Prevention strategies for dental caries in the adolescent

The adolescent period presents a challenge for the dental health care professional--dentally, behaviorally, and developmentally.Changes in the frequency, distribution, and rate of progression for dental caries demand a re-evaluation of the treatment paradigm. The purpose of this article is to suggest dental caries preventive strategies for the adolescent dental patient.     

Periodontal and soft tissue prevention strategies for the adolescent dental patient

Recent research has refocused attention on the contribution of periodontal health to the general health of patients at various ages. This article describes changes in the periodontal tissues of adolescent dental patients related to hormonal fluctuations, lack of proper oral hygiene, and risk-taking behaviors. Attention is placed on the development and prevention of acute and chronic gingival conditions in addition to gingival tissue enlargement as one side effect of certain medications.     

青少年心理行为与牙科焦虑症的相关性研究

目的：调查研究口腔门诊青少年患者心理行为与牙科焦虑症（DA）的相关性。方法：利用改良牙科焦虑量表以及自制青少年心理行为问卷表对400例口腔门诊青少年患者进行问卷调查,对被调查者性别、是否有牙科治疗史以及3种不同的心理行为分组进行分析。结果：回收有效问卷379份,有效率94．75％;不同性别和对DA的发生差异极有统计学意义（P〈0．01）,Pearson列联系数r=0．27;是否有既往口腔科治疗史对DA的发生差异有统计学意义（P〈0．05）,r=0．11;紧张与焦虑行为和自我控制力行为与DA有关（P％0．05）,r分别为0．55和0．35;而内向和羞怯行为与DA无明显关联。结论：DA在青少年患者中常见,性别、既往口腔科科治疗史以及部分心理行为对DA有影响．     

Diabetes and oral health promotion: a survey of disease prevention behaviors

BACKGROUND: Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. METHODS: As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. RESULTS: The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. CONCLUSIONS: Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. CLINICAL IMPLICATIONS: Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.     

Dental beliefs, behaviors and health status among Pacific Asians and Caucasians

Abstract A sample of 50 Caucasians and 46 Pacific Asians were asked to describe their beliefs regarding the causes and consequences of dental disease. The relation among dental beliefs, behaviors and oral health status was examined for each ethnic group. Although Caucasians had more accurate knowledge, they reported fewer health behaviors and had poorer oral health than Asians. Asians knew little about dental disease, but were motivated to maintain their teeth by a concern for esthetics, social acceptance and pain. The findings indicate that important cultural differences exist in dental behaviors, and are related to knowledge and motives.     

Dental needs assessment and access to care for adolescents

For many, the adolescent years can be a difficult emotional period and a time when dental and medical needs may be neglected. Oral health needs are critical factors in the maturation of the adolescent,whether they involve the relief of pain, improved nutrition, an in-crease in self-esteem with orthodontic treatment, or "just" saving the dentition from the ravages of the early stages of periodontal disease. This article reviews demographic characteristics of adolescents in the United States with regard to oral health status, use of dental services, barriers to dental care, and children who have special health needs.     

Desensitization of the gag reflex in an adult with cerebral palsy: a case report

Severe oral hypersensltlvlty and averslve oral behaviors present a significant barrier to dental treatment and compromise oral health status. Although several authors have addressed the reduction of oral hypersensltlvlty and averslve behaviors (such as gagging, retching, and vomit-Ing) In the otherwise well dental patient, treatment for patients with severe disability has not been explored. The successful management of oral hypersensltlvlty and averslve behavior can have significant health benefits. These can be described van outcomes paradigm as physical and social benefits for the patient, psychological benefits for the patient, carer, and practitioner, and organizational benefits for the Institutions providing dental care and medical management. This paper summarizes the management of a severely disabled patient whose averslve behaviors were eliminated with non-Invasive therapy techniques. Oral hygiene was facilitated and health benefits were Identified across a number of domains following successful multi-disciplinary management.     

Socioeconomic status and self-reported oral health in Iranian adolescents: the role of selected oral health behaviors and psychological factors

Objectives: This study investigated health inequality for self-reported oral health outcomes among adolescents. The role of oral health behaviors and psychological factors in explaining oral health inequality was investigated using the hypothesis of mediation. Methods: This was a cross-sectional study that used self-completed questionnaires. This study sampled 639 (315 male and 324 female) 15- to 17-year-old adolescents (second and third grade high school students) of both sexes in the city of Sanandaj in the province of Kurdistan, western Iran. Socioeconomic indicators of the study were subjective socioeconomic status, wealth index, and parental education. Oral health behaviors were measured as toothbrushing frequency, dental flossing frequency, and dental visits. Psychological factors were self-esteem, anxiety, and depression. Self-reported oral health outcomes were single item self-rated oral health and the experience of dental pain. Regression analysis was used to test four conditions for the hypothesis of mediation. Results: The results showed that the inequality is present in oral health for some pairs of relationships between socioeconomic status and oral health outcomes. Adjustment for oral health behaviors and psychological factors, individually and simultaneously, led to loss of statistical significance for some pairs of the relationships. However, adjustment for oral health behaviors and psychological factors led to only small changes in the associations between socioeconomic status and self-reported oral health outcomes. Conclusions: This study found a graded oral health inequality, but no strong evidence to support the hypothesis that oral health behaviors and psychological factors mediate oral health inequality for self-reported oral health outcomes.     

Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions?

Polk DE, Weyant RJ, Manz MC. Socioeconomic factors in adolescents’ oral health: are they mediated by oral hygiene behaviors or preventive interventions? Community Dent Oral Epidemiol 2010; 38: 1–9. © 2009 John Wiley & Sons A/S Abstract – Objectives: To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. Methods: A cross‐sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). Results: Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. Conclusions: There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES‐associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES‐associated disparities occur.     

Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior

The aim of this study was to test the efficiency of an extended model of the theory of planned behavior (TPB) in predicting intention to improve oral health behaviors. The participants in this cross-sectional study were 153 first-year medical students (mean age 20.16, 50 males and 103 females) who completed a questionnaire assessing intentions, attitudes, subjective norms, perceived behavioral control, oral health knowledge, and current oral hygiene behaviors. Attitudes toward oral health behaviors and perceived behavioral control contributed to the model for predicting intention, whereas subjective norms did not. Attitudes toward oral health behaviors were slightly more important than perceived behavioral control in predicting intention. Oral health knowledge significantly affected affective and cognitive attitudes, while current behavior was not a significant predictor of intention to improve oral health behavior. The model had a slightly better fit among females than among males, but was similar for home and professional dental health care. Our findings revealed that attitude, perceived behavioral control, and oral health knowledge are predictors of intention to improve oral health behaviors. These findings may help both dentists and dental hygienists in educating patients in oral health and changing patients' oral hygiene habits.     

Epidemiology of dental caries among adolescents in Tamil Nadu,India

Objective: Economic and dietary changes in the Indian state of Tamil Nadu have led to compromised oral health status of the adolescent population. Adequate epidemiological data are not available to address the prevention or treatment needs in this region of India. The aim of this study was to measure the prevalence and severity of dental caries among adolescents of Tamil Nadu, a southern state of India. Methods: The study sample included 974 adolescent school students (12–15 years of age) from both rural and urban areas of Tamil Nadu, India. The decayed, missing and filled teeth (DMFT) index of these students was measured using the World Health Organization oral health survey method, in a quantitative cross-sectional study. Results: The oral health survey indicated that the prevalence of dental caries among adolescents in rural and urban areas of Tamil Nadu was 61.4%, with an average DMFT score of 2.03. Multiple regression analyses indicated factors such as gender, mother’s education, type of school and caste as significant predictors of dental caries. Conclusion: Female gender, Scheduled Caste and Tribes attending public schools in rural areas were identified as the more vulnerable populations to be affected by dental caries. Oral health policies should be targeted to these adolescent populations in the Tamil Nadu region.Key words: Prevalence of dental caries, severity of dental caries, Thanjavur, Chennai, oral health survey     

2005年广东省5岁人群口腔健康行为抽样调查报告

目的 了解广东省5岁城乡人群口腔健康行为现状,为广东省口腔卫生保健工作提供信息支持.方法 用多阶段分层等容量随机抽样的方法,抽取广东省5岁城乡常住人口360人,男女各半,城乡各半,按照《第三次全国口腔健康流行病学问卷调查方案》设计的5岁儿童家长标准问卷,对受检儿童父母进行现场询问.了解儿童口腔饮食行为、口腔卫生行为、利用口腔医疗服务行为.结果 43.06%的儿童曾有睡前吃甜食的行为.多数儿童刷牙频率为每天1～2次. 76.14%的儿童超过2年以上没有看过牙, 84.00%看牙儿童是因牙齿有问题需要治疗.结论 广东省儿童口腔健康行为尚不完善,有必要加强父母的口腔健康教育,建立正确儿童口腔健康行为.     

Effect of fear on dental utilization behaviors and oral health outcome

OBJECTIVES: This paper assesses the effect of fear on a number of dental utilization behaviors and oral heath outcome in a sample of adult Floridians. METHODS: A telephone survey was conducted in 2004 among 504 adult Floridians. Data collected included sociodemographic factors, specific fear of dental pain (FDP), global FDP, global dental fear, three measures of dental utilization behaviors, and one measure of oral health outcome. Chi-squared tests and logistic regression analyses were conducted to quantify the individual and multivariate associations between fear factors and four behavior and outcome measures. RESULTS: Global FDP was significantly associated with putting off making a dental appointment and approach to dental treatment. Global dental fear showed an independent negative impact on all four behavior and outcome measures; reports regarding specific fear of painful dental events were not significantly associated with four behavior and outcome measures. CONCLUSIONS: Our findings suggest that: (i) dental fear and FDP have independent negative effects on dental utilization behaviors and oral health outcome after controlling for other sociodemographic and general health factors; and (ii) global dental fear encompasses broader components than FDP.     

Oral Health Self-Care Behaviors of Rural Older Adults

Objectives: This analysis describes the dental self-care behaviors used by a multiethnic sample of older adults and delineates the associations of self-care behaviors with personal characteristics and oral health problems. Methods: A cross-sectional comprehensive oral health survey conducted with a random, multiethnic (African-American, American Indian, white) sample of 635 community-dwelling rural adults aged 60 years and older was completed in two rural southern counties. Results: Rural older adults engage in a variety of self-care behaviors, including the use of over-the-counter (OTC) medicine (12.1 percent), OTC dental products (84.0 percent), salt (50.9 percent), prayer (6.1 percent), and complementary therapies (18.2 percent). Some gender and ethnic class differences are apparent, with greater use by women of OTC medicine and salt and greater use by African-Americans and American Indians of OTC medicine and OTC dental products. The use of dental self-care behaviors appears to be driven by need. Those reporting oral pain, bleeding gums, and dry mouth have greater odds of engaging in most of the dental self-care behaviors, including the use of complementary therapies. Conclusions: The major factor leading to the use of self-care behaviors is need. Although oral pain does increase the use of self-care behaviors, so do bleeding gums and dry mouth. Research and practice should address self-care behaviors used for oral health problems in addition to pain. Investigators should expand analysis of dental self-care behavior and the relationship of self-care behavior to the use of professional services. Further research also should explore the use of complementary therapies in dental self-care.     

Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescents in Kilwa district, Tanzania

Background

There is a lack of studies considering social disparity in oral health emanating from adolescents in low-income countries. This study aimed to assess socio-demographic disparities in clinical- and self reported oral health status and a number of oral health behaviors. The extent to which oral health related behaviors might account for socio-demographic disparities in oral health status was also examined.

Methods

A cross-sectional study was conducted in Kilwa district in 2008. One thousand seven hundred and forty five schoolchildren completed an interview and a full mouth clinical examination. Caries experience was recorded using WHO criteria, whilst type of treatment need was categorized using the ART approach.

Results

The majority of students were caries free (79.8%) and presented with a low need for dental treatment (89.3%). Compared to their counterparts in opposite groups, rural residents and those from less poor households presented more frequently with caries experience (DMT>0), high need for dental treatment and poor oral hygiene behavior, but were less likely to report poor oral health status. Stepwise logistic regressions revealed that social and behavioral variables varied systematically with caries experience, high need for dental treatment and poor self reported oral health. Socio-demographic disparities in oral health outcomes persisted after adjusting for oral health behaviors.

Conclusions

Socio-demographic disparities in oral health outcomes and oral health behaviors do exist. Socio-demographic disparities in oral health outcomes were marginally accounted for by oral health behaviors. Developing policies and programs targeting both social and individual determinants of oral health should be an urgent public health strategy in Tanzania.     

Dental care for the handicapped adolescent

A total of 932 physically, mentally and multiple handicapped children, including many adolescents, were examined at their special schools in a mobile dental unit, during a 4-year pilot period, and 744 were treated. Their dental needs were compared with those of 450 children at normal schools. Although a greater proportion of handicapped children were caries-free, more required extractions and periodontal treatment. In the group aged 12-16 years there were more decayed teeth, more missing teeth and fewer fillings than in the controls of the same age. Over 90 per cent of the 744 children were treated satisfactorily in the mobile clinic, cooperation being acceptable in 79 per cent. Only 2 per cent were totally uncooperative and required a general anaesthetic, even for an examination. In total, 8.5 per cent of the children received some treatment under general anaesthesia. Treatment should aim to create understanding by adolescent or parent of good dental health, to obtain oral health, to create the most pleasing appearance possible, to encourage acceptance of further treatment and, where possible, to involve adolescent patients by providing treatment along normal lines.     

Relationship between oral health behaviors and general health behaviors in a Japanese adult population

OBJECTIVE: The aim of this study was to analyze the relationship between oral health behaviors and general health behaviors in adults. METHODS: A total of 2,467 adults (1,208 men and 1,259 women aged 20-59 years) who consulted dentists in Chiba City were administered a questionnaire. RESULTS: Women, older participants, and those living with family had better health behaviors than the other subjects studied. Additive indices for oral and general health behaviors were significantly correlated. Toothbrushing frequency was significantly correlated with five items of general health behavior (smoking, drinking, exercise, eating breakfast, and having medical check-ups). Having dental check-ups was significantly correlated with having medical check-ups. There was a negative correlation between dental flossing and drinking. CONCLUSIONS: Of all oral health behaviors examined, toothbrushing frequency was the most predictive indicator of general health behavior.     

Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders

Self-care behaviors are common and can act as substitutes for or supplements to formal health care services. We tested the hypothesis that problem-oriented dental attenders (POAs) report more dental self-care behaviors than do regular dental attenders (RAs), presumably as a substitute for professional care. The Florida Dental Care Study Is a longitudinal cohort study of changes In oral health, In which we measured dental self-care behaviors related to three common dental problems: toothache pain, bleed-Ing gums, and tooth loss. Despite using less dental care, POAs were less likely to report "conventional" methods as means to prevent the three dental problems; however, they were more likely to report that homemade remedies, topical medications, or mouthwashes were ways to prevent or treat these problems. POAs were also more likely to believe that "nothing can be done" to prevent these problems. Additionally, POAs had more negative dental attitudes, used less dental care during follow-up, had more dental disease, were the only persons who extracted at least one of their own teeth, and were more likely to use tobacco. With the exception of dental self-extractions, no single self-care belief or behavior distinguished POAs from RAs, nor were POAs likely to have different explanations tor dental problems. Instead, the pattern was one of modest differences on a number of items. Although POAs use less dental care, they do not compensate by employing more "conventional" dental self-care behaviors, but report being more likely to employ "unconventional" behaviors. They also are more likely to believe that nothing can be done to prevent dental problems.     

Preventive dental behaviors and their association with oral health status in older white men.

While prevention practices are widely encouraged, the link between the performance of preventive behaviors and oral health status has rarely been examined. This study investigates the association between preventive dental behaviors (recent and long-term) and oral health status and compares the strength of such associations. Longitudinal data over six time points on 649 dentate white men were obtained from the VA Dental Longitudinal Study (DLS). Participants' oral health was measured through dental examinations, and preventive dental behaviors--i.e., toothbrushing, flossing, using interdental devices, seeking dental prophylaxis, and undergoing dental treatment-were assessed by self-report. Oral health status was measured in terms of (1) functioning teeth, (2) sound-equivalent teeth, (3) decayed, missing, and filled teeth, and (4) decayed and filled root surfaces. Pearson correlation and linear regression analysis revealed significant positive associations between most preventive behaviors and measures of oral health status. Dental prophylaxis emerged as the strongest predictor of oral health status. Long-term preventive dental behavior measures explained more variance in oral health status than short-term preventive behaviors measured cross-sectionally.     

The Relationship Between Dental Utilization and Preventive Participation Among a Well-elderly Sample

Previous studies have shown that dental utilization by older people is lower than for the general population. This study hypothesizes that an elder's tendency toward participating in preventive health activities may be an important factor in explaining the likelihood of accessing the dentist. Subjects included 1,911 older individuals who enrolled in the UCLA Medicare Screening and Health Promotion Trial. All were interviewed about their utilization of preventive health services and participation in preventive behaviors. A recent dental visit was positively associated with all sociodemographic variables examined except age and sex. It was also related to health status questions and utilization of the preventive health services and health behaviors studied. Logistic regression analysis showed that both summary preventive health behavior and preventive service utilization variables were important factors in explaining a recent dental visit (model chi-square/221.4, P=.001) along with income, not having a removable prosthesis, and perceiving the need for dental care. This study showed that dental utilization is related to older people's participation in other preventive activities. When in contact with older people, health care professionals should consider current oral and general preventive health status and encourage appropriate referral for preventive activities.