Oral Health and Preventive Dentistry, 01/2013

Purpose: To determine associations between signs and symptoms of temporomandibular disorder (TMD) and harmful oral habits. Materials and Methods: Two hundred forty-four adolescents from a public school in the city of São Roque, Brazil, were evaluated. A screening questionnaire for orofacial pain and TMD recommended by the American Academy of Orofacial Pain was used to determine signs and symptoms of TMD. Patient histories and clinical exams were used to determine harmful oral habits. Results: Eighty-three participants (34%) displayed no signs or symptoms of TMD, 161 (66%) responded affirmatively to at least one item on the questionnaire and 49 (20.1%) gave at least three affirmative responses. Headache was the most frequently reported sign or symptom of TMD (40.6%; n = 99). There was no statistically significant association between gender and signs or symptoms of TMD (P = 0.281). Twenty-five percent (n = 61) of the patients had no harmful oral habits, while 16.4% (n = 40) had only one habit, the most common of which was nail biting. A total of 20.1% (n = 49) reported two harmful oral habits and 38.5% (n = 94) reported three or more such habits. There was a statistically significant association between signs and symptoms of TMD and three or more habits. Conclusion: A statistically significant association was found between signs and/or symptoms of TMD and harmful oral habits in adolescents. Keywords: adolescent health, habits, temporomandibular joint

Purpose: To develop an instrument to measure socioeconomic status (SES) in order to assess SES-related inequalities in oral health in a developing country. Materials and Methods: In order to develop a SES measurement tool, an expert panel generated a primary item pool from which the items were revised after validity and reliability testing. The final instrument was used in a 1100-sample survey in Tehran. SES was calculated using the weights produced by both principal component analysis (PCA) and expert panel two-stage paired comparisons (TSPC) methods. Results: The final instrument contained 10 items. Standardised SES scores derived from TSPC and PCA methods were significantly correlated (r = 0.749, P 0.001). Five-level SES stratification by the two methods revealed a correlation coefficient of 0.701 (P 0.001) for SES class. Conclusion: The newly developed SES index was appropriate to be used in exploring oral health inequalities in the studied sample of the Iranian population. When formulating SES, domestic experts' opinions could help the researchers explore and weight sub-construct factors. Keywords: developing countries, inequality, oral health, paired comparisons, principal component analysis, socioeconomic status

Purpose: To evaluate the diagnosis of halitosis in relation to the oral malodour judge's experience, age, gender and calibration. Materials and Methods: This study included 38 dental patients who volunteered to participate. Patients were evaluated for halitosis by 6 clinicians using the organoleptic method and by measuring mouth exhaled air using a halimeter, which is considered the gold standard. Sensitivity, specificity, and positive and negative predictive values were calculated for each clinician. Consistency between clinicians was evaluated through a kappa test. Significance level was set at P 0.05. Results: Out of the 38 patients, 14 were diagnosed with halitosis by 6 clinicians using a halimeter. The highest sensitivity (89%) was found for clinician No. 6, followed by clinician No. 5 (78%). Specificities were 57% for clinician No. 4 and 36% for clinician No. 1 and No. 5. The most correct positive predictive value (halitosis according to halimeter readings) was made by clinician No. 6 (65%), who also had the highest rates (83%) of negative predictive value (no halitosis according to halimeter readings). There were no statistically significant differences (P > 0.05) between the diagnoses of clinicians No. 1, 2, 3, 5, or 6; however, the diagnoses made by clinician No. 4 were statistically different (P 0.05) than those of all other clinicians. The highest rate of agreement (44%) in diagnoses was between the two calibrated clinicians. However, there was no correlation between the halitosis diagnoses and the age, gender and years of experience of the clinicians. Conclusions: This study indicates that calibration of clinicians is a significant factor in the organoleptic evaluation of halitosis. Keywords: bad breath, halitosis, oral clinician's calibration, organoleptic method

Purpose: This study was designed to assess dentists' knowledge of emergency treatment of traumatic dental injuries (TDIs) in Ankara, Turkey. Materials and Methods: A total of 154 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part was composed of 12 closed-ended questions related to knowledge of how to manage different types of TDIs in children. The questionnaires were answered by 133 general dental practitioners (GDPs) and 21 specialists. The survey data were statistically analysed using the chi-square test and ttest to assess dentists' knowledge. Results: The results show that when the answers were compared, lower numbers of correct answers were noted for questions related to splinting time for avulsed teeth and appropriate treatment for complicated crown-fractured deciduous incisors with large pulp exposure. Greater numbers of correct answers were observed for questions related to the storage medium, systemic antibiotic usage for avulsed teeth and appropriate treatment for intruded primary teeth. The mean number of correct answers from specialists was not significantly greater than that from GDPs (P > 0.05). Conclusion: In conclusion, this survey showed a low level of knowledge of TDI management among the participants and highlights the need to improve dentists' knowledge of TDI treatment protocols. Keywords: attitudes, dental trauma, dentists, emergency treatment, knowledge

Purpose: To assess the prevalence of traumatic dental injuries to permanent anterior teeth in 9- to 14-year-old schoolchildren attending public schools in Anápolis, Brazil, and to investigate the association between the occurrence of these injuries and the size of incisal overjet and type of lip coverage. Materials and Methods: A cross-sectional survey and a two-stage cluster sampling technique were used. The sample size included 765 9- to 14-year-old schoolchildren. Data were collected through clinical examinations and interviews carried out by a trained, calibrated dentist. Oral examinations dealt with the type of traumatic dental injury (TDI), the treatment received, the size of incisal overjet and the type of lip coverage. The teeth examined were maxillary and mandibular incisors. Results: A 16.5% prevalence of dental trauma was found. Boys experienced double the number of girls' injuries. The maxillary central incisors were the teeth most affected, totaling 84.8%. The most frequent type of injury found was enamel fracture (66%), followed by enamel-dentin fracture (27%) and enamel cracks (5%). Only 26% of traumatised teeth were restored. Children with an overjet size > 3 mm were 1.78 times (CI = 1.18 - 2.69) more likely to have a dental injury than children with an overjet size = 3 mm. Children with inadequate lip coverage were 2.18 times (CI = 1.27 - 3.76) more likely to experience dental trauma than children whose lip coverage was adequate. Conclusion: This study shows that the prevalence of traumatic dental injuries among schoolchildren in Anápolis, Brazil is similar to that of other regions in Brazil. The teeth most affected by dental trauma are the maxillary central incisors. Boys run a 2.03-times higher risk of crown fracture than girls, and children with an overjet size > 3 mm are 1.78 times more likely to have dental injuries. In addition, children with inadequate lip coverage are 2.18 times more likely to present traumatic dental injuries than children with adequate lip coverage. Keywords: aetiology, permanent dentition, prevalence, trauma

Purpose: To investigate whether teenagers' knowledge about oral health is influenced by educational methods and to verify the most effective method according to their perception. Methods: The study was performed in Araçatuba, São Paulo State, Brazil, with 127 teenagers from a vocational school. It was realised in 3 steps: 1. An evaluation of knowledge about oral health using a self-applied questionnaire. 2. An application of educational methods, where the students were divided into two groups (A and B). Group A participated in three educational activities that involved lectures, individual demonstration, and participatory activity. Group B was divided into three subgroups (B1, B2, B3) and each of them participated in only one of the methods. 3. The acquired knowledge was evaluated. Group A created a focus group to give their opinion about strategies. Results: With regards to knowledge after the application of the different methods in all groups, there was a statistically significant difference concerning periodontitis, gingivitis and herpes. In group A, after the three activities, and in group B2 after the individual demonstration, an association was found between 'healthy teeth' and 'general health' (P = 0.004 and P = 0.022, respectively). After the individual demonstration, an association was shown between variables of acquired knowledge about 'harmful diet' and 'dental caries' (P = 0.002) as well as 'good diet' and 'prevention of oral diseases' (P = 0.032). The favourite method was individual demonstration, due to the contact with educational materials, followed by participatory activity because it encouraged learning in a more dynamic way. Conclusion: Educational methods influenced knowledge about oral health, with individual demonstration proving to be the most effective method for acquiring knowledge. In the adolescents' view, the participatory activity was the preferred method.

Purpose: To investigate if patients with periodontitis attending the Dental School in Huddinge, Sweden presented with more signs of systemic diseases, such as cardiovascular disease, diabetes mellitus and respiratory diseases, compared to healthy and gingivitis patients. Materials and Methods: In this retrospective study, dental charts were examined where the periodontal diagnoses of patients were known. A total of 325 patients with severe periodontitis and 149 patients without periodontitis, born 1928 to 1968, were identified. Diagnosis regarding the systemic diseases was self-reported. Odds ratios for cardiovascular diseases, diabetes mellitus and respiratory diseases were calculated with a logistic regression model that was adjusted for age, gender and smoking. Results: It was observed that more cases of periodontitis were found in older individuals than the controls (61.7 vs 56.2 years; P 0.001). A total of 44.3% of patients with severe periodontitis also suffered from cardiovascular diseases, 19.1% respiratory diseases and 21.2% from diabetes mellitus. Among the controls, 30.9% had cardiovascular disease, 23.5% suffered from respiratory diseases and 6.7% had diabetes mellitus. Across both groups, hypertension was the most frequent diagnosis. There was a significant association between periodontitis and cardiovascular disease (odds ratio [OR] = 1.79, confidence interval [CI] 1.12-2.86), but not between respiratory diseases and periodontitis (OR = 0.88, CI 0.53-1.47). The risk of diabetes mellitus was greater among those patients with periodontitis (OR = 2.95, CI 1.45- 6.01). Conclusion: This study found that patients with periodontitis presented with more systemic diseases, such as cardiovascular disease and diabetes mellitus than control patients. However, no association was found between periodontitis and respiratory diseases. At the present time, the reasons for the associations or lack of association are unknown. Keywords: register study, risk factor, periodontal disease, Sweden, systemic diseases

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of histiocytes characterised by a proliferation of abnormal and clonal Langerhans cells. LCH most commonly occurs as a localised solitary bone lesion and appears predominantly in paediatric patients. This case resport presents clinicopathological features of this disorder in a 2-year-old boy. The presenting features of the patient included fever, bleeding gums and seborrheic dermatitis-like rash. Intraoral examination and radiographs revealed deep pockets and severe bone loss around all primary molars. Due to severe periodontal destruction, a gingival biopsy was taken. The biopsy specimen revealed heavy infiltration of Langerhans histiocytes. Chemotherapy was administered. Although no clear cause of LCH has been identified, the disease can be triggered by environmental agents and viruses, in particular Epstein-Barr virus. Oral manifestations may be the first or only signs of LCH. Keywords: Langerhans cell histiocytosis, periodontal disease

Purpose: To assess the anti-inflammatory effect of vitamin D on gingivitis at various doses. Materials and Methods: In this randomized controlled trial, daily oral vitamin D supplementation was given in doses of 2000 IU for group A, 1000 IU for group B, 500 IU for group C and a placebo for group D over a 3-month period. The changes in gingival scores were measured after the 1st, 2nd and 3rd months. Results: The gingivitis score changed in direct proportion to the dose of vitamin D supplementation. In group A, the mean gingival scores were 2.4 (baseline), 1.7 after the first month, 0.8 after the second month and 0.3 after the third month. The group B mean baseline gingival score of 2.3 decreased to 2.0 in the first month, 1.1 after the second month and 0.5 after the third month. In group C, the baseline gingival scores were 2.2 and 1.9 after one month, 1.4 after two months and 0.8 by the last visit. Comparing baseline gingivitis scores with the later-visit score using the Wilcoxon paired test, the significant anti-inflammatory effect was seen in group A after one month, in group B at two months and in group C at three months after oral vitamin D supplementation (P 0.0001). However, group D did not show a significant antiinflammatory effect. Conclusion: There is a dose-dependent anti-inflammatory effect of vitamin D on gingivitis. Vitamin D is a safe and effective anti-inflammatory agent in doses ranging from 500 IU to 2000 IU. Results are apparent earlier with the higher dose of 2000 IU. ***This article is not available online.*** Keywords: anti-inflammatory effect, gingivitis, 25 hydroxyvitamin D

Purpose: To retrospectively analyse the frequency and distribution of various biopsied lesions of the gingiva among patients attending a dental teaching institution in Karnataka state in India. Materials and Methods: Data collected from 153 gingival biopsies referred to the Department of Oral Pathology, Yenepoya Dental College in Mangalore, Karnataka state, India during a 5-year period from 2004-2008 were utilised for the purpose of this study. Lesions were categorised by their type and analysed for age, sex and location. Results: Non-neoplastic lesions accounted for 51% while neoplastic and potentially malignant lesions accounted for 49% of the lesions. The most common non-neoplastic lesion was pyogenic granuloma (42.3%), the most common benign neoplasm was fibroma (34.5%) and the most common malignant lesion was squamous cell carcinoma (82.6%). Among all the lesions, the most common was squamous cell carcinoma (24.8% of all the lesions). Conclusions: Unlike in previous studies, squamous cell carcinoma was the most common gingival lesion. The proportion of malignant and potentially malignant lesions was also higher among subjects in the present study than in other populations. Hence, public oral health programmes need to be formulated to better tackle the burden of these diseases. Keywords: fibroma, gingiva, neoplasms, pyogenic granuloma, squamous cell carcinoma

Purpose: To evaluate the efficacy of curcumin mouthwash as an adjunct to scaling and root planing in the treatment of chronic gingivitis and to compare curcumin to chlorhexidine in terms of its anti-inflammatory and anti-microbial properties. Materials and Methods: Thirty patients aged 20-40 years with generalised chronic gingivitis were included in the study. They were randomly divided into 3 groups of 10 each. In group 1, patients underwent scaling and root planing followed by chlorhexidine mouthwash (SRP/CHX Gr-1); in group 2, patients underwent scaling and root planing followed by curcumin mouthwash (SRP/CUR Gr-2); in group 3, patients underwent only scaling and root planing (SRP Gr-3). Gingival and plaque indices were recorded at baseline (day 0) and 7, 14 and 21 days. Differences between the groups were statistically analysed. Results: The clinical parameters showed improvement in all the three groups compared to baseline. When compared to the scaling and root planing group (Gr-3), both curcumin and chlorhexidine groups were found to have statistically significantly better results (P 0.05). However, when curcumin and chlorhexidine groups were compared, the gingival (Löe and Silness) and plaque index (Silness and Löe) scores were not found to be statistically significant (P > 0.05). Conclusion: Curcumin is comparable to chlorhexidine as an anti-inflammatory mouthwash. Thus, it can be considered as an effective adjunct to mechanical periodontal therapy. Keywords: chlorhexidine, curcumin, dental plaque, gingivitis