Self-efficacy perceptions in oral health behavior

Assessment of Differences in Oral Health Knowledge, Attitudes, and Behavior Among Preclinical and Clinical Dental Students

Aim To assess and compare differences in oral health knowledge, attitudes, and behavior among preclinical and clinical dental students of Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. Material and methods A total of 175 students responded to a total of 37 questions regarding their knowledge, attitudes, and behavior regarding dentistry and oral health. The mean percentage scores and standard deviation were calculated to assess the relation between knowledge, attitude, and behavior. Results It was observed that the students in the clinical phase had significantly better knowledge and attitude towards oral health than preclinical undergraduates. There was no significant difference in mean and SD among clinical and preclinical students in behavior while statistically significant differences were observed in their responses to questions related to knowledge (p = 0.000) and attitude (p = 0.007). Female students had better knowledge than male students (p = 0.029). Conclusion Clinical dental students of the institute showed a marginally higher KAP regarding oral health than preclinical students. This might reveal an ineffective transition of the students from the preclinical to the clinical stage. On intergender comparison, the females were better oriented than males towards oral health.

Social support, oral health knowledge, attitudes, practice, self-efficacy and oral health-related quality of life in Chinese college students

Oral health is crucial for health-related quality of life. However, the research on the factors affecting oral health status is not comprehensive enough. This investigation aimed to evaluate the multifaceted determinants of college students' oral health status and explore the impact of social support, oral health literacy, attitudes, behaviors, and self-efficacy on OHRQoL. By surveying 822 students from a university. Baseline data included sociodemographics (gender, age), social support (MSPSS scale), oral health self-efficacy (SESS scale), oral health knowledge, attitudes, and practices (KAP questionnaire), and OHRQoL (OHIP-14 scale). Based on social cognitive theory, partial least squares structural equation modeling (PLS-SEM) and fuzzy set qualitative comparative analysis (fsQCA) were used to examine the relationship between the study variables. PLS-SEM results showed that knowledge, attitude, and practice predicted OHRQoL through self-efficacy. FsQCA results showed that the combination of different variables was sufficient to explain OHRQoL. The conclusion was that self-efficacy plays an important role and the combination of high-level knowledge, positive attitudes, and strong self-efficacy was important in improving OHRQoL. The results of this study provided a reference for the oral health strategy planning of college students in China.

Self-Reported Gum Bleeding, Perception, Knowledge, and Behavior in Working-Age Hong Kong Chinese-A Cross-Sectional Study

Gingivitis and periodontitis are highly prevalent in Hong Kong, where the provision of oral health services is predominantly private. This cross-sectional study aimed to investigate the association between the oral symptoms of gum bleeding and self-reported behavioral factors, beliefs, and knowledge among Hong Kong Chinese. The research team commissioned the Public Opinion Programme of The University of Hong Kong to conduct a structured, population-based, computer-assisted telephone interview (CATI), which covered questions related to the demography, perception, and knowledge (including traditional Cantonese beliefs) of gum health, dental attendance, oral health behavior, and dental anxiety. A total of 1,265 individuals aged 25−60 years old were successfully contacted, and 704 (55.7%) reported prior gum bleeding experience. A total of 516 individuals (64.9% females, median 55−60 years) completed the CATI satisfactorily, and 321 (62.2%) experienced gum bleeding in the past 12 months. The factors that were significantly associated with reports of gum bleeding in the past 12 months include having periodontitis, sensitive teeth, having tertiary or higher education, flossing/interdental cleaning, not cleaning teeth well enough, lack of sleep, consuming too much ‘heaty’ food, avoiding going to the dentist when gums are bleeding, and waiting for gum bleeding to subside (p < 0.05, r2 =0.198; forward stepwise logistic regression). Within the limitations of this study, approximately half of the Hong Kong working-age adults surveyed reported experiencing gum bleeding, and 62.2% of the participants experienced it within the past 12 months. Members of Hong Kong’s working-age population who reported having higher levels of education appeared more readily aware of their gum problems. Those with bleeding gums, especially those who have discernable periodontitis, poor dental awareness/behaviors, and/or a poor lifestyle should be targeted to receive education and encouragement, which will allow them to take action and improve their own gum health.

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030-oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University - Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Oral Health Knowledge, Attitudes, and Behaviors (KAB) of German Dental Students: Descriptive Cross-Sectional Study

Germany's 2030–oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University – Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs. the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies.

Pain and Avoidance during and after Endodontic Therapy: The Role of Pain Anticipation and Self-Efficacy

Background: Pain anticipation has been identified as a predictor of pain and avoidance with respect to endodontic therapy. Self-efficacy is also key to the development and maintenance of health behaviors and achieve patient adherence to treatment. However, the role of self-efficacy has not been studied yet in endodontic treatment. Methods: This study was conducted on 101 patients who needed root canal therapy. They had to fill a questionnaire before treatment registered pain anticipation and self-efficacy; during and after treatment were registered pain intensity and avoidance. Results: Pain anticipation explained pain during (Beta = 0.51, t = 5.82, p ≤ 0.001, [0.34, 0.69]) and after treatment (Beta = 0.38, t = 4.35, p ≤ 0.001, [0.21, 0.55]). Self-efficacy did not have an influence in pain values. Pain anticipation explained avoidance during (Beta = 0.51, t = 3.60, p ≤ 0.001, [0.23, 0.80]) and after treatment (Beta = 0.62, t = 4.29, p ≤ 0.001, [0.33, 0.91]). Self-efficacy had a significant role in avoidance during treatment (Beta = 0.12, t = 2.19, p ≤ 0.03, [0.01, 0.23]) with a strong moderation relationship between pain anticipation and avoidance when self-efficacy was medium (Beta = 0.44, t = 3.24, p = 0.002, [0.17, 0.72]) or high (Beta = 0.84, t = 3.5, p ≤ 0.001, [0.37, 1.33]). Self-efficacy was not significant respect to avoidance after treatment. Conclusions: Self-efficacy is an important variable in endodontic therapy due to their moderating effect between pain anticipation and avoidance behavior during the procedure. It is necessary to improve the results of root canal therapy and reduce patient’s avoidance in order to take into account this variable.

The role of psychological theories in oral health interventions: A systematic review and meta-analysis

OBJECTIVE

In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions.

METHODS

PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT.

RESULTS

From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: -0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (-4.6 [95% CI: -6.49, -2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health.

CONCLUSION

The current meta-analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths.

Mechanical and chemical plaque control in the simultaneous management of gingivitis and caries: a systematic review

AIM

To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries.

MATERIAL AND METHODS

A protocol was designed to identify randomized (RCTs) and controlled (CCTs) clinical trials, cohort studies and prospective case series (PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible.

RESULTS

After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [n = 4; weighted mean difference (WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis.

CONCLUSION

Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries.

Development of an oral health-related self-efficacy scale for use with older adults

AIM

Self-efficacy is considered to be an important factor influencing behavior change; however, there are no existing tools to measure self-efficacy in the context of oral health among older adults. The purpose of the present study was to develop the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) for use with older adults, and to evaluate its reliability and validity.

METHODS

The self-administered questionnaire was completed by 646 Japanese older people. The draft version of the scale consisted of 35 items that were generated to measure the three dimensions of personal beliefs in tooth brushing, observing own oral health status and oral function. We carried out a principal components factor analysis with promax rotation, and investigated the scale's internal consistency and construct validity.

RESULTS

The final version of the scale consisted of three dimensions measured with 20 items. Cronbach's alpha of the GSEOH total scale was 0.924. There were significant differences (P < 0.05) in total scores on the GSEOH for the change process of oral health behavior, and in relation to self-rated oral health.

CONCLUSIONS

We developed the GSEOH, with three factors and 20 items, and confirmed its reliability and validity. More studies are necessary to investigate the cross-cultural validity and reliability with larger samples from other countries. Geriatr Gerontol Int 2017; 17: 1406-1411.

Do dentists have better oral health compared to general population: a study on oral health status and oral health behavior in Kathmandu, Nepal

Background

Dentists are considered role models by the general population in regards to oral hygiene and oral health behavior. This study aimed to access the oral health status of dentists and laypersons, and compare the dentists’ practice of preventive dentistry and oral self-care behaviors to that of the laypersons.

Methods

This cross-sectional study recruited 472 participants (195 dentists and 277 laypersons from the general population). Their oral health/hygiene behavior was assessed using a standardized close-ended multiple choice questionnaire. Oral examination was performed to assess caries using Decayed Missed Filled teeth (DMFT) index and periodontal status using Community Periodontal Index of Treatment Needs (CPITN).

Results

Ninety-six percent of dentists brushed their teeth at least once daily, using fluoridated toothpaste and 80.5% twice daily. Although 94% of laypersons brushed their teeth once daily, they seldom used fluoridated toothpaste. Ten percent of participants in each group were caries free. The mean number of teeth present in the oral cavity (27.4 versus 25.4), mean number of teeth with caries (1.8 versus 3.7) and fillings (2.5 versus 0.4) were significantly different (p < 0.0001) between dentists and laypersons, respectively. Regarding the periodontal status, 82% of dentists had CPITN score of 0 whereas 71% of laypersons had the highest score 3 (p = 0.007), and 81% of the laypersons reported tooth mobility compared to 1% of dentists (p < 0.0001).

Conclusions

The participating dentists had better periodontal status and better self-reported oral health behaviors than the laypersons. Despite similar prevalence of caries in the two groups, the prevalence of decayed and unfilled teeth was lower among the dentists.

The persuasive power of oral health promotion messages: a theory of planned behavior approach to dental checkups among young adults

Although routine dental checkups are important for both oral and overall health, several factors influence young adults' use or nonuse of dental services. The two studies included in this report tested the theory of reasoned action (TRA), the theory of planned behavior (TPB), and an expanded TPB model in predicting young adults' routine dental checkups. Additionally, the study tested the perceived message effectiveness of TPB-based messages. Results support the use of an expanded TPB model (particularly adding satisfaction with the dentist and environmental constraints to the traditional model) for an understanding of routine dental checkup intention and behavior, and, most notably, provide support for the use of subjective norm-based messages to prompt dental checkups. This study lays the groundwork for a health communication campaign encouraging routine dental checkups among young adults. The use of targeting and tailoring to design effective oral health media campaign messages is discussed.

Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior

The aim of this study was to test the efficiency of an extended model of the theory of planned behavior (TPB) in predicting intention to improve oral health behaviors. The participants in this cross-sectional study were 153 first-year medical students (mean age 20.16, 50 males and 103 females) who completed a questionnaire assessing intentions, attitudes, subjective norms, perceived behavioral control, oral health knowledge, and current oral hygiene behaviors. Attitudes toward oral health behaviors and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward oral health behaviors were slightly more important than perceived behavioral control in predicting intention. Oral health knowledge significantly affected affective and cognitive attitudes, while current behavior was not a significant predictor of intention to improve oral health behavior. The model had a slightly better fit among females than among males, but was similar for home and professional dental health care. Our findings revealed that attitude, perceived behavioral control, and oral health knowledge are predictors of intention to improve oral health behaviors. These findings may help both dentists and dental hygienists in educating patients in oral health and changing patients' oral hygiene habits.

The relationship of oral health literacy and self-efficacy with oral health status and dental neglect

OBJECTIVES

We examined the associations of oral health literacy (OHL) with oral health status (OHS) and dental neglect (DN), and we explored whether self-efficacy mediated or modified these associations.

METHODS

We used interview data collected from 1280 female clients of the Special Supplemental Nutrition Program for Women, Infants and Children from 2007 to 2009 as part of the Carolina Oral Health Literacy Project. We measured OHL with a validated word recognition test (REALD-30), and we measured OHS with the self-reported National Health and Nutrition Examination Survey item. Analyses used descriptive, bivariate, and multivariate methods.

RESULTS

Less than one third of participants rated their OHS as very good or excellent. Higher OHL was associated with better OHS (for a 10-unit REALD increase: multivariate prevalence ratio = 1.29; 95% confidence interval = 1.08, 1.54). OHL was not correlated with DN, but self-efficacy showed a strong negative correlation with DN. Self-efficacy remained significantly associated with DN in a fully adjusted model that included OHL.

CONCLUSIONS

Increased OHL was associated with better OHS but not with DN. Self-efficacy was a strong correlate of DN and may mediate the effects of literacy on OHS.

[Practices and meanings of oral health: a qualitative study with mothers of children assisted at the Federal University of Santa Catarina]

This research aimed to know oral health practices and meanings of mothers whose children were attended in the dental pediatric clinics of the Federal University of Santa Catarina. The qualitative method, case study, was used and data were collected by semi-structured interview. The studied population consisted of seven mothers that took their children to odontologic attendance at the university. It was observed that despite previous negative odontologic experiences, economic difficulties and pregnancy have also influenced those mothers to look for and adhere to dental care. The dental visits occurred, mostly, for curative assistance. The mothers took care of their children's teeth because it was considered a maternal responsibility, to prevent dental caries and their consequences, to avoid wasting money with expensive treatment and children's bad experiences with dentists. Mothers received information on the subject from dentists, doctors, nurses, schools, mass communication media and odontology students. Despite of their desire in taking care adequately of their children's health, those mothers don't always have favorable socio-economic conditions to put the obtained instructions into practice.

Determinants of oral hygiene behavior: a study based on the theory of planned behavior

OBJECTIVE

The aim of this study was to develop an index for oral hygiene behavior (OHB) and to examine potential predictors of this actual behavior based on the theory of planned behavior (TPB). Measures of oral health knowledge (OHK) and the expected effect of having healthy teeth on social relationships were included too.

MATERIAL AND METHODS

Using an Internet questionnaire, 487 participants were asked about actual OHB, attitudes (ATT), social norms (SN), perceived behavioral control (PBC), OHK, and expected social outcomes (ESO). Based on a Delphi method involving oral health professionals, a new index for OHB was developed, including tooth brushing, interdental cleaning, and tongue cleaning.

RESULTS

Regression analysis revealed that the TPB variables (ATT, SN, and PBC) and OHK explained 32.3% of the variance in self-reported OHB.

CONCLUSION

The present findings indicate that socio-psychological consequences play a role in oral health care.

Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care

BACKGROUND

Despite improvements over the past two decades, caries and its treatment remain a problem for Scottish children.

AIM

To investigate how the reported childhood dental care experiences of a group of Scottish parents impacted upon the dental treatment they accessed for their children.

STUDY DESIGN

In-depth, semi-structured interviews were conducted with 19 parents of varied age and social background whose children were referred to Dundee Dental Hospital for the assessment of dental extractions. Parents were encouraged to discuss their own and their child's experiences of dental care. The interview data were systematically coded using key theme headings, and summary charts constructed to facilitate the analysis.

RESULTS

A sense of 'uneasiness' pervaded the parents' comments and perceptions of the dental care provided for their children. This was conceptualized as parents 'remembering in words' and 'repeating through actions' their own childhood dental experiences. They remembered and repeated their childhood experiences by delaying dental treatment for themselves and their children.

CONCLUSIONS

Acknowledging the influence of parental dental experience would help ensure that parents of young children access routine care for their children and themselves.

Determinants of oral health behaviors among preuniversity (12th-grade) students in Yazd (Iran): an application of the health promotion model

This study examined the relationships among behavior-specific cognitions and oral health behaviors using Pender's revised health promotion model. Subjects were 300 preuniversity students from 6 high schools in the Yazd district in central Iran. Suitable instruments were designed to measure concepts in the model through validity testing with an expert health panel, and reliability testing with a small sample of students (n = 30). Instruments then were administered to students. Model testing was conducted to identify factors affecting students' practice of oral health behaviors. The results from structural equation modeling indicated that behavior-specific cognitions and affect had a direct effect on oral health behaviors, except activity-related affects. Self-efficacy had an indirect effect on oral health behaviors through perceived barriers. Self-efficacy mediated the effects of behaviors-specific cognitions and affect on oral health behaviors. Together, the variables accounted for 32% of the variance in oral health behaviors. Results of this study can be used to design and evaluate interventions to promote oral health behaviors among students.

A qualitative look at parents' experience of their child's dental general anaesthesia

OBJECTIVES

Caries relapse after treatment of early childhood caries (ECC) under general anaesthesia (GA) has been frequently reported. This research used a qualitative method of inquiry to explore parents' experience of their child's treatment under GA, and their perception of the impact of this treatment on their child.

METHODS

The participants were parents whose children had recently undergone dental rehabilitation under GA. Data was collected by semistructured, open-ended interviews scheduled at the postoperative appointment. Interviews were audio-taped, transcribed, checked and coded into a qualitative computer software program for analysis. Data collection and analysis were done simultaneously, and the interview guide was modified based on responses.

RESULTS

Parents were troubled that their child needed a GA and appeared aware of the complications. While some parents felt 'guilty' and struggled to accept this mode of treatment for their child, others felt 'blameless', and were convinced that the GA was 'preferable' for their child and superior to conventional treatment. Nonetheless, all parents reported some levels of anxiety during the GA; they expressed their emotions with 'fear', 'worry' and 'concern'. After the GA, improvement was reported by most parents in their child's amount of dental pain, sleeping pattern, eating habits and acceptance of parental toothbrushing. The most common changes in their child's behaviour mentioned by parents were increased toothbrushing and decreased consumption of sugary foods. Several children who had had primary teeth extracted were distressed as a result of this 'loss'.

CONCLUSION

The general anaesthetic experience was troubling in a variety of ways for both parents and children. However, an 'early' and positive outcome of the GA was a reported improvement in dental health practices. Parents were more positive about maintaining the health of primary teeth and now knew how to take care of their child's teeth. Future exploration is required to reveal if and how the GA experience will affect long-term preventive behaviours.

Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo

OBJECTIVES

Immigrant children make up a large proportion of the school populations in many western cities. It is likely that their parents have different attitudes and knowledge of dental health than resident populations, and thus provide a challenge to public dental services. This study sought to map existing disparities in oral health among immigrant and western native children in Oslo and to identify differences in parental, cultural and ethnic beliefs and attitudes towards oral health and caries-related behaviours.

METHODS

Caries was recorded of 735 children (3- and 5-year olds), supplemented with radiographs among 5-year olds. Their parents responded to a questionnaire.

RESULTS

Immigrant background, consumption of sweet drinks at bed and social status were the dominant caries risk indicators among the 3-year olds. Among the 5-year olds, the caries risk indicators were immigrant background, parental indulgence, attitude to diet, attitude to oral hygiene, social status and age starting toothbrushing. Being an immigrant was closely associated with higher caries prevalence and experience. Parental attitudes to oral hygiene, diet and indulgence, and caries-related behaviours distinguished immigrants from western natives.

CONCLUSIONS

The results suggest that immigrant groups in western societies require different information packages, modified strategies for forming oral hygiene habits and attitudes related to dental care of children, and encouragement to exercise discipline on factors known to be risks for oral health. These strategies must recognize that immigrants and western natives attach different levels of importance to oral health and dental parameters. It should be paid extra attention to some caries high-risk subgroups.

Cynical hostility as a determinant of toothbrushing frequency and oral hygiene

AIM

Our aim was to investigate whether cynical hostility, self-reported toothbrushing frequency and objectively assessed levels of oral hygiene were associated.

MATERIAL AND METHODS

The present study sample consisted of 4156 30-64-year-old dentate Finns. The questionnaire and the home interview included information about socioeconomic and sociodemographic factors and behavioural variables, such as toothbrushing frequency, dental attendance, smoking and cynical hostility. The level of oral hygiene was assessed during a clinical oral examination. The chi(2) test and ordinal logistic regression analyses were used.

RESULTS

After controlling for sociodemographic and socioeconomic factors, smoking habits and reported dental attendance, the subjects belonging to the lowest cynical hostility level were found to brush their teeth significantly more often and to have better oral hygiene compared with those belonging the highest cynical hostility level. Toothbrushing frequency was adjusted when oral hygiene was used as the outcome variable. The association of cynical hostility with toothbrushing frequency and the oral hygiene seems to be partly dependent on the level of education.

CONCLUSIONS

Cynical hostility is a psychosocial risk marker for the frequency and quality of toothbrushing and it could be a connecting trait between general health behaviour and oral health behaviour.

Adolescents' views of oral health education. A qualitative study

The objective of this study was to investigate adolescents' perceptions and desires with respect to oral health education. A series of focus group sessions was conducted with adolescents in schools. The groups comprised an average of 6 individuals, with a total of 34 participants. The main themes of the discussions were the informants' perceptions of the oral health education in different settings and under varying circumstances. The discussions were transcribed verbatim and analyzed according to the basic principles of Grounded Theory. One of the most important issues appeared to be the dental personnel considering the individual as a subject and not as an object. The adolescents in the study were uncertain about their knowledge of oral health. Often, the participants expressed a wish to be taught more at the dental visit. Information in schools was sparse. The support of parents was acknowledged but little discussed. The methods used in advertisements to describe dental products were met with skepticism. These should not be imitated in oral health education as this might undermine the credibility of the dental services. Girls were perceived to be more interested in health than boys were. Two core categories labeled "credibility" and "confidence", which interacted continually, emerged from the data in the analysis. The results indicate that the credibility of the intermediary of the health messages is essential, as is their ability to create confidence. Thus, oral health education among adolescents is more likely to be successful when credibility and confidence are perceived.

Childhood dental history and adult dental attitudes and beliefs

OBJECTIVE

To examine associations between childhood dental visits and attitudes and beliefs about dental care, and oral health as measured during adulthood.

METHODS

The data were taken from the Florida Dental Care Study (FDCS), a prospective longitudinal study of oral health and dental care, among 683 adults 45 years of age and older who answered questions about early dental history at the 54-month follow-up interview.

RESULTS

Fifty-nine per cent (n = 400) reported having had a dental visit before 18 years of age. Of those with a childhood visit, 72% reported that the first dental visit was a negative experience. Having a childhood dental visit was associated with several positive attitudes and beliefs about dental care. In addition, having early experiences with a dentist was associated with preventive and restorative dental visits and several objective and subjective measures of oral health. Having a negative childhood experience was associated with only one of the adult dental attitude and beliefs subscales, and none of the oral health behaviours.

CONCLUSIONS

Our data suggest that the socialisation associated with early dental visits may occur even though the experience may have been painful or frightening. Although this study design precluded direct inference about causation, these findings do support the utility of further investigations into possible causative linkages between childhood dental experiences and adult attitudinal and dental health outcomes.

Improving patients' compliance with the treatment of periodontitis: a controlled study of behavioural intervention

OBJECTIVES

This clinical trial study investigates whether a behavioural educational intervention based on the autoregulation theory can improve periodontitis patients' compliance with proper dental care at a 1-month follow-up.

MATERIAL AND METHODS

Thirty patients matched for gender (20 men), age (mean age=39 years) and education were randomly assigned to a control or an experimental treatment condition. In the control condition, patients received the regular treatment based on instruction of the proper prophylactic dental care. In the experimental treatment condition, patients received information about the symptoms of periodontitis, the causes, consequences and temporal course, and the types of effective strategy and they were requested to keep daily records of the effects of applying prophylactic dental care on their periodontitis symptoms. In both groups, plaque indices (PIs) (Silness & Löe 1964) were measured prior to treatment and at a 1-month follow-up. A self-report questionnaire also assessed the representation of periodontitis in all patients.

RESULTS

A 2 (time of measurement: baseline versus follow-up) x 3 (PI localization) x 2 (experimental group) mixed-design anova computed on the PI reports a large effect of time, F(1, 28)=267.10, p<0.000, indicating that both groups improved from baseline (mean=1.73, SD=0.08) to the 1-month follow-up (mean=0.56, SD=0.06). It is important to point out that this analysis also revealed the expected Group x Time interaction, F(1, 28)=7.09, p<0.02, partial eta(2)=0.19, indicating that smaller PI were observed in the experimental group (mean=0.24, SD=0.14) than in the control group (mean=0.88, SD=0.38) at follow-up. Post hoc analyses showed that this pattern applies to the proximal and lingual PI but not to the vestibular PI.

CONCLUSIONS

The present data show that the behavioural education intervention is (a) more effective than a classical intervention based on information and training about prophylactic techniques and (b) that it is effective in bringing most patients to normal levels of PI. For clinical practice, it suggests that better results can be obtained if (a) patients are taught a correct representation about periodontitis and (b) patients' sense of self-efficacy is developed through their own direct experience, by observing the effects of their behaviour on periodontitis symptoms.

Relation of different measures of psychological characteristics to oral health habits, diabetes adherence and related clinical variables among diabetic patients

Among diabetic patients, oral health status and oral health behavior have been found to relate to metabolic control. The aim was to analyse which psychological characteristics, i.e. intention, self-efficacy, locus of control or self-esteem related to health behavior most comprehensively explain oral health habits, diabetes adherence, dental caries, deepened periodontal pockets, and the metabolic parameter HbA1c (glycosylated hemoglobin). The study subjects consisted of a group of 149 insulin-dependent diabetic patients. Data were obtained from self-completed questionnaires. The proportions of variance explained by the linear regression model were used as measures in the comparisons. It was found that oral health habits and diabetes adherence correlated. Both dental and diabetes self-efficacy scores were related to oral health habits and diabetes adherence. This indicates that self-efficacy is the best overall determinant of various health behavior practices. The ability of psychological characteristics to explain oral health was limited. Improvement of self-efficacy therefore may have a positive effect on various aspects of health behaviors.

Oral health attitudes and communication with laypersons about orofacial pain among middle-aged and older adults

Communication patterns with persons outside the health care system during a pain episode are poorly understood, yet can have a significant influence on patient behavior. This study examined associations between attitudes and beliefs about oral disease and dental care and talking about orofacial pain with laypersons and health care professionals. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among community-dwelling adults. This study used a prospective design with data collected at baseline and the 42-month follow-up using a standardized interview format. Persons with negative attitudes and beliefs were more likely to have talked to a layperson about pain and less likely to have talked to a health care provider. In addition, the attitude that most consistently differentiated between respondents who had communicated only with a layperson from those who had talked to a health care provider was quality of recent visits, a variable representing more of the interpersonal aspects of a health care visit than the eventual outcomes from the treatment received. Our data are consistent with the hypothesis that lay consultation during a pain episode may substitute for formal care for persons with less positive views of the health care system. Intensity ratings and temporal characteristics of pain were also important determinants of these pain-related communication patterns. These findings emphasize the importance of understanding the communication between persons with pain and non-health care professionals, and how these attitudes and communication preferences relate to the management of pain.

Coping and optimism in relation to dental health behaviour - a study among Finnish young adults

Our aim in this paper was to investigate active coping in relation to optimism, dental health behavior and self-reported dental health among 31-yr-old men and women born in Northern Finland in 1966. Connecting coping strategies and optimism with health behavior is an unexplored approach in dentistry, even though both coping strategies and optimism are known to be associated with many health outcomes. The data were based on a postal questionnaire, which was sent to the Northern Finland 1966 Birth Cohort at age 31 yr (n = 11 541). The number of replies was 8690, with a 75.3% response rate. Active coping was measured using the Ways of Coping Checklist and optimism using a revised Life Orientation Test. Prevalence proportion ratios were estimated by applying a log-binomial regression models. The results showed a correlation between active coping and optimism. Both active coping and optimism were related to different dental health behaviors. The effect of active coping on dental health behavior disappeared by adjusting for optimism, education and gender. The results support the previous findings that active coping acts as a mediator between optimism and health. Optimism was also related to self-reported dental health, which supports the comprehensiveness of optimism as a determinant for health.