrequent and the consumption of sweets was found to be high. There was no correlation between knowledge and attitude scores with that of OHI-S, but a significant correlation was seen between practice and OHI-S scores. Conclusions: Most of the cadets did not have knowledge about the causes and the prevention of dental diseases. A significant number of participants sought further information, hence it can be said that the cadets had a positive attitude towards oral health. There was no correlation seen between knowledge and attitude scores with that of OHI-S measured, but a significant correlation was noted between practice and OHI-S scores. Keywords: attitude, correlation, NCC Cadet, India, oral health knowledge, oral hygiene

Purpose: The aim of the present study was to assess the periodontal condition and smoking status, according to dose and duration information, and to estimate the percentage of subjects with periodontitis attributable to cigarette smoking in a representative adult rural population in southern Brazil. Materials and Methods: Bivariate statistical analysis was used to evaluate the association of smoking status with periodontitis in a cross-sectional study comprising 165 dentate individuals, aged 35 to 66 years, subjected to oral clinical examination of six sites per tooth in all sextants. Results: The prevalence of periodontitis (having >= 1 pocket of >= 4 mm around the index teeth) in the population was 35.2%. Overall, 13.9% had a cumulative loss of attachment > 4 mm; 35.7% of subjects were current smokers, classified as heavy (average 25.3 pack years), moderate (average 14.6 pack years) and light smokers (average 3.1 pack years). Statistical analysis showed that current smokers had an 11 times (95% confidence interval [CI] = 4.69 to 26.62) and former smokers had a nine times (95% CI = 3.29 to 25.96) greater probability of having established periodontitis compared with non-smokers. The number of pack years (P = 0.0004) and years of smoking exposure (P = 0.0013) were associated with an increased prevalence of periodontitis. The number of current smokers with periodontitis might be reduced by 80%, had they not smoked cigarettes. Of the subjects with periodontitis, 64% could be prevented among current smokers by eliminating tobacco consumption. Conclusions: Cigarette smoking was strongly associated with periodontitis, and there was a relationship with dose and duration of smoking. These findings contributed to the evidence of smoking as a risk factor for periodontal disease and support the importance of dose-response analysis on determining the strength of this association. Keywords: periodontal diseases, primary prevention, risk factors, smoking

Purpose: The aim of the present study was to report the radiographical prevalence of overhanging fillings in a group of Swiss Army recruits in 2006 and to relate the dimensions of the overhangs to clinical parameters. Materials and Methods: A total of 626 Swiss Army recruits were examined for their periodontal conditions, prevalence of caries, and stomatological and functional aspects of the masticatory system and halitosis. In particular, the present report deals with the presence or the absence of fillings, the presence or the absence of overhangs and their relation to clinical and radiographic parameters. Results: A total of 16,198 interdental sites were evaluated on bitewing radiographs. Of these sites, 15,516 (95.8%) were sound and 682 (4.2%) were filled. Amalgam restorations were found in 94.1% and resin composite fillings in 5.9% of the sites. Of these 682 sites, 96 (14.1%) yielded overhanging margins of various sizes. This low prevalence of fillings represents not only a substantial reduction when compared with a similar Swiss Army study (Lang et al, 1988), but also an improvement in the quality of dental care delivery to young Swiss males. Plaque Index and Gingival Index increased statistically significantly with the presence of fillings, when compared with healthy non-filled sites. Clinical parameters that were significantly associated with the presence of overhangs included clinical attachment loss. Moreover, between 1985 and 2006 the prevalence of fillings was significantly reduced from 20.0% to 4.2% of all surfaces. Furthermore, the marginal fit of the fillings improved from 33.0% with overhangs to 14.1%. Conclusions: A significant improvement was observed in the periodontal and dental conditions of young Swiss males that was shown to have taken place within the previous two decades. From 1985 to 2006, the prevalence of fillings was reduced fourfold and that of overhanging margins twofold, documenting an improvement in the quality of restorative dentistry. Keywords: army recruits, oral health, overhanging margins, periodontal health, prevention, radiographs, survey

Purpose: The aim of the present study was to test the effects of interdental cleansing with dental floss on supragingival biofilm removal in natural dentition during a 3-week period of experimental biofilm accumulation. Materials and Methods: The present study was performed as a single-blind, parallel, randomised, controlled clinical trial using the experimental gingivitis model (Löe et al, 1965). Thirty-two students were recruited and assigned to one of the following experimental or control groups: Group A used a fluoride-containing dentifrice (NaF dentifrice) on a toothbrush for 60 s twice a day, Group B used an unwaxed dental floss twice a day, Group C used a waxed dental floss twice a day in every interproximal space and Group D rinsed twice a day for 60 s with drinking water (control). Results: During 21 days of abolished oral hygiene, the groups developed various amounts of plaque and gingivitis. Neither of the cleansing protocols alone allowed the prevention of gingivitis development. Toothbrushing alone yielded better outcomes than did any of the flossing protocols. Interdental cleansing with a waxed floss had better biofilm removal effects than with unwaxed floss. Conclusions: Toothbrushing without interdental cleansing using dental floss and interdental cleansing alone cannot prevent the development of gingivitis. Keywords: biofilm, clinical study, experimental gingivitis, inflammation, interdental cleansing, oral hygiene, plaque control

Purpose: The aim of the present qualitative study was to analyse patients' attitudes towards oral health and experiences of periodontal treatment. Materials and Methods: Patients who were referred to a specialist clinic in periodontics were subjected to open-ended interviews before (Abrahamsson et al, 2008), as well as after, the phase of cause-related periodontal therapy. An interview guide was used with themes of interest. The time interval between the interviews was about 6 months. Because the study focused on psychosocial interactions, the qualitative method used for the analysis was Grounded Theory (Glaser and Strauss, 1967). Data collection and analysis were simultaneous processes that focus on psychosocial processes, existing problems and how these problems were dealt with. The interviews were tape-recorded and transcribed verbatim, and consequently analysed in a hierarchical coding process until saturation was met (n = 16). Results: In the analysis, a core category was identified: 'Understanding the seriousness of the disease condition'. This core concept was related to four additional categories and dimensions: 'The need to be treated respectfully', 'To gain insight', 'Frustration about the financial cost for treatment' and 'Feelings of control over the situation'. Taken together, the core category and its related subcategories described a psychosocial process that was related to periodontal treatment. Conclusions: The results elucidated the patients' vulnerability and the importance of patient communication in the treatment for chronic periodontitis in order for the patient to feel in control of the situation. Keywords: chronic periodontitis, grounded theory, interviews, oral health

Purpose: The objective of the present study was to assess the prevalence of untreated caries in a Brazilian paediatric acquired immunodeficiency syndrome (AIDS) patient population and its association with sociodemographic, behavioural and clinical characteristics. Materials and Methods: The study group was comprised of 125 HIV-infected patients (aged 3 to 15 years) who had already manifested AIDS and were assisted in a specialised health care unit. Dental examinations followed the World Health Organization's guidelines for oral health surveys. Family caregivers provided information about the socioeconomic standing and the behaviour of their children. Patients' medical records in the hospital provided information on the clinical status of patients. A Poisson regression analysis was used for assessing the covariates for the prevalence of untreated dental caries, as adjusted by age. Results: The prevalence of untreated caries was 58%; a higher prevalence was found in younger children with primary and mixed dentition. The prevalence of untreated caries associated significantly with lower socioeconomic status (household crowding and schooling of the caregiver), dietary habits (higher frequency of sugar consumption) and poorer clinical status (HIV viral load and symptom severity). Conclusions: The high burden of untreated caries on paediatric AIDS patients reinforced the importance of integrating the clinician with the interdisciplinary health care team that assisted these children. The identification of socioeconomic and behavioural factors associated with caries experience reinforced the importance of the attention that children with AIDS received within their own households for the prevention of dental disease, particularly a proper nutritional advisement and monitoring of dental hygiene. Keywords: AIDS, children, dental care, dental caries