Evaluation of Pacific Islands Early Childhood Caries Prevention Project: Republic of the Marshall Islands

Objectives: This communication reports an outcomes evaluation of the Pacific Islands Early Childhood Caries Prevention Project. Methods: The evaluation includes children in three conditions: a) topical fluoride varnish three times per school year; b) varnish plus twice-per-day toothbrushing; and c) intervention 2 plus three-times-per-day xylitol containing gummy bear snacks at school and home visits to encourage parental involvement. For this evaluation, groups 2 and 3 have been combined. Results: One year after project implementation, mean decayed, extracted, or filled primary teeth was 10.3 [standard deviation (SD)  =  4.3] teeth for group 1, and 8.2 (SD  =  4.0) teeth for the combination of groups 2 and 3 ( P <  0.05). Twenty-four percent of group 1 had cavitated lesions in any permanent molar versus 12.8 percent in groups 2 and 3 combined ( P >  0.05). Conclusion: Evaluation confirms the outcome of a program including both in-school twice-daily toothbrushing with fluoridated toothpaste and frequent applications of fluoride varnish.     

Dental services and perceived oral health: are patients better off going private?

OBJECTIVE: The aim of this study is to determine associations between method of payment for dental services and perceived oral health in the UK. METHOD: A national UK study involving a random probability sample of 2718 adults. Respondents were interviewed in their homes about their method of payment for dental services (private or NHS), service use (time and reason for last dental visit), self-reported oral health status (number of teeth possessed and denture status) and the impact of their oral health on their quality of life (employing the 16-item OHQoL-UK( Copyright) measure). RESULTS: The response rate was 68% (1838/2718). Thirty one percent (575/1838) claimed they paid privately for dental services the last occasion they visited their dentist. This was associated with self-reported number of teeth possessed (P<0.01), denture status (P<0.01), WHO goal of retaining 20 teeth with and without a prosthesis (P<0.05), impact of oral health on life quality (P<0.01), and number of positive oral health influences experienced (P<0.01). However, these associations did not remain apparent having accounted for socio-demographic factors (age, gender, and social class background) and reported dental attendance pattern. CONCLUSION: Difference in perceived oral health exists between private and NHS dental service users. However, this is more likely to be attributed to socio-demographic factors and regular use of services rather than method of payment.     

Oral-Health-Related Quality of Life during Pregnancy

Objectives: The objectives of this study were to assess the differences in oral health and perceived oral-health-related quality of life (OHRQoL) between pregnant and nonpregnant rural Indian women and to describe factors that could possibly influence OHRQoL. Methods: A number of 259 pregnant (mean age 26  ±  5.5) and 237 nonpregnant (mean age 27.8  +  6.9) women who participated in the cross-sectional study were administered the Oral Health Impact Profile–14 questionnaire and underwent oral examination. Results: The results showed that the perceived OHRQoL was significantly poorer among the pregnant women than among nonpregnant women. The mean number of sextants with Community Periodontal Index for Treatment Needs scores of 2 and 3 and the gingival index scores were significantly ( P <  0.001) higher among pregnant women than in the comparison groups. Factors such as pregnancy number ( P <  0.05), decayed, missing, filled teeth scores ( P <  0.001), and Gingival Index scores ( P <  0.001) were significant predictors for OHRQoL. Conclusion: Oral health and perceived OHRQoL were poorer among pregnant women than among nonpregnant women .     

Palliative effect of lafutidine on oral burning sensation

Background:  Lafutidine is a unique histamine H₂-receptor antagonist (H2RA) that has a sensitizing effect on capsaicin-sensitive afferent neurons (CSAN). This effect may make lafutidine useful for the treatment of burning mouth syndrome (BMS).
Methods:  To evaluate the efficacy and safety of lafutidine in patients with oral burning sensation, a randomized controlled trial was performed. Patients who had been receiving other H2RAs with no sensitizing effect on CSAN were randomly assigned to receive lafutidine 10 mg twice daily for 12 weeks, instead of the previous H2RAs, plus gargling with azulene sulfonate sodium (ASS) (lafutidine group, n  = 36) or to continue to receive the previous H2RAs plus ASS gargling (control group, n  = 35). The intensity of burning sensation was scored by means of a visual analog scale (VAS).
Results:  Thirty-four patients in the lafutidine group and 30 in the control group completed the study. In the lafutidine group, the rate of improvement in the VAS score as compared with the baseline value was significant after 4, 8, and 12 weeks of treatment ( P  < 0.05). The improvement rate was consistently higher in the lafutidine group than in the control group; the differences between the groups were significant ( P  < 0.05) after 4, 8, and 12 weeks of treatment. Only two mild abdominal adverse events occurred in the lafutidine group, but neither required the termination of treatment.
Conclusion:  Oral lafutidine is very safe and effective for reducing the intensity of oral burning sensation and may therefore be a viable option for the treatment of BMS.     

Influences of social support on the oral health of older people in Britain

A national UK study involving a random sample of 876 non-institutionalized older people (aged 65 or older) were recruited, to identify the association between social support (living alone), self-reported oral health status and oral health behaviour (use of services). Home interviews were undertaken exploring oral health behaviour (time and reason for last dental visit) and oral health status measures (self-reported number of teeth possessed and denture status). In addition, socio-demographic characteristics were collected. Bivariate analysis identified that social support was associated with time since last dental visit (P < 0.01), reason for last dental visit (P < 0.01), self-reported number of teeth possessed (P < 0.01) and denture status (P < 0.01). In regression analysis, social support emerged as an important predictor of reason for last dental visit and denture status having accounted for other factors in the model (age, gender, social class and educational attainment). Social support is associated with oral health status and oral health behaviour of older people in Britain and is likely to influence both the decision making process of when to seek dental care and what type of treatment to opt for.     

Dental Treatment Improves Self-Rated Oral Health in Homeless Veterans – A Brief Communication

Objective: The aim of this study was to assess homeless veterans' perception of their oral health and the impact that oral disease and treatment have on self-assessed quality of life. Methods: Outcomes included measures of general and oral-specific quality of life and functional status. Single-item self-report of oral health and the General Oral Health Assessment Index were assessed at baseline and after treatment. Results: One hundred and twelve veterans completed the baseline questionnaire, and 48 completed the follow-up. Veterans who were eligible for ongoing dental care had improved General Oral Health Assessment scores, while patients who received only emergency dental care saw a decreased score (2.46 versus −2.12). General Oral Health Assessment improvement was significantly related to fewer teeth at baseline (18 versus 23), a lower baseline General Oral Health Assessment (23.6 versus 28.1), having a denture visit (22 versus 35 percent), and improvement in self-reported oral health (25 versus 42 percent). Conclusion: There was significant improvement in homeless veterans' perceived oral health after receiving dental care.     

Estimation of sCD14 levels in saliva obtained from patients with various periodontal conditions

Aim:  To assess the concentration of soluble CD14 receptor in saliva of people with periodontal disease and healthy patients and its relationship with periodontal status.
Subjects and Methods:  Unstimulated whole saliva samples from patients with chronic periodontitis ( n  =   34), aggressive periodontitis ( n  =   19) and healthy controls ( n  =   17) were obtained for the study. The periodontal status of each subject was assessed by criteria based on probing depth, clinical attachment loss and the extent of periodontal breakdown. The levels of sCD14 were measured in saliva samples with an enzyme-linked immunosorbent assay (ELISA).
Results:  Although no significant difference ( P  >   0.05) was found for salivary sCD14 levels between periodontitis groups, they were significantly greater ( P  <   0.05) than those detected for healthy controls. Furthermore, Spearman's correlation analysis showed statistically significant correlations ( P  <   0.01) between data from salivary sCD14 levels and clinical measurements.
Conclusion:  The findings of the present study re-emphasize the importance of whole saliva as sampling method in terms of immunological purposes in periodontal disease and suggest that the elevated sCD14 concentration may be one of the host-response components associated with the clinical manifestations of periodontal disease.     

VEGF and MVD expression in sinus augmentation with autologous bone and several graft materials

Objective:  The aim of this study was to assess vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) in maxillary sinus augmentation with autogenous bone and different graft materials for evaluating their angiogenic potential.
Methods:  Biopsies were harvested 10 months after sinus augmentation with a combination of autogenous bone and different graft materials: hydroxyapatite (HA, n  =   6 patients), demineralized freeze-dried bone allograft (DFDBA, n  =   5 patients), calcium phosphate (CP, n  =   5 patients), Ricinus communis polymer ( n  =   5 patients) and control group – autogenous bone only ( n  =   13 patients).
Results:  In all the samples, higher intensities of VEGF expression were prevalent in the newly formed bone, while lower intensities of VEGF expression were predominant in the areas of mature bone. The highest intensity of VEGF expression in the newly formed bone was expressed by HA ( P  < 0.001) and CP in relation to control ( P  < 0.01) groups. The lowest intensities of VEGF expression in newly formed bone were shown by DFDBA and polymer groups ( P  <   0.05). When comparing the different grafting materials, higher MVD were found in the newly formed bone around control, HA and CP ( P  <   0.001).
Conclusion:  Various graft materials could be successfully used for sinus floor augmentation; however, the interactions between bone formation and angiogenesis remain to be fully characterized.     

The impact of dental neglect on oral health: a population based study in Hong Kong

OBJECTIVE: The aim of this study was to assess dental neglect (DN) among Hong Kong citizens, to identify socio-demographic variations in DN and to determine the association between DN and oral health (self-reported). DESIGN: Cross sectional population based study involving a random sample of 800 Hong Kong Chinese adults. METHOD: Telephone interview incorporating the dental neglect scale, assessment of self-reported oral health including an oral health related quality of life measure. RESULTS: The response rate was 70% (556/800). Mean dental neglect score of the population was 14.81 (S.D. 3.62) [possible range 6 to 30]. Most commonly, people were neglectful of using professional dental health care. Socio-demographic disparities in DN were apparent, in relation to age (P < 0.05), income (P < 0.05) and educational attainment (P < 0.05). DN was associated with self-reported oral health: denture status (P < 0.05), number of teeth possessed (P < 0.05) and oral health related quality of life (P < 0.05). CONCLUSION: Dental neglect is widespread in Hong Kong, particularly neglect of professional dental care. Socio-demographic disparities in dental neglect were apparent. Dental neglect is associated with self-reported oral health status including how oral health impacts on life quality. These findings have implications in understanding the impact of dental neglect.     

Dental treatment improves self-rated oral health in homeless veterans--a brief communication

OBJECTIVE: The aim of this study was to assess homeless veterans' perception of their oral health and the impact that oral disease and treatment have on self-assessed quality of life. METHODS: Outcomes included measures of general and oral-specific quality of life and functional status. Single-item self-report of oral health and the General Oral Health Assessment Index were assessed at baseline and after treatment. RESULTS: One hundred and twelve veterans completed the baseline questionnaire, and 48 completed the follow-up. Veterans who were eligible for ongoing dental care had improved General Oral Health Assessment scores, while patients who received only emergency dental care saw a decreased score (2.46 versus -2.12). General Oral Health Assessment improvement was significantly related to fewer teeth at baseline (18 versus 23), a lower baseline General Oral Health Assessment (23.6 versus 28.1), having a denture visit (22 versus 35 percent), and improvement in self-reported oral health (25 versus 42 percent). CONCLUSION: There was significant improvement in homeless veterans'perceived oral health after receiving dental care.     

Oral health impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data ( n  = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14-item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects ≥ 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3–0.8) and 0.7 (0.5–0.9) for 30–34-yr-old and 34–74-yr-old subjects, respectively. The odds ratios for those with 1–9 teeth and for those who were edentate were 3.4 (2.4–4.9) and 4.0 (2.6–6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.     

Histological evaluation of direct pulp capping with a self-etching adhesive and calcium hydroxide on human pulp tissue

Aim  To evaluate human pulp tissue response following direct pulp capping with a self-etching adhesive: Clearfil SE BOND (SB).
Methodology  Forty-five sound teeth from 20 subjects were used. Forty-one teeth had their pulp mechanically exposed at the base of a Class 1 cavity preparation and were divided into two groups: group 1, teeth were capped with SB ( n  = 21), and group 2, with calcium hydroxide cement (CH) ( n  = 20). Four teeth were maintained intact as an untreated control group. After 7, 30 and 90 days, respectively, 15 teeth were extracted and processed for light microscopic examination. Pulp healing and bacterial microleakage were assessed by haematoxylin and eosin, Masson trichrome and Brown and Brenn stain techniques. The data were analysed statistically by using the Mann–Whitney U test.
Results  After the 7-day observation period, the inflammatory reaction in the SB group was slight and significantly less severe than that of the CH group ( P  < 0.05). After the 30- and 90-day observation periods, the inflammatory reaction was slight in both groups, but specimens with dentine bridge formation in the SB group were significantly less common than those in the CH group ( P  < 0.05).
Conclusions  Clearfil SB had good biocompatibility with human pulp tissue, but its ability to induce reparative dentine was significantly lower than that of calcium hydroxide.     

IL-6 and IL-8 levels in GCF of the teeth supporting fixed partial denture

Objectives:  To evaluate the gingival crevicular fluid (GCF) contents of interleukin-6 (IL-6) and interleukin-8 (IL-8) and the clinical parameters of the teeth supporting fixed partial denture (FPD) and the contralateral teeth and to assess the effect of scaling and root planning (SRP) on clinical parameters and the GCF levels of cytokines.
Materials and methods:  The study population included 23 patients. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and gingival index (GI) were recorded, and GCF samples were collected for analysis of cytokine levels from the teeth with FPD (Test Group), the contralateral teeth (Control Group) of each participant at baseline. After initial measurements, all participants received primary phase of non-surgical treatment including oral hygiene instruction and scaling and root planning (SRP). At the 1st month and the 3rd month after SRP, these procedures were repeated.
Results:  In both groups, all clinical parameters and the total amount of IL-8 showed decreases from initial to the 3rd month ( P  < 0.05), but from the 1st month to the 3rd month; PD, PI, and GI values significantly increased in the test group ( P  < 0.05).
Conclusion:  The non-surgical periodontal treatment reduced the total amount of IL-8, not IL-6, and the clinical parameters of the teeth with FPD and contralateral teeth. But, there was a trend to the higher levels of PD, PI, and GI in the teeth with FPD. Therefore, a regular program for dental prophylaxis is also important for the maintenance of periodontal health in patients with FPD.     

Why are we ‘weighting’? An assessment of a self-weighting approach to measuring oral health-related quality of life

OBJECTIVE: To determine whether or not self-weighting at an item level contributes to the performance of an oral health-related quality-of-life measure. DESIGN: Data were collected in two national surveys conducted a month apart, one using the "weighted" measure and the other an "unweighted" version of the UK oral health-related quality-of-life measure. In addition, sociodemographic and self-reported oral health status were recorded. RESULTS: The UK oral health-related quality-of-life measure discriminated between groups based on age group (<65, 65 and older) and social class (higher and lower) irrespective of the version of the questionnaire used. Both versions also showed significant associations with self-reported oral health: denture status (P < 0.01) and number of teeth possessed (P < 0.01). In addition, both versions demonstrated predictive ability in identifying those in prosthetic need (<20 teeth and without recourse to a denture, P < 0.01). CONCLUSION: Weighting the UK oral health-related quality-of-life instrument does not improve the psychometric properties of the instrument and thus raises questions about the value of self-weighting at an item level.     

Is negative affectivity associated with oral quality of life?

OBJECTIVES: The personality trait of negative affectivity (NA) is associated with reports of worse physical health, more symptoms and worse health-related quality of life but its associations with oral quality of life (OQOL) are unexplored. In this study we examined the association of NA with OQOL. METHODS: We drew on data from two samples of older men: The VA Dental Longitudinal Study (DLS; n=177) and the Veterans Health Study (VHS; n=514), which included three measures of oral quality of life: the Oral Health-Related Quality of Life Measure (OHQOL), the Oral Health Impact Profile (OHIP), and the Geriatric Oral Health Assessment Instrument (GOHAI). For each OQOL measure, and the GOHAI and OHIP subscales, two regression models were estimated to examine the marginal change in variance due to NA: the first model included age, number of teeth, and self-rated oral health, and the second added NA. RESULTS: In both bivariate and multivariate analyses, higher NA was consistently associated with worse scores on the OQOL measures. In the regression analyses, NA explained an additional.01 to 18% of the variance in OQOL, explaining the most variance in the OHIP and the least in the OHQOL. The addition of NA explained more variance in the more subjective, psychologically oriented GOHAI and OHIP subscales than it did in the more objective, physical function oriented subscales. CONCLUSIONS: Psychosocial factors such as personality are significantly associated with quality of life ratings. Such associations should be taken into account when OQOL measurements are used and interpreted.     

Self-reported oral problems, compared with clinical assessment in an epidemiological study

Abstract:  Objectives:  To study self-reported oral problems in relation to periodontal clinical findings in an epidemiological investigation. Materials and methods:  1676 individuals, 828 men and 848 women, participated. The clinical examination comprised the number of remaining teeth excluding third molars, plaque index (PLI), gingival index (GI), bleeding on probing (BOP%), calculus index (CI) and the number of teeth with pocket depth (PD) ≥5 mm. Participants answered a questionnaire concerning smoking and snuffing habits and described in their own words any oral problems present. Analysis of variance ( anova ), unpaired t -test and chi-squared test were the statistical methods used. Results:  The questionnaire was completed by 99.4% of participants. Problems of the teeth and mouth were reported by 28.9% of respondents comprising 31.8% females and 26.2% males. The difference between the sexes was statistically significant ( P  < 0.05). Of the reported oral problems, 57.4% was of periodontal origin. The differences between subjects with and without self-reported mobile teeth showed significant clinical outcome in PLI ( P  < 0.001), CI ( P  < 0.01), GI ( P  < 0.001), BOP% ( P  < 0.01), the number of teeth with PD ≥ 5 mm ( P  < 0.001) and the number of remaining teeth ( P  < 0.001). The differences between subjects with and without self-reported periodontal disease and with and without bleeding gingiva also showed significant differences in CI ( P  < 0.05), GI ( P  < 0.05) and the number of teeth with PD ≥ 5 mm ( P  < 0.05) and in PLI (0.001), CI ( P  < 0.01), GI ( P  < 0.001) and BOP% ( P  < 0.001) respectively. Conclusions:  Present study clearly shows that self-reported periodontal problems were confirmed by clinical assessments.     

Degree of conversion of dual-cured resin cement light-cured through three fibre posts within human root canals: an ex vivo study

Aim  To evaluate the degree of conversion of one dual-cured resin cement light-cured through three fibre posts within extracted human teeth.
Methodology  Fifteen mandibular premolars were root filled and then divided into three groups. Variolink II was light-cured through the posts (LP, D.T. Light-Post; PP, FRC Postec Plus; SP, Snowpost) within the root canal. The degree of conversion was obtained at 1 mm intervals in 9 mm-deep longitudinally sectioned root canals using an optical microscope connected to an FTIR spectrophotometer ( n  =   10). The light transmission of each post tested was also examined using UV–Vis spectroscopy. Data were analysed using anova and Tukey's test ( α  = 0.05).
Results  The LP and PP posts revealed a light transmission of 10.2% and 7.7%, respectively, whereas the SP post exhibited a significantly lower value of 0.5%. The degree of conversion mean value ranged from 32.78% to 69.73% depending on the depth and type of post. For all the groups, there were significant decreases in the degree of conversion values for the middle region when compared with those for the cervical region ( P  <   0.05). Except at a depth of 1 mm, the SP group consistently exhibited significantly lower degree of conversion values than the other groups ( P  <   0.05). The linear regression analysis revealed a strong correlation between the light transmission of the posts and the overall degree of conversion value for each group ( R ² = 0.9888).
Conclusions  The decrease in the degree of conversion for Variolink II relative to the depth was dependent on the light transmission capacity of the posts tested.     

Effect of pre-processing surface treatments of acrylic teeth on bonding to the denture base

Summary  The aim of this study was to examine the bond strength between acrylic teeth after various surface treatments and processing with either a heat- or microwave-polymerized denture base material. Specimens were prepared and tested according to the methods described in American National Standard/American Dental Association Specification No.15 (Synthetic Polymer Teeth) using a special assembly. Three brands of acrylic teeth were used with the following treatments: control (no treatment), grinding and grinding plus sandblasting. Treatment groups were further divided into two denture base processing subgroups: heat-polymerized and microwave-polymerized methods. Denture base processing to the acrylic teeth was performed according to the manufacturer's recommendations. Bond strength test was performed using a universal testing machine with five specimens and each specimen is composed of six anterior teeth per experimental group. Data were analysed using a three-way anova and the Scheffe' F -test post hoc pair wise comparison at the 95% significance level. The mean bond strength values ranged from 33.1 ± 4.1 to 51.6 ± 2.5 MPa. The bond strength values of sandblasted surfaces were significantly higher than those of the ground surface and the control ( P  < 0.05). Combined (acrylic tooth and denture base resin) cohesive failures were disclosed in all tested samples. Acrylic tooth surface pre-processed surface treatment with grinding plus sandblasting and processed with a heat-polymerized denture base provided the greatest bond strength between acrylic tooth and denture base.     

Structural resistance in immature teeth using root reinforcements in vitro

Abstract –  The purpose of this study was to evaluate in vitro the efficacy of root reinforcements by light-cured composite resin or zirconium fiber post in simulated immature non-vital teeth. Fifty-six bovine incisors teeth were used for this study. The crown of each tooth was removed in the medium third to obtain a standard length of 30 mm. The specimens were divided into four groups ( n  = 14): G1) the root canals were instrumented and enlarged to simulate immature non-vital teeth and were reinforced with a light-cured composite resin using a translucent curing post (Luminex system); (G2) the specimens were instrumented, enlarged and they received root reinforcement with zirconium fiber post; G3 (positive control): they received similar treatment to the G1 and G2 groups, but did not receive root reinforcement; G4 (negative control): the roots were not weakened and did not receive reinforcement. Every tooth was submitted to compressive force using an Instron testing machine with an angle of 45° at a speed of 1 mm min⁻¹ until the fracture. The results showed a markedly increased resistance to fracture in the G1 and G2 ( 122.38 and 122.08 kgf, respectively). Among the results of G1 and G2 there was not any significant difference (P > 0.05) but they were significantly different from the control groups (P < 0.05). The conclusion is that the use of root reinforcements with zirconiun fiber post or composite resin can increase significantly the structural resistance of the weakened teeth, decreasing the risk of the fracture.     

Dental trauma among 5th and 6th grade Arab schoolchildren in Eastern Jerusalem

Abstract –  Dental trauma is an irreversible pathology which after occurrence is characterized by life long debilitating effects. The objective of the study was to measure the prevalence of trauma in anterior permanent teeth among children and associations with independent variables. A total of 453 5th and 6th grade Arab Eastern Jerusalem schoolchildren participated. Trauma, incisal overjet and lip competence were measured by one examiner in the schools. Reasons and location of trauma were assessed by telephone interviews with the parents. The total prevalence of dental trauma was 33.8%. Severe trauma prevalence (involving dentine) was 12.6%. Severe trauma was more prevalent among boys (OR = 2.03, P  = 0.026); children with lip incompetence (OR = 2.71, P  = 0.001); and those with an overjet of 4mm or more (OR = 3.73, P  < 0.001). The main reported causes for dental trauma were falling (29.1%), sports (16.4%), violence (20%) and playing (20%). According to the parents' reports, more fall-related injuries were reported at home, more sport injuries at school, more 'playing' injuries 'outside' ( P  < 0.001). Combination of results with a previous study among Jewish schoolchildren demonstrated: severe dental trauma was related to overjet (OR = 1.73, P  = 0.002), lip incompetence (OR = 2.19, P  < 0.001), gender (OR for males = 1.54, P  = 0.005), but not to ethnicity (Arab or Jewish). The reasons for trauma observed in this study were potentially preventable. A community effort should therefore be pursued, with the aim of educating sports teachers, teachers, health personnel and schoolchildren regarding awareness of dental trauma prevention, with emphasis on utilizing mouthguards and early orthodontic intervention, when financially possible.