Oral Health and Preventive Dentistry, 03/2018

Purpose: To assess whether different levels of malocclusion have different effects on the oral health-related quality of life (OHRQoL) and which domains of OHRQoL could be affected. Materials and Methods: Nine electronic databases were searched. To make studies comparable, studies using the Child Perceptions Questionnaire (CPQ) to measure OHRQoL, and the Dental Aesthetic Index, Index of Orthodontic Treatment Need, and Index of Complexity, Outcome and Need to measure malocclusion were selected for systematic review. Meta-analysis was performed to calculate the weighted mean scores of CPQ. The two independent samples t-test was used to detect whether different severity groups of malocclusion have different CPQ scores. Results: A total of 22 studies were included in this review and 6 were included in the meta-analysis. Most studies used a cross-sectional design and convenience sampling. Meta-analysis showed that the weighted mean scores of CPQ increased with malocclusion severity. The t-test showed nearly all levels of malocclusion affected the domains of functional limitation and social well-being; only very severe malocclusion affected the domains of oral symptoms, emotional well-being and the overall OHRQoL (p 0.05). Conclusion: When OHRQoL was assessed by CPQ11-14 and malocclusion was assessed by orthodontic indices, children with malocclusion could have oral functional limitations and worse social lives; children with very severe malocclusion could further develop oral symptoms and had worse emotional experiences. Future longitudinal population-based studies would be helpful to confirm these results. Keywords: malocclusion severity, quality of life, child perceptions questionnaire, systematic review

Purpose: The aim of this literature review and case report was to point out the relationship between Cowden Syndrome (CS) and severe periodontitis. CS is a rare autosomal dominant disorder characterised by skin and oral hamartomas, and is associated with an increased risk of cancer development. Case Report: The case of a 43-year old male patient affected by Cowden syndrome and presenting severe periodontitis was reported. Results: It can be suggested that the specific gingival morphology of the patient with CS might be a risk factor for the development of periodontal disease, as described in the present case report. Conclusion: Early diagnosis is crucial in patients affected by CS. The dentist may be the first to notice any atypical changes in the oral cavity and refer the patient for further examinations. Moreover, the mucosal and skin changes have a tendency to appear prior to the malignancies associated with the syndrome. This highlights the responsibility of the dentist in the early diagnosis of this progressive pathological syndrome. Keywords: Cowden syndrome, multiple hamartoma syndrome, severe periodontal disease, severe periodontitis

Purpose: Stroke is a leading cause of death in developed countries. Recently, its connection with oral health has been a focus of the medical literature. The aim of this study was therefore to statistically examine the oral health of subjects who previously suffered from stroke and provide a guide for the dental treatment of these patients. Materials and Methods: Stroke patients at least one year after the stroke episode and age- and sex-matched healthy controls were examined: dental and medical stroke histories were recorded, followed by a detailed orofacial examination. A categorisation into three 'dental' subgroups of stroke patients was carried out based on their residual symptoms, the functional deficiency of limbs, and chewing and swallowing difficulties. Indices quantifying oral hygiene (OHI-S), dental status explained by the number of decayed, missing, and filled teeth (DMFT), periodontal status (CAL, CPITN, Mühlemann index), and the status of prosthetic treatment (prosthetic index) were assessed. Statistical comparison was performed between the patient and age- and sex-matched control subjects, as well as between subgroups of stroke patients. Results: One hundred two stroke patients and 98 healthy age- and sex-matched control subjects were examined. The oral health and dental status of stroke patients was worse compared with the control group. Stroke patients had significantly more decayed (2.3 ± 3 vs1.1 ± 1.8; p = 0.01) and missing (19.3 ± 9.5 vs 15.5 ± 9.3; p = 0.005) teeth, but significantly fewer filled (3.6 ± 4.7 vs 7.7 ± 5.6; p 0.001) teeth than did the healthy controls. In stroke patients, clinical attachment loss (CAL) was double that of the control group (p 0.001). A comparison between the subgroups of stroke patients revealed that the most severe findings were in patients who had chewing and swallowing disabilities. Discussion: According to these results, the combination of risk factors of stroke, residual neurological signs after stroke, and poorer socioeconomic conditions results in poor oral hygiene, poor dental and periodontal conditions, and a lower prosthetic index. Special care and attention should be given to the oral hygiene and dental treatment of such patients, to enable good nourishment. Keywords: dental oral health, dysphagia, hemiparesis, periodontal, prosthetic, stroke

Purpose: To assess the self-reported Oral Health Related Quality of Life (OHRQoL) among institutionalised patients in an alcoholic detoxification programme in northern Portugal. Materials and Methods: This analytical cross-sectional study using the Oral Health Impact Profile-49 (OHIP-49) was carried out in 300 individuals institutionalised for alcohol detoxification in withdrawal units. The seven OHIP-49 domain scores and three summary indicators were examined: 'Prevalence' (percentage of people reporting one or more of 49 items at least 'fairly often'), 'Extent' (number of impacts [items] reported at least 'fairly often') and 'Severity' (mean sum of the participants' OHIP score). Results: The sample comprised 83.3% males with a mean age of 44 ± 8.6 years and an abusive alcoholic consumption history of 21.2 ± 11.5 years. The results show a 'prevalence' of 62.4% (95% CI: 56.7%-67.7%), the mean 'extent' was 3.8 (95% CI: 3.2-4.5) impacts and the mean 'severity' level was 54.8 (95% CI: 49.9-59.7). 'Prevalence' was significantly and positively associated with patients with gastroesophageal reflux disease (GERD), those with a higher estimated daily alcohol intake, who previously used hashish and who brushed their teeth after drinking alcohol. 'Extent' was higher among females, those with higher levels of education, patients with GERD, smokers, and those with a higher estimated daily alcohol consumption; it was negatively associated with not brushing teeth. 'Severity' was significantly and positively associated with female gender and smoking, and negatively associated with not brushing teeth. Conclusion: This population of alcohol-dependent patients undergoing an addiction rehabilitation programme presented a high prevalence of negative oral health impacts, but not a high extent or severity. Keywords: dental care, oral health, OHIP, OHRQoL, quality of life

Purpose: To investigate the clinical performance and clinical survival rate of lithium disilicate-based core ceramic (IPS e.max Press) utilised in single crowns and to the accompanying periodontal health status. Materials and Methods: A total of 47 patients with 88 IPS e.max Press single crowns were examined at the Faculty of Dentistry, University of Malaya, using modified United States Public Health Service evaluation criteria (USPHS). These 88 crowned teeth included 19 vital and 69 nonvital teeth that were restored with different post and core materials. The periodontal status was compared using the plaque index (PI), gingival recession (GR), modified papillary bleeding index (MPBI) and probing pocket depth (PPD) between the crowned teeth and contralateral control (sound) teeth. Results: About 96.6% of the crowns exhibited satisfactory clinical performance. The mean survival rate at three years was 97.7%, and 100% at two years with a low incidence of fractures. There were no staitistically significant differences in the mean gingival recession (p = 0.182) and mean plaque scores (p = 0.102) between crowned and control teeth. The crowned teeth had higher mean MPBI (p = 0.000) and PPD (p = 0.051) compared to the contralateral sound teeth. Periodontal response in relation to subgingival crown margins, was statistically significantly lower regarding pocket depths (p = 0.01) and bleeding on probing (p = 0.00). Conclusion: IPS e.max Press crowns exhibited satisfactory clinical performance with high survival rate. No dentinal sensitivity was recorded. Plaque retention and gingival recession were similar to contralateral control teeth. Poor periodontal health was related to the subgingival crown margins. Keywords: all-ceramic, clinical performance, lithium disilicate, single crowns, survival rate

Purpose: To assess the relationship between health locus of control and oral health status among Information Technology (IT) professionals in Hyderabad, India. Materials and Methods: A cross-sectional questionnaire study was carried out among IT employees in Hyderabad city. The behaviour, attitude and perceptions of individuals towards health were assessed using the multidimensional health locus of control scale. Oral health status was evaluated clinically utilising the simplified oral hygiene index, community periodontal index, and loss of attachment index. Data were statistically analysed using SPSS software (v 21.0). Results: A convenience sample of 989 employees (response rate of 82.4%, mean age 26.3 ± 5.0 years) completed the questionnaire. The overall highest mean domain score was recorded for 'chance locus of control' (CLOC; 9.0 ± 2.1) and lowest overall mean domain score for 'internal locus of control' (ILOC; 6.7 ± 0.9). The overall mean scores of DI-S, CI-S and OHI-S were 0.7 ± 0.4, 0.7 ± 0.5 and 1.4 ± 0.8, respectively; there was an inverse relation with age groups. The mean CPI and LOA scores observed among males, ranging from 0.4 ± 0.6 to 1.6 ± 1.1, were statistically significantly higher than those of females, ranging from 0.2 ± 0.5 to 1.3 ± 1.2 (p = 0.00). Powerful locus of control had a statistically significant negative correlation with oral hygiene indices. In contrast, a positive correlation was observed between ILOC and DI-S and OHI-S (r = 0.0672 and r = 0.0639, respectively). Conclusion: This study highlighted that people with a positive attitude regulate their health behaviour and maintain good oral hygiene. Keywords: health behaviour, locus of control, oral hygiene, periodontal health

Purpose: To examine the relationship between mothers' knowledge, attitude and dental caries status and their young children's dental caries status. Materials and Methods: In this cross-sectional study, 153 2- to 6-year old children old and their mothers were dentally examined. Mothers' decayed, missing or filled teeth (DMFT) and children's decayed, missing or filled teeth (dmft) were recorded. A validated questionnaire was used to examine maternal knowledge and attitudes regarding the importance for the oral health of their children. Results: The average age of children and mothers were 5.1 and 31 years, respectively. The mothers' and children's mean DMFT and dmft were 12 and 6, respectively. The mean level of mothers' knowledge was 31.5 out of 40, while the mean attitude was 24.5 out of 30 points. There was a statistically significant inverse correlation between mothers' knowledge and their DMFT (r = -0.7), and between mothers' knowledge and children's dmft (r = -0.6). Also, there was an inverse correlation between mothers' attitude and DMFT (r = -0.8), and between mothers' attitude and dmft (r = -0.7). A direct correlation between mothers' DMFT and children's dmft (r = +0.6) was observed. Conclusion: Attempts at improving the knowledge and attitude in parents have a substantial impact on improving the oral health of next generation. Keywords: parental attitude, parental knowledge, oral health

Purpose: To determine the impact of oral health related quality of life (OHRQoL) on general health in patients suffering from rheumatoid arthritis (RA). Materials and Methods: Ninety-one patients with RA (mean age 52.82 ± 11 years, 75.82% female, 20.87% smokers) and 30 systemically healthy patients (control) were evaluated for their OHRQoL by means of the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP)-14 questionnaires. Self-perceived RA status was assessed using the Routine Assessment of Patient Index Data 3 (RAPID3). Results: The mean SC-GOHAI score was 3.69 ± 2.47 for RA subjects and 1.36 ± 2.69 in the control group. Statistically significant differences were seen between RA and control groups (p 0.05). RA patients with and without periodontitis (PA) exhibited similar SC-GOHAI (Simple Count GOHAI) scores (p = 0.980). No statistically significant differences were observed between any of the groups, either for the OHIP 14-extent or for the OHIP 14-prevalence. RAPID3 scores showed that the majority of the RA patients (65.93%) had high disease severity (RAPID3 >12, mean RAPID3 score 14.39 ± 5.14). Statistically significantly higher values were recorded for general health assessment (PTGE, p = 0.009) and fatigue (FT, p = 0.004) in RA with PA as compared to those without. SC-GOHAI with values between 5 and 8 was statistically significantly associated with high severity health impairment (RAPID3 >12, p = 0.014, OR: 8.64). Conclusion: Within their limits, the present findings indicate that: a) moderate OHRQoL as assessed by GOHAI may contribute to high severity impairment of health in RA patients, and b) the GOHAI questionnaire may represent a more adequate tool than OHIP-14 for assessing OHRQoL in patients suffering from RA. Keywords: general health, oral-health related quality of life, periodontitis, rheumatoid arthritis

Purpose: To investigate the association between plasma CRP levels and periodontal disease during pregnancy. Materials and Methods: Fifty-six pregnant women attending the Antenatal Clinic, UMMC for their first antenatal check-up consented and were recruited for this study: 28 subjects with diseased periodontium (test group) and 28 subjects with healthy periodontium (control). The test group underwent nonsurgical periodontal therapy and the control group was given oral hygiene education. Periodontal parameters and CRP levels were evaluated at baseline and 6 weeks. Pregnancy outcome data were recorded from the Antenatal Clinic, UMMC. Results: Plasma CRP levels in the test group were statistically significantly elevated compared to the control group (8.55 ± 5.28 mg/l vs 5.66 ± 2.91 mg/l). After nonsurgical periodontal therapy, a statistically significant reduction in the CRP level in the test group (2.06 mg/l) along with statistically significant improvement in periodontal status in both groups was observed. The mean birth weight for infants of both groups showed no statistically significant difference. Conclusions: Plasma CRP levels in pregnant women with diseased periodontium were statistically significantly reduced after nonsurgical periodontal therapy. However, no association between CRP levels and adverse pregnancy outcome was observed. Keywords: C-reactive protein, nonsurgical periodontal therapy, periodontal disease, pregnancy

Purpose: To determine and compare the dermatoglyphic patterns and salivary Streptococcus mutans counts, as well as its correlation with dental caries among 3- to 6-year-old children. Materials and Methods: Children 3 to 6 years old who had decayed/extracted/filled teeth (def) ≥ 5 were selected as the study group (n = 50) and those who had def = 0 were selected as controls (n = 50). Dermatoglyphics was recorded using the ink stamp-pad method. Salivary S. mutans levels were estimated by microbial culture of the collected salivary samples; for further confirmation, optochin and bacitracin antibiotic sensitivity tests were done. The chi-squared test, Mann-Whitney U-test, independent Student's t-test, one-way ANOVA were used for comparison among the variables. Correlation was analysed using Pearson's correlation coefficient (r). Results: The study group showed a significantly higher mean number for whorls and S. mutans count, and the control group showed significantly higher ulnar loops and total ridge count. A positive and significant correlation was observed between mean def and S. mutans. Whorls showed a significant and positive correlation with caries and S. mutans, whereas ulnar loops and total ridge count showed a negative correlation. Conclusion: There was a strong correlation between dermatoglyphic patterns (especially ulnar loops, whorls and total ridge count), dental caries and S. mutans level. Keywords: dental caries, dermatoglyphics, salivary bacterial levels