Oral manifestations of systemic diseases

In the clinical examination for systemic diseases, inspection of the oral cavity is often overlooked. This area provides a wide array of clinical signs that may help the clinician establish a diagnosis. This article provides a summary of the more common oral manifestations of systemic disease.     

Oral health of adolescents

Background

Adolescence is a period of life marked by important changes: physical growth and development, emotional changes, the search for one’s own identity and an evolving role in society. Most of these changes will have an impact on health, also with respect of the oral cavity.

Aims

This contribution aims to give an overview of the problems faced by the adolescent (in general and more specifically related to the oral cavity) and the challenges for the dental professional (specific oral problems, challenge of communicating with adolescent patients). The main aim is to provide some useful hints for the follow-up of adolescent patients in everyday dental practice.

Results

Specific oral health concerns in adolescents will include changes in caries risk, dental erosion, trauma, periodontal disease, tooth positioning and malocclusion, emergence of wisdom teeth and so on. On top of this, adolescents are interested in tooth whitening and oral piercings, and they will experiment with tobacco, alcohol and drugs. All of these can further endanger oral health. The dental professional will be faced with a variety of these problems and will need to provide preventive and therapeutic solutions adapted to the specific situation of the adolescent. This necessitates some insight into the world of the adolescent of today. This is especially true since it is known that oral health-related behaviours (e.g. brushing habits, smoking and so on) developed during adolescence are carried over into adulthood and continue to influence (oral) health later in life. This underlines the need for intervention in this age group. However, in this period of life everything is questioned and communication between adolescents and adults is often dramatic. Although the specific effectiveness of following up adolescent patients is recognised, it is remarkable how poor dental literature is with regard to this topic.     

妊娠期妇女的口腔卫生预防保健

目的 调查妊娠期妇女的口腔健康状况及口腔健康教育状况.方法 对500例孕妇患龋率、牙周病及自我保健意识进行调查分析.结果 妊娠期龋齿及牙龈炎患病率分别为49.67%和75.68%, 软垢及牙石发生率分别为86.87%和52.41%,而龋齿和牙龈炎就诊率仅为3.38%,92.32%的孕妇未接受过口腔健康教育.结论 缺乏口腔保健意识和不良口腔卫生习惯是影响孕妇口腔健康状况的主要原因.     

Oral health, hygiene practices and oral cancer

OBJECTIVE: To assess the association between oral health and hygiene practices and oral cancer. METHODS: Hospital-based case-control study in the metropolitan area of S?o Paulo, southeastern Brazil, from 1998 to 2002. A total 309 patients with squamous cell carcinoma of the mouth and the pharynx and 468 controls matched by sex and age were included in the study. Cases were recruited in seven reference hospitals and controls were selected in five out of the seven participating hospitals. Detailed information on smoking, alcohol consumption, schooling, oral health status and hygiene practices were obtained through interviews. Odds ratios (OR) and 95% confidence intervals (95% CI), adjusted by sex, age, schooling, smoking, alcohol consumption as well as the variables oral health status and hygiene practices were estimated using unconditional logistic regression analyses. RESULTS: The use of complete dental prosthesis was not associated with oral cancer but regular gum bleeding showed a strong association (OR 3.1; 95% CI 1.2-7.9). Those who never attended a dental visit were more likely to have oral cancer (OR 2.5; 95% CI 1.3-4.8). Daily mouthwash use showed a stronger association to pharynx (OR 4.7; 95% CI 1.8-12.5) than mouth cancer (OR 3.2; 95% CI 1.6-6.3). CONCLUSIONS: Gum bleeding, no dental care, and daily mouthwash use were factors associated with oral cancer regardless of tobacco and alcohol consumption.     

Oral health and nutritional status in Egyptian elderly

A cross-sectional sample of 253 ambulatory elderly Egyptians (99 males and 154 females) of minimal age, 60 y, living in the metropolitan Cairo area was investigated. Nutritional status assessment was based on body weight, mid-upper arm circumference and skinfold thickness. Additionally, three nutritional indices, namely body mass index, index of adiposity and index of muscularity, were computed. The oral cavity was examined clinically to evaluate the number and health condition of teeth present. Results showed that the anthropometric nutritional indicators were higher than expected, however, they decreased by age in both sexes. In addition, the values of body mass index and index of adiposity in females were significantly higher than in males, while the reverse was observed in regards to muscularity index (p < 0.05). The three nutritional indices in dentate subjects were slightly higher than those in edentulous ones. Moreover, within the dentate groups there was a tendency for increased values of these indices by the increasing number of healthy teeth.     

Oral health behaviour and self-esteem in Swedish children

This study focus on the socio-psychological concept of self-esteem and examines its association with oral health behaviour and with some background variables that have been shown to be of importance in previous studies. In 1995, 3370 12-year-olds answered a questionnaire on social and demographic factors. Questions on attitudes and behaviour were also included. After reducing the number of variables and constructing new variables, multivariate analyses were performed. A polytomous regression on self-esteem showed that having very poor self-esteem as opposed to poor, good and very good self-esteem was associated with being a girl, not living with one's biological parents, poor social support, having less interest in politics, poor adaptation in school and poor oral health behaviour. The results also showed that being a boy, choosing statements reflecting less exemplary behaviour, and being less well adapted in school increased the risk of having poor oral health behaviour, as did ethnic group affiliation and having poor self-esteem. Our results showed that self-esteem is a crucial intervening variable between variables measuring social background and outcome variables, especially oral health behaviour.     

Oral health care services in Europe

Health care is being reformed in Europe. Comparative analyses of oral health care services are scarce. Little is known about the relationship between organisation and financing of services and the effectiveness, efficiency and equity of the services. The purpose of the paper is to present some features of the delivery of oral health care services and to discuss some recent changes in a public health perspective. Some of the recent changes in oral health care are: Decentralisation of management in the public services, less third party payment and higher patient charges, more emphasis on free consumer choice. The dominant model of delivery of oral health care is the single private practitioner. The traditional structure of delivery of dental services is challenged by the demands of societies. There seems to be a trade-off between simplicity and the tailor-made mixed payments: gains in degree of freedom through the use of mixed payment systems have to be balanced against losses in terms of simplicity of implementation and equality of the oral health outcome. The roles of the provider, the consumer and the financing institutions are imbedded in trust and regulation. There is therefore a growing recognition of the necessity for a strong role of public health.     

A systemic approach to occupational and environmental health

As the corporate role in occupational and public health receives increased scrutiny, it is essential to recognize that it is not sufficient to identify specific acts of malfeasance or influence, or even to campaign to address them. A more comprehensive and systemic framework for understanding the role of corporations requires consideration of corporate power and its effects as endemic features of national socioeconomic systems and the rapidly integrating global order. The underlying social structures that produce social and environmental problems, and undermine reform, make systemic change necessary. Identifying this "structure of harm" provides important implications for researchers, policymakers, activists, and others trying to address environmental and social problems, particularly with regard to integrating efforts to address immediate impacts with those for longer-term, systemic change.     

Oral and systemic HPV antibody kinetics post-vaccination among HIV-positive and HIV-negative men

Duration and functional aspects of the oral and systemic antibody responses following HPV vaccination in HIV-negative (HIV^?) and HIV-positive (HIV⁺) men are not well characterized. Oral and systemic HPV-16 and HPV-18-specific antibody levels were evaluated over 18-months of follow-up, in HIV⁺ and HIV^? men. Sera and oral gargles from 147 HIV^? men, ages 27–45 and 75 HIV⁺ men, ages 22–61, who received 3-doses of quadrivalent HPV vaccine were tested for HPV-16 and HPV-18 antibodies at Day 1, Month 7 (1?month post-dose 3), and Month 18 (12?months post-dose 3) and HPV avidity (Day 1, and Month 7) using L1-VLP ELISA.All individuals seroconverted, regardless of HIV-status, following 3-doses of vaccine for HPV-16 and HPV-18. Serum HPV-16 and HPV-18 antibody geometric mean levels were >2-fold lower in HIV⁺ compared to HIV^? men at Month 7 (HPV-16: 808.5 versus 2119.8?EU/mL, and HPV-18: 285.8 versus 611.6?EU/mL, p?<?0.001) but not significantly different at Month 18 (HPV-16: 281.8 versus 359.7?EU/mL, p?=?0.145, and HPV-18: 120.2 versus 93.4?EU/mL, p?=?0.372). Post-vaccination, only oral HPV-16 antibody levels at Month 7 were significantly different between HIV⁺ and HIV^? men (127.7 versus 177.1?EU/mg of IgG, p?=?0.008). Among baseline HPV-seronegative men, circulating levels of HPV-16 and HPV-18 antibodies were up to >3 fold lower in HIV⁺ men, at Months 7 and 18. In contrast, levels of HPV-16 and HPV-18 antibodies after vaccination were not inferior in baseline HPV-seropositive, HIV⁺ men. HPV-16 and HPV-18 avidity was lower among HIV⁺ compared to HIV^? men at Month 7 (HPV-16: 1.95?M versus 2.12?M, p?=?0.027; HPV-18: 1.50?M versus 1.72?M, p?<?0.001).Although differences in peak antibody levels were observed between HIV⁺ and HIV^? men following 3 doses of vaccine, plateau antibody levels were overall comparable, and avidity was relatively high for both groups. These data indicate that the vaccine induced antibody affinity maturation in both HIV⁺ and HIV^? men and will likely result in long-term protective immune responses.     

Oral health: a challenge for the health care team

The objective of this study is to reveal the knowledge of nursing and medicine students from a university in Rio Grande do Sul regarding the importance of promoting dental health. A questionnaire with three semi-structured questions was answered by 26 students from the nursing school, and by 32 students from the medical school. Through the method of triangulation it was concluded that these students had deficient knowledge regarding dental health. Since a small number of the population in Brazil has access to dental clinics, we consider important that nursing and medicine professionals know how to promote dental care among children.     

Oral health information systems--towards measuring progress in oral health promotion and disease prevention

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide.