Dental health and treatment needs of 5-year-old children in the health area of Lambeth, Southwark and Lewisham, England

Abstract 865 children in their first year of full-time education in the health area of Lambeth, Southwark and Lewisham were examined for dental fitness and treatment requirements. Seventy-six percent of the subjects examined required treatment for dental caries and the mean dmft was 4.85. Sixteen percent of erupted permanent first molars were carious. 404 children had marginal gingivitis. All the treatment required for gingivitis and 82% for caries could be carried out by dental auxiliaries. The need for preventive measures is discussed.     

Children's perception of vulnerability to illness and dental disease

Abstract Dental health education attempts to change behaviour by altering an individual's knowledge, attitudes, and belief's about health matters. Perception of vulnerability to illness and dental disease is a central, but poorly understood, health belief. In this study of 303 New Zealand and 297 Australian schoolchildren perceived vulnerability was measured by the degree of expectancy to which subjects believed they would contract health problems. The pattern of health problem expectancy was consistent across age groups, cultures, and other demographic divisions. High expectancies of general health problems and dental caries were associated with potential preventive dental visits and with potential denture wearing. New Zealand schoolchildren, and children from lower socioeconomic backgrounds, had higher expectancies of general health problems and dental caries than Australian or middle class children.     

Knowledge, attitudes and behaviour in relation to dental health of adults in Belfast, Northern Ireland

The aim was to investigate the knowledge, attitudes and behaviour related to dental health of adults living in two neighbouring areas in Belfast, Northern Ireland. 81 adults aged 30 yr or over from two neighbouring residential areas in South Belfast completed a structured interview. The responses of those who retained natural teeth were very different from those who were edentulous. Those in the higher socioeconomic status groups had clearer knowledge, more positive attitudes and more appropriate behaviour related to dental health than those in lower socioeconomic status groups. The differences between the residents of the two areas were less obvious than those noted between the different socioeconomic status groups. It was concluded that the results revealed misconceptions amongst adults in Northern Ireland regarding the causes of dental disease and how it might be prevented both in themselves and in their children.     

Dental knowledge, attitudes, and behaviors of Indochinese and Australian-born adolescents

Since 1975 more than 100,000 Indochinese refugees have settled in Australia. This study compared the dental health knowledge, attitudes, and behaviors of 131 Indochinese and 107 Australian-born adolescents from a state high school in Melbourne, Victoria. The Australian-born subjects demonstrated the highest level of dental knowledge, and the Kampuchean/Laotian subjects the least. Of the three birthplace groups (Australia, Vietnam, Kampuchea/Laos), the Kampuchean/Laotian group were more likely to believe that their dental health was controlled by external forces. The Kampuchean/Laotian group presented the highest proportion of subjects believing they needed dental treatment. In contrast, however, the Kampucheans and Laotians had the lowest perceived value of preventive dental visits with the Australian-born adolescents presenting the highest proportion. The dental health behaviors of the Kampucheans and Laotians were generally the least favorable and those of the Australian-born subjects the most favorable, although all groups were well short of the conventional ideal. One-third of the Kampuchean and Laotian subjects said they had never been to the dentist before. Few Indochinese subjects claimed to be regular visitors to the dentist. Analysis of data using the framework of the Health Belief Model provided little explanatory power in predicting preventive behaviors. A greater understanding of cultural variations between ethnic groups and targeted dental health education programs would appear to be beneficial strategies for improving oral health of high risk adolescents.     

Dental health behavior and attitudes – an application of correspondence analysis

Differences in dental behavior and dental attitudes between people with (almost) all natural teeth, people with a full denture in both jaws and people with a full denture in only the maxilla are visualized by means of correspondence analysis in one overall picture. In this picture the three distinguished subgroups of dental patients and their characteristics are indicated as points in a two-dimensional space. The distances between the points in this picture show to what extent these points are connected. The findings obtained in this study can lead to the conclusion that: a. differences in dental status are related to differences in dental behavior and dental attitudes; b. people with all natural teeth and people with a full denture in both jaws obviously are opposite of each other in many respects, whereas people with a full denture in only one jaw can be characterized as a dental in-between group.     

Effects of school-based dental health education on knowledge, attitudes and behavior of adolescents in San Francisco

A field experiment was done to evaluate the short term effects of a series of classroom preventive dentistry presentations on dental health knowledge, attitudes and reported behavior of adolescents. Eight hundred fifty-four boys and girls, 12-14-yr-old students enrolled in San Francisco middle schools, were randomly divided into experimental and control groups. A written test composed of questions relating to factual dental health knowledge, home care practices, and attitudes to dental health was answered by the experimental group at the beginning and end of the educational intervention and at comparable time intervals by the controls. Results showed a significant increase in knowledge for the experimental group (P less than 0.001), as compared with the control group. Pre-existing attitudes were generally positive for most subjects. Although the educational intervention resulted in no significant differences between the two groups with regard to attitude, there was a significant positive change in attitude within the experimental group (P less than 0.01) from pre- to posttest. In addition, there was a significant increase in the frequency with which the girls in the experimental group reportedly used the toothbrush (P = 0.01) and dental floss (P = 0.01).     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

Dental Public Health for the 21st Century: Implications for Specialty Education and Practice

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6–8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.     

An assessment of the dental public health infrastructure in the United States

OBJECTIVES: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level. METHODS: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information. RESULTS: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards. CONCLUSIONS: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners.     

Changes of dental treatment pattern in Norway in the 1970s

With the aim of gauging utilization rates of dental services, a series of cross-sectional studies were performed in 1973, 1975 adnd 1977. Cluster samples of 1,600 individuals covering the Norwegian population aged 15 and above were interviewed by trained interviewers using standardized questions. The percentage of respondents who reported having seen a dentist within the last 12 months increased from 58 to 64. The receipt of tooth fillings was the predominant course of treatment and was reported by 55% of the interviewees. The percentage reporting preventive services increased from 15 to 26% at the expense of those reporting "blood and vulcanite" denistry. Fifty-two percent, increasing to 53% of the interviewers, claimed to have seen a dentist on a regular basis during the last 5 years. However, this proportion was conceivably overreported. Control questions indicated that 40-45% should be considered regular treatment attenders. Change is apparently taking place in the treatment pattern. The proportion of regular treatment attenders seems to increase by 0.5-1% per year. The treatment profile is also shifting: extractions and denture services are diminishing, preventive services are gaining, while restorative dentistry stands still - for the time being.     

Assessment of the readability of dental health education literature

General dental practitioners have an important role in the dissemination of information to their patients and their advice is often reinforced with written health education material. Unfortunately, this written information is often of limited value for particular groups of patients because of its level of readability. This investigation of the problem was in two parts; firstly, a group of 140 secondary schoolchildren were asked to explain the meaning of a selection of words in common use in dental health education, and secondly, the readability of some current dental health education literature was assessed using the Fog Index. The results indicate that current dental health education literature reflects the reading ability of the designers rather than the ability of the potential target group. Many of the words in the dental profession's preventive vocabulary were not understood by the children. Over 80% were unsure of the meaning of fluoride tablets, gum disease, gingivitis and oral hygiene. The results of this investigation indicate that dentists should ensure that dental health education literature is not unduly complex and should take more time explaining the dental vocabulary in lay terminology.     

Dental health and the application of geographical methodology

Reorganisation of dental services in Britain gives new opportunities for planning. Geographical methodology provides new techniques. An elementary spatial analysis of variations in dental health in Newcastle Area Health Authority (Teaching) shows that dental health varies with availability and access to treatment facilities. Opposite types of geographical distribution of community (School) and general dental services are illustrated showing location biases for each type of service. The evaluation of the spatial distribution of dental services is shown to be basic to planning and a key to improved dental health.     

Utilization of dental services in the adult Danish population 1975

Lack of information on the dental behavior of adults in Denmark has become a major problem in the national planning of dental services. The purpose of this study was to establish the pattern of utilization of dental services among adult Danes (aged 15 and above). A three-stage cluster sampling design covering the total adult population of Denmark was used to draw a representative sample comprising 1,600 persons. Household interviews by trained interviewers were carried out. Of the adults interviewed, 58% reported yearly dental visits the last 5 years, 32% had not seen a dentist or only when in pain, and 10% went irregularly. Differences according to place of living, age, sex, occupation and school dental care were found. 63% of those who had seen a dentist reported bad teeth or were edentulous with or without dentures. 10% reported fear, 9% had good teeth and 5% reported economic difficulties. The most frequent treatments at the latest dental visit were cleaning and filling for the regular patients and extractions and dentures for the nonregular patients. A multiple classification analysis revealed that the number of teeth was the strongest predictor for dental services, with the following predictors in descending order: age, occupation, place of living, economy, sex and school dental care. These variables could explain 58% of the variation in utilization.     

Characteristics of dentally successful and dentally unsuccessful adults

A method is described for identifying two groups of people from a dentate sample according to the prognosis for their retaining their dentition. Dentally successful people were expected to retain teeth into old age. Dentally unsuccessful people were expected to lose all their teeth prematurely. The method appeared valid, as more of the dentally unsuccessful had teeth extracted at the course of treatment immediately prior to a dental survey than dentally successful adults. Furthermore, this trend was also observed in the 3 yr after the survey. A restoratively orientated dental service was unable to satisfactorily meet the treatment and psychological needs of many of the dentally unsuccessful.     

A path analysis of the utilization of dental services

In this paper Andersen's model of health services utilization is applied to the use of dental visits. This analysis builds on previous work by including clinical oral health indicators rather than self-reports as measures of need by using a path model to analyze the dynamics of predisposing, enabling and need factors on dental utilization. The sample consisted of 287 volunteers who were employees of a university health center. The path analysis using ordinary least squares found that sex was the most important variable affecting use of services. Men tended to have higher number of visits due to higher need and women more visits regardless of need. A surprising result was that income had no significant effect on volume of dental visits, which contradicts much of the literature in the area. Finally, the analysis suggests that because of the nature of clinical oral health indicators cross-sectional analysis of dental service utilization may not be appropriate.     

A survey of the dental needs of hospital inpatients in Scotland

Eight hundred and ninety-four inpatients in four hospitals in Edinburgh were assta were used to estimate future inpatients' dental requirements and the hospital dental services which would be necessary to meet these needs. Seventeen percent of the sample was found to be suffering from pain or discomfort of dental origin and over 30% were considered to require some form of dental treatment before their expected date of inpatient discharge.     

A global perspective on changes in the burden of caries and periodontitis: implications for dentistry

The structure and contents of most oral health care systems and the contents of dental curricula reflect a deep-rooted tradition for attempting to cure oral diseases by refined technological means. However, better oral health conditions for the world's populations necessitate the application of up-to-date scientific knowledge to control the major oral diseases. This review points out that not only should the structure and contents of oral health care delivery systems be based on state-of-the-art knowledge about the biology of the oral diseases; they must also take into account the trends for change in caries and periodontal diseases within and between populations, and acknowledge the impact of changes in treatment philosophies for these trends. The oral disease profiles for populations in low- and high-income countries are briefly described, and it is concluded that the rapidly changing disease profiles observed in high-income countries necessitate re-thinking of the future role and organization of dentistry in such countries. The priorities for low- and middle-income countries must be to avoid repeating the mistakes made in the high-income countries. Instead, these societies might take advantage of setting priorities based on a population-based common risk factor approach. If such an approach is adopted, the training of personnel with oral health care competence must be rethought. The authors suggest three different cadres of dental care providers to be considered for an approach that allows health care planners in different populations around the world to prioritize appropriate oral health care with due respect for the socio-economic conditions prevailing.     

Dental hygienists''influence on the patients''knowledge, motivation, self-care, and perception of change

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.     

Dental caries status and treatment needs of the permanent dentition of 6–12-year-olds in Hong Kong

An oral health survey was conducted in 1986 on a representative sample of primary school children in Hong Kong. 1483 Chinese children of both sexes, aged 6-12 yr, attending 56 primary schools were surveyed. The DMFT index for the 6-yr-olds was 0.1, and for the 12-yr-olds it was 1.5. Forty percent of the 12-yr-olds were clinically caries-free. The permanent molars constituted 90% of the total caries experience of the 12-yr-olds. Over 90% of the caries lesions were found in pits and fissures. The dental caries treatment need in the permanent dentition was low and of the simple type. A great reduction in the dental caries experience of the permanent dentition of children has occurred since the introduction of water fluoridation 25 yr ago. In addition to treatment care, preventive measures should be provided by the School Dental Care Service for children with a high caries risk.