Oral Health and Preventive Dentistry, 01/2010

Purpose: Adherence to dental preventive programmes in young adults is low. The aim of the present longitudinal study was to evaluate whether tutoring peers can be a compliance-enhancing tool or not. Methods: In Part 1, two randomly selected classes (49 female students, mean age 19.8 ± 2.3 years) were taught adult toothbrushing technique (the modified Bass technique) in a project-like manner. After the course, knowledge was tested using a class test, and compliance was evaluated using anonymous quantitative questionnaires. Compliance was defined as a reported degree of change from the easy-to-learn childhood toothbrushing techniques to the more efficient and challenging Bass technique. In Part 2 of the present longitudinal study, the compliance of these students was re-evaluated after having developed and applied themselves a programme of how to tutor peers in oral health. Re-evaluation of compliance was performed after 3 and 9 months. Results: In Part 1, 28.5% of the students were compliant after 1 week. Compared with Part 1, the compliance in Part 2 was significantly higher (P u 0.001), both after 3 months (90%) and after 9 months (82%). Conclusions: Tutoring peers can significantly enhance the compliance over a period of 9 months. Tutoring can function as a form of empowerment and can establish a strong sustained health engagement. Tutoring peers in health-related subjects can readily be implemented in schools and might be an additional means of oral health promotion with fewer additional costs. Keywords: compliance, motivation, patient education

Purpose: The objective of the present study was to assess dental anxiety and study its relationship with the perceived Health Locus of Control (HLC) among students in an Indian dental school. Methods: A total of 325 students returned completed history forms that consisted of the Multidimensional Health Locus of Control (MHLC) scale and the Modified Dental Anxiety Scale (MDAS). Results: 'Fear of the needle' was the greatest stimulus of dental anxiety with a mean score of 3.3, which was followed by 'tooth drilling' whose mean score was 2.7. There was also a statistically significant decrease in the mean scores for all of the MDAS items from 1st year to 4th year, except the item related to local anaesthetic injection, whose mean score remained high throughout. The mean scores of the three aspects of the MHLC scale (internal, chance and powerful others) were compared with respect to dental anxiety. The results showed that 'internal' was the most powerful of the three aspects of MHLC among all three anxiety groups. The mean 'internal' score for the low anxiety group was 4.4, which reduced to 4.1 for the high anxiety group. A statistically significant inverse correlation was also found between the 'internal' dimension of MHLC and dental anxiety. Conclusion: Perceived HLC was found to play an important role in predicting the dental anxiety among dental students. Keywords: dental anxiety, dental students, Multidimensional Health Locus of Control

Purpose: The objective of the present study was to investigate whether achievement motives, satisfaction with life and happiness are associated with oral health behaviour and perceived gingival status. Methods: The present study sample consisted of 178 first-year medical students. The questionnaire included information about sociodemographic factors, behavioural variables, perceived oral health status, achievement motives (hope of success and fear of failure), satisfaction with life and subjective happiness scales. Results: It was observed that individuals who presented higher values of satisfaction with life and happiness rated their gingival status as being very good/excellent and that individuals who presented higher values of hope of success reported to brush frequently. When the oral health behaviour was analysed, it was revealed that persons who brushed their teeth more than twice a day reported higher values of hope of success when compared with individuals who reported their toothbrushing frequency to be once a day or less. It was also revealed that persons who visited their clinician for check-ups reported higher values of subjective happiness. Multiple linear regression analyses showed that stress in everyday life and hope of success were positively associated with the toothbrushing frequency and that satisfaction with life was positively associated with the gingival health status. Conclusions: Hope of success and satisfaction with life should be considered as predictors of good oral health behaviour/status. Keywords: achievement motives, oral health, satisfaction with life, subjective happiness

Purpose: The objective of the present study was to study the ability to influence young at-risk patients' attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two interventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%). Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends. Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models. Keywords: adolescent, attitude to health, health education, intervention study, tobacco use

Purpose: Smoking is the most widespread addictive behaviour in the world, as it causes physical and psychological dependence on nicotine. The objective of the present study was to discern the prevalence and the relative risks of nicotine dependence of adult people in Athens, Greece, as this country holds first place in cigarette consumption in the European Union. Materials and Methods: A random sample of 202 current smokers (82 men and 120 women) was drawn from residents aged v 18 years in Athens, the capital of Greece. A questionnaire on the physical (Fagerstrom Test of Nicotine Dependence) and psychological (American Psychiatric Association's diagnostic criteria of nicotine abuse) nicotine dependence was used. Results: According to the results of the present study, 12.4% of the sample reported null physical nicotine dependence, and 31.7% had low, 25.7% had moderate and 30.2% had high nicotine dependence. Multiple logistic regression analysis revealed that younger people (aged 18 to 24 and 25 to 34, odds ratio [OR] = 0.047, P u 0.033 and OR = 0.096, P u 0.038, respectively) were less prone to developing physical dependence. Women tended to be systematically less dependent than men (25% and 37.8% high dependence, respectively). Furthermore, 75.7% of the sample had psychological nicotine dependence. Binary logistic regression analysis and chi-square test revealed that younger people (18- to 24-year-olds, OR = 0.081, P u 0.008) and individuals of inferior education (v2 = 7.826, P u 0.05) were less prone to develop psychological dependence. In addition, women showed a higher percentage of withdrawal symptoms compared with men (80% and 68%, respectively). Conclusions: The results of the present study provided compelling evidence that physical and, in particular, psychological nicotine dependence of adult people in Athens, Greece, was significant, and this calls for a course of action that should be taken by public health policy-makers to reduce smoke consumption. Keywords: clinician, nicotine physical/psychological dependence, smoking, smoking cessation

Purpose: The objective of the present in vitro study was to evaluate the effect of different minerals in combination with 1% citric acid on dental erosion. Materials and Methods: Ninety enamel samples were randomly allocated to nine groups (G1: pure 1% citric acid solution [control]; G2: with 1 mM Ca; G3: with 0.047 mM F; G4: with 1 mM Fe; G5: with 1 mM P; G6: with 1 mM Ca and 0.047 mM F; G7: with 1 mM Ca and 1 mM P; G8: with 1 mM Fe and 0.047 mM F; G9: with 1 mM Ca, 1 mM P, 0.047 mM F and 1.0 mM Fe). The samples were subjected to six pH cycles, each consisting of immersion in pure or modified 1% citric acid (1 min) followed by storage in artificial saliva (59 min). Enamel wear was assessed using profilometry. Results: Data were analysed using analysis of variance and Tukey test (P 0.05). Enamel loss (mean ± SD) amounted to between 0.87 ± 0.30 and 1.74 ± 0.74 lm but did not significantly differ among the groups. Conclusions: The modification of 1% citric acid with different minerals did not have a protective effect on enamel erosion. Keywords: dental erosion, enamel, wear

Purpose: Clinical studies with dentifrices formulated with antimicrobial ingredients typically examine the effects of their use on clinical parameters of dental plaque and gingivitis. The effects of routine use of these formulations on the microorganisms found in the distinct regions of the human mouth remain unexplored. The present cross-over design clinical study compared the effects of brushing with a recently formulated dentifrice with 1% zinc citrate to a control dentifrice on oral bacteria found in oral niches. Materials and Methods: A total of 35 adults completed a 1-week wash-out phase prior to providing baseline samples of dental plaque on the teeth, gums, saliva and scrapings from cheeks and tongue to quantify anaerobic bacteria. Subjects brushed twice daily with a randomly assigned test dentifrice for the next 13 days. On the 14th day, they arrived at the dental clinic prior to oral hygiene and provided samples similar to baseline samples for microbiological examinations. Subjects brushed with the test formulation they used in the previous 13 days, prior to providing additional samples at 5-h post-brushing for microbial assessments. An additional wash-out phase was assigned to subjects prior to completing the study with the alternate test dentifrice. Results: Analyses of log10-transformed microbial counts indicated no statistical differences in the baseline samples from each oral site (P > 0.05), while brushing with the zinc citrate dentifrice resulted in a significant reduction in bacteria in each post-brushing oral site versus the control paste (P 0.05). Brushing with the zinc citrate dentifrice resulted in 38.56%, 23.57%, 26.24% and 29.1% decreases in anaerobic bacteria from dental plaque, tongue, cheek and saliva, respectively, in the overnight samples collected on the 14th day versus the control. Similarly, the 5-h post-brushing samples indicated 24.8%, 34.25%, 37.98% and 38.31% reductions in anaerobic organisms when compared with control. Conclusions: Toothbrushing with the zinc citrate formulation resulted in significant reductions in oral bacteria from all of the intraoral locations. Keywords: adults, anaerobic, bacteria, cheek, clinical study, dental plaque, fluoride, tongue, zinc citrate

Purpose: The aim of the present study was to assess the effectiveness of Terminalia chebula aqueous extract rinse on salivary pH and Streptococcus mutans. Mouthrinses have been in use from time immemorial as a supplement for routine oral hygiene practice. Although a large number of mouthrinses are currently available, many of them possess certain drawbacks, which has necessitated the search for alternate agents. Materials and Methods: Ten per cent of T. chebula extract was prepared. A purposive sample of 30 subjects was selected and randomly divided into extract and control groups. Baseline salivary sample was collected. The freshly prepared extract rinse and control were given to the respective groups. Distilled water was used as a negative control. Salivary samples were collected at 5 and 60 min after rinsing and were subjected to pH and microbiological analyses. An acceptability questionnaire was given to all of the participants. Statistical analysis was done using paired and unpaired t tests. Results: There was a significant reduction in the S. mutans count at 5 and 60 min after rinsing the extract. Salivary pH remained alkaline for a period of 1 h after rinsing the extract. Results of the acceptability questionnaire indicated that the mouthrinse was acceptable to 80% of the subjects. Conclusions: The results of the present study indicate that T. chebula may prove to be an effective anticaries mouthwash owing to its ability to increase salivary pH and inhibit S. mutans. This may also be a valuable public health intervention as it is economical and has multiple health benefits. Keywords: herbal mouthrinse, salivary pH, Streptococcus mutans, Terminalia chebula, total Streptococcus

Purpose: The aim of the present study was to undertake a systematic review to investigate whether mutans streptococci levels are a strong risk indicator/factor for ECC, based on the current quality of the literature regarding the relationship between early childhood caries (ECC) and these microorganisms. Materials and Methods: The authors searched PubMed, Scopus and Cochrane Library databases for papers from 1951 to 2007. The minimal inclusion requirements were assessment of preschool children reporting mutans streptococci counts, mainly in saliva and biofilm samples, and caries assessment. Since the heterogeneity of the studies did not allow a meta-analysis (X2 test), a qualitative analysis was conducted. Results: The electronic search yielded 120 articles, but only 16 scientific papers were critically appraised. Of the 16 scientific papers included in the review, only one cross-sectional study achieved a high value of evidence. Conclusions: It was concluded that mutans streptococci levels are a strong risk indicator for ECC. However, further welldesigned longitudinal studies with high evidence values are required to confirm mutans streptococci levels as a significant ECC risk factor. Keywords: dental caries, primary dentition, preschool child, review, Streptococcus mutans

Purpose: The aim of the present study was to determine the natural fluoride levels in the drinking water supplies of a tropical area of Brazil to identify the cities at risk of high prevalence of dental fluorosis and to provide data for future water fluoridation projects in the region. Materials and Methods: The present study was carried out in Paraíba, in the north-eastern region of Brazil. A total of 223 cities were selected, and local health workers were instructed to collect three samples of drinking water: one from the main public water supply and the other two from a public or residential tap with the same water source. Fluoride analyses were carried out in duplicate using a fluoride-specific electrode coupled to an ion analyser. Results: A total of 167 cities (75%) provided water samples for analysis. Fluoride levels ranged from 0.1 to 1.0 ppm (mg/l). Samples from most of the cities (n = 163, 73%) presented low levels of fluoride ( 0.5 mg/l). Samples from three cities (a total estimate of 28,222 inhabitants exposed) presented 'optimum' fluoride levels (0.6 to 0.8 mg/l). Samples from one city (16,724 inhabitants) with 1.0 mg/l of fluoride in the water were above the recommended level (0.7 mg/l) for the local temperature. Conclusions: It can be concluded that the cities in this area of Brazil presented low natural fluoride levels in the drinking water and could implement controlled water fluoridation projects when technical requirements are accomplished. A high or a moderate prevalence of dental fluorosis due to the intake of natural fluoride in the drinking water is likely to take place in one city only. Keywords: Brazil, dental fluorosis, drinking water, fluoride

Purpose: The aim of the present study was to investigate the possibility that malnutrition and overweight/obesity might act as factors associated with dental caries among 12-year-old children. Methods: This was a cross-sectional study that was carried out on 689 12-year-olds at public schools in the municipality of Caruaru, State of Pernambuco, Brazil, to determine the prevalence of dental caries and malnutrition. A case-control study nested within the cross-sectional study was carried out to determine the association between malnutrition and dental caries. To assess the nutritional status, weight for age, height for age and body mass index were determined. The occurrence of dental caries was determined using the decayed, missing and filled teeth (DMFT) index. Results: The prevalence of caries was 71.8%, with a mean DMFT index of 2.9. The prevalence of height deficit was 9.9%, and the prevalence of risk of overweight and overweight/obesity was 9.3% and 3.2%, respectively. No statistically significant association was found between these nutritional indices and the occurrence of dental caries. Conclusion: The results suggest that malnutrition did not act as a risk factor for dental caries in this population. Keywords: adolescent, dental caries, nutritional status

Purpose: The aim of the present study was to examine the prevalence, severity and association of developmental enamel defects (DED) and dental caries in a sample of 4- and 5-year-old children living in Jeddah, Saudi Arabia. Methods: A total of 510 children were examined in nursery schools using a penlight, a mouth mirror and a CPI probe. Dental defects were described using the modified DED index, the caries were described using the decayed, missing and filled teeth (DMFT) index. Results: The prevalence of DED of any type was 45.4%, with that of demarcated opacities being the highest, followed by hypoplasia. The most frequently affected teeth were maxillary anterior teeth, while the least affected teeth were mandibular incisors. The mean DMFT was 3.9. A positive association between DED and caries was observed. Conclusions: The prevalence of enamel defects and caries was high, as the enamel defects were strongly associated with caries; therefore, this association must be considered when focusing on the prevalence of caries in the Saudi community. Keywords: caries, developmental enamel defects, hypoplasia, opacities, primary dentition

Purpose: The objectives of the present investigation were to study fluoride (F) release from NaF-impregnated chewing sticks (Miswaks) in vitro and to study the F clearance in saliva and the F oral retention in vivo. Materials and Methods: Both fresh and old Miswaks were collected from 10 stores in Saudi Arabia and fluoridated in 0.01%, 0.1%, 0.5%, 1% and 3% NaF. The F release was studied in vitro up to 60 min. In vivo, 10 subjects used Miswaks fluoridated in 0.01%, 0.1%, 0.5%, 1% and 3% NaF for 2 min (Series I). The subjects were asked to spit out all saliva in a beaker during a 12-min period without swallowing. The F present in the obtained saliva was considered to represent the 'F retention'. In Series II, the same type of Miswaks were used as in Series I. Repeated whole saliva unstimulated samples were collected before and up to 30 min after. These two series were carried out in another 10 subjects (Series III and IV), but with Miswaks fluoridated in a more narrow range of concentration (0.05% to 0.5% NaF). Brushing with 1 g of F-containing dentifrice (0.32% NaF) was used as a control. Results: There were only small differences between fresh and old Miswaks, but great variations were observed between Miswaks that were purchased from different stores. Miswaks fluoridated in 0.1% to 0.5% NaF could be considered as an 'optimum level' with respect to both the F concentration in saliva and the F retention. Conclusions: It is recommended to use fresh Miswaks impregnated in 0.1% NaF or a maximum of 0.5% NaF for a day, as they are interesting and safe products for the prevention of caries and could be widely used in countries such as Saudi Arabia. Keywords: chewing stick, fluoride, fluoride retention, impregnation, Miswak, saliva, Salvadora persica