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1.  Dentofacial and Cranial Changes in Down Syndrome 
Objectives
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.
Methods
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.
Results
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%).
Conclusion
The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.
doi:10.1016/j.phrp.2014.09.004
PMCID: PMC4281609  PMID: 25562042
down syndrome; oral Hygiene Index; dentofacial anomaly; macroglossia
2.  Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal 
BMC Oral Health  2013;13:20.
Background
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.
Method
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.
Results
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.
Conclusions
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.
doi:10.1186/1472-6831-13-20
PMCID: PMC3655880  PMID: 23672487
Dental caries; School children; Oral hygiene
3.  Oral Health Status of Disabled Individuals Attending Special Schools 
European Journal of Dentistry  2010;4(4):361-366.
Objectives:
The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled.
Methods:
Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2–6 years (n=24), 7–12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth.
Results:
The age range of patients was 2–26 years (mean age: 11.89±5.19 years). Mean dmft and DMFT scores by age group were as follows: 2–6 years: dmft=2.04±2.24; 7–12 years: dmft=2.24±2.60, DMFT=0.98±2.58; 13+years: DMFT=2.68±2.91. Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest.
Conclusions:
It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.
PMCID: PMC2948746  PMID: 20922154
Disabled individual; Oral health; Caries; Oral plaque
4.  Oral Health Status of Children with Disability Living in Albania 
Materia Socio-Medica  2014;26(6):392-394.
Introduction:
This study was carried out at nine (9) special schools for disabled children in Albania. The aim of the study is to determine the caries prevalence and oral hygiene status of children with different disabilities attending different schools for disabled at Albania.
Methods:
Participants are grouped according disability Autistic Spectrum Disorder, Down syndrome, Cerebral Palsy, Mental Retarded, Blind, Deaf-Mute and age group (0-5, 6-10, 11-14, 15-18 years old children). Caries and oral health status were examined and assessed according WHO 1997 criteria.
Results:
Overall caries prevalence at permanent dentition for all groups is 85.3% and for primary dentition 72%. The mean deft index is 3.4 ± 3.5(p≤0.029), mean DMFT= 4.9±4.6 (p≤0.001) with significance difference across type of disability (Kruskal-Wallis test) for both dentition. The mean OHI-S of total population is 1.91; there is significant difference across disability type (p≤0.001, Anova test) for OHI-S index. In total 43.2 % have good, 49.4% fair and 7.4% bad oral hygiene.
Conclusions:
The subjects in this study had a high prevalence of dental caries, poor oral hygiene and need for restorative care.
doi:10.5455/msm.2014.26.392-394
PMCID: PMC4314158
caries; oral health; disability; hygiene
5.  Discriminative ability of the generic and condition-specific Child-Oral Impacts on Daily Performances (Child-OIDP) by the Limpopo-Arusha School Health (LASH) Project: A cross-sectional study 
BMC Pediatrics  2011;11:45.
Background
Generic and condition-specific (CS) oral-health-related quality-of-life (OHRQoL) instruments assess the impacts of general oral conditions and specific oral diseases. Focusing schoolchildren from Arusha and Dar es Salaam, in Tanzania, this study compared the discriminative ability of the generic Child OIDP with respect to dental caries and periodontal problems across the study sites. Secondly, the discriminative ability of the generic-and the CS Child OIDP attributed to dental caries, periodontal problems and malocclusion was compared with respect to various oral conditions as part of a construct validation.
Methods
In Arusha, 1077 school children (mean age 14.9 years, range 12-17 years) and 1601 school children in Dar es Salaam (mean age 13.0 years, range 12-14 years) underwent oral clinical examinations and completed the Kiswahili version of the generic and CS Child-OIDP inventories. The discriminative ability was assessed as differences in overall mean and prevalence scores between groups, corresponding effect sizes and odd ratios, OR.
Results
The differences in the prevalence scores and the overall mean generic Child-OIDP scores were significant between the groups with (DMFT > 0) and without (DMFT = 0) caries experience and with (simplified oral hygiene index [OHI-S] > 1) and without periodontal problems (OHI-S ≤ 1) in Arusha and Dar es Salaam. In Dar es Salaam, differences in the generic and CS Child-OIDP scores were observed between the groups with and without dental caries, differences in the generic Child-OIDP scores were observed between the groups with and without periodontal problems, and differences in the CS Child-OIDP scores were observed between malocclusion groups. The adjusted OR for the association between dental caries and the CS Child-OIDP score attributed to dental caries was 5.4. The adjusted OR for the association between malocclusion and CS Child-OIDP attributed to malocclusion varied from 8.8 to 2.5.
Conclusion
The generic Child-OIDP discriminated equally well between children with and without dental caries and periodontal problems across socio-culturally different study sites. Compared with its generic form, the CS Child-OIDP discriminated most strongly between children with and without dental caries and malocclusion. The CS Child OIDP attributed to dental caries and malocclusion seems to be better suited to support clinical indicators when estimating oral health needs among school children in Tanzania.
doi:10.1186/1471-2431-11-45
PMCID: PMC3118891  PMID: 21615892
6.  Pattern and severity of early childhood caries in Southern Italy: a preschool-based cross-sectional study 
BMC Public Health  2014;14:206.
Background
This survey was intended to investigate prevalence and severity of early childhood caries (ECC) in a sample of children in Southern Italy and to identify factors that may be related to this condition.
Methods
The study was designed as a cross-sectional survey. The study population (children aged 36–71 months) attending thirteen kindergartens was randomly selected through a two-stage cluster sampling procedure. Parents/guardians of all eligible children were invited to participate filling out a structured self-administered questionnaire, and after having returned the informed consent form an oral examination of the child was performed at school. The questionnaire included information on: socio-demographics about parents/guardians and child, pregnancy and newborn characteristics, oral hygiene habits of child, eating habits particularly on consumption of sweets, access to dental services, and infant feeding practices. The WHO caries diagnostic criteria for deciduous decayed, missing and filled teeth (dmft) and surfaces (dmfs) were used to record ECC and severe-ECC (S-ECC). Univariate and multiple logistic regression analyses were conducted to evaluate statistical associations of social demographics, infant feeding practices, oral hygiene habits, and access to dental services to ECC, S-ECC, dmft and dmfs.
Results
515 children participated in the study. 19% had experienced ECC, and 2.7% severe-ECC (S-ECC), with a mean dmft and dmfs scores of 0.51 and 0.99, respectively. Mean dmft was 2.68 in ECC subjects, and 6.86 in S-ECC subjects. Statistical analysis showed that prevalence of ECC significantly increased with age (OR = 1.95; 95% CI = 1.3-2.91) and duration of breastfeeding (OR = 1.26; 95% CI = 1.01-1.57), whereas it was significantly lower in children of more educated mothers (OR = 0.64; 95% CI = 0.42-0.96), and higher in those who had been visited by a dentist in the previous year (OR = 3.29; 95% CI = 1.72-6.33).
Conclusions
Results of our study demonstrate that even in Western countries ECC and S-ECC represent a significant burden in preschool children, particularly in those disadvantaged, and that most of the known modifiable associated factors regarding feeding practices and oral hygiene are still very spread in the population.
doi:10.1186/1471-2458-14-206
PMCID: PMC3941481  PMID: 24571668
Early childhood caries; Public health; Feeding habits; Children; Prevention
7.  Oral health status and behaviours of preschool children in Hong Kong 
BMC Public Health  2012;12:767.
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1471-2458-12-767
PMCID: PMC3490858  PMID: 22966820
Dental caries; Oral hygiene; Oral health; Toothbrushing; Preschool children; Hong Kong; China
8.  Dental caries in 14- and 15-year-olds in New South Wales, Australia 
BMC Public Health  2013;13:1060.
Background
Dental caries remains one of the most common chronic diseases of adolescents. In Australia there have been few epidemiological studies of the caries experience of adolescents with most surveys focusing on children. The New South Wales (NSW) Teen Dental Survey 2010 is the second major survey undertaken by the Centre for Oral Health Strategy. The survey is part of a more systematic and efficient approach to support State and Local Health District dental service planning and will also be used for National reporting purposes.
Methods
Data for the NSW Teen Dental Survey were collected in 2010 from a random sample of Year 9 secondary school students aged 14 to 15 years from metropolitan and non-metropolitan schools under the jurisdiction of the NSW Department of Education and Training, the Catholic Education Commission and Independent Schools in New South Wales. Nineteen calibrated examiners performed 1269 clinical examinations at a total of 84 secondary schools across NSW. The survey was accompanied by a questionnaire looking at oral health related behaviours, risk factors and the usage of the Medicare Teen Dental Plan.
Results
175 schools were contacted, with 84 (48%) accepting the invitation to participate in the study. A total of 5,357 student consent forms and parent information packages were sent out and 1,256 students were examined; leading to a student participation rate of 23%. The survey reported a mean DMFT for 14 and 15 year olds of 1.2 and it was identified that 45.4% of students had an experience of dental caries. Major variations in caries experience reported occurred by remoteness, water fluoridation status, socio-economic status and household income levels.
Conclusions
The NSW Teen Dental Survey provided state-wide data that will contribute to the national picture on adolescent oral health. The mean DMFT score of 1.2 is similar to the national caries experience data for this age group from the Australian Child Dental Health Survey in 2009.
doi:10.1186/1471-2458-13-1060
PMCID: PMC3840655  PMID: 24209635
Teen dental survey; School children; Adolescents; Caries experience
9.  Risk factors associated with deciduous tooth decay in Iraqi preschool children 
Introduction:
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.
Aim:
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.
Results:
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.
Conclusion:
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.
doi:10.4103/2231-0770.127414
PMCID: PMC3952393  PMID: 24678464
Children; deciduous tooth decay; Iraq; risk factors
10.  Impact of school-based oral health education program on oral health of 12 and 15 years old school children 
Background:
Health education for the school age child is a specialized field within the broad discipline of education. Oral health education program are educational aspects of any curative, preventive and promotional health activity.
Aim:
The study has been undertaken to evaluate the impact of oral health education on the status of plaque, gingival health and dental caries among 12 and 15 years old children attending government school in Shimla city.
Materials and Methods:
Two hundred and seventy six school children participated in the study. The study was conducted over a period of 4 months from May 2010 to August 2010 in Government Senior Secondary School, Sanjauli. Plaque, gingival and caries status was assessed by using Silness and Loe plaque index, Loe and Silness gingival index and WHO modified DMFT index, respectively. Data was analyzed using the software SPSS version 15. Paired t-test and Wilcoxon signed rank sum test were used appropriately for statistical comparisons. P value ≤0.05 was considered statistically significant.
Results:
Overall mean plaque score and gingival score decreased significantly after oral health education irrespective of gender. However, decrease in plaque score among 15 years old female children and gingival scores among 12 and 15 years old female subjects was not significant. Difference in mean caries status was statistically insignificant among all the subjects.
Conclusion:
Short term oral health education program may be useful in improving oral hygiene and gingival health. Coordinating efforts should be enhanced between school personnel, parents and health professionals to ensure long-term benefits of such program.
doi:10.4103/2277-9531.115820
PMCID: PMC3778644  PMID: 24083283
Dental caries; gingival status; oral health education; plaque; school children
11.  Oral lesions and dental status among institutionalized orphans in Yemen: A matched case-control study 
Objectives:
The aim of this study was to assess the prevalence of oral mucosal lesions (OMLs) and dental caries and to evaluate oral health practices among institutionalized orphan-children in Sana’a city, Yemen.
Subjects and Methods:
A sample of 202 institutionalized male-orphan-children in the main orphanage in Sana’a city, were matched to 202 non-orphan schoolchildren. Clinical examination included assessment of OMLs based on standard international diagnostic criteria and evaluation of dental status using the Decayed/decayed, Missed/missed and Filled/filled (DMFT/dmft) index according to World Health Organization recommendations. Demographic data and oral hygiene practices were obtained by interviewing each subject using special questionnaire form.
Results:
Majority of children were in the 12-15 year age group. Nine types of lesions were reported among orphans; the most common lesions were fissured tongue (24.3%), herpes labialis (7.9%) and traumatic ulcers (2.5%). The occurrence of herpes labialis was found to be significantly higher in orphans than in controls (P < 0.01). The prevalence of dental caries was insignificantly lower among the orphans (84.7%) compared with the non-orphans (89.61%; P = 0.136). The mean dmft score was significantly lower in orphans than in controls (2.28 vs. 3.82; P = 0.001).
Conclusions:
The institutionalized children in this orphanage had a high prevalence of OMLs but low prevalence of dental caries, though they revealed poor oral hygiene practices. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of children living in orphanages.
doi:10.4103/0976-237X.128673
PMCID: PMC4012124  PMID: 24808701
Dental caries; institutionalized orphans; oral lesions
12.  Oral Health Status of Patients with Mental Disorders in Southwest Ethiopia 
PLoS ONE  2012;7(6):e39142.
Background
Psychiatric disorders are known to be a risk factor for the development of different oral health problems especially for dental caries and periodontal diseases. In spite of this fact, no study has been conducted to reveal its magnitude in Ethiopia. Hence, this study was conducted to determine the oral health status of psychiatric patients at Jimma University Specialized Hospital (JUSH), Psychiatric Clinic.
Methods
A hospital based cross- sectional study was used from January to May 2011. A total of 240 participants were included in the study. Dental examination was done to measure indices of oral health: decayed, missing, and filled teeth (DMFT) index and community periodontal index (CPI). Oral examination was performed using mirror, probe and explorer by experienced dental doctors. A simple random sampling technique was implemented to collect data. ANOVA test, binary logistic and multinomial logistic regression analyses were done using SPSS 16.0 statistical software.
Results
The mean DMFT score among the psychiatric patients was 1.94±2.12 (mean±SD) with 1.28±1.69, 0.51±1.19 and 0.14±0.48 (mean±SD) for decayed, missed and filled teeth respectively. Only about 24% of the psychiatric patients had a healthy CPI score. Incorrect tooth brushing technique was significantly associated with a DMFT score greater than 2 (AOR = 3.58; 95% CI: 1.65, 7.79). The habit of sweet intake was also associated with dental caries (AOR = 2.91; 95% CI: 1.43, 5.95). Similarly, patients with a smoking habit also demonstrated statistically significant association with dental caries (AOR = 18.98; 95% CI: 5.06, 71.24).
Conclusion
The oral health status of the psychiatric patients was poor. Thus, health education about oral hygiene should be given for psychiatric patients so they can avoid the frequent intake of sweets, smoking and learn correct tooth brushing technique.
doi:10.1371/journal.pone.0039142
PMCID: PMC3377615  PMID: 22723950
13.  Dental caries status of Dai preschool children in Yunnan Province, China 
BMC Oral Health  2013;13:68.
Background
The Dai people, one of the ethnic minorities in China, have a population of 1,260,000. They have the same origin as one of the main ethnic groups of Laos and Thailand. Most of the Dai live in Yunnan province, which is located in the less-developed southwestern part of China. This study aimed to describe the oral health status of Dai preschool children in China and the factors that influence their oral health status.
Methods
An oral health survey was performed between 2011 and 2012 to select Dai five-year-old children using multi-stage stratified sampling in Yunnan. Their dental caries experience was measured using the “dmft” index, and severe caries was assessed using the “pa” index, which is modified from the “pufa” index. Oral hygiene status was assessed using the visual plaque index (VPI). A questionnaire to study the children’s socio-demographic background and oral health-related behaviours was completed by the children’s parents.
Results
A total of 833 children were examined. Their caries prevalence was 89% and 49% of the children had carious tooth with pulp involvement. The mean (SD) dmft score was 7.0 (5.3). Higher dmft scores were found among children who were girls, were currently bottle-fed, took daily sweet snacks, had higher VPI scores, and had visited a dentist within the last year.
Conclusions
The caries prevalence and experience of the five-year-old Dai children in Yunnan, China was high, and almost half had severe caries. The caries experience was associated with gender, snack habits, dental visit habits, and oral hygiene status.
doi:10.1186/1472-6831-13-68
PMCID: PMC4222259  PMID: 24279504
Caries; Children; Ethnic; Minority; China
14.  Oral health survey and oral health questionnaire for high school students in Tibet, China 
Head & Face Medicine  2014;10:17.
Objectives
The aim of this study is to identify the oral health status as well as oral health practices and access for care of graduating senior high school Tibetan students in Shannan prefecture of Tibet.
Methods
Based on standards of the 3rd Chinese National Oral Epidemiological Survey and WHO Oral Health Surveys, 1907 graduating students from three senior high schools were examined for caries, periodontitis, dental fluorosis, and oral hygiene status. The questionnaire to the students addressed oral health practices and present access to oral medical services.
Results
Dental caries prevalence (39.96%) and mean DMFT (0.97) were high in Tibetan students. In community periodontal indexes, the detection rate of gingivitis and dental calculus were 59.50% and 62.64%, respectively. Oral hygiene index-simplified was 0.69, with 0.36 and 0.33 in debris index-simplified and calculus index-simplified, respectively. Community dental fluorosis index was 0.29, with 8.13% in prevalence rate. The questionnaire showed students had poor oral health practices and unawareness for their needs for oral health services. It was also noted that the local area provides inadequate oral medical services.
Conclusions
Tibetan students had higher prevalence of dental diseases and lower awareness of oral health needs. The main reasons were geographical environment, dietary habit, students’ attitude to oral health, and lack of oral health promotion and education. Oral health education and local dentists training should be strengthened to get effective prevention of dental diseases.
doi:10.1186/1746-160X-10-17
PMCID: PMC4049488  PMID: 24884668
Oral health; Questionnaire; Epidemiology; Tibet; Plateau
15.  Dental caries status of Bulang preschool children in Southwest China 
BMC Oral Health  2014;14:16.
Background
Bulang is one of the 55 ethnic minorities in China with a population of around 120,000. They live mainly in Yunnan, which is a less-developed province in southwestern China. Many Bulang people live in remote villages and have little access to dental care. They like hot and sour food and chew betel nut. This study examines the caries status of 5-year-old Bulang children and factors that influence their caries status.
Methods
A sample of 5-year-old Bulang children in Yunnan was selected using a multi-stage cluster sampling method. One trained dentist examined the children using dental mirrors with intra-oral LED light and CPI probes. Caries experience was measured according to the dmft index. Oral hygiene status was recorded according to the visible plaque index (VPI). A parental questionnaire was used to study the children’s oral health-related behaviours.
Results
A total of 775 children were invited and 723 joined the survey. The caries prevalence was 85%, and 38% of them had caries involved in pulp. The mean dmft and dt score were 5.8 ± 4.9 and 5.6 ± 4.8, respectively. Visible plaque was found on 636 children (88%). Multi-factor ANCOVA analysis found that higher dmft scores were found among the children who snacked on sweets daily, had visited a dentist within the last year and had higher VPI scores.
Conclusions
The caries prevalence and experience among 5-year-old Bulang children in Yunnan was high, and most of the caries were left untreated. The caries experience was associated with snacking habits, dental visit habits and oral hygiene.
doi:10.1186/1472-6831-14-16
PMCID: PMC3946148  PMID: 24593701
Caries; Children; Ethnic; Minority; China
16.  Inequalities of caries experience in Nevada youth expressed by DMFT index vs. Significant Caries Index (SiC) over time 
BMC Oral Health  2011;11:12.
Background
With the increasingly polarized distribution of dental caries among children and adolescents, the usual DMFT measure has become a less meaningful population descriptor. To re-focus on identifying the high caries prevalence group the Significant Caries Index (SiC) was created. The aims of this study were to analyze the prevalence and severity of dental caries in Nevada youth over a period of eight years and to compare its expression by means of DMFT and SiC; analyze the caries trends in the population and their underlying factors, and determine whether Nevada youth were at risk for significantly high levels of dental caries.
Methods
Retrospective data was analyzed from a series of sequential, standardized oral health surveys across eight years (2001/2002-2008/2009) that included over 62,000 examinations of adolescents 13-19 years of age, attending public/private Nevada schools. Mean Decayed-Missing-Filled Teeth index (DMFT) and Significant Caries Index (SiC) were subsequently computed for each academic year. Descriptive statistics were reported for analysis of comparative DMFT and SiC scores in relation to age, gender, racial background, and residence in a fluoridated/non-fluoridated community. Logistic regression analysis was used to analyze the differential impact of the variables on the probability of being in the high caries prevalence group.
Results
Comparison of students' mean DMFT to National (NHANES) data confirmed that dental caries remains a common chronic disease among Nevada youth, presenting higher prevalence rates and greater mean scores than the national averages. Downward trends were found across all demographics compared between survey years 1 and 6 with the exception of survey year 3. An upward trend began in survey year six. Over time, the younger group displayed an increasing proportion of cariesfree individuals while a decreasing proportion was found among older examinees. As expected, the mean SiC score was significantly higher than DMFT scores within each survey year across comparison groups (p < 0.001).
Conclusions
Using both caries indices together may help to highlight oral health inequalities more accurately among different population groups within the community in order to identify the need for special preventive oral health interventions in adolescent Nevadans. At the community level, action should focus on retaining and expanding the community fluoridation program as an effective preventive measure. At the individual level the study identifies the need for more targeted efforts to reach children early with a focus on females, Hispanics and Blacks, and uninsured children.
doi:10.1186/1472-6831-11-12
PMCID: PMC3082236  PMID: 21466692
17.  Oral lesions and dental status of autistic children in Yemen: A case–control study 
Purpose:
This study aimed to assess the prevalence of oral lesions among children with autism in Sana’a City, Yemen, and to evaluate their dental status.
Patients and Methods:
This case–control study included 42 children with autism, aged between 5 and 16 years, and 84 age- and gender-matched healthy children as controls. Oral lesions were assessed based on standardized criteria according to the World Health Organization (WHO) recommendations. Dental caries, gingival health, and oral hygiene status were assessed using dmft/DMFT index, Gingival Index (GI), and Plaque Index (PI), respectively. Chi-square test and Mann–Whitney's test were used to compare the groups.
Results:
Compared to controls, children with autism revealed higher proportion of fistulae (9.5% vs. 2.4%), ulcerative lesions (7.1% vs. 1.2%), gingival hyperplasia (4.8% vs. 0.0%), and cheilitis (4.8% vs. 2.4%); however, the differences were not statistically significant. The mean dmft score was significantly higher in children with autism than in controls (5.23 vs. 4.06; P < 0.001). Moreover, children with autism revealed poorer oral hygiene than controls, and the majority had gingivitis.
Conclusions:
Children with autism in Yemen have high prevalence of oral soft tissue lesions, caries, and gingivitis. Therefore, proper oral health education programs should be initiated and directed toward this special section of the society.
doi:10.4103/2231-0762.149040
PMCID: PMC4304059  PMID: 25625079
Autism; dental caries; oral health; Yemen
18.  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.
doi:10.1155/2009/846081
PMCID: PMC2836820  PMID: 20339459
19.  INFLUENCE OF PARENTAL SOCIOECONOMIC STATUS ON CARIES PREVALENCE AMONG CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN 
Background:
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.
Objective:
The present study was conducted to evaluate the relationship between dental caries and socioeconomic status of children attending paediatric dental clinic in UCH Ibadan.
Methods:
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).
Results:
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).
Conclusion:
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.
20.  Socio-demographic and behavioural correlates of oral hygiene status and oral health related quality of life, the Limpopo - Arusha school health project (LASH): A cross-sectional study 
BMC Pediatrics  2010;10:87.
Background
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.
Methods
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).
Results
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.
Conclusion
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.
doi:10.1186/1471-2431-10-87
PMCID: PMC3001697  PMID: 21118499
21.  Gaps in smiles and services: a cross-sectional study of dental caries in refugee-background children 
BMC Oral Health  2015;15:10.
Background
Refugees are reported to experience high rates of dental disease, although there are limited data on refugee children. The aim of this study was to report on oral health in refugee-background children in Australia, and to assess their follow-up at dental services.
Methods
Cross-sectional study of opportunistic oral health screening and subsequent dental service use in refugee-background children attending a refugee health clinic in Victoria, Australia, between November 2006 – November 2010.
Results
350 patients (0 – 18 years, mean age 8 years 7 months) had oral health screening; 241 (68.9%) were born overseas, (176 Africa, 65 other countries) and 109 (31.1%) were born in Australia to African-background families. Parents were concerned about oral health in 65/341 (19.1%) children, with specific concern about caries in only 9/341 (2.6%). On assessment, 155/336 (46.1%) had visible caries and 178/345 (51.6%) had caries experience (dmft/DMFT > 0). Where parents were concerned about caries, they were likely to be present (positive predictive value = 100%), however absence of parent concern about caries was not reassuring (negative predictive value = 56.1%).
Compared to Australian-born children of African background; African-born children were more likely to be referred for further dental care (adjusted PR 1.33, 95% CI [1.02 – 1.73]), although there was no statistically significant difference in caries prevalence. African-born children were less likely to have caries compared to other overseas-born children (adjusted PR 0.73, 95% CI [0.58 – 0.93]). Overall 187/344 (54.4%) children were referred for further dental care; 91/124 (73.4%) attended any dental appointment. Attendance rates were 90% with a phone reminder system for appointments, attendance reduced when this system lapsed.
Conclusions
Oral health is an important public health issue in refugee-background children, despite low levels of parent concern and very few parent reported caries. Routine direct oral health assessment is important in refugee-background children and co-ordinated health systems may help improve their attendance at dental services.
doi:10.1186/1472-6831-15-10
PMCID: PMC4324800  PMID: 25608733
Caries; Children; Dental services; Oral health; Refugee
22.  The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents 
BMC Oral Health  2014;14(1):123.
Background
To assess the prevalence of malocclusion among 12-18-year-old disabled adolescents in Chennai, Tamil Nadu, India, by using the Dental Aesthetic Index (DAI) and to determine the association of malocclusion with dental caries.
Methods
This cross-sectional study included 243 children with various mental disabilities with or without physical infirmities. The Dental Aesthetic Index (DAI) and the dentition status were recorded using the World Health Organization Oral Health Surveys – Basic Methods (1997) Pro-forma. The Decayed (D), Missing (M) and Filled (F) components of the DMF index were calculated using the Dentition Status and Treatment Need (DSTN). A Chi-square test, ANOVA, and t-test were used to derive inferential statistics.
Results
The mean DAI score ± standard deviation was 39.0 ± 12.3. A total of 123 (50.6%) participants (74 males and 49 females) had DAI scores of 36 and above, which indicated a handicapping malocclusion requiring mandatory orthodontic treatment. Sixty-nine (28.4%) adolescents (36 males and 33 females) had DAI scores between 31 and 35, which indicated severe malocclusion, for which orthodontic intervention was desirable. Incisal segment crowding (84.8%) was the most common aspect of the malocclusion. The mean DMFT score was 4.36 ± 3.81, and 82.8% of the participants had a DMFT score > 0. There was no statistically significant correlation between the mean DAI and DMFT scores (r = 0.090, p = 0.15). Only 16 (6.6%) of the adolescents had minor or no anomaly not needing orthodontic treatment.
Conclusions
The prevalence of malocclusion and dental caries was found to be high. However, there was no positive correlation between the severity of malocclusion and dental caries among the surveyed disabled adolescents.
doi:10.1186/1472-6831-14-123
PMCID: PMC4190396  PMID: 25273325
Dental caries; Malocclusion; Disabled children; Epidemiology; Mental retardation
23.  Survey on the Condition of First Permanent Molars in 15-year-old Students in Ahwaz, Iran in 2005 
Background and aims
Many children still face active and uncontrolled dental caries and data is needed for evaluating the situation in many parts of the country. The aim of the present survey was to evaluate the oral health of the young population of Ahwaz, Iran in 2005.
Materials and methods
In this descriptive cross-sectional study, 600 15-year-old students were se-lected randomly. Data was gathered with clinical examination and a questionnaire, collecting data of DMFT of first permanent molars, OHI-S, oral hygiene and nutrition habits, and parents’ education. Statistical analysis was performed by descriptive statistics and t-test.
Results
Mean DMFT of first permanent molars was 1.84 ± 1.54, with a higher value seen among girls. Mean decayed teeth component was 1.56, followed by filled (0.17) and missing (0.1) components. Higher DMFT values were significantly associated with poor OHI-S score (P = 0.001).
Conclusion
The observed oral hygiene status among the 15-year-olds necessitates implementing pre-ventive as well as restorative measures to improve the oral health status of the young population.
doi:10.5681/joddd.2008.012
PMCID: PMC3532736  PMID: 23289060
DMFT; first permanent molar; OHI-S
24.  Oral health of visually impaired schoolchildren in Khartoum State, Sudan 
BMC Oral Health  2013;13:33.
Background
Although oral health care is a vital component of overall health, it remains one of the greatest unattended needs among the disabled. The aim of this study was to assess the oral health status and oral health-related quality of life (Child-OIDP in 11-13-year-old) of the visually challenged school attendants in Khartoum State, the Sudan.
Methods
A school-based survey was conducted in Al-Nour institute [boys (66.3%), boarders (35.9%), and children with partial visual impairment (PVI) (44.6%)]. Two calibrated dentists examined the participants (n=79) using DMFT/dmft, Simplified Oral Hygiene Index (OHI-S), dental care index, and traumatic dental injuries (TDI) index. Oral health related quality of life (C-OIDP) was administered to 82 schoolchildren.
Results
Caries experience was 46.8%. Mean DMFT (age≥12, n=33) was 0.4 ± 0.7 (SiC 1.6), mean dmft (age<12, n=46) was 1.9 ±2.8 (SiC 3.4), mean OHIS 1.3 ± 0.9. Care Index was zero. One fifth of the children suffered TDI (19%). Almost one third (29%) of the 11–13 year old children reported an oral impact on their daily performances. A quarter of the schoolchildren (25.3%) required an urgent treatment need. Analysis showed that children with partial visual impairment (PVI) were 6.3 times (adjusted) more likely to be diagnosed with caries compared to children with complete visual impairment (CVI), and children with caries experience were 1.3 times (unadjusted) more likely to report an oral health related impact on quality of life.
Conclusions
Visually impaired schoolchildren are burdened with oral health problems, especially caries. Furthermore, the 11-13 year olds' burden with caries showed a significant impact on their quality of life.
doi:10.1186/1472-6831-13-33
PMCID: PMC3720199  PMID: 23866155
Visually impaired children; Oral health; Oral health-related quality of life
25.  A case-control study of determinants for high and low dental caries prevalence in Nevada youth 
BMC Oral Health  2010;10:24.
Background
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.
Methods
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.
Results
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.
Conclusions
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.
doi:10.1186/1472-6831-10-24
PMCID: PMC2989299  PMID: 21067620

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