Gender differences in knowledge, attitude, behavior and perceived oral health among adolescents

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.

An Investigation of the Knowledge, Attitudes, and Practices of Physicians Regarding Child Oral Health at Primary Health Centers in Qatar: A Cross-Sectional Study

OBJECTIVES

 The aim of this study was to investigate physicians' knowledge, attitudes, and practices (KAP) in relation to oral health in children attending baby well clinics in primary health care centers (PHCC) in Qatar.

MATERIALS AND METHODS

 A cross-sectional design was adopted in which a piloted self-administered questionnaire was sent electronically to 417 physicians (pediatricians/family physicians) practicing in all PHCCs in Qatar. The questionnaire gathered information concerning demographic characteristics and KAP in relation to oral health in children. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, the frequency of distribution in relation to demographic data and responses to items of the questionnaire was presented. For analytical statistics, associations between independent variables (predictors) and KAP were assessed by employing univariate and multivariate logistic regressions. Predictors which were significantly associated in the unadjusted regression were entered into a final multivariate logistic regression to evaluate their effects after adjustment.

RESULTS

 The response rate was 24%. The overall mean scores of KAP were 61, 60, and 44.4%, respectively. Females were more likely to give positive answers than males (odds ratio [OR] = 12.3, 95% confidence interval [CI] 2.4-62.2, p = 0.02). Age groups 35 to 45 and >45 years had significantly more correct answers than <35 years age group (OR= 7.5, 95% CI = 1.1-56.6 and 9.2, 95% CI 1.2-44.6, respectively, p = 0.05). No significant associations were found between any of the independent variables with attitudes. With respect to practices, multivariate logistic regression revealed that specialty was significantly associated with practices. Pediatricians were more likely to adopt positive practices when compared with family medicine physicians (OR, 95% CI = 5.3 (1-25.6), p = 0.04).

CONCLUSION

 Although physicians demonstrated moderate levels of knowledge and attitudes, this did not reflect positively on their practices. The overall score of practices was considered poor (44.4%). Poor practices in our sample reflected an urgent need for actions and plans to improve this aspect and confirmed other findings which stated that acceptable levels of knowledge or attitudes do not necessarily translate into favorable practices.

Highly educated patients have lower dental compliance during the COVID-19 pandemic: an observational study

BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) is rapidly changed medical habits, and dental clinics have been forced to adapt. This study explored the pandemic-induced changes in patient utilization of dental services to assist practitioners in responding efficiently to similar public crises as references in the future.

METHODS

We retrospectively analyzed the correlation between patient profiles and dental visits attendance within 2 months before and during the outbreak.

RESULTS

A total of 332 patients, 210 women and 122 men (total number of visits: 1068) were enrolled in this study. A significantly lower attendance rate was noted during the COVID-19 period (70.3%) than prior to the pandemic (83.4%). The rate of return visits for patients with a high education level during the COVID-19 period was significantly reduced from 96.5 to 93.1%. In addition, the number of days between two visits significantly increased during the pandemic.

CONCLUSIONS

Our results indicate that, during the pandemic period, the attendance rates of return dental appointments decreased, and the rate of missed appointments for patients with a high educational levels was higher than that of patients with a low educational level.

CLINICAL RELEVANCE

Preventive management of these patients who are easy to miss dental appointments may enable more effective use of medical resources.

Oral Hygiene in Adolescence: A Questionnaire-Based Study

Oral health is fundamental to our well-being, especially in adolescence. The aim of this study is to investigate oral hygiene knowledge through a questionnaire in a sample of adolescents, paying particular attention to those wearing orthodontic braces. The study was designed as a descriptive report of a local survey. An anonymous questionnaire was distributed to individuals born between 2000 and 2005, both on paper and online. Among 213 adolescents answering the questionnaire, 206 went to the dentist at least once (most of them between 5 and 9 years old), and 144 experienced at least one session of professional oral hygiene. Approximately 83% of the sample brushed their teeth at least twice a day, while only 7% used dental floss daily. Only 54% of respondents wearing orthodontic braces were advised to undergo professional oral hygiene during their orthodontic treatment. Education on oral hygiene at home came only from their parents for 61% of the whole sample. Most respondents had their first visit to the dentist apparently too late. Flossing was rare, whether the adolescents wore orthodontic braces or not. In many cases, professional oral hygiene was not common during orthodontic treatment. Adolescents did not learn about oral hygiene from a dental specialist.

A psychological intervention for caries active young adults, a randomized controlled trial

Objective

The aim of the present study was to evaluate the effect of a brief version of the behavioral intervention Acceptance and Commitment Therapy (ACT) on reducing gingivitis and plaque levels after 18 weeks.

Materials and methods

One hundred thirty‐five caries‐active young adults (18–25 years of age), recruited from two public dental clinics, participated in this parallel group randomized control trial (RCT). Participants in the intervention (n = 67) received two ACT sessions in combination with standard information on oral health, and participants allocated to the control group (n = 68) received standard information only. Gingivitis and plaque levels were recorded at baseline and at the 9‐ and 18‐week follow‐ups. The effect of the intervention versus standard information alone was analyzed by intention‐to‐treat and per protocol, applying the General Linear Model (GLM). Exploratory analyses for the intervention and control groups were conducted to evaluate the effect of gender and smoking habits on the gingivitis and plaque outcome. The CONSORT guidelines for RCT were followed.

Results

A significant decrease in gingivitis and plaque levels was observed over time, irrespective of treatment allocation. However, the ACT intervention was not significantly more effective at reducing gingivitis and plaque scores than standard information alone, even though the intervention participants had maintained their improvement to a greater extent. The exploratory analysis revealed that females improved their gingivitis and plaque levels significantly more than the males in the intervention group (p = 0.025 for gingivitis and p = 0.013 for plaque).

Conclusion

A brief ACT intervention was not proven to be more effective than standard information alone at improving oral health in a sample of young adults with poor oral health. However, ACT seems to have a positive effect on oral health among females. (TRN ISRCTN15009620).

Motivators and barriers to oral hygiene self-care among adolescents in Malaysia: A qualitative study

OBJECTIVE

Having good oral hygiene self-care, especially a regular toothbrushing habit will promote lifelong oral health. Therefore, understanding the factors that influence an adolescent's oral hygiene behaviour is important in developing effective oral health programmes for this age group. This study aimed to explore the motivators and barriers to adolescents' oral hygiene self-care by exploring the perspectives of secondary school students from three government schools in the state of Selangor, Malaysia.

METHODS

Focus group discussions (FGD) were conducted with Form 2 (14-years-old) and Form 4 (16-years-old) students from selected secondary schools in Selangor using a semi-structured topic guide until data saturation was reached. Data were transcribed verbatim and analysed using framework method analysis.

RESULTS

A total of 10 FGDs were conducted involving 77 adolescents. The motivators for good oral hygiene self-care were appearance, fear of oral disease, consequences of oral disease and past toothache experience. The barriers for oral hygiene self-care were poor attitude towards oral care, lack of confidence in toothbrushing skills, snacking habit and the taste of toothpaste.

CONCLUSION

Understanding the motivators and barriers to adolescents' oral hygiene self-care is the first step in designing effective oral health education messages. The findings from this study can be used as a guide for oral health education programmes and development of materials that fulfil the needs of the adolescent population.

Does flossing before or after brushing influence the reduction in the plaque index? A systematic review and meta-analysis

OBJECTIVES

The purpose of this systematic review was to assess whether flossing before or after influences plaque index reduction.

METHODS

This systematic review was conducted according to the guidelines of the preferred reporting items for systematic reviews and meta-analyses and registered with the International prospective register of systematic reviews under number CRD42019126239. The PICO question was, 'does flossing before or after brushing have any effect on reducing dental plaque?'. An electronic search was performed until April 2020 in the following databases: PubMed/MEDLINE, Scopus Web of Science and Cochrane Library. The initial database search resulted in 9679 references, and after detailed analysis of the titles and abstracts of the selected studies, the inclusion/exclusion criteria were applied, and 06 complete articles were downloaded and selected for further analysis. After the complete 02 articles were selected, 60 patients with a mean age of 23.1 years were studied and compared dental flossing before or after dental brushing.

RESULTS

The results showed that there was no statistical difference between brush-floss and floss-brush in reducing plaque index (p = 0.91, RR: 0.01, 95% CI: -0.16, 0.18).

CONCLUSIONS

Flossing before or after brushing has no significant effect on reducing dental plaque index. However, more clinical studies should be conducted.

Oral health awareness, attitude towards dental treatment, fear of infection and economic impact during COVID-19 pandemic in the Middle East

Objectives

To assess the impact of COVID‐19 on oral hygiene (OH) awareness, attitude towards dental treatment, fear of infection and economic impact in the Middle East.

Methods

This survey was performed by online distribution of questionnaires in three countries in the Middle East (Jordan, Iraq and Egypt). The questionnaire consisted of five sections: the first section was aimed at collecting demographic data and the rest sections used to assess OH awareness, attitude towards dental treatment, degree of fear and economic impact of COVID‐19. The answers were either multiple choice, closed‐end (Yes or No) or 5‐point Likert scale for the last four sections.

Results

A total of 3782 respondents completed the questionnaire. Overall, OH awareness was low (mean ±SD; 1.84 ± 1.03), while attitude towards dental treatment (5.04 ± 1.68) and economic impact (11.29 ± 4.37) were moderately affected. In addition, fear of infection showed moderately high level (14.04 ± 4.11). All subgroups of the demographic variables showed significant differences among them in relation to OH awareness and attitude towards dental treatment. The regression model suggested country, gender, age, education level, income level and fear as predictors for OH awareness (R² 0.036) and attitude towards dental care (R² 0.141).

Conclusions

The pandemic negatively impacted the level of OH awareness. However, the attitude towards dental treatment was moderately affected. Increasing public fear and compromised economy influenced OH awareness and the attitude towards dental treatment.

Selected Behavioural Factors Affecting Oral Health in Schoolchildren: Results from the Health Behaviour in School-Aged Children (HBSC) Slovak Study

Oral diseases, particularly dental caries, affect as much as nine in 10 persons globally. Its development starts during childhood. Behavioural factors play an important role in its aetiology. The aim of the research was to analyse the prevalence of selected behavioural factors associated with dental caries in Slovak adolescents. Selected factors, such as toothbrushing less than once a day, consumption of sweets and sweetened soft drinks daily and their combination, were analysed using data from Health Behaviour in School-Aged Children surveys carried out in 2005/2006, 2009/2010, 2013/2014 and 2017/2018 in Slovakia. The target group consisted of 11- to 13-year-old schoolchildren. The results were analysed by sex and socioeconomic status. The consumption of sweets and sweetened soft drinks, despite declining, remains widespread (41.3% of boys and 39.6% of girls in 2017/2018). The absence of daily toothbrushing, similarly as a co-occurrence of factors, were more frequent in boys (10.6% and 5.0% in 2017/2018, respectively) than in girls (5.1% and 2.3% in 2017/2018, respectively). The absence of daily toothbrushing was associated with a lower socioeconomic situation. In conclusion, behavioural risk factors affecting oral health are widespread in Slovak adolescents. Despite the positive development of the epidemiological situation, effective interventions, as well as the improvement of oral hygiene in lower socioeconomic groups, are needed.

Relationship between oral hygiene knowledge, source of oral hygiene knowledge and oral hygiene behavior in Japanese university students: A prospective cohort study

The aim of this prospective cohort study was to examine whether oral hygiene knowledge, and the source of that knowledge, affect oral hygiene behavior in university students in Japan. An oral exam and questionnaire survey developed to evaluate oral hygiene knowledge, the source of that knowledge, and oral hygiene behavior, such as the frequency of tooth brushing and regular dental checkups and the use of dental floss, was conducted on university student volunteers. In total, 310 students with poor tooth brushing behavior (frequency of tooth brushing per day [≤ once]), 1,963 who did not use dental floss, and 1,882 who did not receive regular dental checkup during the past year were selected. Among these students, 50, 364, and 343 in each respective category were analyzed in over the 3-year study period (follow-up rates: 16.1%, 18.5%, and 18.2%, respectively). The odds ratios (ORs) and 95% confidence intervals (CIs) for oral hygiene behavior were calculated based on oral hygiene knowledge and the source of that knowledge using logistic regression models. The results showed that dental clinics were the most common (> 50%) source of oral hygiene knowledge, and that a more frequent use of dental floss was significantly associated with dental clinics being a source of oral hygiene knowledge (OR, 4.11; 95%CI, 1.871–9.029; p < 0.001). In addition, a significant association was seen between dental clinics being a source of oral hygiene knowledge and more frequent regular dental checkups (OR, 13.626; 95%CI, 5.971–31.095; p < 0.001). These findings suggest the existence of a relationship between dental clinics being the most common source of oral hygiene knowledge and improved oral hygiene behavior in Japanese university students.

Educational inequalities in access to fixed prosthodontic treatment in Norway. Causal effects using the introduction of a school reform as an instrumental variable

OBJECTIVES

Equality in access to dental services, independent of level of education, is an important aim of Scandinavian welfare policy. In Norway, this policy is the main justification for a dental public subsidy scheme for adults. An important part of the subsidy scheme is to cover the cost of fixed prosthodontic treatment, including implant-based crowns and bridges for premolars, canines and incisors. A stated policy goal is to secure equal access to everybody in need of these services, independent of their level of education. The aim of this study was to estimate the causal effect of education on the probability of receiving fixed prosthodontic treatment in the adult Norwegian population.

METHODS

During the period 1960-1972, all municipalities in Norway were required to increase the number of compulsory years of education from seven to nine years. We used this education reform as the instrumental variable to create exogenous variation in the individual's number of years of education. The education data were combined with data from the Norwegian Health Economics Administration, which contained our outcome variable. Our sample included individuals with 9 years education or less. Altogether 113 237 individuals were included in the study.

RESULTS

For men, the first stage regression coefficient was 0.87 (confidence interval: 0.82-0.92). This means that the reform resulted in 0.87 additional years of education. For men, the probability of receiving fixed prosthodontic treatment increased by 0.67 percentage points per additional year of schooling. For women, the first stage regression coefficient was 0.84 (confidence interval: 0.79-0.88). The second stage regression coefficient was small (= 0.0022) and not statistically significant at a conventional level.

CONCLUSION

From a welfare policy point of view, for men, the subsidy scheme has not succeeded to redistribute resources so that dental services are accessible independent of their social status.

Sex differences in the association between obesity and gingivitis among 12-year-old South Brazilian schoolchildren

OBJECTIVE

To assess the association between weight status and gingivitis in a representative sample of 12-year-old schoolchildren from South Brazil.

BACKGROUND

An association between obesity and gingivitis in children and adolescents has been observed; however, the present evidence has major limitations.

METHODS

A cross-sectional study was conducted in Porto Alegre, South Brazil, from September 2009 to December 2010 and included a representative sample of 1528 12-year-old schoolchildren attending public and private schools. Data collection included the application of a questionnaire, recording of anthropometric measures (weight and height), and clinical examination (gingival bleeding index, recorded in four sites per tooth). The outcome of the study was the prevalence of gingivitis, defined as the proportion of schoolchildren presenting ≥52% of bleeding sites (based on the median). Weight status was categorized according to body mass index into normal, overweight, or obese. The association between predictor variables and gingivitis prevalence was assessed using Poisson regression models. Unadjusted and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated.

RESULTS

Gingivitis prevalence was 48.7% (95% IC = 33.8-63.6) and, on average, schoolchildren presented 51.8% (95% IC = 46.2-57.5) of bleeding sites. Obese individuals had 13% higher prevalence for presenting gingivitis than did normal-weight ones (PR = 1.13, 95% CI = 1.09-1.18, P < .001). The stratified analysis showed that this association was sex-specific: Obese girls presented a greater chance of having gingivitis (adjusted PR = 1.21, 95% CI = 1.09-1.34, P < .001), but such association was not observed among boys (PR = 1.07, 95% CI = 0.95-1.20, P = .29).

CONCLUSION

This study showed sex differences in the association between obesity and gingivitis among 12-year-old South Brazilian schoolchildren.

Nutrition Awareness and Oral Health among Dental Patients in Palestine: A Cross-Sectional Study

Nutrition plays a key role in oral and dental health. Similarly, oral health affects nutrition status and diet intake. Consumption of much cariogenic nutrients such as sugar affects dental and gum health. The awareness of dietary practices that affect the oral health is an essential component in the dental care system. The knowledge of the dietary factors that affect the oral health is a major component in the treatment plan. In this vein, this study was conducted to determine the level of awareness of nutrition information affecting oral health among dental patients who visit the private and university dental clinics in West Bank, Palestine. A total of 169 patients were invited to join the study and signed the consent form. A pretested questionnaire was used to collect the required data which included patients' sociodemographics, medical history, oral care practices, dietary practices, and oral health-related nutritional awareness. Face and content validity were verified, followed by a pilot study to determine the questionnaire reliability alpha, and the data were collected from October to November 2018. The Construct Validation was done using the Rasch measurement model, and the descriptive statistical analysis was done to determine the level of awareness and the difference among the groups using SPSS version 21. The total mean score of the nutrition awareness was (9.3 ± 2.8), with higher level of nutrition awareness among females, and the highest score was 16 out of 17. The good oral health condition was reported among 44%, fair 32%, poor 16%, and bad 10% while excellent oral health was reported among only 5% of the participants. There was no significant relationship between level of nutritional awareness with economic status, level of education, or area of living. For oral health, females showed significantly better oral and gum health levels (p < 0.05). The overall level of nutrition knowledge among the participants is insufficient. These results point to the need for oral health and nutrition educational courses and programs to improve oral and nutritional awareness and knowledge among Palestinian people and dental patients in particular. Improving the dietary habits and oral practices with lifestyle changes should also be encouraged.

Barriers and facilitators for adolescent girls to take on adult responsibility for dental care - a qualitative study

Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county. Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis. Results: The study findings could be summed into the theme "Triggers for adolescent girls to take on or not take on adult responsibility for dental care". The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories. Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

Dental avoidance among adolescents - a retrospective case -control study based on dental records in the public dental service in a Swedish county

Objective: This study aimed to investigate the occurrence of missed dental appointments among 16-19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009-2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents' individual situation and be observant of early signs of avoidance.

Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial

OBJECTIVE

To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders.

MATERIALS AND METHODS

A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later.

RESULTS

The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective.

CONCLUSIONS

Daily text messages are more effective at improving oral hygiene than weekly text messages.

Practice-based research agenda priorities selected by patients: findings from a dental practice-based research network

OBJECTIVES

This study aimed to identify (i) which practice-based research agendas had the highest priority among patients and (ii) whether priorities varied significantly with patient age and gender.

METHODS

We conducted a cross-sectional questionnaire survey of 482 patients from 11 outpatient dental practices. The patients were shown 31 items concerning practice-based research questions and asked to select the three items in which they were most interested. We generated a rank order of the 31 items. Subsequently, the 31 items were categorised into 10 groups, and we performed subgroup analyses according to age and gender using chi-square tests.

RESULTS

"Age-specific care to maintain oral health (n = 86)" was rated as the most interesting research question. When data were analysed according to age, patients less than 40 years old rated "Orthodontic treatment", "Esthetic dental care" and "Topical fluoride application" as interesting questions significantly more frequently than did patients 40 years old or older (P < 0.01)?, while patients 40 years old or older rated "Regular dental check-ups", "Dental implant", "Diet and food" and "Social health insurance" as more interesting than did patients less than 40 years old (P < 0.05). When data were analysed according to gender, female patients rated the questions on aesthetic dental care as more interesting than did male patients (P < 0.01), whereas male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05).

CONCLUSIONS

Patients assessed "Age-specific care to maintain oral health" as the highest priority among a broad range of research topics. This study also quantified patient priorities for research agendas according to age and gender group. Designing future research with these priorities in mind will promote patient-centred evidence.

Dental Caries Status and Caries Risk Factors in Students Ages 12-14 Years in Zhejiang, China

Background

An accurate and valid caries prevention policy is absent in Zhejiang because of insufficient data. Therefore, the aim of this study was to investigate oral health status and related risk factors in 12- to 14-year-old students in Zhejiang, China.

Material/Methods

Using multi-stage, stratified, random sampling, we recruited a total of 4860 students aged 12 to 14 years old from 6 regions in Zhejiang in this cross-sectional study. Dental caries was measured using the Decayed, Missing and Filled Teeth (DMFT) index and the Significant Caries Index (SiC). Information concerning family background and relevant behaviors was collected in a structured questionnaire. Logistic regression analysis was used to study risk factors related to dental caries.

Results

The overall prevalence of dental caries was 44% and the mean DMFT and SiC scores were 1.14 and 3.11, respectively. Female students had a higher level of dental caries than male students (P<0.01). The annual increase in caries prevalence was 3% with increasing age, and the DMFT score was 0.15. The results of logistic regression analysis showed that female sex, older age, snacks consumption once or more per day, fair or poor self-assessment of dental health, toothache experience, and dental visits were the most significant risk factors for dental caries, with odds ratios ranging from 1.24 to 2.25 (P<0.01).

Conclusions

The prevalence of dental caries in 12- to 14-year-old students in Zhejiang was low, with a tendency to increase compared with previous oral surveys. Female sex, older age, increased sugar intake, poor oral health self-assessment, and bad dental experience were the most important factors increasing dental caries risks.

Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation

Background

White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive.

Objective

Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment.

Trial design

Randomized, single-centre, double-blind, parallel-group, placebo-controlled study.

Participants

Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding.

Interventions

Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24).

Outcomes

Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5).

Randomization

Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each).

Recruitment

The clinical study duration lasted from March 2011 to September 2013.

Blinding

Unblinding was performed after complete data evaluation.

Numbers analysed

Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18).

Outcome

Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation.

Harms

Similar adverse events occurred in both groups; none was classified as possibly related to the study product.

Limitations

The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation.

Conclusion

Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment.

Registration

The study was registered with ClinicalTrials.gov (Identifier: NCT01329731).

Protocol

The protocol wasn't published before trial commencement.

Associations between dental knowledge, source of dental knowledge and oral health behavior in Japanese university students: A cross-sectional study

The aim of this study was to investigate the associations between dental knowledge, the source of dental knowledge and oral health behavior in a group of students at a university in Japan. A total of 2,220 university students (1,276 males, 944 females) volunteered to undergo an oral examination and answer a questionnaire. The questionnaire assessed dental knowledge, the source of dental knowledge and oral health behavior (e.g., daily frequency of tooth brushing, use of dental floss and regular dental checkups). The odds ratio and 95% confidence interval for oral health behavior based on dental knowledge and source of dental knowledge were calculated using logistic regression models. Of the participants, 1,266 (57.0%) students obtained dental knowledge from dental clinics, followed by school (39.2%) and television (29.1%). Logistic regression analyses indicated that use of dental floss was significantly associated with source of dental knowledge from dental clinics (P = 0.006). Receiving regular dental checkups was significantly associated with source of dental knowledge; the positive source was dental clinic (P < 0.001) and the negative sources were school (P = 0.004) and television (P = 0.018). Dental clinic was the most common source of dental knowledge and associated with better oral health behavior among the Japanese university students in this study.

Oral health status and possible explanatory factors of an inner-city low-income community

Background/purpose

Individuals with low income bear a number of health challenges to healthcare services. Vancouver's Downtown Eastside (DTES) is known to be a low-income community in a metropolitan city. Because it is difficult to reach, the oral health (OH) status of these residents is unknown. The objectives of this study are (1) to design a tool and strategy to collect OH information in a low-income community, (2) to characterize the OH status and related factors among low-income adults, and (3) to identify the explanatory factors for their OH status.

Materials and methods

Mobile screening clinics were established in the gathering centers of the DTES, and those of 19 years of age or older were recruited. Data were collected through survey interviews and clinical examinations. Potential explanatory factors were investigated by regression analysis.

Results

The 356 screened participants were mostly males, middle-aged, less educated, and living with low income (≤CAD$20,000/y). About 80% had dental coverage, mostly from public programs (94%). Many (86%) perceived a dental need. Among dentate participants (n = 306), on average, 3.8 decayed, 8.6 missing, 4.9 filled teeth, and a care index of 41.5% were observed. Social factors (barriers to care and length of DTES residence), dental hygiene (brushing/flossing), and personal (hepatitis C virus infection/methadone usage) factors contributed to their care index level.

Conclusion

This is the first time that comprehensive information regarding OH status has been collected from a low-income, inner-city community in Canada. Further investigations in the challenges and needs in accessing dental care may develop solutions for better OH in similar communities.

Oral Health Knowledge, Attitude, and Practices Among Dental and Medical Students in Eastern India - A Comparative Study

Objectives:

To compare oral health knowledge, attitude, and practices among dental and medical students in a Health care centre at Bhubaneswar, Odisha, India.

Materials and Methods:

One hundred and fifty BDS and MBBS students each from Kalinga Institute of Dental Sciences and Kalinga Institute of Medical Sciences of KIIT University, Bhubaneswar respectively, were invited to participate in this survey using a self-administered structured questionnaire in English comprising 27 questions, which was designed to evaluate the oral health knowledge, attitude, and practices. The obtained data was analyzed using the Statistical Package for the Social Sciences version 20 software.

Results:

On comparison of the scores of knowledge, attitude, and practice, the mean knowledge score was significantly higher among dental students than medical students. The study also showed that female students (both dental and medical) had better oral health knowledge and showed better oral health practices than male students. Karl Pearson's correlation coefficient test showed that, although dental students had better knowledge and attitude towards oral health, there was a lack of adequate practice among them.

Conclusion:

Further emphasis on oral health is necessary in undergraduate training to improve oral health knowledge, attitude, and practice among dental and medical students as they will act as role models for oral health education among individuals and community at large.

The Oro-Facial Investment Scale (OFIS) - A Novel Outcomes and Evaluation Measure for Self-Appraised Oro-Facial Behavioural and Aesthetic Constructs among Professional Healthcare Students of Belagavi : A Cross-Sectional Study

INTRODUCTION

Several studies have shown that self perceived dental appearance is an important determinant in the decision to seek treatment.

AIM

The aim of the present study was to assess the self-perceived oral health knowledge, attitude, practice, behaviour and perception among 18-20 year old students of professional healthcare institutions in Belagavi city, Karnataka.

MATERIALS AND METHODS

The novel 21 item Oro-Facial Investment Scale (OFIS) formulated for this study was distributed to 600 students of professional healthcare institutions (200 each from Medical, Physiotherapy and Ayurveda specialties respectively). Psychometric properties of the questionnaire were assessed. Descriptive statistics and chi-square test were applied.

RESULTS

Total 98.17% practiced the use of facial and oral care products on a regular basis. All 600 participants disagreed that they hate their facial appearance and the way their teeth looked. Out of 200 Ayurveda students, 37 were unsatisfied with the appearance of their teeth. Also, majority of the respondents agreed that they take prompt care of oral wounds or lesions. While majority of the subjects did not feel conscious when a dentist checks their teeth, a robust 153 respondents expressed their reservations for their dental examination to be performed.

CONCLUSION

The OFIS seamlessly amalgamates the dental unit with the immediate facial components; hence, bringing together, in harmony, a multifaceted dimension in self assessment of the overall facial and dental behavioural practices.

Gender differences in the pathways of family factors influencing children's oral health behaviours: a cross-sectional study of primary school students in Beijing, China

OBJECTIVE

Research on what family factors influence children's oral health behaviours (COHB) in developing countries is limited, and there have been no path analyses accounting for gender differences in these factors. Thus, our study evaluated gender differences in COHB including the influencing pathways of family factors in China.

MATERIALS AND METHODS

Through multistage cluster sampling, 915 pairs of mothers and children from six public elementary schools in Beijing completed self-administered questionnaires regarding COHB, parents' modelling behaviours (PMB), parents' controlling behaviours (PCB), parents' oral health knowledge and attitudes (PKA), and children's oral health knowledge and attitudes (CKA). The influencing factors were analysed using path analysis.

RESULTS

Compared with boys, girls showed significantly better performance in drinking less carbonated drinks regularly (8.6% vs. 16.9%). For both genders, PMB shad a significant direct influence on COHB, while PKA had an indirect influence through PMB. In the boys' model, PKA indirectly influenced COHB through CKA. In the girls' model, socioeconomic status had a positive direct effect on COHB.

CONCLUSIONS

The gender differences were not as large as expected. Given that slightly different influential factors for COHB exist between boys and girls, interventions should take note of the similarities and differences in pathways.

Factors Associated with Halitosis in White-Collar Employees in Shanghai, China

Objective

To investigate the factors associated with halitosis in Chinese white-collar employees.

Materials and Methods

Subjects in three randomly selected office buildings in Shanghai, China, were enrolled in this cross-sectional study using cluster random sampling. Oral malodor was assessed by measuring volatile sulfur compounds (VSCs) with a portable sulfide monitor. Subjects’ oral health, including dental caries, periodontal status, and tongue coating, was evaluated clinically. A questionnaire was used to obtain information about participants’ demographic characteristics, oral hygiene habits, and health behaviors.

Results

Of the 805 subjects invited to participate in this study, 720 were enrolled (89.4% response rate). Data from these subjects were used for statistical analyses. The prevalence of halitosis was 33.2%. In the final regression model, halitosis was significantly related to tongue coating thickness, periodontal pocket depth, no food consumption within 2 hours prior to oral examination, and less intake frequency of sweet foods.

Conclusions

In this Chinese white-collar population, tongue coating and periodontal disease were associated with halitosis. Oral hygiene education should be provided at the population level to encourage the maintenance of oral health and fresh breath. Consumption of sweet foods may reduce VSC production, although this finding requires further investigation.

Evaluation of oral health attitude and behavior among a group of dental students in Puducherry, India: A preliminary cross-sectional study

CONTEXT

Oral behavior reflects individual perception on oral health. Behavior and attitude of oral health providers, especially dentists, towards oral health affect their capacity to deliver oral health care services. This attitude plays a important role in determining the oral health condition of population.

AIM

The purpose of this study is to evaluate the oral health attitude and behavior among a group of dental students in India and to find any gender-based differences in terms of oral health attitude and behavior.

MATERIALS AND METHODS

A total of 282 dental students of Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry, India participated in the study. A simplified English version of Hiroshima University Dental-Behavioral Inventory (HU-DBI) was adopted.

STATISTICAL ANALYSIS USED

SSP version 2.80 software was used to analyze the data. Chi-square test was used to find the differences in the distribution of "yes" among students from the different academic year as well as between male and female students. Statistical significance was set at P ≤ 0.05.

RESULTS

Statistical significance was observed for the responses between the students from different academic years brushing frequency, careful brushing of teeth, using brush with hard bristles, careful self-evaluation of brushing and satisfied appearance of teeth and gums. Male students preferred to use a tooth brush with hard bristles and regular mouth washes than female students. With regards to worrying about bad breath, male students had more "yes" responses than females.

CONCLUSIONS

Oral health attitude and behavior increased with the increasing levels of dental education, and no significant differences were observed among male and female dental students.

Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: A meta-analysis

OBJECTIVE

Development of dental caries, specifically, white spot lesions (WSLs), continues to be a well-recognized and troubling side effect of orthodontic fixed appliance therapy, despite vast improvement in preventive dental techniques and procedures. The aim of this meta-analysis is to evaluate, determine, and summarize the incidence and prevalence rates of WSLs during orthodontic treatment that have been published in the literature.

MATERIALS AND METHODS

According to predetermined criteria, databases were searched for appropriate studies. References of the selected articles and relevant reviews were searched for any missed publications.

RESULTS

In the 14 studies evaluated for WSLs, the incidence of new carious lesions formed during orthodontic treatment in patients was 45.8% and the prevalence of lesions in patients undergoing orthodontic treatment was 68.4%.

CONCLUSION

The incidence and prevalence rates of WSLs in patients undergoing orthodontic treatment are quite high and significant. This widespread problem of WSL development is an alarming challenge and warrants significant attention from both patients and providers, which should result in greatly increased emphasis on effective caries prevention.

Health investment behaviours and oral/gingival health condition, a cross-sectional study among Swedish 19-year olds

OBJECTIVES

To test the hypothesis that certain individual, environmental and lifestyle factors are positively associated with beneficial health investment behaviours and oral/periodontal health among adolescents.

METHODS

Five hundred and six randomly selected 19-year old subjects living in two different areas (Fyrbodal and Skaraborg) in the county council of Västra Götaland, Sweden participated in a clinical examination and answered questionnaires covering psycho-social and health behavioural issues. Two oral-health models were estimated with gingivitis score as an objective and self-perceived oral health as a subjective indicator. Three health- investment behaviour models were designed with indicators directly related to oral health and two with indicators related to general health as well. The explanatory variables included gender, upper secondary education programme, native country, living area, general self-efficacy and parents' education level.

RESULTS

In the objective oral-health model, theoretical studies and living in the Skaraborg area were both positively associated with a lower gingivitis score. For the subjective oral-health indicator, none of the explanatory variables showed statistical significance. In the investment-behaviour model with 'tooth-brushing ≥ 2 times daily' as a health indicator, female gender and theoretical studies showed statistically significant associations. With the indicators 'no/few missed dental appointments', 'no tobacco use' and 'weekly exercise', theoretical studies were statistically significant and positively associated. In the investment model with 'perceived oral health care attention' as an indicator, a high score of general self-efficacy was significantly associated with the feeling of taking good care of the teeth.

CONCLUSIONS

Individual, environmental and lifestyle factors are associated with young individuals' oral health investment behaviours and gingival health conditions.

A randomized controlled clinical study of the effect of daily intake of Ascophyllum nodosum alga on calculus, plaque, and gingivitis

OBJECTIVE

The aim of this study is to evaluate, in a randomized controlled cross-over study, the effect of daily intake of the alga Ascophyllum nodosum on supragingival calculus, plaque formation, and gingival health over a 6-month period.

MATERIAL AND METHODS

Sixty-one adults with moderate to heavy calculus formation since their last yearly recall visit participated. In a randomized order over two 6-month periods, they swallowed two capsules daily, comprising a total of 500 mg dried marine alga powder (Ascophyllum nodosum, ProDen PlaqueOff®) or two negative control tablets. During the study, the participants maintained their regular oral habits. Their teeth were professionally cleaned at the start of each period and after the 6-month registrations. A wash out period of 1 month separated the two 6-month periods. Supragingival calculus (Volpe Manhold), gingivitis (Löe and Silness), gingival bleeding (Ainamo and Bay), and plaque (Quigley-Hein) were registered at screening and at the end of the two periods. Differences in oral health between the test and control periods were analyzed using a paired t test and Wilcoxon signed rank test.

RESULTS

Fifty-five participants completed the study. After the alga intake, the mean calculus reduction was 52% compared to the control (p < 0.0001). Fifty-two participants showed less calculus formation in the alga group than in the control group. Plaque (p = 0.008) and gingival bleeding (p = 0.02) were also significantly less in the alga group. However, no significant difference was found between the groups for gingivitis (p = 0.13).

CONCLUSIONS

The alga intake significantly reduced the formation of supragingival calculus and plaque and occurrence of gingival bleeding. The alga has a systemic effect on oral health.

CLINICAL RELEVANCE

Daily intake of the alga Ascophyllum nodosum as an adjunct to customary oral hygiene showed a major reduction of supragingival calculus formation and reduced plaque formation. In addition, the calculus in the alga group was characterized by a more porous and less solid structure and was easier to remove than the calculus in the control group.

Structural equation modeling to assess gender differences in the relationship between psychological symptoms and dental visits after dental check-ups for university students

OBJECTIVE

Some studies have shown a relationship between psychological symptoms and oral health behaviors. However, it is unknown whether gender differences affect the relationship between psychological symptoms and oral health behaviors. In addition, gender differences in the relationship between dental anxiety and dental visits for treatment or regular check-up are unclear. The objective of the present study was to explain the relationships among gender differences, psychological symptoms, oral health behaviors, dental anxiety and 'expectation of dental visit', evaluated as 'dental visits when treatments are recommended' in university students.

MATERIALS AND METHODS

A total of 607 students (311 males, 296 females) aged 18-38 years old were examined. The information was collected via questionnaire regarding gender, psychological symptoms and oral health behaviors. Psychological symptoms were assessed using the Hopkins Symptom Checklist. Structural equation modeling was used to test pathways from these factors to 'expectation of dental visit'. Multiple-group modeling was also conducted to test for gender differences.

RESULTS

Psychological symptoms were related to low expectation of dental visit in females, but there was no such relationship in males. Oral health behaviors were related to expectation of dental visit in both genders.

CONCLUSIONS

Psychological symptoms were directly related to expectation of dental visit in females and oral health behaviors were related to expectation of dental visit in both genders. To promote dental visits after dental check-ups at school, it might be necessary to improve oral health behaviors in both genders and to evaluate psychological symptoms, especially in females.

Odontogenic Infections: A 1-year Retrospective Study

OBJECTIVES

The purpose of this study was to analyze the prevalence, demographic patterns and management of odontogenic infections in patients undergoing treatment in an outpatient dental emergency service of a university hospital.

MATERIALS AND METHODS

In a retrospective study of the year 2012, all patients suffering from odontogenic infections were included. Demographic data, diagnosis and the conducted treatment were analyzed. Odontogenic infections were defined as pulpitis, apical and marginal periodontitis, abscesses and pericoronitis.

RESULTS

A total of 2,058 out of 4,209 emergency patients suffered from odontogenic infections. The majority (45.0%) had an apical periodontitis, 20.8% abscesses, 17.3% a marginal periodontitis, 16.3% a pulpitis and 5.8% a pericoronitis. Mean age was 37.5 ± 17.0 years standard deviation (SD) (1.2-96.4). Most patients were 20 to 29 years (24.6%), followed by the age group of 30 to 39 year old patients (21.0%). Males were affected more frequently (55.5%) than females (45.5%). Most of the patients (64.5%) of the patients received a dental or surgical treatment. Antibiotics were prescribed in 31.7% of cases. Amoxicillin was the most common prescribed antibiotic (54.5%).

CONCLUSION

Odontogenic infections represent one of the main reasons for consulting the emergency service. Due to the high number of cases and the severe complications, dentists have to be familiar with the surgical management of odontogenic infections as well as the appropriate use of antibiotics.

CLINICAL SIGNIFICANCE

Nearly half of all patients who sought, treatment in the emergency service had an odontogenic infectious disease. This should be considered for the organization and planning of the service.

Evaluation of gingival bleeding awareness by comparison of self-reports and clinical measurements of freshman dental students

Objective:

The aims of this descriptive, cross-sectional investigation were to evaluate the gingival health awareness of dental students by comparing their clinical gingival bleeding scores and self-reports, and to compare differences in awareness between males and females.

Methods:

In total, 100 (51 males, 49 females) freshman dental students were included in the study. Periodontal indices recorded were: Presence of plaque percentage (plaque index [PI], %), percentage of sites of bleeding on probing (BOP, %), probing depth, and community periodontal index (CPI). Percent agreement, kappa agreement, sensitivity, and specificity were calculated by comparing their self-reported gingival bleeding and BOP%.

Results:

The self-reports of gingival bleeding exhibited statistically significant correlations with BOP% in females (r = 0.42, P = 0.003). Female students showed a higher degree of awareness when kappa agreement, 0.23 (males: 0.16, females: 0.39), sensitivity, 48% (males: 42%, females: 51%), and specificity, 95% (males: 90%, females: 100%) were calculated. Although male dental students had higher PI and CPI scores, there was no significant difference by gender in the clinical measurements.

Conclusions:

According to our results, the validity of self-reported gingival bleeding was higher among dental students than in previous population-based studies. Female dental students showed a higher degree of awareness than males of their gingival health. Half of the included dental students could not differentiate whether they had gingival bleeding when there was actual bleeding. More emphasis should be given to the education of dental students regarding the relationship between gingival bleeding and active periodontal disease.

Oral health behaviors in a sample of portuguese adolescents: an educational issue

BACKGROUND

The objective of this study was to determine the prevalence of oral health behaviors among a sample of Portuguese adolescents and to evaluate the association with socio-demographic factors.

METHODS

This cross-sectional study was conducted among 447 adolescents aged 12-19 years, attending a public school in Sátão, Portugal. A self-administered questionnaire was applied for data collection.

RESULTS

The prevalence of tooth brushing (twice-a-day or more) was 90.6%. About 6% of adolescents reported daily flossing, which was more frequent among female gender (female, OR=2.03, 95%CI= (1.35 to 3.05)) and adolescents older than 15 years (>15years, OR=1.90, 95%CI= (1.24 to 2.92)). Sixty-seven percent had at least one dental appointment in the previous twelve months. The prevalence of dental appointments was associated with the father´s professional situation (unemployed, OR=0.33, 95% CI= (0.17 to 0.65)) and crowding index (>1, OR=0.4, 95%CI=(0.16 to 0.98)). Thirty-two point nine percent of adolescents referred having at least one episode of dental pain during their lives.

CONCLUSION

The results highlight the need for improvement of oral health community programs and primary preventive strategies to reduce the risk of oral diseases and develop better oral health behaviours.

Factors Associated with Oral Health Status in American Indian Children

The literature reports psychosocial, environmental, and cultural factors related to Early Childhood Caries (ECC), but few studies have included American Indian/Alaska Native (AI/AN) populations. AI/AN children have the highest prevalence of ECC among any population group in the United States. This study examined socio-demographic characteristics of children and their parents/caregivers and psychosocial characteristics of parents/caregivers as risk factors for baseline oral health status of preschool children in the Navajo Nation, as part of a 3-year cluster randomized clinical trial to evaluate the effectiveness of trained community workers providing a fluoride varnish and oral health promotion intervention to. The study recruited 1,015 children at 52 Head Start Centers. Baseline ECC data were collected by calibrated dental hygienists for 981 of the children ages of 3-5 years, and a Basic Research Factors Questionnaire (BRFQ) was completed by their parents/caregivers. Bivariable analysis revealed that dmfs was higher in older children; in males; in children with male parents/caregivers; and when the parent/caregiver had less education and income, worse oral health behavior in caring for their children's teeth, and higher scores for external powerful others and external chance locus of control, greater perceived susceptibility and barriers, and lower scores for community risky behavior. In a multiple linear regression model, the variables that remained statistically significant were child's age and gender, and oral health behavior score of the parent/caregiver. Intervening to improve parent/caregiver oral health behavior in caring for the teeth of children potentially could in AI/AN children.

Factors Affecting the Formation, Severity and Location of White Spot Lesions during Orthodontic Treatment with Fixed Appliances

OBJECTIVES

The purpose of the present study was to investigate factors affecting the formation, severity and location of white spot lesions in patients completing fixed appliance therapy.

MATERIAL AND METHODS

A total of 45 patients (19 males and 26 females, mean age 15.81 years, standard deviation 2.89 years) attending consecutively Aberdeen Dental Hospital (ADH) between January and June 2013 to have their fixed appliances removed were given a questionnaire to elicit information regarding their dental care and diet. They were then examined clinically as well as their pre-treatment photographs to record treatment data and white spot lesion (WSL) location and severity using a modified version of Universal Visual Scale for Smooth Surfaces (UniViSS Smooth). Absolute risk (AR) and risk ratios (RR) were also calculated.

RESULTS

The incidence of at least one WSL observed in patients was 42%, with males displaying a higher incidence than females. The highest incidence of WSLs was recorded on the maxillary canines and lateral incisors, and on the maxillary and mandibular premolars and first molars. The gingival areas of the maxillary and mandibular teeth were the most affected surfaces. Significant (P < 0.05) relationships were found between the presence of WSLs and the following factors: poor oral hygiene (OH), males, increased treatment length, lack of use of fluoride supplements, use of carbonated soft drinks and/or fruit juices and the use of sugary foods. Poor OH posed the highest risk of developing WSL (RR = 8.55).

CONCLUSIONS

42% of patients have developed white spot lesions during fixed appliance therapy. Various contributing risk factors were identified with the greatest risk posed by a poor oral hygiene.

The influence of mothers' lifestyle and health behavior on their children: an exploration for oral health

Background:

Parents and teachers involvement reinforce health promotion programs for children's health.

Objectives:

The purpose of this study was to evaluate mothers’ lifestyle behavior and its association with children's oral health.

Materials and Methods:

The study was a cross sectional study on 383 children and their mothers who were selected from 6 primary schools in Tehran, Iran. Mothers and children who participated in this study were asked to complete a questionnaire containing demographic questions, knowledge of oral health, attitude towards the oral health behavior, and oral health behaviors. Furthermore, the Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) were assessed by two calibrated dentists. Data were analyzed with multilevel mixed model analyses.

Results:

The average age of the children and their mothers were 11.6 and 38.4 years, respectively. Mothers’ higher knowledge, higher educational status, positive attitude, higher frequent oral health behaviors, lower DMFT and lower CPI were all associated significantly with children’s higher oral health status.

Conclusions:

The results suggest that to improve children’s oral health, educational interventions should focus on both children and mothers to obtain a more promising outcome.

The impact of gender on caries prevalence and risk assessment

Dental caries remains a common disease worldwide. There is evidence indicating that many caries risk factors provide a gender bias, placing women at a higher caries risk. Generally, dental caries disproportionally affects the poor and racial or ethnic minorities worldwide, with women suffering more from the disease. Differences in access to care as reflected by untreated caries rates also reflect gender disparities. There is a lack of evidence in regard to gender differences and dental caries. Therefore, there is an urgent need to develop the evidence necessary to meet the oral health needs of both women and men worldwide.

Descriptive analysis of toothbrushing used as an aid for primary prevention: a population-based study in Sebha, Libya

This study aimed to assess toothbrushing behavior and descriptively analyze the effect of age and gender. Two thousand and six people from the city of Sebha, Libya, aged 1 to 64 years (mean age 26.9 ± 11.6 years, 1,463 females and 543 males) constituted the study sample. Data was collected using a self-administered questionnaire. Overall, 85.3% were using a toothbrush and toothpaste as a cleaning aid, whereas 6.3% never brushed their teeth. Only 36.1% brushed twice daily. Age and gender were significantly associated with use of a toothbrush and frequency of toothbrushing. This data serves as a baseline to implement a "preventive self-care instruction program."

Oral health locus of control in a Swedish adolescent population

OBJECTIVE

The aim was to test and evaluate the psychometric properties of the Oral Health Locus of Control (OHLoC) instrument and its relation to dental anxiety, self-efficacy and self-perceived oral health among Swedish adolescents.

MATERIALS AND METHODS

A random sample of 758 (63% of 1208 invited) 19-year-old individuals in three residential areas in western Sweden (two rural, one urban) answered a set of questionnaires prior to a dental examination.

RESULTS

The face and content validity of the OHLoC was deemed good in pilot interviews with individuals of the target age. Explorative factor analysis verified the dimensions of the OHLoC sub-scales (internal, external, chance locus of control) with loadings from 0.503 - 0.812, explaining 54.6% of the variance. Construct validity was confirmed in relation to two other psychometric scales, on dental anxiety (DAS) and on general self-efficacy (GSE), with correlations in the expected directions. In multivariate logistic regression analyses, the internal sub-scale displayed the most consistent statistically significant associations with self-perceived oral health, also when accounting for gender, demography and health behavior. There were no significant differences between genders on the OHLoC, but females scored statistically significantly higher on the DAS (p = 0.005) and lower on the GSE (p = 0.021) than males.

CONCLUSIONS

The Swedish version of the OHLoC appears to have acceptable psychometric properties for use in an adolescent population.

Oral health-related perceptions, attitudes, and behavior in relation to oral hygiene conditions in an adolescent population

The aim was to analyze oral health-related perceptions, attitudes, and behavior in relation to oral hygiene conditions among 19-yr-old Swedish subjects. A random sample of 506 individuals was clinically examined regarding oral hygiene conditions and provided questionnaire-based information on oral health-related perceptions, attitudes, and behaviors. Higher scores of plaque and gingivitis were significantly related to the following perceptions: (i) a less favorable oral health situation, (ii) a lower satisfaction with the esthetic appearance of the teeth, (iii) more frequent gingival bleeding during toothbrushing, (iv) less favorable self-care of the teeth, (v) a lower possibility to impact on own oral health, (vi) a lower importance of cleaning the teeth, and (vii) a lower importance of good oral health conditions. More favorable oral hygiene conditions and more positive perceptions, attitudes, and behaviors towards oral health were found among female subjects than among male subjects. In conclusion, adolescents with high scores of plaque and gingivitis had less positive perceptions, attitudes, and behaviors towards oral health than those with more favorable oral hygiene conditions.

The role of school-based dental programme on dental caries experience in Yogyakarta Province, Indonesia

OBJECTIVES

To assess the effectiveness of a school-based dental programme (SBDP) in controlling caries by measuring the relationship between the SBDP performance and caries experience in children aged 12 in Yogyakarta Province, Indonesia, by taking into account influencing factors.

METHODS

A cross-sectional survey was undertaken of 1906 children participating in SBDPs. Four SBDPs were chosen by good and poor performances in urban and rural areas. Caries was assessed using WHO criteria whereas behaviour and socio-demographic factors were collected using a questionnaire administered to the children.

RESULTS

The decayed, missed, and filled teeth (DMFT) of children in good SBDPs (2.8 ± 2.4) was lower than that of the counterparts (3.8 ± 3.4). From path analysis using a structural equation model (SEM), place of residence (OR = 4.0) was shown to have a strongest direct relationship to caries experience, whereas SBDP performance showed no direct relationship. At the same time, SBDP performance was significantly related to frequencies of dental visits (OR = 0.3), sugar consumption (OR = 0.8), and tooth brushing (OR = 3.2), which in turn are interrelated with place of residence, gender, and mother's education.

CONCLUSIONS

The study suggests that the differences in DMFT of children in good and poor performance SBDPs were caused by relation to social factors rather than by relation to oral health service activities.

Exploring the role of peer density in the self-reported oral health outcomes of older adults: a kernel density based approach

Previous research has documented that oral health is inextricably linked with overall health and is an important component of successful aging. Additionally, peer social interactions are known to improve older adults' general well-being by increasing social opportunities and knowledge of local resources. This study examines the relationship between peer density of participants aged 50 and older in the ElderSmile program and self-reported oral health in northern Manhattan. Results from logistic regression models found that higher peer kernel density estimation values are associated with better self-reported oral health. This reinforces the need for place-based health interventions, and provides new evidence of the importance of peer communities for older adults.

Major differences in oral health knowledge and behavior in a group of Iranian pre-university students: a cross-sectional study

To establish efficient methods for self-prevention of oral diseases, assessment of dental health behavior and knowledge in various social classes is necessary. The main purpose of this study was to determine the major differences in oral health knowledge and behavior in a group of Iranian pre-university students. In this cross-sectional study, 591 pre-university students from different regions of Mashhad, Iran were randomly selected to complete a questionnaire consisting of two parts including dental health behavior and knowledge. Scores were recorded and statistical analyses performed to determine the correlation between dental health behavior and knowledge. Data was analyzed with Student's t-test, one-way analysis of variance and Pearson correlation. The mean score of dental health knowledge was significantly lower than the dental health behavior (2.95 ± 0.02 vs. 3.31 ± 0.05, P < 0.001). This difference was observed with gender, birth location and major subject of study. The dental health behavior of Iranian pre-university students was inadequate and their dental health knowledge was at a lower level compared to their behavior. Experimental science students had better oral health behavior compared to other students.