Oral Health and Preventive Dentistry, 03/2008

Purpose: The objectives of this study were to describe oral health-related quality of life (OHRQoL) and its associated factors in an Indian adult population. Materials and Methods: Four hundred and fourteen general dental patients completed the Indian translations of the oral health impact profile (OHIP)-14 and the general health questionnaire (GHQ)-12 through personal interviews. A clinical examination was also performed for dental caries, gingivitis and plaque levels. Results: Sufficient reliability (/ = 0.85) and construct validity were demonstrated for the questionnaire. The mean decayed, missing or filled teeth of the study population was 6.93 and the mean gingival index and plaque index scores were 1.07 and 1.06, respectively. Caries status and the number of missing teeth were found to be significantly correlated with most of the subdomains of the OHIP-14. The GHQ-12 scores were also significantly correlated with the 'functional limitation' and 'psychological disability' domains of the OHIP-14. Higher OHIP-14 scores were associated with higher dental anxiety. Females perceived a higher sense of 'social handicap' and 'handicap' due to their oral status than males. It was also found that patients with caries and missing teeth had higher GHQ-12 scores. Conclusions: The results of this study showed that caries status, psychological distress and dental anxiety had an important effect on the OHRQoL. Keywords: behavioural sciences, India, oral health-related quality of life, reliability, validity

Purpose: To longitudinally evaluate oral habits and their effects on the developing occlusion in Nigerian children. Materials and Methods: A longitudinal epidemiological survey of 145 3- to 5-year-old children in a pre-primary section of a primary school near the Dental Centre, University College Hospital, Ibadan, Nigeria. The children at the first examination (Time 1) were screened for oral habits. They were then followed up and those located 4 years later were reassessed for oral habits (Time 2) in the primary school section of the same establishment. Only subjects who were actively engaged in non-nutritive sucking were coded positive. The occlusal features at Time 1 were recorded according to Foster and Hamilton, whereas at Time 2 the molar relationship was based on Angle's classification. Both descriptive statistics and Pearson correlation coefficient were used in the data analysis. Results: At Time 1, only 5 (3.4%) children in the original sample size were non-nutritive suckers, whereas at Time 2, 19 (31%) of the final sample size were involved in oral habits, with three of the initial children still involved, giving an incidence rate of 26.2%. Of the initial five non-nutritive suckers at Time 1, four were digit suckers and one a lip sucker. At Time 2, eight children were involved in digit sucking; seven in tongue thrusting/sucking, two in both digit and tongue sucking and two were nail biters. Five (4.5%) of 11 subjects with a Class 1 molar relationship at Time 1 had a Class II molar relationship at Time 2. The correlations between the oral habits at the two stages of occlusal development and anterior open bite were statistically significant (P 0.01). Conclusions: There was an increase in the number of children involved in oral habits at the early mixed dentition stage with significant correlations between oral habits and anterior open bite as well as a higher tendency towards Class II molar relationship for those with initial Class I. Keywords: Nigerian children, occlusal development, oral habits

Purpose: To assess the impact of oral health related quality-of-life (OHQoL) on patients presenting at the Department of Periodontology and Fixed Prosthodontics using a German version (the OHQoL-GE) of the oral health-related quality-of-life in the UK (OHQoL-UK) questionnaire. Materials and Methods: A total of 251 patients were invited to fill out the OHQoL-GE. In addition, patients were given a checklist of dental-related items over the past year including 'tooth ache', 'dental treatment', 'bleeding gums', 'swollen gums' and 'problems with dental prosthesis'. Prior to being seen by a dental professional, the patients completed the questionnaires. During the new patient clinic visit, medical and dental history, age, gender, number of teeth present and presence or absence and type of dental prosthesis were recorded. In addition, a basic periodontal examination (BPE) was performed. Results: Two hundred and fifteen OHQoL-GE questionnaires were completed. OHQoL-GE scores were significantly associated with patients' self-reported symptoms and problems in the past year: experiences of 'tooth ache' (P 0.05), 'swollen gums' (P 0.001) and 'problems with dental prosthesis' (P 0.05) with the exception of 'bleeding gums' (P = 0.102) and 'dental treatment' (P = 0.739). In addition, OHQoL-GE scores were directly correlated with the BPE (rs = -0.295, P 0.01), the number of teeth present (rs = 0.190, P 0.01) and inversely correlated with age (rs = 0.152, P 0.05). Patients with removable partial dentures had the lowest median score of 43 (interquartile range, IQR 23), patients without dental prosthesis had a median score of 46 (IQR 18) and patients with fixed dental prosthesis (FDP) had the highest score of 54 (IQR 26). The differences were statistically significant between patients without dentures and patients with FDP (P 0.05), and between removable denture wearers and patients with FDP (P 0.05). Conclusions: The issues were periodontal and prosthetic status, number of teeth present and age impact on quality-oflife. This has implications in understanding the consequences of dental health and in the use of patient-centred outcomes in dental research. The OHQoL-GE demonstrates discriminative validity in a population seeking dental advice and/or treatment. Keywords: dental care, dental health, German language, OHQoL, periodontal status, prosthetic status, quality-of-life, tooth loss

Purpose: The aims of this study were first to identify the risk indicators for permanent tooth extraction in patients who were receiving free dental treatment, and second to determine whether or not the reasons for tooth extraction are related to socio-demographic factors. Materials and Methods: Bangladeshi adults who visited Dhaka Dental College Hospital participated in this study. For each extraction, the clinician recorded age, sex, educational status, type of tooth extracted, dietary habits, oral hygiene, history of smoking and betel quid chewing and reasons for tooth extraction. A series of bivariate analyses and logistic regression analyses were carried out to assess the effects of major variables. Results: A total of 868 teeth were extracted from 582 patients. Among them, 586 (67.5%) of the teeth were extracted due to caries and its sequelae, 161 (18.5%) and 121 (13.9%) were extracted for periodontal and other reasons. Logistic regression analysis revealed that tooth extraction due to caries had significant associations with age (P = 0.0001), tooth type (P = 0.013), consumption of sweets, snacks and soft drinks (P = 0.0001 and P = 0.0001, respectively), frequency of teeth cleaning (P = 0.007) and dental attendance pattern (P = 0.004). For tooth extraction due to periodontal disease, associations with age (P = 0.001), educational level (P = 0.018), tooth type (P = 0.024), betel quid chewing (P = 0.0001), smoking habit (P = 0.032), method of teeth cleaning (P = 0.001) and the use of dentifrices (P = 0.024) were statistically significant. Conclusions: In this group of patients, caries and its sequelae were the most common reasons for extraction of teeth, followed by periodontal disease. Betel quid chewing, smoking and dietary and oral hygiene habits were also significant predictors of tooth loss. Keywords: betel quid chewing, dental caries, periodontal disease, permanent tooth loss, poor adult population

Purpose: The aim of the study was to explore and gain an understanding of patients' views on their periodontal conditions, their perceived impact of periodontitis on daily life, as well as their attitudes to oral health and expectations of treatment. Materials and Methods: The study subjects were patients with chronic periodontitis, who had been referred to a specialist clinic. The constant comparative method for grounded theory was used to collect and analyse the data. Audiotaped, open-ended interviews were conducted after periodontal examination, but before treatment. The interviews were transcribed verbatim and consecutively analysed in hierarchical coding processes and continued until saturation was reached (n = 17). In the analysis, a conceptual model that outlined the steps involved in the diagnosis of periodontitis was generated. The core concept of the model, keeping up appearance and self-esteem, was related to the following four additional categories and their dimensions; doing what you have to do - trying to live up to the norm, suddenly having a shameful and disabling disease, feeling deserted and in the hands of an authority, and investing all in a treatment with an unpredictable outcome. Results: The results illustrated that subjects diagnosed with chronic periodontitis felt ashamed and were willing to invest all they had in terms of time, effort and financial resources to become healthy and to maintain their self-esteem. However, they perceived a low degree of control over treatment decisions and treatment outcome. Conclusions: The results demonstrate the vulnerability of patients diagnosed with chronic periodontitis and emphasise the importance of communication in dentistry. Keywords: chronic periodontitis, grounded theory, interviews, oral health

Aims: The purpose of the present study was to assess the prevalence and pattern of periodontal disease among green marble mine labourers and to use the data to provide a baseline for planning and evaluation of oral health care. Materials and Methods: The study area was located in the Udaipur district of Rajasthan, India, divided into four geographical zones: Masoron ki ovri, Rushabhdev, Khandiovri and Kagdar Bhatiya. This study comprised 513 male subjects in four age groups (18 to 25, 26 to 34, 35 to 44 and > 45 years) collected using the stratified cluster sampling method. The data were collected by World Heath Organization (WHO) oral health assessment form, and clinical examination was conducted by the methods recommended by the WHO oral health surveys. There were three examiners, all of whom were calibrated before the survey for inter-examiner variability. The reliability was tested by means of weighted kappa statistics, which were 89% for periodontal data. Data were statistically analysed using SPSS/PC+ (SPSS software, Illinois, USA). Results: The prevalence of periodontal disease was found to be 98.2%. Bleeding on probing and calculus were widespread. The mean number of healthy sextants decreased abruptly with an increase in age. The greatest periodontal destruction was manifested in the 35 to 44-year-old age group, with 0.4 sextants having deep pocket probing depths. Conclusions: The present level and pattern of periodontal disease in marble mine workers is severe, and the implementation of oral health promotion and prevention is urgently needed. Keywords: community periodontal index, marble mine labourers, periodontal status

Background: Betel nut and tobacco chewing is a common practice in south-east Asia. In India, betel nut is commonly chewed in the form of pan, with or without tobacco. Numerous studies have shown the carcinogenic potential of betel nut and tobacco. Betel nut and tobacco are also known to have deleterious effects on the oral tissues. Purpose: The aim of our study was to evaluate and compare the periodontal effects of pan chewing with or without the use of tobacco as an ingredient. Materials and Methods: The periodontal status of 300 subjects (150 subjects were pan chewers with tobacco and 150 subjects were pan chewers without tobacco) was evaluated using the community periodontal index (CPI). The subjects were selected by the stratified random sampling method. The oral hygiene status of the subjects was evaluated using the simplified oral hygiene index. Results: CPI code-4, with a probing depth of 6 mm or more, was seen in 30% of pan chewers with tobacco compared with 7.3% of pan chewers without tobacco. It was found that pan chewers with tobacco had 4.7 times more risk of having pockets than pan chewers without tobacco. The higher codes of loss of attachment were seen in pan chewers with tobacco compared with pan chewers without tobacco. It was found that pan chewers with tobacco had 7 times more risk of having loss of attachment when compared with the pan chewers without tobacco. Conclusions: The results show higher incidence of periodontal diseases in pan chewers who use tobacco compared with pan chewers who do not use tobacco. Based on the results, it was concluded that, although betel nut has deleterious effects on the periodontium, the addition of tobacco leads to a synergistic effect between betel nut and tobacco on the periodontal tissues. Keywords: betel nut, pan, periodontal diseases, tobacco

Purpose: To clinically evaluate the additional effect of adding 0.12% chlorhexidine digluconate (CHX) to a 0.05% sodium fluoride (NaF) mouth rinse in arresting active enamel caries lesions after 28 days. Materials and Methods: A short-term double-blind clinical trial that included a total of 170 children, aged 11 to 15 years, with active smooth surface caries lesions (average 6.52) was conducted. The participants were enrolled and randomly distributed into two equal groups. Under the supervision of the research team, the children rinsed with a 15 ml solution of either 0.05% NaF (G1) or 0.05% NaF + 0.12% CHX (G2) for 1 min/day for 28 days. A clinical examination was carried out at the beginning and at the end of the study with children who underwent supervised tooth brushing. A calibrated examiner, who was unaware of the treatment given to each subject, examined all smooth surfaces dried with compressed air, isolated and illuminated with a reflector. The surface was considered active (A) or arrested (I). The frequency of A or I surfaces was evaluated by calculating the difference between the number found at the beginning and at the end of the trial. Results: No significant differences were detected between the two groups with respect to caries lesion surfaces at baseline (6.49 ± 4.45 - G1, 6.55 ± 4.23 - G2, respectively), nor were differences found when age and gender were taken into consideration. Arrestment proportions were 84.4% (G1) and 85.3% (G2) (P = 0.71; not significant). Conclusions: Although both solutions showed high arrestment proportions, the addition of CHX did not improve the arrestment capacity of the NaF mouth rinse. Keywords: chlorhexidine, dental caries, fluoride, randomised controlled trial

Purpose: Dental erosion can be measured by different methods. The aim of the present study was to check the applicability of common methods to determine initial erosive effects. Materials and Methods: Enamel surfaces (4.5 mm2) were eroded in vitro by treatment with hydrochloric acid (pH 2, 2.3 and 2.6) for 5 to 60 s or 240 s, respectively. Erosive effects were assayed with three different methods: Knoop's diamond indentation, profilometry and the determination of the dissolved calcium ions (Ca2+) in a colorimetric assay based on the arsenazo-III-reaction. Results: Erosivemineral loss of > 1 lmaremeasurable with profilometry. This corresponds to the erosive effects that occur after 60 s or more. Profilometric data yielded variance of up to 50%. Knoop's diamond indentation also showed some limitations: the depth of indentation reached a plateau after 30 to 120 s and the measurements showed variance of up to 85%. With the colorimetric assay, short time erosive effects occurring within 5 s could be assessed precisely and kinetically. The method allowed small amounts of 400 pmol Ca2+ per well to be quantified in small volumes with little variability. Conclusions: For evaluation and quantification of short time erosive effects, the colorimetric method is superior to diamond indentation and profilometry. Keywords: calcium, erosion, microhardness, photometry, profilometry

Background: Tooth wear has been generally described as being caused by erosion, abrasion and attrition. Erosion is currently believed to be the major factor involved in tooth wear, and its contribution in the development of tooth wear may be increasing. Among the numerous causes of erosion, extrinsic factors are the most common. Damage of tooth tissue has been described in battery factory workers due to acidic aerosol, but this has not been reported among roadside 'battery technicians' who dispense acidic solutions with a pipette, and often taste it to determine its 'specific gravity'. Case Description: A 24-year-old man was referred to the authors' clinic for management of his grossly damaged teeth after presenting for oral diagnosis. History and investigation pointed to extensive erosive lesion as a result of abnormal and prolonged use of lead-acid rechargeable battery solution in his workplace. Clinical Implications: These groups of workers are prone to severe dental erosion, thereby compromising their oral function and health. They are also prone to a range of illnesses, especially kidney disease, because the acid solution is significantly rich in dissolved lead. Therefore, medical referral for complete assessment is required when any of this group present with an unexplained associated illness. Keywords: battery technician, dental erosion