Individual Oral Health Research Articles

Prevention of early childhood caries (ECC) through parental toothbrushing training and fluoride varnish application: A 24-month randomized controlled trial

ObjectivesTo investigate the effectiveness of hands-on training in parental toothbrushing, with or without semi-annual applications of 5% sodium fluoride varnish in preventing ECC. MethodsStudy was conducted in Hong Kong where water is optimally fluoridated. Children aged 8–23 months were recruited and randomly allocated to one of three groups: Gp 1 – control, one-off oral health education talk to parents; Gp 2 – oral health education talk and parental toothbrushing training, reinforced every 6 months; Gp 3 – semi-annual application of fluoride varnish onto child's teeth in addition to the intervention provided to Gp 2. Clinical examinations of the children and interviews were conducted at baseline and after 24 months to assess the children's dental caries status and toothbrushing behaviour. ResultsOut of the 450 child–parent dyads recruited at baseline, 415 (92%) remained after 24 months. At baseline, 2% of the children had non-cavitated enamel caries lesions and the mean dmft score was 0.03±0.24. Most of the children did not have daily parental toothbrushing (65–73%) and self toothbrushing (86–90%). At 24-month follow-up, including both non-cavitated and cavitated carious lesions, the incidences of ECC in Gp 1 to Gp 3 were 11.9%, 11.8%, and 17.5%, respectively (p>0.05); and the mean new dmft scores in Gp 1 to Gp 3 were 0.3, 0.2, and 0.3, respectively (p>0.05). Proportions of parents who practiced parental toothbrushing twice daily were 62.7%, 60.4%, and 65.7% in Gp 1 to Gp 3, respectively (p>0.05). ConclusionsIn a water fluoridated area, hands-on training in parental toothbrushing, with or without semi-annual application of 5% sodium fluoride varnish may not have additional effect on preventing ECC in young children with low risk of dental caries compared to provision of oral health education to parents. Clinical significanceIn a water fluoridated area, provision of individual oral health education to parents may be sufficient for preventing ECC in young children below age 3. Supplemental training in parental toothbrushing and semi-annual applications of fluoride varnish may not have additional caries prevention effect in young children with low risk of dental caries.

Gender Variations in the Psychological Factors as Defined by the Extended Health Belief Model of Oral Hygiene Behaviors

Oral self-care practice is an effective preventive measure for maintaining good individual oral health which is an integral part of one's general health. The aim of this analysis was to investigate gender variations in the psychological factors as defined by the extended health belief model (HBM) and oral hygiene behaviors (OHB). Females reported higher values on perceived severity and self-efficacy and lower values on perceived barriers. Exploratory regression analyses revealed that for males perceived barriers and self-efficacy were relatively important determinant of OHB, whereas among females only self-efficacy was relevant. Gender variations in OHB and in the psychological determinants should be considered when designing practical recommendations for improving OHB.

Gender Variations in the Psychological Factors as Defined by the Theory of Planned of Oral Hygiene Behaviors

Oral self-care practice is an effective preventive measure for maintaining good individual oral health which is an integral part of one's general health. The aim of this analysis was to investigate gender differences in the psychological factors defined by the Theory of Planned Behavior applied to oral hygiene behavior (OHB). For males only attitudes were important determinants of intention to improve OHB, whereas among females were relevant also social related aspects as social norms, perceived difficulty and perceived control. Insight in gender variations in the psychological determinants of OHB is relevant to refine preventive approaches to modify OHB for male and women in the desired direction.

The Differential Weight of Factors for Estimation of Individual Oral Health Index

The Differential Weight of Factors for Estimation of Individual Oral Health Index

군인 흡연자와 비흡연자의 구강환경변화와 구강건강에 대한 인식

Objectives : The purpose of this study was to investigate the awareness towards oral health environmental changes and oral health in smokers and non-smokers in soldiers. Methods : Data were obtained from 350 soldiers serving at Unit M in Gwangju and Gyeonggi-do and ROTC candidates at University Y in Gyeonggi-do from April 28 to May 5, 2013. Collected data were analyzed by SPSS 12.0 program and a significant level was set at 0.05. Results : Non-smokers had more knowledge on tooth staining or gum diseases than smokers(p<0.05). The awareness towards the causes of oral cancer was not much different between the smokers and the non-smokers. The soldiers having dental health education tended to smoke less than those who had no education(p<0.05). The awareness towards individual oral health revealed no difference between the smokers and the non-smokers. Non-smokers had higher subjective knowledge on of the importance of the oral health, smoking influence on the oral health, and secondhand smoking impact on the health(p<0.05). Conclusions : The oral health education by the dental hygienists is very important in the military camps. Non-smokers tended to have higher knowledge on oral health than the non-smokers.

Dental neglect among college going adolescents in Virajpet, India

Introduction: Dental neglect (DN) has been defined as behavior and attitudes which are likely to have detrimental consequences for the individual's oral health, or more specifically as failure to take precautions to maintain oral health, failure to obtain needed dental care, and physical neglect of the oral cavity. Aim: The aim was to assess the association of DN with dental caries and oral hygiene among adolescents in Virajpet, India. Materials and Methods: A total of six hundred adolescents aged 15-18 years were selected. DN was recorded using self-administered questionnaire. Oral health status was clinically assessed using simplified oral hygiene index (OHI-S) and dental caries through dentition status as per WHO criteria. Results: The mean DN score for this population was 10.18. Sociodemographic variables and Dental Attendance pattern were significantly associated with DN. Mean decayed missing filled value and OHI-S values were also significantly associated with DN. Conclusion: The present study revealed that variations in DN exist in relation to sociodemographic characteristics and pattern of dental attendance. In addition, oral health status was significantly associated with DN among adolescents.

Additive Interaction of Oral Health Disorders on Risk of Hypertension in a Japanese Urban Population: The Suita Study

This study assessed the relationship between different oral health markers-periodontitis, gingival bleeding, tooth number, and occlusal status-and hypertension in a Japanese urban population. A total of 1,643 participants with no prior cardiovascular disease (mean age = 66.6 years; 43.4% women) underwent comprehensive health checkups, including a lifestyle questionnaire and dental examination in the Suita Study. In the multivariable-adjusted logistic model, none of the individual oral health markers, namely severe periodontitis, gingival bleeding, lowest quartile of tooth number, and malocclusion, were significantly associated with increased odds of hypertension. The additive effects of oral health markers on hypertension were examined and showed that, compared with subjects with no component of the oral health markers, the multivariale-adjusted odds ratio of hypertension in those with ≥3 components was 1.82 (95% confidence interval (CI) = 1.23-2.72; P = 0.003). In the subpopulation without antihypertensive medication (n = 1,148; 59.8% women), a significant graded relationship between multivariable-adjusted systolic blood pressure and the number of components was found (P trend = 0.03), and, compared with subjects with no component of the oral health markers, having ≥3 components was related to a higher systolic blood pressure (β = 5.41; 95% CI = 1.16-9.66; P = 0.01). There is an additive relationship between oral health disorders and risk of hypertension. Our results suggest that the existence of moderate or severe oral health disorders-that is, several concomitant oral health disorders-is associated with risk of hypertension.

A new indicator of the oral hygiene habits of disabled persons: relevance of the carer's personal appearance and interest in oral health

To investigate whether there is a relationship between the oral hygiene habits of individuals with severe disability the carer's personal appearance and interest in oral health. The study group was formed of 60 disabled persons and their respective carers who came for the first time to consultation in the Special-Needs Dentistry Unit of the University of Santiago de Compostela, Spain. All the carers answered a standardised questionnaire of 28 questions divided into four sections: disabled individual's demographic data, disabled individual's general medical details, social aspects of the carer (personal appearance of the carer and interest in oral health), and disabled individual's oral hygiene habits. The personal appearance of the carers and their interest in the disabled individual's oral health were evaluated using independent scales designed specifically for the study, with five binary items in each scale. The carer's personal appearance and interest in the disabled individual's oral health showed a statistically significant relationship with the individual's oral hygiene habits, particularly with respect to the frequency and duration of toothbrushing, need for physical restraint during toothbrushing, use of a manual toothbrush and use of toothpaste. The carer's personal appearance and interest in the disabled individual's oral health are good indicators of the oral hygiene habits of an individual with severe disability. Consideration should be given to the inclusion of these aspects as a complementary element of the dental record.

Oral health problems and mortality

Background/purposePrevious studies have shown the relationship between individual oral health conditions and mortality; however, the relationship between mortality and multiple oral health conditions has not been examined. This study investigates the link between individual oral health problems and oral comorbidity and mortality risk. Materials and methodsData are derived from the National Health and Nutrition Examination Survey 1999–2004, which is linked to the National Death Index for mortality follow-up through 2006. We estimated the risk of mortality among people with three individual oral health conditions—tooth loss, root caries, and periodontitis as well as with oral comorbidity—or having all three conditions. ResultsSignificant tooth loss, root caries, and periodontal disease were associated with increased odds of dying. The relationship between oral health conditions and mortality disappeared when controlling for sociodemographic, health, and/or health behavioral indicators. Having multiple oral health problems was associated with an even higher rate of mortality. ConclusionIndividual oral health conditions—tooth loss, root caries, and periodontal disease—were not related to mortality when sociodemographic, health, and/or health behavioral factors were considered, and there was no differential pattern between the three conditions. Multiple oral health problems were associated with a higher risk of dying.

Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren

The dynamic properties of molar-incisor-hypomineralisation lesions (MIH) may impact negatively on personal daily oral care resulting in increased treatment needs. To describe and compare individual oral health care practices between MIH-affected and non-affected children, to evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars, and to explore the role of reported fluoride exposure in the development of MIH. A cluster sample of 7-9 year-old Iraqi schoolchildren (823 of 1000 eligible, response rate 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Of these 153 were diagnosed with the defect and were referred to as MIH-affected children. Mothers of the participating children were asked to complete an oral health-questionnaire administered at schools. This included questions regarding child's history of dental visits, fluoride intake and the pattern of oral hygiene practices. Assessment of the dental treatment requirements for the first permanent molars was performed in a sample subset drawn from a larger data set of affected children (n=100) having their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System. The sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. Of the total sample, approximately 71% of parents had taken their children to the dentist at some stage. For the total sample, tooth restoration or extraction was the most likely causes for seeking dental care at the first dental appointment (57.9%). Tap water was the main source of water consumed at home by the majority of children (77.8%). The prevalence of dental caries and tooth restorations was higher in hypomineralised affected molars (78.5%) than in the defect-free molars (33.7%). MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts (82.4%, 68.2%; respectively). They were over three times (OR = 3.18) more likely to visit the dentist complaining of pain and were over six times (OR = 6.37) more likely to seek dental care due to tooth sensitivity than their non-affected peers. No significant differences were found between the study groups in terms of tooth brushing and toothpaste history with brushing frequency "once-a-day" was commonly reported in both groups (75.5%). Early exposure to fluoridated water appeared to have a protective effect for MIH (OR=0.38). Affected molars required more than twice the amount of restorative care than unaffected molars. MIH did not seem to have an impact on the personal daily oral hygiene practices; however, MIH patients were commonly seeking dental consultation and needed care more often to improve their oral health.

Family history and oral health: findings from the Dunedin Study.

The effects of the oral health status of one generation on that of the next within families are unclear. To determine whether parental oral health history is a risk factor for oral disease. Oral examination and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial-risk groups for caries/tooth loss (high risk and low risk) based on parents' self-reported history of tooth loss at the age-32 assessment interview. Probands' dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5-32). Caries/tooth loss risk analysis was conducted for 640 proband-parent groups. Reference groups were the low-familial-risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio-economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high-familial-risk group was 1.41 [95% confidence interval (CI) 1.05, 1.88] and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high-familial-risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents' oral health. Nonetheless, when information was available for one parent only, associations were significant for some outcomes. People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual's oral health status. Associations are strongest when data from both parents can be obtained.

Residential Rurality and Oral Health Disparities: Influences of Contextual and Individual Factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.

Calibration of self-reported oral health to clinically determined standards.

Self-report of oral health is an inexpensive approach to assessing an individual's oral health status, but it is heavily influenced by personal views and usually differs from that of clinically determined oral health status. To assist researchers and clinicians in estimating oral health self-report, we summarize clinically determined oral health measures that can objectively measure oral health and evaluate the discrepancies between self-reported and clinically determined oral health status. We test hypotheses of trends across covariates, thereby creating optimal calibration models and tools that can adjust self-reported oral health to clinically determined standards. Using National Health and Nutrition Examination Survey (NHANES) data, we examined the discrepancy between self-reported and clinically determined oral health. We evaluated the relationship between the degree of this discrepancy and possible factors contributing to this discrepancy, such as patient characteristics and general health condition. We used a regression approach to develop calibration models for self-reported oral health. The relationship between self-reported and clinically determined oral health is complex. Generally, there is a discrepancy between the two that can best be calibrated by a model that includes general health condition, number of times a person has received health care, gender, age, education, and income. The model we developed can be used to calibrate and adjust self-reported oral health status to that of clinically determined standards and for oral health screening of large populations in federal, state, and local programs, enabling great savings in resources used in dental care.

Summary of: Evaluation of in vivo denture plaque assessment methods

Background Measurement and assessment of denture plaque can provide valuable information regarding an individual's oral health status and assessment of new treatments or products. Current methods tend to rely on subjective indices or image analysis derived planimetric (area measurement) assessment of stained plaque on dentures. Plaque indices are most commonly used to assess plaque coverage without image capture. This is not ideal because the methods are subjective, examiner bias may occur, there is no reproducibility between studies, the methods have lower accuracy and sensitivity than image analysis, and there is no record. To the authors' knowledge, no standardised published method of denture plaque assessment is currently employed for product development and testing. Method In this study visual and planimetric plaque assessment methods were compared using reference dentures. In addition, an in vivo study compared these methods for evaluating denture cleanser efficacy. Results and conclusions The results show that blinded image scoring is more representative of the true plaque area coverage than 'live' denture scoring, detecting significant decreases in plaque coverage. Planimetric analysis provides a more sensitive and less subjective technique with greater differentiation between treatments. However, analysis is very time consuming. Thus, a number of recommendations are made regarding quantification of denture plaque for the assessment of cleanser products.

Evaluation of in vivo denture plaque assessment methods

Measurement and assessment of denture plaque can provide valuable information regarding an individual's oral health status and assessment of new treatments or products. Current methods tend to rely on subjective indices or image analysis derived planimetric (area measurement) assessment of stained plaque on dentures. Plaque indices are most commonly used to assess plaque coverage without image capture. This is not ideal because the methods are subjective, examiner bias may occur, there is no reproducibility between studies, the methods have lower accuracy and sensitivity than image analysis, and there is no record. To the authors' knowledge, no standardised published method of denture plaque assessment is currently employed for product development and testing. In this study visual and planimetric plaque assessment methods were compared using reference dentures. In addition, an in vivo study compared these methods for evaluating denture cleanser efficacy. The results show that blinded image scoring is more representative of the true plaque area coverage than 'live' denture scoring, detecting significant decreases in plaque coverage. Planimetric analysis provides a more sensitive and less subjective technique with greater differentiation between treatments. However, analysis is very time consuming. Thus, a number of recommendations are made regarding quantification of denture plaque for the assessment of cleanser products.

Models for individual oral health promotion and their effectiveness: a systematic review

There is a recognized need to deliver oral health information to people during clinical encounters to enable them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health education have been shown to be largely ineffective and new approaches are required to address personal motivations for preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for individual oral health promotion. Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that met the inclusion criteria. Thirty-two studies were identified in the fields of clinical prevention and health education, motivational interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective method for altering health behaviours in a clinical setting. There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the MI approach within the oral health field.

"Six-month recall dental appointments, for all children, are (un)justifiable"

Each child is an individual with specific needs, which necessitates a different plan of management based on the type of oral disease or disability present. This raises a question as to whether the customary fixed six-month recall visits for children commonly advocated by dental professionals need to be altered/adjusted so as to reflect the individual's oral health needs more closely, in order to optimize their clinical and cost-effectiveness. This paper provides a comprehensive review of the evidence to either justify or refute the six-month recall dental appointments for all children. Based on the available evidence, we conclude that the judgment about appropriate intervals should be made by the dental practitioner on an individual risk basis as insufficient evidence exists to either justify, or refute the six-month recall dental appointments.

Comprehensive dental treatment of a patient with Huntington's disease: literature review and case report

Huntington's disease is an inherited neurodegenerative disorder for which there is no cure. Because of the physical impairment and medication side effects, these patients can experience extensive oral disease. A patient presented to the dental clinic with complaints of oral pain and an inability to chew due to extensive caries and periodontal disease. General anesthesia was required to treat his oral problem due to the patient's disease-associated uncontrolled movements, psychological status, and extensive oral disease. As varying anesthesia techniques have been recommended for patients with Huntington's disease, medical consultation was important to restore this individual's oral health.

Prevalence and distribution of odontogenic cysts in Sicily: 1986 - 2005

The objective of this study was to assess the prevalence of odontogenic cysts (OCs) in Sicily and evaluate their distribution during a 20-year period. A cross-sectional retrospective study was carried out in 1,310 cysts of the jaw diagnosed in 12,197 individuals, who consecutively attended the Odontostomatologic Clinic of Palermo from 1986 to 2005. 1,273 cysts were classified as odontogenic, whereas only 37 were non-odontogenic. In the former group, the most frequent lesions were radicular cysts (84.5%), followed by dentigerous OCs (11.4%). Inflammatory radicular cysts were observed more in male gender, younger age at diagnosis and anterior maxilla as site of presentation. Unlike dentigerous cysts, the frequency of radicular cysts decreased from 10.4% in 1986-1995 to about 8% in 1996-2005 (P < 0.0001). Inflammatory radicular cysts are the most represented group among OCs in our area with a higher prevalence than that reported in other countries. The decreasing epidemiologic trend with time could be attributed to the possible changes in individual oral health behavior.

The influence of oral hygiene on salivary quality in the Ames Test, as a marker for genotoxic effects

Squamous cell carcinomas of the upper aerodigestive tract are a global health-political challenge. Accordingly, current research efforts are aimed towards the opportunities for early recognition of risk patients, and at the recognition of risk factors related to carcinogenesis. We determined the revertant number of the variety Salmonella typhimurium TA 98 and TA 100 after incubation, with saliva samples from 100 probands as a measure of a genotoxic environment within the oral cavity, depending on the dental status as measure of oral health. Beside chronic alcohol (p=0.032) and tobacco consumption (p<0.001), the dental status displayed in partial aspects (high plaque index, high number of decayed teeth, prosthetically not rehabilitated status, p <or= 0.050) a significant connection with the genotoxic salivary activity. The periodontal status and the type of restorative filling material, as well as dental prostheses, however, had no important influence on the revertant number (p >or= 0.104). Therefore, it can be concluded that the polymicrobial supragingival plaque, as a possible independent factor, possesses a relevant mutagenic interaction with saliva, and that individual oral health is a co-factor in the development of carcinomas in the oral cavity.