Oral Health and Preventive Dentistry, 03/2014

Purpose: To evaluate and compare the effect of triphala extract mouthrinse and chlorhexidine on dental plaque and gingivitis. Materials and Methods: In this double blind, crossover study, 120 qualifying boarding-school students aged 13-16 years were randomised into three groups: 10% triphala, 0.2% chlorhexidine and negative control. The study was conducted in 3 phases of 1-month duration each and a washout period of 15 days. During the experimental period, subjects rinsed with the allocated mouthrinse once daily for 30 s under supervision. The plaque and gingival status was assessed using the Turesky modification of the Quigley and Hein plaque index (QHI) and the gingival index (Löe and Silness) at baseline and at the end of each phase. The results were tested for significance at P < 0.05. Results: Triphala and chlorhexidine yielded a significant reduction in plaque and gingival index scores as compared to negative control (P < 0.001). No significant difference was found between the scores obtained with triphala and chlorhexidine mouthwashes. Conclusion: The antiplaque and antigingivitis activity of triphala closely parallels that of chlorhexidine. Keywords: antigingivitis, antiplaque, chlorhexidine, triphala

Purpose: To determine the effect of mechanical tooth cleaning by toothbrush and dental floss on mutans streptococci in the saliva of preschool children. Materials and Methods: This blinded, randomised controlled clinical trial included 54 3-year-old preschool children with detectable mutans streptococci in saliva. The children were randomly divided into a test and a control group. Dental college students cleaned the teeth of test group participants with toothbrush and dental floss under the indication of a plaque disclosing agent once a day. The control group received no intervention. Dentocult SM Strip mutans (D-SM) strips were used to test the mutans streptococci in saliva. Results: The D-SM test scores declined from 1.82 to 0.95 for the test group after the teeth were cleaned 10 times (P < 0.001) and the scores increased to 1.62 after tooth cleaning ceased for 2 weeks (P > 0.05 compared with baseline). The D-SM level of the control group did not change significantly. Conclusion: Meticulous and continuous plaque control with toothbrush and dental floss can decrease the mutans streptococci level in preschool children. However, the effect ceased as the intervention ceased. Keywords: dental flossing, Dentocult SM Strip, mutans streptococci, preschool children, toothbrushing

Purpose: To identify and review the psychometric properties of instruments available for measuring oral health literacy. Materials and Methods: A comprehensive computerised search was carried out using six databases. The final papers were rated for level of evidence and scientific quality. Results: A total of 621 potentially relevant articles were retrieved in the primary search. Twenty-nine studies using 13 oral health literacy instruments were included in the final analysis. After applying an international standards framework, all included studies were categorised as evidence level '2c'. Qualities of evidence were rated with STROBE guidelines. Psychometric analysis indicated various levels of validity and reliability across the instruments. Conclusions: As an emerging field, the number and reliability of oral health literacy instruments is rapidly growing, although many are in preliminary stages of testing. The majority of these focus on functional literacy and were developed in English for North American contexts. Further work is indicated to measure oral health literacy as a wider construct across diverse populations.

Purpose: To assess the association between oral and general hygiene behaviours in 12-year-old Iranians and the impact of sociodemographic and educational factors on the association. Materials and Methods: A representative random sample of 550 12-year-old Iranian adolescents from two deprived tribes answered a 41-item questionnaire on sociodemographic background, education and oral and general hygiene behaviours. The association between toothcleaning frequency and other study outcome variables were tested using binary logistic regression. The sex differences in the study outcome variables were investigated using chi-square and Mann-Whitney tests. Results: The frequency of toothcleaning was significantly associated with a general hygiene behaviour: frequency of taking a bath (OR 0.5; 95% CI: 0.3, 0.7). This association remained significant when sociodemographic factors and educational factors were added to the model both separately (P < 0.001) and together (P < 0.001). Girls were significantly more likely than boys to clean their teeth once or more times a day (OR 2.4; 95% CI: 1.7, 3.4). Conclusion: Oral and a general hygiene behaviour were strongly associated. Oral, general and environmental hygiene programmes should use integrated approaches. Keywords: adolescents, general hygiene, oral hygiene

Purpose: Dental anxiety is a common phenomenon influencing the relationship between a patient and a doctor as well as the course of treatment. The aim of the study was to assess the oral health status and hygiene habits among adult patients with respect to their level of dental anxiety. Materials and Methods: 117 consecutive adult patients referred to the Department of Conservative Dentistry and Paedodontics of Wroclaw Medical University were included in the study. There were 58 women (49.57%) and 59 men (50.43%). The mean age of the patients was 36.57 ± 16.76 years. The level of dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). To evaluate dental health status and oral hygiene, the following indices were used: total number of decayed, missing and filled teeth (DMF/T) as well as surfaces (DMF/S), approximal plaque index (API), oral hygiene index (OHI), debris index (DI) and calculus ondex (CI). Results: The study revealed that the patients with high MDAS presented a higher calculus index (CI). There was a negative correlation between a high level of dental anxiety measured by MDAS and the number of filled teeth (F/T) as well as the number of filled dental surfaces (F/S). There was no significant correlation between dental anxiety as measured with the MDAS and age, gender or level of education; however, smokers had a significantly higher anxiety level than non-smokers. Conclusions: Dental anxiety has a negative influence on oral health status; the higher the level of dental anxiety, the lower the number of filled teeth and the higher the calculus index. Poor dental and periodontal health may have many somatic as well as psychosocial consequences, both of which lower the quality of life of the patient. Keywords: adult, dental anxiety, Modified Dental Anxiety Scale (MDAS), oral health, oral hygiene

Purpose: To assess the practices and behaviour among Betel nut users in Ghaziabad and to detect the clinically associated oral mucosal lesions and conditions. Materials and Methods: A community-based survey was conducted in Ghaziabad among 332 betel nut users. Data on betel nut use was obtained through a self-administered questionnaire. Oral mucosal lesions and conditions were recorded using WHO criteria. Results: Out of 332 betel nut users, 32.8% consumed Gutkha. 62.3% users used betel nut with tobacco. Most of the study population started chewing betel nut because of peer pressure and the habit started at the workplace or school. A majority found that there was no physical discomfort due to the habit. The significant oral diseases detected were oral leukoplakia in 11.7% and oral submucous fibrosis in 6.1% of individuals. Conclusion: The findings of the present study revealed that 74.7% of the participants were current chewers. 30.4% of all participants had oral mucosal lesions and conditions. Keywords: betel nut, behaviour, oral mucosal lesion and conditions, practices

Purpose: Occlusal splints are often prescribed when treating patients with bruxism. The objectives were to determine (a) whether using occlusal splints improves patients' oral health-related quality of life (ohrqol) and (b) whether the quality of the patient-provider relationship affects these patients' splint-related responses and their ohrqol. Materials and Methods: Survey data were collected from 233 patients who had received bite splints during the 5 years prior to data collection. Results: The data showed that 5% of these patients had never used their splint, 20% had used it in the past, and 75% still used it at the time of data collection. Patients using the splint agreed more strongly that their current oral health status had improved, had more positive splint-related responses and more positive pain-related ohrqol scores than patients who were no longer using the splint. The more patients agreed that they were satisfied with their provider, the more positively they evaluated their bite splints and the more positive was their ohrqol. Conclusions: Bite splint users have more positive splint-related responses and a better pain-related ohrqol than patients who received a bite splint but do not use it any longer. The quality of the patient-provider relationship plays an important role in the patients' splint-related responses as well as in the degree to which patients' ohrqol improves. Keywords: bruxism, communication, compliance, cooperation, occlusal splint, quality of life

Purpose: To review 22 patients with globus pharyngis among a group of 39 patients who presented with burning mouth syndrome and to highlight the clinical presentation and treatment outcome of these oropharyngeal symptoms, often ignored by practicing oral surgeons. Patients and Methods: We carried out a retrospective review of 39 patients with burning mouth syndrome seen at oral surgery units of three specialist hospitals in Enugu, Nigeria between 2001 and 2010. The focus was on the 22 of these patients with burning mouth syndrome and globus pharyngis (the persistent sensation of having phlegm, a pill or some other sort of obstruction in the throat when there is none). Relevant information included patients' oral habits and dental status, past medical history, sociodemographic data, onset of symptoms and treatment outcome. Results: Amongst the 22 patients, 8 (36.4%) were males while 14 (63.6%) were females, giving a male to female ratio of 1:1.8. Of the 8 male patients, 3 (37.5%) were retrenched workers, 2 (25%) were drug addicts, 2 (25%) had a history of psychiatric problems and 1 (12.5%) had post-radiation therapy due to diagnosis of adenocystic carcinoma. Amongst the 14 female patients, 6 (42.8%) were divorcees, 3 (21.4%) were unemployed and unmarried, 2 (14.3%) had menopausal problems, 2 (14.3%) had dental prostheses and 1 (7.2%) had a history of mental disorder. Conclusion: Globus pharyngis can present at the same time in some individuals with burning mouth syndrome. The emotional aetiological factor in this unusual ailment calls for proper examinations and a multidisciplinary approach in the management of patients who presented with burning mouth syndrome, especially with a history of depression. Keywords: burning mouth syndrome, Enugu, globus hystericus, globus pharyngis, Nigeria

Purpose: To examine the associations between the numbers of posterior functional contacts (FCs) and selected nutrient intakes and serum/plasma nutrient values in 3,554 adults 25 years of age and older from the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Materials and Methods: FCs consist of the number of zones of contact between the maxillary and opposing mandibular posterior teeth when the maxillary and mandibular posterior teeth are together. There were 16 possible zones of contact. Nutrient intakes were calculated from one 24-h dietary recall and selected nutritional biochemistries were measured. Multivariate linear regression was used to examine the association between the numbers of FCs and nutrient intakes or serum/plasma nutrient values, controlling for potential confounding variables. Results: Males with 6 or more FCs had higher vitamin A (P < 0.05), C (P < 0.05), E (P < 0.01) and B-6 intakes (P < 0.05) than those with 5 or fewer FCs. Females with 6 or more FCs had higher dietary ber (P < 0.05), vitamin E (P < 0.05) and folate intakes (P < 0.05) than those with 5 or fewer FCs. Males and females with 6 or more FCs had higher serum β-carotene than those with 5 or fewer FCs (P < 0.05 and P < 0.001, respectively). Males with 6 or more FCs had higher serum folate levels than those with 5 or fewer FCs (P < 0.01), and females with 6 or more FCs had higher serum vitamin C levels than those with 5 or fewer FCs (P < 0.05). Conclusions: Dietary intakes and serum levels of certain nutrients differ by the number of FCs present. Keywords: dietary recall, functional contacts, NHANES, serum nutrients

Purpose: To determine the prevalence and identify signi cant socioeconomic predictors of dental caries among children aged 9 and 14 in Jeddah, Saudi Arabia. Materials and Methods: A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders were screened (N = 1655) for caries. A parent questionnaire was administered to collect information on selected socioeconomic indicators. Untreated caries was the outcome of interest. Categorical variables were reported as frequencies and percentages; crude and adjusted odds ratios of caries association with SES were produced with 95% con dence intervals and P-values. Results: A total of 1655 students were examined. The overall caries experience was 83.13%. Untreated caries prevalence in primary and permanent teeth of all students was 63.01% and 56.7%, respectively. In primary teeth, mother's education, family income and having medical insurance were signi cant unadjusted predictors of caries. Family income was the only adjusted predictor of caries in primary teeth. In permanent teeth, most SES indicators were signi cant in the univariate analysis. However, mother's education was the only adjusted variable associated with caries. Conclusions: The prevalence of caries is rising and aggregate measures of SES did not distinguish between children with or without caries, particularly among younger children. The most powerful individual SES predictors of caries were family monthly income and parents' education. Until a more valid aggregate measure of SES is available, communitywide approaches to caries prevention and risk reduction for all young children should be utilised to reduce SES-related caries risk. Keywords: caries, children, permanent teeth, predictors, prevalence, primary teeth, oral health, Saudi Arabia, socioeconomic