Oral health status and oral health behaviour of middle-aged and elderly people in PR China

The Efficacy and Safety of a Herbal Toothpaste in Reducing Gingivitis: A Double-Blind, Randomized, Placebo-Controlled, Parallel Allocation Clinical Trial

AIM

To examine the efficacy and safety of the toothpaste containing Rhizoma Chuanxiong and Rhizoma Imperatae extracts in reducing gingivitis.

METHOD

A double-blind clinical trial was conducted, in which 120 volunteers were randomly assigned to the test group (N = 60) or the control group (N = 60). Tetramethylpyrazine, senkyunolide A, ferulic acid, and ligustilide are the main effective components of Rhizoma Chuanxiong and Rhizoma Imperatae contains the main components of cylindrin, carotene, 5-hydroxytryptamine, potassium, and calcium. The control group used placebo toothpaste containing neither Rhizoma Chuanxiong extract nor Rhizoma Imperatae extract. Plaque, gingivitis, and bleeding were assessed at the baseline, prior to the supragingival scaling, and at 4, 8, and 12 weeks.

RESULTS

During the trial, both test and control groups showed a decreasing trend compared to the baseline. At the end of 12 weeks, with respect to Gingival Index (GI), Bleeding Index (BI), and Bleeding on Probing percentage (BOP%) scores, there were significant differences between test and control groups (GI, P<0.001, BI, P<0.001, and BOP%, P<0.001, resp.). After 4 weeks of usage, there were no statistically significant differences in all of GI, BI, and BOP% scores between the two groups. However, the decrease became statistically significant at next two intervals (GI, P<0.001, BI, P<0.001, and BOP%, P<0.001, resp.) in the efficiency of GI, BI, and BOP% which was 8.04%, 11.02%, and 37.16%, respectively. There were no treatment-related adverse events reported.

CONCLUSION

The toothpaste containing Rhizoma Chuanxiong and Rhizoma Imperatae extracts was well tolerated and significantly reduced gingivitis and bleeding after usage for 12 weeks. There was better improvement at molars, and the more serious the baseline status was, the better the efficacy was.

Using NHANES oral health examination protocols as part of an esophageal cancer screening study conducted in a high-risk region of China

BACKGROUND

The oral health status of rural residents in the People's Republic of China has not been extensively studied and the relationship between poor oral health and esophageal cancer (EC) is unclear. We aim to report the oral health status of adults participating in an EC screening study conducted in a rural high-risk EC area of China and to explore the relationship between oral health and esophageal dysplasia.

METHODS

National Health and Nutrition Examination Survey (NHANES) oral health examination procedures and the Modified Gingival Index (MGI) were used in a clinical study designed to examine risk factors for esophageal cancer and to test a new esophageal cytology sampling device. This study was conducted in three rural villages in China with high rates of EC in 2002 and was a collaborative effort involving investigators from the National Institutes of Health and the Cancer Institute of the Chinese Academy of Medical Sciences.

RESULTS

Nearly 17% of the study participants aged 40-67 years old were edentulous. Overall, the mean number of adjusted missing teeth (including third molars and retained dental roots) was 13.8 and 35% had 7 contacts or less. Women were more likely to experience greater tooth loss than men. The average age at the time of first tooth loss for those with no posterior functional contacts was approximately 41 years for men and 36 years for women. The mean DMFT (decayed, missing, and filled teeth) score for the study population was 8.5. Older persons, females, and individuals having lower educational attainment had higher DMFT scores. The prevalence of periodontal disease (defined as at least one site with 3 mm of attachment loss and 4 mm of pocket depth) was 44.7%, and 36.7% of the study participants had at least one site with 6 mm or more of attachment loss. Results from a parsimonious multivariate model indicate that participants with poor oral health wemore likely to have esophageal dysplasia (OR = 1.59; 95% CI 1.06, 2.39).

CONCLUSION

This report describes the first use of NHANES oral health protocols employed in a clinical study conducted outside of the United States. The extent and severity of poor oral health in this Chinese study group may be an important health problem and contributing factor to the prevalence of EC.

Changing use and knowledge of fluoride toothpaste by schoolchildren, parents and schoolteachers in Beijing, China

OBJECTIVE

To assess the oral hygiene practices, current use of and knowledge about fluoride toothpaste among schoolchildren, parents, and schoolteachers; to describe the attitudes of parents and schoolteachers in relation to improving schoolchildren's oral health.

DESIGN

Cross-sectional study.

PARTICIPANTS

1,557 schoolchildren, 1,132 parents, and 352 schoolteachers were recruited by multistage stratified sampling procedure in a district of Beijing, China.

METHODS

Self-completed questionnaire.

RESULTS

The percentage of schoolchildren, parents, and schoolteachers who actually used fluoride toothpaste was 88%, 86%, and 87%, respectively, and 74-78% of the respondent groups brushed their teeth twice a day or more. 64% of schoolchildren, 73% of parents, and 74% of schoolteachers confirmed the caries preventive effect of fluoride toothpaste. Toothpaste recommended by oral health professional organisations was preferred by respondents - particularly by schoolchildren - when purchasing toothpaste (86%). 93% of parents and 56% of schoolteachers recognised their important role in promoting children's oral health; however, their lack of knowledge seemed to be a major obstacle in fulfilling this role.

CONCLUSIONS

The use of fluoride toothpaste in Beijing appears to have increased during the past decade. In addition to mass communication comprehensive school-based oral health programmes are needed to continuously promote the use of fluoride toothpaste among schoolchildren.

Illness-related behaviour and utilization of oral health services among adult city-dwellers in Burkina Faso: evidence from a household survey

BACKGROUND

In sub-Saharan Africa, the availability and accessibility of oral health services are seriously constrained and the provision of essential oral care is limited. Reports from the region show a very low utilization of oral health care services, and visits to dental-care facilities are mostly undertaken for symptomatic reasons. The objectives of the present study were to describe the prevalence of oral symptoms among adults in Ouagadougou, capital city of Burkina Faso and the use of oral health services and self-medication in response to these symptoms and to measure the associations between predisposing, enabling and needs factors and decisions to seek oral health care.

METHODS

The conceptual design of the study was derived from both the Andersen-Newman model of health care utilization and the conceptual framework of the WHO International Collaborative Study of Oral Health Outcomes. Data were obtained by two-stage stratified sampling through four areas representative of different stages of urbanization of Ouagadougou. The final study population comprised 3030 adults aged 15 years or over and the response rate was 65%.

RESULTS

Overall, 28% of the respondents had experienced an oral health problem during the past 12 months; a high proportion (62%) reported pain or acute discomfort affecting daily life. In response to symptoms, only 28% used oral health facilities, 48% used self-medication and 24% sought no treatment at all. Multivariate analyses revealed that several socio-economic and socio-cultural factors such as religious affiliation, material living conditions and participation in a social network were significantly associated with the use of oral health care services by adults who had experienced oral health problems during the previous year.

CONCLUSION

The proportion of people who have obtained oral health care is alarmingly low in Ouagadougou and self-medication appears to be an important alternative source of care for adult city-dwellers. Decision-makers in sub-Saharan countries must seek to ensure that access to essential oral health care is improved.

Oral health knowledge, attitudes and behaviour of adults in China

OBJECTIVES

To describe oral health behaviour, illness behaviour, oral health knowledge and attitudes among 35-44 and 65-74-year-old Chinese; to analyse the oral health behaviour profile of the two age groups in relation to province and urbanisation, and to assess the relative effect of socio-behavioural risk factors on dental caries experience.

METHODS

A total number of 4,398 35-44-year-olds and 4,399 65-74-year-olds were selected by multistage stratified cluster random sampling which involved 11 provinces in China. Data were collected by self-administered structured questionnaires and clinical examinations (WHO criteria).

RESULTS

32% of the 35-44-year-olds and 23% of the 65-74-year-olds brushed at least twice a day but only 5% used fluoridated toothpaste; 30% and 17% respectively performed 'Love-Teeth-Day' recommended methods of tooth brushing. A dental visit within the previous 12 months was reported by 25% of all participants and 6% had a dental check-up during the past two years. Nearly 15% of the subjects would visit a dentist if they experienced bleeding from gums; about 60% of the subjects paid no attention to signs of caries if there was no pain. Two thirds of the urban residents and one fifth of the rural participants had economic support for their dental treatment from a third party, either totally or partially. Significant variations in oral health practices were found according to urbanisation and province. At age 35-44 years 43% of participants had daily consumption of sweets against 28% at age 65-74 years. Dental caries experience was affected by urbanisation, gender, frequency, time spent on and method of tooth brushing. Knowledge of causes and prevention of dental diseases was low with somewhat negative attitudes to prevention observed.

CONCLUSION

Systematic community-based oral health promotion should be strengthened and preventive-oriented oral health care systems are needed, including promotion of further self-care practices and the use of fluoridated toothpaste.

Comparison of utilization of dental care services among Chinese- and Russian-speaking immigrant elders

OBJECTIVE

The purpose of the study was to identify factors predictive of use of dental services among Chinese- and Russian-speaking immigrant elders.

METHODS

The data for this analysis were collected from the 1997 survey "Assessing public health and health care needs of Russian-speaking elderly immigrants." A similar survey was replicated among Chinese-speaking elderly immigrants in 2000. Community-based samples of 300 Russian elders and 177 Chinese elders were recruited for the study.

RESULTS

Chinese elders used dental care services at lower rates than Russian elders. Education, length of stay in the U.S., social support, and smoking behavior were significant predictors for the use of dental services among Chinese. However, among Russian elders, age, income, and denture use predicted utilization of dental services.

CONCLUSIONS

Although Chinese- and Russian-speaking elders have similar immigrant experiences and share the same geographic location and urban setting, the two groups have different patterns of dental service use. These differences may be due to differences in socio-demographic characteristics, values, attitudes and knowledge of oral health and dental care, and unique cultural backgrounds.

The second national survey of oral health status of children and adults in China

OBJECTIVES

To describe the oral health status of Chinese children and adults at national level in relation to location and province and to highlight changes in dental caries experience.

DESIGN

Cross-sectional study, oral epidemiological survey based on WHO methodology, clinical examinations.

SETTING

National survey by National Committee for Oral Health.

SUBJECTS

Representative samples of provinces, districts, townships; cluster sampling including subjects aged 5,12,15,18, 35-44 and 65-74. Each age group consisted of 23,452 participants, i.e. total of 140,712 individuals.

RESULTS

At age 5, 76.6% were affected by dental caries and mean dmft was 4.5. Mean DMFT varied from 1.0 in 12-year-olds, 1.4 in 15-year-olds, 1.6 in 18-year-olds, 2.1 in 35-44-year-olds to 12.4 in 65-74-year-olds. In adults, caries experience was higher in females than in males. The effect of urbanisation on caries prevalence in children varied by province and age. Among adolescents and young adults caries levels were high in urban areas while caries experience was high for old-age people of rural areas. At national level, changes in dental caries prevalence of 12- and 15-year-olds were small. However, some provinces with extensive oral health programmes (e.g. Love Teeth Day) showed declining caries experience whereas provinces with limited preventive activities had increasing levels of caries. For all age groups, gingival bleeding and calculus were most frequent. Severe periodontal conditions were relatively rare.

CONCLUSION

The systematic implementation of preventive oral care and community-oriented health programmes are needed for the continuous promotion of oral health in China.

Utilization of dental services in Southern China

A population's utilization of dental services is an important parameter in oral health care planning, which has rarely been studied in China. The objectives of this report were to describe the dental service utilization pattern of middle-aged and elderly Chinese and to analyze the influence of selected variables on the use of dental services. A Guangdong Province population of 1,573 35- to 44-year-olds and 1,515 65- to 74-year-olds recruited from urban and rural communities was interviewed in their local dialect. It was found that 23% of the middle-aged and 24% of the elderly subjects had visited a dentist within the preceding year. The two most commonly cited reasons for not having seen a dentist for at least 3 years were: no perceived need, and no serious dental problems. Among subjects who had visited a dentist within 3 years, the 3 most commonly received treatments were: fillings, extractions, and dental prostheses. Furthermore, a logistic regression analysis showed that women, subjects who lived in urban areas, were better educated, were wealthier, and had better oral health knowledge were more likely to be a recent dental service user. In conclusion, dental service utilization among the adult Southern Chinese was found to be low, problem-driven, and influenced by some socio-economic factors.

An Oral Health Survey in Southern China, 1997: background and methodology

Relatively limited information is available about the oral health in the Guangdong Province of Southern China, the closest neighbor to Hong Kong. The study intended to explore the oral health status, knowledge, attitudes, and dental care utilization in the Guangdong population as a basis for formulating strategies for oral health prevention and treatment. Through multi-stage stratified and quota-sampling, individuals from urban as well as rural communities were selected (5- to 6-; 12-; 35- to 44-; and 65- to 74-year-olds; total N = 6251). Structured interviews and clinical examinations were performed. Inter-examiner reliability was high (kappa = 0.60-0.96). Samples of community water were taken for fluoride assessment. Overall, the sample surveyed was acceptably representative of the population, with some under-representation of rural residents and agricultural workers. Re-weighting was performed in appropriate analyses. The data analysis model used in the Second International Collaborative Study was used as a guide for the present data analysis. This approach has not previously been used on a Mainland Chinese population.

Oral health knowledge, attitudes, and practices of Chinese adults

Only recently have behavioral aspects been taken into consideration in oral health studies in China; thus, relevant information on perceptions in adult Chinese about oral health care is inadequate. In 1996-97, a large-scale oral epidemiological study was conducted in Southern China. Among its objectives were to describe the oral health knowledge, attitudes, and practices of the urban and rural adults living in Southern China and to analyze the influence of selected demographic and socio-economic factors. From 8 urban and 8 rural communities in Guangdong Province, 1,573 35- to 44-year-olds and 1,515 65- to 74-year-olds were sampled. Specially trained interviewers from the staff of local government or hospitals conducted face-to-face structured interviews. Almost all of the middle-aged and more than 90% of the dentate elderly surveyed claimed that they brushed their teeth every day and used toothpaste during toothbrushing, but awareness about fluoride content was lacking. The respondents had poor oral health knowledge but positive attitudes toward oral health, providing a basis for more community-based oral health education programs, especially targeting adults who are less-well-educated and have fewer socio-economic advantages.

Coronal and root caries in Southern Chinese adults

Southern China is the most prosperous part of China, but information useful for oral care planning is very limited. A large-scale epidemiological survey was conducted in 1996-97. The objectives of this report were to describe the coronal and root caries of the adult Southern Chinese and to analyze the influence of selected demographic and socio-economic factors on the disease pattern. A total sample of 1,573 35- to 44-year-olds and 1,515 65- to 74-year-olds from 8 urban and 8 rural survey sites in Guangdong Province participated in an oral health interview and underwent clinical examination. World Health Organization examination procedures and diagnostic criteria were used. The weighted mean DMFT scores of the middle-aged and the elderly subjects were 4.8 and 16.1, respectively. People living in rural areas had a higher DMFT score than those living in urban areas (4.9 vs. 4.3 in the 35- to 44-year-olds and 16.5 vs. 14.7 in the 65- to 74-year-olds). In both age groups, MT was the major component of the DMFT score. Analysis of covariance showed that women and those who were economically less well off had higher DMFT scores in both age groups. The weighted prevalence rates of decayed/filled roots were 12% and 37%, with a mean of 0.2 and 0.7 teeth affected, in the middle-aged and the elderly, respectively. In conclusion, socio-economic factors had a considerable effect on the dental caries status of adults in Southern China.

Periodontal conditions in adult Southern Chinese

Periodontal diseases remain a concern in adult populations, but there have been no systematic descriptions of periodontal conditions, which have included periodontal attachment loss, among Southern Chinese. The main aim of this report is to describe the periodontal conditions in adult Chinese and to investigate factors that may have influenced periodontal attachment loss. Subjects were recruited from urban and rural survey sites throughout Guangdong. In total, 1,572 35- to 44-year-old subjects and 1,286 65- to 74-year-old subjects completed a structured interview and underwent a periodontal examination, which included the Community Periodontal Index (CPI) and periodontal Attachment Loss (ALoss) recordings. Calculus was found as the highest CPI score in 61-68% of the 35- to 44-year-old subjects and in 54-57% of the 65- to 74-year-olds. Shallow pockets were found as the highest CPI score in about one-third of both the urban and the rural subjects in both age groups, and deep pockets in 3-7% of the subjects. ALoss was more prevalent than pockets in both age groups. On the basis of the ALoss recordings, about one-third of the subjects in both age groups were categorized as exhibiting considerable ALoss for their age. In both age groups, logistic regression analysis indicated that being male, wearing partial dentures, and reporting less frequent toothbrushing were found to be associated with considerable ALoss.

Tooth loss, occluding pairs, and prosthetic status of Chinese adults

The objectives of this analysis were to describe the numbers of teeth lost and those indicated for extraction, dental prosthetic status, and occluding tooth pairs among adults in Southern China and to investigate factors affecting tooth mortality. A sample consisting of 1,573 35- to 44-year-old and 1,515 65- to 74-year-old urban and rural Chinese was examined clinically by calibrated examiners. Teeth not present for any reason were defined as missing (MT). The sum of MT and teeth indicated for extraction (IMT) was defined as adjusted missing teeth (AMT). Only 4.4% of the urban and 3.4% of the rural 65- to 74-year-olds were edentulous. MT were not significantly different between urban and rural residents, but more IMT were found in rural residents. Women, those who had a lower education level, and those who were less wealthy had more AMT in both age groups. Smoking was found to be associated with AMT in the 35- to 44-year-olds. Eighteen percent of the urban and 27% of the rural elderly had no occluding tooth pairs after IMT were accounted for, and only 38% and 30%, respectively, had 10 or more occluding pairs. Fifty-one percent of the urban and 43% of the rural elderly were found to have some form of dental prostheses in either jaw. A partial denture was more common in urban residents in both age groups.