Factors influencing the assessment of treatment needs

Self-reported and clinically diagnosed dental needs among institutionalized adults in Vijayawada: A cross-sectional study

BACKGROUND

Frail and functionally dependent elderly people, living in institutions, have difficulties in accessing dental care. Hence, the present study aims to determine the relationship between subjective need and the equivalent clinical findings in an attempt to understand the factors that contribute to individual's perception of the need for dental care among institutionalized adults in Vijayawada.

MATERIALS AND METHODS

A cross-sectional study is conducted in all old age homes in Vijayawada. A total of 182 subjects were interviewed with a questionnaire consisting of demographic details, dental behavior (last visit, reason for the last visit), and self-rating of oral health and impact of oral problems, followed by the clinical examination for oral mucosal condition, dentition status and treatment needs, prosthetic status and treatment needs, and periodontal status by using World Health Organization proforma.

RESULTS

Results showed that normative needs of subjects are significantly more than the self-perceived needs. Response of subjects regarding their present condition of mouth and teeth is 65.4% of subjects reported good and 0.5% reported poor, with respective to perceived oral symptoms 61.9% of subjects' complaints of hypersensitivity and 23.1% of subjects were having toothache and 80.5% subjects are having difficulty in eating. The overall prevalence of complete Edentulous and require complete denture was 12.1%, and 60.4% required partial denture.

CONCLUSION

About half of the participants confirmed need for problem-oriented dental care. The main reason for the problems faced by the institutionalized people is due to lack of teeth which could be prevented by appropriate care.

Fatores relacionados à autopercepção da necessidade de tratamento odontológico entre idosos

OBJETIVO: Analisar fatores associados à autopercepção da necessidade de tratamento odontológico entre idosos. MÉTODOS: Foram pesquisados 5.326 indivíduos incluídos em amostra dos idosos (65-74 anos) brasileiros do inquérito domiciliar de saúde bucal realizado em 2002/2003 pelo Ministério da Saúde. A análise foi baseada no modelo de Gift, Atchison & Drury e foi utilizada a regressão de Poisson para análise de inquéritos com amostras complexas. RESULTADOS: Do total da amostra, 2.928 (55%) idosos relataram necessitar tratamento odontológico. A autopercepção dessa necessidade foi menor entre aqueles com 70 anos ou mais (RP=0,94; IC 95%: 0,89;0,99), que não receberam informações sobre como evitar problemas bucais (RP=0,89; IC 95%: 0,83;0,95) e que eram edentados (RP=0,68; IC 95%: 0,62;0,74). Foi maior entre aqueles que autoperceberam: saúde bucal regular (RP=1,31; IC 95%: 1,21;1,41) ou ruim/péssima (RP=1,29; IC 95%: 1,19;1,41); aparência como regular (RP=1,23; IC 95%: 1,15;1,32) ou ruim/péssima (RP=1,28; IC 95%:1,18;1,39); mastigação como regular (RP=1,08; IC 95%: 1,01;1,15) ou ruim péssima (RP=1,13; IC 95%:1,05;1,21); os que relataram dor nos dentes ou gengivas nos seis meses anteriores ao inquérito (RP=1,27; IC 95%: 1,18;1,36); os que necessitavam de prótese em uma arcada (RP=1,29; IC 95%: 1,19-1,39) ou em ambas (RP=1,27; IC 95%: 1,16;1,40). CONCLUSÕES: Informação, condições de saúde bucal e questões subjetivas estiveram associadas à autopercepção da necessidade de tratamento odontológico. Os resultados reforçam a necessidade de capacitar os indivíduos para realizarem o auto-exame bucal e identificar precocemente os sinais e sintomas não dolorosos das lesões da mucosa, da cárie e da doença periodontal.

Is the observed association between periodontitis and atherosclerosis causal?

Most of the documentation of possible causal links between periodontitis and atherosclerosis-related diseases appears indirect or circumstantial. There is, however, an increasing number of both experimental and longitudinal epidemiological studies which seem to support a causal relationship. A critical evaluation of the epidemiological data available might therefore be appropriate. The present study is based on a literature search using Ovid medical data base covering the period from 1989 to October 2000 and applying specific inclusion criteria. Based on a critical evaluation of the 14 investigations selected from a total of 21 retrieved from the search, a causal relationship between periodontitis and atherosclerosis-related diseases appeared possible. However, the nature both of periodontitis and atherosclerosis is multifactorial, and caution should be exercised when implicating periodontal disease in the causation of atherosclerotic disorders.

The periodontal disease problem. A comparison between industrialised and developing countries

There is no reason to believe that periodontal diseases in industrialised and developing countries are in principle different. That is, not in the sense that the problem is caused by a different set of periodontal diseases, with different micro-organisms and a different natural history, needing a different approach towards prevention and treatment. Indeed, from a public health perspective the relative similarities in periodontal conditions around the world are far more striking than the differences. The view that periodontal diseases are a much more prevalent and a severe problem in the developing countries seems to be true only in terms of poorer oral hygiene and considerably greater calculus retention, already at a young age, but not so clear for periodontal destruction in adults.

Awareness of periodontal diseases: the professional and the civil servant

Newly qualified dentists and dental hygienists should have a good level of awareness of periodontal diseases. However, for a variety of reasons this knowledge may not be regularly updated or applied in practice. This paper considers how professional awareness can be influenced by such factors as: maintaining an up to date understanding of the nature of periodontal diseases, the routine use of appropriate screening and examination techniques, factors influencing assessment of treatment need, patient records, continuing professional education and an understanding of patient expectations. It goes on to describe how civil servants may help to stimulate improvements in awareness levels to periodontal diseases by promoting continuing education, epidemiological research and national oral health strategies as well as through legislation and regulation. The paper concludes that although a range of organisations can promote improvements in professional awareness, unless simultaneous efforts are made to improve the awareness of the general public to periodontal diseases, it is difficult to see how there can be an improvement in the periodontal health of the population.

Periodontal conditions in a 7-19-year-old student population in Araraquara, São Paulo, Brazil, 1995

The Purpose of this study was to assess the periodontal conditions and treatment needs in 7-19-year-old Brazilian school children and adolescents enrolled in the urban public schools in Araraquara, São Paulo, Brazil, in 1995, to provide baseline data for monitoring changes in their periodontal status. A sample of 1,956 school children and adolescents aged 7 to 19 years was examined by two examiners previously calibrated using the CPITN (Community Pe riodontal Index of Treatment Needs). The results showed that bleeding was the most frequently observed periodontal condition in all age groups, with a mean of 3.0 sextants affected at age 15. The presence of calculus increased with age. In the 15-19-year age group, calculus and shallow pockets (3.5-5.5 mm) were observed in 39.8 per cent and 1.6 per cent of the adolescents, respectively. In order to achieve the WHO oral health goal of no more than one sextant scoring GPITN 1 (bleeding) or 2 (presence of dental calculus) at age 15, priority should be focused on primary prevention programs to benefit the periodontal health of the majority.

Relationship between CPITN and periodontal attachment loss findings in an adult population

This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score < or = 1 did not have attachment loss > or = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss > or = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment loss > or = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment loss > or = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss > or = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels < or = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.

An analysis of primary and contributing reasons for extraction of permanent teeth given by the dentist

The aim of the present study was to collect information about primary, secondary, and tertiary reasons that dentists gave for extracting permanent teeth and to determine whether and how dentist-associated characteristics might influence the relative emphasis on clinical diagnosis versus non-disease considerations given as reasons. A national random sample of Norwegian dentists (n = 500) recorded reasons for tooth extraction during a period of 2 weeks in 1988 (response rate, 70%). Nine hundred and eight-five teeth were extracted from 692 patients. Disease-/condition-related diagnoses topped the list for primary and secondary reasons for extraction, whereas patients' wishes, economy, and esthetics came to the forefront among tertiary reasons. Logistic regression analysis showed that the choice between clinical diagnosis and non-disease considerations as primary and secondary reasons for extraction was significantly but moderately influenced by variables associated with the dentist.

Perceived need and use of oral health services among adolescents and adults in Tanzania

The perceived need and use of oral health services among adolescents and adults in Tanzania were studied. One region from each of the country's five zones was chosen at random. Final sample selection (n = 1061) was done in the main towns of the selected regions. Participants were interviewed using a structured questionnaire which dealt with perceived need for dental treatment and use of oral health services and several demographic variables. Frequency tables were computed and analyzed. Odds ratios were calculated based on 2 x 2 tables and logistic regression models. The majority, 82% (95% CI: 79-85%) had sought treatment due to pain or for tooth extraction. Perceived need, dissatisfaction with own oral health status and use of oral health services were slightly more frequent among women. Bleeding gums had no explanatory value on the dependent variables. The strongest explanatory variable in a logistic regression model for perceived need and dissatisfaction with own oral health status was previous dental treatment with an estimated odds ratio of 6.4 (95% CI: 4.7-8.7) and 7.2 (95% CI: 5.3-9.9), respectively. People living nearest a treatment facility tended to use the services more [odds ratio 1.3 (95% CI: 0.8-2.1)]. A very strong relation between previous dental problems and use of oral health services was found, namely an odds ratio of 68.8 (95% CI: 39.0-121.4). The findings in the study may be useful in the attempts to implement Tanzania's National Plan for Oral Health.