National Dental Health Research Articles

Oral streptococcal infective endocarditis among individuals at high risk following dental treatment: a nested case-crossover and case-control study

It is not clear whether Viridans Group Streptococcal Infective Endocarditis (VGS-IE) among individuals at high risk is more frequent following bacteraemia caused by invasive dental procedures (IDPs) than after daily bacteraemia caused by chewing and tooth brushing. The aim of this nested study was to assess if VGS-IE was temporally associated with IDPs in a national cohort of individuals at high risk. This nested case-control and case-crossover study was based on a Swedish national cohort study of 76,762 individuals at high risk of IE due to complex congenital heart disease, prosthetic heart valve or previous IE. Participants were living in Sweden between July 1st, 2008 and January 1st, 2018. The frequency of IDPs during the 3 months before VGS-IE was calculated and compared to controls (sampled 1:10). A case-crossover study was conducted to account for residual confounders. Participants were identified using the national patient register, and IDPs were identified using the national dental health register. 98,247 IDPs were carried out in the cohort during the study period: 624 occasions of oral surgery, 44,190 extractions and 53,433 sessions of subgingival scaling. The study could not confirm that IDPs were more common among cases (4.6%) than controls (4.1%), OR=1.22 [95% Confidence Interval (CI) 0.64-2.3], or during case- (3.3%) than reference periods (3.8%), OR=0.89 [95% CI: 0.68-1.17]. Restricting the analysis to the period when cessation of antibiotic prophylaxis for the prevention of IE in Swedish dentistry was recommended, from the 1st of October 2012 to the 1st of January 2018, did not alter the results of the case-control study: OR 0.64, 95% CI: 0.20-2.09, or the case-crossover study: OR 0.58, 95% CI: 0.15-2.19. The study could not confirm that VGS-IE is associated with IDPs among individuals at high risk. A study with larger sample size could clarify whether there is a lack of association. The finding of a small (<5%) proportion of cases temporally associated with IDPs is similar to that of the previous large-scale study on IDPs and VGS-IE. Funding was provided by the Board of doctoral education at Karolinska Institutet, the Public Health Agency of Sweden, Folktandvården Stockholm AB, Steering Group for Collaborative Odontological Research at Karolinska Institutet and Stockholm City County, and the Swedish Dental Association.

Association of Nationwide Water Fluoridation, changes in dental care legislation, and caries-related treatment needs: A 9-year record-based cross-sectional study

ObjectivesThe implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. MethodsThis cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. ResultsA multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. ConclusionMandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. Clinical significanceOur findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

Выбор лечебных материалов в качестве корневого наполнителя среди биоактивных силеров (обзор литературы)

According to WHO (2012), Russian and foreign researchers data, prevalence rate of dental diseases among children reaches 75–95 %, among adults – 100 %, and in age groups above 35 years old, dental and mouth cavity problems become the primary concern. Despite intensification of the sanitation process in clinical dentistry, many researchers note the tendency of decrease in national dental health. Dealing with such an important medical-social goal as radical decrease of dental illnesses is in the area of complex approach not only to realization of sanitation-prophylaxis measures, but also in using novel ideas in dental services. The problems of legal regulations and administrative management of dental clinics in new economic conditions are key priority areas for the modern Russian medical industry. Rapid development of medical services market, improvement medical insurance services, providing more freedom for medical organizations in implementation of its activities marked the significance of search for more effective mechanisms of dental clinics work organization, focused on dental services improvement. High quality medical care should provide financial-economy and medical-social efficacy of healthcare development programs, determined to improve population quality and duration of life. Herewith, currently there are no unified criteria to determine medical care quality in Russia and abroad. The expediency to perform independent medical expertise of performed dental services is beyond dispute. Objectification of final treatment result evaluation is possible only when the patient medical condition data is available, determination of causal relationships between medical personnel actions and their consequences for the health of a citizen.

Prevalence of Periodontitis in Patients with Established Rheumatoid Arthritis: A Swedish Population Based Case-Control Study.

IntroductionThe possible hypothesis of a link between periodontitis and rheumatoid arthritis (RA), specifically anti-citrullinated protein antibody (ACPA) positive RA, prompted us to investigate the prevalence of periodontitis in the Swedish Epidemiological Investigation of RA (EIRA), a well-characterised population-based RA case-control cohort.MethodsPeriodontal status of 2,740 RA cases and 3,942 matched controls was retrieved through linking EIRA with the National Dental Health Registry (DHR), where dental diagnostic- and treatment codes on the adult Swedish population have been registered. Dental records from 100 cases and controls were reviewed to validate the periodontal diagnostic codes in DHR.ResultsThe reviewed dental records confirmed 90% of the periodontitis diagnoses in DHR among RA cases, and 88% among controls. We found the positive predictive value of periodontitis diagnoses in the DHR to be 89% (95% CI 78 to 95%) with a sensitivity of 77% (95% CI: 65 to 86%). In total, 86% of EIRA participants were identified in DHR. The risk for periodontitis increased by age and current smoking status in both cases as well as controls. No significant differences in prevalence of periodontal disease in terms of gingivitis, periodontitis, peri-implantitis or increased risk for periodontitis or peri-implantitis were observed between RA cases and controls. In addition, there was no difference on the basis of seropositivity, ACPA or rheumatoid factor (RF), among patients with RA.ConclusionsOur data verify that smoking and ageing are risk factors for periodontitis, both in RA and controls. We found no evidence of an increased prevalence of periodontitis in patients with established RA compared to healthy controls, and no differences based on ACPA or RF status among RA subjects.

저소득층 노인의 의치만족도에 영향을 미치는 요인

Objectives: The purpose of this study was to investigate the factors influencing on the denture satisfaction in the low income elderly people. Methods: The subjects were 143 elderly people from 60 to 75 years old wearing dentures and receiving consistent follow-up in the public health center in Busan. A self-reported questionnaire was filled out by the elderly people from February 1 to March 1, 2013. The questionnaire consisted of denture satisfaction, social variables, and psychological variables. Data were analyzed by ANOVA and multiple regression analysis using SPSS 18.0. The sociodemographic characteristics included gender, age, and chronic diseases. The recognition of oral health included pronunciation, denture maintenance, mastication ability, and education for denture care. The questionnaire was measured by Likert 5 scale. Results: Gender, chronic disease, denture care instructions, and the self-preception of the oral health after denture treatment were closely correlated with denture satisfaction(p<0.001). Age and the number of repairs were very important factor to denture satisfaction(p<0.05). Elderly women were more satisfied with denture than men and those who had no chronic diseases tended to be more satisfied with denture. Those who received oral care instructions were more satisfied with the denture than those who did not. The younger age group and no repairing prosthetic group tended to be more satisfied with the denture. Conclusions: It is important to provide the denture management services to the low income elderly when they demand the services. The national dental health policy must be focused on connection of the elderly people denture services with the public health center.

Dental health and treatment needs in people with leprosy in China

To evaluate the dental health status and treatment needs of people affected by leprosy in China, and provide a basis for the development of national or regional dental health programmes to cover the treatment needs of this population. A cross-sectional study with 613 former leprosy patients was carried out in six leprosy villages, in three provinces in China (Nanjing, Taixing and Jiangyan in Jiangsu Province, Hanzhong and Shangluo in Shanxi Province and Yongzhou in Hunan Province). A questionnaire about demographic and clinical data was used. The World Health Organization's (WHO) basic methods were used to determine the tooth-based treatment needs. Periodontal status was determined by using the Community Periodontal Index of Treatment Needs (CPITN). In addition, prosthetic normative needs were assessed. Among the 613 people affected by leprosy, there were 472 people (77%) who had never visited a dentist and 172 people (28.1%) had never brushed their teeth; 302 (49.3%) brushed their teeth once a day. However, there were 267 people (43.6%) who thought their dental health was at an average level and 108 (17.6%) thought they had good dental health. 55.6% of the subjects required dental fillings, 32.7% required pulp care and restoration, and 71.1% required extraction. On CPITN, 23.2% of the subjects scored 2, 28.6% scored three and 48.0% scored four, showing that these people required systematic periodontal treatment. In addition, 84.5% of the subjects needed normative prosthetic treatment. Most of the subjects with leprosy in this study lacked self-care knowledge on dental health, and especially self-awareness of dental conditions. Normative treatment needs of people affected by leprosy were very high. This result calls for improved oral health education and oral health care in people with leprosy. Oral health education might preferably be integrated into already existing leprosy rehabilitation programs.

A Review of Indonesia’s Dental Health - Past, Present and Future

Access to dental health care markedly improves citizens’ dental health status, which in turn improves the national quality of life. This paper aims to review the literatures of the Indonesian Dental Health. All of the related factors that influence dental health were described from 1995 to 2013. Economic and geographic barriers to access dental care still exist in Indonesia. Periodic evaluation on government policy is essential to develop an adequate dental health care system, which then could improve outcomes of the national dental health status.

Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis.

This study assessed trends in social inequalities in tooth loss in the United Kingdom between 1988 and 2009. Data from 20,126 adults who participated in the latest three national Adult Dental Health Surveys in England, Wales and Northern Ireland were used. Social class was determined using the 6-point Registrar General’s Social Class. Three indicators of tooth loss were analysed; the proportion of edentate people among all adults and the number of teeth and the proportion with functional dentition (defined as having 20+ teeth) among dentate adults. Trends were modelled within an age, period and cohort framework using partial least squares regression (PLSR). Confidence intervals for PLSR estimates were obtained using non-parametric bootstrapping. The Slope and Relative Index of Inequality (SII and RII) were used to quantify social inequalities in tooth loss. Between 1988 and 2009, absolute inequalities in total tooth loss narrowed (SII changed from −28.4% to −15.3%) while relative inequalities widened (RII from 6.21 to 20.9) in the whole population. On the other hand, absolute and relative social inequality in tooth loss remained fairly stable over time among dentate adults. There was an absolute difference of 2.5–2.9 in number of teeth and 22–26% in the proportion with functional dentition between the lowest and highest social classes. In relative terms, the highest social class had 10–11% more teeth and 25–28% higher probability of having functional dentition than the lowest social class. The findings show pervasive inequalities in tooth loss by social class among British adults despite marked improvements in tooth retention in recent years and generations. In the whole adult population, absolute inequalities in tooth loss have narrowed while relative inequalities have increased steadily. Among dentate adults, absolute and relative inequalities in number of teeth and proportion of people with functional dentition have remained significant but unchanged over time.

Perceptions and behaviors of dental practitioners with regard to the National Health Insurance

Objectives: The present study aimed to examine the perceptions and behaviors of dentists regarding the National Dental Health Insurance, and their opinions for improving its policies. Methods: A self-report survey was conducted with 1,321 dentists selected from the Alumni Association of the W University College of Dentistry. We finally recovered and analyzed 243 questionnaires, excluding those returned with insincere answers. Results: Only 40.3% of the practitioners recorded the disease name, 12.8% of medical records were unrecorded, and 54.5% of the respondents did not receive the expenses borne by the principal. In addition, 14.0% of the practitioners had administrative dispositions or had been penalized with surcharge, and 74.6% of the respondents stated that dental care benefits should be expanded. Further, 92.2% of the respondents agreed that a course on dental health insurance should be offered at the university. Additionally, 80.6% of the participants stated that they were willing to participate in supplementary training programs that emphasize on dental health insurance. If supplementary training programs were to take place, 46.0% of the participants reported that they preferred courses that focused on dental health insurance in general, and 22.2% reported that they should focus on the decrease in health insurance. Finally, participants reported that insurance claims for each department had reduced for periodontal treatment (70.7%), other treatments (15.7%), and endodontic treatment (9.6%). Conclusions: It is necessary for dental practitioners to be educated on the National Health Insurance, in general, as well as on insurance claims.

Analysis of the attitudes and needs/demands of dental practitioners in the field of patient safety and risk management

Patient safety is a relatively new discipline aimed at improving the quality of care, minimising treatment errors and improving the safety of patients. Although health professions always have a specific concern for patient safety, few practitioners have a clear understanding of the broad context and not all health-care providers practice it. This might well be because of limited availability of information and materials as well as a lack of national or international laws and regulations. Thus, through member National Dental Associations (NDAs) of FDI (World Dental Federation), the present study aimed at analysing the attitudes of dental practitioners to the issues of patient safety and risk management, and the availability of materials and laws and regulations. Determination of their specific needs and demands in these fields was also attempted. For this purpose, an online questionnaire was developed for the member NDAs to respond. Questions mainly focused on the awareness regarding patient safety, availability of materials and regulations and the particular topics for which dentists needed further knowledge and information. A total of 40 responses were received. While some countries lack any documents, patient safety documents and materials were available in some countries but they were mostly limited to infection control and radiation protection and did not address other important aspects of patient safety. The NDAs clearly demanded more information. A significant number of countries also lacked national laws and/or regulations regarding patient safety. Although dentistry always has a genuine concern for patient safety, the findings of the survey suggest that yet more efforts are needed to improve the knowledge, understanding and awareness of dental practitioners regarding its broad context and the relatively 'new' patient safety culture. NDAs, dental educators, national, regional and international dental organisations and health authorities all can play significant roles to achieve these goals.

도시와 농어촌지역 중·고등학생의 구강건강인식 및 구강보건 의식행태 비교연구

A comparative study of the dental health perception and dental health behaviors among 12,325 middle and high school students in urban and rural areas was conducted by using "2010 National Dental Health Investigation". The results of this study are as follows. For the dental health perception and the utilization of dental service, all middle and high school students had a low perception of the their dental health status toward the farming and fishing regions from the urban. For the time of tooth-brushing among the dental health behaviors, most middle and high school students brushed their teeth after lunch. In connection with the frequency of cariogenic snack intake, high school students had a greater percentage toward the farming and fishing regions from the urban. For the dental health status, middle school students in big cities had a high average of carious permanent teeth, but high school students had a high average of carious permanent teeth toward the farming and fishing regions from the urban. In other words, there was no significant difference in missing permanent teeth, filling permanent teeth and decay permanent teeth between middle school students by region, but high school students had a greater percentage of the dental health perception and dental health behaviors toward the farming and fishing regions from the urban, showing a little difference. Consequently, there was a relationship between middle and high school students' perception of dental health and their behaviors of dental health.

Changes in problem‐based and routine‐based healthcare attendance: a comparison of three national dental health surveys

Healthcare utilization either may be guided by a preventive orientation leading to regular visits to the doctor, or it may be triggered by impaired health. Using data from three German national surveys, we wanted to examine whether the effects of income on the utilization of dental health services increased over time owing to the considerable decrease in insurance coverage over the years and the increase in higher out-of-pocket costs from patients. Data from three national dental health surveys (1989, 1997 and 2005) were used. The data of all respondents aged between 35 and 44 years were available, and the number of caries-free and unrestored healthy teeth was used as outcome. Over the years, the proportion of routine attenders increased considerably, and the dental health measure used indicates the improvement. The least educated respondents and those with the lowest income profited less than other groups. In spite of higher copayments, the effects of income on the utilization of dental care did not increase over time. Regarding the results of education, a significant effect was only found in the study from 2005. No clear differences between routine- and problem-oriented attenders emerged with respect to the dental health measure chosen. Material conditions and education had effects on utilization behaviour. Contrary to expectation, increasing copayments did not yield higher effects of income on healthcare utilization.

Self-Reported Oral Health Status of Adults Resident in Medway, Kent in 2009

In order to assess the oral health status, oral behaviours and use of oral healthcare services of the adult population of Medway (Kent) in 2009, NHS Medway commissioned an assessment. Its aims were to understand oral health and impacts, behaviours and the use of dental services in order to inform future development of dental services. A self-reported postal questionnaire survey using relevant questions from the 1998 national Adult Dental Health Survey (ADHS) was performed. A stratified sample was drawn from all those aged 16 years and over, living in Medway and registered with a general medical practice. Stratification was into the three areas within Medway (Chatham, Gillingham and Rainham, and Rochester and Strood). Where appropriate, respondents answered the questions using a five-point Likert scale. The resulting data were analysed by area of domicile, age, gender, and deprivation. Eight thousand questionnaires were sent out, of which 3101 (39%) were returned. Because of this low response and the need to weight responses to represent the distribution of the Medway population, this investigation must be considered as a service evaluation rather than a research project. Of respondents, 4% were edentate, 16% had 1-20 teeth, and 80% had 21 or more teeth. Fifty-one per cent of respondents reported at least one oral health impact; most commonly this was physical pain and psychological discomfort; least commonly, social disability and handicap. Sixteen per cent reported that their last dental visit was over 24 months ago and 31% reported that they attended only when in trouble or never (most commonly, because of anxiety and cost). There were marked variations in oral health status and use of dental services between those living in the most and least deprived areas. • Medway adults were more likely than the 2009 national ADHS respondents to be dentate but less likely to have 21 or more teeth. •Oral health impacts have been substantial, especially the experience of physical pain. •Proportionately more people than the 2009 national ADHS respondents reported attending a dentist in the previous 24 months. The most common reasons for non-attendance were anxiety and cost. •These findings have implications for the future development of the Medway oral health strategy and for all those working in primary care dentistry.

POLÍTICA NACIONAL DE SAÚDE BUCAL: ACESSIBILIDADE E UTILIZAÇÃO DE SERVIÇOS ODONTOLÓGICOS ESPECIALIZADOS EM UM MUNICÍPIO DE MÉDIO PORTE NA BAHIA

A atual Política de Saúde Bucal no Brasil tem ampliado a oferta de ações especializadas em odontologia. O presente estudo avaliou a oferta, utilização e acesso dos usuários a esse serviço em um município de médio porte na Bahia. Este foi um estudo de corte transversal por meio de entrevista estruturada junto aos usuários e análise de dados secundários. O estudo revelou que a maioria dos usuários fez/está fazendo tratamento odontológico na atenção básica (61,0%). A análise bivariada apontou para diferenças significantes entre o tipo de procedimento especializado e a integralidade na atenção básica (p=0,009), entre o tipo de procedimento e o tempo para agendamento (p=0,004) e a faixa etária do usuário (p=0,000), sendo a integralidade menor entre adultos em busca de prótese. O tempo de agendamento da primeira consulta variou entre as especialidades, mas 44,5% dos usuários conseguiram agendar para até 15 dias. A taxa de utilização do serviço foi muito baixa para a endodontia e a cirurgia oral menor (16,1% e 26,5%, respectivamente). Recomenda-se a adoção de um sistema de gestão de metas por especialidade para aumentar a taxa de utilização do serviço e reduzir a principal barreira organizacional identificada, que foi a dissociação entre a oferta potencial e a utilização.

SP1-48 Reductions in dental caries in 3-year-old children in greater Glasgow and Clyde

The objective of this study was to examine dental inspection data from 3-year-old children in Greater Glasgow and Clyde, Scotland, over 4 years to assess oral health trends during a...

치과 무면허 불법시술 경험 패턴 연구 : 2006 국민 구강건강 실태조사 자료

Abstract In this study, the patterns of people who get dental services from unqualified dental practitioners were identified by using 2006 National Dental Health Investigation. There were 4,543 people in total and the group was divided into two groups - those who had experience of receiving dental services from unqualified practitioners and of those who had not. The most pattern model was CHAID. It was patterned that 39% of those who are more than 68 years would experience such unqualified dental service, and it was found that 3% of those who are less than 33 years experienced such a service. It was found that 45% of those who are 55 or 68 years and woman would experience such unqualified dental service, and 32% of those who are 55 or 68 years and man experienced such a service. With the increase in health awareness, the burden of medical bills is also rising. However, cases of unqualified dental treatments that could cause extremely dangerous symptoms are also rising recently. Therefore it is most important to anticipate those groups who are most exposed to unqualified dental services, and educate them with appropriate information and publicise about the danger.

Household Expenditure in Dental Health Care: National Estimations in Mexico for 2000, 2002, and 2004

To estimate the expenditure on dental care of Mexican households, analyze their trends, and determine the factors associated with the decision to spend and the amount of money spent in 2000, 2002, and 2004. Using the National Survey of Household Income and Expenditure for 2000, 2002, and 2004, the national dental health care expenditure was calculated. To facilitate comparability across years, all expenditure was converted to pesos of 2004, using the National Consumer Price Index (11.201 pesos per USD). Proportion of households incurring catastrophic expenditures was also estimated. To evaluate the association between environmental, household, and individual characteristics with the amount of dental health care expenditure, the Heckman regression model was used to control for self-selection bias. More than 6,467 million pesos (MP) were spent in 2000 (8.5 percent of all households had some expenditure), over 3,925 MP in 2002 (4 percent households), and above 5,136 MP in 2004 (5 percent households), with an average expenditure of $806, $1,000, and $987 pesos, respectively. Prevalence of catastrophic expenditure because of dental health care was 0.8 percent in 2000 compared to 0.01 and 1.8 percent in 2002 and 2004, respectively. The Heckman model showed that municipal development, stratum, and age of the head of household significantly influenced the amount spent on dental care in all 3 years. Household capacity to pay and wealth index had a positive and statistically significant association in the 3 years with the preceding decision to spend. Variables associated with the amount of expenditure and the decision of spending support the existence of inequities in health care financing in the Mexican population.

The orthodontic condition of children in the United Kingdom, 2003

The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys in the United Kingdom. This paper reports on the orthodontic condition of children aged 12 and 15 years. A representative sample of children across the UK were invited to participate in a clinical dental examination in school. Two thousand, five hundred and ninety-five 12-year-olds and 2,142 15-year-olds were examined. Current and past orthodontic treatment and type of appliance worn were recorded. Orthodontic treatment need was assessed by the Modified IOTN in those not undergoing treatment. A postal questionnaire sought parents' views on the orthodontic condition of their children and perceived need for treatment. At age 12, 35% were judged to have an orthodontic treatment need, 57% had no need and 8% were wearing an appliance. The corresponding figures at age 15 were, 21% (need), 65% (no need) and 14% (wearing appliance). A higher proportion of girls (p < 0.05) were wearing an appliance than boys. A greater proportion of 15-year-olds were undergoing treatment than in the 1993 and 1983 surveys and the use of fixed appliances had increased. In this representative sample of UK children, one in five were still judged as having an orthodontic treatment need at age 15 years, as determined by the modified index of orthodontic treatment need. However, considerable variation was observed between professional and lay perceptions of need.

The reported impact of oral condition on children in the United Kingdom, 2003

The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys of the United Kingdom. This paper is concerned with how children are reported to have been affected by their oral condition during the 12 month period immediately preceding the survey and how this relates to the children's experience of caries, their dental attendance behaviour and their social class. The information was gathered by self-completion questionnaire distributed to the parents of half of the sample who were clinically examined in the dental survey. Some form of impact was reported by the parents of 22% of five-year-olds, 26% of eight-year-olds, 34% of 12-year-olds and 28% of 15-year-olds. The pattern of responses to the eight impact questions was broadly similar across age groups. The most frequently reported type of impact was pain in all age groups. Impacts on oral function, self-confidence, orally related activity and on the child's emotions were experienced by 4-10% of children of all ages. Fewer children (1-2%) were reported to have experienced more far reaching impacts affecting their social functioning, general health and life overall. Most children were reported not to have experienced any of the problems covered by the questionnaire. Of those who did, most reported a single problem and for most this was pain. Nevertheless there was a group of children for whom oral function, self-confidence, orally related activity, emotions, social functioning, their health or their life in general were reported to have been affected by their oral condition. The nature of dental care which is appropriate for such children needs to be determined.

Oral health habits amongst children in the United Kingdom in 2003

The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys. This paper presents data on parental attitudes towards the care of children's teeth and gums, reported oral hygiene behaviours and clinical measures of hygiene and periodontal health in 2003 and highlights trends since previous surveys. A total of 10,381 children were examined in schools by trained and calibrated examiners. Four measures of hygiene and periodontal health were recorded as part of the clinical examination. In addition, 3,342 questionnaires were completed by parents of a sub-sample of these children. The questionnaire enabled information to be collected about reported oral health behaviours and parental attitudes. About three quarters of children across all age groups are reported to brush their teeth twice daily. A range of oral health products was reported as being used in addition to toothbrushes and toothpaste. There is a trend in parental preferences towards restoration of teeth rather than extractions and towards a better understanding of dental caries prevention. Although overall a higher proportion of children in this survey appeared to have gingival inflammation, plaque and calculus than 10 and 20 years ago, there was no change in the proportion of older children with gingivitis. Dental practitioners have a role to play in reinforcing these positive attitudes and encouraging appropriate and effective oral hygiene behaviours in their child patients.