Oral Health and Preventive Dentistry, 01/2011

Purpose: The aim of the present study was to compare and assess the oral health status of 12-year-old children from two socially disadvantaged groups in the Udupi district of South India. Materials and Methods: A total of 327 children were examined in Ashrama schools, and 340 children were randomly selected for comparison from other government schools. Modified WHO proforma was used for clinical examination. Oral hygiene practices, dental fluorosis, periodontal status, dentition status and dentofacial anomalies were assessed and compared. Chi square test was used for comparison between categorical variables and Mann-Whitney test for comparison between two groups for quantitative variables. P u 0.05 was considered as statistically significant. Results: Dental fluorosis was detected in 22.9% children from Ashrama schools, whereas in the comparison group 14.4% children had dental fluorosis (P u 0.001). Mean Decayed teeth and DMFT value in Ashrama school children were 1.15 ± 1.62, and 1.15 ± 1.62, respectively. In the comparison group, the corresponding values were 0.46 ± 0.98 and 0.48 ± 1.04, respectively (P u 0.001). The mean number of sextants in the Ashrama school children with Community Periodontal Index score 2 was 2.00 ± 1.53, whereas in the comparison group it was 1.31 ± 1.53 (P u 0.001). No significant differences were noted between two groups with respect to Dental Aesthetic Index scores. Conclusions: The present study revealed higher levels of dental caries experience, untreated dental disease and social disadvantage of the children attending Ashrama schools, providing evidence for the need to address the health inequalities of these children. Schlagwörter: dental care for children, oral health, social indicators

The objectives of this study were to assess the relationship between Locus of Control (LoC) and oral health among a group of rural adolescent school children and to examine the influence of socioeconomic status (SES) on the association between health, LoC and oral health status. A total of 318 children 15 years of age from a public and private school formed the study population. The children were administered following the Indian translation of the 18-item Multidimensional Health Locus of Control scale, and subsequently examined for caries and oral hygiene. T tests and correlation analyses showed a significant relationship between higher 'Internal' Locus of Control and dental caries. A hierarchical multiple regression analysis was performed to assess the effect of socioeconomic status on LoC and oral health using three interaction models which showed a statistically significant interaction between 'Internal' LoC and socioeconomic status on caries. Socioeconomic stratum-specific estimates of the relationship between the LoC and caries revealed a positive association between Internal LoC and caries in the middle socioeconomic group. The results demonstrated the relationship between Locus of Control and oral health, and the role of socioeconomic status having a strong bearing on this relationship. Schlagwörter: Locus of Control, oral health, socioeconomic status

Purpose: To record, determine and discuss the gender influence on the overall prevalence of occlusal characteristics of primary dentition of 4- to 6-year-old children of Bagalkot City, India. Materials and Methods: A total of 1000 children (583 boys and 417 girls) 4 to 6 years old were evaluated clinically for primary molars, primary canines, developmental spaces, measurements of overjet and overbite, crowding, anterior or posterior cross bite, midline discrepancies, lateral profile, as well as assessment of the presence of lip incompetency. A stratified cluster random sampling procedure was executed to collect the representative sample. Results: Highly significant differences between males and females were observed for the prevalence of flush terminal plane molar relationship, class I and II canine relationship, overjet and overbite of 0 to 2 mm, and for both convex and straight profile. A significant difference was seen for the occurrence of mesial step and asymmetric molar relationship, presence of developmental and primate spaces, shift in maxillary dental midline, presence of both single tooth anterior and bilateral posterior cross bite, overjet of 2 to 4 mm and convex profile. Conclusions: The data revealed that most of the children had a malocclusion and that there was a significant difference between male and female occlusal characteristics. This highlights the importance of identifying children who are in need of orthodontic treatment for dental health or aesthetic reasons. The study also indicated that the prevalence of most of the occlusal characteristics were comparable with other communities, but there existed substantial differences in prevalence of some traits. Schlagwörter: gender, malocclusion, occlusion, prevalence

Purpose: Tobacco use is a major risk factor in oral and systemic diseases. Current national guidelines outline activities that positively contribute towards tobacco cessation. Little is known about dental hygienists' role in tobacco cessation activities. This study investigates dental hygienists' performance of tobacco cessation activities in the dental surgery and explores factors associated with this performance. Materials and Methods: Dental hygienists in south-east England on the register of the British Society of Dental Hygiene and Therapy completed a postal questionnaire survey in 2008. Results: A total of 439 (61%) questionnaires were returned, representing both part-time (66.7%) and full-time (33.3%) hygienists working in the private (69.5%) and non-private sectors (30.5%). Most hygienists recorded positive attitudes towards tobacco cessation. Overall, 162 (41.9%) reported performing four or more tobacco cessation activities. The less-commonly performed activities indicated to patients the value of attending NHS Stop Smoking Services for specialised help, with hygienists referring patients to the NHS Stop Smoking Services and offering assistance to those who do not wish to attend NHS stop Smoking Services. Higher reported numbers of tobacco cessation activities performed were statistically significantly associated with a higher number of positive attitudes held (P = 0.004), while socio-demographic and professional attributes were not. Conclusion: Tobacco cessation activities, as recommended by national guidelines, are not always performed by dental hygienists. Efforts are needed to promote the dental hygienist's role in tobacco cessation, especially in relation to referring patients to NHS Stop Smoking services. These efforts should focus on changing the attitudes of dental hygienists, especially on their effectiveness in promoting tobacco cessation. Schlagwörter: attitudes, dental hygienist, tobacco cessation activities

The purpose of this review was to summarise the fundamentals about black stain, its diagnosis and possible differential diagnoses as well as its microbiology and therapy. In addition, various studies investigating the relationship between black stain and dental caries are examined. Many studies report lower caries prevalence in children with black stain, but this finding could not be confirmed by all authors. Also, a negative relation between degree of staining and caries severity has been described. Reasons for these results are not yet clear but it was speculated that they are related to the specific oral microflora described in black stain-affected individuals. Schlagwörter: black stain, dental plaque, extrinsic tooth stain, pigmented dental plaque

Purpose: To assess the prevalence and severity of dental caries among 12-year-old schoolchildren and to examine its possible association with maternal schooling. Materials and methods: A cross-sectional study involving a representative sample (n = 253) of the 12-year-old schoolchildren enrolled in 14 schools of the municipality of Curitibanos, Brazil was carried out in 2006. Clinical information was obtained through the World Health Organization criteria. Non-clinical data were obtained through interviews with schoolchildren. Associations were analysed using chi-square test or Fisher exact test followed by non-conditional multiple logistic regression analysis to test the independence of associations between outcome and explanatory variables. P-values were set at 0.05. Results: The prevalence of caries was 81.7% and the mean decayed, missing or filled teeth score was 4.08. Prevalence was significantly higher among girls, with a prevalence ratio of 2.58 (95% CI 1.25, 5.32) (P = 0.010); among schoolchildren from mothers with lower education level, with a prevalence ratio of 3.26 (95% CI 1.32, 8.06) (P = 0.010); and among schoolchildren who had ever visited a dentist, with a prevalence ratio of 2.91 (95% CI 1.14, 7.62) (P = 0.030). Conclusions: The prevalence and severity of caries were higher than the Brazilian national average. The prevalence was statistically associated with maternal schooling, had visited a dentist, and gender. Schlagwörter: dental caries, educational status, epidemiology, socioeconomic factors, students

Objective: To determine the fluoride concentrations of commercial dentifrices marketed in West Africa. Design: In vitro measurement of the total fluoride concentration by liquid gas chromatography, and of the free fluoride concentration with a fluoride sensitive electrode. Setting: Collection of fluoride dentifrices in public markets and supermarkets in and around the capital of The Republic of The Gambia, Banjul, after a systematic search. Materials: All commercially available different brands sold in The Gambia and produced locally or in other African countries (Egypt, Morocco, Nigeria and South Africa). Outcome measures: Total and free fluoride concentrations of dentifrices in parts per million. Results: Seven different dentifrices were detected with NaMFP as the predominant fluoride source. Four dentifrices showed a total fluoride concentration above 1,000 ppm F-. The products showed - in general - a lower free fluoride concentration. Only one product with NaF as fluoride supplement showed both total and free fluoride concentrations above 1,000 ppm F-. Four products contained calcium-based abrasive additives. Conclusion: The measurement of total and free fluoride concentrations of dentifrices available in The Gambia (West Africa) showed inhomogeneities. This was particularly verified where fluoride compounds were combined with calciumbased abrasives. If so, it is recommended that the total fluoride content should be measured by gas chromatography. Periodic quality control of dentifrices should be introduced in areas with an under-developed consumer-counselling infrastructure. Schlagwörter: Africa, dentifrice, fluorides, sodium fluoride, sodium monofluorophosphate

Purpose: The aim of this present clinical and microbiological study was to evaluate the efficacy of the association of locally delivered 10% doxycycline hyclate (Atridox®) with scaling and root planing in the periodontal treatment of smokers. Materials and methods: Forty-five patients with chronic periodontitis having a minimum of two periodontal pockets (>5 mm) and satisfying the inclusion and exclusion criteria were selected. Sites were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of 10% doxycycline hyclate (SRP-D). Plaque index (PI), gingival index (GI), periodontal pocket depth (PD), clinical attachment level (CAL) and total anaerobic colony count (TACC) were recorded at baseline, one month and three months respectively. Differences between baseline and each period were considered for analysis. Results: There was a significant reduction in plaque score, gingival score, periodontal pocket depth and total anaerobic colony count from baseline in both groups at all time intervals. Clinical attachment level showed a significant gain in both groups. However, PD reduction (P 0.001) and CAL gain (P 0.001) were significant in the test group as compared to control at the end of 3 months. Reduction in total anaerobic colony count from baseline was significant (P = 0.02) in the test group compared to control at the end of 3 months. Conclusions: The use of locally delivered doxycycline may constitute an important adjunct for the treatment of chronic periodontitis in smokers. Schlagwörter: chronic periodontitis, doxycycline hyclate, smokers

Purpose: There exists meagre information on the prevalence of periodontal conditions among adults in Nepal. Therefore, appropriate data on periodontal conditions are needed to facilitate planning, monitoring and evaluation of oral health programmes. The objective of the present study was to determine the prevalence of periodontal conditions among adults aged between 33 and 97 years in Nepal and also to elucidate any possible risk predictors of periodontal problems. Materials and Methods: The total subjects included in the present study were 1210 (33 to 49 years [n = 596] and 50 to 97 years [n = 614]). Community Periodontal Index scores were used to assess the periodontal status of the selected subjects. Self-reported data were used to ascertain oral health behaviour. Results: Logistic regression analyses showed the following observations for the age group 33 to 49 years: (1) bleeding was more likely found among those subjects who resided in rural areas and upper hill terrain, and among those who used non-fluoridated dentifrice; (2) bleeding was, however, less likely to be observed among those with primary or unfinished secondary school education (PSE); (3) calculus deposits were accentuated in illiterates, whereas less calculus formation was experienced by alcohol users; (4) periodontal pocket 4 to 5 mm was predominantly seen among illiterates and those with PSE, smokers and those who used non-fluoridated dentifrice; (5) periodontal pocket v 6 mm was observed among illiterates and those with PSE and those who used non-fluoridated dentifrice. With regard to 50 years old and above, the following observations were noticed: (1) bleeding was associated with the use of non-fluoridated dentifrice; (2) chewing betel nut showed a protective effect with regard to calculus formation; (3) being illiterate increased the likelihood of having periodontal pockets 6 mm or more in depth. Conclusions: Several findings of the present study are in concordance with empirical evidence. However, the protective effect of alcohol and betel nut against calculus formation needs to be investigated further. Schlagwörter: adults, CPI scores, Nepal, periodontal conditions

Objectives: The objective of this study is to examine whether the well-known association between periodontal disease and smoking persists after adjusting for job classification. Methods: A sample of 16,110 employed Japanese males aged 20-69 years was included in the study. Periodontal examinations were conducted using the Community Periodontal Index. The association between periodontal disease and smoking status was examined using logistic regression adjusting for age, diabetes and job classification. Job classification was based on criteria of the Japanese Ministry of Health, Labour and Welfare. There are nine major job groups: (1) Professional (professionals, specialists), (2) Managers, (3) Office workers (computer operators, clerks, secretaries), (4) Skilled worker (factory workers, construction workers), (5) Salespersons (shop assistants), (6) Service occupations (superintendents, cleaners or car park attendants), (7) Security (guards), (8) Farmers and fishermen, (9) Transport and telecommunication workers (truck drivers). Results: Current and former smokers were more likely to have periodontal disease than non-smokers. Adjusting for job classification attenuated the association between smoking and periodontal disease but did not eliminate the association. The odds ratios for the association between smoking and Community Periodontal Index score 3 or 4 attenuated from 2.25 to 2.04 and from 2.62 to 2.52 for individuals aged 20 to 39 and 40 to 69 years, respectively. The effect of job classification on the association between periodontal disease and smoking was higher among younger participants aged 20 to 39 years. Conclusions: Smoking persisted as an important determinant of periodontal disease after adjusting for job classification in Japanese employed males. Schlagwörter: inequality, job classification, periodontal status, smoking

Summary: This case report is of a rare occurrence of necrotic ulcerative changes in a female patient with Fanconi's anaemia and its successful periodontal management. Background: The response of the periodontium to certain genetic and haematological disorders may vary from bleeding, ulcerations and necrosis to a more severe form of periodontitis. Periodontal management in such conditions still remains an enigma with respect to the timing of the periodontal intervention with regard to the systemic wellbeing of the patient. Methods: Necrotising ulcerative lesions in a patient with Fanconi's anaemia (FA) progressed rapidly in a week's time necessitating early preliminary periodontal care, which included scaling and root planning using ultrasonic equipment supplemented with hydrogen peroxide irrigation, in conjunction with systemic antibiotics and blood transfusion. Results: Following 1 unit (500ml) of fresh whole blood transfusion 24 hours preoperatively, basic periodontal therapy, comprising of removal of necrotic slough and thorough scaling was done. There was marked resolution of the necrotic ulceration and related symptoms when the patient was followed up for a period of 1 month. Conclusion: This report reconfirms most oral manifestations of Fanconi's anaemia and is the first of its kind to associate necrotic ulcerative changes of the gingiva with FA. It also goes a step further to emphasise the clinical significance of multidisciplinary approach towards successful patient management, which was the primary objective. Schlagwörter: blood transfusion, Fanconi's anaemia, gingival necrosis, gingival ulceration, periodontal therapy