Oral Health and Preventive Dentistry, 02/2011

Purpose: To determine the perceptions/beliefs and related practices of child healthcare workers regarding teething problems in Ile-Ife, Nigeria. Materials and Methods: This cross-sectional study consisted of 103 out of 140 child healthcare workers at the Obafemi Awolowo University Teaching Hospitals Complex who responded to a structured self-administered questionnaire. The child healthcare workers comprised dentists, paediatricians, community health physicians, pharmacists and community health nurses. The data were analysed using STATA (Intercooled release 9) for Windows. Results: A total of 77 (74.8%) child healthcare workers believed in systemic signs and symptoms of teething in children. A majority of the dentists (79.3%) and pharmacists (96.2%) believed in teething problems. None of them based their belief on evidence-based scientific principles, but instead on personal experience (36.4%), books (26%), local myths (20.8%) and school/workshop (16.8%). Fever (18.2%) and diarrhoea (15.6%) were the most prevalent symptoms and signs believed to be associated with teething. Fifty-seven of the child healthcare workers routinely prescribed various drugs for teething problems. The most prescribed drugs were paracetamol (70.2%), antibiotics (14.0%) and teething mixture (7.0%). Conclusions: Most child healthcare workers in the study believed in teething problems and the beliefs were not based on evidence. They also prescribed various drugs for teething problems. Keywords: tooth eruption

Purpose: The study was conducted to evaluate the relationship between the Dental Aesthetic Index (DAI) and Index of Orthodontic Treatment Need (IOTN) with subjective perceptions of dental aesthetics, function, speech and orthodontic treatment need. Methods: This is an observational cross-sectional study. The children were assessed using the DAI and IOTN. A questionnaire pertaining to dental aesthetics and function was recorded. Results and conclusions: The aesthetic components of the indices correlated well with aesthetic perceptions of patients, whereas functional components did not have a significant correlation with functional perceptions. The two indices could be used consistently in the present population. Keywords: Dental Aesthetic Index, Index of Orthodontic Treatment Need, subjective questionnaire

Purpose: To assess any clustering between obesity, dental health, and lifestyle factors (dietary patterns, physical activity, smoking, and alcohol consumption) among adolescents. Material and Methods: A cluster sample of 15-year-old Danish adolescents (DA) from eight municipalities was selected. Self-reported questionnaires for adolescents and their mothers to assess body-mass index (BMI), socioeconomic and lifestyle factors, and clinical examinations to examine adolescents' dental status (DMFT) were used. Descriptive statistics, chi-square tests, and factor analysis were applied. Results: The mean DMFT was 2.03 and mean BMI was 21.30 among DA.Of the whole sample, 62% experienced caries (DMFT > 0) and 16% were classified as obese. No association appeared between obesity and DMFT (p > 0.05). Most adolescents were likely to have breakfast every day (76%), but their daily consumption of fruit was lower (38%). More than half of adolescents reported having physical exercise (66%) and no alcohol consumption (57%). Smokers were more likely to consume alcohol (80%) but less likely to exercise (44%) than nonsmokers (alcohol consumption, 55%; exercise, 68%), (P 0.05). Principal component analysis revealed that DMFT and obesity were interrelated in DA. Conclusion: In line with earlier studies, obesity and dental caries share common lifestyle factors among adolescents, regardless of nationality and different health-care systems. Thus, it seems that dental health is a global health concern. There is a need for collaboration between dental and general health-care providers to manage both obesity and dental caries in adolescents by using a holistic approach. Keywords: obesity, dental caries, lifestyle, adolescents

Objective: The aim of the study was to test the hypothesis that all Australians based on clinical need have equal access to health services for the removal of impacted teeth as hospital in-patients. Methods: Data for the current analysis were obtained from the Western Australian Hospital Morbidity Data System (HMDS) for the six financial years 1999/00 to 2004/05. All cases of in-hospital treatment for impacted teeth were analysed and then correlated with socioeconomic status, geographic location of the patients, place of primary residence, and age. Results: In-patient extraction rates are significantly higher in the 10- to 19-year-old and the 20- to 29-year-old age groups when compared to the other age groups. A young adult from a higher socioeconomic group is 4 times more likely to have an impacted tooth removed in a hospital than his or her counterpart from a lower socioeconomic group, which is significant. Similarly, people living in highly accessible metropolitan areas have a 3 times greater chance of being hospitalised for this procedure than those from the remote and rural areas. Conclusion: There are significant differences among different groups based on socioeconomic status and access to health services for in-hospital removal of impacted teeth, thus rejecting the hypothesis. This raises doubts over the nature of the procedure, considering that most patients are young, non-Indigenous, and live in metropolitan areas. This implies that some of the procedures seem to be elective and there is a need for introduction of guidelines in Australia for removal of impacted teeth, which could reduce expenditures significantly. However, further research is required in this area. Keywords: impaction, Indigenous, non-Indigenous

Purpose: The objectives of this study were 1) to compare the efficacy of biofilm removal with conventional (Bitufo 22) and triple-headed (DenTrust) toothbrushes on smooth and occlusal surfaces, and 2) to verify the influence of the person who performs the toothbrushing (mother vs dentist). Materials and Methods: Twenty children aged 4 years old with sound, complete primary dentition participated in this crossover study. The quantity of biofilm was evaluated using the bacterial plaque revealer Plaque Test (Vivadent) before and after toothbrushing by the mother or dentist for 1 minute per arch. This was done at two separate appointments, one week apart, with one type of toothbrush at the first and the other type at the second appointment. The Green & Vermillion index (1960) was used for smooth surfaces and Rodrigues et al (1999) indexes for the occlusal surfaces. Data were submitted to analysis of variance. Results: A statistically significant difference was observed on biofilm removal on occlusal and smooth surfaces, regardless of the toothbrush used or who performed the brushing (P 0.0001). The triple-headed toothbrush showed a better performance than the conventional one on smooth and occlusal surfaces when the mother had brushed the teeth. The conventional toothbrush showed a better performance only on occlusal surfaces when the dentist performed the brushing (P 0.0001). The dentist removed significantly more biofilm than the mother, 76% and 53%, respectively (P 0.0001). Conclusion: It was concluded that effective biofilm removal was achieved with both toothbrushes; however, the tripleheaded type had a better performance on surfaces when the mother brushed the teeth. The dentist removed more biofilm than the mother. Keywords: toothbrushes, effectiveness, oral hygiene, dental plaque, preschool children

Purpose: Dentine hypersensitivity is one of the most frequently recorded complaints of dental discomfort. Current evidence implicates patent dentinal tubules in hypersensitive dentine, and it follows that one effective way to reduce dentine sensitivity is to occlude the dentinal tubules. The purpose of this study was to compare the efficacy of two different desensitising agents, Cervitec varnish and Gluma varnish. Materials and Methods: Two hundred fifty patients self-reporting dentine hypersensitivity completed the paired split mouth randomised, subject-blind study. Each participant had a minimum of two sensitive teeth in at least two different quadrants and displaying a response of >=3 cm to an evaporative stimulus. The hypersensitivity levels were measured with a tactile stimulus (scratchometer), thermal stimulus (cold water test), and an evaporative stimulus (air blast test) using a visual analogue scale. The teeth were evaluated immediately after treatment, and at 4 and 12 weeks after application of the chlorhexidine-containing varnish Cervitec and the glutaraldehyde-containing varnish, Gluma Desensitizer. Results: Statistical analysis indicated that both the desensitising varnishes were effective in alleviating dentine hypersensitivity at all time intervals compared to baseline. There was a highly statistically significantly greater reduction in dentine hypersensitivity to evaporative stimulus, cold stimulus, and tactile stimulus after application of Cervitec than after Gluma Desensitizer (P 0.001). Conclusion: Both the varnishes have a therapeutic potential to alleviate dentine hypersensitivity at all time intervals compared to baseline. However, Cervitec varnish is more efficacious in reducing dentine hypersensitivity than Gluma varnish at both 4 weeks and 12 weeks post-treatment. Keywords: dentine hypersensitivity, Cervitec varnish, Gluma varnish, visual analogue scale, scratchometer, thermal test

In addition to regular professional oral hygiene visits and the application of appropriate preventive medications, successful preventive strategies involve oral health promotion, patient education and patient compliance. The Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) complex has been shown to remineralise tooth surfaces in situ when delivered in oral care products. This complex has a unique ability to deliver bio-available calcium and phosphate when they are needed most. The effectiveness of casein derivatives, specifically CCP-ACP, in caries prevention and lesion reversal has been supported by many controlled clinical studies. This review summarises the research on Casein phosphopeptide-amorphous calcium phosphate complex and provides information related to its benefit in dentistry. Further research is required to provide a scientifically supported recommendation for other clinical applications. Keywords: amorphous calcium phosphate, casein phosphopeptide, remineralisation, review

Purpose: The purpose of this single-blind randomised controlled clinical trial was to verify the impact of progressive toothbrush age on clinical variables of dental plaque and gingival conditions. Materials and Methods: A total of 110 undergraduates were randomly assigned to one of four groups according to toothbrush age, as measured at 4, 8, 12, and 16 weeks. Clinical parameters (plaque and gingival indices) were assessed at 1 week (initial) and final periods. The wear of toothbrushes was evaluated by the wear index. Results: Despite progressive toothbrush age, plaque and gingival indices were similar after the toothbrushing periods (p > 0.05, ANOVA). Significantly more plaque and gingivitis were present on lingual/palatal surfaces as compared with facial surfaces for all weeks, including the baseline (P 0.001, paired t test.). The wear index increased from 4 weeks to 16 weeks. Plaque and gingival indices did not show statistical differences among 'lowest wear', 'moderate wear' and 'highest wear' (P > 0.05, ANOVA). Conclusion: Under the experimental conditions of this study, progressive toothbrush age did not lead to a decrease in plaque control. It was concluded that toothbrush age may not be critical in ensuring optimal plaque control. Keywords: dental plaque, gingivitis, oral hygiene, plaque control, toothbrush

Purpose: To compare the removal of dental biofilm with soft and medium filament toothbrushes. Materials and Methods: Twenty-five patients refrained from performing mechanical or chemical plaque control for 96 hours prior to the experiment in order to allow dental biofilm accumulation on the tooth surfaces. After the period of dental biofilm accumulation, quadrants were randomised and participants brushed different quadrants with soft and medium toothbrushes, with or without dentifrice. After plaque disclosure, the Quigley-Hein (Turesky) plaque index was assessed by a blinded examiner before and after toothbrushing. In addition, photographs before and after brushing were taken for evaluation of gingival abrasion. Results: The results revealed that medium toothbrushes removed high amounts of dental biofilm compared to soft toothbrushes (P 0.05). Considering gingival abrasion, intergroup analysis demonstrated a statistically significant difference on the cervical regions, with a higher proportion of abrasions in the medium toothbrush group (P 0.01). Conclusion: Medium toothbrushes have a greater ability to remove biofilm and cause gingival abrasion than do soft toothbrushes. Keywords: toothbrushing, dental plaque, gingival recession

Purpose: Periodontal diseases have a multifactorial etiology and their risk factors are influenced by modifiable and nonmodifiable factors. The information on periodontal disease and associated risk factors in the Vietnamese population is sparse. Vietnamese dental patients are specific groups with high dental needs and often have greater overall oral health problems. Thus, the purpose of this study was to examine the relationships of periodontal disease to sociodemographic, health-behavioural, and biological characteristics in Vietnamese dental patients. Materials and Methods: A sample of 243 subjects was selected from the National Hospital of Odonto-Stomatology in Hochiminh City. The sociodemographic and health-behavioural characteristics were investigated by a questionnaire. Oral examination including dental and periodontal conditions was conducted. Bacterial load in tongue coating and hemoglobin in saliva were assessed using the BANA test and Perioscreen test. Results: The Perioscreen test showed moderate sensitivity (0.752) and specificity (0.746) to periodontal disease. The binary logistic regression analyses indicated that older subjects (OR = 2.5), or those who did not frequently visit a dentist (OR = 4.1), brushed their teeth only once a day (OR = 2.5), did not use dental floss (OR = 2.9), were past smokers (OR = 3.1), current smokers (OR = 4.1), or had positive BANA test results (OR = 12.0) were more likely to have periodontal disease. Conclusion: The results revealed the periodontal disease was related to age, dental visit behaviour, smoking behaviour, frequency of tooth brushing, use of dental floss, bacterial load in the tongue coating, and hemoglobin in saliva. Keywords: smoking, bacteria, hemoglobin, periodontal disease, Vietnam

Objectives: To evaluate the association of salivary calcium level with periodontal status in a case-control study model. Materials and Methods: Fifty adult non-smoking subjects recruited from an Indian dental educational institution were categorised into case and control groups on the basis of a full-mouth periodontal examination. The case group was comprised of 25 subjects diagnosed with chronic generalised periodontitis and the control group included 25 periodontally healthy individuals. Basic demographic data was obtained and 3 ml of unstimulated saliva was collected. Salivary calcium levels were assayed by the ion selective electrode method. Results: The mean age for cases (46.6 ± 6.9 years) was significantly higher than that for controls (42.4 ± 6.3 years). The mean number of teeth for the case group (28 ± 3) was significantly lower than that for the control group (31 ± 1). The mean salivary calcium level in the case group (2.11 ± 0.24 mmol/L) was significantly higher than in the control group (1.86 ± 0.25 mmol/L) when ANCOVA for age adjustment was applied. Conclusions: Periodontal disease is associated with higher salivary calcium levels than that in periodontal health, indicating that the calcium level of saliva could possibly be a risk factor for development of periodontal diseases. Keywords: chronic periodontitis, periodontal disease, salivary calcium