Oral Health Index Research Articles

Oral-health status of inpatients with schizophrenia in Taiwan

Background/purpose A cross-sectional survey of oral health was conducted in a specific psychiatric hospital in Yu-Li, Hualien County, eastern Taiwan in 2006. In this study, we provide descriptive epidemiological information on the oral-health status of inpatients with schizophrenia and evaluate associations between some potential factors and oral-health indices in this population. Materials and methods In total, 1103 inpatients with schizophrenia participated in this survey. A clinical survey method, consisting of an oral examination with dental instruments and a light source, was used. The indices of this survey were consistent with those recommended by the World Health Organization. Multiple regression models were used to measure the independent effect of each subject’s characteristics on specific oral-health indices. Results Among subjects with schizophrenia, the caries experience was 98.5%; the average number of decayed, missing, and filled permanent teeth (DMFT) was 13.9; the mean filling rate of the DMFT index was 14.3%; average number of teeth was 17.7; 5% were edentulous; and 39.4% had periodontal pockets of >4 mm (community periodontal index ≥3). The multiple regression results indicated that the DMFT, number of teeth, and community periodontal index ≥3 were only associated with age after adjusting for other potential independent variables. At the same time, aging men with lower educational levels and a longer stay in institutions were likely to have lower filling rate of the DMFT index scores in this population. Conclusions The findings of this study indicate the unmet dental-treatment needs of inpatients with schizophrenia and support the conclusion that they lack proper dental care. We therefore suggest that long-term care institutions that care for inpatients with schizophrenia should exert greater efforts in providing dental care for this special population.

Oral Health Status of Psychiatric In-patients in Serbia and Implications for Their Dental Care

To determine oral health status and identify predictors of oral health in a representative sample of psychiatric in-patients in Serbia. The study included 186 psychiatric in-patients and 186 control participants without psychiatric illness matched to the study group by age, sex, marital status, education level, employment, and monthly income. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth (DMFT) index; community periodontal index; and plaque index. Participants were also interviewed about their dental health behavior and their medical records were examined. Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency. Psychiatric in-patients in Serbia have poorer oral health than healthy controls. It is necessary to intensify preventive dental care in this vulnerable population.

Esthetics and biocompatibility of composite dental laminates

Background: Advances in modern dental materials provide patients with a choice of natural looking veneers to provide esthetic restorations. These may be directly fabricated composite resin veneers or indirectly fabricated veneers. This study was carried out to evaluate the clinical effect of new generation indirect veneering composites and to compare them with veneers fabricated from direct composite restorations. Methods: The present study was carried out in the Prosthodontics department of a medical college. A total of forty patients requiring restoration of the anterior teeth using composite veneers were selected and either of the two materials was used to fabricate the veneers. Result: Clinical evaluation was done for esthetics and periodontal health. Statistical analysis showed that there were no significant changes to the periodontal health during the period of the study. Conclusion: The evidence obtained from this study indicates that both direct as well as indirect composite materials had clinically acceptable outcomes in terms of restoration of esthetics. Biocompatibility with the periodontal tissues of both materials was also evident by the improvement in oral health indices used in the study.

Osteonecrose de mandíbula em pacientes com lúpus eritematoso sistêmico juvenil observada em exame de imagem

The objective of the present study was to evaluate radiographic changes of the temporomandibular joint (TMJ) in patients with juvenile systemic lupus erythematosus (JSLE) and a control group. Panoramic radiographies of the TMJ of 26 JSLE patients and 28 healthy individuals were evaluated. Multislice computed tomography (MCT) was performed on those patients who presented flattening and/or destruction of mandibular condyles. Demographic data, oral health indices, clinical manifestations, laboratory exams, and treatment were evaluated. Important radiographic changes consistent with osteonecrosis of the mandible, confirmed by MCT of the TMJ, were observed in 2/26 (8%) JSLE patients versus 0% in the control group (P = 0.22). Mild clinical dysfunction and abnormal TMJ mobility were observed in 67% and 54% of the patients, respectively. Age of onset, disease duration, and current age were similar in JSLE patients with and without severe radiographic changes of TMJ (9.3 versus 10.8 years, P = 0.77; 3.3 versus 2 years, P = 0.63; 12.6 versus 13.5 years, P = 0.74, respectively). Significant differences in gender, socioeconomical status, oral health indices, clinical manifestations, laboratory exams, and treatment were not observed between both subgroups (P 0.05). Both JSLE patients with osteonecrosis of the mandible had active chronic disease, used corticosteroids for a prolonged period, and had mild TMJ dysfunction. Antiphospholipid antibodies were not observed in those two patients, and neither one had been treated with bisphosphonate. Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up.

Salivary lipid peroxidation and total sialic acid levels during healthy gestation and postpartum: A longitudinal study

Objectives This study investigated salivary lipid peroxidation (LPO) as an oxidative stress marker and salivary total sialic acid (TSA) as an inflammatory response during gestation and postpartum. Design and methods Salivary LPO and TSA levels, using the Ledwozyw and Warren methods respectively, were obtained in healthy pregnant women followed up during gestation and 6 – 8 weeks postpartum, and in healthy non-pregnant controls. All were with good oral health. Results LPO was significantly higher than controls during all trimesters and postpartum and in the second trimester than in the third trimester and postpartum. TSA in the second trimester was significantly higher than in any other group. First trimester levels were significantly higher than postpartum . Oral health indices remained within normal levels for the duration. Conclusion The salivary LPO profile followed plasma gestation and postpartum profiles in the literature but the salivary TSA differed in that after the 2nd trimester, rather than persisting, it decreased.

Igual Tratamiento Protésico Diferente Calidad de Vida en Adultos Mayores

PurposeDetermine if there is a relationship between prosthetic repairs/ new prosthesis and quality of life on elderly by quintile determined by GOHAI scores modifications. MethodsFor 500 elderly patients, ages 75 to 85 years, removable prosthetic wearers in both maxillaries, 100 from each quintile (Casen 2003), who lived in Providencia, Las Condes, Vitacura and Lo Barnechea borrows, prosthesis quality expressed in the number of repairs after clinical examination was assessed and the Geriatric Oral Health Index (GOHAI) was obtained before, (pre) and 12 month after renovation of their prosthesis (post). Prosthetic adherence was also evaluated at a recall 12 and 24 month later. All data was processed using Systat 11 program. For the variable GOHAI by categories, Chisquare was used. Prosthetic repairs and adherence was expressed in frequency. ResultsGOHAI pre/post by I, II, III, IV, and V quintiles were: Low/Medium, Medium/High, High/High, High/High, High/High. The average of prosthetic repairs from I, II, III, IV, and V quintiles were 15.3– 14.1–12.2–8.2 and 9.2. Prosthetic adherence from I, II, III, IV, y V quintiles were12/24 month: 81%/69%-90%/85-93%/92%-96%/94% y 93%/92%. ConclusionsProsthesis quality expressed in the number of repairs does influence Geriatric Oral Health index on elderly from the III, II and I quintiles. It does not influence on elderly from the V and IV quintiles. Never the less for the same prosthetic treatment, adherence is proportional to the quintiles but the first quintile has the highest prosthesis abandon 12 and 24 month later.

Measuring the Oral Health of Nursing Home Elders

The primary purposes of this descriptive and prospective pilot study was to test the feasibility of a nursing and dental hygiene team to measure specific oral health indices in a sample of older adults residing in nursing homes (NHs). The secondary purpose was to determine the relationship between plaque and dentate status. Oral health indicators, functional status scores, and behavioral scores were collected and analyzed from 38 female NH residents from two geographically, organizationally, and economically diverse NHs. Persons with dentures had significantly lower plaque scores than those with natural dentition. Rural NH residents and African American NH residents had fewer filled teeth, indicating a potential lack of access to dental care. Oral health indicators were collected safely and efficiently from NH residents using a nursing and dental hygiene collaborative approach. Nursing and dental hygiene collaborations hold promise for improving the oral health in institutionalized elders.

Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists (LEMONADE Study): Study Design and Profile of Nationwide Cohort Participants at Baseline

BackgroundTo examine the association between oral health and general well-being, we are currently conducting a nationwide cohort study comprising members of the Japan Dental Association (JDA). Herein, we describe the study design and the profile of the participants at baseline.MethodsFrom 2001 through 2006, the participants completed a baseline questionnaire that surveyed factors related to lifestyle, general health, and oral health. Morbidity and mortality have been monitored by using information from fraternal insurance programs operated by prefectural dental associations. All respondents provided written, informed consent for participation and the use of their insurance data.ResultsA total of 21 272 JDA members participated in the baseline survey (response rate, 36.2%). Their mean age ± SD was 52.3 ± 12.3 years; 8.0% were women. Among the respondents, 30.2% of men and 10.7% of women were current smokers; 73.5% of men and 44.8% of women were current drinkers. The cohort scored higher on oral health indices than did the general Japanese population: dentists were more likely to brush their teeth ≥3 times/day, to have ≥20 teeth, to have fewer lost teeth, to be free from periodontal diseases, and to have higher General Oral Health Assessment Index scores. There was, however, considerable inter-individual variation in scores on the indices.ConclusionsMore than one-third of JDA members participated in the study. Their oral average health status was better than that of the general population. Nevertheless, it will be possible to compare morbidity and mortality between those with better and worse scores on oral health indices.

Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs.

BackgroundThe oral health condition of individuals with special health care needs have been reported in literature to be influenced by various sociodemographic factors, including living conditions and severity of impairment. This study was carried out to determine the oral health status and treatment needs of children and young adults attending a day institution for those with special needs.MethodsThis study was carried out as part of an oral health screening program organized by the institution and consent was obtained from parents and guardians before the screening. All information was supplied by the parents during the screening using a questionnaire completed by the dentist. Oral examination was carried out on all consenting subjects in attendance on the days of screening in the school clinic with parents and teachers in attendance, using standard World Health Organisation oral health indices to assess dental caries, oral hygiene status, malocclusion and other oral health parameters.ResultsFifty-four subjects aged 3–26 years (mean 12.28 ± 6.82 years) and comprising 72.2% males and 27.8% females participated in the study. Over 90% were from parents of high and middle level educational background. Thirty-six (66.7%) were caries free, with a mean dmft score of 0.7 ± 1.77 and mean DMFT score of 0.4 ± 1.44 with no significant difference across gender (p = 0.5) and parents' educational status (p = 0.43). The mean OHI-S of the total population in this study was 1.36 ± 0.16. Females had a mean score of 0.88 ± 1.10 while males had a mean score of 1.55 ± 1.24 with no significant difference (p = 0.6). Twenty-five (46.3%) had good oral hygiene, 17 (31.5%) had fair oral hygiene and 12 (22.2%) had poor oral hygiene, with no significant difference across gender (p = 1.11) and age groups (p = 0.07). Fifteen (27.8%) had gingivitis with no significant difference across age groups (p = 0.17). Forty-five (83.3%) had Angle's class I malocclusion, 6(11.1%) class II and 3 (5.6%) class III. Chronologic enamel hypoplasia was found in 9 (16.7%) of the total population. Up to 53.7% of the total population will require oral prophylaxis, 33.3% required restorations on their posterior teeth and 12.9% required veneers for labial facing of hypoplastic enamel.ConclusionThe subjects in this study had a high prevalence of dental caries and need for restorative care. They would benefit from parental education on diet modification, improvement of oral hygiene practices and regular dental visits.

Inequalities in oral health for children with disabilities: a French national survey in special schools.

BackgroundDespite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.MethodTwenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.ResultsDC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI).ConclusionClinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.

Clinical Impact of Oral Health Indexes in Dental Extraction of Hemophilic Patients

Periodontal disease in patients with hemorrhagic disorders may lead to severe bleeding during dental treatment. This study evaluated the clinical impact of oral health indexes in hemophilic patients undergoing tooth extraction. Thirty-one hemophilic patients underwent teeth extractions using autologous fibrin glue and an oral antifibrinolytic drug (epsilon-aminocaproic acid). Oral health indexes (plaque, PI; gingival, GI; and decay-missing-filling-teeth, DMFT index) were evaluated before tooth extraction. Postsurgical bleeding episodes were observed in 6 hemophilic patients (1 severe, 3 moderate, and 2 mild type). The PI and GI index in the bleeding group were 1.8 and 1.7, respectively, and 1.8 for both of the non-bleeding groups (PI, P = .8; GI, P = .56). The global DMFT index was 18 in the bleeding group and 19.6 in the non-bleeding group (P = .67). The status of oral health did not interfere with bleeding caused by dental extraction of hemophilic patients.

Estimation of salivary bacteria capable of inhibiting and stimulating Streptococcus mutans and its correlation to dental caries and untreated carious teeth

Bacteriocins are bacteriocidal proteinaceous molecules produced by the Gram-positive bacteria not active against the produced strain. Many investigations have revealed that certain bacteria using antibacterial or the inhibitory substance inhibit some other bacteria. A study was conducted in a group of 60 children to ascertain whether any correlation exists between the proportion of salivary bacteria inhibiting and stimulating Streptococcus mutans and the oral health indices (DMFT, deft and Community Periodontal Index of Treatment Needs). A definite inverse correlation was observed between the percentage of salivary inhibiting S. mutans and untreated carious teeth (UCT).

Providing a Numerical Measure of Oral Health – Can it be Done and How Accurate is it?

An Index of Oral Health (OHX) was developed by Burke and Wilson in the mid 90s. Use of the index involves assessing patient comfort and satisfaction in addition to the assessment of caries, periodontal disease, toothwear, mucosa, occlusion and dentures, where appropriate. On completion of this structured examination, the clinician arrives at an overall oral health index (OHX) for the patient, which is expressed as a fraction of the maximum achievable score. The index was modified by Denplan UK by amending the calculations to produce the Oral Health Score (OHS). The Reproducibility of the OHX and OHS was tested at Birmingham Dental Hospital and School during 2001 and 2002 and was found to be satisfactory. The dentists' opinions on the OHX and OHS were assessed by means of questionnaires. Most of the dentists felt that both were easy to use.

Perceived oral health: changes over 5 years in one Swedish age‐cohort

Objective: The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5‐year period, 1992–1997, using a cohort population from two Swedish counties.Methods: In 1992, a cross‐sectional mail questionnaire was sent to all 50‐year‐old persons in two counties in Sweden, Örebro and Östergötland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model.Results: There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analysed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. Conclusion: Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. However, this also means that the social differences remain, despite the official goals of increased equity.

Perceived oral health: changes over 5 years in one Swedish age-cohort.

The purpose of this study was to investigate if a change in the social gradients in perceived oral health occurred over a 5-year period, 1992-97, using a cohort population from two Swedish counties. In 1992, a cross-sectional mail questionnaire was sent to all 50-year-old persons in two counties in Sweden, Orebro and Ostergötland, and altogether there were 8888 persons. In 1997, the same population was sent a new questionnaire. The cohort, comprising the same respondents from 1992 and 1997, was of 5363 persons. An index of perceived oral health was constructed out of three questionnaire variables: satisfaction with teeth, chewing ability and the number of remaining teeth. This index value was set as a dependent variable in a regression model. Reports of toothache were investigated in a separate logistic regression model. There were obvious social gradients in the perceived oral health index both in 1992 and in 1997. Marital status, foreign birth, education and occupation were all substantially related to the perceived oral health. The change in perceived oral health was analyzed. Almost half of the cohort (47.4%) showed no change at all. Those with increased and those with decreased health were rather evenly distributed on both sides, with 22.0% with better health in 1997 and 30.6% with worse health. Gender and education were related to toothache experience. Changes have been moderate in the perceived oral health in this cohort, despite the rather drastic changes in the remuneration of dental care during this study time. On the other hand, this also means that the social differences remain, despite the official goals of increased equity.

Assessment of an oral health scoring system by GDPs

An Oral Health Index (OHX) has been designed to provide a numerical measure of the overall state of a patient's oral health by means of a series of simple clinical examinations. This has been amended to produce the Oral Health Score (OHS). Objective To assess, by means of a questionnaire, the ease of use and understanding of the OHS by general dental practitioners. Methods 350 GDPs were asked to participate in the project, of whom 329 agreed. These dentists were given a lecture of 2 hours' duration on the OHS. The participating dentists were requested to use the OHS for a period of 1 year. At the end of this period, a questionnaire was delivered to them by post, with an explanatory letter and reply-paid envelope. Results Completed, useable questionnaires were received from 239 GDPs, a 77% response rate. Ninety three per cent of respondents considered the OHS instructions to be satisfactory. The respondents' views on the criteria on which the OHS component assessments are based indicated that over 90% of respondents agreed with the criteria for caries, adequacy of restorations, periodontal assessment, mucosal assessment and assessment of dentures. A majority of respondents agreed that the OHS provided a valid representation of oral health. Conclusion The results of the present study indicate that the OHS is considered to be an easy-to-use measure of a patient's oral health and that it provides a valid representation of a patient's oral health.

Simultaneous measurement of the viability, aggregation, and live and dead adherence of Streptococcus crista, Streptococcus mutans and Actinobacillus actinomycetemcomitans in human saliva in relation to indices of caries, dental plaque and periodontal disease

Salivary proteins have multiple functions and many share similar functions, which may be why it has been difficult to relate variations in their concentrations to oral health and ecology. An alternative is to focus on variations in the major functions of saliva. An hydroxyapatite-coated microplate model has been developed that simultaneously measures saliva-promoted bacterial viability, bacterial aggregation, and live and dead bacterial adherence, while simulating oral temperature and shearing forces from swallowing. That model was applied to resting whole and stimulated parotid saliva from 149 individuals, using representative strains of Streptococcus crista, S. mutans, and Actinobacillus actinomycetemcomitans. Two major factors were defined by multivariate analysis (this was successful only for whole-saliva). One factor was correlated with aggregation, live adherence and dead adherence for all three strains; the other was correlated with total viability of all three strains. Participants were grouped <25th percentile and >75th percentile for each factor. Those groups were compared for clinical indices of oral health. Caries scores were significantly lower in those with high scores for aggregation–adherence, regardless of whether total viability scores were low or high. Live bacteria always predominated on surfaces when live and dead adherence scores were expressed as ratios. However, participants with high scores for aggregation–adherence showed significantly more dead adherent bacteria than those with low scores (these ratios were uncorrelated with total viability). This finding may indicate that extreme differences in the ability to kill bacteria on surfaces can influence caries risk.

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population.

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.

A pilot study on improving oral care in long-term care settings. Part II: Procedures and outcomes.

This pilot study attempts to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. Twelve residents of a county long-term care (LTC) facility cared for by a group of nursing assistants who completed a 6-week oral health training program constituted the experimental group. Resident Plaque Index (PI) and Gingival Index (GI) scores were compared at baseline, and 6 weeks and 12 weeks after nursing assistant training to a matched group of residents (n = 11) cared for by nursing assistants who had not completed oral health training. Both the PI and GI scores of the experimental residents improved significantly compared to the control residents between baseline and 12 weeks (Student t test, p = .039, p = .017, respectively). This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.

A pilot study on improving oral care in long-term care settings. Part I: Oral health assessment.

Surveys of oral health in long-term care (LTC) settings have consistently documented low levels of health. In the complex LTC environment, programs to improve oral health have yet to be well defined. The purpose of this pilot project was to determine if a program of training for nursing assistants in combination with adjunctive aids to oral care could improve resident oral health indicators. This pilot study demonstrated improved oral health indexes among residents cared for by trained nursing assistants who had access to adjunctive oral care aids. Additional studies are needed to define the nature of oral caregiving in LTC settings as well as specific regimens which can assure continued oral health improvement in this environment.