Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (
ocial determinants; mental health; university students; 26 countries
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.
Dental caries; School children; Oral hygiene
This study was conducted to determine factors affecting utilization of dental health services among intermediate female school students in Riyadh. In addition to assessing their satisfaction with the dental care received during the last dental visit.
Subjects and methods
Self-administered questionnaires were distributed among students attending eight public and four private schools. These schools were selected randomly to represent the four different administrative zones in Riyadh.
Of 600 questionnaires distributed, 531 were complete and suitable for analysis. Nearly three quarters of the students visited the dentist more than once during the last 2 years. A bout 75% had their treatment in private dental clinics and 63% made their visits for routine treatment. The quality of dental care was found to be the most encouraging factor for utilization of dental services, whereas, far geographic location of the dental clinics was the most discouraging factor. For those who received treatment in the government clinics, the most discouraging factor was post operative complications (P < 0.0001), while the most encouraging factor was the availability of friendly staff (P < 0.0001). The high cost of dental care was the most discouraging factor for utilizing the dental services for those who visited private clinics (P < 0.0001), while the high quality of dental care was the most encouraging factor (P < 0.009). Students who made their visits because of pain highly considered modern clinics and those recommended by friends as highly encouraging factors (P < 0.002), while they considered the high cost of dental care as discouraging factor for using dental services (P < 0.038). Students who visited the dentist for routine treatment gave the quality of dental care as encouraging for the use of dental clinics (P < 0.0001). Satisfaction with dental care was found to be significantly associated with high quality of dental care, convenient appointment, friendly staff, modern dental clinics and clinics recommended by friends.
Quality of dental care, reasonable fees for dental services and close location of dental clinics to students’ homes are encouraging factors for utilization of dental services.
Dental health services; Utilization factors; Patient satisfaction
Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored.
The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates.
People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear.
Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear.
Inequality in oral health is a major challenge. Oral diseases and their risk factors accumulate throughout life. The objective of this cross-sectional study was to examine the association of longest job with oral health status and oral health behavior among older Japanese.
Subjects were a total of 23,191 (11,310 males and 11,881 females) community-dwelling individuals aged 65 or over, living independently and able to perform daily activities from 30 municipalities across Japan. The outcome variables were oral health status (number of teeth, use of denture or bridge and subjective oral health status) and oral health behavior (dental visit for treatment and use of interdental brush or dental floss). The longest job was used as an explanatory variable. Age, educational attainment, equivalent income, and densities of dentists and population in municipalities were used as covariates. Two-level (first level: individual, second level: municipality) multilevel Poisson regression analyses were performed for each sex.
Multilevel Poisson regression analyses showed that all variables of oral health status and oral health behavior were significantly associated with longest job after adjusting for all covariates except denture/bridge use and dental visit for females. People whose longest jobs were sales/service, skilled/labor, agriculture/forestry/fishery or others, or who had no occupation were more likely to have poor oral health status and oral health behavior compared to those whose longest jobs were professional/technical.
The longest job may be one of the major determinants of oral health status and oral health behavior in Japanese older people.
Longest job; Oral health status; Oral health behavior; Older people; Cross-sectional study
The aims of this study were to determine factors associated with dental visit and to describe barriers to utilisation of oral health care services among antenatal mothers attending the Obstetric and Gynaecology Specialist clinic in Hospital Universiti Sains Malaysia.
A structured, self-administered questionnaire was used obtain information on the variables of interest pertaining to the current pregnancy from 124 antenatal mothers.
The majority of the mothers claimed that their oral health status was good (67.0%) or very good (2.4%). On the contrary, most of them admitted of having had at least one oral health problem (59.7%) including cavitated (43.5%) and painful teeth (15.3%), bleeding gum (21.0%), and bad breath (10.5%). However, only 29% of the mothers visited dentist during the current pregnancy. Factors associated with the mothers' dental visit were exposure to oral health education before the pregnancy and awareness of relationship between poor maternal oral health and adverse pregnancy outcomes with odds ratio of 4.06 (95% CI: 1.67-9.78) and 3.57 (95% CI: 1.30-9.77) respectively. Common excuses given by most mothers include perceptions of not having any oral health problems (65.9%), long waiting time at the clinic (71.6%), and no immediate treatment given by the dentist (64.8%).
Utilisation of oral health care services among antenatal mothers was low. Mothers who reported dental visit were more likely to be those who had received oral health education before the current pregnancy and knew of the association between poor maternal oral health and adverse pregnancy outcomes. Dissatisfaction with the services rendered and perceptions of not having any oral health problems were the main barriers.
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.
The aim of this study was to use the Hiroshima University - Dental Behavioral Inventory (HU-DBI) to compare oral health attitudes and behavior of dental and civil engineering students in Colombia. The HU-DBI's survey consisting of twenty dichotomous responses (agree-disagree) regarding tooth brushing, was completed at University Antonio Narino for the dental students and the University of Cauca for the civil engineering students. The Spanish version of the HU-DBI questionnaire was taken by 182 of 247 dental students and 411 of 762 engineering students. The data was-statistically analyzed by the chi-square test and backward logistic regression. Compared to the engineering students, the dental students were more likely to agree with questions such as “I am bothered by the color of my gums”(OR = 2.2, 95% CI: 1.3-3.7),“I think I can clean my teeth well without using toothpaste” (OR = 3.0, 95% CI: 1.5-5.9), “I have used a dye to see how clean my teeth are” (OR = 2.9, 95% CI: 1.9-4.3), and “I have had my dentist tell me that I brush very well” (OR = 2.0, 95% CI: 1.3-3.1). The dental education curriculum in a dental school compared to a civil engineering school in Colombia indicated that a three-phase curriculum in didactics and clinics increased oral health attitudes and behavior from entry to graduation.
oral health; behavior; tooth brushing; dental students; dental school curriculum; Colombia
Residents of Appalachia may benefit from oral cancer screening given the region’s higher oral and pharyngeal cancer mortality rates. The current study examined the oral cancer screening behaviors and recent dental care (since dentists perform most screening examinations) of women from Ohio Appalachia.
Women from Ohio Appalachia were surveyed for the Community Awareness Resources Education (CARE) study, which was completed in 2006. A secondary aim of the CARE baseline survey was to examine oral cancer screening and dental care use among women from this region. Outcomes included whether women (n=477; cooperation rate = 71%) had ever had an oral cancer screening examination and when their most recent dental visit had occurred. Various demographic characteristics, health behaviors and psychosocial factors were examined as potential correlates. Analyses used multivariate logistic regression.
Most women identified tobacco-related products as risk factors for oral cancer, but 43% of women did not know an early sign of oral cancer. Only 15% of women reported ever having had an oral cancer screening examination, with approximately 80% of these women indicating that a dentist had performed their most recent examination. Women were less likely to have reported a previous examination if they were from urban areas (OR=0.33, 95% CI: 0.13–0.85) or perceived a lower locus of health control (OR=0.94, 95% CI: 0.89–0.98). Women were more likely to have reported a previous examination if they had had a dental visit within the last year (OR=2.24, 95% CI: 1.03–4.88). Only 65% of women, however, indicated a dental visit within the last year. Women were more likely to have reported a recent dental visit if they were of a high socioeconomic status (OR=2.83, 95% CI: 1.58–5.06), had private health insurance (OR=2.20, 95% CI: 1.21–3.97) or had consumed alcohol in the last month (OR=2.03, 95% CI: 1.20–3.42).
Oral cancer screening was not common among women from Ohio Appalachia, with many missed opportunities having occurred at dental visits. Education programs targeting dentists and other healthcare providers (given dental providers are lacking in some areas of Ohio Appalachia) about opportunistic oral cancer screening may help to improve screening in Appalachia. These programs should include information about populations at high risk for oral cancer (eg smokers) and how screening may be especially beneficial for them. Future research is needed to examine the acceptability of such education programs to healthcare providers in the Appalachian region and to explore why screening was less common among women living in urban areas of Ohio Appalachia.
Appalachia; oral cancer; screening; USA
Objectives: This study was designed to identify association between self reported dental attendance patterns and family structure in the UK.
Design: A national study involving 666 women with dependent children.
Setting: Home interviews were undertaken exploring time and reason for last dental visit. In addition, numerous sociodemographic and service related characteristics were collected.
Results: Bivariate analysis identified that family structure was associated with respondents' self reported dental attendance patterns: marital status (p<0.01), number of children (p<0.05), and age of children (p<0.05). When the combined effects of age, family structure, income, educational attainment, working status, and service factors (difficulty obtaining a NHS dentist and time taken to get an appointment) on dental attendance were explored, family structure emerged as a very important predicator of service use. Notably, young (age 16–34) single mothers and those with more than two children were less likely to have attended the dentist within the past year for reasons other than a dental emergency compared with older (age 35 or more), mothers from a two parent family and those with one or two children.
Conclusion: Family structure is associated with self reported dental attendance patterns. Young single mothers with more than two children may be failing to monitor their oral health appropriately.
To assess the knowledge, attitude, self-reported practices, and prescription patterns regarding dental floss amongst a select population of dentists in India.
Materials and Methods:
A pretested 30-item questionnaire was self-administered by authors to the dental faculty and postgraduate students in dental schools in Delhi-National Capital Region (NCR). Nine dental institutes were selected by simple random sampling procedure among 15 institutions and a total of 255 dentists were included in the study.
The data obtained were analyzed by SPSS version 18. Descriptive statistics such as frequencies were calculated and Pearson's Chi-square test was used with P value fixed at 0.05.
There was lack of adequate knowledge regarding dental floss, among dentists in India. 78% of the dentists responded that the routine use of dental floss was necessary for good periodontal health. Majority of the dentists cited lack of awareness, availability, and cost as the major factors affecting floss usage. Lack of training in the dental education programs may have an impact on the prescription patterns as well. 15.3% of those surveyed do not use floss at all. 63.9% of the dentists prescribed floss routinely to their patients and considered factors like education, occupation, and socioeconomic status of the patient before prescribing dental floss.
Health education programs regarding dental floss are necessary to create awareness among the general population and adequate training at undergraduate level is also essential to increase the prescription practices. Dentists should practice recommended oral self-care and act as role models.
Attitude; dental floss; dentists; India; knowledge; practices; survey
To determine oral health literacy (REALD-30) and oral health literacy-related outcome associations, and to calculate if oral health literacy-related outcomes are risk indicators for poor self-reported oral health among rural-dwelling Indigenous Australians.
468 participants (aged 17-72 years, 63% female) completed a self-report questionnaire. REALD-30 and oral health literacy-related outcome associations were determined through bivariate analysis. Multivariate modelling was used to calculate risk indicators for poor self-reported oral health.
REALD-30 scores were lower among those who believed teeth should be infrequently brushed, believed cordial was good for teeth, did not own a toothbrush or owned a toothbrush but brushed irregularly. Tooth removal risk indicators included being older, problem-based dental attendance and believing cordial was good for teeth. Poor self-rated oral health risk indicators included being older, healthcare card ownership, difficulty paying dental bills, problem-based dental attendance, believing teeth should be brushed infrequently and irregular brushing. Perceived need for dental care risk indicators included being female and problem-based dental attendance. Perceived gum disease risk indicators included being older and irregular brushing. Feeling uncomfortable about oro-facial appearance risk indicators included problem-based dental attendance and irregular brushing. Food avoidance risk indicators were being female, difficulty paying dental bills, problem-based dental attendance and irregular brushing. Poor oral health-related quality of life risk indicators included difficulty paying dental bills and problem-based dental attendance.
REALD-30 was significantly associated with oral health literacy-related outcomes. Oral health literacy-related outcomes were risk indicators for each of the poor self-reported oral health domains among this marginalised population.
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.
Dental caries; education of parent; occupation of parent; urbanization
To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system.
A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were <18 years; of the remaining 1,307, 221 (17%) refused to participate, and 85 (6%) were excluded as edentate or reporting no dental visit, leaving 1,001 eligible subjects in the sample. The questionnaire covered insurance status, socio-demographics, frequency of tooth brushing, dental attendance as reasons for, and time since last dental visit, and dental service received then. Data analysis included the chi-square test and logistic regression.
Of the subjects, 71% had a dental insurance. Those with no insurance were more likely to report tooth extractions (OR=1.5) than those with an insurance coverage; for all other treatments no differences according to the insurance status appeared. Among the insured subjects, extractions were more likely for those reporting a problem-based dental visit (OR=6.0) or having a low level of education (OR=2.3).
In Iran, with its developing oral health care system, dental insurance had only a minor impact on dental services reported.
Adults’ dental care; Dental services; Dental insurance
Agricultural worker families encounter multiple barriers to accessing all needed dental care. This study investigated predisposing, enabling, and need factors associated with children's past year dental utilization among Hispanic agricultural worker families in central California.
Oral health survey and clinical data were collected from families participating in a larger, population-based study in 2006-7. Generalized estimating equation logit regression assessed effects on a dental visit among children aged 0-17 (n=405). Analyses adjusted for clustering of children in the same household. Predisposing (sociodemographics), enabling (child's dental insurance, usual source of dental care, caregiver past year dental visit, acculturation level, income and education), and need (caregiver's oral health rating, perception of cavities, and clinically-determined treatment urgency) factors were examined.
Half (51%) the children had a past year dental visit, while 23% had never been to a dentist. In the final model, children were less likely to have a past year dental visit if they were foreign-born, male, had caregivers that thought they had cavities or were unsure, and if the dentist recommended treatment ‘at earliest convenience’. Children aged 6-12, with a regular dental care source, and whose caregivers had a recent dentist visit were more likely to have a past year dental visit.
Children were more likely to have a past year dental visit if they had a usual source of dental care (OR =4.78, CI=2.51-9.08), and if the caregiver had a past year dental visit (OR=1.88, CI=1.04-3.38). Emphasis should be placed on these two modifiable factors to increase children's dental utilization.
Cross-Sectional Studies/utilization; Dental Health Surveys/utilization; Hispanic Americans
Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents’ socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children’s use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1–5 years.
Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children’s Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals.
Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as “poor” used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child’s oral health as “fair/poor” were less likely to have visited the dentist for preventive care.
This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.
Dental care; Healthcare disparities; Oral health; Preschool children; Health perceptions
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.
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.
pregnancy; dental caries; oral health; post-partum; health status disparities; Hispanic
Estimate the prevalence of dental caries based on clinical examinations and self-reports and compare differences in the prevalence and effect measures between the two methods among 18-year-olds belonging to a 1993 birth cohort in the city of Pelotas, Brazil.
Data on self-reported caries, socio-demographic aspects and oral health behaviour were collected using a questionnaire administered to adolescents aged 18 years (n = 4041). Clinical caries was evaluated (n = 1014) by a dentist who had undergone training and calibration exercises. Prevalence rates of clinical and self-reported caries, sensitivity, specificity, positive and negative predictive values, absolute and relative bias, and inflation factors were calculated. Prevalence ratios of dental caries were estimated for each risk factor.
The prevalence of clinical and self-reported caries (DMFT>1) was 66.5% (95%CI: 63.6%–69.3%) and 60.3% (95%CI: 58.8%–61.8%), respectively. Self-reports underestimated the prevalence of dental caries by 9.3% in comparison to clinical evaluations. The analysis of the validity of self-reports regarding the DMFT index indicated high sensitivity (81.8%; 95%CI: 78.7%–84.7%) and specificity (78.1%; 95%CI: 73.3%–82.4%) in relation to the gold standard (clinical evaluation). Both the clinical and self-reported evaluations were associated with gender, schooling and self-rated oral health. Clinical dental caries was associated with visits to the dentist in the previous year. Self-reported dental caries was associated with daily tooth brushing frequency.
Based on the present findings, self-reported information on dental caries using the DMFT index requires further studies prior to its use in the analysis of risk factors, but is valid for population-based health surveys with the aim of planning and monitoring oral health actions directed at adolescents.
Background and objectives:
The need to attain and maintain good
oral hygiene among pregnant women cannot be over emphasized
as periodontal diseases in pregnancy have been linked with poor
pregnancy outcomes. This study assessed the variables that affect
oral hygiene status among pregnant women in a south-western
Four hundred and five pregnant Nigerian women
were assessed for their oral hygiene status using the Oral Hygiene
Index-Simplified. Demographic and pregnancy statistics were also
obtained and the relationships between these and oral hygiene status
The mean age was 25.35 ± 5.02 years. Most of the women
(96.0%) had never visited a dentist or any other oral health care
provider and only 12.5% of those who had been attended by dental
care givers have ever had professional dental cleaning. The oral
hygiene status appeared to worsen as parity increased (p=0.047)
while the use of the toothbrush and paste was associated with good
oral hygiene (p=0.007). Higher education was associated with use
of the tooth brush and paste (p=0.046) and good oral hygiene (p=
The positive effect of education on oral hygiene
practices is highlighted in this study. However there is still need
for proper health enlightenment in this population with regards to
use of the available oral health care facilities.
Oral hygiene; Pregnancy; Nigeria.
Dental neglect has been found to be related to poor oral health, a tendency not to have had routine check-ups, and a longer period of time since the last dental appointment in samples of children and adults. The Dental Neglect Scale (DNS) has been found to be a valid measure of dental neglect in samples of children and adults, and may be valid for adolescents as well. We administered the DNS to a sample of adolescents and report on the relationships between the DNS and oral health status, whether or not the adolescent has been to the dentist recently for routine check-ups, and whether or not the adolescent currently goes to a dentist. We also report the internal and test-retest reliabilities of the DNS in this sample, as well as the results of an exploratory factor analysis.
One hundred seventeen adolescents from seven youth groups in the Seattle-Tacoma metropolitan area (Washington State, U.S.) completed the DNS and indicated whether they currently go to a dentist, while parents indicated whether the adolescent had a check-up in the previous three years. Adolescents also received a dental screening. Sixty six adolescents completed the questionnaire twice. T-tests were used to compare DNS scores of adolescents who have visible caries or not, adolescents who have had a check-up in the past three years or not, and adolescents who currently go to a dentist or not. Internal reliability was measured by Cronbach's alpha, and test-rest reliability was measured by intra-class correlation. Factor analysis (Varimax rotation) was used to examine the factor structure.
In each comparison, significantly higher DNS scores were observed in adolescents with visible caries, who have not had a check-up in the past three years, or who do not go to a dentist (all p values < 0.05). The test-retest reliability of the DNS was high (ICC = 0.81), and its internal reliability was acceptable (Cronbach's alpha = 0.60). Factor analysis yielded two factors, characterized by home care and visiting a dentist.
The DNS appears to operate similarly in this sample of adolescents as it has in other samples of children and adults.
Smoking is associated with tooth loss. However, smoking's relationship to the specific reason for tooth loss in postmenopausal women is unknown.
Postmenopausal women (n = 1,106) who joined a Women's Health Initiative ancillary study (The Buffalo OsteoPerio Study) underwent oral examinations for assessment of the number of missing teeth, as well as the self-reported reasons for tooth loss. The authors obtained information about smoking status via a self-administered questionnaire. The authors calculated odds ratios (ORs) and 95 percent confidence intervals (CIs) by means of logistic regression to assess smoking's association with overall tooth loss, as well as with tooth loss due to periodontal disease (PD) and with tooth loss due to caries.
After adjusting for age, education, income, body mass index (BMI), history of diabetes diagnosis, calcium supplement use and dental visit frequency, the authors found that heavy smokers (≥ 26 pack-years) were significantly more likely to report having experienced tooth loss compared with never smokers (OR = 1.82; 95 percent CI, 1.10-3.00). Smoking status, packs smoked per day, years of smoking, pack-years and years since quitting smoking were significantly associated with tooth loss due to PD. For pack-years, the association for heavy smokers compared with that for never smokers was OR = 6.83 (95 percent CI, 3.40-13.72). The study results showed no significant associations between smoking and tooth loss due to caries.
Conclusions and Practical Implications
Smoking may be a major factor in tooth loss due to PD. However, smoking appears to be a less important factor in tooth loss due to caries. Further study is needed to explore the etiologies by which smoking is associated with different types of tooth loss. Dentists should counsel their patients about the impact of smoking on oral health, including the risk of tooth loss due to PD.
Tooth loss; periodontal diseases; caries; smoking; menopause; women's health