Oral Health and Preventive Dentistry, 03/2009

Purpose: The aim of this study was to evaluate decision making with regard to detection and treatment of carious lesions on occlusal tooth surfaces and to evaluate the possible costs related to the different treatment plans of a group of clinicians in private practice. Materials and Methods: Forty extracted permanent teeth with no fillings or macroscopic carious cavitations were selected and radiographed, using a standard method similar to bitewing and then mounted in two models. A sample of 130 clinicians in private practice in Piracicaba, Brazil were asked to carry out combined visual-radiographic caries examination of the occlusal surfaces and to recommend possible treatment plans for each surface. Teeth were sectioned bucco-lingually and caries was assessed using a stereomicroscope and classified as either enamel or dentine lesions. The costs of treatments suggested by each examiner were calculated, using a fee scale reported by the Brazilian Federal Council of Dentistry. Results: Most teeth (53.7%) that were found to be sound on histological examination were considered to have enamel lesions. In 85.7% of these cases, the clinicians recommended restorative treatments. There was about 14-fold difference among clinicians concerning the costs related to decision making. Conclusion: Not only did the clinicians overestimate the presence and depth of carious lesions, but they also tended to treat enamel lesions using invasive therapeutic procedures. Great disparities were observed with regard to treatment costs related to decision making. Assuming an in vivo situation, the clinicians may be performing overtreatments and consequently interfering in the quality of patients' oral health. Keywords: caries detection, health care costs, patient care planning

Purpose: The aim of the present study was to determine the prevalence of malocclusions and dental characteristics of schoolchildren aged between 10 and 12 years in the city of Fortaleza, Ceará in northeastern Brazil. Materials and Methods: Two hundred and sixty-four children (107 boys and 157 girls) were examined using the Angle classification system. The occlusal characteristics studied were the measurements for overbite, overjet, crowding and midline diastema. The children who were selected had not had prior orthodontic treatment and were born in Ceará, as were their parents and grandparents. Results: Of the schoolchildren who were studied, 25.8% had normal occlusion, 47.7% had Class I malocclusion, 22.3% had Class II malocclusion and 4.2% had Class III malocclusion. There was no statistically significant difference between age and gender; 30.3% of the individuals had a normal overbite and 36.7% and 19.7% had increased and reduced overbites, respectively. A normal overjet was found in 33.7% of the subjects and increased and reduced overjet was found in 50% and 3.4%, respectively. Dental crowding was observed in 62.5% and the presence of midline diastema was observed in 14.8% of the schoolchildren. Conclusions: The most prevalent occlusal status was Class I malocclusion, with no distinction between age and gender. Increased overbite and overjet were predominant. There was a high occurrence of dental crowding among the subjects in contrast to the few cases of midline diastema. Keywords: children, malocclusion, prevalence

Purpose: The aim of this study was to investigate the predictive value of the traditional multidimensional health locus of control (MHLC) scale, a corresponding dental health locus of control (DHLC) scale and dental health values (DHVs) regarding students' dental health before and after a video programme that presented information about dental diseases and instructions on oral hygiene. Materials and Methods: A group of 217 university students participated in this study. Before the video programme was presented, assessments were made of MHLC, DHLC and DHVs. Plaque and gingival indices were obtained in a clinical examination conducted before (plaque index [PLI] 1 and gingival index [GI] 1) and 10 weeks after (PLI 2 and GI 2) the presentation of the programme. Results: The percentage of tooth surfaces exhibiting plaque and of sites involving gingivitis decreased and was statistically significant between baseline and re-examination for both males and females. The females exhibited statistically significant better PLI 1 and GI 1 values and stronger DHVs than males. Also, better GI 1 values were found to be statistically significant and related to stronger DHVs for females. A stronger trust in the dental health personnel regarding the dental health was related to more gingivitis at the initial examination (GI 1). For males, stronger internal DHLC was related to more plaque at the final examination (PLI 2). Conclusion: The only psychological scales that showed some relationship to the measures of dental health were DHLC and DHVs. Gender was the strongest related variable to dental health. Keywords: dental health locus of control, dental health values, oral health

Purpose: The aim of this study was to assess the orthodontic treatment complexity and need in Nigerian adolescents as well as to ascertain the relationship between these professionally assessed facets of orthodontic provision and the oral health-related quality of life in the adolescents. Materials and Methods: The orthodontic treatment complexity and need in 274 adolescents who were drawn from four secondary schools in Ibadan, Nigeria aged 12 to 17 years (142 (51.8%) females and 132 (48.2%) males) were examined using the index of complexity, outcome and need. The oral health-related impacts of the same subjects were assessed using the shortened version of the oral health impacts profile. In addition to the descriptive statistics, the Pearson chi-square test was used in the analysis of data. Results: Cases that were considered to belong to the easy complexity grade accounted for 20.1% while difficult/very difficult complexity grades accounted for 9.8%. Boys had significantly fewer complexity grades that were in the easy grade (P < 0.05). Of the subjects, 42% would need orthodontic treatment and 62.4% had some oral health-related impacts, with boys suffering significantly more impacts than girls. The relationship between oral health-related impacts and treatment need was significant (P < 0.05) unlike with complexity (P > 0.05). Conclusions: The orthodontic treatment complexity and need in these Nigerian adolescents was comparable to Caucasians including the association with oral health-related impacts on daily activities. Keywords: Nigerian adolescents, oral health-related quality of life, orthodontic treatment complexity and need

Purpose: The objective of the present study was to evaluate the behaviour of the wearers of removable dentures in relation to cleaning and maintaining the prosthesis. Materials and Methods: Two hundred and thirty-one people were interviewed, most of whom were females, over 60 years of age and participants in the Center for Integrated Study and Support to the Elderly. Results: After analysing the responses, it was verified that most people brush their dentures three times a day using dentifrice and only go to the clinician when they have a complaint. They do not receive follow-up appointments for checkups, do not use immersion cleaners for their dentures and do not remove their dentures during the night. Conclusions: It was concluded that the study sample did not receive proper orientation for the conservation of removable dentures, which may consequently reduce the useful life of dentures and cause social and functional problems. Keywords: cleanness, maintenance, removable dentures

Purpose: The aim of the present study was to investigate whether resilience, hope, perceived oral health status and oral health-related behaviours were associated. Materials and Methods: The study sample consisted of 198 first-year medical students in Romania. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, resilience and hope. Results: Women had more resilience and 'personal competence' than men (P < 0.05). Resilience and hope were correlated with perceived dental health (P < 0.01). Perceived dental health was related to current non-treated caries, satisfaction with the appearance of one's own teeth, toothache last time and resilience (P < 0.001). Age, gender, current extracted teeth, perceived gingival bleeding and hope were not independent distinguishing variables after adjustment for internal heterogeneity. When oral health behaviours (toothbrushing, flossing, mouthrinse frequency and pattern of dental visit) were evaluated, it was demonstrated that flossing frequency was correlated with resilience and hope (P < 0.01). Conclusions: The results suggested that resilience and hope might be a psychosocial risk marker that influences perceived oral health status and behaviours. Keywords: hope, oral health behaviour, perceived oral health status, resilience

Purpose: The aim of the present study was to evaluate the effect of providing outreach oral health care services on the oral health status and oral health-related quality of life to institutionalised elders in Hong Kong. Materials and Methods: At baseline, 232 Chinese adults aged 65 to 80 years living in 14 elderly homes participated in a free oral health examination and completed a validated Chinese version of general oral health assessment index (GOHAI) in a face-to-face interview. Afterwards, free dental treatments, including extractions, scaling and fillings, were offered to the subjects every year according to their needs. On the third year, the subjects were examined and interviewed again at least 6 months after the last treatment. Results: A total of 144 elders (62.1%) were examined and interviewed at the time of evaluation. Their oral health status had improved greatly compared with that found at baseline. They had fewer decayed teeth (1.3 versus 2.0, P < 0.001), and a lower proportion of the dentate subjects had periodontal pockets (60.9% versus 28.9%, P < 0.001). However, no significant change in their mean GOHAI score between baseline and the time of evaluation was detected. Despite this, a higher proportion of the elders were satisfied with their own oral health at the time of evaluation compared with baseline (66.2% versus 75.7%, P = 0.047). Conclusions: The provision of outreach oral health care services can lead to an improvement in both the assessed and the perceived oral health status of institutionalised elders. Keywords: Chinese, dental care, elders, oral health-related quality of life

Purpose: Maintaining a high level of periodontal and oral health in patients undergoing renal dialysis is of paramount importance because of the inherent compromised host defence mechanisms. The aim of the present study was to determine the periodontal status and the level of dental caries in renal dialysis patients in Kerman, Iran. Materials and Methods: A cross-sectional study was conducted on two groups of patients: one including 68 renal dialysis patients (test) and the other including 30 healthy subjects (control). Half-mouth measurements of Gingival Index (GI), Plaque Index (PI), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL) and bleeding on probing (BOP) as well as decayed, missing or filled teeth (DMFT) index were recorded. Results: The GI, BOP, PPD, CAL and GR were significantly greater among the test group as compared with the control group; however, the DMFT did not differ significantly among the groups. There was no relationship between the duration of the dialysis and the periodontal indices. Conclusions: It seems that patients with chronic renal failure have less favourable periodontal health than normal patients. The present study showed that oral home care practices were inadequate. Thus, preventive programmes to promote the oral health status of haemodialysis patients are needed. Keywords: dental, gingivitis, haemodialysis, periodontal, renal

Purpose: The aim of the present study was to investigate perceived oral health in patients with Crohn's disease (CD) in comparison with a control group without CD. Materials and Methods: The study population comprised 1943 patients with CD recruited from the Swedish National Patients Organisation of inflammatory bowel disease and 1000 randomly selected controls. All participants received a questionnaire with questions concerning socioeconomic variables, education, civil status, income, dental care habits, oral health and tobacco use. Results: Eighty-eight per cent of the patients and 75% of the controls answered the questionnaire. Patients with CD perceived their oral health to be worse than controls. The odds ratio (OR) for the patients to estimate their oral health as much worse than others in the same age group was 9.7 (95% CI, 5.8 to 16.4) after adjustment for age, smoking habit, gender and education. The patients also reported a significantly greater need for dental treatment than the controls, with an OR of 5.7 (95% CI, 4.2 to 7.9) after taking into account the age, smoking habit, gender and education. Furthermore, the patients with CD reported significantly more mouth-related problems than controls (OR 3.2), such as significantly more caries and more gingival bleeding. Of note, there were significantly more smokers in the patient group. Conclusions: The results of the present study show that patients with CD perceived their oral health to be worse and have a greater need for dental treatment compared with the control group. Keywords: Crohn's disease, oral health, questionnaire

Purpose: The aim of this study was to compare the ability of the bristles of newly developed toothbrushes in removing artificial plaque deposits from the interproximal areas of a jaw model. Materials and Methods: Four toothbrushes were evaluated in this study: A, two differences in level patterns, combination of flat and extremely high-tapered filaments; B, one difference in level pattern, combination of flat and extremely high-tapered filaments; C, rippled pattern and high-tapered filaments; and D, rippled pattern and tapered filaments. The brushing simulator was adjusted to provide a horizontal brushing stroke of 20 mm at a rate of 190 strokes per minute for a duration of 1 min. A 200-g force was applied to the brush head. A plaque-like substrate was placed in the facial and the interproximal sides of the artificial teeth that had the cross-sectional dimensions of mesial face in the maxillary right first molar and distal face in the second premolar. The results were photographed, and the area of penetration and the cleaning effectiveness were calculated for each picture by computer digital image analysis. This test was repeated five times for the toothbrush for each design that was evaluated. The resulting data were analysed using ANOVA and the Scheffe test. Results: The rate of plaque removal was the highest with toothbrush A that gave a significantly greater removal of the artificial plaque than the other three toothbrushes on the maxillary right first molar mesial surface (P < 0.05). Conclusion: These results suggest that toothbrush A was more effective in plaque removal in this in vitro model used for determining the interproximal penetration of the four bristle designs. Keywords: interproximal cleaning, jaw model, manual toothbrush

Purpose: The aim of this study was (1) to determine the fluoride content in the meals served to children aged up to 36 months in daycare centres of two municipalities with different levels of fluoride in the water supply, (2) to calculate the mean fluoride ingested daily by the children when consuming those meals and (3) to analyse the contribution of this consumption to the development of dental fluorosis. Materials and Methods: Samples of the meals served to the children were collected during a whole week. The fluoride content of the samples of solid foods and milk was analysed using an ion-specific electrode combined with reference electrode after diffusion facilitated by hexamethyldisiloxane. Samples of beverages were buffered with an equal volume of total ionic strength adjustment buffer and analysed using a combined electrode. The results were compared using the Mann-Whitney test. Results: Mean fluoride contents of the meals were of 0.204 ± 0.179 and 0.322 ± 0.242 lg F/mL (P < 0.05), respectively, in the municipalities with low and adequate fluoride content. Daily fluoride intake in the former was 0.013 ± 0.003 mg/kg body weight/day and in the latter was 0.012 ± 0.001 mg/kg body weight/day (P > 0.05). Conclusions: The children were not exposed to dental fluorosis in the daycare centres. However, the risk cannot be ignored, considering the meals and the use of fluoridated dentifrices at home may also contribute to fluoride intake. Keywords: fluoride, fluorosis, oral health

Purpose: The aim of this survey was to evaluate the knowledge and attitudes of Iranian elementary school teachers with regard to emergency management of dental trauma, in a northwestern urban area. Materials and Methods: A total of 160 teachers from 40 schools, all selected randomly, were included in the study. A three-part self-administered questionnaire surveying teachers' background, knowledge of the growth patterns of children's dentition, general dental trauma, fractured and avulsed teeth, as well as attitudes regarding dental trauma was used. Chi-square analysis was performed to examine the effect of educational background, gender, length of service and topics they teach on their knowledge and attitudes on the management of dental trauma. Results: A majority of the participants had received tertiary education. Regarding the management of tooth fracture, 52.4% provided appropriate answers. A similar proportion (50.6%) realised that they should replant a permanent avulsed tooth. However, they had little knowledge on the correct procedures; less than a fifth were acquainted with the urgent need for action. Only 38% knew about appropriate washing mediums and about a third were familiar with proper storage media. Health teachers and those with higher educational background (16 years of education) were significantly more knowledgeable regarding the disciplines of avulsion management. Teachers with a high level of experience (third decade) were also more knowledgeable in terms of prevalence of dental trauma accidents. Conclusions: The current survey indicated a substantial lack of knowledge regarding dental trauma management among elementary school teachers. Educational campaigns to improve their knowledge and awareness seem crucial for this group of adults who are usually the first to respond in cases of dental trauma accidents in schools. Keywords: attitude, dental trauma, elementary school teachers, knowledge