Oral Cleanliness Research Articles

Use of miswak versus toothbrushes: oral health beliefs and behaviours among a sample of Jordanian adults

This descriptive survey aimed at determining the perceived relationship among miswak, the toothbrush, and toothbrush-plus-miswak usage on oral health beliefs and behaviours of Jordanian adults, 18-60 years old, seeking dental care in the city of Irbid, northern Jordan. Patients (n = 138) voluntarily completed a self-designed questionnaire prior to their dental appointments at public and private clinics. Overall, the level of oral health knowledge was low; of 71 people who attempted to define dental plaque, only 26% knew the meaning of dental plaque. While 12% have never been to a dentist, and 12% visit the dentist on a regular basis, the majority (63.2%) of the respondents reported that they visit the dentist only when they have pain. The majority (72%) use the toothbrush, 20.5% use the toothbrush-plus-miswak and only 3% use miswak alone. Toothbrush users believe that using the toothbrush-plus-miswak is most effective in reducing mouth debris (chi2 = 32.069, d.f. = 16, P = 0.01); and level of education is significantly associated with the type of oral cleaning device used (chi2 = 25.817, d.f. = 12, P = 0.05). There was no significant difference between toothbrush users and toothbrush-plus-miswak users in terms of how they perceive their oral health status. About 19% of the study participants use dental floss, 60.9% use mouth rinses and 8.3% use inter-dental brushes. Educated people (baccalaureate or associate degrees) tended to use toothbrushes and toothbrush-plus-miswak. The toothbrush-plus-miswak users are most likely to spend 1-2 min each day cleaning their teeth (chi2 = 34.9, d.f. = 20, P = 0.02) than those using other devices. Respondents who use the toothbrush are most likely to visit the dentist when they have pain (chi2 = 34.02, d.f. = 12, P = 0.00) than those using other devices. The oral health awareness level among Jordanian adults is poor and needs to be improved. Evidence-based and community-based dental health education and a philosophical change from disease-oriented and pain management care to primary preventive care are highly recommended for the Jordanian population.

Eating habits, smoking and toothbrushing in relation to dental caries: a 3‐year study in Swedish female teenagers

The aims of the present study were to describe eating, toothbrushing and smoking habits in a cohort of Swedish female adolescents, and to relate the findings to dental caries increment. The research took the form of a longitudinal study. The study sample consisted of a cohort of 162 girls under regular dental care, aged 12 years at baseline, who were followed for 3 years, from the sixth to the ninth grade. Eating, oral cleaning and smoking habits were self-reported three times per year through a questionnaire, and caries data at baseline and after 3 years were collected from dental records. The results showed significantly (P < 0.05) impaired eating habits during the study period and that adherence to regular main meals diminished. In the eighth grade, one-third of the girls skipped breakfast before school and only 50% had their free school lunch daily. The omission of breakfast and irregular main meals, as well as smoking were significantly associated with caries (decayed, missed and filled surfaces) increment in the eighth grade (odds ratio = 4.1-4.9, P < 0.05). Snacks, light meals, soft drinks and sweets were already frequently consumed at baseline and continued to be so over the years. Although > 95% of subjects reported that they brushed their teeth at least once a day, approximately 20% did not do it every evening, and this figure remained stable over the study period. However, snacks, soft drinks and sweets, and toothbrushing habits had no significant influence on caries development. Dietary advice for caries prevention in adolescent girls should focus on the importance of retaining regular main meals, and especially, not skipping breakfast.

P39 Evaluation of patient oriented outcome using SF‐36 in halitosis therapy

Objective To evaluate the patient oriented outcome of medical interventions, Medical Outcome Study Short Form‐36 (SF‐36) is a widely used, self‐administered questionnaire. The SF‐36 has eight dimensions of health status consisting of Physical Function (PF), Role‐ Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), SF (Social Function), Role‐ Emotion (RE) and Mental Health (MH). Furthermore, each dimensional score and two summary scores about physical and mental regions can be calculated by the algorithm. The aim of this study was to examine the application of SF‐36 to the clinical parameter of halitosis.Subjects and methods Seventy patients visiting our special clinic for halitosis were the subjects. In this study, we defined the healed persons as follows. They received our therapy two or more times, and the duration was over 2 months. After our therapy, they declared that the oral malodor of themselves could not bother them. In addition, they accepted to receive the general dental check‐up regularly after the initial therapeutic period. The SF‐36 was filled by the subjects at the first visit of our clinic and the first time of the regular check‐up. The content of our therapy was mainly involved measurement of oral malodor, supporting for oral self‐care, professional oral cleaning and counseling. All management concerning SF‐36 was performed according to the manual of SF‐36, version 1.2, Japanese edition.Results and discussion Among all 70 subjects, GH, VT, SF, RE, MH and mental summary scores were significantly lower than national averages. Among the healed persons (n = 17), only SF score significantly rose after receiving our therapy. These results suggest that the consciousness of the improvement in social function could be an important outcome of halitosis therapy. In conclusion, measuring health related QOL using SF‐36 might be useful for evaluating the efficacy of halitosis therapy.

Oral health and treatment needs of the long-term hospitalised elderly.

To determine the oral health and treatment needs of the long-term hospitalised elderly. The Laakso long-term hospital, Helsinki, Finland. A cross-sectional study with clinical oral examinations. All long-term patients (n = 260) aged 60 and older. Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. Subjects' mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long-term hospitalised elderly.

Oral cleanliness and periodontal status of children in the south western and north western regions of Nigeria

Oral cleanliness and periodontal status of children in the south western and north western regions of Nigeria

Nosocomial Serratia marcescens outbreak in Osaka, Japan, from 1999 to 2000.

To investigate and control an outbreak of bloodstream infections (BSIs) caused by Serratia marcescens and to identify risk factors for respiratory colonization or infection with S. marcescens. Epidemiologic investigation, including review of medical and laboratory records, procedural investigations, pulsed-field gel electrophoresis (PFGE) typing of environmental and patient isolates, statistical study, and recommendation of control measures. All patients admitted to a 380-bed, secondary-care hospital in Osaka Prefecture, Japan, from July 1999 through June 2000 (study period). Seventy-one patients were colonized or infected with S. marcescens; 3 patients who developed primary BSIs on the same ward within 5 days in June 2000 had isolates with indistinguishable PFGE patterns and indwelling intravenous catheters for more than 5 days. On multivariate analysis, among 36 case-patients with positive sputum specimens and 95 control-patients, being bedridden (odds ratio [OR], 15.91; 95% confidence interval [CI95], 4.17-60.77), receiving mechanical ventilation (OR, 7.86; CI95, 2.27-27.16), being older than 80 years (OR, 3.12; CI95, 1.05-9.27), and receiving oral cleaning care (OR, 3.10; CI95, 1-9.58) were significant risk factors. S. marcescens was isolated from the fluid tanks of three nebulizers and a liquid soap dispenser. The hospital did not have written infection control standards, and many infection control practices were found to be inadequate (eg, respiratory equipment was used without disinfection between patients). Poor hospital hygiene and the lack of standard infection control measures contributed to infections hospital-wide. Recommendations to the hospital included adoption of written infection control policies.

Targeted supervised toothbrushing reduces caries increment

Design Randomised Controlled TrialIntervention Supervised toothbrushing on schooldays with 1000 ppm fluoride toothpaste with toothpaste and brushes supplied for home use one class in each school was allocated to intervention and compared to a within-school control over a 2-year period. Dental examinations were performed by a single-blinded examiner at 6-monthly intervals.Outcome measure Visual examinations of caries at D1 level (all visible cavitated and non-cavitated lesions in enamel and dentine). Approximal and occlusal surfaces were also examined using Fibre-optic transillumination (FOTI).Results 86% of those examined at baseline completed study. At baseline children in both groups had similar levels of oral cleanliness; however, children from the more deprived areas had poorer levels of cleanliness. There was no significant difference between the groups in the caries increment in the deciduous teeth after 2 years. Dental immaturity had a significant effect on subsequent caries development. After 2 years there was a significantly less caries in the permanent molars in the intervention group, with 32% fewer D1 lesions (95% CI 4–60%) and 56% fewer D3 lesions (95% CI 13–101%).Conclusions A targeted supervised toothbrushing programme with support for home use resulted in a significant reduction in caries increment.

Increased prevalence of dental caries and poor oral hygiene in juvenile idiopathic arthritis.

Recent decades have seen a trend to treat juvenile idiopathic arthritis (JIA) with increasing immunosuppression to improve the long-term outcome. Poor oral hygiene and dental decay cause significant morbidity, and patients with chronic disease (who may be further immunocompromised by treatment) are at greater risk. This study investigated patients with JIA using standard measures of oral health. One hundred and forty-nine patients with JIA were included. The children were attending a regional paediatric rheumatology service and the adults were attending an adult rheumatology clinic. Random age- and sex-matched healthy controls were recruited from a dental teaching hospital. The structured dental examination included standard epidemiological indices of oral hygiene (gingival index, plaque index, oral cleanliness index) and dental decay [DMFT (decayed, missing or filled teeth) index]. JIA patients, at all ages, had increased levels of dental decay and poor oral hygiene. This increased level of decay was statistically significant in the patients aged 0-11 yr. Significant levels of untreated caries and increased levels of missing teeth were found in JIA, suggesting that patients with JIA had less restorative dental treatment, with tooth extraction often the chosen option for the treatment of dental decay. This is the largest study of oral health in JIA and is cross-sectional with non-diseased controls. It shows significantly increased levels of poor oral hygiene and dental decay in patients with JIA. The high levels of untreated dental decay suggest barriers to dental care. These results emphasize the role of regular dental care in the multidisciplinary management of JIA.

Improving oral health: current considerations.

The high incidence of periodontal disease among adults in the Western world indicates that in most cases, routine dental care could be considerably improved. The progressive effect of the disease suggests that improvements in oral cleanliness are mandatory if large numbers of adults are to retain their teeth into old age. Data show that periodontal disease can be minimized through effective plaque control, and that a combination of brushing, interdental cleaning, and chemotherapeutic agents (e.g. mouthwash) is beneficial to patients with plaque control problems. The vast majority of adults do not follow an adequate home-care routine. Average brushing times are low, and only a minority of patients regularly floss. In addition, in those patients who do regularly brush and floss, a deterioration of plaque control occurs over time, suggesting that compliance is a major issue. The principal challenge for dental professionals is to identify how best to elicit an improvement.

Does a clinical evaluation of oral cleanliness correlate with caries incidence in preschool children? Findings from a cohort study.

The aim of this study was to assess whether a clinical evaluation of oral cleanliness reflects subsequent caries incidence. Oral examination of 180 children (1- to 4-year-olds) was carried out twice in a six-month period. Caries prevalence at baseline (dfs) in 1- to 2-year-olds (group A) and 3- to 4-year-olds (group B) correlated significantly with oral cleanliness as well as salivary mutans streptococci count (MS). Caries increment (delta(dfs)) correlated significantly with oral cleanliness in group A but not in group B, while delta(dfs) significantly correlated with MS in group B and slightly correlated with that in group A. ANCOVA revealed that dfs was significantly higher at the second examination than at baseline in group B, even after adjusting for oral cleanliness. This finding was confirmed by Wilcoxon test when group B was divided in three categories (low, middle and high) based on oral cleanliness. This suggests that the relationship between delta(dfs) and oral cleanliness decreased with age and that the significant positive correlation found in group B by our point-prevalence survey is derived from the remainder of the positive correlation that occurred at a younger age.

Caries experience and oral cleanliness in cystic fibrosis homozygotes and heterozygotes.

In the present study, the caries experience (ie, the number of decayed, missing, and filled teeth) and oral cleanliness (ie, measures of plaque, calculus, and gingival bleeding) of patients homozygous for cystic fibrosis (CF; n = 42), patients heterozygous for CF (n = 48), and healthy control subjects (n = 62) were recorded and statistically analyzed. Those who were homozygous for CF had a significantly lower caries experience than both the control subjects (P <.001) and those who were heterozygous for CF (P =.011). They also had significantly less gingival bleeding sites than the controls (P =.014) and those heterozygous for CF (P =.019). Patients heterozygous for CF showed significantly more extensive restorations than those who were homozygous (P =.015) and significantly more missing teeth than the controls (P =.008), whereas the controls had significantly more missing teeth than those who were homozygous for CF (P <.001). Although those homozygous for CF are expected to have a high caries risk because of their essential sugar-rich diet, they did not have a significantly higher caries experience in this study. Their better gingival health and lower caries experience may be attributed to medication use (antibiotics) and as-yet unidentified intrinsic salivary mechanisms.

Chewing sticks: timeless natural toothbrushes for oral cleansing.

It is generally accepted that oral hygiene maintenance through regular removal of dental plaque and food deposits is an essential factor in the prevention of dental caries and periodontal disease. Methods for oral hygiene vary from country to country and from culture to culture. Despite the widespread use of toothbrushes and toothpastes, natural methods of tooth cleaning using chewing sticks selected and prepared from the twigs, stems or roots from a variety of plant species have been practised for thousands of years in Asia, Africa, the Middle East and the Americas. Selected clinical studies have shown that chewing sticks, when properly used, can be as efficient as toothbrushes in removing dental plaque due to the combined effect of mechanical cleaning and enhanced salivation. It has also been suggested that antimicrobial substances that naturally protect plants against various invading microorganisms or other parasites may leach out into the oral cavity, and that these compounds may benefit the users by protection against cariogenic and periodontopathic bacteria. Some clinical epidemiological studies are in support of this, and many laboratory investigations have suggested the presence of heterogeneous antimicrobial components extractable using different chemical procedures. A few recent studies have identified some of the active antimicrobial compounds. Today, chewing sticks are still used in many developing countries because of religion and or tradition, and because of their availability, low cost and simplicity. The World Health Organization also encourages their use. The Year 2000 Consensus Report on Oral Hygiene states that chewing sticks may have a role to play in the promotion of oral hygiene, and that evaluation of their effectiveness warrants further research.

Effects of smoking and treatment status on periodontal bacteria: evidence that smoking influences control of periodontal bacteria at the mucosal surface of the gingival crevice.

We examined whether smoking status could influence growth of potentially pathogenic bacteria in the periodontal environment of treated and untreated periodontal patients. We have previously reported effects of treatment status on marker bacteria in our patients. We established a history of any smoking during 6 months prior to microbiological sampling (F-ME, 16 smokers out of 64; MHM, 70 smokers out of 185). We used a commercial immunoassay to quantitate Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in paper point samples from periodontal sites. Logistic regression showed that in smokers, neither P. gingivalis nor A. actinomycetemcomitans was quantitatively increased, while P intermedia was somewhat increased. Multiple regression demonstrated that smoking disrupts the positive relationship between increasing probing depth and increasing bacterial growth that is found in non-smokers. In smokers, growth of marker bacteria at shallow sites (< or =5 mm) was significantly increased to the levels found at deeper sites (>5 mm) in both smokers and non-smokers. Supragingival plaque biofilm was identified as a reservoir for marker bacteria; smokers and nonsmokers had equal ranges of oral cleanliness. Smoking-associated periodontitis is not simply a reflection of oral cleanliness. Smoking extends a favorable habitat for bacteria such as P. gingivalis, P. intermedia, and A. actinomycetemcomitans to shallow sites (< or =5 mm). Molecular byproducts of smoking interfere with mechanisms that normally contain growth of damaging bacteria at the surface of the oral mucosa in gingival crevices. In this way, smoking can promote early development of periodontal lesions.

The oral cleanliness and periodontal health of UK adults in 1998

The oral cleanliness and periodontal health of UK adults in 1998

The oral cleanliness and periodontal health of UK adults in 1998.

Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population.

Adolescents' sense of coherence, oral health status, and oral health-related behaviours.

To investigate the relationship between sense of coherence (SOC) and oral health. It was hypothesised that subjects with better oral health status and better oral health-related behaviours have higher levels of SOC. A cross-sectional study was conducted in Goiânia-GO, Middle-West Brazil, on a sample of 664 15-year-olds randomly selected from schools. Data were collected through questionnaires, the short version of Antonovsky's SOC Scale (13-item) and clinical dental examinations. Multiple logistic regression and polytomous ordered regression were used in the data analysis. Two sets of outcome variables were selected for the analyses: oral health status (dental caries, oral cleanliness, and periodontal disease), and oral health-related behaviours (frequency of sugar intake, toothbrushing frequency, and pattern of dental attendance). Adolescents' SOC was associated with their caries experience in anterior teeth (OR=0.81 for 10 units increase in SOC scale; 95% CI=0.66-0.98), but the relationship did not remain significant after controlling for other factors. Adolescents with higher SOC were less likely to visit the dentist mainly when in trouble, compared with those with lower SOC (OR=0.83, 95% CI=0.71-0.98), or equivalently more likely to visit for mainly check-ups. Other measures of oral health status and behaviours were not significantly associated with SOC. SOC was identified as a psychosocial determinant of adolescents' oral health-related behaviour, particularly affecting their pattern of dental attendance.

Dental caries and periodontal conditions among primary school children in Morogoro municipality, Tanzania.

To describe the occurrence of dental caries and periodontal conditions among standards three and four primary school children in Morogoro municipality and compare the obtained oral health indicators with the goals stipulated in the National Plan for Oral Health by the year 2002. Cross sectional study of the oral health status among eight to 15-year old primary school children. Primary schools in Morogoro municipality, Tanzania. A total of 1,297 standards three and four children in five primary schools randomly selected from a list of 36 primary schools of Morogoro municipality were examined for oral health status. Dental caries and periodontal status were recorded using the criteria described in the WHO manual for Oral health Surveys, Basic Methods (1997). Oral cleanliness was assessed using plaque index. Dental caries prevalence, experience and its distribution by tooth type and jaw and prevalence and severity of periodontal conditions and oral cleanliness. Seventy six percent of the children were caries free, and the mean DM-T was 0.41. No fillings were encountered. Seventy six per cent of carious lesions were in pits and fissures of lower molars. Only 21% of the caries lesions were in the pits and fissures of upper molars. Seventy five per cent of the children had all sextants with no gingivitis or calculus. Mean sextants with gingivitis, calculus and visible plaque were 0.25, 0.69 and 2.44 respectively. Standard four and standard four children in Morogoro municipality primary schools had very low levels of dental caries, good oral hygiene and a very low prevalence of gingivitis. No restorative treatment had been provided to these pupils. It is recommended that Morogoro municipality should start a dental caries treatment programme in primary schools in order to attain the national goal of 10% of the "F" component of DMF-T by the year 2002.

Biting back at poor oral hygiene.

Nurses who work in a critical care area face many challenges within their daily role of caring for very sick patients in a stressful and high-tech environment. Underpinning their advanced skills should be a broad base of fundamental nursing skills that has been formulated from research-based evidence. It is, however, the author's belief that oral hygiene--a crucial nursing skill--is not always provided using research-based practice. For this reason, a critical analysis of the issues surrounding the provision of oral hygiene to orally intubated patients within intensive care may provide useful indicators of how the problem could be addressed. This paper considers why orally intubated patients are at particular risk of developing oral health problems, the use of oral assessment tools and the various techniques employed in oral cleansing. The consequences for the patient of poor oral care will also be discussed.

Changes in oral health over ten years amongst UK children aged 4-5 years living in a deprived multiethnic area.

To examine the changes over a decade in caries experience amongst children aged 4-5 years living in a deprived multiethnic community in the United Kingdom. Cross-sectional surveys. Schools and nurseries in the Old Trafford area, Manchester, England, 1989, 1990, 1991 and 1998. Mean dmft, oral cleanliness and proportion of children with rampant caries. The unadjusted Odds Ratio for caries free children examined in 1998 compared with children examined prior to 1998, was only significant amongst the white group. White children examined in 1998 were over three times more likely to be caries free than white children examined previously. South Asian children whose mothers were non English speaking examined in 1998 were almost twice as likely to have good/fair oral cleanliness than those examined prior to 1998. Moreover, South Asian children whose mothers were non-English speaking in 1998 were over three times more likely not to have rampant caries than their counterparts in the earlier years. There were significant improvements in caries and oral health amongst white children over the decade, and although less marked these were mirrored amongst South Asian children.

Inequalities in oral health for deprived multiethnic communities

Objective To examine the changes over a decade in caries experience amongst children aged 4-5 years living in a deprived multiethnic community in the United Kingdom. Design Cross-sectional surveys. Setting Schools and nurseries in the Old Trafford area, Manchester, England, 1989, 1990, 1991 and 1998. Main outcome measures Mean dmft, oral cleanliness and proportion of children with rampant caries. Results The unadjusted Odds Ratio for caries free children examined in 1998 compared with children examined prior to 1998, was only significant amongst the white group. White children examined in 1998 were over three times more likely to be caries free than white children examined previously. South Asian children whose mothers were non English speaking examined in 1998 were almost twice as likely to have good/fair oral cleanliness than those examined prior to 1998. Moreover, South Asian children whose mothers were non-English speaking in 1998 were over three times more likely not to have rampant caries than their counterparts in the earlier years. Conclusion There were significant improvements in caries and oral health amongst white children over the decade, and although less marked these were mirrored amongst South Asian children.