Oral Health and Preventive Dentistry, 02/2014

Purpose: No nationwide oral health survey has previously been carried out in Jordan. The aims of the study were to assess the burden of dental caries and gingival health among children aged 6 and 12 years in relation to sociodemographic factors and to ascertain the trend over time in the occurrence of caries and the need for dental care. Materials and Methods: A cross-sectional epidemiological survey was carried out which included 2496 children aged 6 years and 2560 children aged 12 years selected by stratified cluster sampling. Children were examined in schools and data comprised information about caries and gingival health status. WHO methodology and criteria were applied. Structured questionnaires were used to collect information about oral hygiene, dental visits, consumption of sugars and parents' level of education. Results: The caries prevalence rates were 76.4% in 6-year-olds and 45.5% in 12-year-olds, and caries experience was 3.3 dmft and 1.1 DMFT, respectively. The prevalence of caries varied significantly by sex and geographical region. In both age groups, children of the social low and middle groups had significantly higher levels of caries experience, more untreated decayed teeth and fewer filled teeth than did children of the upper socioeconomic group. Multivariate regression analysis showed that social class was the most important independent variable for caries. The results from 2005 were compared with similar data collected in the capital, Amman, in 1993. For all social classes, the mean caries experience and the amount of untreated dental caries increased over time. Moreover, 17.7% of 6-year-old children and 49.1% of the 12-year-olds had gingival bleeding. Significant differences in gingival health were found by sex, location, geographical areas and socioeconomic group. Conclusion: Oral disease is a significant public health problem in Jordan. Strengthening of the school oral health programme is needed for effective prevention and control of caries and promoting gingival health. A systematic school oral health programme including oral health promotion should be established. Keywords: dental caries, gingival health, Jordan, social inequality, trends in dental caries

Purpose: To describe caries prevalence and oral-health-related behaviours in a sample of homeless adults from the city of Porto, Portugal. Materials and Methods: Subjects attending any of two temporary shelters or two institutions that provide meal programmes were consecutively invited (n = 196); 42 (21.4%) refused to participate. Trained interviewers applied a structured questionnaire to obtain sociodemographic, behavioural, health and oral health status data. An oral examination was conducted to evaluate the past and present history of caries (Decayed Missing Filled Teeth [DMFT] index) and the presence of oral lesions. Those classifi ed as houseless were considered for the present analysis (n = 141). The association between homelessness, sociodemographic and behavioural characteristics and oral health indexes was quantifi ed through crude β coeffi cients and β coeffi cients adjusted for age, gender, education, nationality and duration of homelessness, as well as the respective 95% confi dence intervals (CI). Results: The median age of the participants was 45 years, most were male (86.3%), reported having less than a 9thgrade education (80.1%) and were unemployed (82.1%). The median duration of homelessness was 24 months. The mean (SD) DMFT index, number of decayed, lost and fi lled teeth were 12.8 (7.9), 4.2 (4.4), 8.0 (7.6) and 0.6 (1.9), respectively. Older subjects and those homeless for longer periods presented higher DMFT index scores (β = 3.4, 95% CI: 0.0 to 6.8) and higher number of decayed teeth (β = 2.8, 95% CI: 0.4 to 5.2). Filled teeth were more frequent among the more educated (>9 vs ≤4 years: β = 1.6, 95% CI: 0.7 to 2.6). Conclusions: This population of homeless subjects showed poor oral health, particularly with respect to caries and missing teeth, resulting in high oral treatment needs. Keywords: caries, DMFT, homeless, oral health

Purpose: The present cross-sectional study was conducted to assess and compare the mean number of non-cavitated (initial lesions, IL) and cavitated carious lesions (WHO criteria) per child in the permanent dentition and to correlate it with the plaque index among 12- to 15-year-old government and private school children. Materials and Methods: 481 schoolchildren aged 12-15 years were selected randomly by multistage random sampling from two government and two private schools. Demographic details were collected at the time of examination. Baseline plaque scores were recorded using the Silness and Löe plaque index. Immediately after brushing and drying the teeth, cavitated lesions were recorded based on WHO recommendations and non-cavitated lesions were recorded using the IL criteria of Nyvad et al and Fyffe et al. Results: The mean number of surfaces with cavitated and non-cavitated lesions for government school children was 2.13 ± 2.98 and 3.21 ± 2.97, respectively, and 1.24 ± 1.86 and 3.08 ± 2.33 for private school children, respectively. WHO + IL surfaces among private school children were 4.33 ± 3.48 and in government school children 5.35 ± 4.45. There was a positive correlation of plaque score with IL (r = 0.63) and WHO+IL (r = 0.73). Conclusion: Non-cavitated lesions are about twice as common as cavitated carious lesions in school children. Government school children had a higher number of cavitated and non-cavitated carious lesions when compared with private school children. Keywords: caries epidemiology, caries risk predictors, early caries, non-cavitated carious lesions, precavitated caries

Purpose: To investigate the attitudes and beliefs towards oral health care based on gender, age and educational levels of a cross section of a South Indian population in Hyderabad city. Materials and Methods: The study comprised a convenience sample of the general population of Kamalanagar area, Kothapet ward, Hyderabad city, Andhra Pradesh. The questionnaire consisted of close-ended questions and was divided into three sections to gather the demographic details, self-reported attitudes (A1-A9) and beliefs (B1-B16) about dentistry. For all these questions, a 'yes' response denoted a negative/unfavourable attitude/belief and 'no' response a positive/favourable attitude/belief towards dentistry. Results: The mean age of the respondents was 33.21 ± 13.39 years with the majority possessing a university degree (672; 60%). Based on the age groups, statistically significant differences were noted for preferring to go to a traditional healer first (A1) (P = 0.01) and with regard to the cleanliness of dental clinics (A9) (P = 0.003). Likewise, education also influenced the attitudes of the respondents, where the more well-educated respondents significantly more often answered 'no' to the items 'dental visit only when in pain' (A2) (P = 0.001) and 'visit only with family, friends and neighbours' (A3) (P = 0.02) and concerning cleanliness of the dental clinics (A9) (P = 0.05). Statistically significant differences was documented for most of the questions according to educational levels except for 'dental treatment is very expensive' (B4), 'tooth lost anyhow' (B6) and 'regular dental check-up not required' (B14). The overall comparison of attitude scores revealed no significant difference for the variables. Nevertheless, educational level showed significant differences for belief score with a higher mean score for university graduates (9.82 ± 3.36) (P = 0.001). Conclusion: Within the limits of the study, it can be concluded that a higher educational level led to a significantly more positive response to dentistry as compared to gender and age groups. In addition, the influence of traditional, social and cultural factors on dental care among this population cannot be ruled out. Keywords: attitude, belief, dental care, India, self-reported

Purpose: Insufficient attention paid by public institutions to primary oral health protection measures has contributed to a poor oral health status in Kosovo, especially in children. Because the oral health promotion activities identified the significant roles of mothers in primary prevention, the aim of this study was to determine the level of knowledge and the behaviour of mothers in connection with the caries experience of their children. Materials and Methods: 664 of the mothers who accompanied their children to dental visits were interviewed and data on maternal knowledge and attitudes towards the oral health of preschool children were collected. The children underwent dental examination and the dmft index was recorded. Results: The mean dmft index in all children was 6.30 ± 3.23. A high prevalence of early childhood caries was recorded. The highest mean dmft was recorded for children whose mothers had finished primary and secondary school (6.41 ± 3.36 and 6.62 ± 2.87, respectively). The mothers displayed insufficient knowledge regarding dental visits, feeding, oral hygiene maintenance and the utilisation of fluoride/antimicrobial agents. Conclusions: The results of this study show that the level of knowledge about oral health among interviewed mothers is very low to nonexistent. Mothers need to be educated and encouraged that they are a key factor in improving the oral health habits of their children. Since caries represents a serious public health problem in Kosovo, an overall preventive programme for oral health promotion is needed, including the oral health education of mothers. Keywords: caries experience of preschool children, mothers' knowledge, oral health education

Purpose: Widespread internet usage worldwide allows increased access to medical and dental information and can be used for patient self-education. However, because there is little evidence about how the internet is impacting dentistry, this survey was conducted to determine how dental patients in Bangalore, India, use it as a source of information on oral health and to discover how it affects oral hygiene practices of patients. Materials and Methods: The data was collected from 572 patients attending the outpatient departments of public and private hospitals by administering a specially designed proforma questionnaire. The chi-square test (P 0.05) was used to determine differences between different groups i.e. based on age, health care delivery and educational status of study participants. Results: Out of 572 respondents using the internet, 150 (26.2%) used it for information on oral health. A higher number of males than females and a significantly higher percentage of people aged 18 to 40 years used the internet. A significantly higher number of respondents utilising dental health care from private providers used the internet as a source of information on oral health. The difference in the usage of internet for information on oral health by gender and age groups was due to higher internet access at the work place and through cybercafés. A significantly higher number of patients from the private sector and with higher educational background used the internet. Conclusion: Low socioeconomic status and a low educational level act as barriers to using the internet, which may explain the results of this study. Creating awareness amongst people of different educational backgrounds through appropriate means (following an individualised approach based on educational qualification) would increase internet use for acquiring information on oral health. Keywords: information, internet, oral health

Purpose: To evaluate microleakage from an antibacterial adhesive and bonding agent added to the ssure sealant on intact enamel. Materials and Methods: One hundred twenty sound third mandibular molars were randomly divided into 6 groups of 20 teeth each. Occlusal pits and ssures were sealed with un lled sealant material (Clinpro, 3M) after pretreatment with 1. phosphoric acid etching (control); 2. acid etching + Adper Single Bond 2 (SB, 3M); 3. chlorhexidine digluconate (CHX, Ultradent) + acid etching; 4. CHX + acid etching + SB; 5. acid etching + Clear l Protect Bond (CPB, Kuraray) 6. CPB alone. After 6-month water storage and thermocycling, the specimens were placed in 0.5% fuschin, sectioned and evaluated under a digital microscope. The data were compared between groups with Kruskal-Wallis and Mann-Whitney tests. Results: Differences between groups were statistically signi cant at P 0.05. Acid etching alone and with SB showed the lowest microleakage, followed by acid etching + CPB. Chlorhexidine with and without bonding agent showed the greatest microleakage. Conclusion: Conventional acid etching alone or with a one-bottle adhesive were the two most effective methods of reducing microleakage from ssures. Acid etching together with a self-etching adhesive showed better results than self-etching alone. Appling CHX increased microleakage in sealed teeth. Keywords: antibacterial agents, dental adhesive, dental leakage, pit and ssure sealants

Purpose: Considering the antioxidant, anti-inflammatory and antimicrobial properties of green tea, this study aimed to evaluate the antibacterial effect of mouthrinses containing green tea extract vs 0.2% chlorhexidine on selected microorganisms in vitro. Materials and Methods: The antibacterial activity of both mouthrinses and the pure green tea extract was assessed by using disk diffusion and the minimal inhibitory concentration (MIC) methods against five microorganisms: Streptococcus mutans, Streptococcus sanguis, Enterococcus faecalis, Pseudomonas aerogenosa and Escherichia coli. Growth inhibition zones were measured in mm after 24 h of incubation at 37°C. The two mouthrinses were assessed at concentrations of 1, 2, 4, 8, 16, 32, 64, 128, 256 and 512 mg/ml to determine the MIC, which was interpreted as the lowest concentration of the agent that completely inhibited the growth of the test species. Results: 0.2% chlorhexidine produced a larger zone of growth inhibition than did the mouthrinse made of green tea extract (P 0.01). Paradoxically, the growth inhibition zones of the tested bacteria were significantly larger in pure extract of green tea than in 0.2% chlorhexidine (P 0.01). The chlorhexidine mouthrinse inhibited the growth of all tested species and exhibited significantly lower MICs than did the green tea mouthrinse (P 0.01). Conclusions: Even though the mouthrinse made with green tea extract presented an in vitro antimicrobial activity inferior to 0.2% chlorhexidine, the pure extract had considerable bactericidal effect. Keywords: antibacterial effect, 0.2% chlorhexidine, green tea, mouthrinse

Purpose: The aim of this work was to evaluate whether self-reported systemic diseases were associated with caries experience. Materials and Methods: Medical history data and caries experience (DMFT and DMFS; Decayed, Missing due to caries, Filled Teeth/Surface) were obtained from the University of Pittsburgh School of Dental Medicine dental registry and DNA repository. Information on 1,281 subjects was evaluated (839 with primary caries and 492 with secondary caries experience). Regression analysis was used to test for association between caries experience and disease status. Results: Associations were found between caries experience and specific conditions: stroke (R2 = 0.007, P = 0.001), asthma (R2 = 0.003, P = 0.025), hepatitis (R2 = 0.009, P = 0.0001), liver disease (R2 = 0.009, P = 0.00001), high blood pressure (R2 = 0.072, P = 0.00001) and diabetes (R2 = 0.03, P = 0.00001). We found primary caries to be associated with hepatitis (DMFT with R2 = 0.011, P = 0.002 and DMFS with R2 = 0.008, P = 0.006). We also found an association between secondary caries and asthma (DMFS with R2 = 0.006, P = 0.04), high blood pressure (DMFT with R2 = 0.014, P = 0.005 and DMFS with R2 = 0.043, P = 0.00001) and diabetes (DMFT with R2 = 0.013, P = 0.007 and DMFS with R2 = 0.023, P = 0.00001). Conclusion: Hepatitis, asthma, high blood pressure, stroke, liver disease and diabetes are associated with higher caries experience. Keywords: AIDS, asthma, cardiovascular diseases, caries, diabetes, epilepsy, hepatitis, high blood pressure, HIV, kidney disease, liver disease, stroke, tuberculosis

Purpose: To examine the socioeconomic and behavioural risk factors for periodontal disease in women of childbearing age and evaluate the extent of public awareness of the association between oral health and pregnancy in China. Materials and Methods: Cross-sectional data from 832 women (including 188 pregnant women) from Yuyao, Zhejiang Province were collected using a structured questionnaire. Demographic data were used to measure the participants' socioeconomic status. The questionnaire assessed knowledge and behaviours related to personal oral hygiene and utilisation of dental care services. Data were divided into pregnant and non-pregnant groups for multivariate logistic regression analysis. Results: In total, 88.3% pregnant women and 74.2% non-pregnant women reported periodontal symptoms. Abnormal body mass index (BMI ≤ 18.5, odds ratio, OR = 0.76, 95% CI 0.27-0.97, P = 0.024; BMI ≥ 23.9, OR = 1.83, 95% CI 1.12-3.35, P = 0.035) was significantly associated with self-reported periodontal disease. Minimal mental stress (OR = 0.56, 95% CI 0.43-0.94, P = 0.028), high annual household income (OR = 0.69, 95% CI 0.17-0.82, P = 0.008), advanced oral hygiene aids (OR = 0.33, 95% CI 0.18-0.49, P 0.001) and knowledge of the link between pregnancy and periodontal disease (OR = 0.57, 95% CI 0.33-0.96, P = 0.016) were associated with decreased incidence of selfreported periodontal disease. Conclusions: A low socioeconomic background was correlated with the high incidence of self-reported periodontal disease among women of childbearing age in China. Education about primary oral health and equitable distribution of dental services might be expected to improve oral health in this specific population. Keywords: oral health, periodontal disease, pregnancy, self-reporting, socioeconomic status

Purpose: To assess the perception regarding periodontists and periodontal therapy among general dental practitioners (GDPs) of Belgaum city. Materials and Methods: A questionnaire study was conducted among 120 GDPs of Belgaum city comprising 13 closed-ended questions. The questions addressed the following variables: demographics of the dentist, service as GDP, periodontal services provided by the GDP and periodontal services referred to the periodontists. Results: One hundred GDPs responded to the survey. 83% had specialists visit their practice and 78% felt the need for having a consultant periodontist attached to their practice. The procedures performed by the general dental practitioners were as follows: scaling (100%), scaling and root planing (78%), splinting (61%), gingivectomy (47%), ap surgery (24%), frenectomy (33%), crown lengthening (23%), root coverage procedures (12%), bone grafts (8%) and implants (8%). The procedures for which GDPs preferred the service of periodontists include bone grafts (87%), ap surgery (80%), root coverage procedures (77%), crown lengthening (63%) and others. 90% agreed that expertise is required for performing surgical periodontal procedures. 86% agreed that periodontists are competent to treat periodontal diseases. 38% to 55% noticed failures in periodontal procedures even after making use of a periodontist's service. 72% did not provide implant care in their clinic. 84% felt the role of periodontists was limited to post placement maintenance. Conclusion: A variety of periodontal services were offered by GDPs. The most common services were non-surgical in nature. Keywords: general dental practitioners (GDPs), periodontists, questionnaire survey