The influence of peer social networks on toothbrushing behaviour in Iranian adolescents in Mashhad

Dorri M, Sheiham A, Watt R. The influence of peer social networks on toothbrushing behaviour in Iranian adolescents in Mashhad. Community Dent Oral Epidemiol 2010; 38: 498–506. © 2010 John Wiley & Sons A/S Abstract – Objectives: This study aimed to assess the association between the quality and quantity of peer social networks and toothbrushing behaviours of Iranian adolescents in Mashhad. The second objective was to examine whether peer social networks go some way to explain the sex difference in toothbrushing behaviours in Iranian adolescents in Mashhad. Methods: A representative stratified random sample of 1132 sixth grade Iranian students in Mashhad, with an average age of 12.4 (SD = 0.8) years, answered a 37‐item questionnaire. The questionnaire had items on sociodemographic characteristics (age, sex and parents’ education level), education achievement (last year’s final average mark), frequency of toothbrushing behaviours and peer social networks (number of close friends, frequency of meeting friends, club membership and quality of peer groups). Binary logistic regression analysis was employed to test the association between toothbrushing frequency and peer social networks. Results: Adolescents who met their friends moderately often and had stronger ties with their friends were more likely to brush their teeth twice or more a day; P = 0.05 and P < 0.001, respectively. Club membership and number of close friends were not associated with toothbrushing frequency. Girls were significantly more likely to brush their teeth twice or more a day. They had weaker peer social networks than boys (P < 0.001). When adjusted for sex and father’s education level, all peer social networks variables were significantly associated with toothbrushing frequency. However, the interaction between sex and peer social networks variables was not significant. Conclusions: Peer social networks are related to toothbrushing frequency among Iranian adolescents in Mashhad but do not explain the differences in toothbrushing frequency between sixth grade Iranian boys and girls.     

Frequency of orthodontic treatment in German children and adolescents: influence of age, gender, and socio-economic status

Orthodontic treatment is a common dental procedure in developed countries. However, the frequency and factors associated with treatment demand are different between countries. The aim of this study was to examine the frequency of orthodontic treatment in German children and adolescents and to analyse the influence of age, gender, and socio-economic status (SES; education and region) on the frequency of treatment. Subjects in a random population sample of 1538 German children and adolescents, aged 11-14 years, were interviewed at home in the autumn of 2008 regarding current orthodontic treatment and associated factors. Approximately one-third (33.5 per cent) of the subjects interviewed were undergoing orthodontic treatment at that time. In a multivariable logistic regression model, the likelihood of receiving orthodontic treatment was higher for girls [odds ratio (OR) = 1.32, 95 per cent confidence interval (CI): 1.06-1.65], for high school pupils (OR = 1.19, 95 per cent CI: 1.06-1.34), and for children and adolescents living in the western part of Germany (OR = 1.45, 95 per cent CI: 1.00-2.08) and increased with age (OR = 1.13 per year, 95 per cent CI: 1.02-1.25). Subjects undergoing orthodontic treatment more often received prophylactic measures (OR = 2.06, 95 per cent CI: 1.63-2.59) compared with those not currently receiving orthodontic treatment. The frequency of orthodontic treatment in Germany largely depends on gender and SES.     

Estimation and comparison of significant caries index and the pattern of sugar consumption among 12-year-old school going children of two different socioeconomic strata.

The purpose of this study was to estimate and compare the Significant Caries Index (SiC), the pattern of sugar consumption, and to know the oral hygiene practices in a sample of 200, 12-year-old school going children of two different social classes residing in both urban and rural areas. The subjects were divided into two social classes based on the per capita monthly income. Twenty-four hour dietary records of five consecutive days were obtained from each subject. The results showed that all the subjects brushed daily. More number of children belonging to social class I and urban area brushed twice a day. While there were no significant differences in DMFT among the study groups, SiC index was higher in males, subjects of social class I, and urban residents. Sweet score, Total sugar exposure and Between-meal sugar exposure were more in males, subjects of social class I, and urban residents, whereas At-meal sugar exposure was more in females, subjects of social class II, and rural residents. From a preventive point of view, males, subjects of higher socioeconomic background, and urban residents seem to be the most important target groups for dental health communication programs focusing on the frequency of sugar consumption and dietary counselling.     

Communication skills instruction utilizing interdisciplinary peer teachers: program development and student perceptions

Lack of curricular time, faculty time, and funding are potential limitations for communication skills training in dentistry. Interdisciplinary collaboration amongst health care faculties could address these limitations. This article describes the development, implementation, and student perceptions of a communication skills program in dentistry. The program has four components: Knowledge, Observation, Simulation, and Experience (KOSE) and spans over the second and third years of dental school. KOSE allows students to obtain knowledge of and observe effective communication skills and practice these skills in the simulated and nonsimulated environment. A key feature of KOSE is the utilization of fourth-year medical and dental students as peer teachers. Evaluation of KOSE was geared toward student perceptions. Cross-sectional data were gathered via written surveys from 143 learners (second- and third-year dental students) in 2006-07. Students perceived the ability to recognize effective communication, demonstrated awareness of their communication strengths and weaknesses, and reported that skills gained were transferable to actual patient care. Interdisciplinary collaboration was a feasible way to address the lack of resources in the development of a communications skills program, which was perceived to be worthwhile by learners.     

Flossing behaviour in English adolescents

Abstract. The aim of this study was to investigate the relation between flossing behaviour and other health, cleanliness and social behaviours in adolescents. Data from a survey of 41142, 12–16-year-old children from 244 secondary schools throughout England were analysed to obtain information about flossing frequency, dental attendance and recalled advice about flossing, and some general cleanliness and social behaviours. Subjects completed a questionnaire, anonymously, in class during normal school hours. Flossing frequency was found to change with age, its use becoming less frequent from age 12 through age 16 years. There was a significant relationship between flossing frequency and the time since the last dental attendance, the more recent attenders flossing more frequently, 6% of subjects recalled receiving advice about flossing at their last dental attendance and higher proportions of those who used floss recalled such advice, compared with non-flossers. Flossing frequency was also found to correlate positively with frequencies of washing hands after visiting the lavatory and bathing, and having a current friend of the opposite gender. There was only a small association between smoking habit and flossing, and only in school years 8 and 10: subjects most committed to smoking used floss slightly more frequently than those who did not smoke. Factor analysis showed evidence of gender differences in perceptions of flossing. Males equated use of floss with health-related behaviours while females associated flossing more with cleanliness behaviours. This finding is consistent with gender differences in toothbrushing behaviour reported in previous studies. The present study provides further insights into the history of dental flossing.     

Long-term treatment outcome for adolescents with temporomandibular pain

Objectives: This study aims to evaluate long-term, self-perceived outcome in adulthood for individuals treated as adolescents for temporomandibular disorder (TMD) pain in two previous randomized controlled trials (RCTs).

Materials and methods: The study included 116 subjects (81% females) treated for frequent TMD pain in two separate RCTs 5–21 (M?=?14.8, SD =4.9) years previously. Treatment consisted of occlusal appliance (OA) (n?=?41, 35.3%) or relaxation training (RT) combined with information for the control (Co) group (n?=?50, 43.1%), both compared to non-responders receiving additional, sequential treatment (ST) in a crossover study (n?=?25, 21.6%). Participants answered a questionnaire on their experience of frequency and intensity of TMD pain impaired chewing capacity and daily social activities, help-seeking behaviour and treatment, general health, other pain, and depressive symptoms.

Results: Older participants reported lower levels of frequency and intensity of TMD pain, impairment, and depressive symptoms, as well as better general health. Females reported more frequent and more intense TMD pain, greater impairment and more often reported ‘other pain’ compared to males. Non-responders receiving ST experienced significantly more TMD, and other pain and higher impairment levels compared to other groups. Those treated with an OA had sought additional treatment significantly less often since the RCTs than ST and RT/Co-treated individuals.

Conclusions: Adolescents treated with OA showed somewhat better sustained improvement over the extended follow-up period than those treated with RT/Co. Non-responders to treatment and females exhibited a poorer outcome. These groups need particular attention and extended or different treatments to achieve a better long-term outcome.     

Lifestyle and psychosocial correlates of oral hygiene practice among Indonesian adolescents

Poor oral hygiene leads to poor oral health, which in turn has negative impacts on overall health and quality of life. This study aimed to evaluate the prevalence and associated factors of oral hygiene practice among school‐going adolescents in Indonesia. Secondary analysis of cross‐sectional, nationally representative data from the 2015 Indonesia Global School‐based Health Survey, covering 11,142 students aged 11‐18 years, was performed. Multiple logistic regression was employed to explore associations between lifestyle, psychosocial factors, and tooth‐brushing frequency. Around 10.8% of the students brushed their teeth less frequently than the recommended twice‐daily regimen. Male gender, lower socio‐economic status, poor dietary practice, longer sedentary time, drug use, psychological distress, less peer support, and no parental support were associated with infrequent tooth brushing. The findings support the need to integrate oral health promotion into general health actions that target families, schools, and social environments of adolescents to develop healthier habits.     

Social acceptance and facial behavior in children with oral clefts.

OBJECTIVE: To examine and compare social acceptance, social behavior, and facial movements of children with and without oral clefts in an experimental setting. DESIGN: Two groups of children (with and without oral clefts) were videotaped in a structured social interaction with a peer confederate, when listening to emotional stories, and when told to pose specific facial expressions. PARTICIPANTS: Twenty-four children and adolescents ages 7 to 16(1)/(2) years with oral clefts were group matched for gender, grade, and socioeconomic status with 25 noncleft controls. MAIN OUTCOME MEASURES: Specific social and facial behaviors coded from videotapes; Harter Self-Perception Profile, Social Acceptance subscale. RESULTS: Significant between-group differences were obtained. Children in the cleft group more often displayed "Tongue Out," "Eye Contact," "Mimicry," and "Initiates Conversation." For the cleft group, "Gaze Avoidance" was significantly negatively correlated with social acceptance scores. The groups were comparable in their ability to pose and spontaneously express facial emotion. CONCLUSIONS: When comparing children with and without oral clefts in an experimental setting, with a relatively small sample size, behavior analysis identified some significant differences in patterns of social behavior but not in the ability to express facial emotion. Results suggest that many children with oral clefts may have relatively typical social development. However, for those who do have social competence deficits, systematic behavioral observation of atypical social responses may help individualize social skills interventions.     

Temporomandibular disorders in adolescents. Epidemiological and methodological studies and a randomized controlled trial

The aim of the present thesis was to investigate different aspects of temporomandibular disorders (TMD) and pain such as prevalence, diagnostics, and treatment among adolescents. The reliability of a questionnaire and the clinical examination and diagnoses according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were assessed. Overall, we found it possible to assess and diagnose TMD in adolescents in a reliable way. The prevalence of TMD pain, gender differences, and the need for treatment were investigated among 864 adolescents from a Public Dental Service clinic. Seven percent of the subjects received a pain diagnosis according to the RDC/TMD, and the prevalence was higher among girls than boys. More subjects with TMD pain reported school absence and analgesic consumption compared to controls. Approximately every second subject who reported TMD pain also perceived a need for treatment. In an evaluation of psychosocial and dental factors, the following were found to play an important role in adolescents with TMD: stress, somatic complaints, and emotional problems. Three treatment methods were compared in a randomized controlled trial: brief information only, brief information and occlusal appliance, and brief information and relaxation therapy. In the brief information and occlusal appliance group, 60%--significantly more than in the other two groups--experienced a reduction of at least 50% in TMD pain. The influence of somatic and emotional stimuli was evaluated, and we found that adolescents with TMD pain were significantly more sensitive to not only aversive somatic but also pleasant somatic stimuli compared with healthy controls. The results suggest that not only nociceptive but also cognitive processes are implicated in chronic pain states in young TMD subjects. In conclusion, TMD pain is more common in girls than in boys and affects daily life. TMD pain in adolescents can best be improved by traditional treatment with occlusal appliance combined with brief information.     

Oral health behaviours according to demographic characteristics in Korean adolescents: a national representative sample

Objectives: To provide information on how to teach correct oral health behaviour to youths and to develop programmes to that end, this study examined the oral health behaviour and demographic characteristics of adolescents. Methods: The raw data of ‘The Third 2007 Youth Health Behavior Online Survey’ carried out by the Korea Center for Disease Control and Prevention were analysed. Independent t‐test, one‐way ANOVA, and chi‐squared analyses were used to assess the relationships between oral health behaviours and demographic characteristics. Results: The oral health behaviour of the adolescents who were investigated differed significantly depending on their demographic characteristics (P < 0.001). Tooth brushing frequency differed significantly depending on gender and student grade (P < 0.001) and the frequency of visits to a dental clinic differed depending on the gender, student grade, type of residential area (urban/rural), and type of school (middle or high) (P < 0.001). School grade, type of residential area, and type of school also affected the likelihood of receiving preventive dental treatment (P < 0.001). Conclusions: Adolescents who were in lower grades, female, and lived in large urban communities visited dental clinics more frequently and received more preventive dental treatment than adolescents who were in higher grades, male and resided in small urban and rural areas. These results highlight the need for the further development and dissemination of oral health programmes.     

Orthodontic treatment need and demand in a group of Nigerian adults: a teaching hospital-based study.

Adults may be less influenced by peer perceptions and are, generally, more stable in their concerns about appearance compared to adolescents. This study aimed at assessing the level of objective orthodontic treatment need and demand for such care among the Nigerian adults in a referral centre (University College Hospital, Ibadan) as well as their social class. The Dental Aesthetic Index was used to assess the objective orthodontic treatment need while the social class of the subjects was according to the Registrar General's social class. During the study period (January 2001-September 2002), 49 adults aged 20-55 years with mean age of 25+ 6.3 (SD) years accounting for 27.5% of all orthodontic patients were seen. Equal proportions of the subjects had normal or minor malocclusions needing no treatment or slight treatment need and very severe or handicapping malocclusions with treatment considered mandatory (32.6% each). Next were severe malocclusions with treatment highly desirable accounting for 20.4%, followed by definite malocclusions with treatment elective (14.3%). Majority (71.4%) of the subjects was of the middle class families.     

Development and implementation of communication skills in dentistry: an example from South Africa.

Dental students should realise early in their careers -- in dental school -- the importance of developing and mastering sound communication skills with patients. As a result, the aim of this study was to develop and implement a course in communication skills for third year dental students. The methodology employed in the study comprised the following three phases: Phase I: identification of specific outcomes essential for the dentist to be competitive in the emerging South African dental environment. Phase II: development of an outcome-based course according to the South African Qualifications Authority format (Purpose, Embedded knowledge, Assessment criteria). Phase III: implementation of the course. Implementation of the course involved a pre- and post-training cycle. The subjects were 67 third year dental students. The following instruments were employed: a study guide; a case study; an assessment rubric; two questionnaires, namely "Patient's" feedback and "Dentist's" feedback; a standardised patient. The results were as follows: the class as a whole scored significantly higher during training cycle 2 compared with training cycle 1 (P < 0.0001). The important roles of trust, empathy and active listening in establishing a meaningful relationship with a patient, which was conveyed by means of the course, were emphasised by the majority of students.     

Promoting interpersonal skills and cultural sensitivity among dental students

This study evaluated interpersonal communication skills among third- and fourth-year dental students during two clinical communications training programs. Students participated in two clinical communications (CC) training sessions, each comprised of four encounters with patient instructors (PIs) who were trained to enact standardized patient scenarios. Scenarios in CC1 addressed straightforward patient care situations in dentistry (e.g., bridge adjustment), while CC2 added cultural sensitivity issues to the dental scenarios. After each encounter, patient instructors used the Arizona Clinical Interviewing Rating Scale (ACIR) to rate the students' interpersonal skills and gave the students feedback on their performance. The students also received feedback and coaching from dental school faculty in debriefings after encounters with the PIs. Students anonymously rated the program at the end of each session. To evaluate the program, students' performance was compared within and between the two training sessions. Analysis showed statistically significant increases in interpersonal communication skills within each training session (p<0.05) from unsatisfactory to above satisfactory levels. Performance scores at the start of CC2 were statistically lower than at the end of CC1, suggesting that performance wanes without practice. Student evaluations of the program were very positive. Interpersonal communication skills improved during this patient instructor program.     

Clermont-Ferrand dental school' curriculum: an appraisal by last-year students and graduates

Objective:  Last-year students and young graduates of the Clermont-Ferrand dental school (France) assessed their professional skills in order to shed light on those which are perfectly mastered and those which are not, with the aim of improving the undergraduate training given by the school.
Methods:  A questionnaire was handed out to students in their last two years and to young graduates ( n  = 170). They were asked to appraise their self-assessed level concerning 52 skills using a 0–10 visual analogue scale. The respondents also had to highlight the five skills which, according to them, needed to be improved during the programme.
Results:  Thirteen skills obtained a score lower than 5/10 showing a need of more thorough training, notably in the fields of implantology, paradontal surgery, temporomandibular joint disorders and dental practice financial management. Among these, five skills were found that demand in depth acquisition according to respondents. However, these five skills are not necessarily the ones which obtained the lowest scores.
Conclusions:  Our school needs to improve the quality of its training, notably by reorganising some of its courses and by intensifying student' training in outreach programmes, particularly in private practice, where skills like the financial management of a dental practice could be more easily acquired than in a hospital environment.     

Maternal discourse features used with language-normal preschoolers with facial deformities.

Discourse features of 10 mothers of language-normal preschool children with repaired cleft palates were examined. Mothers had been provided training in infant stimulation. Fifty-six percent of the communication initiations within the mother-child dyads were made by the mothers. That level of responsibility for continuity of communication resembles the percentage of discourse initiation reported for mothers of language-normal children without orofacial clefts. All categories of utterance types were used by the subjects; a predominance was found among attention-getters and indirect directives. Distribution of discourse features appears to differ from that reported for mothers of both language-normal and language-impaired children who do not have orofacial clefts.     

A communication skills course for undergraduate dental students

Sixty-seven third-year dental students in Dunedin, New Zealand, participated in a communication skills course, using simulated patients, case-based scenarios, videotaped interviews, and class roleplays. The course introduced active listening techniques, taking a medical history, and emotion-handling skills. This course was adapted from an existing course for medical students run by the Department of Psychological Medicine, Dunedin School of Medicine. The results of the student evaluation questionnaire (n = 59) indicated that students rated the course very highly. Retrospective ratings indicated that the students considered communication skills to be significantly more important as a component of their undergraduate training after completion of the course than prior to it. As might be expected, students whose ratings were higher after the course also reported that the course helped them to develop new communication skills and techniques; increased their interest in the subject and their self-confidence; rated the tutor as more effective and the course materials as more helpful; and considered the course to be significantly more stimulating than those students whose ratings of the importance of communication skills remained the same or decreased.     

Does peer mentoring work? Dental students assess its benefits as an adaptive coping strategy

Dental students deal with various stressors while in dental school. While some develop adaptive coping skills, others may suffer from damaging effects of constant and increasing levels of stress. This study evaluated a peer mentoring program at a dental school in the Midwest to determine student perceptions of its benefits and to identify areas for improvement. Data were collected through a survey sent out to all dental classes online. The twenty-five-item survey was based on student responses during two focus groups held to elicit student assessment of the peer mentoring program. Sixty-six percent of the student body participated with representation from all four classes. Students find their peer mentoring program an effective tool in helping them deal with stress especially during transition phases of their curriculum, first into dental school and later from preclinic to the clinics. Having a mentor means easy access to an available person who can help students relieve anxieties about dental school. Experiencing dental school enables a student to serve as a mentor, so a non-dental student is seen as not effective. Peer mentoring needs to be loosely structured and flexible and should cover all years in the dental curriculum.     

Relationship between general hygiene behaviours and oral hygiene behaviours in Iranian adolescents

The objective of the present study was to investigate the relationship between oral hygiene behaviours and general hygiene behaviours among Iranian adolescents living in Mashhad. A representative stratified random sample of 1,054 Iranian adolescents, in the sixth grade of school, answered a 37-item questionnaire on socio-demographic characteristics, frequency of toothbrushing behaviours, frequency of taking showers, and frequency of changing underwear, as measures of general hygiene behaviours. Binary logistic-regression analysis was employed to test the association between toothbrushing behaviours and general hygiene behaviours. The results showed that toothbrushing frequency was significantly associated with the frequency of taking showers (odds ratio: 2.40; 95% confidence interval: 1.86, 3.09) and the frequency of changing underwear (odds ratio: 2.14; 95% confidence interval: 1.65, 2.78). These associations were significant for girls and boys when tested separately and remained significant after adjusting for gender and father's education level. Girls were significantly more likely than boys to practice oral hygiene and general hygiene behaviours. In conclusion, there was a positive association between general hygiene and oral hygiene behaviours among Iranian adolescents. This association has important applications for planning health and hygiene-promoting programmes.     

Factors related to missed and cancelled dental appointments among adolescents in Norway

The aim of this study was to explore possible explanatory factors related to high frequency of missed/cancelled dental appointments during the age group 12-18 yr. A total of 754 20 yr olds completed a questionnaire including variables measuring demographics, occupation (school/job), attendance pattern, attitudes to dentists, opinion about importance of dental treatment, and the psychometric scales Dental Fear Scale (DFS), Dental Beliefs Survey (DBS) and Geer Fear Scale (GFS). Based on written consents, the following data were recorded from their dental records: the total number of scheduled appointments, the number of missed and cancelled appointments and the individual caries experience of those in the age group 12-18 yr. A total of 124 subjects who had missed/cancelled 20% or more of their dental appointments during this age were defined as a target group. A stepwise regression model indicated that the likelihood of being included in the target group increased by a factor of 6.0 if the subject had forgotten dental appointments during the last 5 yr, by a factor of 3.5 for working or without specified occupation (as opposed to attending school), by a factor of 2.7 for negative beliefs of dentists, and by a factor of 2.1 for high caries experience.     

Overview of ethical issues in clinical studies.

Research in human subjects should be conducted only if the rights and welfare of the participants are protected. Prospective study subjects must be given adequate information about all aspects of a study so that they can make a rationally exercised decision about participation; coercive techniques to solicit participants should not be used. Research in humans may be classified in one of three categories: A. Research on treatment of existing conditions; B. Research on preventive measures; and C. Research other than for treatment or prevention. Different concerns and aspects of informed consent assume particular importance in each category. In research on the treatment of existing conditions, untreated or placebo-treated control groups are rarely justified if the condition is irreversible. In research on preventive methods prospective subjects should be informed of the likelihood of receiving an ineffective treatment, if one or more placebo groups are included. A randomized clinical trial is usually the best design for studies of preventive methods. Nonrandomized designs, that are feasible and statistically valid, may be employed in order to avoid depriving some subjects from receiving effective preventive methods. In social or behavioral research, confidentiality of collected information and privacy of the subject are essential considerations.