Oral Health and Preventive Dentistry, 04/2012

Purpose: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010. Materials and Methods: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire. Results: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%. Conclusion: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition. Keywords: child welfare, dentition, malocclusion, public health dentistry

Purpose: To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. Materials and Methods: In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilm. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. Results: The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. Conclusions: Tooth wipes are effective in removing biofilm from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies. Keywords: babies, dental biofilm, hygiene methods

Purpose: The Index of Dental Anxiety and Fear (IDAF-4C+) constitutes a theory-grounded, reliable and valid instrument, which, due to its modular structure, allows different uses such as assessing dental anxiety levels, establishing preliminary dental phobia diagnoses and identifying feared stimuli. This study aimed to develop a Spanish version of the original IDAF-4C+ and evaluate its psychometric properties. Materials and Methods: A sample of 231 Spanish undergraduate students (70.6% female; mean age 21.4 years) completed a questionnaire comprising the Spanish version of the IDAF-4C+ and other measures related to dental anxiety. The structure, reliability and validity of the adapted IDAF-4C+ were analysed. Results: The adapted IDAF-4C fear module yielded a single-factor structure and demonstrated good internal consistency (Cronbach's alpha) and test-retest reliability. It shared a greater amount of variance with phobia diagnoses than the Modified Dental Anxiety Scale (MDAS) and a single-item measure of dental fear (SIDF). Moreover, the IDAF-4C was moderately to highly correlated with the MDAS and the SIDF measure, as well as with variables connected with dental anxiety such as negative dental thoughts, having had a negative dental experience and negative affect. The frequency of dental visits was also linked to IDAF-4C scores, and IDAF-stimulus items involving cognitive vulnerability, interpersonal and cost concerns were associated with dental attendance. Conclusion: The Spanish version of IDAF-4C+ presents similar psychometric properties to the original version which, considering the advantages of this instrument, qualifies the adapted one for its use in different research and applied contexts. Keywords: assessment, dental anxiety and fear, dental phobia, dental visits

Purpose: To assess the knowledge, attitude, behavioural response and use of preventive measures regarding a pandemic H1N1 influenza outbreak among dental students. Materials and Methods: In a cross-sectional study, a total of 448 dental students (118 in preclinical categories, 330 in clinical categories) were surveyed using a self-administered, structured questionnaire pretested through a pilot survey. Results: Out of 448 dental students, 92.6% had heard about swine flu, whereas only 64.3% of them knew about the H1N1 virus. More than 50% of dental students showed a positive response towards swine flu attitude, and pandemic H1N1 influenza modified the behaviour of dental students. Respondents rated hand washing and face masks as the most effective measures for the prevention of pandemic influenza. Conclusion: Half of the dental students had enough information and showed a positive attitude towards a H1N1 pandemic influenza outbreak. However, the behavioural response of the participants was poor. Keywords: attitude, behaviour, dental students, knowledge, swine flu

Purpose: To assess the oral health knowledge, attitude and practices of 15-year-old schoolchildren in Udupi Taluk, Southern India and to identify their social determinants. Materials and Methods: In this cross-sectional study, the sample was selected using stratified cluster random sampling. A self-administered questionnaire was filled out by the participants and evaluated using bivariate and multivariate analyses. Results: A total of 664 children were assessed. About 90% of participants had knowledge about causes of dental caries and the role of toothbrushing in its prevention. Lower proportions (40% to 60%) of participants were aware of gum disease and the role of fluoride and dental floss. A majority (>90%) of the children used a toothbrush and toothpaste, 63.3% of the children did not know whether their toothpaste contained fluoride or not, 61.9% of them cleaned their teeth two or more times a day and only 18.2% of the children visited the dentist for routine check-ups. In the multivariate analysis, a rural area of residence was associated with increased odds of inadequate oral hygiene behaviour (OR: 1.67, 95% CI: 1.10-2.52), of not having recently visited a dentist (OR: 1.89, 95% CI: 1.20-2.98) and of doing so only due to pain (OR: 2.52, 95% CI: 1.57-4.05). Attending private school was associated with decreased odds of these (OR: 0.36, 95% CI: 0.24-0.55; OR: 0.56, 95% CI: 0.36-0.89; OR: 0.39, 95% CI: 0.25-0.63 respectively), but it contributed significantly to a higher diet score (i.e. more sugary products consumed) (ß: 9.11. 95% CI: 2.97-15.25). Conclusion: There is a need to improve the oral health knowledge, attitude and practices in the target population with emphasis on improvement of oral hygiene and dental visit behaviours amongst rural and government school children and diet in private school children. Keywords: adolescent, health attitudes, health knowledge, health practice, India, socioeconomic factors

Purpose: To assess and compare the oral health status and treatment need among the preschool children attending Anganwadi Centres associated with a special learning programme (SLP) and the control group. Materials and Methods: The study was designed to include 3- to 5-year-old preschool children attending Anganwadis. An Anganwadi (meaning courtyard) Centre is the focal point for the delivery of services to children and mothers. The Anganwadis associated with the special learning programme and the control group Anganwadis consisted of 255 and 275 children, respectively. The special learning programme comprised general health education and growth monitoring services that were continuously reinforced to expectant and nursing mothers of children below 6 years of age by a team of members of a nearby medical college. Information on demographic and socioeconomic parameters (maternal literacy and occupation, paternal literacy and occupation, family income), oral hygiene practices, dietary habits and dental visits was obtained, and oral examination was done in the two groups. Results: The mean plaque index and mean gingival index score among the SLP Anganwadi group were 0.18 ± 0.22 and 0.15 ± 0.28, respectively, and among the control group these indices were 1.06 ± 0.50 and 0.50 ± 0.00, respectively. The mean dmft score among the SLP group was 3.40 ± 4.84 vs 4.32 ± 4.69 in the control group (p < 0.05). The distribution of children without any treatment need was 50.2% in the SLP group and 33.5% in the control group. Conclusion: The SLP Anganwadi group had a better oral health status and less treatment need than the control Anganwadi group. This demonstrates that there is a beneficial effect of general health education on oral health. Keywords: Anganwadi Centres, general health education, oral health status, preschool children, special learning programme

Purpose: To describe the tooth status, periodontal status, oral hygiene and snacking habits of children in four villages in northeastern Myanmar. Materials and Methods: This was a cross-sectional study using a convenient sampling protocol. All children ages 5 and 12 years from four villages were examined by an experienced epidemiologist, and the status of their primary and permanent dentition, respectively, was reported using the diagnostic criteria recommended by the World Health Organisation. A parental questionnaire survey was performed to study the children's habits. Results: A total of 95 5-year-old and 80 12-year-old children were examined. It was found that 94% and 39% of the 5- and 12-year-old children, respectively, had never brushed their teeth. Few children had snacking habits. Most of the children - 75% of the 5-year-olds and 85% of the 12-year-olds - had no caries experience. The mean dmft score of the 5-year-olds was 0.9, while the mean DMFT score of the 12-year-olds was 0.2. Signs of moderate to severe gingivitis were found in 42% of the 5-year-olds, and 40% of the 12-year-olds had dental calculus. Conclusions: The prevalence and severity of dental caries among the children in the four villages in northeastern Myanmar was low. Their oral hygiene habits and periodontal conditions were not satisfactory and need to be improved. Keywords: Burma, caries, children, gingivitis, Myanmar, oral hygiene, periodontal

Purpose: To assess the prevalence of malocclusion in schoolgirls at a private high school and whether it has increased or not over 40 years by comparison with previous surveys on early and middle adolescence in Japan. Materials and Methods: Conventional dental examination including evaluation of occlusion was performed in 2,378 schoolgirls who were enrolled in the seventh and the tenth grade between the years 2004 and 2006. The presence of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and crowding of teeth was recorded by visual inspection. The prevalences of various types of malocclusion were compared between the two grade groups and with data from the previous surveys. Results: The proportions of malocclusions in the tenth grade (55.7%) and seventh grade (55.3%) were found to be similar. The prevalences of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and tooth crowding in the seventh grade students were 9.4%, 0.6%, 4.1%, 0.6%, 8.4% and 19.1%, respectively. The corresponding values in tenth grade students were almost the same except for deep bite, which was significantly lower than that in the seventh grade. Comparison with previous surveys indicated that the proportions of malocclusions taken as a whole had not changed over 40 years, whereas anterior crossbite, edge-to-edge incisor relationship, open bite and tooth crowding had decreased significantly within the last 20 years. Conclusion: Significant changes in the proportions of malocclusions as a whole in adolescents were not found over the last four decades. Keywords: high school, Japanese, malocclusions, orthodontics, prevalence, student

Purpose: To assess the role of toothbrushing self-efficacy (TBSE) in toothbrushing (TB) behaviour and diabetes management, measured in terms of HbA1c knowledge, quality of life, BMI, self-reported health and physical activity among Turkish type-II-diabetes (DM2) patients. Materials and Methods: A pilot study using self-administered health questionnaires was conducted among a random sample of 60 patients (aged 40 to 70 years) in Istanbul, Turkey. The assessed variables were: TBSE, TB, glycated haemoglobin (HbA1c) knowledge, quality of life, BMI, self-reported health and physical activity. Descriptive statistics, frequency distributions, Pearson's correlation, the chi-square test and MANOVA were applied. Results: Almost half of the patients reported low TBSE (mean >= 53%). and TB once a day (54%). Most (77%) did not know their HA1C level and they were overweight (42%) and obese (32%). Almost half of the patients reported good quality of life (> mean, 55%), being physically active (51%) and in good health (mean < 46%). The patients reporting high levels of TBSE were more likely to know their HbA1c (OR = 10.5: 95%CI = 1.01-103.24) and to report better health (OR = 10.0: 95%CI = 1.80-55.63) and were less likely to be obese (OR = 0.16: 95%CI = 0.02-1.00) (P < 0.05). There was a strong correlation between TBSE and TB (rs = 0.61, P < 0.01). Conclusion: The present study underlines the need for TBSE-integrated common health promotion for oral health and DM2, considering the relation of TBSE, HbA1c, BMI and toothbrushing. Keywords: BMI (body mass index), diabetes management, oral health behaviour, self-efficacy, WHOQOL-Bref

Purpose: To determine the effectiveness of herbal and fluoridated toothpastes on plaque and gingival scores among 18- to 25-year-old female participants residing in a working women's hostel. Materials and Methods: Sixty participants residing in a working women's hostel in Belgaum city, aged between 18 and 25 years, comprised the study population. The 60 participants were randomly allocated to the experimental and control groups. The experimental group was asked to use a herbal toothpaste (Himalaya Herbal Healthcare) and the control group a fluoridated toothpaste (Colgate Dental Cream) twice a day for 6 weeks. The plaque and gingival indices were recorded according to Silness and Löe (1964) and Löe and Silness (1963), respectively, at baseline, 3 weeks and 6 weeks of usage of the toothpastes. Results: Baseline plaque and gingival scores were 1.53 ± 0.9 and 1.22 ± 0.13 for the control group and 1.30 ± 0.15 and 1.19 ± 0.12 for the experimental group, respectively. At 6 weeks, plaque and gingival scores were 0.86 ± 0.18 and 0.80 ± 0.2 for the control group and 0.99 ± 0.14 and 0.9 ± 0.21 for the experimental group, respectively. Statistically significant differences were obtained before and after the intervention in both groups (P < 0.001). Conclusion: The herbal toothpaste was as effective as the conventionally formulated dentifrice in controlling plaque and gingivitis. Keywords: fluoridated toothpaste, gingival index, herbal toothpaste, plaque index

Purpose: To evaluate the effect of tobacco smoking and salivary calcium on the periodontal status of young adults. Materials and Methods: Plaque index, gingival bleeding on probing, supragingival calculus, DMFT index, salivary flow, pH and salivary calcium in unstimulated salivary samples were recorded in smokers and nonsmokers. Results: There were no significant differences between smokers and nonsmokers with respect to salivary flow (P = 0.08) and calcium level (P = 0.09). Significant correlations (P < 0.05) were found between a higher calcium level and higher probing depth (r = 0.60), higher number of teeth with probing depth of more than 4 mm (r = 0.70), greater clinical attachment level (r = 0.49) and lower number of teeth bleeding on probing (r = -0.50). Conclusion: Moderate smoking of tobacco cigarettes in young healthy subjects may not have a significant impact on salivary flow or calcium concentrations in unstimulated saliva, but an association exists between an increased level of salivary calcium and development of periodontal disease. Keywords: calcium, periodontal diseases, saliva, tobacco smoking, young adult