Oral Health and Preventive Dentistry, 04/2006

The most common condition affecting all women is menopause and most women spend one third of their lives after the menopause. Menopause is accompanied by a number of characteristic physical changes, some of which are manifested in the oral cavity. Purpose: The objective of this study was to evaluate the oral health status of a group of menopausal women who visited a menopause clinic in Ankara, Turkey. Materials and Methods: A total of 348 women, aged 44-65 (mean 52.17 ± 4.67), who spontaneously attended the menopause clinic at Hacettepe University Hospital, Ankara, Turkey, (between 1998 and 2000) were interviewed and examined by a trained dentist over a two-year period. Their oral status was determined by the same dentist by using the follwing indices on the basis of WHO criteria: Decayed, Missing and Filled Teeth (DMFT); Decayed, Missing and Filled Teeth Surfaces (DMFS); Root, Decayed, Filled (RDF); and Community Periodontal Index (CPI). Oral complaints and denture status was also assessed. The data were analysed by means of difference between groups. Results: A total of 23% of the women were using hormones and 77% were not. The most significant symptom was oral dryness with 48.8% in the hormone users and 68.3% in the non-users (p 0.05). A total of 36.3% of the hormone users and 39.5% of the non-users were edentulous (p > 0.05). DMFT, DMFS and CPI values of non-users were higher than the hormone users (p 0.001). RDF values did not show any significant difference between hormone users and non users (p > 0.05). Conclusions: These data suggest that menopause might play a role in the oral status of women. The use of hormones seemed to affect oral health positively. Parole chiave: menopause, oral health, Turkey

Purpose: The aim of this study was to examine the validity and reliability of the Com-DAS (combined dental anxiety scale) as an indicator for children's perceived dental anxiety and to investigate the effect of age, gender and socio-economic factors on dental anxiety. Materials and Methods: A total of 258 children aged between 8 and 12 years, who had not visited a dentist before, were randomly selected from three different socio-economic status groups. A new scale was developed by combining the C-DAS (Corah's dental anxiety scale) and FIS (facial imaging scale), and named Com-DAS. Original C-DAS was used for validation. Results: There was a high correlation between C-DAS and Com-DAS (r = 0.69). The lowest correlation was in 8-year-old children (r = 0.46), however the mean difference between the scales in this age group was not statistically significant (p > 0.05). The Com-DAS scores showed no statistical difference according to gender, whereas there was a significant difference according to age and socio-economic status (p = 0.001 in both cases). Conclusion: The Com-DAS used in this study may be of use in those communities where the children and their families have limited literacy skills and their understanding of modern dental procedures may be influenced by non-qualified dental practice. Parole chiave: children, dental anxiety, socio-economic status

Purpose: The aim of this study was to evaluate the effectiveness of a repeated oral health education programme on oral health knowledge and hygiene of visually impaired students. Materials and Methods: The study was conducted at one of the two visually impaired boarding schools of Istanbul, Turkey. The number of subjects was 65, comprising 28 totally and 37 partially visually impaired students between 7 and 17 years of age. A 24-item verbal questionnaire was developed to record their general health, impairment, the socio-economic profile and education level of their parents, oral health knowledge, sources of information about oral health, awareness of sugar intake/ caries risk, frequency of dental check-ups and oral hygiene habits, as well as any difficulties they experienced thereby. They were given individual training on oral care three times with two-month intervals within the nine-month framework of the programme. To measure the oral hygiene status, plaque index (PI) and gingival index (GI) scores were recorded of all teeth at four sites throughout the sessions. After completion of the programme, the oral health knowledge of the students was evaluated using the same questionnaire to determine the effectiveness of the programme. Results: Statistically significant improvements were found at the level of oral health knowledge and oral hygiene status both in totally and partially visually impaired students at the end of the study (p 0.001) as compared with at the beginning. No significant difference was found between the knowledge of totally visually impaired and partially visually impaired students. Conclusion: It was concluded that with an appropriate programme, the oral health knowledge of visually impaired students could be improved. This programme, if conducted on a one-to-one basis, ensures clinical and statistical significance. Parole chiave: education, oral health, visual impairment

Purpose: The purpose of this cross-over, double-blind, placebo-controlled, randomised in situ study was to evaluate the remineralisation of demineralised enamel specimens using a CHX/NaF mouthrinse in comparison with a CHX- and a placebomouthrinse. Materials and Methods: Twenty-four volunteers received intraoral appliances with mounted demineralised enamel specimens. They rinsed their mouths twice a day (10 ml for 1 minute) with the respective preparation. After 14 days, the in situ mineral gain and fluoride uptake were determined. Results: Mineral gain was significantly higher after using CHX/F mouthrinse (358.4 ± 372.1 Vol.%·µm) compared with CHX (95.6 ± 192.2 Vol.%·µm) and placebo treatment (80.8 ± 159.6 Vol.%·µm). Moreover, CHX/F treatment (2751.1 ± 1494.9 µg/cm3) resulted in a significantly higher fluoride uptake compared with CHX- (83.8 ± 94.0 µg/cm3) and placebo- (136.6 ± 137.3 µg/cm3) mouthrinses. Conclusion: The in situ study approves that using a CHX/F mouthrinse supports the remineralisation of initial carious lesions. Parole chiave: caries, chlorhexidine, enamel, mouthrinse

Purpose: To investigate oral health behaviour and smoking habits among academic staff members in Iran's dental schools in relation to their personal and academic background characteristics. Materials and Methods: Out of 15 state dental schools, seven were selected randomly as clusters. All of the educators who were present (total n = 363) were asked to voluntarily fill in a self-administered pre-tested questionnaire. In addition to background and academic characteristics, the questionnaire requested information on smoking habits, oral self-care, and dental check-ups. Recommended oral self-care was defined as brushing at least twice a day and frequent use of fluoridated toothpaste. Chi-square test and binary logistic regression model served for statistical analyses. Results: A total of 291 educators filled in the questionnaire (response rate = 80%). Women reported higher frequencies of brushing (p = 0.001), use of fluoridated toothpaste (p = 0.002), flossing (p 0.01) and eating sugary snacks (p = 0.01) compared with men. Habitual cigarette and pipe smoking was reported by 22% and 3% of male educators respectively. Familiarity with the field of oral public health correlated to higher frequencies of brushing (p = 0.05) and flossing (p = 0.03). Smoker educators reported less favourable oral self-care habits than non-smokers. Female gender (p = 0.002, OR = 2.7) and familiarity with the oral public health field (p 0.01, OR = 2.5) were associated with recommended oral self-care criteria. Conclusion: Dental educators should have positive attitudes towards and beliefs in effectiveness of preventive dentistry in order to increase public awareness of its importance. Parole chiave: dental education, dental faculty, oral hygiene, preventive dentistry, smoking

Purpose: To test a system of measuring early plaque formation (EPF) and its subgingival extension as related to the presence or absence of a plaque free zone (PFZ). Materials and Methods: EPF was measured by three independent examiners following two consecutive 72-hour periods of undisturbed plaque build-up. One of the examiners further measured EPF following a 96-hour period in the presence of chlorhexidine or placebo. The classification system was composed of criterion 0 (plaque-free dental surface), criterion 1 (presence of plaque and PFZ) and criterion 2 (absence of PFZ, subgingival extension of plaque). Intra- and inter-examiner reliability were evaluated by means of the percentage of absolute agreement (c), Kappa (k) and Kendall (kd) coefficients. The third experiment consisted of a double-blind, placebo-controlled, cross-over trial. Plaque build-up in the presence of 0.12% chlorhexidine was assessed by employing the classification system described. Results: The percentage of absolute intra- and inter-examiner agreement ranged from 85.43% to 75.63% and from 77.31% to 75.35% respectively. Chlorhexidine and placebo rinses showed similar percentages of criterion 1 surfaces, 62.6% and 51.5% respectively (p = 0.343). Of the surfaces, 44.3% showed criterion 2 after the use of placebo, while 3.4% of surfaces showed this criterion with the chlorhexidine (p = 0.007). Conclusion: The events associated with EPF can be appropriately scored with this classification system. Chlorhexidine rinses inhibit both the plaque colonization of the dental surfaces as well as its subgingival extension. Parole chiave: dental plaque/diagnosis, dental plaque/prevention and control, early plaque formation, reliability

Purpose: The aim of this study was to evaluate the cleaning efficacy of interdental brushes with different stiffnesses, e.g. soft and hard interdental brushes with identical brush diameter. Materials and Methods: Cylindrical soft and hard interdental brushes with diameters of 2,3 and 5 mm each were tested. Sixteen extracted human molars were fixed in split cast models to simulate eight interdental spaces. After coating the teeth with a dye to simulate plaque, digital photographs were taken from the proximal surfaces in a highly standardised set-up. The teeth were repositioned and the proximal surfaces were cleaned in a standardised manner. Post-brushing digital photographs were taken as before. After digital subtraction, the cleaned area was measured by pixel count and the relative cleaning efficacy was calculated. Results: The cleaning efficacy values of soft and hard interdental brushes of corresponding size in extra-small, small, medium and large interdental spaces as well as overall showed no statistically significant difference. In small, medium and large interdental spaces, increasing brush diameters resulted in higher cleaning efficacy; these differences were statistically significant. Irregular values were seen in extra-small interdental spaces. Conclusion: Both hard and soft interdental brushes cleaned the proximal tooth surfaces effectively. The filament stiffness had no statistically significant influence on the cleaning efficacy. Parole chiave: cleaning efficacy, filament stiffness, interdental brushes, mechanical plaque control

Purpose: To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children). Materials and Methods: A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus. Results: Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus. Conclusion: This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies. Parole chiave: bleeding on probing, Brazil, community periodontal index, dental calculus, health promotion