Oral Health and Preventive Dentistry, 02/2009

Purpose: The aim of this study was to systematically review the studies on the association between diabetes mellitus (DM) and destructive periodontal disease. Methods: The methods applied include a literature search strategy, inclusion and exclusion criteria for selecting the studies, characteristics of the studies, quality assessment and meta-analysis. Data sources included PubMed, EMBASE, SciELO and LILACS. Selected papers were articles relating to human studies investigating whether or not diabetes is a risk factor for periodontitis and if it influences the response to periodontal therapy. Those papers that were published between January 1980 and June 2007 were retrieved. Results: Of the 2440 identified studies, 49 cross-sectional and eight longitudinal studies met the inclusion criteria. Twenty-seven of the 49 cross-sectional studies that are included in this review detected more periodontal disease in diabetic subjects compared with non-diabetic subjects. The greater risk of periodontal disease progression was associated with type 2 DM, and one study associated DM with response to periodontal therapy. Methodological flaws of most of the studies included inadequate control for confounders, insufficient statistical analysis and lack of information about sampling design. Random effect model showed a significant association with clinical attachment level (mean difference = 1.00 [CI 95% = 0.15 to 1.84]) and periodontal pocket depth (mean difference = 0.46 [CI 95% = 0.01 to 0.91]) between type 2 diabetics and non-diabetics. Conclusions: Type 2 DM can be considered a risk factor for periodontitis. More studies are needed to confirm the harmful effects of type 1 DM on periodontal disease. Keywords: diabetes mellitus, meta-analysis, periodontal disease, periodontitis, systematic review

Purpose: The aim of this study was to evaluate the severity of the findings of dental plaque, calculus and deepened periodontal pockets in relation to self-reported toothbrushing frequency in a group of elderly Lithuanians. The authors hypothesised that those reporting twice daily toothbrushing exhibit less severe periodontal findings. Materials and Methods: A cross-sectional study of 94 dentate patients aged 60 or older was conducted at two public dental offices in Lithuania. Half-mouth recordings of dental plaque, calculus and deepened periodontal pockets were expressed as mean values per subject. These indicators described the severity of periodontal findings. A selfadministered questionnaire provided information on toothbrushing frequency, age, gender and education. Statistical evaluation included chi-square test, analysis of variance and logistic regression. Results: None of the subjects were plaque-, calculus- or pocket-free. Of all, 26% reported that they brushed their teeth at least twice daily, 36% once daily and 38% less frequently. Women (P = 0.004), younger (P = 0.002) and higher educated respondents (P 0.001) reported twice daily toothbrushing more frequently than did their counterparts. Twice daily toothbrushing was clearly associated with the least severe conditions regarding dental plaque (P = 0.03) and deepened pockets (P 0.001), but not calculus (P = 0.39). Logistic regression models revealed higher level of education as the strongest factor odds ratio (OR = 2.7; P = 0.04) explaining the lowest scores of dental plaque. Higher frequency of toothbrushing was the strongest factor (OR = 2.1; P = 0.03) to explain the lowest scores of deepened periodontal pockets. Conclusion: Twice daily toothbrushing contributes to better periodontal health in the elderly subjects and should be encouraged at every dental appointment. Keywords: calculus, deepened periodontal pockets, dental plaque, elderly subjects, toothbrushing frequency

Background: Contaminated toothbrushes may play a role in the transmission of local or systemic diseases. As modern dentistry emphasises prevention and infection control, toothbrushes should be correctly stored, disinfected and changed at regular intervals. Purpose: The aim of this study was to test the efficacy of 3% neem, 2% triclosan, 0.2% chlorhexidine gluconate and 1% sodium hypochlorite as toothbrush disinfectants against Streptococcus mutans. Materials and Methods: This was a double-blind, linear crossover, within-group comparative experimental trial conducted among 40 children aged 12 to 15 years. The study was divided into five phases: (1) distilled water (control); (2) 3% neem; (3) 2% triclosan; (4) 0.2% chlorhexidine gluconate; and (5) 1% sodium hypochlorite. The toothbrushes were collected after 5 days of brushing and were soaked for 12 h in antimicrobial solutions of separate phases, after which the toothbrushes were submitted for microbial analysis to check for the presence of S. mutans. Results: The mean colony-forming units (CFUs) of S. mutans at phase 1 when compared with baseline was not significant (P = 0.17). The other phases had a significant drop in mean CFUs of S. mutans from baseline (P 0. 001). The percentage reduction of mean CFUs of S. mutans from baseline was the highest in phase 2 (86%). Conclusion: It can be concluded that all the solutions are effective in toothbrush decontamination, but 3% neem has greater efficacy than other solutions. Keywords: antimicrobial solutions, contamination, neem, Streptococcus mutans, toothbrush, triclosan

Purpose: The aim of this study was to evaluate the efficacy of three topical fluoride treatments to arrest initial root carious lesions. Materials and Methods: Forty patients participated in a randomised study. Of the 60 root carious lesions that were included, 20 were randomised for treatment with the Carisolv® chemo-mechanical technique and the Duraphat (2.23% F) fluoride varnish, 20 with Duraphat alone and 20 with stannous fluoride solution (8%). The lesions were treated at baseline and after three and six months; a clinical evaluation was carried out on these occasions and after 1 year. Results: All but four lesions were categorised as arrested caries during the 1-year follow-up period: 18 in the Carisolv/Duraphat group and 19 each in the Duraphat and the stannous fluoride groups, respectively. There was a minor reduction in the mean size of the lesions of around 0.1 to 0.2 mm height and width and a moderate change in colour from a lighter to a darker appearance. No obvious differences were found between the groups. The mean percentage of mutans streptococci in plaque from all lesions was 3.5% at baseline, and it decreased to 1.8% during the year. The decrease was, however, not statistically significant, and no significant differences were found between the groups. Conclusions: It can be concluded that the frequent topical application of fluoride could be a successful treatment for incipient root carious lesions, irrespective of the type of fluoride treatment used. Keywords: chemo-mechanical caries removal, clinical trial, fluoride varnish, root caries, stannous fluoride

Purpose: The aim of this study was to examine the relationship between self-control and self-confidence, and students' self-rated oral health and oral-health-related behaviours. Materials and Methods: The present study sample consisted of 178 first-year medical students. The questionnaire that was used in this study included information about sociodemographic factors, behavioural factors, self-reported oral health status, self-control and self-confidence. Results: The results showed that mean levels of self-confidence in individuals with current extracted teeth and with poor/ very poor perceived gingival condition were statistically significant and lower than those with no current extracted teeth and with self-rated excellent gingival health (P 0.05). Also participants with self-reported gingival bleeding showed lower values of self-control compared with those with healthy non-bleeding gingiva (P 0.05). When oral health behaviour was evaluated, it was shown that students with higher scores of self-control were more likely to use everyday mouthrinses (P 0.05). The multiple linear regression analyses showed, for self-rated oral and gingival health status as dependent variable, a strong association with students' self-confidence level (P 0.05). Conclusions: The results support the view that self-confidence is related with oral health status, and individuals with impaired oral and gingival health have a low self-confidence level. Keywords: oral health behaviour, oral health status, self-confidence, self-control

Purpose: The aim of this study was to estimate the oral impact on daily performances (OIDPs) and its association with self-reported quality of life, sociodemographic and oral health conditions, self-reported oral symptoms and access to a clinician in elderly people. Materials and Methods: A cross-sectional study was performed involving individuals over the age of 59 years, resident in the city of Florianópolis, Brazil. A sample of 180 individuals selected in a two-stage approach was examined and interviewed. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to collect data on self-reported quality of life. The OIDP questionnaire was used to collect data on oral impact on daily performances. The criteria for the clinical data were those proposed by the World Health Organization. The dependent variable was the oral impact on daily performances. The chi-square test was used to examine the association between the dependent and the exploratory variables. Variables were inserted in a model of multiple logistic regression. The level of significance was set at P 0.05. Results: The proportion of individuals who reported oral impact on daily performances was 45.6%. The results of the multiple logistic regression analysis showed that only the altered condition of the oral mucosa and the social domain of the WHOQOL-BREF maintained an independent association with oral impact on daily performance. Conclusion: Of the investigated elderly individuals 45.6% reported oral impact on daily performances. Those who presented altered oral mucosa and had a lower performance in the WHOQOL-BREF social domain were more likely to report such an impact. Keywords: elderly, oral health, quality of life, social life

Purpose: The aim of this study was to investigate the association between cognitive and behavioural factors of preadolescents and those of their mothers, assessed in terms of self-efficacy beliefs and toothbrushing among Turkish and Finnish population in the framework of Social Cognitive Theory. The specific objective was to test if this possible association worked regardless of cultural differences. Materials and Methods: Self-administered questionnaires for Finnish (n = 338) and Turkish (n = 611) pre-adolescents and their mothers were used to collect the information on cognitive (pre-adolescent and maternal self-efficacy) and behavioural factors (toothbrushing frequencies). Results: Turkish mothers and pre-adolescents reported lower levels of self-efficacy and toothbrushing than did their Finnish counterparts (P 0.005). Finnish pre-adolescents reporting high self-efficacy were more likely to have mothers with high levels of self-efficacy (OR = 2.14, 95% CI = 1.16 to 3.93), (P = 0.014). Similar positive associations emerged between Turkish (OR = 2.45, 95% CI = 1.70 to 3.52), (P = 0.001) and Finnish (OR = 6.76, 95% CI = 2.21 to 20.65), (P = 0.001) pre-adolescent self-efficacy and maternal recommended (twice daily) level of toothbrushing behaviour. For pre-adolescents' toothbrushing, their own self-efficacy was the common explanatory variable. Binary logistic regression models revealed that the maternal toothbrushing accounted for the Turkish pre-adolescents' toothbrushing behaviour, whereas maternal self-efficacy did so for the Finnish pre-adolescents' (P 0.001) toothbrushing behaviour. Conclusions: This study underlines the need for integration of pre-adolescent self-efficacy and maternal cognition and behaviour into oral health intervention programmes because of their relation to recommended toothbrushing behaviour among pre-adolescents, regardless of cultural differences. These findings seem to fit with the Social Cognitive Theory, which emphasises the significance of cultural factors and cognition as the determinants of behaviour. Keywords: culture, maternal, mothers, oral hygiene, pre-adolescent, self-efficacy, Social Cognitive Theory, toothbrushing behaviour

Purpose: The role of demographic, socioeconomic and psychological factors that influence the subjective assessment of dental needs has been the subject of contemporary dental research. The aim of this study was to determine the relationship between self-reported and clinically diagnosed dental needs, with the view of understanding the factors that affect subjective assessments of dental problems. Materials and Methods: A random sample of 130 subjects, aged 21 to 63 years, was selected from the non-academic staff members of the Athens University of Economics and Business. Data were obtained for 92% (120 participants) of the sample by a questionnaire-based interview and a clinical examination. The questions concentrated on the demographic and socioeconomic characteristics and the ratings of oral health, the perceived need, oral functional impacts and the level of satisfaction with the appearance. In the clinical examination, the oral health status of the participants was thoroughly recorded. Results: A strong relationship was detected with the presence of caries, badly broken and missing teeth, and selfreported need for care. Embarrassment due to one's dental health was also associated with the perceived need, although satisfaction with the appearance was not. Neither demographic and socioeconomic status nor self-rated oral health was significantly associated with a currently perceived dental problem. Conclusion: Perceived need for dental care is affected by parameters other than demographic and socioeconomic status (i.e. parameters that are associated with the presence of symptoms and/or impacts on everyday life). Therefore, functional and psychological impacts of the disease seem to be as important, if not more, as the clinical indicators while estimating the dental needs. Keywords: normative need, oral functional impacts, oral health, perceived need, subjective assessment

Purpose: The aim of this study was to investigate whether self-liking, self-competence, body investment and perfectionism were associated with self-reported oral health status and oral-health-related behaviours. Materials and Methods: The study sample consisted of 217 first-year dental students. The questionnaire included information about sociodemographic factors, behavioural variables, self-reported oral health status, self-liking, selfcompetence, body investment and perfectionism. Results: Significant differences were found on self-liking, self-competence and body investment subscales according to several variables: perceived dental health, current non-treated caries, current extracted teeth, satisfaction by the appearance of own teeth, the last time toothache occurred, self-reported gingival condition and self-reported gum bleeding. When oral health behaviours were analysed, an association between self-liking, self-competence and body investment subscales and flossing, mouthrinse and dental visit pattern was revealed. Toothbrushing frequency once a day or less was observed in persons with low-levels of self-liking, body care, body protection and perfectionism. Multiple linear regression analyses revealed that age, gender, smoking habits, anxiety, stress, depression in everyday life, selfliking, self-competence, body image, care and protection were positively associated with oral health behaviours. Conclusions: The results suggested that self-liking, self-competence and body investment subscales might be the psychosocial risk markers that influence self-reported oral health status and behaviour. Keywords: body investment, oral health, perfectionism, self-competence, self-liking