Oral Health and Preventive Dentistry, 02/2010

Dental anxiety shares similar characteristics with many clinical anxiety disorders, and this is especially the case with other specific fears and phobias. These often debilitating conditions comprise several different dimensions, including cognitive, emotional, behavioural and physiological components. In addition, dental anxiety and fear are associated with a range of aversive health consequences. A number of indices have been developed to measure dental anxiety and fear, but their sheer number is indicative of a continuing problem with delineating the concept of dental fear and anxiety and how these should best be measured. This paper addresses the widespread confusion in the use of relevant terminology and aims to trace and assess the theoretical underpinnings of a selection of the most widely used self-report measures. It is concluded that the most popular measures of dental anxiety and fear lack adequate or sufficiently explained theoretical foundations. This is of concern given that these scales, by their very nature, serve to define the concept they aim to measure. Keywords: anxiety, assessment, dental fear, scale development

Purpose: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. Materials and Methods: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. Results: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. Conclusions: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers. Keywords: dental, education, students, tobacco use cessation

Purpose: The objective of the present study was to determine the association between oral disease, access to dental care and social class in a random sample of five-year-old preschool children in Belo Horizonte, Minas Gerais, Brazil. Materials and Methods: A cross-sectional study was carried out on a sample of 551 five-year-old children who were randomly selected from preschools. Oral health status was assessed using the decayed, missing or filled teeth (dmft) index as well as the presence of visible plaque, gingivitis and supragingival calculus. Oral examinations were performed by two examiners (j > 0.80). The clinical outcome variables were dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. Social class was assessed using the City Hall database. Results: Children without caries represented 63.9% of the sample. Mean overall dmft was calculated to be 1.56, and the decayed teeth component was the highest in all of the social classes. Missing teeth, caries with pulp involvement and dental root fragment had higher proportions and the filled teeth component had the lowest proportion in children from the lowest social class. Visible dental plaque was present in 45.4% of the children. Except for the filled teeth component, all of the clinical outcome variables had a significant association with social class status (P < 0.001), regardless of child's gender. Conclusions: Oral disease in the primary dentition and access to dental treatment are affected by social and cultural factors. Keywords: dental caries, oral health, preschool children, social class

Purpose: The aim of the present study was to assess the cross-cultural adaptation and reliability and validity of the Oral Aesthetic Subjective Impact Score (OASIS) for the perception of oral aesthetics in Brazilian adolescents. Materials and Methods: The cross-cultural adaptation was developed in agreement with internationally recommended methodology. The psychometric properties were assessed by application of the Brazilian version of the OASIS in 304 adolescents aged 13 to 19 years who were enrolled at two public schools and one private school in Tubarão, Brazil. The internal consistency of the instrument was measured using Cronbach's alpha. The reliability was estimated through stability and homogeneity, using the Intraclass Correlation Coefficient and the Bland-Altman agreement. Validity was determined by comparing the OASIS-Brazil with the aesthetic component of the instrument Oral Impact on Daily Performance (OIDP) using the Spearman Rank Correlation Coefficient. Results: The internal consistency obtained was 0.52. Inter-observer and intra-observer correlations were strong, 0.87 and 0.83, respectively. The correlation with the aesthetic part of OIDP was 0.44. Conclusions: The results showed that the process of cross-cultural adaptation was successful and the adapted instrument showed good psychometric properties. Keywords: aesthetics, cross-cultural adaptation, oral health, orthodontics, psychometric properties

Purpose: The objective of the present study was to emphasise the oral and dental findings of a male patient with the Maroteaux-Lamy syndrome who successfully underwent bone marrow transplantation (BMT) at the age of 22 months. Case Report: A 15-year-old boy was referred to the Dentistry Division of the Catholic University of Brasília, Brazil, for dental diagnosis. General characteristics of the Maroteaux-Lamy syndrome, such as a large head, a short neck, corneal opacity, an open mouth with macroglossia, enlargement of the skull and a long anteroposterior dimension, were observed. The patient had received the benefit of a BMT at an early stage. Therefore, characteristics were presented in a moderate form, except for the skeletal symptoms. Discussion: Maroteaux-Lamy syndrome, also known as mucopolysaccharidosis type VI, is a lysosomal storage disorder that is caused by a deficiency of arylsulphatase B, which leads to an accumulation of dermatan sulphate in tissues and its increased excretion in urine. The deposition of mucopolysaccharides leads to a progressive disorder involving multiple organs. It is a rare condition that is inherited as an autosomal recessive trait. The characteristic features of this disease include retardation in growth, a large head, a short neck, corneal opacity, typical facies and spinal abnormalities. The main dental findings of this syndrome include gingival hyperplasia, hypertrophy of the maxillary alveolar ridge, macroglossia, unerupted dentition, malocclusions and dentigerous cyst-like follicles. BMT is a therapeutic treatment that is given to permanently replace any disorder caused due to the deficiency of enzymes in patients with storage diseases. Keywords: Maroteaux-Lamy syndrome, mucopolysaccharidosis VI, orofacial features

Purpose: The aim of the present study was to assess the oral mucosal health status of young male adults (aged 18 to 24 years) in Switzerland and to correlate their clinical findings with self-reported risk factors such as tobacco use and alcohol consumption. Materials and Methods: Data on the oral health status of 615 Swiss Army recruits were collected using a standardised selfreported questionnaire, followed by an intraoral examination. Positive clinical findings were classified as (1) common conditions and anatomical variants, (2) reactive lesions, (3) benign tumour lesions and (4) premalignant lesions. The main locations of the oral mucosal findings were recorded on a topographical classification chart. Using correlational statistics, the findings were further associated with the known risk factors such as tobacco use and alcohol consumption. Results: A total of 468 findings were diagnosed in 327 (53.17%) of the 615 subjects. In total, 445 findings (95.09%) were classified as common conditions, anatomical variants and reactive soft-tissue lesions. In the group of reactive soft-tissue lesions, there was a significantly higher percentage of smokers (P < 0.001) and subjects with a combination of smoking and alcohol consumption (P < 0.001). Eight lesions were clinically diagnosed as oral leukoplakias associated with smokeless tobacco. The prevalence of precursor lesions in the population examined was over 1%. Conclusions: Among young male adults in Switzerland, a significant number of oral mucosal lesions can be identified, which strongly correlate with tobacco use. To improve primary and secondary prevention, young adults should therefore be informed more extensively about the negative effects of tobacco use on oral health. Keywords: alcohol consumption, epidemiology, oral lesions, oral mucosal alterations, tobacco use, young adults

Purpose: The objective of the present study was to determine the prevalence of xerostomia (dry mouth sensation) and hyposalivation in elderly type-2 diabetic individuals and to establish whether such conditions might be associated with their socioeconomic status and/or medical and oral health conditions. Materials and Methods: The present cross-sectional study included 315 functionally independent elderly individuals, aged 60 years or above, residing in Natal, northeastern Brazil. A total of 52 subjects self-reported to be diabetic. The data on the subjects' health condition were collected using a questionnaire, performing a physical examination and sialometry (unstimulated and stimulated whole saliva flow rates), and the variables were subjected to descriptive statistics, chi-square and Student t test (a = 0.05). Results: The prevalence of dry mouth was found to be 25%. Hyposalivation was found in 48% and 46% of the subjects in unstimulated and stimulated conditions, respectively. The only factor that was associated with xerostomia among the diabetics was workplace (P = 0.01), suggesting that elderly diabetics working at home might be less likely to have dry mouth than those working outside. No variable assessed was associated with hyposalivation, in either unstimulated or stimulated salivary flow. Conclusions: The prevalence of dry mouth and hyposalivation was high in elderly diabetics. Only at-home jobs were observed to be associated with dry mouth. There was no association between hyposalivation and the variables assessed, with regard to either unstimulated or stimulated saliva. Further studies, involving larger samples, are required to confirm the present findings. Keywords: elderly, diabetes mellitus, salivation, xerostomia

The present review summarises the effects of titanium tetrafluoride (TiF4) on the development and progression of carious and erosive lesions. The mode of action of TiF4 is due to the formation of an acid-stable surface layer, which provides mechanical protection to the surface, and to an increased fluoride uptake, which might chemically reduce demineralisation of dental hard tissues. Most in vitro studies showed that TiF4 is effective in reducing the formation of carious and erosive enamel and dentine lesions. Thereby, TiF4 was equally or more effective than sodium fluoride (NaF), amine fluoride (AmF) or stannous fluoride (SnF2). While clinical data confirm the caries-preventive effect, clinical trials analysing the anti-erosive effect of TiF4 are lacking. Few data available from in situ studies revealed conflicting results by showing either no effect or a beneficial effect of TiF4 on enamel erosion. Even though research focused on TiF4, there is also evidence to show that other metal fluorides, such as zirconium and hafnium tetrafluorides, affect enamel and dentine demineralisation. Conclusion: The potential of TiF4 to prevent acid demineralisation requires further research to confirm the promising in vitro results obtained by in situ studies and clinical trials. Keywords: caries, dentine, enamel, erosion, tetrafluoride

Purpose: The aim of the present study was to assess the relationship between dental caries and dietary patterns in Sri Lankan adolescents. Materials and Methods: The sample consisted of 1218, 15-year-olds who were selected from 48 schools in the Colombo district of Sri Lanka using a stratified cluster sampling technique. Data were collected by distributing questionnaires among both adolescents and their parents and by conducting an oral examination of all adolescents. A validated 13 foods/food groups food frequency questionnaire was used to obtain dietary information. Results: Factor analysis extracted three dietary patterns from the 13 foods/food groups, and these patterns accounted for 41.44% of variation in the dietary intake. They were labelled as sweet, healthy and affluent dietary patterns. From the multiple logistic regression analysis, the sweet dietary pattern, household income and oral hygiene status emerged as significant predictors of dental caries. Conclusions: It was concluded that dietary pattern labelled as sweet emerged as a significant predictor of dental caries. Keywords: adolescents, dental caries, dietary patterns

Purpose: Patients who have received irradiation therapy on the head and neck area are known to suffer from reduced saliva flow and may therefore use acidic candies to relieve symptoms of dry mouth. However, such acidic candies have erosive potential even among healthy individuals. Therefore, the aim of the present study was to determine if calciummodified acidic candies have reduced erosive potential in irradiated cancer patients. Materials and Methods: Nineteen cancer patients (26 to 70 years) ipsilaterally irradiated on the head and neck area sucked control and calcium-modified acidic candies, while their whole saliva was collected into a closed system. The erosive potential of both candies was evaluated from saliva degree of saturation with respect to hydroxyapatite and by dissolution of hydroxyapatite (HAp) directly in candy-stimulated saliva. The results were compared to normative data that were previously obtained on 20 healthy test persons (21 to 29 years). Results: No significant difference was obtained in the saliva flow rates between control and calcium-modified candy. However, the saliva became significantly less undersaturated with respect to HAp when sucking calcium-modified compared to control candy (P < 0.001) and more undersaturated for both candies in ipsilaterally irradiated cancer patients compared to normative data (P < 0.001). HAp dissolution was found to be significantly lower in patients sucking the modified candy compared to the control candy (P < 0.01) and, surprisingly, slightly lower in patients compared to normative data. Conclusions: Modified acidic candy with calcium has reduced erosive potential in patients irradiated on the head and neck area and could therefore be used as a favourable stimulant for relief of dry mouth. Keywords: dry mouth, erosive potential, food modification, irradiation treatment, saliva stimulation

Purpose: The objective of the present in situ study was to evaluate the influence of dental plaque on human enamel erosion. Materials and Methods: Thirteen volunteers wore acrylic palatal devices with four enamel specimens that were prepared from freshly extracted impacted human third permanent molars (4 x 4 mm), randomly selected and distributed into two vertical rows, corresponding to the following groups: GI, erosion of dental plaque-free samples, and GII, erosion of dental plaque-covered samples. For the formation of dental plaque, the specimens were placed 1 mm below the level of the appliance and covered with a plastic mesh to allow the accumulation of dental plaque. The palatal device was continuously worn by the volunteers for 14 consecutive days and then immersed in a soft drink (Coca-Cola, 150 ml) for 5 min, three times a day. Half of the surfaces of specimens were coated with nail varnish for profilometry tests. The study variables included the depth of enamel surface wear (profilometer, vertical ranges in lm) and the percentage of superficial microhardness change (%SMHC). Data were analysed using the t test (P < 0.05). Results: The %SMHC and depth of enamel surface wear were significantly higher for GI (-87.82% ± 3.66 and 4.70 lm ± 1.65) than for GII (-13.79% ± 4.22 and 0.14 lm ± 0.03). Conclusions: It was concluded that the dental plaque formed in situ was able to protect the enamel surface against erosion by a cola soft drink, thus reducing the depth of enamel surface wear and the %SMHC. Keywords: dental erosion, dental plaque, dental wear, enamel, soft drinks

Purpose: The aim of the present study was to evaluate the recommendations relating to the use of approximal cleaning aids given by dental hygienists and dentists, the self-care practices in a Swedish population and the ability to remove dental plaque. Materials and Methods: A structured questionnaire was randomly distributed to 500 dental hygienists and 500 dentists and a similar questionnaire was distributed to 1000 randomly selected individuals, divided equally into the following age groups: 15 to 20, 21 to 40, 41 to 60 and > 60 years. A clinical examination evaluating the ability to remove approximal dental plaque was also carried out in a total of 60 regular users of approximal cleaning aids. Plaque was scored before and after cleaning with a toothpick, dental floss or an interdental brush. Results: The response rate was 82%, 79% and 68% for the three groups. The results reveal that dental hygienists give more detailed information about a majority of the aspects that are related to the use of approximal cleaning aids compared with dentists (P < 0.01 or P < 0.001). The majority of the dental staff give recommendations to children and adolescents firstly to prevent dental caries and to older individuals to improve periodontal health. The use of different approximal cleaning aids on a daily basis varied with respect to age group (2% to 42%); dental floss dominated in the younger age groups and interdental brushes in the two oldest groups. In the clinical study, the largest plaque reduction was produced by the interdental brush (83%), followed by toothpicks (74%) and dental floss (73%). Conclusions: The present study indicated the importance of individual recommendations related to the use of approximal cleaning aids. Keywords: approximal caries, choice of products, interproximal cleaning aids, oral hygiene, questionnaire, self-care practices

Purpose: The objective of the present study was to determine if there existed any difference between the attitudes and behaviour apart from dental caries status among health professional and other professional college students and to investigate the association of oral health attitudes and behaviour with dental caries. Materials and Methods: The Hiroshima University-Dental Behaviour Inventory (HU-DBI) questionnaire was used to survey 1824 young student population of Udaipur, India. Dental caries status was evaluated using the World Health Organization caries diagnostic criteria for decayed, missing and filled teeth and surfaces (DMFT and DMFS, respectively). Results: There was a significant difference (P < 0.05) between the health professional and other professional college students for various components of DMFT and DMFS. Moreover, health professional students reported significantly higher HU-DBI scores (better oral health attitudes and behaviour) than their comparative group. Untreated dental caries played a major contribution to the total DMFT scores in both the groups, with 0.23 and 0.28 mean decayed teeth reported among health professional and other professional students, respectively. Decayed and missing teeth components exhibited a significant negative correlation with HU-DBI scores, whereas a positive correlation existed with the filled teeth component. Conclusions: A difference existed between the health professional and other professional students with regard to caries experience, oral health attitudes and behaviour. DMF indices and their components were related to most of the oral health attitudes and behaviours. Decayed and missing teeth components were negatively related while filled component was positively related to HU-DBI score. Keywords: caries status, health professional students, oral health attitudes, oral health behaviour