Oral Health and Preventive Dentistry, 03/2010

Purpose: The aim of the present study was to compare dental caries and periodontal disease status associated with oral microflora among smokeless tobacco chewers and non-chewers. Materials and Methods: Forty-two smokeless tobacco chewers and 42 non-chewers (age 20 to 60 years) were assessed for dental caries and periodontal disease status using the Decayed Missing Filled Surface (DMFS) Index, Community Periodontal Index (CPI) and Loss of Attachment (LA) Index. Stimulated saliva and subgingival plaque samples were collected from each subject for performing a culture-based analysis of 20 types of oral microorganisms. Qualitative and semi-quantitative culture-based analysis using MacConkey agar, and aerobic and anaerobic blood agar was carried out to determine the total cultivable microflora. Mutans-Sanguis agar, Pfizer selective Enterococcus agar and Rogosa SL agar were used for the culture of microorganisms associated with dental caries. Mann-Whitney U test and Student t test were employed to compare colony-forming units (CFUs) and caries experience between smokeless tobacco chewers and nonchewers. Z proportionality test was used to compare the periodontal disease status. Results: Caries experience among chewers (26 of 42), that is those subjects who were affected by caries, was significantly less at 61.9% (mean DMFS = 3.5) compared to non-chewers (38 of 42, 90.5%) (mean DMFS = 5.5) (P < 0.05). Deep pockets measuring > 5.5 mm on a CPI probe were found among 26.2% of chewers and 19.1% of nonchewers, with no statistically significant differences (P > 0.05). Counts of Lactobacillus species were significantly lower among chewers (median CFU = 0.788 x 105) than among non-chewers (median CFU = 1.52 x 105) (P < 0.05). Prevotella and Porphyromonas species had a median CFU of 0.04 x 105 in chewers and 0.15 x 105 in non-chewers, whereas Fusobacterium species had a median CFU of 0.02 x 105 in chewers and 0.1 x 105 in non-chewers (P < 0.05). Conclusions: A higher percentage of caries among non-chewers can be explained by greater numbers of Lactobacillus species in this population. Chewers experienced a slightly higher incidence of periodontal disease than non-chewers, but the difference was not significant. These clinical observations suggest a lower ability of Gram-negative bacteria to mediate more periodontal disease in this population. Keywords: dental caries, periodontal disease, smokeless tobacco

Purpose: The present study was primarily carried out to assess the severity of malocclusion and treatment needs of 14- to 15-year-old schoolchildren of Bangalore, India, using the Dental Aesthetic Index (DAI) and to correlate them with the subjective perception of aesthetics, function, speech and treatment needs. Methods: A total of 1618 students aged 14 to 15 years, who were randomly selected from 40 government and private schools, were included in the present study. The subjects were asked about their self-perception of malocclusion using a structured questionnaire. A Likert scale was used to assess their perception. They were then subjected to a clinical examination, wherein the malocclusion and the treatment needs were assessed using the DAI. The data were analysed using the SPSS version 10 statistical package. Results: Most of the subjects were satisfied with the arrangement of their teeth. Weak but statistically significant correlations were found between all of the variables (P < 0.01). Correlation was found to be greater between aesthetics and speech (r = 0.489; P < 0.01), aesthetics and the DAI component (r = 0.342; P < 0.01), and subjectively and objectively perceived treatment needs (r = 0.476; P < 0.01). There was no significant difference observed between the children in private and government schools (P > 0.05). Aesthetics was the most common reason for seeking treatment. Conclusions: Most of the subjects were satisfied with the appearance of their teeth, masticatory function and speech. The perception of dissatisfaction with dental appearance increased with increasing severity of malocclusion. However, the same did not apply for masticatory function and speech. Self-perception of treatment need was low. Keywords: Dental Aesthetic Index, malocclusion, subjective perceptions

Purpose: The Oral Health Impact Profile (OHIP) questionnaire measures oral health-related quality of life and is widely used for assessing subjective oral health status. The objective of the present study was to describe the translation and validation of the shortened 14-item OHIP for native Persian (Farsi) speakers living in Iran. Materials and Methods: The authors translated the OHIP-14 into Persian (OHIP-14-P), followed by back-translation into English, after which the Persian version was revised and modified. They administered the questionnaire to native Persian-speaking clients at a university-based dental clinic in Tehran, Iran (n = 240, 123 females and 117 males, mean age 39, range 18 to 76). They examined the convergent validity and discriminative validity of OHIP by analysing their association with various self-reported health outcomes. They evaluated the test-retest reliability by administering the instrument to 37 patients a second time. They analysed the internal consistency and reliability using a intraclass correlation coefficients (ICC) and Cronbach's reliability coefficient, respectively. Results: The associations between scores of OHIP-14-P and its subscales with self-reported general (rs [Spearman's rank correlation coefficient] range 0.38 to 0.52) and oral health (rs range 0.25 to 0.45) confirmed convergent validity. Discriminative validity was confirmed through the significant relationship between OHIP-14-P scores with both the experience of pain and satisfaction with oral health (P < 0.001). The instrument's test-retest reliability (ICCs: 0.75 to 0.88) and internal consistency (Cronbach's a: 0.45 to 0.73 and Cronbach's a if subscale deleted: 0.88 to 0.85) were satisfactory. Conclusions: The Persian version of OHIP-14 was found to be a valid and reliable measure, and appropriate to be used among native Persian speakers visiting a dental clinic. Keywords: epidemiology, OHIP, oral health, oral health impact profile, quality of life, validation

Purpose: The aim of the present study was to investigate the malocclusion status and treatment needs of adolescents with cleft lip and/or palate aged between 12 and 18 years, and to compare them with those of non-cleft subjects. Materials and Methods: A cross-sectional survey was conducted at the Outpatient Department, Plastic and Reconstructive Surgery, KLE's Hospital and Medical Research Centre, Belgaum, India, during the period March to September 2004. The sample comprised 56 cleft lip and/or palate subjects aged between 12 and 18 years who were matched with 168 non-cleft subjects (controls) selected from the general population. The clinical examination was conducted using methods recommended by the World Health Organization oral health surveys. The Dental Aesthetic Index (DAI) was used to record the data. Results: About 37.5% of cleft lip and/or palate subjects and 60.71% of controls scored a DAI u 25 (no abnormality or minor malocclusion). About 51.78% of cleft lip and/or palate subjects and approximately one-third of controls (35.71%) scored a DAI of 26 to 30 (definite malocclusion). Subjects with cleft lip and/or palate disorder (8.92%) and controls (2.97%) scored a DAI of 31 to 35 (severe malocclusion, P = 0.06). Subjects with cleft lip and/or palate disorder (1.78%) and controls (< 1%) scored a DAI v 36 (handicapping malocclusion). Conclusions: A majority of the cleft lip and/or palate subjects exhibited severe malocclusion, and treatment was highly desirable when compared to non-cleft subjects. Keywords: cleft lip, cleft palate, Dental Aesthetic Index, malocclusion, treatment needs

Purpose: The aim of the present study was to assess the occurrence of reported subjective oral dryness in relation to objective sialometric values in a randomly selected group and a dental care-seeking group. Materials and Methods: A questionnaire assessing subjective oral dryness was sent out to a randomly selected sample of 200 individuals. The dental care-seeking group was recruited from among patients attending the Department of Oral Diagnostics, Malmö University. A total of 200 patients were asked to participate in the present study. In total, 312 individuals (78%) completed the survey and 157 individuals agreed to participate in the complementary clinical examination that included measures of salivary flow rate. Results: The reported subjective oral dryness was 20% and 28.6% for the randomly selected group and the dental careseeking group, respectively. No statistically significant differences were found between the two study populations with regard to percentage of reported subjective oral dryness, and stimulated and unstimulated salivary flow rates (P > 0.05). In the dental care-seeking group, individuals reporting subjective oral dryness presented 'a small degree of abrasion in the dentine in the incisor region' to a greater extent (P < 0.05). No statistically significant association between subjective oral dryness and unstimulated and stimulated salivary flow rates was found in either of the studied populations (P > 0.05). Individuals identified with subjective or objective oral dryness presented to a greater extent a history of oral rehabilitation compared to individuals who showed no indication of oral dryness. Conclusions: No association between sialometric measures and subjective report of oral dryness was found in the present study. Keywords: dry mouth, oral dryness, saliva, sialometry, xerostomia

Purpose: The objective of the present study was to evaluate whether sensitivity to bitter taste and perception of sweet taste have an influence on dental caries in urban and rural areas. Materials and Methods: The caries experience in 181 children, aged 12 years, from rural and urban areas of southern Brazil, was assessed according to World Health Organization guidelines. Sensitivity to the bitterness of phenylthiocarbamide was determined using the Harris-Kalmus procedure, and the sweet taste thresholds of sucrose were measured by Nilsson and Holm's method. Results: The caries index (DMFT > 0) was 3.73 (SD = 2.26) in the rural area and 3.51 (SD = 2.14) in the urban area. The sensitivity to bitter taste and sweet taste perception showed significant association with the gender of schoolchildren (P = 0.04). Girls were predominant in the high sweet perception taster group (62.3%) and the bitter taster group (59.4%). No significant difference in sweet perception status could be observed between the groups of low and high caries severity. The genetic ability to taste bitterness significantly influenced the levels of caries only in children from the urban area (P = 0.005). Bitter non-tasters presented higher severity of caries. A positive correlation was observed between sensitivity to bitter taste and sweet taste perception among children in the rural (r = 0.42, P = 0.002) and urban areas (r = 0.36, P = 0.001). Conclusions: These findings suggest that the bitter non-tasters are more susceptible to dental caries than the tasters in the urban area. Keywords: dental caries, risk factors, students, taste perception

Purpose: This prospective clinical trial compared the retention rate and caries-preventive efficacy of two types of sealant modalities over a 3-year period. Materials and Methods: Using a split-mouth randomised design, 1280 sealants were randomly applied on sound permanent second molars of 320 young patients aged between 12 and 16 years. Half of the teeth (n = 640) were sealed with a resin-modified glass ionomer cement (RMGIC) (VitremerTM, 3M ESPE) and the other half (n = 640) with a conventional light-cure, resin-based fissure sealant (LCRB) (Fluoroshield, Dentsply Caulk). Teeth were evaluated at baseline, 6-, 12-, 18-, 24-, 30- and 36-month intervals with regard to retention and new caries development. Results: On the sealed occlusal surfaces after 3 years, 5.10% of RMGIC and 91.08% of LCRB sealants were totally intact and 6.37% of RMGIC and 7.65% of LCRB sealants were partially intact. New caries lesions were found in 20.06% of RMGIC sealed occlusal surfaces, compared to 8.91% for LCRB sealants. Conclusions: The findings of the present clinical study suggest that RMGIC should be used only as a transitional sealant that can be applied to newly erupting teeth throughout the eruptive process, whereas LCRB sealants are used to successfully prevent occlusal caries lesions once an effective rubber dam can be achieved. It can be concluded that there are differences between the RMGIC and LCRB sealants over a 3-year period in terms of the retention rate and caries-preventive efficacy. RMGIC can serve as a simple and economic sealing solution, however provisional. Due to its poor retention rate, periodic recalls are necessary, even after 6 months, to eventually replace the lost sealant. Keywords: dental caries, light-cure resin-based sealant, pit and fissure sealants, preventive dentistry, resin-modified glass ionomer cement

Purpose: The aim of the present study was to analyse caries prevalence and fluorosis as well as oral hygiene habits in schoolchildren in north Namibia. Materials and Methods: In 2004, 120 pupils (1st to 8th grade, mean age: 12.3 ± 2.8 years) of the Ombili Primary School were examined by one calibrated clinician for caries (DMFT) according to the World Health Organization criteria, oral hygiene (API) and fluorosis (Dean's index), categorised according to the four different farms where they lived. In addition, samples of drinking water were obtained from the wells of the farms and analysed for quality and mineral content. Results: The pupils at the different farms showed very different caries prevalence (range: 17% to 50% caries-free children) and mean DMFT values (0.96 to 2.67). Oral hygiene measures were not common (60.8% none) or inefficient (mean proximal plaque index: 89.5%) and did not differ greatly between the different farms. The fluoride concentration in drinking water varied considerably (0.28 to 1.06 mg/l). The prevalence of dental fluorosis in all schoolchildren was 65.8%, the Community Fluorosis Index (CFI) was 1.41 and it differed clearly for pupils from the four farms (CFI: 0.5 to 1.65). The DMFT index showed a statistically significant correlation with the fluoride concentration of the drinking water (P < 0.05). Conclusions: Based on these results, fluoride concentration in drinking water should be monitored in the future. In parallel, a caries-preventive programme should be developed, as high concentrations of fluoride in drinking water alone do not result in acceptable caries levels. Keywords: dental caries, fluorosis, oral hygiene

Purpose: The aim of the present study was to evaluate the pattern of fluoride-containing dentifrice use and associated factors in Brazilian preschoolers. Materials and Methods: A structured questionnaire was answered by parents of 432 children, who were aged 2 to 6 years, from 12 public preschools in Ijuí, South Brazil. Primary outcomes were age of starting fluoride-containing dentifrice use and amount of dentifrice applied to the toothbrush. Poisson regression with robust variance was used to determine the factors associated with the main outcomes. Results: About 75% of the participants were introduced to fluoride-containing dentifrice before the age of 2 years. The current predominant amount of dentifrice used was obtained by transversal (57.7%), followed by longitudinal deposition on the toothbrush (33.6%), corresponding to 0.3 and 0.9 g of dentifrice, respectively. Previous dental visits and maternal education greater than 4 years were associated with the introduction of fluoride-containing dentifrice before 2 years of age. The probability of using dentifrice in amounts higher than the recommendations doubled in children aged 5 and 6 years. Conclusions: Oral health interventions should reinforce the importance of early introduction of fluoride-containing dentifrice, especially in less-educated mothers. Furthermore, the amount of dentifrice should be reduced to maximise the caries-preventive effect while minimising dental fluorosis. Keywords: dental caries, dental fluorosis, dental visits, dentifrice, fluoride

Purpose: The aim of the present study was to identify the underlying patterns of oral cleaning habits and the use of fluoride, and to investigate their variations by studying the socioeconomic characteristics among Finnish dentate adults aged 30 to 64 years. Materials and Methods: Participants of the nationwide Health 2000 survey who were dentate, aged 30 to 64 years, and underwent a health interview and a clinical oral examination, were included in the present study (n = 4419). Results: In total, 79% of the women and 46% of the men reported to have brushed their teeth twice or more daily; 16% of the women and 14% of the men reported daily use of an electric toothbrush and 14% of the women and 5% of the men reported daily use of dental floss or an interdental brush. Factor analysis revealed five oral cleaning habit patterns, which were named modern, rational, before-breakfast, social and irrational. The modern cleaning pattern was associated with higher levels of education, and the rational cleaning with younger age, female gender and higher levels of education. The before-breakfast cleaning pattern was associated with male gender and lower levels of education, and the social cleaning with older age, female gender and higher levels of education. The irrational cleaning pattern was associated with older age. Conclusions: Adults have various oral cleaning habit patterns, each of which is associated with the subjects' socioeconomic characteristics. Keywords: dentate adults, oral cleaning habits, underlying habit patterns, use of fluoride

Purpose: The aim of the present study was to perform a review of the effects of infiltrants and sealers on the inhibition of enamel demineralisation. Materials and Methods: The authors searched the Cochrane Library, Embase, PubMed and Web of Science (ISI) for papers published between January 1970 and September 2008. The main search terms were 'artificial caries' or 'caries treatment' or 'caries-like lesion' or 'white spot lesion' or 'enamel demineralisation' or 'natural caries' and 'enamel' and 'sealant' or 'resin infiltration'. The inclusion criteria were studies that produced artificial non-cavitated enamel lesions before the application of sealant in in vivo or in vitro studies. Studies excluded were those that had not produced artificial non-cavitated enamel lesions before the application of sealant; had evaluated the inhibition of enamel demineralisation around restorations, sealant and orthodontic bracket/bands; had not evaluated the inhibition of enamel demineralisation after the sealant application; and had not applied sealant materials. Selected papers were given scores, from A to C, according to predetermined criteria. Results: Eighteen studies were identified and included in the project critical appraisal. Two papers were classified as Grade A, nine as Grade B and seven as Grade C. Conclusions: It can be concluded that while fissure sealing acts as a diffusion barrier on the top of the lesion surface, the infiltration technique creates a barrier inside the lesion by replacing the mineral lost with a low-viscosity light-curing resin. Keywords: artificial caries, enamel, non-cavitated lesion, sealant