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1.  Oral Health Status of Psychiatric In-patients in Serbia and Implications for Their Dental Care 
Croatian Medical Journal  2010;51(5):443-450.
To determine oral health status and identify predictors of oral health in a representative sample of psychiatric in-patients in Serbia.
The study included 186 psychiatric in-patients and 186 control participants without psychiatric illness matched to the study group by age, sex, marital status, education level, employment, and monthly income. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth (DMFT) index; community periodontal index; and plaque index. Participants were also interviewed about their dental health behavior and their medical records were examined.
Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P < 0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P < 0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P < 0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.
Psychiatric in-patients in Serbia have poorer oral health than healthy controls. It is necessary to intensify preventive dental care in this vulnerable population.
PMCID: PMC2969139  PMID: 20960594
2.  The association between dental and periodontal diseases and sickle cell disease. A pilot case-control study 
The Saudi Dental Journal  2014;27(1):40-43.
This is a pilot case-control study conducted to investigate the prevalence of dental caries and periodontal disease and examine the possible association between oral health deterioration and SCD severity in a sample of Saudi SCD patients residing in the city of Al-Qatif, Eastern Province, Saudi Arabia.
Materials and methods
Dental examination to determine the Decayed, Missing and Filled Teeth index (DMFT), Community Periodontal Index (CPI), and plaque index system were recorded for 33 SCD patients and 33 age and sex-matched controls in the Al-Qatif Central Hospital, Qatif, Saudi Arabia. Self-administered surveys used to assess socio-economic status; oral health behaviors for both SCD patients and controls were recorded. In addition, the disease severity index was established for all patients with SCD. SPSS data analysis software package version 18.0 was used for statistical analysis. Numerical variables were described as mean with a standard deviation.
Decayed teeth were significantly more in individuals with ages ranging from 18 to 38 years with SCD compared to the control group (p = 0.036) due to oral hygiene negligence. The mean number of filled teeth was significantly lower in individuals with SCD when compared to the control group (p = 0.015) due to the lack of appropriate and timely treatment reflected in the survey responses of SCD patients as 15.2% only taking oral care during hospitalization. There were differences between the cases and controls in the known caries risk factors such as income level, flossing, and brushing habit. The DMFT, CPI, and plaque index systems did not differ significantly between the SCD patients and the control group.
Data suggest that patients with SCD have increased susceptibility to dental caries, with a higher prevalence of tooth decay and lower prevalence of filled teeth. Known caries risk factors influenced oral health more markedly than did factors related to SCD.
PMCID: PMC4273253  PMID: 25544813
Sickle cell disease; Dental caries; Periodontal
3.  Oral Health Status of a Sample of Prisoners in Enugu: A Disadvantaged Population 
The aim of this study is to determine the oral health status of a sample of prisoners at the Federal Prison in Enugu. The health status of inmates in the prison system needs to be incorporated into data and reports that summarize the state of the nation's health; this will encourage the provision of health care to prisoners and foster development of the nation's health.
Subjects and Methods:
The study involved 230 inmates of the Federal Prison in Enugu. An interviewer-administered questionnaire was used to gather data on the demographic characteristics of the participants, social habits, methods and frequency of cleaning the mouth. Intraoral examination was carried out to determine caries and periodontal statuses employing decayed missing and filled teeth (DMFT) index and community periodontal index of treatment needs respectively. The proportions of participants with other soft and hard tissue conditions were also recorded. Frequency distribution tables with mean values were generated for categorical variables and non-parametric test was used to relate DMFT values with frequency of cleaning the mouth.
Among the participants, 67.0% (154/230) had decayed teeth or tooth missing due to caries. None of the decayed teeth was restored yielding a 0.0% (0/230) index of restorative provision. Spearman correlation (rho) between ranks of DMFT and frequency of cleaning the mouth was -0.32 (95%CI=-0.43 to -0.19). 5.2% (12/230) participants had community periodontal index (CPI) score of 0 and 94.8% (218/230) had CPI of 1, 2, 3 or 4. Also, 56.1% (129/230) had extrinsic stains on their teeth and 17.3% (40/230) presented with fractured teeth.
More than half of the participants were affected by dental caries and periodontal health was compromised in the majority of them. Measures to improve their oral health and the establishment of dental health-care facility in the institution are strongly encouraged.
PMCID: PMC4160699  PMID: 25221723
Dental needs; Periodontal status; Prisoners
4.  Dental conditions in inpatients with schizophrenia: A large-scale multi-site survey 
BMC Oral Health  2012;12:32.
Clinical relevance of dental caries is often underestimated in patients with schizophrenia. The objective of this study was to examine dental caries and to identify clinical and demographic variables associated with poor dental condition in patients with schizophrenia.
Inpatients with schizophrenia received a visual oral examination of their dental caries, using the decayed-missing-filled teeth (DMFT) index. This study was conducted in multiple sites in Japan, between October and December, 2010. A univariate general linear model was used to examine the effects of the following variables on the DMFT score: age, sex, smoking status, daily intake of sweets, dry mouth, frequency of daily tooth brushing, tremor, the Clinical Global Impression-Schizophrenia Overall severity score, and the Cumulative Illness Rating Scale for Geriatrics score.
523 patients were included in this study (mean ± SD age = 55.6 ± 13.4 years; 297 men). A univariate general linear model showed significant effects of age group, smoking, frequency of daily tooth brushing, and tremor (all p’s < 0.001) on the DMFT score (Corrected Model: F(23, 483) = 3.55, p < 0.001, R2 = 0.42) . In other words, older age, smoking, tremor burden, and less frequent tooth brushing were associated with a greater DMFT score.
Given that poor dental condition has been related with an increased risk of physical co-morbidities, physicians should be aware of patients’ dental status, especially for aged smoking patients with schizophrenia. Furthermore, for schizophrenia patients who do not regularly brush their teeth or who exhibit tremor, it may be advisable for caregivers to encourage and help them to perform tooth brushing more frequently.
PMCID: PMC3466126  PMID: 22901247
Aging; Dental caries; Schizophrenia; Smoking; Tooth brushing; Tremor
5.  Changing dental caries and periodontal disease patterns among a cohort of Ethiopian immigrants to Israel: 1999–2005 
BMC Public Health  2008;8:345.
Dental epidemiology has indicated that immigrants and minority ethnic groups should be regarded as high risk populations on the verge of oral health deterioration. The objectives of this study were to measure the changing pattern of dental caries, periodontal health status and tooth cleaning behaviour among a cohort of Ethiopian immigrants to Israel between the years 1999–2005.
Increment of dental caries and periodontal health status was recorded among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and CPI indices. Data were gathered during 1999–2000 and five years later, during 2004–2005. Participants were asked about their oral hygiene habits in Ethiopia and in Israel five years since their immigration.
Regarding dental caries, at baseline 70.1% of the examinees were caries-free, as compared to 57.3% after five years. DMFT had increased from 1.48 to 2.31. For periodontal health status, at baseline, 94.7% demonstrated no periodontal pockets (CPI scores 0–2) and 5.3% revealed periodontal pockets (CPI scores 3&4), compared to 75.6% and 24.4%, respectively after five years. At baseline, 74% reported cleaning their teeth exclusively utilizing chewing and cleaning sticks common in Ethiopia. After five years, 97% reported cleaning their teeth exclusively utilizing toothbrushes.
The deterioration in the oral health status, especially the alarming and significant worsening of periodontal health status, among this immigrant group, emphasizes the need for health promotion and maintenance among immigrants and minority groups in changing societies. An "acclimatizing and integrating" model of oral health promotion among minority and immigrant groups is suggested.
PMCID: PMC2565680  PMID: 18828927
6.  Dentofacial and Cranial Changes in Down Syndrome 
This study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.
The cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.
The majority of the patients were males (n = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).
The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.
PMCID: PMC4281609  PMID: 25562042
down syndrome; oral Hygiene Index; dentofacial anomaly; macroglossia
7.  Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal 
BMC Oral Health  2013;13:20.
Chepang communities are one of the most deprived ethnic communities in Nepal. According to the National Pathfinder Survey, dental caries is a highly prevalent childhood disease in Nepal. There is no data concerning the prevalence of caries along with knowledge, attitude and oral hygiene practices among Chepang schoolchildren. The objectives of this study were to 1) record the prevalence of dental caries 2) report experience of dental pain 3) evaluate knowledge, attitude and preventive practices on oral health of primary Chepang schoolchildren.
A cross sectional epidemiological study was conducted in 5 government Primary schools of remote Chandibhanjyang Village Development Committee (VDC) in Chitwan district. Ethical approval was taken from the Institutional Review Board within the Research Department of the Institute of Medicine (IOM) Tribhuvan University. Consent was obtained from parents for conducting clinical examination and administrating questionnaire. Permission was taken from the school principal in all schools. Data was collected using a pretested questionnaire on 131 schoolchildren aged 8-16-year- olds attending Grade 3–5. Clinical examination was conducted on 361 school children aged 5–16 –year-olds attending grade 1–5. Criteria set by the World Health Organization (1997) was used for caries diagnosis. The questionnaires, originally constructed in English and translated into Nepali were administered to the schoolchildren by the researchers. SPSS 11software was used for data analysis.
Caries prevalence for 5–6 –year-old was above the goals recommended by WHO and Federation of Dentistry international (FDI) of less than 50% caries free children. Caries prevalence in 5-6-year-olds was 52% and 12-13-year-olds was 41%. The mean dmft/DMFT score of 5–6 –year-olds and 12 -13-year -olds was 1.59, 0.31 and 0.52, 0.84 respectively. The DMFT scores increased with age and the d/D component constituted almost the entire dmft/DMFT index. About 31% of 8-16-year-olds school children who participated in the survey reported having suffered from oral pain. Further, the need for treatment of decayed teeth was reported at 100%. About 76% children perceived teeth as an important component of general health and 75% reported it was required to eat. A total 93% children never visited a dentist or a health care service. Out of 56% children reporting cleaning their teeth daily, only 24% reported brushing their teeth twice daily. About 86% of the children reported using toothbrush and toothpaste to clean their teeth. Although 61% children reported to have received oral health education, 82% children did not know about fluoride and its benefit on dental health. About 50% children reported bacteria as the main cause of tooth decay and 23% as not brushing teeth for gingivitis. Frequency of sugar exposure was low; 75% of children reported eating sugar rich food once daily.
Caries prevalence of 5–6 –year- old Chepang school children is above the recommended target set by FDI/WHO. The study reported 31% schoolchildren aged 8-16-year old suffered oral pain and decayed component constituted almost the entire dmft/DMFT index. The brushing habit was reportedly low with only 24% of the children brushing twice daily. A nationwide scientifically proven, cost effective school based interventions is needed for prevention and control of caries in schoolchildren in Nepal.
PMCID: PMC3655880  PMID: 23672487
Dental caries; School children; Oral hygiene
8.  Relationship Between Dietary Patterns and Dental Health in Type I Diabetic Children Compared With Healthy Controls 
Dietary habits are established in childhood and will persist until adulthood, being one of the human health pillars. Many diseases of humans have roots in the individuals’ diet, of which dental caries are one of the common infectious diseases. Diabetes Mellitus is also considered as the most common metabolic disorder in children.
The purpose of this study was to compare the dietary patterns of children with type I Diabetes Mellitus with that of non-diabetic children, in relation to dental caries.
Materials/Patients and Methods:
In this study, 31 patients (13 boys and 18 girls, mean age of 11 ± 5.4 years) with type I Diabetes Mellitus referred to the Diabetes Mellitus Center and university hospitals were selected. Controls were 31 healthy students matched for age and sex. The study was based on the data obtained from the questionnaire containing information about dietary patterns and oral hygiene habits, social class and decayed/missing/filled teeth (DMFT) index. Dietary patterns were assessed using a food frequency questionnaire developed on the basis of caries preventing or inducing foods and then scored. Data were analyzed by using the t-test and McNamara’s test.
Diabetic children had less frequent cariogenic snacks than their controls. The mean diet scores for diabetic and healthy subjects were 7.65 ± 3.27 and 11.9 ± 2.03 (P < 0.05), respectively. There was no significant difference in DMFT between the diabetics and controls (3.71 ± 2.48 vs. 4.35 ± 2.74, respectively). There were also no differences in frequency of tooth brushing and use of mouth washes. However, more diabetics reported that they have never used dental floss compared to controls (42.2% vs. 71%, P < 0.05). Having cheese with bread as snack was more prevalent in diabetics (P < 0.05).There was a positive correlation between DMFT and dietary scores (r = 0.3, P < 0.05).
Controls scored higher in their dietary habits and dental flossing but lower in tooth brushing and mouth washing. More diabetics tend to have snacks like cheese and bread, which is a caries-preventing habit.
PMCID: PMC3964440  PMID: 24719722
Diabetes Mellitus; Dental Caries; Diet
9.  A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain 
Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student’s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043). Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients.
Key words:Gerodontology, oral health, older adult, psychiatric patients, schizophrenia.
PMCID: PMC3548649  PMID: 23229258
10.  Risk indicators of oral health status among young adults aged 18 years analyzed by negative binomial regression 
BMC Oral Health  2013;13:40.
Limited information on oral health status for young adults aged 18 year-olds is known, and no available data exists in Hong Kong. The aims of this study were to investigate the oral health status and its risk indicators among young adults in Hong Kong using negative binomial regression.
A survey was conducted in a representative sample of Hong Kong young adults aged 18 years. Clinical examinations were taken to assess oral health status using DMFT index and Community Periodontal Index (CPI) according to WHO criteria. Negative binomial regressions for DMFT score and the number of sextants with healthy gums were performed to identify the risk indicators of oral health status.
A total of 324 young adults were examined. Prevalence of dental caries experience among the subjects was 59% and the overall mean DMFT score was 1.4. Most subjects (95%) had a score of 2 as their highest CPI score. Negative binomial regression analyses revealed that subjects who had a dental visit within 3 years had significantly higher DMFT scores (IRR = 1.68, p < 0.001). Subjects who brushed their teeth more frequently (IRR = 1.93, p < 0.001) and those with better dental knowledge (IRR = 1.09, p = 0.002) had significantly more sextants with healthy gums.
Dental caries experience of the young adults aged 18 years in Hong Kong was not high but their periodontal condition was unsatisfactory. Their oral health status was related to their dental visit behavior, oral hygiene habit, and oral health knowledge.
PMCID: PMC3765426  PMID: 23957895
Dental caries; Periodontal disease; Negative binomial regression
11.  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
12.  The Effect of Intensive Oral Hygiene Care on Gingivitis and Periodontal Destruction in Type 2 Diabetic Patients 
Yonsei Medical Journal  2009;50(4):529-536.
This study aimed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients.
Materials and Methods
Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender, and randomly allocated into intervention (40 people) and control groups (35 people). Tooth brushing instruction, oral health education, and supra-gingival scaling were implemented in all patients at baseline. This program was repeatedly conducted in intervention patients every month for 6 months, and twice at baseline and the sixth month in the control. Oral health was measured by decayed, missing, and filled teeth (DMFT), plaque index, calculus index, bleeding index, patient hygiene performance (PHP) index, tooth mobility, Russel's periodontal index, and community periodontal index (CPI). Diabetes-related factors, oral and general health behaviors, and sociodemographic factors were interviewed as other confounding factors. An analysis of covariance (ANCOVA) was used with SPSS for Windows 14.0.
At baseline, there were no significant differences between the two groups in average of periodontal health (calculus index, bleeding index, Russel's periodontal index, CPI, and tooth mobility), diabetes-related factors (fasting blood glucose, postprandial blood glucose, and HbA1c), and in distribution of sociodemographic factors and health behaviors. In intervention group, plaque index, dental calculus index, bleeding index, and PHP index were reduced fairly and steadily from the baseline. There were significant differences in plaque index, dental calculus index, bleeding index, PHP index, and Russel's periodontal index between the two groups at sixth month after adjusted for baseline status.
Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration.
PMCID: PMC2730616  PMID: 19718402
Dental prophylaxis; oral hygiene; periodontal diseases; type 2 diabetes mellitus
13.  Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos 
BMC Oral Health  2009;9:29.
In recent decades low-income countries experienced an increasing trend in dental caries among children, particularly recorded in 12-year olds, which is the principal WHO indicator age group for children. This increases the risks of negative affects on children's life. Some data exist on the oral health status of children in low-income countries of Southeast Asia. However, information on how oral health is associated with socio-behavioural factors is almost not available. The aims of this study were to: assess the level of oral health of Lao 12-year-olds in urban and semi-urban settings; study the impact of poor oral health on quality of life; analyse the association between oral health and socio-behavioural factors; investigate the relation between obesity and oral health.
A cross sectional study of 12-year old schoolchildren chosen by multistage random sampling in Vientiane, Lao P.D.R (hereafter Laos). The final study population comprised 621 children. The study consisted of: clinical registration of caries and periodontal status, and scores for dental trauma according to WHO; structured questionnaire; measurement of anthropometric data. Frequency distributions for bi-variate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables.
Mean DMFT was 1.8 (SEM = 0.09) while caries prevalence was 56% (CI95 = 52-60). Prevalence of gingival bleeding was 99% (CI95 = 98-100) with 47% (CI95 = 45-49) of present teeth affected. Trauma was observed in 7% (CI95 = 5-9) of the children. High decay was seen in children with dental visits and frequent consumption of sweet drinks. Missed school classes, tooth ache and several impairments of daily life activities were associated with a high dD-component. No associations were found between Body Mass Index (BMI) and oral health or common risk factors. The multivariate analyses revealed high risk for caries for children with low or moderate attitude towards health, a history of dental visits and a preference for drinking sugary drinks during school hours. Low risk was found for children with good or average perception of own oral health. High risk for gingival bleeding was seen in semi-urban children and boys.
Although the caries level is low it causes considerable negative impact on daily life. School based health promotion should be implemented focussing on skills based learning and attitudes towards health.
PMCID: PMC2781791  PMID: 19917089
14.  Do dentists have better oral health compared to general population: a study on oral health status and oral health behavior in Kathmandu, Nepal 
BMC Oral Health  2014;14:23.
Dentists are considered role models by the general population in regards to oral hygiene and oral health behavior. This study aimed to access the oral health status of dentists and laypersons, and compare the dentists’ practice of preventive dentistry and oral self-care behaviors to that of the laypersons.
This cross-sectional study recruited 472 participants (195 dentists and 277 laypersons from the general population). Their oral health/hygiene behavior was assessed using a standardized close-ended multiple choice questionnaire. Oral examination was performed to assess caries using Decayed Missed Filled teeth (DMFT) index and periodontal status using Community Periodontal Index of Treatment Needs (CPITN).
Ninety-six percent of dentists brushed their teeth at least once daily, using fluoridated toothpaste and 80.5% twice daily. Although 94% of laypersons brushed their teeth once daily, they seldom used fluoridated toothpaste. Ten percent of participants in each group were caries free. The mean number of teeth present in the oral cavity (27.4 versus 25.4), mean number of teeth with caries (1.8 versus 3.7) and fillings (2.5 versus 0.4) were significantly different (p < 0.0001) between dentists and laypersons, respectively. Regarding the periodontal status, 82% of dentists had CPITN score of 0 whereas 71% of laypersons had the highest score 3 (p = 0.007), and 81% of the laypersons reported tooth mobility compared to 1% of dentists (p < 0.0001).
The participating dentists had better periodontal status and better self-reported oral health behaviors than the laypersons. Despite similar prevalence of caries in the two groups, the prevalence of decayed and unfilled teeth was lower among the dentists.
PMCID: PMC3994336  PMID: 24655533
Dentist; Oral health behavior; Oral health status; Dental caries; DMFT; Periodontal status; CPITN
15.  A survey of oral health in a Sudanese population 
BMC Oral Health  2012;12:5.
We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan.
A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index.
Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm.
The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.
PMCID: PMC3311612  PMID: 22364514
Dental caries is a lifetime disease and its sequelae have been found to constitute health problems of immense proportion in children. Environmental factors such as culture, socioeconomic status, lifestyle and dietary pattern can have a great impact on cariesresistance or caries-development in a child.
The present study was conducted to evaluate the relationship between dental caries and socioeconomic status of children attending paediatric dental clinic in UCH Ibadan.
Socio-demographic data for each child that attended paediatric dental clinic, UCH Ibadan within a period of one year was obtained and recorded as they presented in the dental clinic, followed by oral examination for each of them in the dental clinic to detect decayed, missing and filled deciduous and permanent teeth (dmft and DMFT respectively).
The mean dmft and DMFT score for the 209 children seen within period of study were 1.58 ± 2.4 and 0.63+1.3 respectively. Highest caries prevalence (46.9%) was found within the high social class while the caries prevalence in middle and low social class were 40.5% and 12.6% respectively. The highest dmft/DMFT of >7 was recorded in two children belonging to high social class. The difference in dmft in the three social classes was statistically significant (x 2 = 51.86,p= 0.008) but for DMFT, it was not statistically significant (x2 = 6.92, p = 0.991).
Caries experience was directly related to socio-economic status of the parents of the studied children with highest caries prevalence in high and middle socioeconomic classes.
PMCID: PMC4111067  PMID: 25161425
Dental Caries and Socioeconomic status.
17.  Oral health status and behaviours of preschool children in Hong Kong 
BMC Public Health  2012;12:767.
Dental caries is a major public health problem in many countries. Since the last territority-wide dental survey of Hong Kong preschool children was conducted in 2001, a survey to update the information is necessary. This study aimed to describe the dental caries experience of preschool children in Hong Kong and factors affecting their dental caries status.
A stratified random sample of children from seven kindergartens in Hong Kong was surveyed in 2009. Ethical approval from IRB and parental consent was obtained. Clinical examinations of the children were performed by two calibrated examiners using disposable dental mirrors, an intra-oral LED light and ball-ended periodontal probes. A questionnaire to investigate possible explanatory factors for caries status was completed by the children’s parents. Caries experience was recorded using the dmft index. Multifactor-ANOVA was used to study the relationship between dental caries experience, and the background and oral health-related behaviours of the children.
Seven hundred children (53% boys), mean age 5.3 ± 0.7 years were examined. The mean dmft score of the surveyed children was 2.2 and 51% of them had no caries experience (dmft = 0). Most (>95%) of the decayed teeth were untreated. Statistically significant correlations were found between dental caries experience of the children and their oral health-related habits, family income, parental education level and parental dental knowledge.
Early childhood dental caries was prevalent among the preschool children in Hong Kong. Their caries experience was associated with their oral health-related behaviours, socio-economic background, and parental education and dental knowledge.
PMCID: PMC3490858  PMID: 22966820
Dental caries; Oral hygiene; Oral health; Toothbrushing; Preschool children; Hong Kong; China
18.  The association between the upper digestive tract microbiota by HOMIM and oral health in a population-based study in Linxian, China 
BMC Public Health  2014;14(1):1110.
Bacteria affect oral health, but few studies have systematically examined the role of bacterial communities in oral diseases. We examined this relationship in a large population-based Chinese cancer screening cohort.
Human Oral Microbe Identification Microarrays were used to test for the presence of 272 human oral bacterial species (97 genera) in upper digestive tract (UDT) samples collected from 659 participants. Oral health was assessed using US NHANES (National Health and Nutrition Examination Survey) protocols. We assessed both dental health (total teeth missing; tooth decay; and the decayed, missing, and filled teeth (DMFT) score) and periodontal health (bleeding on probing (BoP) extent score, loss of attachment extent score, and a periodontitis summary estimate).
Microbial richness, estimated by number of genera per sample, was positively correlated with BoP score (P = 0.015), but negatively correlated with tooth decay and DMFT score (P = 0.008 and 0.022 respectively). Regarding β-diversity, as estimated by the UniFrac distance matrix for pairwise differences among samples, at least one of the first three principal components of the UniFrac distance matrix was correlated with the number of missing teeth, tooth decay, DMFT, BoP, or periodontitis. Of the examined genera, Parvimonas was positively associated with BoP and periodontitis. Veillonellacease [G-1] was associated with a high DMFT score, and Filifactor and Peptostreptococcus were associated with a low DMFT score.
Our results suggest distinct relationships between UDT microbiota and dental and periodontal health. Poor dental health was associated with a less microbial diversity, whereas poor periodontal health was associated with more diversity and the presence of potentially pathogenic species.
Electronic supplementary material
The online version of this article (doi:10.1186/1471-2458-14-1110) contains supplementary material, which is available to authorized users.
PMCID: PMC4223728  PMID: 25348940
Microbiota; Oral health; Dental caries; Periodontitis; Bleeding on probe; Attachment loss
19.  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
20.  Risk factors associated with deciduous tooth decay in Iraqi preschool children 
Tooth decay (TD) is common in children with significant consequences on systemic well-being, growth and quality of life, as well as increasing the risk of decay in the permanent teeth.
The aim of the present study is to define risk factors associated with deciduous TD (DTD) in Iraqi preschool children.
Materials and Methods:
From the 1st June to 31st December 2012, a case-control study was carried out on 684 children under the age of 6 years who attended Al-Aulwyiah pediatric teaching hospital in Baghdad. Clinical examination and World Health Organization caries diagnostic criteria for decayed, missing and filled teeth (DMFT) were applied. Data including gender, residence, socio-economic status (SES), parental education level, parental smoking, tooth brushing frequency, type of feeding during infancy and the presence of any systemic disease in the child were sought.
The mean DMFT score in the case group was 2.03 ± 1.39, of which decayed teeth formed 1.93. Males had a higher mean DMFT (2.10 ± 1.08) than females (1.96 ± 1.70) but with no statistically significant difference. The study revealed that residence, SES, parental education level and tooth brushing frequency were dependent risk factors significantly associated with DTD. However, gender, parental smoking and pattern of feeding during infancy were not significantly associated with DTD. Only four children with systemic disorders (1.2%), namely asthma and congenital heart diseases, were noticed to have DTD.
Pediatricians and dentists could provide dental preventive and screening measures. Confronting relevant risk factors associated with DTD and improving access to oral care services are suggested. In addition, promotion of oral health programs through school curricula is needed.
PMCID: PMC3952393  PMID: 24678464
Children; deciduous tooth decay; Iraq; risk factors
21.  A case-control study of determinants for high and low dental caries prevalence in Nevada youth 
BMC Oral Health  2010;10:24.
The main purpose of this study was to compare the 30% of Nevada Youth who presented with the highest Decayed Missing and Filled Teeth (DMFT) index to a cohort who were caries free and to national NHANES data. Secondly, to explore the factors associated with higher caries prevalence in those with the highest DMFT scores compared to the caries-free group.
Over 4000 adolescents between ages 12 and 19 (Case Group: N = 2124; Control Group: N = 2045) received oral health screenings conducted in public/private middle and high schools in Nevada in 2008/2009 academic year. Caries prevalence was computed (Untreated decay scores [D-Score] and DMFT scores) for the 30% of Nevada Youth who presented with the highest DMFT score (case group) and compared to the control group (caries-free) and to national averages. Bivariate and multivariate logistic regression was used to analyze the relationship between selected variables and caries prevalence.
A majority of the sample was non-Hispanic (62%), non-smokers (80%), and had dental insurance (70%). With the exception of gender, significant differences in mean D-scores were found in seven of the eight variables. All variables produced significant differences between the case and control groups in mean DMFT Scores. With the exception of smoking status, there were significant differences in seven of the eight variables in the bivariate logistic regression. All of the independent variables remained in the multivariate logistic regression model contributing significantly to over 40% of the variation in the increased DMFT status. The strongest predictors for the high DMFT status were racial background, age, fluoridated community, and applied sealants respectively. Gender, second hand smoke, insurance status, and tobacco use were significant, but to a lesser extent.
Findings from this study will aid in creating educational programs and other primary and secondary interventions to help promote oral health for Nevada youth, especially focusing on the subgroup that presents with the highest mean DMFT scores.
PMCID: PMC2989299  PMID: 21067620
22.  Chair-Side Quantitative Oral-Microflora Screening for Assessing Familial Correlation of Periodontal Status and Caries Prevalence 
PLoS ONE  2014;9(1):e87100.
Aim: Our goal was to investigate the relationship between clinical status and the presence of carious or periodontal pathogens among parent-child familial pairs. Clinical practices of risk assessment with consideration of familial pathogen interaction might reduce the need for therapy, improve patient outcomes, and ultimately reduce oral disease burden. Materials and Methods: In this study, we enrolled 30 parent-child pairs, with the children exhibiting complete deciduous dentition or mixed dentition with only permanent first molars. Clinical statuses were evaluated using caries and periodontal disease indicators, including the sum of decay and the number of missing or filled teeth (DMFT) for adults, decay, extraction caused by dental disease, and filled teeth (deft), for children, probing depth, and plaque control record (PCR). Supra- and sub-gingival bacteria were determined based on semi-quantitative measurements of microbial infection by using data from the Dentocult® SM test (caries-related organisms) and the PerioCheck® test (periodontal disease-related organisms). Results: No statistically significant relationship was detected between the prevalence of periodontal pathogens and that of cariogenic pathogens in the oral cavity. However, the clinical status of caries (DMFT) was negatively correlated with the clinical status of periodontal disease (pocket depth) in parents who were infected with dominant periodontal pathogens (r = −0.59, p<0.01). Parents’ DMFT scores were positively correlated with children’s deft and PCR scores. PCR and deft scores of children appeared to decrease significantly with the parent’s pocket depth. Conclusion: The study showed that the quantity of caries pathogens were not significant related to periodontal pathogens, but the caries clinical outcome is negative related with periodontal clinical outcome between familial pairs.
PMCID: PMC3907388  PMID: 24498022
23.  Oral health status and treatment needs among psychiatric inpatients in Rennes, France: a cross-sectional study 
BMC Psychiatry  2013;13:227.
Severe mental disorders have a chronic course associated with a high risk for co-morbid somatic illnesses and premature mortality and oral health is critical for overall systemic health. But general health care needs in this population are often neglected. Some studies have aimed at determining the oral health status of psychiatric in-patients but to date, no emphasis has been placed on oral health of psychiatric patients in France. The goal of this study was to assess the oral health and treatment needs of institutionalized patients in a large psychiatric hospital, where a dental service was available and free, to compare it with the average population, with psychiatric in-patients in other countries and to provide recommendations for psychiatrists and care-giving staff.
The dental status (DMFT), the oral hygiene (OHIS: Simplified Oral Hygiene Index), the saliva flow rate were recorded on a randomized patient sample. Demographic and medical data were retrieved from the institutional clinical files.
Among the 161 examined patients, 95 (59.0%) were men and 66 (41.0%) were women. The mean age was 46.9 ± 17.5 years. The majority was diagnosed schizophrenia (36.6%) or mood disorders (21.1%). The mean OHIS was 1.7 ± 1.1. Among the 147 patients who agreed to carry out the salivary examination, the average saliva flow rate was 0.3 g ± 0.3 g/min. Saliva flow under the average rest saliva flow (0.52 mg/min) was found for 80.3% of the patient. The mean DMFT was 15.8 ± 8.8 (D = 3.7 ± 4.4, M = 7.3 ± 9.4, F = 4.7 ± 4.9) and significantly increased with age (p < 0.001) and degree of disability (p = 0.003) (stepwise linear regression). Eighteen patients (11.2%) were edentulous.
The DMFT was similar to low income French population but psychiatric patients had almost 4 times more decayed teeth, slightly less missing teeth and 1.5 times less filled teeth. Oral health appeared to be better than in most other countries. But compared to general population, the still unmet dental and prosthetic needs indicated the major need of enhanced access to dental care and specific preventive programs.
PMCID: PMC3856526  PMID: 24053587
Dental caries/epidemiology; Dental health survey; Hospital, Psychiatric; Schizophrenia/complications
24.  Dental caries and associated factors among primary school children in Bahir Dar city: a cross-sectional study 
BMC Research Notes  2014;7(1):949.
Dental caries is the most common chronic infectious disease of childhood caused by the interaction of bacteria, mainly Streptococcus mutans and sugary foods on tooth enamel. This study aimed at determining the prevalence and associated factors of dental caries among primary school children at Bahir Dar city.
A school based cross-sectional study was conducted at Bahir Dar city from October 2013 to January 2014. Systematic random sampling technique was used to select the children. Structured questionnaire was used to interview children and/or parents to collect socio demographic variables. Clinical dental information obtained by experienced dentist using dental caries criteria set by World Health Organization. Binary and multiple logistic regression analysis were computed to investigate factors associated with dental caries.
Of the 147 children, 82 (55.4%) were girls. Majority of the children (67.6%) cleaned their teeth using traditional method (small stick of wood made of a special type of plant). The proportion of children having dental caries was 32 (21.8%). Primary tooth decay accounted for 24 (75%) of dental caries. The proportion of missed teeth was 7 (4.8%). The overall proportion of toothache and dental plaque among school children were 40 (27.2%) and 99 (67.3%), respectively. Grade level of 1–4 (AOR = 3.9, CI = 1.49 -10.4), poor habit of tooth cleaning (AOR = 2.6, CI = 1.08 - 6.2), dental plaque (AOR = 5.3, CI = 1.6 - 17.7) and toothache (AOR = 6.3, CI = 2.4 – 15.4) were significantly associated with dental caries.
Dental caries is a common public health problem in school children associated with poor oral hygiene, dietary and dental visit habits. Therefore, prevention measures such as health education on oral hygiene, dietary habits and importance of dental visit are obligatory for children.
PMCID: PMC4307198  PMID: 25540044
Dental caries; Dental plaque; Children
25.  Poor Dental Status and Oral Hygiene Practices in Institutionalized Older People in Northeast Brazil 
In this study we describe the dental status and oral hygiene practices in institutionalized older people and identify factors associated with poor dental status. A cross-sectional study was performed in a nursing home in Fortaleza, the capital of Ceará State (northeast Brazil). The number of decayed, missing, and filled teeth (DMFT) was assessed in the residents of the nursing home (n = 167; mean age = 76.6 years). The mean DMFT value was 29.7; the mean number of missing teeth was 28.4. Ninety-three (58.1%) were edentulous. Almost 90% practiced oral hygiene, but only about half used a toothbrush. Only 8% had visited a dentist in the preceding three months. Most of the variables regarding oral hygiene habits (such as the use of toothbrush, frequency of oral hygiene per day, regular tooth brushing after meals) did not show any significant association with the DMFT. In multivariate regression analysis, age, general literacy level, and practice of oral hygiene were independently associated with the DMFT (R2 = 0.13). Institutionalized older people in northeast Brazil have poor dental status, and oral hygiene practices are insufficient. Dental health education is needed focusing on the special needs of this neglected and socioeconomically deprived population to improve their quality of life.
PMCID: PMC2836820  PMID: 20339459

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