Self – perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys

Background  

Clinical (normative) and subjective (self-assessment) evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self–perceived assessment) as compared to clinical examinations (normative assessment) and to evaluate the implications of the results in understanding the public's perception of oral health.     

Can Questionnaires Replace Clinical Surveys to Assess Dental Treatment Needs of Adults?

OBJECTIVE: The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK. METHODS: A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard. RESULTS: Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need. CONCLUSIONS: Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities.     

Dental health and treatment needs among a sample of Bangladeshi medical users aged 40 years and over living in Tower Hamlets, UK

AIM: To assess the dental health status and treatment needs of Bangladeshi medical care users aged 40 years and over and to explore the relationship of oral disease status, tobacco usage and paan (betel quid) chewing. DESIGN: Multi-centre cross-sectional study. SETTING: General medical practitioners' waiting areas in Tower Hamlets, UK. SUBJECTS: 185 Bangladeshi adults aged 40 years and over. INTERVENTION: A clinical examination and an interview schedule. MEASURES: Dental status, periodontal status, dental plaque, calculus and denture status. Tobacco smoking and paan chewing behaviour. RESULTS: The response rate was 74%. 85% of participants were dentate with an average number of 24 (SD +/- 5.4) standing teeth. The mean DMFT score was 5.38, with missing teeth (3.81) being the major component. The decayed component was 0.43 and the filled was 1.14. 46% of participants were assessed as being free from gingivitis. Significant relationships between chewing paan and aspects of dental and periodontal status were found. Impacts of oral health were reported by 45% of the respondents. The normative need for dental treatment was 96% with a perceived need of 48%. CONCLUSION: There was considerable normative dental need. Whilst caries experience was low, there were high levels of periodontal treatment needs. Paan chewing was related to aspects of dental and periodontal status.     

Quality evaluation of oral health record-keeping for Finnish young adults

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.     

A baseline survey: oral health status of prisoners--Western Cape.

South African prison populations continue to grow because of the escalating crime and an overstretched judicial system. The aim of this study was to assess the oral health status of prison inmates in the Western Cape (Pollsmoor, Goodwood, Paarl and Worcester). A cross-sectional epidemiological survey involving a clinical oral examination and face-to-face interviews was used to collect information on DMFT, periodontal health, perceived needs and the knowledge, attitudes and behaviour of inmates to oral health. Clinical examinations were carried out using WHO criteria. Of the 340 study participants, 264 were male and 76 were female. The prevalence of oral disease was high. The mean DMFT was 15.45 and the total DMFT increased with age. There was a reported impact on oral health quality of life, with many citing problems with eating, drinking and pain. Self-reported dental needs indicated a perceived need for dentures, scaling and fillings. Over two thirds of the sample (72%) reported that the dental services that they presently receive are poor. This study found a high prevalence of dental caries and periodontal disease among the correctional service populations. There is an urgent need for the development of a basic oral health care package that should be offered to all inmates as eventually many of them will be returning to the community.     

Association of self-perceived periodontal status with oral hygiene, probing depth and alveolar bone level among young adults

The literature regarding self-reported dental/oral health data suggests that certain self-reported information is valid. The objective of this study was to show whether self-perceived periodontal conditions can predict actual periodontal status measured by probing depth and radiographic bone level. Participants completed a questionnaire regarding systemic health, education, smoking status, oral hygiene habits and self-perception of their own periodontal status using a visual analog scale (VAS); they were examined clinically and radiographically. More than two-thirds self-perceived their periodontal status as between 5 and 8 (out of 10). Smoking was related to radiographic bone loss, but not to the number of sites with PD > or = 5mm. Periodontal self-assessment correlated with the number of sites with PD > or = 5mm (p = 0.013), the number of sites with radiographic bone loss > or = 3 mm (p = 0.045), as well as with plaque index (p = 0.003) and daily flossing (p = 0.022). For a cutoff of 5 in the VAS score, sensitivity of 84% and specificity of 22% were found for high PD and sensitivity of 85% and specificity of 24% for bone loss.     

Oral health-related quality of life, sense of coherence and dental anxiety: an epidemiological cross-sectional study of middle-aged women

ABSTRACT: BACKGROUND: Few publications report on the relationship between salutogenesis, as measured by the concept of sense of coherence, and oral health-related quality of life. Even less information is to be found when the behavioural aspect of dental anxiety is added. The aim of the present study was to evaluate how oral health-related quality of life is related to sense of coherence and dental anxiety. METHOD: The study had a cross-sectional design and included 500 randomly selected women in Gothenburg, Sweden, 38 and 50 years of age, from health examinations in 2004-05. The survey included questionnaires covering global questions concerning socio-economic status, oral health/function and dental care behaviour, and tests of oral health-related quality of life, sense of coherence, and dental anxiety. RESULTS: High dental anxiety and low sense of coherence predicted low oral health-related quality of life. In addition, socioeconomic status as measured by income, perceived oral functional status as captured by chewing ability and self-reported susceptibility to periodontal disease were also important predictors of oral health-related quality of life. CONCLUSION: Dental anxiety and sense of coherence had an inverse relationship with regard to oral health-related quality of life. These associations were stronger than other risk factors for low oral health-related quality of life.     

Oral health and its impact on the life quality of homeless people in Hong Kong

OBJECTIVES: To report on the oral health status and its impact on the life quality of homeless people in Hong Kong. DESIGN: A cross sectional epidemiological survey involving clinical oral examinations and face-to-face interviews with 147 homeless participants. Clinical examinations were carried out following WHO criteria. The impact of oral health on quality of life was assessed with the short form of Oral Health Impact Profile, OHIP-14. RESULTS: Over 90% had caries experience and most related to untreated decay. The mean DMFT score for dentate subjects was 8.1 (DT = 3.4, MT = 4.0, FT = 0.7). Periodontal disease was highly prevalent, 96% having periodontal pockets. The burden of oral health on their daily lives was common, 88% reporting an oral health impact within the past year. A multiple regression analysis indicated that the OHIP-14 score had significant associations with self-rated oral health, dental pain, employment status and length of time being homeless (p < 0.05). Those who assessed rated oral health as 'poor/very poor', reported dental pain in the past year, were unemployed, and homeless for more than one year had poorer oral health related quality of life (significantly higher OHIP scores) than their counterparts. CONCLUSION: Among the homeless population studied, oral health status was poor and its impact on their life quality was substantial. The oral health impact was associated with socio-demographics and perceived dental problems.     

Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care

OBJECTIVE: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care. METHODS: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale. RESULTS: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem. CONCLUSIONS: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.     

Oral health status of homeless people in Hong Kong

The authors report on an oral health survey among Hong Kong Chinese homeless people. A total of 140 homeless men underwent clinical examination and were interviewed with a structured questionnaire. More than 90% had evidence of caries experience; most (75%) were related to untreated caries. The mean DMFT score was 9.0 (DT=3.2, MT=5.2. FT=0.6). Periodontal disease was highly prevalent, with 96% having periodontal pockets. The dental problems most frequently reported by the homeless were: bleeding gums or drifting teeth (62%), dental pain (52%) and tooth trauma (38%). More than 70% of the study's participants perceived a need for dental care. The population surveyed had poorer oral health compared to the general population. High levels of dental needs, both normative and perceived, were found. There is a need to provide more accessible and affordable oral health services to this group of people.     

A Two‐Domain Self‐Report Measure of Periodontal Disease Has Good Accuracy for Periodontitis Screening in Dental School Outpatients

Background: The assessment of periodontitis and treatment needs is primarily based on clinical and radiographic examinations. Albeit effective in predicting treatment needs, these examinations are costly, time‐consuming, and impractical for assessing population‐level needs. The purpose of the present study is to evaluate a two‐domain self‐report questionnaire for rapid periodontitis screening. Methods: Six hundred white adult individuals, dentate or partially dentate and seeking dental therapy at a university clinic, underwent oral examination utilizing the full‐mouth Community Periodontal Index of Treatment Needs (CPITN). To assess predictive value of self‐reported periodontal measures (SRPMs) for periodontitis screening, four questions were formulated. Two questions aimed to assess “dentist‐diagnosed periodontal disease” and two inquired about “self‐assessed periodontitis.” Multiple logistic regression models were used to construct receiver‐operating characteristic curves, and predictor selection was performed via a forward stepwise selection process. Results: Five hundred thirty‐five volunteers with a mean age of 50.1 years elected to respond to SRPMs via telephone interview. After oral examination, 17.8% of participants were assessed as having CPITN = 4, representing compromised periodontal status. Sensitivity and specificity for correctly classifying compromised periodontal status ranged from 5.3% to 72.6%, and 87.8% to 99.5% for individual SRPMs. Sensitivity and specificity were increased when combining a measure of self‐assessed periodontal disease and a measure of dentist‐diagnosed disease as predictors. Addition of age and sex maximized sensitivity/specificity at 82.1%/82.2%. Diabetic status, smoking, and body mass index did not enhance the prediction. Conclusions: A two‐domain self‐report measure combining two self‐report items with age and sex has good sensitivity and specificity for periodontitis screening in a white, university‐based population. The proposed self‐report measure can be valuable for periodontitis screening in resource‐limited settings where gold standard clinical examination may not be pragmatic. Further validation studies are required to assess whether findings from this study are context‐specific.     

Health behaviors and their relation to metabolic control and periodontal status in type 2 diabetic patients: a model tested using a linear structural relations program

BACKGROUND: Although it has been reported that diabetic control is beneficial in managing periodontal disease, there are few studies in the literature where the relationship between singular behavioral factors and periodontal status has been examined. The aim of this study was to examine the simultaneous interrelationships among selected medical/dental variables and 5 behavior components with general health behavior (GHB), perceived fatigue (PF), diet control (DC), regular diet (RD), and dental behavioral inventory (HU-DBI) scores, using data from a study of 102 type 2 diabetic patients. METHODS: A hypothesized model was tested by a linear structural relations program (LISREL). RESULTS: There was a significant correlation between oral health behavior and calculus accumulation (r = 0.399; P<0.001). Correlations were found between calculus and periodontal status measured by gingivitis index and probing depth (r = 0.232; P<0.05, r = 0.279; P<0.01, respectively). The final model was found to be consistent with the data (chi2 = 55.0, df = 47, P = 0.197; GFI = 0.922). Oral health behavior affected periodontal status through its effect on calculus but not plaque accumulation. General health behavior had significant effects on oral health behavior and diet behavior (P<0.05 and P<0.001, respectively). Diet behavior affected both plaque accumulation and metabolic control (P<0.05 and P<0.01, respectively). However, the result was the virtual absence of a significant pass coefficient between metabolic control and periodontal status. CONCLUSIONS: The severity of the 2 diseases seemed to be connected indirectly through health behaviors such as diet behavior and oral health behavior.     

Use of clinical services compared with patients' perceptions of and satisfaction with oral health status

OBJECTIVES: To examine the relationship between rates of clinical service use and self-reported perception of and satisfaction with oral health status. METHODS: Dental services provision rates were calculated using health maintenance organization electronic data for members 55 years of age and older with at least four years of eligibility between 1990 and 2000. A mail survey yielded 986 responses (response rate = 65.7%). Poisson regression was used to examine the relationship between service utilization rates and self-reported perception of and satisfaction with oral health status, controlling for age, education, sex, and marital status. RESULTS: Perceptions of oral health status and levels of satisfaction with oral health status generally were closely associated. Greater dissatisfaction with oral health status and perception of poorer oral health status were associated with higher usage of nonpreventive dental services. Less satisfaction with oral health status was associated with higher restorative services usage and lower preventive services usage and slightly associated with periodontal service usage. Perception of a less favorable oral health status was strongly associated with higher restorative and periodontal services usage, but had only a weak association with preventive services usage. CONCLUSIONS: Dental plan members' service use is associated with their perception of their oral health status and their level of satisfaction with it. Future work should seek to clarify whether opinions on oral health status and satisfaction are a result of clinical experiences over time or whether the behavior and the values associated with seeking and obtaining care instead shape opinions on status and satisfaction.     

Factors associated with perceived oral health status in older individuals

AIM: To assess factors associated with perception of oral health in older individuals. DESIGN: A cross sectional study. SETTING: A densely populated urban area in Sri Lanka. PARTICIPANTS: 585 older adults aged 60 years and above of which 475 were living at home and 110 in institutions. The present analysis is limited to 235 subjects who were subjected to a clinical oral examination. METHOD: The data were collected by means of an interviewer-administered questionnaire and a clinical oral examination. RESULTS: Overall, 48% of the dentate and 42% of the edentate perceived their oral health as poor. The final model of the hierarchical logistic regression analysis for the dentate revealed that presence of retained roots, mobile teeth, >20 missing teeth and perceived need for dental care were significantly associated with poor perceived oral health status. For the edentate, perceived need for dental care, loss of taste sensation and difficulty in eating were significantly associated with poor perceived oral health status. CONCLUSIONS: Factors associated with perceived oral health status differed between the dentate and the edentate. Clinical oral health indicators emerged as significant predictors of perceived oral health status in the dentate although the explanatory power of these indicators on perception of oral health was low.     

Eating disorders and oral health: a matched case-control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.     

Oral health attitudes, knowledge, and behavior among school children in North Jordan

The aim of this study was to assess the knowledge, attitude, and behavior of school children towards oral health and dental care as well as to evaluate the factors that determine these variables. School children (n=557) of an average age of 13.5 years attending public schools in North Jordan were recruited into this study. The subjects completed a questionnaire that aimed to evaluate young school children's behavior, knowledge, and perception of their oral health and dental treatment. The participants' oral hygiene habits (such as tooth brushing) were found to be irregular, and parents' role in the oral hygiene habits of their children was limited. The study population showed higher awareness of caries than periodontal conditions. Irregular visits to the dentist were found to be common, and toothache was the major driving factor for dental visits. Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. The children in this study also recognized the importance of oral health to the well-being of the rest of the body. Parents were not proactive in making sure that their children received regular dental care. Parents' knowledge and attitudes about the importance of oral health care and their fears about dental treatment influenced their children's dental care. The results of this study indicate that children's and parents' attitudes toward oral health and dental care need to be improved. Comprehensive oral health educational programs for both children and their parents are required to achieve this goal.     

Childhood caries in the state of Kentucky,USA: a cross-sectional study

Background

Few publications report on the relationship between salutogenesis, as measured by the concept of sense of coherence, and oral health-related quality of life. Even less information is to be found when the behavioural aspect of dental anxiety is added. The aim of the present study was to evaluate how oral health-related quality of life is related to sense of coherence and dental anxiety.

Method

The study had a cross-sectional design and included 500 randomly selected women in Gothenburg, Sweden, 38 and 50 years of age, from health examinations in 2004–05. The survey included questionnaires covering global questions concerning socio-economic status, oral health/function and dental care behaviour, and tests of oral health-related quality of life, sense of coherence, and dental anxiety.

Results

High dental anxiety and low sense of coherence predicted low oral health-related quality of life. In addition, socioeconomic status as measured by income, perceived oral functional status as captured by chewing ability and self-reported susceptibility to periodontal disease were also important predictors of oral health-related quality of life.

Conclusion

Dental anxiety and sense of coherence had an inverse relationship with regard to oral health-related quality of life. These associations were stronger than other risk factors for low oral health-related quality of life.

     

A comparison of perceived and actual dental needs of a select group of children in Texas.

Dental caries (DMFS) evaluations were made for 150 children in Grades 2 to 7. Three months later, a trained interviewer questioned 120 children from 100 families to determine atitudes toward oral hygiene and dental health on the part of (a) the child, (b) the parent, along with (c) the child's perception of the parent's attitude, and (d) the parent's perception of the child's attitude. Evaluation of the perceived attitudes toward oral hygiene revealed a statistically significant correlation between the child's attitude and the degree of dental health as well as between the attitudes of child and parent. Conclusions were: (1) parents were not accurate in their perception of the dental health habits of their children, (2) children were not performing acceptable routine oral hygiene procedures, (3) children accurately perceived the attitudes of their parents toward dental health, and (4) children's actual dental health behavior as manifested by dental health status was related to the attitudes of their parents.     

Relationships among dental functional status, clinical dental measures, and generic health measures

Current measures of dental health status are primarily clinical in nature and rely on clinical and radiographic assessment of the patient's dental health. Information about a patient's ability to perform usual activities related to good dental health--for example, chewing, speaking, and smiling--is not routinely collected. This study investigated what measures contribute to dental functional status, how they are related to traditional clinical measures, whether dental factors contribute to other generic measures of health, and the extent to which dental factors contribute to overall quality of life. Regression analyses of interview and clinical data from 159 dental patients show that while periodontal status and the number of dental symptoms do explain some of dental functional status, the clinical measures of decayed, missing, and filled teeth do not. Severity of medical condition is correlated with decayed/missing teeth and periodontal health. Quality of life is explained by medical functional status, perceived medical health, and perceived dental health. The dental functional status index may be useful in clarifying the relationship between dental health and overall health and quality of life measures.