Oral Health and Preventive Dentistry, 04/2007

Purpose: To evaluate the dental status of 12-year-old children in 2004, an epidemiological survey called 'National pathfinder about children's oral health in Italy' was planned. The present paper describes the clinical calibration method. Materials and Methods: Thirty children (20 caries-affected and 10 caries-free) were selected. Seven examiners received 35 hours of training and calibration in making clinical measurements by a single trainer. The trainer's diagnosis was the benchmark validity reference. Increase in sensitivity was tested using paired Student's t-test. Inter-examiner reliability for DMFS was evaluated using Pearson's correlation coefficients and ANOVA. Percent agreement and Kappa statistics were calculated for dichotomous judgments (tooth-by-tooth analysis and caries prevalence). Results: The raters' sensitivity increased from calibration I to calibration II (p 0.05). For DMFS a good agreement between raters was found without significant differences among them at both calibration exercises. The Pearson's correlation coefficients between all pairs of raters were significant (p 0.001) after both calibration exercises. Tooth-by-tooth reliability was high: the strength of agreement was substantial or almost perfect in calibration I (Kappa statistics from 0.81 to 0.95) and almost perfect in calibration II (Kappa statistics from 0.92 to 0.97). Regarding caries prevalence, sensitivity, specificity, percent agreement and Kappa statistics results were high but without significant differences between individual pairs of observations in the two calibration sessions (p > 0.05). Conclusions: The results suggest that sensitivity measurements should be used for agreement assessments in addition to the other World Health Organization-recommended reliability measurements. Kappa statistics are the eligible measurement of reliability for dichotomous judgments. Keywords: caries, dental health, epidemiology, examiner calibration

Purpose: The present study examined associations between the oral health behaviour (OHB) of Iranian mothers and the OHB and oral health status of their children. Materials and Methods: In 2005, two self-administered questionnaires provided data on the OHB of a random sample of 9- year-old children (n = 459) and their mothers in Tehran, Iran. Brushing frequency, use of fluoridated toothpaste and number of sugary snacks between meals served as oral self-care (OSC) assessment criteria for both. A clinical examination was performed for children at school. DMFT/dmft values, the restoration index (RI) and the unmet treatment needs index (UTN) facilitated an assessment of children's dental status and treatment. Chi-square test, bivariate correlation, and binary logistic regression model were employed in these analyses. Results: Mother's OSC correlated with child's OSC (r = 0.18; p 0.01). The reported children's brushing frequency correlated with mothers' brushing frequency (r = 0.2; p 0.01). High maternal OSC levels were associated with lower dental treatmemt (DT) values in children (p 0.01). Children's RI was positively and UTN negatively associated with mothers' OSC (p 0.01). In the model, mothers' OSC (OR = 2.1) and female gender (OR = 2.1) were associated with children's OSC, while mothers' OSC was strongly associated with DT (OR = 11.0) and RI (OR = 34.0) in children. Conclusions: Higher OSC levels of the surveyed mothers were reflected positively in the oral health status and behaviour of their offspring. The potential of mothers to play a significant role in the oral health of their children should be kept in mind when developing oral health promotion programmes. Keywords: child behaviour, dental health, maternal behaviour, oral health behaviour, oral self-care

Objective: To gather epidemiological information on oral health knowledge, attitudes and behaviour of Israeli 12-year-olds. Materials and Methods: A stratified, cluster, random and convenience sample of 12-year-old children was drawn. Stratification was by size of community, by administrative areas (regions) and by ethnicity (Jewish/other). The representative sample of 12-year-olds was asked to self-complete the questionnaire of ICS II, which was translated into Hebrew. The questions gather information regarding knowledge, attitude and dental health behaviour. Results: 1294 children completed the questionnaire, of which 84% reported brushing their teeth once or more per day. Girls brushed 1.68 times more frequently than boys. Of the children, 64% had visited a dentist in the last year. The vast majority of the children (90%) expressed satisfaction with their last visit. Conclusions: Oral health habits of 12-year-old Israeli children are comparable to those of other countries. The dental health education in Israel should focus health messages to different schoolchildren according to the differences found in this survey. Keywords: attitude and behaviour, dental health knowledge, prevalence, survey

Purpose: The aim of this study was to assess smoking and alcohol use in Romanian dental and medical students. Materials and Methods: A total of 185 questionnaires were distributed to male and female dental and medical students (first and sixth year). Results: Across all groups, 60.86% of the responders have never been smokers, while the prevalence of smoking among the different groups was 28.84% for Year 1 dental students, 53.18% for Year 6 dental students, 39.58% for Year 1 medical students and 36.36% for Year 6 medical students. Unadjusted linear regressions showed significant linear relationships between average number of cigarettes smoked a day and average age when students started smoking (p 0.05). Of Year 6 dental students, 41.30% have drunk at least once a week, compared with 24% of dental freshmen. The use of alcohol among males was significantly higher than in females (p 0.0001). Unadjusted linear regressions showed significant linear relationships between frequency of smoking and alcohol consumption (p 0.05). Conclusions: Both medical and dental students in Romania may benefit from preventive interventions in universities addressing the health risk behaviours of alcohol use and smoking. Keywords: smoking, alcohol, dental students, medical students

The reduction in salivary flow in patients subjected to head and neck irradiation induces changes in the oral microflora and increases the risk of oral mucosal infections. The frequent presence of fungi, particularly Candida, in the oral environment of these patients complicates identification of the most important cariogenic bacteria with the commercial CRT Bacteria® (Ivoclar Vivadent) culture media. Such identification is important for the application of chemical measures to control cariogenic bacteria in these patients, since it has been shown that simple fluoride application is unable to control caries in this population. Objective: The aim of this study was to obtain a simple medium that inhibits Candida spp. growth and allows the specific growth of Streptococcus mutans and Lactobacillus spp. Thus, reliable counts of cariogenic species can be achieved. Materials and Methods: Stimulated saliva samples from 30 head- and neck-radiotherapy patients were seeded in commercial CRT Bacteria® culture medium and in two different media designed by our group: mitis salivarius bacitracin agar (MSBA), containing 5% potassium tellurite and fluconazole 64 µg/ml (MSBTPF) for the isolation of Streptococcus; and Man, Rogosa and Sharpe (MRS) agar, containing bacitracin 0.2 U/ml and fluconazole 32 µg/ml (MRSBF) for the isolation of Lactobacillus spp. Results: Candida growth was inhibited 100% in the media developed in this study. In all the samples seeded, growing of colonies in MRSBF was identified as Lactobacillus, while in CRT Bacteria® for Lactobacillus spp. this species was only isolated in 48.1% of the samples. S. mutans was identified in 71.4% of the colonies that grown in MSBTPF medium, while in CRT Bacteria® for S. mutans, this species was only identified in 35% of the colonies obtained. Conclusion: The culture medium developed in the present study was able to inhibit the 100% of Candida spp. growth. These new media permit reliable counts of cariogenic bacteria in irradiated patients. Keywords: Candida, caries risk, culture medium, head- and neck-irradiated patients, Lactobacillus spp., Streptococcus mutans

Purpose: This study aimed to describe the profile and the purchasing pattern of the customers of two sweet shops in Kuwait. Materials and Methods: The data were collected by observing 500 customers in two sweet shops between 11 a.m. and 2 p.m. and between 5 p.m. and 10 p.m. during a two-week period. One shop was in the city (Capital Governorate; n = 330) and the other was in the suburban area (Ahmadi Governorate; n = 170). Every tenth adult customer was also interviewed, when they had completed their purchasing. Results: There were 58.2% females and 41.8% males among the customers. The mean estimated age of the customers was 29.6 (SD = 13.8) years. The mean payment for the purchase was $5.32 USD (SD 2.350). Females commonly purchased larger amount of sweets (42.6%) compared with males (30.1%; p0.001). Chocolate was the most common choice of purchase (71%), and only 10% of the products were sugar-free products. The mean age of the customers interviewed was 35.6 years (SD = 9.4). The favourite sugar product of the interviewed customers was also chocolate (36%). The proportion of the customers considering sugar-free products as their favourite decreased consistently with increasing age. More than half of the customers used soft drinks every day (58%). Conclusion: Knowledge of the caries risk from sweets needs to be increased with a health education programme. Increasing the availability of sugar-free or tooth-friendly products should be one of the aims of the Kuwait Ministry of Health. Keywords: dental caries, diet, Kuwait, prevention

Purpose: This study attempts to describe the caries experience in 12-year-old schoolchildren in Piracicaba, Brazil, and to verify the relationship between the disease and socioeconomic factors, and behavioural variables related to oral health. Materials and Methods: The random sample consisted of 939 individuals from public and private schools in Piracicaba, São Paulo State, Brazil, in 2005. A calibrated dentist performed the examination in an outdoor setting, under natural light, using CPI probes and mirrors, following WHO recommendations. A questionnaire was sent to the parents to collect information on socioeconomic level and behavioural variables related to dental health. The mean number of decayed, missing and filled permanent teeth and surfaces (DMFT/DMFS), the Care Index and the SiC (Significant Caries Index) were determined. Multiple logistic regression analyses using the stepwise procedure were performed in order to identify the risk indicators for the DMFT and for the polarisation group. Results: The DMFT and the SiC Index were 1.32 (SD = 1.92) and 3.52 (SD = 1.86), respectively, and the Care Index was 75.0%. The regression models showed that females and children with either low family income or low education level of the fathers were prone to have caries or take part in the polarisation group. Conclusion: The 12-year-old individuals from Piracicaba presented a low prevalence of caries. Nevertheless, those high carieslevel individuals showed moderate caries experience. The socioeconomic and the behavioural variables related to dental health were risk indicators of caries in permanent dentition not only for the entire sample, but also for the polarisation group. Keywords: dental caries, epidemiology, schoolchildren

Purpose: The aims of the present study were to determine (i) the long-term disease recurrence in intraosseous defects that had undergone an open flap debridement (OFD) procedure with or without enamel matrix derivative (EMD); and (ii) whether and to what extent clinical changes recorded on teeth treated with surgery were similar at sites involved or adjacent to the intraosseous defect. Materials and Methods: Eleven patients contributing twelve reconstructed intraosseous defects were retrospectively recruited and included for analysis. Immediately before surgery, at 12 months post-surgery and at long-term examination (6-8 years post-surgery), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the test site (representative of the reconstructed intraosseous defect) and the control site (representative of an adjacent non-reconstructed site) of each tooth treated with surgery. Results: All patients received monthly professional maintenance up to 12 months after surgery, and every 6 months or less frequently thereafter. In test sites, CAL varied from 5.4 ± 0.8 mm at 12 months to 6.5 ± 1.0 mm at the long-term examination. PPD increased from 3.7 ± 0.4 mm at 12 months to 4.3 ± 0.6 mm at the long-term examination, the changes being not statistically significant. When PPD and CAL changes from 12 months to the long-term examination were compared between test and control sites, no significant differences were found. Conclusions: Within its limitations and considering the limited sample size, the present study indicates that (i) the attachment gain that has been achieved by means of a surgical reconstructive procedure (based on OFD with/without EMD) may be mostly maintained over a 6-8 year follow-up period; and (ii) the extent of disease recurrence, as assessed by attachment loss and pocket deepening, was similar at sites involved or adjacent to the intraosseous defect. Keywords: disease progression, disease recurrence, intrabony defect, maintenance therapy, reconstructive surgery

Purpose: The aims were to evaluate a simple method to disclose a microbial shift in saliva and to investigate the short- and long-term effects of daily use of xylitol-containing chewing gums on mutans streptococci (MS) and [14C]-xylitol uptake in saliva. Materials and Methods: In a pilot set-up, saliva samples were collected from 15 healthy adults and the uptake of xylitol was compared with a specific assay determining xylitol-sensitive MS. The main study consisted of 109 schoolchildren (mean age 9.9 years) who volunteered after informed consent. The children were randomly allocated to a test or control group. The control group was given two pellets containing sorbitol and maltitol 3 times daily for 4 weeks and the test group received identical pellets with xylitol as single sweetener (total dose 6.2 g/day). Saliva samples were collected at baseline, after 4 weeks and 6 months after the intervention. The outcome measures were MS and total viable counts, proportion of MS and salivary uptake of [14C]-xylitol. Results: The pilot study disclosed a fair positive correlation (p 0.05) between the assays. The proportions of MS and salivary xylitol uptake decreased significantly in the xylitol group by 60% and 30% respectively after 4 weeks compared to baseline which was in contrast to the sorbitol/maltitol group (p 0.05). Six months after the intervention, the outcome measures did not differ significantly from baseline in any of the groups. Conclusion: A relatively high daily dose of xylitol could alter salivary microbial composition during the intervention period but no long-term impact was observed. Keywords: chewing gum, mutans streptococci, oral microflora, saliva, xylitol

Purpose: To estimate the incidence of traumatic dental injuries (TDI) and determining risk factors in adolescents in Luzerna, Brazil, over a period of three years. Materials and Methods: A longitudinal study was carried out with adolescents born in 1988 and 1989 attending the schools of the city. Two examinations were performed in the adolescents in the year 2001 and 2004. The sample size was 176 individuals; however, it was decided to invite all 246 students enrolled in 2001. Clinical examinations were carried out through criteria for TDI used in the National Survey, UK, in 1994. Results: The incidence ratio was of 13.2% (CI 95% 7.9-18.5). The incidence among males was 15.1% (CI 95% 7.6-22.6) and among females 11.0% (CI 95% 3.9-18.1) (p = 0.440) with a relative risk (RR) of 1.38 (CI 95% 0.60-3.14). In relation to increased incisal overjet, the incidence ratio in the exposed individuals was found to be 21.2% (CI 95% 7.3-35.1) and in the nonexposed 11.1% (CI 95% 5.7-16.8) (p = 0.122). Individuals exposed to an increased incisal overjet presented an RR of 1.91 (CI 95% 0.84-4.34). The incidence in the individuals exposed to inadequate lip coverage was 12.5% (CI 95% 2.3-22.7) and in the non-exposed it was 13.4% (CI 95% 7.4-19.5) (p = 0.879). The RR among the exposed was 0.93 (CI 95% 0.36-2.38). Conclusion: The incidence of TDI was 13.2%. For males, having increased incisal overjet and inadequate lip coverage were not considered as risks factors. Keywords: dental trauma, incidence, incisal overjet, students, trauma

Purpose: The aim of the present study was to compare the effect of systemically administered lycopene (LycoRed™) as a monotherapy and as an adjunct to scaling and root planing in gingivitis patients. Materials and Methods: Twenty systemically healthy patients showing clinical signs of gingivitis were involved in a randomised, double-blind, parallel, split-mouth study. The subjects were randomly distributed between the two treatment groups: experimental group (n = 10), 8 mg lycopene/day for 2 weeks; and controls (n = 10), placebo for 2 weeks. Quadrant allocation within each group was randomised with two quadrants treated with oral prophylaxis (OP) and two quadrants not receiving any form of treatment (non-OP). Bleeding index (SBI) and non-invasive measures of plaque (PI) and gingivitis (GI) were assessed at baseline, 1 and 2 weeks. Salivary uric acid levels were also measured. Results: All the treatment groups demonstrated statistically significant reductions in the GI, SBI and PI. Treatment with OPlycopene resulted in a statistically significant decrease in GI when compared with OP-placebo (p 0.05) and non-OP-placebo (p 0.01). Treatment with non-OP-lycopene resulted in a statistically significant decrease in GI when compared with non-OPplacebo (p 0.01). The OP-lycopene group showed a statistically significant reduction in SBI values when compared with the non-OP-lycopene group (p 0.05) and the non-OP-placebo group (p 0.001). There was a strong negative correlation between the salivary uric acid levels and the percentage reduction in GI at 1 and 2 weeks in the OP-lycopene group (r = -0.852 and -0.802 respectively) and in the non-OP-lycopene group (r = -0.640 and -0.580 respectively). Conclusions: The results presented in this study suggest that lycopene shows great promise as a treatment modality in gingivitis. The possibility of obtaining an additive effect by combining routine oral prophylaxis with lycopene is also an exciting possibility, which deserves further study. Keywords: antioxidant therapy, gingivitis, gingivitis therapy, lycopene