Oral Health and Preventive Dentistry, 04/2010

Purpose: The PRECEDE-PROCEED (P-P) model is a framework for designing health education/promotion programmes. While the P-P model has been used to design community-based oral health programmes, outcome assessments of the model are seldom reported. The aim of the present study was to explore whether pathways in the P-P model accurately reflect the current status of environmental/behavioural assessment in a Japanese community and to examine whether using the linear structural relations (LISREL) programme would improve the model. Materials and Methods: In a community health centre in Japan, a questionnaire with 29 items regarding oral health was distributed to 824 mothers with 3-year-old children. The items were compiled into eight variables that were tested using the LISREL programme. Goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI) and root mean square error of approximation (RMSEA) were statistically analysed before and after P-P model modification. Results: The GFI, AGFI and RMSEA were 0.913, 0.776 and 0.161 before, and 0.975, 0.939 and 0.075 after P-P model modification, respectively. Indirect effects on the quality of life from the predisposing, reinforcing and enabling factors became stronger than those in the initial P-P model. The overall fit of the modified P-P model was significantly better than that of the P-P model without modification, which did not accurately reflect the status of environmental/behavioural assessment in the community. Conclusions: The modified P-P model reflected the current status of environmental/behavioural assessment in the community. Health education models should be tested rigorously to ensure that they fit the reality of people's behaviour. Keywords: oral health promotion, LISREL analysis, PRECEDE-PROCEED model

Purpose: The objective of the present study was to explore the moderating effects of sleep disturbance, fatigue and vitality on self-reported oral-health status and oral-health related behaviours. Measurements and Results: The present study sample consisted of 213 first-year dental students at the University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania. The questionnaire included information about sociodemographic factors, behavioural variables and self-reported oral-health status. Subjective Vitality Scale, Fatigue Assessment Scale and Karolinska Sleep Questionnaire were used to assess quality of sleep, vitality and fatigue. The duration of sleep in 41.2% of students was < 7 h per night. It was revealed that 11.7% of the students experienced daily disturbed sleep, 20.4% had daily premature awakening and 50.5% presented frequent difficulties awakening. Significant differences were found among disturbed sleep, impaired awakening, vitality and fatigue scales according to several variables: perceived dental health, satisfaction by appearance of own teeth, self-reported gingival condition, mouth rinse frequency and reason for the dental visit, while multiple linear regression analyses revealed that vitality and impaired awakening were independent determinants of self-rated oral and gingival health status. Disturbed sleep index, impaired awakening, fatigue and vitality were positively associated with oral-health related behaviours. Conclusions: The authors concluded that the disturbed sleep index, impaired awakening, fatigue and vitality were associated with oral-health status and behaviour. Keywords: fatigue, flossing, mouth rinse, oral health, sleep disturbance, toothbrushing, vitality

Purpose: The aim of the present study was to assess the prevalence, distribution and sociodemographic factors associated with tooth wear among Sri Lankan adolescents. Materials and Methods: A total of 1200 17-year-olds were selected from government, private and international schools in the Colombo district of Sri Lanka using a two-stage cluster sampling technique. The data were collected using a pretested, validated self-administered questionnaire and by conducting a clinical examination. Tooth wear was recorded using a modified version of Smith and Knight's tooth wear index. Results: The prevalence of tooth wear among Sri Lankan adolescents was found to be 22.4%. In nearly 13.7%, tooth wear was confined to the enamel, whereas 8.7% had wear lesions extending up to the dentine. Occlusal surface was the most frequently affected surface, while the first molar was the most frequently affected tooth. Tooth wear was significantly associated with the type of school attended, father's occupational status and mother's level of education. Conclusions: The present study found that nearly one-fourth of the adolescents were affected by tooth wear. These findings are in agreement with those from developed countries where tooth wear has been shown to be an emerging oral health problem. Keywords: adolescents, prevalence, tooth wear

Purpose: The aim of the present study was to determine the prevalence of malocclusion among schoolgirls and to assess malocclusion using the Index of Orthodontic Treatment Need (IOTN). Materials and Methods: A total of 350 subjects were selected by a multistage randomised cluster sampling method. All of the selected subjects were schoolgirls aged 14 to 17 years. Malocclusion was determined using the IOTN. A chi-square test was performed to evaluate the data obtained. Results: The present study reported that 16.3% of subjects had no treatment need, 35.7% had a mild treatment need, 35.4% had a moderate treatment need and a further 5.2% to 7.4% had a severe to extreme treatment need, respectively. Therefore, the prevalence of malocclusion was found to be 83.7% among Tehranian schoolgirls of age 14 to 17 years. Conclusions: The prevalence of malocclusion is very high among Tehranian schoolgirls; therefore, greater care is required to reduce this prevalence. Keywords: epidemiology, IOTN, malocclusion, orthodontics, prevalence, Tehran

Purpose: Nowadays, gloves are worn routinely by most general dental practitioners while treating patients, with latex being the most commonly used glove material worldwide. The aim of the present study was to determine the prevalence of allergy to latex gloves among dental professionals of Udaipur, Rajasthan, India. Materials and Methods: In this cross-sectional study, a total of 163 dental professionals (73% males and 27% females) were surveyed using a pre-tested self-administered questionnaire. The questionnaire was comprised of a total of 12 items and gave information about the participants and their glove use, namely demographic profile, working habits and glove use, signs and symptoms related to glove use, any other type of allergy, as well as precautions taken to minimise it. The statistical analysis was performed using chi-square and Fisher's exact tests to compare frequency and percentage. The level of significance was set at P u 0.05. Results: A total of 26 (16%) dental professionals reported allergy to latex gloves, of which females (27.3%) reported significantly greater allergy than males (11.8%) (P = 0.016). The number of years of glove use was significantly associated with allergy to latex gloves (P = 0.000). The prevalence of allergy to latex gloves was significantly greater for those who had allergy to pollen grains, foodstuffs and rubber dam, those who had asthma or history of eczema and those with family history of allergy. However, allergy to latex gloves was independent of age, type of gloves used, hours of use per day as well as number of patients seen per day. Conclusions: The present study showed a high rate of allergy to latex gloves among dental professionals in Udaipur, Rajasthan, India. Keywords: dental professionals, glove use, allergy to latex gloves

Purpose: Scientific evidence supports the application of caries-preventive agents in children and adolescents, and this knowledge must be applied to the practice of dentistry. There are few multi-region data that allow for comparisons of practice patterns between types of dental practices and geographical regions. The objective of the present study was to characterise the use of specific caries-preventive agents for paediatric patients in a large multi-region sample of practising clinicians. Methods: The present study surveyed clinicians from the Dental Practice-based Research Network who perform restorative dentistry in their practices. The survey consisted of a questionnaire that presented a range of questions about caries risk assessment and the use of preventive techniques in children aged 6 to 18 years. Results: Dental sealants (69%) or in-office fluoride (82%) were the most commonly used caries-preventive agents of the cariespreventive regimens. The recommendation of at-homecaries-preventive agents ranged from36%to7%,with themost commonly usedagent being non-prescription fluoriderinse. Clinicianswho practised in a large grouppracticemodel andclinicianswho come from the Scandinavian region use caries risk assessment more frequently compared to clinicians who come from regions that had, predominantly, clinicians in private practice. Whether or not clinicians used caries risk assessment with their paediatric patients was poorly correlated with the likelihood of actually using caries-preventive treatments on patients. Conclusions: Although clinicians reported the use of some form of in-office caries-preventive agent, there was considerable variabilityacross practices. These differences could represent a lack of consensus across practising clinicians about thebenefits of caries-preventive agents, or a function of differing financial incentives, or patient poolswith differing levels of overall caries risk. Keywords: caries, chewing gum, chlorhexidine, dental sealant, fluoride

Purpose: The aim of the present study was to analyse the association between socioeconomic and behavioural factors and the presence of active non-cavitated caries lesions in 12-year-old adolescents in Piracicaba, São Paulo, Brazil. Materials and Methods: A cross-sectional study was carried out in 1001, 12-year-old adolescents who were selected by the cluster sampling method. A modified version of the World Health Organization criteria for identifying lesions including white lesions (WL) in enamel was used. Information on behavioural and socioeconomic factors was obtained using a semi-structured questionnaire. The outcome variables were DMFS, DMFS+WL and WL. The data obtained were analysed using the chi-square test and a logistic regression model. Results: The mean DMFS was 1.87 (SD = 3.05) and DMFS+WL was 2.27 (SD = 3.66). The logistic regression model showed that income was statistically significantly associated with DMFS, DMFS+WL and WL, whereas educational level of the father, number of residents in the house and number of dental visits were associated with DMFS and DMFS+WL. The onset of toothbrushing was associated with WL. Conclusions: The present study showed that economic factors are associated with all stages of caries development. In addition to these factors, family size, number of dental visits, educational level of the father and onset of toothbrushing could be considered markers of dental health risk. Keywords: behaviour, non-cavitated caries, oral epidemiology, socioeconomic conditions

Purpose: The aim of the present study was to assess and compare the antibacterial effect of garlic extract with those of chlorhexidine and negative control mouthwashes against Streptococcus mutans. Materials and Methods: The present study was carried out in two phases. In Phase 1, the zone of inhibition of various concentrations of garlic extract against S. mutans was determined using the cup and plate method. The minimum concentration at which a zone of inhibition appeared was further employed to prepare a mouthwash that was used in Phase 2. This phase included 45 dental students whose baseline salivary S. mutans level was assessed. They were randomly divided into three groups: '1' representing students using garlic extract mouthwash (garlic extract + water + sorbitol + spearmint oil), '2' representing those using chlorhexidine (0.2%) mouthwash and '3' representing those using a negative control (water + sorbitol + spearmint oil). All of the subjects were advised to use 10 ml of the assigned mouthwash once daily after their last meal for a duration of 7 days. On day 8, the post-treatment salivary S. mutans counts were assessed, and the data were analysed and compared by performing appropriate statistical tests. Results: Phase 1: the 3% concentration was the minimum concentration at which a zone of inhibition was observed. Phase 2: a reduction in post-test S. mutans counts in all three groups was found. The mean difference that was observed in the garlic extract group was 5.23 x 10⁵ CFU/ml, in the chlorhexidine group 2.63 x 10⁵ CFU/ml and in the negative control group 1.18 x 10⁵ CFU/ml. The differences among all three groups were statistically significant (P < 0.05) and that between the negative control and the garlic group was highly significant (P < 0.001). Conclusions: Garlic extract is effective against S. mutans when tested both in vitro and in vivo. As S. mutans is one of the primary aetiological organisms in dental caries development (Loesche, 1986), and in the present study garlic extract has been shown to be effective against S. mutans, garlic extract mouth rinse might be used as an effective remedy in the prevention of dental caries. Keywords: chlorhexidine mouthwash, garlic mouthwash, Streptococcus mutans

Purpose: The aim of the present study was to evaluate the clinical efficacy of an experimental dentifrice (CH) containing an antimicrobial agent (1% chloramine-T). Materials and Methods: A clinical, fully randomised, double-blind comparative study was designed for 30 selected patients aged 15 to 50 years, with no periodontal disease, decay or other oral diseases, good general health and the presence of dental plaque and sulcus bleeding. Baseline Turesky modified plaque index (PI) and sulcus bleeding index (SBI) were scored for all patients. Volunteers randomly received the experimental dentifrice (CH) or a commercial-brand dentifrice containing triclosan (TR). Both dentifrices were provided in identical, number-labelled tubes, and the subjects were instructed to use the supplied dentifrice only for their usual oral hygiene, three times a day for a duration of 7 days. After 7-day use of dentifrices, the PI and SBI were assessed again. The data obtained were subjected to the Kruskal- Wallis test, followed by Dunn's post hoc test. Results: After 7-day use of dentifrices, the PI scores diminished significantly for both evaluated dentifrices. The SBI values decreased significantly for both experimental and commercial-brand dentifrices. Conclusions: Both dentifrices reduced PI and SBI. By comparing the experimental and gold-standard dentifrice, it was found that there was no statistically significant difference between the PI and SBI scores after their use, suggesting that they exerted a similar effect on the oral health indexes. Keywords: clinical trial, dentifrices, development of formulations, oral health

Purpose: The aim of the present pilot study was to investigate the microbial profile in saliva and supragingival plaque samples collected from caries-active adolescents before and after a daily short-term intake of milk supplemented with the probiotic bacteria. Materials and Methods: The present study group consisted of 18 caries-active adolescents of both sexes who volunteered for participation giving an informed consent. The study has a randomised placebo-controlled double-blind pilot design with two parallel arms. After a 2-week run-in period, the subjects were instructed to drink 2.5 dl of milk supplemented with Lactobacillus rhamnosus LB21 (10⁷ CFU/ml) (test) or standard control milk (placebo) once daily for a period of 2 weeks (intervention period). Samples of stimulated whole saliva and supragingival plaque were collected at baseline (after run-in) and immediately after the end of the intervention period (follow-up). The salivary levels of mutans streptococci and lactobacilli were estimated by conventional culturing on selective agar plates. The presence and level of 19 oral species associated with the caries process were determined using the checkerboard DNA-DNA hybridisation technique. Differences between the groups were assessed using the non-parametric Wilcoxon-Mann-Whitney and chi-square tests. Results: The mean caries experience was high with an average of 7.0 ± 3.8 proximal enamel lesions. The most prevalent dominating species in the plaque samples were Streptococcus mitis, Veillonella parvula and Streptococcus gordonii. The saliva samples displayed a more mixed profile, with Streptococcus mitis, Rothia dentocariosa, Lactobacillus casei and Lactobacillus curvata being frequently identified species. All of the subjects harboured mutans streptococci in their saliva, with 61% of them colonised with salivary lactobacilli. No statistically significant differences in the microbial profiles or the estimated counts between the baseline and follow-up samples, or between the two study groups, were observed. Conclusions: The present study showed that a short-term daily intake of milk supplemented with the probiotic bacterium L. rhamnosus LB21 did not significantly affect the microbial profiles or the levels of caries-associated bacteria in saliva and supragingival plaque samples collected from caries-active adolescents. Keywords: adolescents, biofilm, caries, DNA-DNA hybridisation, saliva

Purpose: Hyaluronan, commonly known as hyaluronic acid, has been shown to have anti-inflammatory action, bacteriostatic effect and antioxidant properties, thus making its use as a long-term anti-plaque and anti-gingivitis agent an appealing proposition. The aim of the present study was to evaluate the efficacy of 0.025% hyaluronan-containing mouthwash in comparison with 0.2% chlorhexidine and a water-based mouthwash and also to evaluate its antibacterial efficacy on isolated strains of periodontopathogens. Materials and Methods: Forty-five volunteers in a hospital setting were recruited. A single-blinded, parallel design, randomised controlled trial was carried out and the 4-day plaque re-growth model was used to study the efficacy of the three mouthwashes. Microbiological and clinical evaluation was performed by culturing and using dental indices, respectively. The three mouthwashes used in the present study were commercially available 0.025% sodium hyaluronate, 0.2% chlorhexidine and a water-based rinse (negative control). Effects of the three mouthwashes were tested on the growth of isolated strains of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa) and Prevotella intermedia (Pi). Results: In vitro, hyaluronan had a distinct effect on the growth of Aa and Pi with no effect on the growth of Pg. In vivo, the differences between the individual rinse solutions and the water-based solution showed significantly less plaque regrowth with respect to both chlorhexidine (P = 0.033) and hyaluronan (P = 0.045) when compared to the negative control. The difference between chlorhexidine and hyaluronan was not statistically significant (P = 0.69). Conclusions: Hyaluronan (0.025%)-containing mouthwash was comparable to chlorhexidine (0.2%) in inhibiting plaque growth in vivo, and it significantly reduced the growth of Aa and Pi in vitro. Keywords: anti-inflammatory, antioxidant, anti-plaque, hyaluronan, mouthwash

Purpose: Patients presenting with leukaemic blast crisis with acute myeloid leukaemia (AML) may have gingival enlargements that interfere with oral hygiene. Few large cohort studies of gingival lesions have been carried out on AML patients. The aim of the present study was to assess gingival and periodontal pathology at the time of presentation, prior to chemotherapy, in a cohort of adult patients presenting at a cancer hospital in Kerala, a region located in southern India. Materials and Methods: A total of 73 young adult patients (mean age 20.6 ± 2.3) who were diagnosed with AML were examined. These patients did not suffer from any other systemic disorder. The oral hygiene status, gingival overgrowth (GO) and periodontal status were assessed using traditional clinical indices. Results: Around three-quarters of the patients had either fair or poor oral hygiene. A statistically significant association between dental plaque levels and both GO and periodontal index (P < 0.001) was observed. Conclusions: Poor oral hygiene is a risk factor for leukaemic GO and for destructive periodontal disease. Both conditions add to the microbial burden these patients are exposed to. In patients showing high levels of oral hygiene, the GO tends to be mild and does not seem to be problematic, especially with respect to mechanical tooth cleaning. Keywords: acute leukaemia, dental calculus, dental plaque, gingival overgrowth, oral hygiene

Purpose: The complexity of molar furcation areas provides a challenge for periodontal treatment that leads to more tooth loss when compared to other tooth types. Furcation entrance dimension (FED) of molar teeth affects treatment outcomes and prognosis considerably. The aim of the present study was to determine the FED in first and second mandibular molars among Jordanian adults and to assess the relationship to gender. Materials and Methods: The sample consisted of 430 first and second mandibular molars that were extracted in four dental clinics of the Ministry of Health. The teeth were sorted according to gender after extraction and those meeting the following conditions were selected: intact crowns with completely preserved cementoenamel junction, intact furcation areas and roots lacking restorations. The FEDs were measured under magnification using a computer system (AutoCad 2005) equipped with a digital camera (HP Photosmart). Results: A high percentage (63.5%) of FEDs were wider than 0.75 mm, with buccal furcations wider than lingual ones and first molar furcations having wider furcations than those of second molars among Jordanian adults. A significant difference in the mean FEDs between male and female patients was observed in the second molar. Conclusions: Furcation involvements in Jordanian adults are more suitable for treatment with standard hand curettes than those reported in other cultures, as a high percentage (63.5%) of the FEDs were wider than the width of a standard Gracey curette blade. A significant difference between sexes in the second molar was observed. The use of other instruments, such as ultrasonic devices, should be taken into account during scaling and root planing as about 37.5% of the furcation would not be adequately instrumented with standard curettes. Keywords: curette, furcation, perio, plaque, root planing