Oral Health and Preventive Dentistry, 05/2015

Purpose: The aim of this paper was to review the current literature associating the non-bisphosphonate cancer-treatment drugs Denosumab, Bevacizumab and Sunitinib (used with or without bisphosphonate [BP]) with the presence of osteonecrosis of the jaws (ONJ) in patients. Materials and Methods: A literature review was conducted using the keywords osteonecrosis of the jaws, oral biphosphosnates, Denosumab, Bevacizumab and Sunitinib. Articles were obtained that reported cases of ONJ associated with the use of Denosumab, Bevacizumab and Sunitinib. Results: The literature shows that Denosumab can cause ONJ associated with triggers such as microtraumas or dental extractions. The combination of the drug along with zoledronic acid may have a synergistic effect. Bevacizumab may cause ONJ; however, there is much controversy regarding its synergistic action when used with BP. Sunitinib causes ONJ, and together with BP could increase the risk of developing lesions. Conclusion: Denosumab, Sunitinib or Bevacizumab are causal agents in the development of ONJ. The combination of any of these along with BPs could increase the risk of developing ONJ over that posed by BP treatment alone. Keywords: Bevacizumab, Denosumab, osteonecrosis, Sunitinib

Purpose: To study the association of smoking with poor oral hygiene status and halitosis in a comparative cross-sectional study. Materials and Methods: 100 smokers and 100 nonsmokers ages 18-50 years were recruited for this study in Kota Bharu, Malaysia. Oral hygiene (good/fair vs poor) was determined using the Simplified Oral Hygiene Index, and the halitosis level was measured using a Halimeter. Subjects were instructed to refrain from consuming foods containing garlic, onions, strong spices, alcohol and using mouthwashes 48 h prior to the examination. The halitosis levels were quantified by recording volatile sulphur compounds (VSCs) three times at 3-min intervals, resulting in a mean halitosis score. Various statistical analyses were performed, ranging from simple frequency analysis to multivariable modelling. Results: The proportions of subjects with poor oral hygiene and high halitosis were 24.0% and 41.5%, respectively. According to bivariate analyses, both problems were significantly less frequent among younger adults (halitosis), females, subjects with higher education, those with adequate habits to maintain good oral hygiene, those who had recent dental visits and those self-reporting fewer health problems. The percentages of poor oral hygiene and high halitosis were significantly higher in smokers (p 0.001). However, almost all these variables failed to show significance in the multivariate analyses, with the exceptions of smoking for both poor oral hygiene and halitosis, education for poor oral hygiene, and age, self-reported health problems and time since the previous dental visit for halitosis. Conclusion: These findings demonstrate a significantly higher level of halitosis and poorer oral hygiene in smokers than nonsmokers. Keywords: halitosis, oral hygiene, nonsmokers, smokers

Purpose: To examine the relationship between environmental tobacco smoke (ETS) and oral pigmentation in schoolchildren. Materials and Methods: Oral photographs of 117 systemically healthy, nonsmoking children and young adults (aged 10 to 21 years) were randomly selected from two rural schools. Closed-ended questionnaires were designed for this age group and used to record answers given by the subjects. The subjects were divided into two groups based on age: group 1 (10 to 14 years) and group 2 (15 to 21 years). There were 58 subjects in group 1 and 59 in group 2. Gingival pigmentation was classified using the Melanin Index Score (MIS) into MIS-0 (no pigmentation), MIS-1 (solitary unit(s) of pigmentation in papillary gingiva) and MIS-2 (continuous band extending from 2 neighbouring solitary units). Results: In group 1, 17.24% of subjects displayed MIS-0 compared to only 5.08% in group 2. The difference between the groups was found to be statistically significant according to Student's t-test (p 0.001). In group 2, 38.98% of subjects showed MIS-2 as compared to only 17.24% subjects in group 1. Conclusion: Despite the relatively small sample size, the results of the present study confirmed previously reported findings that ETS has an influence on both the prevalence and the severity of gingival pigmentation. Keywords: children, gingival pigmentation, tobacco smoke

Purpose: To assess self-medication practice-related awareness for correct usage and its association with demographic factors among patients reporting to a dental college. Materials and Methods: This descriptive cross-sectional questionnaire-based study was conducted among 300 patients reporting to the People's College of Dental Sciences and Research Centre, Bhopal, India. Only patients ≥ 18 years of age were included and consenting participants anonymously completed the questionnaire, with incomplete questionnaires being excluded from the study. The semi-structured questionnaire containing both open- and closedended questions was prepared in the local language and included demographic data, name of self-medication, frequency of self-medication, periods of illness, duration, dose, frequency of drug administration, symptoms for which drugs were used, satisfaction with healthcare facilities, source of information for self-medication, presence of chronic illness, adverse effects to self-medication seen in patients and drug interactions. The unpaired t-test and chi-square test were used for statistical analysis. p-values 0.05 were considered statistically significant. Results: A significant association was seen between education and self-medication. It was observed that the subjects who fell ill more frequently consumed medications on their own more often. Medications were most commonly taken for cough, cold and fever. The most preferred medicine was paracetamol. Most of the subjects found the medicines effective in helping them relieve their symptoms. However, not even half of the subjects were aware of the dose, duration, side-effects or interactions of medicines. There was a significant association between knowledge about side-effects and side-effects experienced from medication. A significant association was also seen between knowledge about side-effects and frequency of self-medication. Conclusion: Self-medication and non-doctor prescribing are relatively common in Bhopal. Knowledge regarding the appropriate usage of medication is inadequate. Education to help patients decide on the appropriateness of selfmedication is required. Keywords: nonprescription drugs, over the counter (OTC), prescription, prescription drugs, prescription fees, selfmedication

Purpose: To assess the impact of oral health status on the oral health-related quality of life (OHRQoL) of incarcerated Brazilian male adolescents. Materials and Methods: A cross-sectional survey with 102 male adolescents incarcerated at the São Francisco Juvenile Detention Facility, Piraquara, Brazil in 2010 was carried out. Dental caries, oral hygiene, periodontal status, malocclusion, dental fluorosis and dental trauma were analysed. The Oral Health Impact Profile (OHIP-14) was administered to measure OHRQoL, along with a questionnaire addressing sociodemographic variables, health-related aspects and dental experience. Descriptive statistical analysis and univariate and multiple Poisson regression with robust variance were performed. Results: The prevalence of adolescents who reported an impact on OHRQoL was 64% (95% CI: 54-73) and the mean OHIP-14 score was 6.69 (SD = 8.79; median = 3.00). In the multiple regression model, the prevalence of a negative impact on OHRQoL was significantly higher among individuals with untreated caries (PR = 1.74; 95% CI: 1.10-2.77), those who reported having discomfort in the teeth or mouth (PR = 1.33; 95% CI: 1.03-1.73), using tobacco prior to internment (PR = 1.53; 95% CI: 1.04-2.24) and maintaining a stable relationship (PR = 1.31; 95% CI: 1.01-1.70) in comparison to individuals who did not exhibit these conditions. Moreover, each month of internment represented an increase in the prevalence of an impact on OHRQoL (PR = 1.03; 95% CI: 1.01-1.06). Conclusion: Incarcerated male adolescents reported that oral health problems exerted an influence on quality of life, with untreated caries exhibiting the greatest impact. Keywords: adolescent, institutionalised, oral health, quality of life

Purpose: To assess the knowledge, attitude and practice regarding tobacco cessation among dentists in Hyderabad city, India. Materials and Methods: A cross-sectional questionnaire study was conducted among 264 dentists registered in the local Indian Dental Association branch, Hyderabad, Andhra Pradesh, India. The questionnaire comprised of 35 items and used a five-point Likert scale to assess tobacco use prevention and cessation counseling. Results: The majority of the study participants were females (55.7%) with a mean age of 29.9 ± 7.5 years. No significant gender difference was observed for any of the mean domain scores. A statistically significant difference was noted between age groups in the 'Knowledge' domain, 'professional role and identity' item (P = 0.03) vs the 'Practice' domain, 'social influences' item (P = 0.05) with 40+ years having a higher mean score (6.5 ± 1.5). In terms of the education, those possessing Bachelor's of Dental Science had a significantly higher mean score (10.8 ± 2.2) for the 'Attitude' question 'belief about consequences' (P = 0.05) than did those with a Master's degree. The reported barriers were insufficient reimbursement (48.1%), lack of tobacco-related self-help material/pamphlets for patients (46.5%) and lack of patient motivation to receive tobacco cessation counseling (43.6%). Conclusion: In the present study, although dentists possessed knowledge about tobacco cessation, it was not adequate. Dental professionals play an important role in educating patients regarding the oral health risks of tobacco use and motivating them to quit. Keywords: cessation, counseling, dentists, tobacco, use

Purpose: To measure the oral health-related quality of life (OHRQoL) among young individuals presenting with dental anxiety and exaggerated gag reflex and to compare it to the OHRQoL among young individuals attending restorative dental treatment. Materials and Methods: Patients with dental anxiety and/or exaggerated gag reflex who were referred to the Department of Oral Medicine were included. Clinical examinations included DMFT index (Decayed, Missing and Filled Teeth) according to the WHO criteria and oral hygiene was assessed with the plaque index (PI). The survey included the validated Hebrew version of the Oral Health Impact Profile (OHIP-14). Results: Overall, 322 patients completed the study. The dental anxiety group consisted of 68 patients, the exaggerated gag reflex group of 54 patients and the control group of 200 patients. Control group patients presented with lower PI and DMFT values. Patients with dental anxiety and/or exaggerated gag exhibited worse OHIP-14 scores overall as well as on each separate subscale. PI and DMFT were found to be in strong relation to the OHIP-14. Multivariable logistic regression analysis of factors influencing the OHIP-14 scores revealed a significant influence of the DMFT score. Conclusions: Patients with dental anxiety and exaggerated gag reflex were shown to suffer considerably from impaired oral health-related quality of life. This impairment may be attributed to a higher prevalence of caries and avoidance of dental treatment. Those populations should be identified and monitored carefully as well as encouraged to seek the appropriate behavioural treatment in order to improve their dental heath and oral health related quality of life. Keywords: avoidance, coping, fear, oral disease, quality of life

Purpose: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the buffering capacity of saliva and plaque pH in individuals with cerebral palsy (CP). Materials and Methods: A total of 15 3- to 8-year-old subjects with CP living in a governmental institution were included in this study. Dental plaque pH and the buffering capacity of saliva were measured at the first visit (baseline) and accepted as control values. CPP-ACP complex (GC Tooth Mousse) was applied to the children twice a day. Measurements were repeated after the 1st, 2nd, 3rd, 4th, 6th and 8th weeks. Results: Plaque indicator data show decreased acidogenicity in the 8-week period. Although there were no significant differences between the baseline and the 1st, 2nd and 3rd weeks' pH scores, a statistically significant difference was observed between the initial and 4th, 6th and 8th weeks' plaque pH scores. Saliva buffer scores were found to statistically significant increase between baseline and the 3rd, 4th, 6th and 8th weeks. Conclusion: Daily application of 10% w/v CPP-ACP paste is effectively changes saliva buffering capacity and plaque pH, thus promoting caries prevention in the primary and mixed dentition of CP children. Keywords: buffering capacity, cerebral palsy, CPP-ACP, plaque pH, saliva

Purpose: To investigate possible association between the transmission of mutans streptococci and sharing the immune system component Human Leucocyte Antigen (HLA) class II in mother-child pairs. Material and Methods: Plaque samples from 43 mother-child pairs were cultivated and screened for mutans streptococci. In 14 pairs where both mother and child harboured the bacteria, the strains were genotyped by Random Amplified Polymorphic DNA and samples were run on PAGE gels. Analysis of genetic identity between mother and child strains was performed with help of software and Dice similarity index. The distribution of HLA of serogroup DR4 (HLA DR4) was studied in relation to maternal transmission and mutans streptococci colonisation in children. The study hypothesis was that in pairs where both mother and child were HLA DR4 positive, transmission of mutans streptococci was more likely. Results: No correlation between the presence of HLA DR4 in mother and child and maternal transmission of mutans streptococci was established. However, the results showed no linkage between mutans streptococci colonisation and HLA DR 4. Of 15 children with mutans streptococci, 12 were HLA DR4 positive. Conclusion: The result suggests that presence of HLA DR4 could be a predisposing factor for colonisation with mutans streptococci in children. Keywords: colonisation, HLA, mother-child pair, mutans streptococci, transmission

Purpose: To evaluate dentists' professional experience and knowledge of emergency management of tooth avulsion injuries in Rio de Janeiro, Brazil. Materials and Methods: A total of 100 questionnaires were evaluated. The first part of the questionnaire consisted of questions regarding personal information. The second part evaluated dentists' knowledge of emergency management in cases of dental avulsion. The responses for each question were counted and expressed as percentages. Results: All dentists had a college degree or above. Only three dentists had a Master's or PhD degree. Most of the dentists (94.5%) considered time and storage media important for the prognosis of avulsed teeth. However, the dentists did not show consistent responses about the adequate time and ideal storage media to transport avulsed teeth. Conclusion: The study highlighted Brazilian dentists' need for continuing education in order to improve current knowledge in emergency management of avulsed teeth. Keywords: dental trauma, emergency, tooth avulsion

Purpose: To assess the prevalence of developmental defects of the enamel (DDE) in permanent first molars and incisors and their association with dental caries in two age groups of children living in Wielkopolska, Poland. Materials and Methods: The sample consisted of 225 children ages 6-8 years and 245 children ages 12-14 years (mean age ± SD = 9.9 ± 2.6). Dental defects were described using the modified DDE index. Caries experience was recorded using the DMFT index (number of decayed, missing and filled teeth) for all permanent teeth and for first permanent molars and incisors (DMFT-IM). Results: Overall, 25.7% of the subjects had at least one permanent first molar or incisor affected by DDE. Diffuse opacity was the most common type of DDE, while hypoplasia was the least prevalent. The mean number of teeth with caries (DT) and the mean number of molars and incisors with caries (DT-IM) were higher in subjects with enamel hypoplasia and/or demarcated opacity than in subjects without DDE or with diffuse opacities (p 0.05). Caries prevalence was higher in children with hypoplasia and/or demarcated opacity than in subjects without DDE. The differences were statistically significant only for the younger group (p 0.05). Conclusion: The overall tooth prevalence of DDE in molars and incisors is comparable to that observed in low-fluoride communities. However, a preponderance of diffuse defects suggests the need for further investigation into the aetiology of DDE among Polish children. The results confirm that demarcated opacities and hypoplasia should be considered important caries risk factors. Keywords: demarcated opacity, dental caries, developmental enamel defects, diffuse opacity, enamel hypoplasia