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1.  Socio-demographic and behavioural correlates of oral hygiene status and oral health related quality of life, the Limpopo - Arusha school health project (LASH): A cross-sectional study 
BMC Pediatrics  2010;10:87.
Promoting oral health of adolescents is important for improvement of oral health globally. This study used baseline-data from LASH-project targeting secondary students to; 1) assess frequency of poor oral hygiene status and oral impacts on daily performances, OIDP, by socio-demographic and behavioural characteristics, 2) examine whether socio-economic and behavioural correlates of oral hygiene status and OIDP differed by gender and 3) examine whether socio-demographic disparity in oral health was explained by oral health-related behaviours.
Cross-sectional study was conducted in 2009 using one-stage cluster sampling design. Total of 2412 students (mean age 15.2 yr) completed self-administered questionnaires, whereas 1077 (mean age 14.9 yr) underwent dental-examination. Bivariate analyses were conducted using cross-tabulations and chi-square statistics. Multiple variable analyses were conducted using stepwise standardized logistic regression (SLR) with odds ratios and 95% Confidence intervals (CI).
44.8% presented with fair to poor OHIS and 48.2% reported any OIDP. Older students, those from low socio-economic status families, had parents who couldn't afford dental care and had low educational-level reported oral impacts, poor oral hygiene, irregular toothbrushing, less dental attendance and fewer intakes of sugar-sweetened drinks more frequently than their counterparts. Stepwise logistic regression revealed that reporting any OIDP was independently associated with; older age-groups, parents do not afford dental care, smoking experience, no dental visits and fewer intakes of sugar-sweetened soft drinks. Behavioural factors accounted partly for association between low family SES and OIDP. Low family SES, no dental attendance and smoking experience were most important in males. Low family SES and fewer intakes of sugar-sweetened soft drinks were the most important correlates in females.
Socio-behavioural factors associated with higher odds ratios for poor OHIS were; older age, belonging to the poorest household category and having parents who did not afford dental care across both genders.
Disparities in oral hygiene status and OIDP existed in relation to age, affording dental care, smoking and intake of sugar sweetened soft drinks. Gender differences should be considered in intervention studies, and modifiable behaviours have some relevance in reducing social disparity in oral health.
PMCID: PMC3001697  PMID: 21118499
2.  Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study 
Dental caries, dental pain and reported oral problems influence people's oral quality of life and thus their perceived need for dental care. So far there is scant information as to the psychosocial impacts of dental diseases and the perceived treatment need in child populations of sub-Saharan Africa.
Focusing on primary school students in Kilwa, Tanzania, a district deprived of dental services and with low fluoride concentration in drinking water, this study aimed to assess the prevalence of dental pain and oral impacts on daily performances (OIDP), and to describe the distribution of OIDP by socio-demographics, dental caries, dental pain and reported oral problems. The relationship of perceived need estimates with OIDP was also investigated.
A cross-sectional study was conducted in 2008. A total of 1745 students (mean age 13.8 yr, sd = 1.67) completed an extensive personal interview and under-went clinical examination. The impacts on daily performances were assessed using a Kiswahili version of the Child-OIDP instrument and caries experience was recorded using WHO (1997) criteria.
A total of 36.2% (41.3% urban and 31.4% rural, p < 0.001) reported at least one OIDP. The prevalence of dental caries was 17.4%, dental pain 36.4%, oral problems 54.1% and perceived need for dental treatment 46.8% in urban students. Corresponding estimates in rural students were 20.8%, 24.4%, 43.3% and 43.8%. Adjusted OR for reporting oral impacts if having dental pain ranged from 2.5 (95% CI 1.8–3.6) (problem smiling) to 4.7 (95% CI 3.4–6.5) (problem sleeping),- if having oral problems, from 1.9 (95% CI 1.3–2.6) (problem sleeping) to 3.8 (95% CI 2.7–5.2) (problem eating) and if having dental caries from 1.5 (95% CI 1.1–2.0) (problem eating) to 2.2 (95% CI 1.5–2.9) (problem sleeping). Students who perceived need for dental care were less likely to be females (OR = 0.8, 95% CI 0.6–0.9) and more likely to have impacts on eating (OR = 1.9, 95% CI 1.4–2.7) and tooth cleaning (OR = 1.6, 95% CI 1.6–2.5).
Substantial proportions of students suffered from untreated dental caries, oral impacts on daily performances and perceived need for dental care. Dental pain and reported oral problems varied systematically with OIDP across the eight impacts considered. Eating and tooth cleaning problems discriminated between subjects who perceived need for dental treatment and those who did not.
PMCID: PMC2726126  PMID: 19643004
3.  Socio-behavioural factors and early childhood caries: a cross-sectional study of preschool children in central Trinidad 
BMC Oral Health  2013;13:30.
Early childhood caries (ECC) is a public health problem due to its impact on children’s health, development and well being. Little is known about early childhood oral health in the West Indies or the influence of social and behavioural factors on the prevalence and severity of early childhood caries in this preschool population. The aims of this study were to describe the prevalence and severity of ECC in preschool children in a region of central Trinidad and to explore its relationship with social and behavioural factors.
A cross-sectional survey was undertaken on children aged 3-5 years-old from a random sample of preschools in central Trinidad. Oral health examinations were conducted for children for whom parental consent was given, using WHO criteria (visual diagnosis / cavitation at d3). A self-reported questionnaire was distributed to all parents and caregivers. Variables included socio-demographics, oral health knowledge, attitudes and behaviours, visible caries experience and treatment need.
251 children were examined, 50.2% were male with a mean age of 3.7 years (SD 0.67) and 71% were of Indian ethnicity. The prevalence of ECC was 29.1% and the prevalence of severe early childhood caries (S-ECC) was 17.5%. 29.9% of children had some treatment need, with 12% in need of urgent care or referral. Poisson generalized linear mixed model analysis found a higher rate of visible caries experience for children who ate sweet snacks more than twice a day (p < 0.001), had poorer parental dental health ratings (p < 0.0001), a previous dental visit (p < 0.0001) and difficulty finding dental care (p < 0.001).
The prevalence and severity of ECC in central Trinidad was related to oral health behaviours and access to dental care. Oral health promotion should include more supportive and practical advice for parents and caregivers of preschool children along with improved access to dental care to enable primary prevention and management of ECC.
PMCID: PMC3708808  PMID: 23834898
Early childhood caries; Preschool children; Oral health behaviour; West Indies
4.  Factors associated with dental attendance among adolescents in Santiago, Chile 
BMC Oral Health  2007;7:4.
Dental treatment needs are commonly unmet among adolescents. It is therefore important to clarify the determinants of poor utilization of dental services among adolescents.
A total of 9,203 Chilean students aged 12–21 years provided information on dental visits, oral health related behavior, perceived oral health status, and socio-demographic determinants. School headmasters provided information on monthly tuition and annual fees. Based on the answers provided, three outcome variables were generated to reflect whether the respondent had visited the dentist during the past year or not; whether the last dental visit was due to symptoms; and whether the responded had ever been to a dentist. Aged adjusted multivariable logistic regression models were used to assess the influence of the covariates gender; oral health related behaviors (self-reported tooth brushing frequency & smoking habits); and measures of social position (annual education expenses; paternal income; and achieved parental education) on each outcome.
Analyses showed that students who had not attended a dentist within the past year were more likely to be male (OR = 1.3); to report infrequent tooth brushing (OR = 1.3); to have a father without income (OR = 1.8); a mother with only primary school education (OR = 1.5); and were also more likely to report a poor oral health status (OR = 2.0), just as they were more likely to attend schools with lower tuition and fees (OR = 1.4). Students who consulted a dentist because of symptoms were more likely to have a father without income (OR = 1.4); to attend schools with low economic entry barriers (OR = 1.4); and they were more likely to report a poor oral health status (OR = 2.9). Students who had never visited a dentist were more likely to report infrequent tooth brushing (OR = 1.9) and to have lower socioeconomic positions independently of the indicator used.
The results demonstrate that socioeconomic and behavioral factors are independently associated with the frequency of and reasons for dental visits in this adolescent population and that self-perceived poor oral health status is strongly associated with infrequent dental visits and symptoms.
PMCID: PMC1853081  PMID: 17425778
5.  Self-rated oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians 
BMC Oral Health  2014;14(1):140.
There is scarce information available on oral health service utilization patterns and common oral hygiene practices among adult Nigerians. We conducted the 2010–2011 national oral health survey before the introduction of the national oral health policy to determine the prevalence of oral health service utilization, patterns of oral hygiene practices, and self reported oral health status, among adults in various social classes, educational strata, ethnic groups and geopolitical zones in Nigeria.
We conducted a cross-sectional survey in North-Central, North-West, South-East, South-South and South-West geopolitical zones of Nigeria. Multi-stage cluster sampling method was used for the sample selection. We administered a structured questionnaire to a total of 7,630 participants. Information on the socio-demographic characteristics, oral hygiene practices and oral health services utilization pattern of participants was obtained.
We interviewed 7, 630 participants (55.6% female). The participants ages ranged between 18 and 81 years, mean age was 37.96 (SD = 13.2). Overall 21.2% of the participants rated their oral health status as very good, 37.1% as good and 27.4% as fair. Only 26.4% reported having visited the dentist at least once prior to the conduct of the survey. More than half of these visits (54.9%) were for treatment purpose. Utilization of oral health services was significantly (p < 0.05) associated with being older, more educated and being engaged in a skilled profession. More educated persons, females and younger persons used toothbrushes for daily tooth cleaning. Age, sex, marital status, level of education and occupation were significantly related to daily frequency of tooth cleaning (p < 0.05).
Our results show that while most Nigerian adults have a positive view of their oral health status, majority reported poor oral health utilization habits. Older persons resident in the northern zones of the country and less educated persons displayed poorer oral hygiene practices. The study findings suggest that there is low oral health service utilization among adult Nigerians and that socio-demographic variables influence oral health utilization habits and oral hygiene behavior among adult Nigerians Further studies to identify other factors influencing oral health behavior are suggested.
PMCID: PMC4258058  PMID: 25427860
Socio-demographic factors; Oral health; Oral hygiene; Toothbrushing; Dental attendance; Nigerians
6.  Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis 
BMC Public Health  2012;12:773.
Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly.
Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors
Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR = 1.9), those who reported myocardial infarction (OR = 3.8), urinary incontinence (OR = 2.7), those who rated their oral health worse than others (OR = 3.2), and those who did not use dental services (OR = 2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively.
Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.
PMCID: PMC3490998  PMID: 22971075
Elderly; Oral health; Frailty syndrome; Utilization of dental services
7.  Self-reported oral health and associated factors in the North Finland 1966 birth cohort at the age of 31 
BMC Oral Health  2014;14(1):155.
The Northern Finland 1966 birth cohort (NFBC 1966) is an epidemiological study where the participants have been controlled since pregnancy both in field tests and using questionnaires. This study aimed to evaluate cross-sectionally the association of self-reported oral symptoms (dental caries and bleeding of gums) with sociodemographic and health behavior factors among the subjects.
Of the 11,541 original members of the cohort, 8,690 (75%) responded to the questionnaire on oral health (dental decay, gingival bleeding and self-estimated dental treatment need) and sociodemographic factors, general health and health behavior. Cross-tabulation and chi-squared tests as well as multiple logistic regression analysis were used to analyze the association between the outcome and explanatory variables.
The study group was equally distributed between the genders. One third of the subjects reported having dental decay, one fourth gingival bleeding and a half a dental treatment need. As compared to women, men reported significantly more frequently symptoms (p < 0.05). Logistic regression analysis revealed low tooth brushing frequency increasing the odds most for all oral symptoms ((OR 1.57 (1.39–1.78) for dental decay, 1.94 (1.68-2.24) for gingival bleeding and 1.42 (1.26-1.61) for dental treatment need). Frequent smoking was associated with dental decay (OR 1.63 (1.44–1.84)) and treatment need OR (1.39 (1.23–1.56)), whereas poor general health (OR 1.71 (1.48–1.96)) and high BMI (OR 1.19 (1.03–1.36)) both were associated with gingival bleeding.
Males with single marital status, BMI over 25, poor general health and poor oral health behaviors are at risk for self-reported poor oral health and dental treatment need.
PMCID: PMC4274689  PMID: 25516106
Self-reported oral health; Health behavior; Dental health surveys; Adults; Epidemiological
8.  Impact of Oral Health Behaviors on Dental Caries in Children with Intellectual Disabilities in Guangzhou, China 
Dental care is consistently reported as one of the primary medical needs of children with disabilities (IDC). The aim of the present study was to explore the influence of oral health behaviors on the caries experience in children with intellectual disabilities in Guangzhou, China. A cross-sectional study was carried out in 477 intellectually disabled children, 12 to 17 years old, who were randomly selected from special educational schools in Guangzhou. A self-administered parental questionnaire was used to collect data on socio-demographic characteristics and oral health behavior variables, and 450 valid questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dental caries. The average age of those in the sample was 14.6 years (SD = 1.3), 68.4% of whom were male, and the caries prevalence rate was 53.5% (DMFT = 1.5 ± 2.0). The factors significantly affecting the development of dental caries in IDC included gender, the presence or absence of cerebral palsy, and the frequency of dental visits and toothbrushing. In conclusion, the presence of cerebral palsy contributed to an increase risk of caries experience in intellectually disabled children, while toothbrushing more than twice a day and routine dental visits were caries-protective factors. Oral health promotion action may lead to a reduction in dental caries levels in IDC.
PMCID: PMC4211020  PMID: 25340906
dental caries; prevalence; intellectually disabled child; oral health behavior
9.  Risk indicators for severe impaired oral health among indigenous Australian young adults 
BMC Oral Health  2010;10:1.
Oral health impairment comprises three conceptual domains; pain, appearance and function. This study sought to: (1) estimate the prevalence of severe oral health impairment as assessed by a summary oral health impairment measure, including aspects of dental pain, dissatisfaction with dental appearance and difficulty eating, among a birth cohort of Indigenous Australian young adults (n = 442, age range 16-20 years); (2) compare prevalence according to demographic, socio-economic, behavioural, dental service utilisation and oral health outcome risk indicators; and (3) ascertain the independent contribution of those risk indicators to severe oral health impairment in this population.
Data were from the Aboriginal Birth Cohort (ABC) study, a prospective longitudinal investigation of Aboriginal individuals born 1987-1990 at an Australian regional hospital. Data for this analysis pertained to Wave-3 of the study only. Severe oral health impairment was defined as reported experience of toothache, poor dental appearance and food avoidance in the last 12 months. Logistic regression models were used to evaluate effects of demographic, socio-economic, behavioural, dental service utilisation and clinical oral disease indicators on severe oral health impairment. Effects were quantified as odds ratios (OR).
The percent of participants with severe oral health impairment was 16.3 (95% CI 12.9-19.7). In the multivariate model, severe oral health impairment was associated with untreated dental decay (OR 4.0, 95% CI 1.6-9.6). In addition to that clinical indicator, greater odds of severe oral health impairment were associated with being female (OR 2.0, 95% CI 1.2-3.6), being aged 19-20 years (OR 2.1, 95% CI 1.2-3.6), soft drink consumption every day or a few days a week (OR 2.6, 95% 1.2-5.6) and non-ownership of a toothbrush (OR 1.9, 95% CI 1.1-3.4).
Severe oral health impairment was prevalent among this population. The findings suggest that public health strategies that address prevention and treatment of dental disease, self-regulation of soft drink consumption and ownership of oral self-care devices are needed if severe oral health impairment among Indigenous Australian young adults is to be reduced.
PMCID: PMC2827466  PMID: 20102640
10.  Dental plaque, preventive care, and tooth brushing associated with dental caries in primary teeth in schoolchildren ages 6–9 years of Leon, Nicaragua 
Our study aimed to evaluate the effect of various risk indicators for dental caries on primary teeth of Nicaraguan children (from Leon, Nicaragua) ages 6 to 9, using the negative binomial regression model.
A cross-sectional study was carried out to collect clinical, demographic, socioeconomic, and behavioral data from 794 schoolchildren ages 6 to 9 years, randomly selected from 25 schools in the city of León, Nicaragua. Clinical examinations for dental caries (dmft index) were performed by 2 trained and standardized examiners. Socio-demographic, socioeconomic, and behavioral data were self-reported using questionnaires. Multivariate negative binomial regression (NBR) analysis was used.
Mean age was 7.49±1.12 years. Boys accounted for 50.1% of the sample. Mean dmft was 3.54±3.13 and caries prevalence (dmft >0) was 77.6%. In the NBR multivariate model (p<0.05), for each year of age, the expected mean dmft decreased by 7.5%. Brushing teeth at least once a day and having received preventive dental care in the last year before data collection were associated with declines in the expected mean dmft by 19.5% and 69.6%, respectively. Presence of dental plaque increased the expected mean dmft by 395.5%.
The proportion of students with caries in this sample was high. We found associations between dental caries in the primary dentition and dental plaque, brushing teeth at least once a day, and having received preventive dental care. To improve oral health, school programs and/or age-appropriate interventions need to be developed based on the specific profile of caries experience and the associated risk indicators.
PMCID: PMC3843599  PMID: 24247119
oral health; dental caries; schoolchildren; primary dentition; Nicaragua; dental epidemiology
11.  Performance and cross-cultural comparison of the short-form version of the CPQ11-14 in New Zealand, Brunei and Brazil 
The Child Perception Questionnaire (CPQ11-14) is a self-report instrument developed to measure oral-health-related quality of life (OHRQoL) in 11-14-year-olds. Earlier reports confirm that the 16-item short-form version performs adequately, but there is a need to determine the measure's validity and properties in larger and more diverse samples and settings.
The objective of this study was to examine the performance of the 16-item short-form impact version of the CPQ11-14 in different communities and cultures with diverse caries experience.
Cross-sectional epidemiological surveys of child oral health were conducted in two regions of New Zealand, one region in Brunei, and one in Brazil. Children were examined for dental caries (following WHO guidelines), and OHRQoL was measured using the 16-item short-form item-impact version of the CPQ11-14, along with two global questions on OHRQoL. Children in the 20% with the greatest caries experience (DMF score) were categorised as the highest caries quintile. Construct validity was evaluated by comparing the mean scale scores across the categories of caries experience; correlational construct validity was assessed by comparing mean scores and children's global ratings of oral health and well-being.
There were substantial variations in caries experience among the different communities (from 1.8 in Otago to 4.9 in Northland) and in mean CPQ11-14 scores (from 11.5 in Northland to 16.8 in Brunei). In all samples, those in the most severe caries experience quintile had higher mean CPQ11-14 scores than those who were caries-free (P < 0.05). There were also greater CPQ scores in those with worse self-rated oral health, with the Otago sample presenting the most marked gradient across the response categories for self-rated oral health, from 'Excellent' to 'Fair/Poor' (9.6 to 19.7 respectively).
The findings suggest that the 16-item short-form item impact version of the CPQ11-14 performs well across diverse cultures and levels of caries experience. Reasons for the differences in mean CPQ scores among the communities are unclear and may reflect subtle socio-cultural differences in subjective oral health among these populations, but elucidating these requires further exploration of the face and content validity of the measure in different populations.
PMCID: PMC3130632  PMID: 21649928
Adolescents; caries experience; quality of life; validity; short-form CPQ11-14
12.  Association of oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh 
Background: To associate oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. Materials & Methods: A cross sectional questionnaires based survey was conducted among the subjects of Bhopal district, Madhya Pradesh. The survey was carried among 101 subjects aging from 20-40 years. Subjects under investigation were belonging to various occupations. They were assigned a questionnaire. Questionnaire consisted of four parts, first part consists of socio-demographic data along with dental visiting habits, second part has OHqOL-questionnaire, third part has general health (sf-12) and fourth part has hospital anxiety and depression questionnaire. Questionnaire was used for assessment of OHqOL. It consists of 16 questions which takes into account both effect and impact of oral health on quality of life. Dental anxiety and depression was measured by Hospital Anxiety and Depression Scale. Each question was provided with four options and numbering ranging from 0-3. For general health consideration sf-12 v2 was being used, which calculates two values PCS and MCS giving result in percentage. Results: A large proportion of respondent perceived oral health as having an enhanced effect on their quality of life in all three aspects that is general health, social and psychological. This is in stark contrast to other studies, where only physical aspects of oral health were more frequently considered to have the greatest overall impact of life quality compared with items relating to social, psychological and general health aspects. Conclusion: Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including dental attendance patterns. How to cite this article: Shet RG, Jain G, Maroli S, Srivastava KJ, Kasina SP, Shwetha GS. Association of oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. J Int Oral Health 2013; 5(6):1-8 .
PMCID: PMC3895711  PMID: 24453438
Dental anxiety and depression; general health; hospital anxiety and depression scale; OHqOL
13.  Oral Health-Related Quality of Life in institutionalized elderly in Barcelona (Spain) 
Objective: The objective of this study is to describe the oral health status and the factors associated with oral health-related quality of life (OHRQoL) in people aged 65 and older institutionalized in Barcelona in 2009. Study Desing: Cross sectional study in 194 elderly. The dependent variable was poor OHRQoL, according to the Geriatric Oral Health Assessment Index (GOHAI). The independent variables were socio-demographic data, last dental visit, subjective and objective oral health status. Robust Poisson regression analysis was used to determine the factors associated with OHRQoL as well as the strengths of association (Prevalence Ratios with respective confidence intervals at 95%). Results: According to GOHAI, 94 women (68.1%) and 36 men (64.3%) had poor OHRQoL. The average DMFT index (number of decayed, missing and filled teeth) was 22.8, with mean 10.2 remaining teeth. According to the Community Periodontal Index only 1.9% were healthy. 33.8% of the sample (35.5% of women and 30.4% of men) presented edentulism, 54.2% needed upper dental prostheses (51.1% of women and 60.7% of men) and 64.7% needed lower ones (61.6% of women and 71.4% of men). Only 7.2% had visited a dentist in the past year (8.8% of women and 3.6% of men). After fitting several multivariate adjusted robust Poisson regression models, poor OHRQoL was found to be associated to self-reporting problems with teeth or gums, self-reporting poor opinion about teeth/gums/denture and also associated to functional edentulism, needing upper denture, but not to socio-demographic factors or time since last dental visit. Conclusions: The study population has poor objective oral health. A high percentage has poor OHRQoL associated to subjective and objective oral health conditions. Dental care is required and these services should be included in the Spanish National Health System.
Key words:Oral health, homes for the aged, elderly, self-assessment, quality of life, geriatric oral health assessment index (GOHAI).
PMCID: PMC3613882  PMID: 23385501
14.  Perceived dental treatment need among older Tanzanian adults – a cross-sectional study 
BMC Oral Health  2007;7:9.
Need perceptions for dental care play a key role as to whether people in general will seek dental care. The aim was to assess the prevalence of perceived need of problem based dental care, dental check-ups and any type of dental care. Guided by the conceptual model of Wilson and Cleary, the relationship of perceived need for dental care with socio-demographic characteristics, clinically defined dental problems and self-reported oral health outcomes was investigated. Partial prosthetic treatment need was estimated using a socio-dental approach.
A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. Information from interviews and clinical examination became available for 511 urban and 520 rural adults (mean age 62.9 yr).
51.7% (95% CI 46.2, 57.0) urban and 62.5 % (95% CI 53.1, 70.9) rural inhabitants confirmed need for dental check-up, 42.9% (95% CI 36.9, 48.9) urban and 52.7% (95% CI 44.5, 60.6) rural subjects confirmed need for problem oriented care and 38.4% (95% CI 32.4, 44.6) urban versus 49.6% (95% CI 41.8, 57.4) rural residents reported need for any type of dental care. Binary and ordinal multiple logistic regression analyses revealed that adults who reported bad oral health and broken teeth were more likely to perceive need for dental care across the three outcome measures than their counterparts. Socio-demographic factors and clinically defined problems had less impact. Based on a normative and an integrated socio-dental approach respectively 39.5% and 4.7% were in need for partial dentures.
About half of the participants confirmed need for problem oriented care, dental check-ups and any type of dental care. Need perceptions were influenced by perceived oral health, clinically assessed oral problems and socio-demographic characteristics. Need estimates for partial denture was higher when based on clinical examination alone compared to an integrative socio-dental approach.
PMCID: PMC1939845  PMID: 17625014
15.  Dental caries in relation to socio-behavioral factors of 6-year-old school children of Udaipur district, India 
Dental Research Journal  2012;9(6):681-687.
Based on the previous national oral health survey in India, some variation was observed in oral health status and behavior between the urban and rural population. Thus, the present study aimed to assess the dental caries experience in deciduous dentition of 6-year-old urban and rural schoolchildren of Udaipur district and to evaluate the influence of socio behavioral characteristics on dental caries experience.
Materials and Methods:
A combination of multi stage and cluster sampling procedure was executed to collect a representative sample of 875, 6-year-old school children. Clinical examination for caries was conducted using dmft (decayed, missing and filled teeth) index. Socio - demographic information was collected prior to clinical examination in addition to information on oral health behavior by personal interviews.
Only 7.8% children reported of brushing their teeth twice or more than twice daily. Rural children visited the dentist less often than the urban children (P < 0.05). Greater proportion of boys (62.2%) experienced caries than girls (55.1%), decayed component constituted a major contribution for dmft. Multivariate analysis demonstrated the influence of gender, urbanization, tooth brushing frequency, dental visits, parent's education and occupation on caries occurrence.
Rural children and boys experienced greater caries than their urban and girl counterparts. Caries experience was related to the parent's occupation and education. Moreover, caries occurrence was influenced by brushing frequency and dental visiting habits.
PMCID: PMC3612213  PMID: 23559941
Dental caries; education of parent; occupation of parent; urbanization
16.  Ethnic and socio-economic disparities in oral health outcomes and quality of life among Sri Lankan preschoolers: a cross-sectional study 
The distribution and severity of dental caries among preschool children vary according to the socio-economic and ethnic differences within and between countries. Understanding socio-economic influences on child oral health could inform early interventions to reduce the oral health burden throughout the life-cycle. The aim of this study is to examine the socio-economic and ethnic influences on oral health among preschoolers in Kegalle, Sri Lanka.
The study involved 784 children aged between 48–72 months recruited from 84 pre-schools in the Kegalle district in Sri Lanka. Cross-sectional data were collected by means of an oral examination of the children and a self-administered questionnaire to their parents/caregivers. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess Oral Health related Quality of Life (OHQoL). Univariate and multivariate models of Poisson regression were used to investigate the associations between the variables.
Compared to children whose fathers had tertiary education, those whose fathers did not study beyond grade 5, had more caries measured in terms of decayed, missing and filled surfaces (dmfs) (IRR = 2.30; 95% CI: 1.30, 4.06; p < 0.01) and experienced poor OHQoL at child (IRR = 2.52; 95% CI: 1.20, 5.31; p < 0.05) and family (IRR = 1.59; 95% CI: 1.11, 2.27; p < 0.05) levels. However, lower educational attainment among mothers was associated with better OHQoL among children. Compared to the Sinhalese ethnic group, Tamils had more gingival bleeding (bleeding surfaces) (IRR = 3.04; 95% CI: 1.92, 4.81; p < 0.001) and poor OHQoL at child level (IRR = 2.07; 95% CI: 1.19, 3.60; p < 0.01), whereas Muslims had poor OHQoL at family level (IRR = 1.42; 95% CI: 1.10, 1.84; p < 0.01). Children of low-income families had more gum bleeding (IRR = 1.00; 95% CI: 0.99, 1.00; p < 0.05) compared to children of high-income families.
Socio-economic and ethnic differences in oral health outcomes exist among this population of preschoolers. Interventions targeting children of fathers with low educational levels and ethnic minority groups are required to reduce inequalities in oral health in Sri Lanka and other similar countries.
PMCID: PMC3830507  PMID: 24228941
Oral health; Dental caries; Bleeding gums; Quality of life; Socio-economic disparities; Preschoolers; Sri Lanka
17.  Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan 
BMC Oral Health  2009;9:30.
HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors.
Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview.
A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8).
Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.
PMCID: PMC2784752  PMID: 19917090
18.  An Examination of Racial/Ethnic Disparities in Children’s Oral Health in the United States 
Assess the extent apparent racial/ethnic disparities in children’s oral health and oral health care are explained by factors other than race/ethnicity.
Data Source
2007 National Survey of Children’s Health, for children 2–17 years (N=82,020). Outcomes included parental reports of child’s oral health status, receipt of preventive dental care, and delayed dental care/unmet need. Model-based survey data analysis examined racial/ethnic disparities, controlling for other child, family, and community/state (contextual) factors.
Unadjusted results show large oral health disparities by race/ethnicity. Compared to non-Hispanic Whites, Hispanics and non-Hispanic Blacks were markedly more likely to be reported in only fair/poor oral health (odds ratios (ORs) [95% confidence intervals] 4.3 [4.0–4.6], 2.2 [2.0–2.4], respectively), lack preventive care (ORs 1.9 [1.8–2.0], 1.4 [1.3–1.5]), and experience delayed care/unmet need (ORs 1.5 [1.3–1.7], 1.4 [1.3–1.5]). Adjusting for child, family, and community/state factors reduced or eliminated racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 [1.5–1.8] and 1.2 [1.1–1.4], respectively. Adjustment eliminated disparities in each group for lacking preventive care (AORs 1.0 [0.9–1.1], 1.1 [1.1–1.2]), and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need (AOR 0.6 [0.6–0.7]).
Racial/ethnic disparities in children’s oral health status and access were found to be attributable largely to determinants such as socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at the social, economic, and other factors associated with minority racial/ethnic status, and may also have collateral positive effects on sectors of the majority population who share similar social, economic and cultural characteristics.
PMCID: PMC3702186  PMID: 22970900
children; oral health; race/ethnic disparities
19.  Spanish version of the Oral Health Impact Profile (OHIP-Sp) 
BMC Oral Health  2006;6:11.
The need for appraisal of oral health-related quality of life has been increasingly recognized over the last decades. The aims of this study were to develop a Spanish version (OHIP-Sp) of the Oral Health Impact Profile and to evaluate its convergent and discriminative validity, and its internal consistency.
The original 49-items OHIP was translated to Spanish, revised for understanding and semantics by two independent dentists, and then translated back to English by an independent bilingual dentist. The data originated in a cross sectional study conducted among high school students from the Province of Santiago, Chile. The study group was sampled using a multistage random cluster procedure yielding 9,203 students aged 12–21 years. All selected students were invited to participate and all filled a questionnaire with information on socio-demographic factors; oral health related behaviors; and self-reported oral health status (good, fair or poor). From this group, 9,163 students also accepted to fill a detailed questionnaire on socio-economic indicators and to receive a clinical examination comprising direct recordings of clinical attachment levels (CAL) in molars and incisors, tooth loss, and the presence of necrotizing ulcerative gingival lesions.
The participation rate and the questionnaire completeness were high with OHIP-Sp total scores being computed for 9,133 subjects. Self-perceived oral health status was associated with the total OHIP-Sp score and all its domains (Spearman rank correlation). The OHIP-Sp total score was also directly associated with the 4 dental outcomes investigated (Mann-Whitney test) and the largest impact was found for the outcomes, 'tooth loss' with a mean OHIP-Sp score = 13.5 and 'CAL >= 3 mm' with a mean OHIP-Sp score = 13.0.
The OHIP-Sp revealed suitable convergent and discriminative validity and appropriate internal consistency (Cronbach's α). Further studies on OHIP-Sp warrant the inclusion of populations with a higher disease burden; and the use of test-retest reliability exercises to evaluate the stability of the test.
PMCID: PMC1534011  PMID: 16827940
20.  Association between parental guilt and oral health problems in preschool children: a hierarchical approach 
BMC Public Health  2014;14(1):854.
Dental caries and traumatic dental injury (TDI) can play an important role in the emergence of parental guilt, since parents feel responsible for their child’s health. The aim of the present study was to evaluate the influence of oral health problems among preschool children on parental guilt.
A preschool-based, cross-sectional study was carried out with 832 preschool children between three and five years of age in the city of Campina Grande, Brazil. Parents/caregivers answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The item "parental guilt" was the dependent variable. Questionnaires addressing socio-demographic variables (child’s sex, child’s age, parent’s/caregiver’s age, mother’s schooling, type of preschool and household income), history of toothache and health perceptions (general and oral) were also administered. Clinical exams for dental caries and TDI were performed by three dentists who had undergone a training and calibration exercise (Kappa: 0.85-0.90). Poisson hierarchical regression was used to determine the significance of associations between parental guilt and oral health problems (α = 5%). The multivariate model was carried out on three levels using a hierarchical approach from distal to proximal determinants: 1) socio-demographic aspects; 2) health perceptions; and 3) oral health problems.
The frequency of parental guilt was 22.8%. The following variables were significantly associated with parental guilt: parental perception of child’s oral health as poor (PR = 2.010; 95% CI: 1.502-2.688), history of toothache (PR = 2.344; 95% CI: 1.755-3.130), cavitated lesions (PR = 2.002; 95% CI: 1.388-2.887), avulsion/luxation (PR = 2.029; 95% CI: 1.141-3.610) and tooth discoloration (PR = 1.540; 95% CI: 1.169-2.028).
Based on the present findings, parental guilt increases with the occurrence of oral health problems that require treatment, such as dental caries and TDI of greater severity. Parental perceptions of poor oral health in their children and history of toothache were predictors of greater feelings of parental guilt.
PMCID: PMC4150983  PMID: 25128429
Guilt; Dental caries; Tooth injuries; Preschool child
21.  Social Determinants of Tooth Loss 
Health Services Research  2003;38(6 Pt 2):1843-1862.
To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.
Data Sources/Study Setting
The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth.
Study Design
We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.
Data Collection Methods
In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.
Principal Findings
African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.
Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.
PMCID: PMC1360976  PMID: 14727800
Tooth loss; health disparities; race; socioeconomic status
22.  Oral health status among long-term hospitalized adults: a cross sectional study 
PeerJ  2014;2:e423.
Background. Many Long-Term Care (LTC) institutionalized patients are the most frail and functionally dependent among the geriatric population and have significant oral health disparities.They often suffer from dental neglect due to limited access to appropriate professional dental care. These patients have chronic health situations and are treated with medications, which increase their risk of oral diseases. Despite the growth in elderly population in Israel, there is insufficient data regarding their oral health status and treatment needs.
Objective. To describe the oral health status of the LTC hospitalized adults in a geriatric and psychiatric hospital in Israel.
Methods. Data was recorded from LTC hospitalized adults with a physical and/or mental disabilities in a cross-sectional research design, which included general health anamnesis and clinical oral examination. Variables included gender, medicines, oral hygiene (OH), using dentures, number of caries lesions and residual teeth. Univariate analyses included Pearson χ2 and t-test analyses. Multivariate analyses included logistic and linear regressions while the outcome variables were categorical OH index and number of carious cavitations, number of residual teeth and carious teeth percentage.
Results. 153 participants were included in the study with a mean age of 65.03 ± 18.67 years. 31.3% of the patients were edentulous, and only 14% had partial or full dentures. Females had a significantly higher number of caries cavitation than males (P = 0.044). The number of caries cavitation was higher among patients with poor OH (P < 0.001) and when taking Clonazepam (P = 0.018). Number of residual teeth was higher in the fair OH group (P < 0.001). Carious teeth percentage was higher among the poor OH group (P < 0.001).
PMCID: PMC4060041  PMID: 24949240
Oral health; Institutionalised hospital care; Edentulousness and oral hygiene
23.  Clinically Determined and Self-Reported Dental Caries Status During and After Pregnancy Among Low-Income Hispanic Women 
This analysis assessed, during and one-year after pregnancy: 1) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; 2) factors associated with high levels of professionally determined or self-reported oral disease.
Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and one-year post-partum (PP).
During pregnancy and PP, 93% had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists’ determinations were modest (ranging from 45–80% for sensitivity and 41–77% for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94%), but negative predictive values were low (<23%). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR=0.44).
There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically-determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate analyses. Ever having a professional teeth cleaning significantly predicted less disease PP.
PMCID: PMC3990252  PMID: 23889689
pregnancy; dental caries; oral health; post-partum; health status disparities; Hispanic
24.  Dental caries and treatment needs of Yemeni children with down syndrome 
Dental Research Journal  2014;11(6):631-635.
Oral health in Down syndrome (DS) children has some peculiar aspects that must be considered in the follow-up of these patients. The objective of the present study was to assess the prevalence of dental caries and treatment needs among children with DS in Yemen and also to investigate the association between these outcomes with various socio-demographic and clinical variables.
Materials and Methods:
This cross-sectional study involved 96 children with DS aged between 6 and 15 years. Data were gathered through the use of a questionnaire and clinical observation. The dentition status and the treatment needs were recorded according to World Health Organization recommendations. ANOVA, Chi-square test, t-test and multiple regression analyses were applied using the statistical package for the social sciences (SPSS, Chicago, IL, USA) version 20.0 software, with P < 0.05 considered as significant.
The results showed that 93.8% of the subjects had dental caries; overall, decayed missing filled surfaces (dmfs), decayed missing filled teeth (dmft), DMFS, DMFT were 10.35, 4.44, 4.32 and 2.45, respectively. Stepwise linear regression analysis has revealed that age was the most important predictor for DMFT and DMFS, while early age and less frequent teeth brushing were the most predictors for dmft and dmfs. Restorative care and extractions were the most needed specific treatments.
The findings of this study demonstrate that children with DS in Yemen have a high prevalence of dental caries and extensive unmet needs of dental treatment. They would benefit from frequent oral health assessment.
PMCID: PMC4275630  PMID: 25540656
Dental caries; down syndrome; risk factors; Yemen
25.  Validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross-sectional study of adolescents in Uganda 
BMC Oral Health  2003;3:5.
Assessing oral health related quality of life impact of mouth in adolescents is a relatively ignored area in dental research. This study aimed to examine reliability and validity of an abbreviated version of the oral impact of daily performance (OIDP) questionnaire and to analyse the interrelationship among OIDP scores, socio-demographic characteristics and oral health status in Uganda.
1146 adolescents (mean age 15.8, response rate 87%) attending secondary schools in Kampala (urban) and Lira (rural) completed a survey instrument designed to measure subjective oral health indicators including the eight-item OIDP frequency scores. A clinical examination was conducted among 372 students (mean age 16.3, response rate 72%) and caries was assessed following the World Health Organisation criteria (1997).
62% of the students experienced at least one oral impact during the 6 months preceding the survey. Cronbach's alpha for the OIDP frequency items was 0.91 and the corrected item-total correlation ranged from 0.62 to 0.75. Discriminant and construct validity were demonstrated in that the OIDP scores varied systematically in the expected direction with missing teeth and self-report indicators of oral health status, respectively. Socio-demographics and dental attendance did not predict OIDP through interaction with clinical indicators but varied systematically and independently with OIDP frequency scores in the multivariate analysis.
the OIDP frequency score have acceptable psychometric properties in the context of an oral health survey among Ugandan adolescents. Some evidence of the importance of social and personal characteristics in shaping adolescents' responses to oral disorders was provided.
PMCID: PMC212323  PMID: 12943555
adolescents; Uganda; OIDP; validity; reliability; caries experience; social factors

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