Trends in toothbrushing and utilization of dental services in Finland

Oral health behavior and HbA1c in Indian adults with type 2 diabetes

Prevention and treatment of oral diseases and diabetes require persistent daily self-care, as there is a mutual association between periodontitis severity and level of diabetes control. In this questionnaire study, we investigated oral health behavior, attitudes, and knowledge of diabetes-related factors among 500 Indian adults with type 2 diabetes mellitus. The questionnaire asked about oral self-care, dental visits, self-perceived problems, and knowledge of the relationship between diabetes and oral health. The most recent glycosylated hemoglobin (HbA1c) value was obtained from patient medical records. Overall, 22% of participants reported twice-daily toothbrushing; women were more likely than men to brush twice daily (P< 0.001). With respect to age and diabetes control, participants aged 35-44 years with good diabetes control had the highest rate of twice-daily brushing (P< 0.001). Oral self-care and use of dental services were poor among participants. The present results indicate that Indians with type 2 diabetes need further promotion of oral self-care and regular dental checkups to compensate for their increased risk of oral disease.

Determinants of preventive oral health behaviour among senior dental students in Nigeria

BACKGROUND

To study the association between oral health behaviour of senior dental students in Nigeria and their gender, age, knowledge of preventive care, and attitudes towards preventive dentistry.

METHODS

Questionnaires were administered to 179 senior dental students in the six dental schools in Nigeria. The questionnaire obtained information on age, gender, oral self-care, knowledge of preventive dental care and attitudes towards preventive dentistry. Attending a dental clinic for check-up by a dentist or a classmate within the last year was defined as preventive care use. Students who performed oral self-care and attended dental clinic for check-ups were noted to have complied with recommended oral self-care. Chi-square test and binary logistic regression models were used for statistical analyses.

RESULTS

More male respondents agreed that the use of fluoride toothpaste was more important than the tooth brushing technique for caries prevention (P < 0.001). While the use of dental floss was very low (7.3%), more females were more likely to report using dental floss (p=0.03). Older students were also more likely to comply with recommended oral self-care (p<0.001). In binary regression models, respondents who were younger (p=0.04) and those with higher knowledge of preventive dental care (p=0.008) were more likely to consume sugary snacks less than once a day.

CONCLUSION

Gender differences in the awareness of the superiority of using fluoridated toothpaste over brushing in caries prevention; and in the use of dental floss were observed. While older students were more likely to comply with recommended oral self-care measures, younger students with good knowledge of preventive dental care were more likely to consume sugary snacks less than once a day.

Acute inflammation in horizontal incompletely impacted third molar with radiolucency in the elderly

Although radiolucency has been shown as a risk of infection, the poorly understood effects of aging on radiolucency correlate with acute pericoronitis, which has a high risk of infection extending any complications. We reviewed the records of 346 consecutive patients aged more than 41 years to evaluate whether pericoronal radiolucency below the crown in mandibular horizontal incompletely impacted third molars is related to acute inflammation. The frequency of acute inflammation in teeth with pericoronal radiolucency below the crown was similar to that in teeth without; however, the odds ratio of acute inflammation exhibited in women aged more than 61 years compared to women aged 41–50 years was 9.77 (95% confidence interval [CI]: 1.67–57.29; P < <0.05), and in women aged more than 61 years compared to women aged 51–60 years was 26.25 (95% CI: 2.94–234.38; P < 0.01). The odds ratio of severe acute inflammation exhibited in men aged more than 61 years compared to men aged 41–50 years was 16.67 (95% CI: 1.76–158.27; P < 0.01). These odds ratios indicate an association of acute pericoronitis, including the severe forms of acute inflammation that result from pericoronitis, with pericoronal radiolucency below the crown in the elderly.

Radiolucency below the crown of mandibular horizontal incompletely impacted third molars and acute inflammation in men with diabetes

Although mandibular third molar has a high risk of infection extending any complications, the influence of diabetes on radiolucency and acute inflammation in pericoronitis remains unclear. The present study was to evaluate whether radiolucency below the crown is related to acute inflammation in mandibular horizontal incompletely impacted third molars and to review the records of 140 men more than 45 years with and without diabetes. The odds ratio of exhibiting acute inflammation was 3.38 (95% CI: 1.13-10.16, p < 0.05) and that of exhibiting severe acute inflammation was 15.38 (95% CI: 3.56-66.49, p < 0.0001), indicating an association of acute pericoronitis in diabetes. The frequency of radiolucency below the crown and below the root in diabetics was similar to that in nondiabetics. However, the odds ratio of exhibiting both radiolucency below the crown and acute inflammation under the diabetic condition was 4.85 (95% CI: 1.60-14.73, p < 0.01), whereas that of diabetics showing both radiolucency below the root and acute inflammation was 0.46 (95% CI: 0.06-3.74, p = 0.74). Radiolucency below the crown and acute inflammation were associated with diabetes, but that below root and acute inflammation were not associated with diabetes, indicating that the region below the crown carries susceptibility to acute pericoronitis, whereas the periodontium shows a protective effect against acute pericoronitis.

Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country

OBJECTIVE

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua.

MATERIAL AND METHODS

A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression.

RESULTS

The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs.

CONCLUSION

Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.

Gender differences in child-related and parent-related determinants of oral health-related lifestyle among 11- to 12-year-old Finnish schoolchildren

OBJECTIVE

The aim of this study was to ascertain whether child-related and parent-related characteristics were associated differently with oral health-related lifestyle among boys and girls.

MATERIAL AND METHODS

The study population consisted of 5th and 6th graders and their parents in Pori, Finland. There were 1691 children ranging in age between 11 and 12 years. The data were gathered by questionnaires. For the analyses, we grouped children and parents within three lifestyle groups: favorable, moderate and poor. Differences in child-related and/or parent-related characteristics between boys and girls were analyzed with logistic regression analyses; those with a favorable lifestyle comprised the healthy lifestyle group, and those with a moderate or poor lifestyle the unhealthy lifestyle group.

RESULTS

Oral health-related lifestyle was healthy more often among girls than among boys. In both genders, those who considered toothbrushing important for pleasing authorities more often had a healthy lifestyle. Girls who considered toothbrushing important for health and appearance were more likely to have a healthy lifestyle than those who did not. The effect of parents' oral health-related lifestyle was slightly stronger among boys than among girls. Among girls, however, high occupational level of father was indicative of healthy lifestyle.

CONCLUSIONS

Among girls and boys, there are similarities and differences in factors related to oral health-related lifestyle. The parents' model is important for both, but the effect is stronger among boys than among girls. Among girls, attitudes on health and appearance are positively associated with a health-related lifestyle.

Oral health and its determinants among Mongolian dentists

This study compares the dental health of dentists with that of their population counterparts, and relates dentists' oral health to oral health behavior and professional preventive knowledge and orientation. A questionnaire requesting information on the dentists' oral health, preventive knowledge, and orientation and oral health behavior, was targeted at all actively practicing dentists (n = 250) in the Mongolian capital of Ulaanbaatar. A self-reported dentigram served as the basis for assessing dental health, while the 1996 National Oral Health Survey provided data for comparison with population counterparts. The response rate was 98%. Compared to their general-population counterparts, younger dentists exhibited a similar level of caries experience (DMFT) and missing teeth (NMT), whereas older dentists exhibited a lower level. In all age groups, mean numbers of decayed teeth (DT) among dentists were much smaller than for their population counterparts, whereas mean numbers of filled teeth (FT) were much higher. Of all, 81% reported brushing their teeth twice daily or more, 62% used fluoride-containing toothpaste always or almost always, and 52% consumed sugar-containing foods between main meals less than once a day. The better oral health behavior of dentists was best explained by their greater preventive knowledge and their better dental health by better oral health behavior in logistic models. It is concluded that among these dentists there is room for improvement of their own oral health behavior. Towards this end, specially designed continuing education courses could serve to improve dentists' health-related knowledge and change their oral self-care behavior.

Oral self-care among adults with diabetes in Finland

OBJECTIVES

The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland.

METHODS

The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion.

RESULTS

The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed.

CONCLUSIONS

A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.

The theory of reasoned action in describing tooth brushing, dental caries and diabetes adherence among diabetic patients

OBJECTIVES

Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin-dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence.

MATERIAL AND METHODS

Cross-sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records.

RESULTS

The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015).

CONCLUSIONS

Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.

[Life-styles determining the oral health of adolescents in Vitoria (Gasteiz):and evaluation]

OBJECTIVE

To assess the factors determining oral health in adolescents in school at Vitoria (Gasteiz).Design. Descriptive epidemiological study.

PARTICIPANTS

Randomised representative sample of 1,380 students from public and private schools. Setting. Vitoria (Gasteiz). MAIN MASUREMENTS AND RESULTS: A questionnaire on bucco-dental health was self-administered. 41.9% of the adolescents brushed their teeth three times or more a day (2.2 ( 0.98 times a day), with greater frequency in girls. 64% never used dental floss, and 30% did so only at times. 88.1% did not complement their oral hygiene with mouth-washes. Consumption of commercial cakes and pastries was 0.74 ( 1.12 times a day; and of sweets, 1.58 ( 3.15 times a day. 81.9% of the adolescents valued their mouth and dental health the same as the health of other organs of their bodies. 63.5% did not know whether any compound was added to the water as a preventive measure against dental disease; and 83.2% of those who thought something was added did not know what compound it was. 66.7% had been to the dentist during the previous year; 28.2% had not been for over a year.

CONCLUSION

The oral health habits of adolescents in Vitoria (Gasteiz) show deficiencies that could be corrected through Health Education Programmes and promotion of the use of preventive dental services.

Oral self-care and periodontal health indicators among adults with diabetes in Finland

We assessed the effects of oral self-care on periodontal health indicators among adults with diabetes. The sample consisted of 120 dentate individuals, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic in southwest Finland. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN). A questionnaire focused on self-treatment, self-prevention, and self-diagnosis of oral diseases, utilization of dental services, and patients' knowledge and attitudes towards oral health. The New Century model of oral health promotion was used as a theoretical framework for analysis of determinants of oral self-care. Although individuals aged 40 years or older were more frequent interdental cleaners, significantly better oral health indicators were found among younger patients. Women reported brushing their teeth more frequently, and differences in plaque and calculus indices were significantly lower than those of men. Self-reported good oral condition was strongly associated with frequent dental visits and less plaque and calculus. No missing teeth and age less than 40 years were predictors of lower plaque, calculus, and CPITN scores. A significant association was found only between frequent dental visits and reduced amount of calculus. Self-reported frequency of oral health habits among adults with diabetes seemed to have little effect on periodontal health indicators. Adults with diabetes should benefit from comprehensive oral self-care, and more attention is needed for improving the quality and outcome of these habits.

Self-preventive oral behavior in an Italian university student population

BACKGROUND/AIM

The aim of this study was to assess the oral hygiene attitude and the professional preventive examination compliance in Italian university students.

METHOD

A sample of 202 students attending the University of Bologna was randomly selected and interviewed about their preventive oral health attitude and compliance. All students reported using toothpaste and most of them (92.1%) brushed their teeth at least 2x a day using artificial, medium stiffness bristles. The toothbrush was generally (81.6%) replaced within 3 months. Few subjects (14.9%) said they used dental floss daily or utilized other devices. A majority of subjects (59.9%) had a dental examination within the year previous to the interview. Cluster analysis was performed.

RESULTS

4 groups were identified with homogeneous oral hygiene behavior and compliance toward professional preventive examination. Only one cluster, representing 33.6% of the sample, showed consistent frequency and modalities of oral hygiene habits. The other clusters seemed to be defective with interproximal cleaning procedures and compliance toward professional preventive care. Since the sample was characterized by a young, urbanized, homogeneous group with a high educational level and frequently from an upper middle class social status, the analysis probably gives a supra-estimation of the positive behavior.

CONCLUSION

It is rational to suppose that strategies to promote dental service utilization, patients' compliance and a professional style oriented toward prevention may be useful to improve the oral health condition in the young adult Italian population.

Locus of control beliefs predicting oral and diabetes health behavior and health status

Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific.

Does dental service utilization drop during economic recession? The example of Finland, 1991-94

After enjoying rapid economic growth in the 1980s, Finland suffered a deep economic recession that began in 1990. It has been claimed that recession and uneven subsidies influence the use of dental services negatively. Finnish adults born after 1956 and world war veterans are entitled to subsidized dental care either in the Public Dental Service (PDS) or in the private sector. Other adults pay their treatment costs.

OBJECTIVES

The purpose of this paper is to determine whether the economic recession in Finland during the early 1990s affected the use of dental services.

METHODS

The data were collected by the National Research and Development Centre for Welfare and Health using a method called CATI (Computer Assisted Telephone Interview). The target population was non-institutionalized persons aged 25-79 years.

RESULTS

About one-third of those interviewed had visited a dentist during the previous 6 months and this proportion was stable during the years studied. Number of teeth, length of education, income and sex had the highest predictive values for use of dental services as analyzed by multiple logistic regression. Two-thirds had visited a private practitioner, one-third a PDS clinic and a small percentage some other dentist or denturist.

CONCLUSIONS

The results showed that the dental service utilization by Finns was stable during this period of economic downturn and only minor changes occurred in the mean number of visits. The most prominent change was seen in the youngest age group, among whom dental utilization decreased by almost 10%. The study indicated that subsidies do not strongly affect dental utilization today.