Oral Health and Preventive Dentistry, 01/2012

Probiotics are defined as live microorganisms which, when administered in appropriate amounts, confer a health benefit to the host. Although these organisms are naturally present in food and water, they can also be deliberately added to some foods because of their beneficial effects for human health. The potential application of probiotics for oral health has recently attracted the attention of several teams of researchers. However, only a few clinical studies have been conducted so far, and the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease and halitosis. This article summarises the currently available data on the potential benefits of probiotics for oral health. Keywords: Bifidobacterium, prebiotics, probiotics, synbiotics

Purpose: To explore the public perception of cross-infection prevention methods and their role in disease transmission, among patients attending Jordan University Hospital. Materials and Methods: A systemic random sample of 310 dental patients with a mean (SD) age of 35.1 (14.80) years was selected (42.6% males and 57.4% female). Patients were interviewed prior to dental appointments by a specially trained and calibrated dentist. Responses of the patients were recorded in the structured questionnaire, maintaining their privacy and confidentiality. The data were entered into a Microsoft Excel spreadsheet and analysed using the SPSS statistical package to obtain the prevalence rates of patients' perceptions, which were then cross tabulated with gender, age and other variables. Significant differences were determined using the chi-square test, when appropriate. Results: Of the respondents, 83.5% found it necessary for the dentist to wear gloves, and 65.8% stated the reason was to prevent cross infection from one patient to another. About three-quarters (74.8%) found it necessary for the dentist to wear a mask; when asked about the reason, 52.3% stated prevention of cross infection from dentist to patient. Regarding wearing protective glasses, about three-quarters (73.9%) found it unnecessary for the dentist to do so. The majority (76.8%) stated the method of HIV transmission was by dentists using needles previously used for patients infected with AIDS; 71% knew there is no vaccine against HIV. Only half (49%) reported that hepatitis could be transmitted by blood transfusion. Approximately two-thirds (67.4%) knew there is a vaccine against hepatitis. About 53.5% claimed their knowledge regarding infection transmission was obtained through watching television programmes about cross infection. Conclusion: Dental patients in Jordan need to be equipped with adequate knowledge about cross-infection control, thus education reinforcement is imperative. Keywords: cross-infection control, dentists, gloves, hepatitis, HIV, Jordan, public perception

Purpose: To assess the age the of the first dental visit and the association of self-perceived oral health, socioeconomic and clinical indicators with healthcare utilisation in Brazilian preschool children. Materials and Methods: An epidemiological survey with 455 5- to 59-month-old children was conducted on National Children's Vaccination Day in Santa Maria, RS, Brazil. Data about age and reasons for the first dental visit, healthcare utilisation, socioeconomic status and self-perceived oral health were collected by means of a parental semi-structured questionnaire. Calibrated examiners evaluated the prevalence of dental caries (WHO) and dental trauma. The assessment of the association used Poisson regression models (prevalence ratio; 95% confidence interval [CI]). Results: A total of 24.2% (95% CI: 20.3% to 28.4%) of the study sample had already had a first dental visit. Older children, those with dental caries and dental trauma and whose mothers had a higher level of education were more likely to have gone to the dentist. Children of low socioeconomic status were more likely to have visited public than private healthcare services. The reasons for the first dental visit were associated with clinical indicators of the sample. The distribution of utilisation of the types of oral healthcare services (public or private) varied across the socioeconomic groups. Non-white children with dental caries and dental trauma tended to visit a dentist only for treatment reasons. Conclusion: Socioeconomic and clinical indicators are associated with the use of dental services, indicating the need for strategies to promote public health and reorientation of services that facilitate dental access for preschool children. Keywords: accessibility, health services, oral health, socioeconomic indicators

Purpose: To identify the oral health attitudes/behaviour among dental students in Jordan, and analyse the variations in oral health attitudes based on gender and level of education. Materials and Methods: Out of the 653 registered dental students at the faculty of dentistry, 580 students (455 females and 125 males, mean age = 20.1 ± 1.6 years) participated in the study (response rate 89%). The Hiroshima University-Dental Behavioural Inventory (HU-DBI) was used to assess oral heath attitudes and behaviour of the participants. Data were analysed using the chi-square test, and statistical significance was set at P 0.05. Results: Females had better oral health attitudes and behaviour, especially towards visiting the dentist, toothbrushing habits and oral hygiene practice (P 0.05). Also, students from the higher years had better oral health attitudes, behaviour and knowledge, especially towards gingival health, oral hygiene practice, toothbrushing and visiting the dentist (P 0.05). Conclusion: Dental students in Jordan had poor oral health attitudes and behaviour. Females had better oral health knowledge, attitudes and behaviour than males. With increasing years of study, some aspects of dental students' oral health behaviour and attitudes improved. However, this improvement was limited and students should be encouraged to become an example of oral health for their society. Better comprehensive dental education with early exposure to dental health and prevention was suggested to improve dental students' oral health attitudes and behaviour. Keywords: dental students, HU-DBI, oral health behaviour

Purpose: To determine the impact of education on stages of change of behaviour in Iranian senior high school students for interdental cleaning based on the transtheoretical model. Materials and Methods: This experimental study took place from April to November 2010. 306 students were selected by multistage cluster sampling and placed into two groups: control (153 students) and intervention (153 students). Appropriate instruments and the intervention programme were designed with the purpose of improving stages of interdental cleaning behaviour, perceived benefits and self-efficacy, as well as reducing perceived barriers and gingival index (GI). The impact of the intervention programme was assessed after 24 weeks and the GI of each student was recorded for both groups before and after intervention. The data were analysed using SPSS software and the chi-square, t test, ANOVA, paired t test, Mann-Whitney U-test and sign test. Results: The intervention had a significant, positive impact on improvement of the stages of interdental cleaning behaviour, increase in self-efficacy, perceived benefits, decrease in perceived barriers and improvement of GI (P 0.001). After the intervention, the average grades of self-efficacy, perceived barriers and perceived benefits in the control group vs the intervention group were significantly different (P 0.001 to 0.01). Conclusion: The programme was found to positively influence the stages of change and potential indicators of interdental cleaning behaviour and GI. It is suggested that this model be used for interventions in the other population groups. Keywords: gingival index, oral and dental self-care behaviour, transtheoretical model

Purpose: A growing body of evidence supports an association between coronary heart disease (CHD) and dental diseases, particularly periodontitis (PD). The present study was designed to assess the relationship between childhood dental care and adult CHD in a single community dental clinic. Materials and Methods: Consecutive patients (n = 223) at a single urban U.S. dental clinic were asked to complete a questionnaire regarding the details of their childhood and present dental care as well as CHD and PD diagnoses. Results: A significantly greater proportion of patients who reported a lack of prophylactic dental care in childhood also reported a present diagnosis of CHD (54.2% vs 23.6%, P 0.001). In a multivariate logistic regression model including the traditional CHD risk factors of smoking, family history, age and sex, the relationship between dental care in childhood and reduced CHD remained significant (OR = 0.318, 95% CI = 0.159-0.635, P = 0.001). This association cannot be explained wholly by a mechanism involving the development of PD in patients with poor childhood dental care, as PD was not significantly associated with CHD in the multivariate model (OR = 1.646, 95% CI = 0.836-3.239, P = 0.149). Conclusions: In our single dental clinic assessment, adequate childhood professional dental prophylactic care was associated with reduced CHD in adulthood, an association independent of traditional risk factors. Further studies are required to better define the magnitude of this association. Keywords: coronary heart disease, dental prophylaxis, periodontitis

Purpose: To examine the accuracy of a screening programme for potentially malignant disorders of the oral mucosa by visual inspection in primary health care. Materials and Methods: The study was based on secondary data from the Primary Care Information System maintained by seven units of family health in São Paulo City managed by a non-governmental agency. The reference population was composed of 15,072 residents 50 years old or more of both genders. The study population comprised 2,980 individuals. During screening in community settings, the oral mucosa was examined by trained dentists and distributed into two categories: (a) screen negative (b) screen positive. All participants underwent comprehensive clinical exams by a general dental practitioner supervised by a specialist. Individual records were grouped in a working dataset. Point and 95% confidence interval estimates were calculated regarding measures of sensitivity (Se), specificity (Sp) and positive and negative predictive values (PPV and NPV, respectively). Results: 18.0% of the population was considered screen positive. A total of 133 lesions (4.5%) were identified and 8 cases of oral cancer were confirmed, which corresponded to a prevalence rate of 27 cases in 10,000 people, a much higher rate than expected. The measures found were Se: 91.7% (85.3-95.6), Sp: 85.4% (84.1-86.7), PPV: 22.7% (19.3-26.5), NPV: 99.5% (99.2-99.8). The visual screen presented high accuracy. Conclusion: The test presented high sensibility and specificity values. From a public health point of view, the high accuracy levels showed the importance of oral health teams on family health strategy for more comprehensive primary care. Targeting risk groups and delegating the screening to community health agents may improve PPV and coverage. Keywords: control, detection, oral neoplasms, screening accuracy

Purpose: To evaluate the changes in the enamel surface microhardness following the application of various suspensions of Crest and Pooneh toothpastes with and without fluoride. Materials and Methods: Fifty-six enamel blocks of primary incisors were exposed to a pH-cycling regime consisting of demineralisation and remineralisation solution, then suspensions of the dentifrices Crest 1100, Crest 500, Pooneh 500, Pooneh without fluoride. Changes of the enamel surface microhardness in pre-demineralisation (initial), post-demineralisation (demineralised) and post-remineralisation (final) stages were measured for four groups and were analysed using the Student t test and one-way ANOVA. Results: The percentages of changes in surface microhardness for Crest 1100, Crest 500, Pooneh 500 and Pooneh without fluoride were 45.4, 35.4, 28.6 and 23.7, respectively. Conclusion: Average changes of surface microhardness for Crest 1100 were significantly higher than Crest 500, Pooneh 500 and Pooneh without fluoride. Keywords: dentifrice, fluoride, microhardness, pH cycling, re/demineralisation

Purpose: To evaluate caries experience and fluorosis prevalence in 12-year-old schoolchildren in Piracicaba, Brazil in 2007 and to verify the relationship of these changes with socioeconomic and behavioural variables. Materials and Methods: The sample consisted of 724 schoolchildren from public and private schools. A calibrated dentist performed the examination under natural light using CPI probes and mirrors. The mean number of decayed, missing and filled permanent teeth (DMFT) and the SiC (Significant Caries Index) were determined for dental caries and the Thylstrup and Fejerskov index (T-F) for fluorosis. Socioeconomic and behavioural variables were collected by means of a questionnaire. Multiple logistic regression analyses were performed to verify the relationship of caries and fluorosis with socioeconomic and behavioural variables. Results: The DMFT and SiC indices were 0.85 (±1.54) and 2.52 (±1.72). Fluorosis prevalence was 29.42%. The regression models showed that children whose families earned up to four minimum wages were 2.58 times more prone to having caries than those whose families earned over four minimum wages. Furthermore, children who visited the dentist were 4.27 times more likely to have DMFT > 0. However, for fluorosis, the regression model was not significant. Conclusions: The 12-year-old schoolchildren in Piracicaba presented very low caries prevalence. Significant associations were observed between the presence of caries, monthly family income and visiting the dentist. Considering dental fluorosis, the majority of the sample presented no clinical signs of fluorosis. Keywords: dental caries, epidemiology, fluorosis prevalence

Purpose: To evaluate the caries experience, oral hygiene status and oral health knowledge of a group of visually impaired students. Materials and Methods: The study was conducted at one of the largest visually impaired children's schools among students aged between 7 and 16 years (n = 178) in Istanbul, Turkey. A 16-item questionnaire was asked in addition to a clinical tooth examination. The 16-item verbal questionnaire was developed to record the students' general health, impairment, the socioeconomic profile and education level of their parents, oral health knowledge, sources of information about oral health and oral hygiene habits. Oral hygiene was assessed according to Greene and Vermillion's Simplified Oral Hygiene Index (OHI-S). To measure the oral hygiene status, OHI-S index scores were recorded. Additionally, DMFT and dft indices were documented. Results: Only 26.40% of children were caries free, and only 2.2% of students had good oral hygiene. A total of 3.3% of these students were mildly retarded and 2.8% of them had a developmental disability. Visually impaired children exhibited a fair-to-poor level of oral hygiene. Conclusion: Maintenance of oral hygiene remains the greatest challenge in the care of visually impaired children. Keywords: caries experience, oral health knowledge, oral hygiene, visually impaired children

Purpose: To examine the literature with respect to periodontitis and issues specific to women's health, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. Materials and Methods: The literature was evaluated to review reported associations between periodontitis and genderspecific issues, namely, hormonal changes, adverse pregnancy outcomes and osteoporosis. Results: Collectively, the literature provided a large body of evidence that supports various associations between periodontitis and hormonal changes, adverse pregnancy outcomes and osteoporosis; however, certain shortcomings were noted with respect to biases involving definitions, sample sizes and confounding variables. Specific cause and effect relationships could not be delineated at this time and neither could definitive treatment interventions. Conclusion: Future research must include randomised controlled trials with consistent definitions, adequate controls and sufficiently large sample sizes in order to clarify specific associations, identify cause and effect relationships, define treatment options and determine treatment interventions which will lessen the untoward effects on the at-risk populations. Keywords: adverse pregnancy outcomes, osteoporosis, periodontitis

Purpose: The present study assessed halitosis after treatment of gingivitis by using different diagnostic modalities. Materials and Methods: A total of 27 patients (47 ± 7 years old; 14 women, 13 men) diagnosed with chronic periodontitis underwent supragingival mechanical debridement (day 0). Measurement of volatile sulfur compounds (VSC), visual analogue scale (VAS) and organoleptic assessment, visible plaque index (VPI) and gingival bleeding index (GBI) were obtained at baseline (prior to treatment of gingivitis) and then after 30, 90, and 180 days. The Friedman test was used to compare outcome data at days 0, 30, 90, and 180. Post-hoc comparison (tongue cleaning and non-cleaning) was performed using the Student t test for VSC and VAS and the Mann-Whitney test for organoleptic measurements. The level of significance was set at 5%. Results: VSC and VAS means (days 0 and 180) were, respectively, 463.41 ppb (± 496.12 ppb) and 245.96 ppb (± 301.51 ppb) and 6.28 cm (± 2.23 cm) and 5.03 cm (± 2.01 cm). The frequency of high organoleptic scores (3 to 5) declined from 96.29% (day 0) to 81.48% (day 30), with a reduction of around 50% at day 180. Post-hoc comparison did not reveal any significant differences between the indicators analysed. Conclusion: Supragingival plaque control reduced halitosis in patients with periodontitis, but tongue cleaning vs no tongue cleaning did not yield different results. Keywords: gingivitis treatment, halitosis, supragingival plaque control