Periodontal and dental conditions of a school population in a volcanic region of Tanzania with highly fluoridated community drinking water

Introduction

Dental fluorosis is endemic in the Rift Valley in Africa, especially around volcanic areas, due to the high fluoride content in daily drinking water.

Objective

This study evaluates the oral health status and types of occlusion in a school population, and to assess the possible association between dental fluorosis and other pathologies such as decay, gingivitis and periodontitis.

Material and methods

An observational study of 581 individuals recruited from a public secondary school in Arusha, Northern Tanzania was undertaken. The indices used were: the Silness & Löe Plaque Index, the Community Periodontal Index and the Decayed/Missing/Filled index. Descriptive statistical analyses were performed and a chi-square test was used to assess the associations between independent variables.

Results

Almost all the school children evaluated (96.73%) presented Angle class I dental occlusion, and 75.22% presented some degree of dental fluorosis. Most of the population (511, 87.95%) showed bleeding on probing. A moderate/high degree of some dental pathology (DMF score) was recorded in 14.46%. The association between dental fluorosis, gingival bleeding and tooth decay indicated a higher concentration of pathology in groups with more severe fluorosis (p<0.05).

Conclusion

In this large population sample, both tooth decay and gingivitis were significantly associated with moderate or severe dental fluorosis.

Knowledge and Awareness of Oral Manifestations of Diabetes Mellitus and Oral Health Assessment among Diabetes Mellitus Patients- A Cross Sectional Study

BACKGROUND AND OBJECTIVES

Diabetes mellitus has increased rapidly throughout the world. The objectives of our study were to assess the knowledge and awareness about oral manifestations of diabetes, among type 2 diabetes mellitus patients, their risk for developing oral diseases due to complications associated with diabetes mellitus, and at same time, to perform an oral examination to detect these oral symptoms, if present any, along with the recording of Decayed Missing Filled Teeth Index (DMFT) and Community Periodontal Index (CPI) index.

METHODOLOGY

Structured questionnaires consisting of 12 different statements on the knowledge base of oral manifestations of diabetes mellitus were distributed to 447 Type 2 diabetes mellitus patients. Following this oral examination, brushing and dental visit history were noted, and CPI index and DMFT indices were recorded in all the patients.

RESULTS

Results showed that the knowledge about oral manifestations of diabetes mellitus was poor with a mean value of 4.92 out of a possible score of 12. Among the study subjects, the average score of men was 4.42 while that of females, was 5.41. These scores, when subjected to statistical analysis, were highly significant. (P value- 0.005) Subjects also showed significantly high DMFT (P value <0.001) and CPI scores (P value- 0.270).

CONCLUSION

Our study concluded that there is a significant lack of knowledge about oral manifestations of diabetes mellitus among patients and hence steps have to be taken to increase their awareness through various outreach programs. All health professionals need to work together for promoting better oral health so that oral complications of diabetes can be brought under control.

Development and validation of two questionnaires: Dental home care and dental health in Swedish dogs

BACKGROUND

Dental disease is one of the most common health problems in dogs. However, no studies have investigated the attitudes, opinions and practices of dog owners, veterinarians and veterinary nurses regarding dental health and preventative dental home care in dogs. The objective of this study was therefore to develop and validate questionnaires for this purpose, in accordance with survey methodology guidelines.

METHODS

Questionnaire items were determined based on the authors' academic knowledge and clinical experience, and modified throughout the validation process. Several measures were taken to reduce sampling, coverage, measurement and non-response errors. Content validity was assessed by Subject-Matter Experts (SME) and cognitive interviews were conducted in accordance with the "think-aloud protocol". Non-response analysis was performed using several methods.

RESULTS

Constructs were identified using exploratory factor analysis and two predefined constructs from the dog owner questionnaire were confirmed "Dog owners' attitudes towards brushing their dog's teeth" (Cronbach's α = 0.86) and "Dog owners' assessment of their dog's dental health" (α = 0.76). Additionally, exploratory factor analysis identified three potential constructs. In the veterinary health practitioner questionnaire, two constructs were identified: "Veterinary health practitioners' attitudes towards dental chews and dental feed" (α = 0.78) and "Veterinary health practitioners' attitudes and opinions on dental problems and dental cleaning" (α = 0.73). Non-response analysis showed a higher proportion of women in the sample of dog owners and veterinarians compared to the target populations. Veterinarians in the sample were also younger. In contrast, gender and age distributions in veterinary nurses did not differ between sample and target.

CONCLUSION

The validation presented in this work showed that the developed questionnaires could be used as accurate and reliable tools for measuring attitudes and practices regarding dental home care in dogs among Swedish dog owners, veterinarians and veterinary nurses.

Effect of prophylactic actions on the state of oral health and hygienic habits in a selected age group

INTRODUCTION AND OBJECTIVE

The aim of the study was investigation of the effect of simple prophylactic methods on the motivation for concern about oral hygiene among 13-15-year-olds.

MATERIAL AND METHODS

The study covered 98 children from 4 groups attending junior high school. Adolescents from 3 groups were randomly qualified for conducting prophylactic procedures, while the fourth group constituted the control group. Three examinations were performed: preliminary and check-up examinations after 4 and 12 months. The state of the teeth and periodontium and the frequency of brushing of teeth were evaluated.

RESULTS

After 4 months, an increase in the number of decayed teeth was observed in all groups; in the control group it was significantly higher compared to the groups subjected to prophylactic actions. After 4 months in the groups covered by prophylactic actions, a significant decrease was obtained in the number of adolescents with CPITN > 0. In the examinations performed after 12 months, no significant differences were found in the value of the DMF and the CPITN index in the examined groups. In both examinations, after 4 and 12 months, the declared frequency of brushing teeth increased, especially in the group which had been provided individual instructions concerning oral hygiene.

CONCLUSIONS

1) Implementation of prophylactic methods resulted in an improvement in the state of oral health among junior high school adolescents. 2) Prophylactic actions should be regularly repeated. 3) The provision of individual instruction with supervised individual teaching of brushing teeth resulted in an improvement in the motivation for concern about oral hygiene.

A survey to assess knowledge, practice, and attitude of dentists in the Western region of Saudi Arabia

Objectives:

To assess knowledge regarding the management of odontogenic infections by dentists in Jeddah, Kingdom of Saudi Arabia.

Methods:

In this cross-sectional study, 150 practitioners responded to a 26-item paper-based questionnaire between August and December 2014. The questionnaire evaluated knowledge and current clinical practices in managing odontogenic infections, as well as the attitude towards antibiotic use and resistance in the community. Basic medical knowledge (BMK) and critical knowledge (CK) scores were calculated from the dentists’ response to these questions and were compared according to educational level (bachelor and postgraduate degree holders).

Results:

The mean BMK score was 1.98 ± 0.4 and CK score was 1.89 ± 0.3. Dentists with bachelor’s degrees had higher BMK scores than those with a postgraduate degree (p=0.005), but CK was not significantly different (p=0.400). Most dentists (77%) would prescribe antibiotics after a routine dental extraction, and would undertake definitive surgical treatment (49.2%) only after a localized space infection developed. Although 82.2% agreed that routine prescription of antibiotics increases bacterial resistance in the community, 71% believe that prescribing an antibiotic after routine oral surgical procedures prevents odontogenic infections.

Conclusion:

Dentists in Jeddah require further education through lectures and workshops to stay up to date on current concepts in odontogenic infection management.

The Role of Biobehavioral, Environmental, and Social Forces on Oral Health Disparities in Frail and Functionally Dependent Nursing Home Elders

The purpose of this article is to review the literature on and discuss how interactions between bio-behavioral aging, nursing home environments, and social forces shaping current health care policies have contributed to oral health disparities in frail and functionally dependent elders who reside in nursing homes. Emerging empirical evidence suggests links between poor oral health with dental plaque deposition and systemic disease, such as nursing home-acquired pneumonia. The majority of nursing home residents lack either the functional ability or the mental capacity to perform their own mouth care and therefore must rely on others to perform mouth care for them. Certified nursing assistants (CNAs), who provide the majority of care activities, were unsure how to provide care to residents who engaged in care-resistive behaviors. The nurses who supervise the CNAs have limited knowledge regarding the provision of mouth care in general, and they specifically lack knowledge regarding the provision of mouth care to elders exhibiting care-resistant behavior. Elders in nursing homes have limited options when paying for dental care; Medicare does not generally cover routine dental care. Medicaid coverage varies widely between individual states; even when coverage exists, low Medicaid reimbursements discourage dentists from accepting Medicaid patients. The strategies needed to reduce these oral health disparities are complicated but not unrealistic. Investigators willing to embrace this cause will have no shortage of opportunities to test methods to improve the delivery of oral care as well as to monitor and reassess these methods.

[Non-communicable disease and their significance for dental medicine]

Non-communicable diseases (NCDs), such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes mellitus, are responsible for most deaths worldwide. In view of the rising prevalence and the long-term consequences of NCDs, their prevention is a public health priority. Dentistry plays an important role in this endeavor. Since oral and general diseases share common risk factors (e.g., poor oral hygiene, unhealthy diet, alcohol abuse, tobacco consumption, distress), preventive measures may target both oral diseases (e.g., dental caries, periodontal diseases, oral tumors) and medical NCDs. Consequently, dental medicine assumes an important medical and social role, which has been recognized by the World Health Organization and the General Assembly of the United Nations. To fulfill its mission successfully, consideration of the principles of evidence-based dentistry is a prerequisite. At the same time, the new development provides dentistry with the opportunity to critically reflect on its current and future orientation.

Assessing Treatment Options Based on Expected Long-Term Results: Case Report Demonstrates 6-Year Outcomes

A patient whose chief concern was the esthetics of her anterior teeth presented for a second opinion after it had been recommended that crowns be placed throughout her mouth. Examination revealed numerous defective and some fractured restorations with recurring caries. With treatment goals including creating and maintaining a healthy periodontal environment, leveling the occlusal plane, and decreasing biomechanical risk, the treatment plan incorporated an interdisciplinary approach that utilized orthodontics, a Kois deprogrammer, and implant therapy. Demonstrating 6-year outcomes, this report discusses use of a method to assess treatment options based on expected long-term results.

Preventive Dentistry and Oral Hygiene

The biggest oral health campaign in the United Kingdom is called "National Smile Month" and it starts in May. For this occasion, the occupational medicine team of Kensington Hospital is holding special events highlighting preventive dentistry and oral hygiene.

A competency matrix for global oral health

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.

Dental needs of psychiatric patient with eating disorders

AIM : Aim of this study is to determine the dental care needs of patients with eating disorders and the need of interdisciplinary collaboration of psychiatrists, psychologists and dentists. This gives the opportunity to complete diagnosis and treatment.

METHODS

In this study, 40 daily treated psychiatric patients were examined. Patients with diagnoses of chapters F4.xx, F5x.x, F6x.x ICD-10, were included in the study.During a stomatological consultation detailed clinical examination was conducted, including oral health index - API. Swabs were taken for microbiological examination - bacteriological and mycological. Each patient was assigned for X-ray picture.

RESULTS

Among the patients many had poor oral hygiene, tooth enamel erosion, frequent oral infections both fungal and bacterial were present. All patients required dental treatment. In several cases there were severe symptoms in the form of large enamel erosion, and numerous chronic periapical inflammation requiring rapid intervention.

CONCLUSIONS

Dental needs of patients with eating disorders are enormous and these patients often require immediate dental treatment. Interdisciplinary diagnosis and treatment provides complete picture of the patient's problems and the possibility of full recovery.

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents

BACKGROUND

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents.

METHODS

Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male.

RESULTS

Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care.

CONCLUSIONS

Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed.

Promoting oral health through community engagement

Persistent health disparities still exist in the U.S. despite decades of focus on the importance of prevention. Individual behaviors are the major contributor to oral health. By partnering and linking with community organizations, oral health professionals can expand their reach, overcome the obstacles to delivering effective prevention activities in dental offices and improve the oral health of the most underserved and vulnerable populations, who bear the greatest burden of dental disease.

How do parents look after children's teeth? A qualitative study of attitudes to oral health in the early years

This study aimed to examine how parents and carers of pre-school children care for their children's teeth. Twelve in-depth interviews were conducted with mothers of pre-school children at a children's centre in Bristol. The interviewees were aged between 29 and 37 years, and the number of children in the families ranged from one to four, with their age range spanning four weeks to 11 years. Using a grounded theory approach, transcribed interviews were coded and analysed until several themes emerged from the data. The study identified an overarching theme of parents' belief that oral health care for their children was common sense, which was a key factor influencing advice seeking from professionals. Sub-themes were the difficulties in establishing home oral healthcare routines and a lack of knowledge of when to register their child with a dentist. Advice was often given inconsistently and parents experienced difficulties accessing services, with many not seeking advice and information pro-actively. The study concluded that some parents are missing out on important early information, advice and care around oral health for their young children.

Prevention of dental disease versus surgical treatment

The members of the Minnesota legislature have debated methods by which access to dental care and treatment of dental disease can be improved at a cost lower than that of present delivery systems. This review sheds light on some significant aspects of what the dental profession has learned over the last century that has proven significantly beneficial to the overall health of the American populace. Recommendations are made in the use of cost-effective dental public health interventions that could be used to provide better access and improved dental health at lower cost.

Oral health-related risk behaviours and attitudes among Croatian adolescents--multiple logistic regression analysis

The aim of this study was to explore the patterns of oral health-related risk behaviours in relation to dental status, attitudes, motivation and knowledge among Croatian adolescents. The assessment was conducted in the sample of 750 male subjects - military recruits aged 18-28 in Croatia using the questionnaire and clinical examination. Mean number of decayed, missing and filled teeth (DMFT) and Significant Caries Index (SIC) were calculated. Multiple logistic regression models were crated for analysis. Although models of risk behaviours were statistically significant their explanatory values were quite low. Five of them--rarely toothbrushing, not using hygiene auxiliaries, rarely visiting dentist, toothache as a primary reason to visit dentist, and demand for tooth extraction due to toothache--had the highest explanatory values ranging from 21-29% and correctly classified 73-89% of subjects. Toothache as a primary reason to visit dentist, extraction as preferable therapy when toothache occurs, not having brushing education in school and frequent gingival bleeding were significantly related to population with high caries experience (DMFT > or = 14 according to SiC) producing Odds ratios of 1.6 (95% CI 1.07-2.46), 2.1 (95% CI 1.29-3.25), 1.8 (95% CI 1.21-2.74) and 2.4 (95% CI 1.21-2.74) respectively. DMFT> or = 14 model had low explanatory value of 6.5% and correctly classified 83% of subjects. It can be concluded that oral health-related risk behaviours are interrelated. Poor association was seen between attitudes concerning oral health and oral health-related risk behaviours, indicating insufficient motivation to change lifestyle and habits. Self-reported oral hygiene habits were not strongly related to dental status.

Primary oral health care

The aim of this review was to describe the background and evolution of primary oral health care (POHC), including the development of an oral health policy, by identifying the resources necessary for oral health services, reviewing the evidence of the effectiveness of oral health promotion and education, providing essential oral health care, and establishing evidence of the benefits of regular dental visits for effective POHC. At present, evidence for the effectiveness of oral health education and regular dental visits is very weak. Nevertheless, POHC needs to be developed as an integral part of primary health care (PHC). Therefore, a need exists to increase financial investment, resources and workforce in PHC to lower the prevalence of dental caries and periodontal disease in the Middle-East using the POHC approach.

Probiotics and oral health: an update

Probiotics are micro-organisms, principally bacteria, which, when ingested, confer health benefits beyond basic nutrition. Probiotics have been extensively studied for their health promoting effects. The main feld of research has been focussed on the gastro-intestinal tract. However, in the past few years probiotics have also been investigated from an oral health perspective and their use has shown promising results with respect to control of chronic conditions, such as dental caries, periodontitis, halitosis and candidial infections. Despite the immense potential of probiotics, hardly any randomised, controlled trials have been conducted on their action and application and studies on their effects on oral health are still in early stages. Hence, more research is needed before any evidence-based conclusions can be drawn. This paper considers some recent literature and insights on which further investigations could be based.

The crisis of women and at-risk populations needing dental care in Tennessee: challenges and engagement efforts

Women's health issues are receiving increased attention, including the differences in their dental needs and experiences. Biological and social factors are strong determinants of physical and dental health along the entire life spectrum. Socio-environmental place also contributes significantly to some of the barriers to quality and quantity of health care received, placing population groups who have less access to care at risk. Considerable disparities exist in who receives dental care and what type of dental treatment is received among different segments of the population. Greater illumination of these issues in all discussions related to healthcare of women and at-risk populations continues to be a needed focus of concern. The plight of women and at-risk populations and problems influencing access to care are addressed.

[The 1562 De dentibus by Girolamo Cardano]

"In the year 1562, having noticed that none of the ancient or modern physicians had treated the subject of dental care, I wrote this first book on the teeth". So begins the preface to the five books of the Opuscula medica senilia by Girolamo Cardano, the first organic text on dentistry in history. It competed with the famous Libellus de dentibus by Bartolomeo Eustachio that appeared in 1563 (but was written in 1562). However, our intention is not to establish precedence but bring to reader's attention Cardano's work that complemented Eustachio's anatomy and physiology of the teeth with their pathology and therapy. This article summarises Cardano's biography and gives a brief review of literature on the De dentibus and of his first complete translation from Latin into Italian. De dentibus is the first of the five books of the Opuscula and is divided into three chapters, as described below. Chapter one, De dentibus, recalls briefly the anatomy and embryology of human teeth as bones and compares them with the teeth of some animals. Follows a description of systemic and local procedures, to preserve, protect, and cure the teeth. Preservation and protection are related to diet, sleep, physical activity, systemic and local medicaments, and amulets., whereas therapy involves remedies taken over from the Ancient Greek and Roman medicine (Hippocrates, Archigenes, Galen, Scribonius, Pliny the Younger, Ezio, Marcellus Empiricus ) and Arabic medicine (Avicenna in particular). The chapter continues with guidelines and procedures for shedding teeth that are damaged beyond repair using a special saltpetre and alum distillate of Cardano's own invention, which he finds very effective. The chapter concludes with tooth extraction tools and methods, especially the one by Scribonius Largo with red-hot iron. Chapter two, -De morbis dentium in specie, describes diseases that affect the teeth and that can cause ache, mobility, weakness, numbness, or deformity (dolor, commotio, imbecillitas, stupor, deformitas). All these conditions may interact, creating a wide range of situations. Ache has seven possible causes that include altered humour, a cavity, a nerve injury, an abscess, breath (flatus), worms, and cold, and Cardano describes the remedies at physician's disposal that even include spells. The causes of mobility are the same as for the ache plus periodontal problems such as dry root or alveolar laxity, and the author discusses local and systemic treatment options. Weakness is considered the worst of the dental pathologies, as it can easily require extraction. Stupor is caused by the corruption of the tooth or a nerve injury, and Cardano refers to it as a life-threatening condition (quoad vitam) in older people if untreated, but also easy to remedy if detected early. Cardano then identifies a whole series of deformities: tooth colour, roughness, fracture, position, number, absence, length, calculus, bad smell, and porosity, and for each of them he offers a wide variety of remedies, in part original and in part borrowed from the ancients. In the last part, Cardano stresses the need to extract as few teeth as possible: "I've never seen anyone die from the diseases of the teeth, except for a tooth extracted inappropriately" To emphasize the dichotomy between medicine and surgery, he explains that tooth care is medical, but extraction requires an experienced surgeon. Chapter three, De fluxione, frequentissima causa morborum dentium, identifies gumboil as a frequent cause of dental disease, and describes the pathogenesis and therapy of gumboil-related diseases, gout in particular.

Deletion syndrome 22q13: what the dentist should know to manage children with Phelan-McDermid syndrome effectively

Deletion Syndrome 22q13 (or Phelan-McDermid Syndrome) is a very rare genetic disorder characterized by general neonatal hypotonia, absent to delayed speech, and global developmental delays. With only 600 cases reported worldwide, the disease remains largely under-diagnosed, but diagnosis is on the rise. Current thinking suggests that 22q13 Deletion Syndrome may be one of the principal causes of idiopathic mental retardation. Patients with Phelan-McDermid Syndrome, especially children, can be a challenge for dental professionals, as it is often associated with autism. Dentists see patients with all kinds of special needs, developmental conditions and disabilities. Children with Phelan-McDermid Syndrome need dental care just like every other child. As with other autism-related disorders, children with Phelan-McDermid Syndrome need sameness and continuity in their environment. The dental literature, however, offers very little information to aid the dentist in the management of these children. This article aims to make dentists aware of the disorder and provides tips and recommendations that dentists may find helpful to manage Phelan-McDermid children more effectively.

Strengthening of oral health systems: oral health through primary health care

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care.

[Disorders of the stomatognathic system in patients with short stature]

Growth hormone (GH) is a polypeptide hormone produced by the cells of pituitary. Production of growth hormone is carried out in a pulsating manner, and the frequency and intensity of the pulses is dependent on age and gender. Growth hormone deficiency (GHD) is characterized by, among others, slow growth process often from early childhood, delayed bone age. The aim of the study was to describe dental problems of children with short stature with a special attention on disorders at the craniofacial region such as decreased growth of maxilla and mandible, gnathic and bite dysfunctions, delayed teeth eruption, tooth caries susceptibility. Growth hormone treatment undertaken at the right time significantly influences on correct development of cranial bones and dentition, and supports orthodontic treatment.

Effects of radiotherapy to the jaws. 2: Potential solutions

Dental maintenance and rehabilitation of head and neck cancer care is becoming more important as the outcome of cancer treatment improves. The management of these patients can be very difficult for a number of reasons as discussed in part one of this two-part series. This second part attempts to suggest possible solutions for the management of the major oral health problems encountered by these patients during and after their cancer treatment.

Effects of radiotherapy to the jaws. I: The scale of the problem

Cancer care has become one of the main targets of the National Health Service in England and with cancer patients surviving longer, it is likely that head and neck cancer patients will make up a large proportion of patients seen within secondary care settings in the future. The management of these patients can be very difficult for a number of reasons. Part one of this paper attempts to highlight the major oral health problems encountered by these patients during and after their cancer treatment and supported by the current literature. Part two of this series will address the dental management of head and neck oncology patients undergoing radiotherapy with particular attention of possible improvement to current management strategies for these patients.

Modeling social dimensions of oral health among older adults in urban environments

In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by older adults in urban environments, this article presents a portfolio of systems science models that have been developed on the basis of observations from the ElderSmile preventive screening program operated in northern Manhattan, New York City, by the Columbia University College of Dental Medicine. Using the methodology of system dynamics, models are developed to explore how interpersonal relationships influence older adults' participation in oral health promotion. Feedback mechanisms involving word of mouth about preventive screening opportunities are represented in relation to stocks that change continuously via flows, as well as agents whose states of health care utilization change discretely using stochastic transitions. Agent-based implementations illustrate how social networks and geographic information systems are integrated into dynamic models to reflect heterogeneous and proximity-based patterns of communication and participation in the ElderSmile program. The systems science approach builds shared knowledge among an interdisciplinary research team about the dynamics of access to opportunities for oral health promotion. Using "what if" scenarios to model the effects of program enhancements and policy changes, resources may be effectively leveraged to improve access to preventive and treatment services. Furthermore, since oral health and general health are inextricably linked, the integration of services may improve outcomes and lower costs.

[Updates on rickets and osteomalacia. dental diseases in rickets]

Rickets is characterized by mineralization defect in bone and cartilage. X-linked hypophosphatemic rickets (XLH) is the most common form of inherited rickets. Mineralization defect is observed in dentin as well as in bone and cartilage in XLH. The dominant feature is the occurrence of infectious periradicular abscesses on deciduous and permanent teeth, not associated with trauma or decay. Dental care including the maintenance of good oral hygiene and periodical examinations should be performed. A preventive sealing of occlusal surfaces can be considered. Endodontic treatment or extraction are carried out in the presence of periradicular abscesses. Further studies are necessary for elucidating mechanisms of dentin mineralization defect and the occurrence of periradicular abscesses and for developing preventive and curative measures in XLH.

Oral health education and disease prevention in primary dental care: insight from a pilot intervention targeting children aged 0-7 years in northeast England

This paper outlines a number of issues arising from a primary-care and community-based oral health education (OHE) and disease prevention pilot targeting children aged 0-7 years in County Durham and Darlington during a six month period in 2011-12. The paper highlights the key practical challenges experienced by the NHS dental practices that provided OHE predominantly in community venues and the issues arising for those involved in managing the pilot on a day to day basis. Finally, the paper suggests potential solutions and learning points for dental public health practitioners. The work described in this paper relates to three relevant dental public health competencies: strategy development and implementation; strategic leadership and collaborative working for health and oral health improvement.

Public policy and legislation for oral health: a convergence of opportunities

The first surgeon general's report regarding oral health, Oral Health in America, called for a national effort to improve oral health among Americans and raised awareness of the importance of oral health; however, many Americans continue to experience poor oral health and are unable to access oral health care. Renewed national interest in oral health and access to oral health care through recent public policy documents and legislation presents a convergence of opportunities for the dental hygiene profession to continue to serve as a strong voice for the prevention of oral disease and the promotion of oral health for all segments of the population.

Dental erosion as oral disease. Insights in etiological factors and pathomechanisms, and current strategies for prevention and therapy

Dental erosion is induced by the exposure to acids, and together with physical impacts, contributes to the wear and tear of the dentition throughout a lifetime. It is a multifactorial condition, and so far several etiological and protecting factors have been identified. Based on a thorough diagnosis and identification of the acid sources, current preventive and therapeutic strategies focus on causal strategies bringing the acid exposure to a safe level, and/or strengthening the tooth surface against demineralization. There is increasing knowledge about the erosion inhibiting potential of fluorides particularly of compounds with polyvalent metal cations. The paper critically reviews the current literature providing a brief overview on what is known about diagnosis, prevalence, etiology and risk factors with the main focus on preventive and therapeutic strategies.

The oral health benefits of chewing gum

The use of sugar-free gum provides a proven anti-caries benefit, but other oral health effects are less clearly elucidated. Chewing sugar-free chewing gum promotes a strong flow of stimulated saliva, which helps to provide a number of dental benefits: first, the higher flow rate promotes more rapid oral clearance of sugars; second, the high pH and buffering capacity of the stimulated saliva help to neutralise plaque pH after a sugar challenge; and, lastly, studies have shown enhanced remineralisation of early caries-like lesions and ultimately prospective clinical trials have shown reduced caries incidence in children chewing sugar-free gum. This paper reviews the scientific evidence for these functional claims and discusses other benefits, including plaque and extrinsic stain reduction, along with the possibility of adding specific active agents, including fluoride, antimicrobials, urea and calcium phosphates, to enhance these inherent effects. The evidence for a specific effect of xylitol as a caries-therapeutic agent is also discussed. In conclusion, it is asserted that chewing gum has a place as an additional mode of dental disease prevention to be used in conjunction with the more traditional preventive methods.

Indications of antibiotic prophylaxis in dental practice- review

Antibiotics are frequently used in dental practice. Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry. Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria. It is indicated when there is evidence of clinical sign involvement and spread of infection. Antibiotics are prescribed in dental practice for treating odontoge nic infections, non-odontogenic infections, as prophylaxis against focal and local infection. Special care needs to be addressed to patients with organ transplants, poorly controlled diabetes and pregnancy. Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care. The present paper reviews the indications of antibiotics in dental practice.

Effect of early preventive dental visits on subsequent dental treatment and expenditures

OBJECTIVE

Professional organizations recommend a preventive dental visit by 1 year of age. This study compared dental treatment and expenditures for Medicaid children who have a preventive visit before the age of 18 months with those who have a visit at age 18-42 months.

METHODS

This retrospective cohort study used reimbursement claims for 19,888 children enrolled in North Carolina Medicaid (1999-2006). We compared the number of dental treatment procedures at age 43-72 months for children who had a visit by age 18 months with children who had a visit at ages 18-24, 25-30, 31-36, and 37-42 months using a zero-inflated negative binomial model. The likelihood and amount of expenditures at age 43-72 months were compared by group using a logit and ordinary least squares regression.

RESULTS

Children who had a primary or secondary preventive visit by age 18 months had no difference in subsequent dental outcomes compared with children in older age categories. Among children with existing disease, those who had a tertiary preventive visit by age 18 months had lower rates of subsequent treatment [18-24 mo incidence density ratio (IDR): 1.19, 95% confidence interval (CI), 1.03-1.38; 25-30 mo IDR: 1.21, 95% CI, 1.06-1.39; 37-42 mo IDR: 1.39, 95% CI, 1.22-1.59] and lower treatment expenditures compared with children in older age categories.

CONCLUSIONS

In this sample of preventive dental users in Medicaid, we found that children at highest risk of dental disease benefited from a visit before the age of 18 months, but most children could delay their first visit until the age of 3 years without an effect on subsequent dental outcomes.