The role of sugar, xylitol, toothbrushing frequency, and use of fluoride toothpaste in maintenance of adults’ dental health: findings from the Finnish National Health 2000 Survey

Burden of oral diseases predicts development of excess weight in early adolescence: a 2-year longitudinal study

Dental caries, gingivitis, and excess weight are highly prevalent, interconnected chronic conditions. The association of oral health with the development of adiposity among children is sparsely addressed. We examined the association of oral health to the development of excess weight and central obesity in early adolescence during a 2-year follow-up period. This prospective study was conducted with 2702 children aged 9-12 years at baseline from the Finnish Health in Teens study. Their weight development was followed up for 2 years. Body mass index with age- and sex-specific cut-offs and the waist-height ratio indicated weight status and central obesity. Oral health data (caries experience and gingivitis/calculus) were collected from outpatient records of public dental services. Having both caries experience and gingivitis/calculus was considered burden of oral diseases. Of the sample, 74% were caries-free but 70% exhibited gingivitis and/or calculus, and 20% had both caries experience and gingivitis/calculus. During the follow-up period, 5.3% (n = 124) and 4.7% (n = 118) of the children became overweight/obese or centrally obese, respectively. Having both caries experience and gingivitis/calculus associated with the development of excess weight in a fully adjusted model (HR 1.75, 95% CI 1.03-2.97) but not of central obesity. Caries experience or gingivitis/calculus alone did not associate with adiposity development.

CONCLUSION

Having burden of oral diseases without excess weight at early adolescence could imply future weight gain; thus, normal-weight individuals with both caries experience and gingivitis/calculus could be targeted with preventive measures. Our findings warrant further research to explore whether oral diseases and the development of obesity merely share risk factors or if their relationship is of causal nature.

WHAT IS KNOWN

• Association of excess weight with caries experience and gingivitis is known to exist both cross-sectionally and longitudinally in children and adolescents.

WHAT IS NEW

• Burden of oral diseases, that is, having both caries experience and gingivitis/calculus, was associated with becoming overweight or obese 2 years later during early adolescence. • Normal-weight individuals with burden of oral diseases at early adolescence could be targeted with preventive measures against excess weight gain.

Underlying pathways of social inequality in tooth loss: the mediating role of sugary beverages and diabetes

BACKGROUND

Previous studies show social inequality in tooth loss, but the underlying pathways are not well understood. The aim was to investigate the mediated proportion of sugary beverages (SBs) and diabetes and the association between educational level and tooth loss, and to investigate whether the indirect effect of SBs and diabetes varied between educational groups in relation to tooth loss.

METHODS

Data from 47,109 Danish men and women aged 50 years or older included in the Danish Diet, Cancer and Health Study was combined with data from Danish registers. Using natural effect models, SBs and diabetes were considered as mediators, and tooth loss was defined as having <15 teeth present.

RESULTS

In total, 10,648 participants had tooth loss. The analyses showed that 3% (95% confidence interval 2-4%) of the social inequality in tooth loss was mediated through SBs and diabetes. The mediated proportion was mainly due to differential exposure to SBs and diabetes among lower educational groups.

CONCLUSIONS

The findings show that SBs and diabetes to a minor degree contribute to tooth-loss inequalities. The explanation indicates that individuals in lower educational groups have higher consumption of SBs and more often suffer from diabetes than higher educational groups.

Patients' awareness regarding the quality of their oral hygiene: development and validation of a new measurement instrument

BACKGROUND

The present research aimed to develop and validate a standardised survey instrument for the assessment of patients' awareness of the quality of their oral hygiene performance.

METHODS

A digital questionnaire was developed that assesses both patients' naïve self-perceptions of oral cleanliness (SPOC_n) after tooth brushing and patients' perceptions after being informed how oral cleanliness may be captured in dentistry (SPOC_d). Three studies (N = 56 adults, N = 66 adolescents and one of their parents, N = 24 university students) assessed the instrument's feasibility (patient reports), reliability (internal consistency), validity (correlation with other constructs; sensitivity to manipulation of actual tooth brushing), and the correlation with actual oral cleanliness after tooth brushing.

RESULTS

All study groups accepted the questionnaire well; average answering times were less than 5 min. Cronbach's α exceeds 0.90; correlational analyses support the discriminant validity regarding oral hygiene related self-efficacy expectations and stages of change; manipulation of oral hygiene behaviour results in the expected changes of SPOC scores. Patients' SPOC correlate only moderately with actual oral cleanliness. The comparison between SPOC_d scores and actual oral cleanliness indicate that they considerably overestimate their oral hygiene performance.

CONCLUSIONS

The SPOC questionnaire is an easy-to-use, well-accepted, reliable and valid instrument for the assessment of patients' awareness of the quality of their oral hygiene for research and clinical purposes. The results of the questionnaire may help to reveal unrealistic self-perceptions of patients regarding their oral hygiene. It can raise their awareness of the need to improve their skills and/or efforts in this regard. Trial registration The third study was an interventional study and was registered in the appropriate national register ( www.drks.de ; ID: DRKS00018781; date of registration: 12/09/2019).

Associations of diet quality, food consumption, eating frequency and eating behaviour with dental caries experience in Finnish children: a 2-year longitudinal study

We examined cross-sectional and longitudinal associations of dietary factors with caries experience in a population sample of 487 children aged 6-9 years at baseline examinations of the Physical Activity and Nutrition in Children (PANIC) Study. Altogether, 406 of these children attended 2-year follow-up examinations. Food consumption and eating frequency were assessed using 4-day food records, diet quality using the Baltic Sea Diet Score (BSDS) and eating behaviour using the Children's Eating Behavior Questionnaire. Caries experience was examined clinically. The cross-sectional associations of dietary factors with caries experience at baseline were analysed using linear regression and the longitudinal associations of dietary factors with a change in caries experience over follow-up using generalised mixed-effects regression adjusted for other risk factors. A higher consumption of high-fibre grain products (standardised regression coefficient β = -0·16, P = 0·003) and milk (β = -0·11, P = 0·025) and higher BSDS (β = -0·15, P = 0·007) were associated with lower caries experience, whereas a higher consumption of potatoes (β = 0·11, P = 0·048) and emotional overeating (β = 0·12, P = 0·025) were associated with higher caries experience. Higher snacking frequency (fixed coefficient β = 0·07, P = 0·033), desire to drink (β = 0·10, P = 0·046), slowness in eating (β = 0·12, P = 0·027) and food fussiness (β = 0·12, P = 0·018) were associated with higher caries experience, whereas enjoyment of food (β = -0·12, P = 0·034) and higher BSDS (β = -0·02, P = 0·051) were associated with lower caries experience.

Effect of Beverage Consumption Frequency on DMFT Index among Iranian Adult Population: An AZAR Cohort Study

Background

Given the effect of oral and dental condition on emotional and physical health and the different effects of beverage consumption on decayed, missing, and filled teeth (DMFT) as one of the indicators of oral health in different populations, this study aimed to investigate the effect of beverage consumption and its frequency on DMFT among Iranian adult population.

Materials and Methods

The data of this cross-sectional study were obtained from AZAR (Azerbaijan) cohort, conducted on 15,006 adults aged 35 to 70 years old in Shabestar County, Iran. Demographic and nutritional data were collected by nutritionists through the "Food Frequency Questionnaire," and DMFT index by general practitioners trained by a dentist according to the World Health Organization (WHO) guidelines. Beverages including milk, doogh, natural fruit juice, black tea, nonalcoholic beer, coffee, sugar-sweetened beverages, and artificial fruit juice were studied.

Results

A total of 14,966 adults with the mean age of 49.64 ± 9.28 were enrolled. The participants' mean DMFT value was 21.27 ± 8.95. Weekly consumption of tea and coffee beverages resulted in 13% (95% confidence interval: 3% to 22%) lower DMFT compared to daily consumption (p=0.01). However, there was no association between DMFT and other beverages.

Conclusion

The higher DMFT values with the daily consumption of tea and coffee beverages showed that a part of adults' oral health is affected by beverages; therefore, this should be considered by healthcare authorities in order to manage carries development in the communities.

Associations Between Diet Quality and Dental Caries in Low-Income Women

BACKGROUND

The Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes.

OBJECTIVE

The objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women.

DESIGN

In this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module.

PARTICIPANTS/SETTINGS

Participants in this study were part of a larger research project-Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data.

MAIN OUTCOME MEASURES

The exposure was diet quality and the main outcome measure was DMFT score.

STATISTICAL ANALYSIS

Dental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality-as assessed by HEI-2015 total and component scores-and dental caries experience, adjusting for the covariates.

RESULTS

Caries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores.

CONCLUSIONS

This research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.

The effect of diet drinks on caries among US children: Cluster analysis

BACKGROUND

The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis.

METHODS

In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R² statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design.

RESULTS

Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8).

CONCLUSIONS

The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood.

PRACTICAL IMPLICATIONS

Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Gender-dependent associations between occupational status and untreated caries in Japanese adults

The aim of this study was to examine whether the presence of untreated caries is different across occupational status among Japanese adults. This was a cross-sectional survey of 1,342 individuals (990 males and 352 females) aged 40-64 yr who underwent medical and dental checkups at a healthcare center in 2011. Oral examination was performed by a dentist and the presence of untreated caries was defined as having at least one untreated decayed tooth. Data regarding current occupational status were obtained using a self-administered questionnaire; the participants were classified into five groups: professionals and managers, clerical and related workers, service and salespersons, agricultural, forestry, and fishery workers, and homemakers and unemployed. Gender-specific odds ratios (ORs) and 95% confidence intervals (CIs) of occupational status for the presence of untreated caries were estimated using logistic regression. After adjusting for potential confounders, female professionals and managers (OR=3.51, 95% CI=1.04-11.87) and service and salespersons (OR=5.29, 95% CI=1.39-20.11) had greater risks of the presence of untreated caries than female homemakers and unemployed. However, this tendency was not observed among males. In conclusion, there was a significant difference in risk of the presence of untreated caries by occupational status among females.

Attitudes and behavioural factors relating to toothbrushing and the use of fluoride toothpaste among caries-active Swedish adolescents - a questionnaire study

OBJECTIVE

The aim of this study was to identify attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents.

MATERIALS AND METHODS

This cross-sectional study is based on an earlier clinical, two-year toothpaste intervention study. At the last appointment, 206 adolescents (of 211) answered a questionnaire comprising nine semi-closed questions.

RESULTS

The majority (93%) brushed their teeth every day, while 7% did so only occasionally. Most participants (77%) brushed twice a day, while 12% brushed just once a day. About half of those brushing just once a day forgot to brush in the evening. Similarly, more than half of the adolescents (53%) used 1 cm of toothpaste or less on their toothbrush. Moreover, 49% brushed for less than 2 min, 41% brushed for 2 min and 10% for more than 2 min. The majority (73%) rinsed with water after toothbrushing. A difference between boys and girls was also observed; 87% of the girls brushed twice a day, whereas only 67% of the boys did so and boys more frequently forgot in the evening.

CONCLUSIONS

Attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents are still inadequate after two years of toothpaste intervention. There are several areas where improvements can be made, such as frequency of brushing, brushing time, amount of toothpaste and post-brushing procedures. The majority (81%) included 'fresh breath' as a reason for performing oral hygiene and this aspect can be used by dental staff in health promotion.

Oral hygiene practices and their socio-demographic correlates among Nepalese adult: evidence from non communicable diseases risk factors STEPS survey Nepal 2013

Background

Oral diseases remain a significant public health problem in Nepal, as do oral health behaviours. Socio-demographic factors play a crucial role in driving oral hygiene practices. This study aims to identify oral hygiene practices and associated socio-demographic factors in Nepalese population.

Methods

This descriptive, cross-sectional study recruited 4200 adults (15–69 years) through multistage cluster sampling. Data obtained from the WHO NCD STEPS instrument version 2.2 were analysed in STATA 13.0 using complex sample weighted analysis.

Results

Prevalence of cleaning teeth at least once a day was 94.9 % (95 % CI: 93.7–95.9), while that of cleaning teeth at least twice a day was 9.9 % (95 % CI: 8.2–11.9). Use of fluoridated toothpaste was seen among 71.4 % (95 % CI: 67.9–74.7) respondents. A 3.9 % (95 % CI: 3.1–5.0) made a dental visit in the last 6 months.

The 45–69 years age group had lesser odds of cleaning teeth at least once a day (AOR: 0.4; 95 % CI: 0.2–0.8), in comparison to 15–29 years age group. Women had greater odds of cleaning teeth at least twice a day (AOR: 1.7; 95 % CI: 1.1–2.4) and having visited a dentist in the last 6 months (AOR: 2.2; 95 % CI: 1.2–3.8) compared to men. With reference to rural residents, urban population had higher odds of using fluoridated toothpaste (AOR: 2.3; 95 % CI: 1.4–3.4) and making a dental visit within the last 6 months (AOR: 1.9; 95 % CI:1.1–3.6). Inhabitants of the Terai had five-fold (AOR: 4.9; 95 % CI: 3.1–7.8) greater odds of cleaning teeth once per day than did hill residents. Those with higher education had greater odds than non-formal education holders of cleaning teeth at least once a day (AOR: 9.0; 95 % CI: 2.9–27.7), cleaning teeth at least twice a day (AOR: 5.6; 95 % CI: 2.9–10.6), using fluoridated toothpaste (AOR: 13.9; 95 % CI: 8.4–23.1), and having visited a dentist in the last 6 months (AOR: 2.8; 95 % CI: 1.4–5.4).

Conclusions

Cleaning teeth at least once a day is widely prevalent in Nepal and a substantial number of population use fluoridated toothpaste. However, cleaning teeth twice a day and visiting a dentist is less common. Being women, Terai residents, urban residents, and educated were significantly associated with oral hygiene practices assessed in this study.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0294-9) contains supplementary material, which is available to authorized users.

Validity of self-reported number of teeth and oral health variables

BACKGROUND

Oral condition and number of teeth were investigated by questionnaire in the Japan Multi-Institutional Collaborative Cohort (J-MICC Study). The aim of the present study was to assess the validity of the tooth number measure by comparing the self-reported number of teeth with the number of teeth determined at clinical dental examination.

METHODS

A self-administered questionnaire and dental examination were performed by 1275 participants of a company medical examination who requested dental check-up and 377 subjects of the J-MICC study. The validity of the tooth number measure was assessed by comparing the self-reported number of teeth with that determined at clinical examination. Spearman's rank correlation coefficient was calculated to quantitatively evaluate the validity.

RESULTS

In males, the mean clinically-examined and self-reported numbers of teeth were 26.5 and 24.8 teeth, respectively. In females, the mean clinically-examined and self-reported numbers of teeth were 26.4 and 25.5 teeth, respectively. There was a tendency toward underestimation of the number of natural teeth by self-reporting. A significant correlation was observed between the clinically-examined and self-reported numbers of teeth in total (ρ = 0.69) and both males (ρ = 0.70) and females (ρ = 0.67).

CONCLUSIONS

The self-reported oral health variables were valid and reflected clinical status. Further revision of the question on the remaining tooth in the questionnaire improves the validity of self-reported number of teeth.

Long-term healthy lifestyle patterns and tooth loss studied in a Swedish cohort of middle-aged and older people

The promotion of a healthy lifestyle has become an issue of public health importance in the context of ageing populations and increasing prevalence of chronic diseases.

OBJECTIVE

(i) To estimate changes in use of fluoridated tooth paste, use of tooth picks, smoking and alcohol consumption and (ii) to examine whether experience with incident or prevalent tooth loss predict healthy lifestyle transitions from age 50 to 70.

METHOD

In 1992, 6346 individuals born in 1942 agreed to participate in a prospective cohort study and 3585 completed follow-up questionnaires in 1997, 2002, 2007 and 2012. Statistical analyses were conducted by chi-square statistics, Cochran's Q and logistic regression.

RESULTS

In total, 15.7% and 74.0% reported incident (tooth loss only in 2012) and prevalent tooth loss (tooth loss in 1992 and 2012). Significant differences occurred between the 1992 and 2012 prevalence of using toothpicks (from 48.3% to 69.1%), smoking (from 26.9% to 10.1%) and alcohol consumption (from 41.5% to 50.5%), 29% and 15.6% increased use of toothpicks and alcohol consumption, whereas 15.5% stopped daily smoking. Increased use of fluoridated tooth paste, smoking cessation and failure to increase use of toothpicks was associated with prevalent tooth loss between age 50 and 70.

CONCLUSION

This study revealed positive and negative trends in oral health behaviours over a 20-year period in persons aged 50 at baseline. Mixed support was obtained for the assumption that oral health promoting lifestyle transitions follow experience with tooth loss. Older people with tooth loss experience could benefit from targeted counselling aimed at coping with oral diseases.

Orofacial pain and symptoms of temporomandibular disorders in Finnish and Thai populations

OBJECTIVE

Cultural or ethnic factors may play an important role in subjects' pain reports. The aim of the study was to compare the prevalence of orofacial pain symptoms between Finnish and Thai populations.

MATERIALS AND METHODS

The Finnish study population comprised the Northern Finland Birth Cohort 1966, of which 5696 subjects participated in the present study. The Thai sample consisted of 1501 randomly selected people living in 10 different districts in Bangkok. Data on orofacial pain was collected based on questionnaires.

RESULTS

After adjusting for age, gender and education, the logistic regression analysis showed that Thai subjects had an increased risk for reporting oral pain (OR = 4.5, 95% CI = 3.7-5.4), tooth pain (OR = 2.0, 95% CI = 1.8-2.4) and pain in the face (OR = 1.5, 95% CI = 1.2-1.7).

CONCLUSIONS

It can be concluded that Thai people report more orofacial pain symptoms than Finnish subjects. Cross-cultural factors exist in the background of reporting pain symptoms in the oral and facial area.

Thirty years of evolution of oral health behaviors in the working-age Poles

INTRODUCTION

In an average Polish person aged 35-44, more than 16 teeth have or had been affected by dental caries. Of that number, almost half of the teeth have already been extracted. Oral health behaviours contribute to this civilization disease in 50%. Such poor oral health status limits the ability of the affected people to take many social and professional roles.

OBJECTIVES

To evaluate current oral health behaviours and their trends among 35-44 year old Polish people during the period of recent 30 years.

MATERIAL AND METHODS

The data were obtained from the International Collaborative Studies conducted in 1978 and 1988 at the Nofer Institute of Occupational Medicine, Łódź, Poland, under the auspices of the World Health Organization (WHO) as well as from 3 stages of the study on Nationwide Monitoring of Oral Health Status and Its Conditioning performed in 1998, 2002 and 2010. The researchers evaluated oral health behaviours and oral health condition of 5425 subjects.

RESULTS

Despite a noticeable improvement, poor oral health behaviours are observed in 30%-40% of the adults. In the analysed period, the number of people brushing their teeth at least twice a day increased by more than 10% and the number of people using dental floss increased by 38%. Only 60% of the adults visited a dentist at least once a year. Reduced accessibility of state-run, free-of-charge dental care has caused that over 58% of Poles paid for their dental services. Every 3rd person of working age has not visited a dentist for longer than 2.5 half years, primarily due to behavioural and financial reasons. Oral health behaviours of Polish people are among the poorest in Europe.

CONCLUSIONS

Despite a noticeable improvement of the behaviours, gap between the Poles and citizens of other highly developed countries is around 20 years. A health promotion programme including oral health issues, if implemented in workplaces, might considerably reduce this gap.

Saliva composition in three selected groups with normal stimulated salivary flow rates, but yet major differences in caries experience and dental erosion

OBJECTIVE

It was hypothesized that, by comparing matched subjects with major differences in these dental diseases, but yet normal saliva flow rates, it would be possible to obtain data on the effect of saliva composition on dental disease isolated from the effect of the flow rate. Thus, the aim of the study was to compare the major physicochemical characteristics of stimulated whole saliva in three groups of 85 subjects, each with normal saliva flow rates and at least 24 remaining teeth.

MATERIALS AND METHODS

A group with very little dental disease (healthy), a group with dental erosion (erosion) and a group with very high caries experience (caries) were chosen. Furthermore, the aim was to determine whether differences among groups could also be found on an individual level.

RESULTS

Although it was not possible to retrieve three groups whose members were completely identical, the present study points in the direction that, on a group level, subjects with very little dental disease seemed to have a more favorable physicochemical saliva composition with respect to higher calcium, phosphate, bicarbonate, pH, degree of saturation with respect to hydroxyapatite and a lower critical pH (p < 0.05 or less). However, on an individual level the explanatory power for the saliva composition was only 10% for caries experience and only 11% for dental erosion (p < 0.001).

CONCLUSION

The compositional analyses performed in this study on stimulated whole saliva, including major physicochemical characteristics of saliva, will most likely have little predictive value for future dental caries and erosion in single individuals.

The global burden of periodontal disease: towards integration with chronic disease prevention and control

Chronic diseases are accelerating globally, advancing across all regions and pervading all socioeconomic classes. Unhealthy diet and poor nutrition, physical inactivity, tobacco use, excessive use of alcohol and psychosocial stress are the most important risk factors. Periodontal disease is a component of the global burden of chronic disease, and chronic disease and periodontal disease have the same essential risk factors. In addition, severe periodontal disease is related to poor oral hygiene and to poor general health (e.g. the presence of diabetes mellitus and other systemic diseases). The present report highlights the global burden of periodontal disease: the ultimate burden of periodontal disease (tooth loss), as well as signs of periodontal disease, are described from World Health Organization (WHO) epidemiological data. High prevalence rates of complete tooth loss are found in upper middle-income countries, whereas the tooth-loss rates, at the time of writing, are modest for low-income countries. In high-income countries somewhat lower rates for edentulism are found when compared with upper middle-income countries. Around the world, social inequality in tooth loss is profound within countries. The Community Periodontal Index was introduced by the WHO in 1987 for countries to produce periodontal health profiles and to assist countries in the planning and evaluation of intervention programs. Globally, gingival bleeding is the most prevalent sign of disease, whereas the presence of deep periodontal pockets (≥6 mm) varies from 10% to 15% in adult populations. Intercountry and intracountry variations are found in the prevalence of periodontal disease, and these variations relate to socio-environmental conditions, behavioral risk factors, general health status of people (e.g. diabetes and HIV status) and oral health systems. National public health initiatives for the control and prevention of periodontal disease should include oral health promotion and integrated disease-prevention strategies based on common risk-factor approaches. Capacity building of oral health systems must consider the establishment of a financially fair service in periodontal care. Health systems research is needed for the evaluation of population-oriented oral health programs.

Demographic, socioeconomic, and behavioral factors affecting patterns of tooth decay in the permanent dentition: principal components and factor analyses

OBJECTIVES

Dental caries of the permanent dentition is a multifactorial disease resulting from the complex interplay of endogenous and environmental risk factors. The disease is not easily quantitated due to the innumerable possible combinations of carious lesions across individual tooth surfaces of the permanent dentition. Global measures of decay, such as the DMFS index (which was developed for surveillance applications), may not be optimal for studying the epidemiology of dental caries because they ignore the distinct patterns of decay across the dentition. We hypothesize that specific risk factors may manifest their effects on specific tooth surfaces leading to patterns of decay that can be identified and studied. In this study, we utilized two statistical methods of extracting patterns of decay from surface-level caries data to create novel phenotypes with which to study the risk factors affecting dental caries.

METHODS

Intra-oral dental examinations were performed on 1068 participants aged 18-75 years to assess dental caries. The 128 tooth surfaces of the permanent dentition were scored as carious or not and used as input for principal components analysis (PCA) and factor analysis (FA), two methods of identifying underlying patterns without a priori knowledge of the patterns. Demographic (age, sex, birth year, race/ethnicity, and educational attainment), anthropometric (height, body mass index, waist circumference), endogenous (saliva flow), and environmental (tooth brushing frequency, home water source, and home water fluoride) risk factors were tested for association with the caries patterns identified by PCA and FA, as well as DMFS, for comparison. The ten strongest patterns (i.e. those that explain the most variation in the data set) extracted by PCA and FA were considered.

RESULTS

The three strongest patterns identified by PCA reflected (i) global extent of decay (i.e. comparable to DMFS index), (ii) pit and fissure surface caries and (iii) smooth surface caries, respectively. The two strongest patterns identified by FA corresponded to (i) pit and fissure surface caries and (ii) maxillary incisor caries. Age and birth year were significantly associated with several patterns of decay, including global decay/DMFS index. Sex, race, educational attainment, and tooth brushing were each associated with specific patterns of decay, but not with global decay/DMFS index.

CONCLUSIONS

Taken together, these results support the notion that caries experience is separable into patterns attributable to distinct risk factors. This study demonstrates the utility of such novel caries patterns as new outcomes for exploring the complex, multifactorial nature of dental caries.

Is the use of fluoride toothpaste optimal? Knowledge, attitudes and behaviour concerning fluoride toothpaste and toothbrushing in different age groups in Sweden

OBJECTIVES

The most effective method to prevent caries is the regular use of fluoride toothpaste. The aim of this study was to evaluate self-care routines in a population by identifying knowledge, attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits.

METHODS

A questionnaire was sent to 3200 individuals in two municipalities in Sweden. Four age groups representing different life stages were chosen: 15-16, 31-35, 61-65 and 76-80 years of age. The participants were selected from the population register by random selection of birth dates.

RESULTS

Totally 2023 (63%) individuals answered the questionnaire. The majority (84-94%) in all age groups brushed their teeth twice a day or more often. Good toothpaste behaviour identified as brushing at least twice a day, using at least 1 cm toothpaste, brushing 2 minutes or longer and using a small amount of water when rinsing was reported by only 10% of the respondents. The factors that increased the odds for having good caries-preventive behaviour were: (i) being female, (ii) being younger than 35 years, (iii) having knowledge about fluoride, (iv) finding use of fluoride toothpaste important and (v) rating own oral health as good.

CONCLUSIONS

The population seems to have embraced regular toothbrushing with fluoride toothpaste to a large extent. However, regarding techniques for using fluoride toothpaste effectively, there was great potential for improvement, especially among the older respondents.