Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease

Aim: To evaluate the associations of periodontal health status and oral health behaviours with chronic obstructive pulmonary disease (COPD).
Materials and Methods: We conducted a case–control study of 306 COPD patients and 328 controls with normal pulmonary function. Their periodontal status and respiratory function were clinically examined and information on oral health behaviours was obtained using a validated questionnaire.
Results: Patients with COPD had fewer teeth and a higher plaque index than the controls. Univariate analysis showed that tooth brushing times and method, experience of dental floss use, dental visit and regular supra-gingival scaling, and oral health knowledge were significantly related to the risk of COPD. After adjusting for age, sex, and body mass index and stratifying by smoking status, inappropriate tooth brushing method ( p =0.025 among non-smokers), lower regular supra-gingival scaling ( p =0.027 among non-smokers and p <0.0001 among former smokers), and poorer oral health knowledge ( p <0.0001 among non-smokers and p =0.019 among former smokers and p =0.044 among current smokers) remained significantly associated with COPD.
Conclusions: Poor periodontal health, dental care, and oral health knowledge were significantly associated with an increased risk of COPD. Our findings indicate the importance of promoting dental care and oral health knowledge that can be integrated into the prevention and treatment of COPD.     

Oral and general health behaviours among Chinese urban adolescents

Abstract – Objectives: The objectives of this study were to measure the association of general and oral health‐related behaviours with living conditions and to explore the interrelationships between general and oral health‐related behaviours in Chinese urban adolescents. Methods: A cross‐sectional survey of 2662 adolescents was conducted in eight Chinese provincial capitals. The response rate was 92%. The study population was selected through multistage cluster sampling and comprised three age groups: 11, 13 and 15 years. Data on oral and general health, lifestyles as well as living conditions were collected by means of self‐administered structured questionnaires. Several additive indices were constructed from answers to the questions on specific behaviour, and participants were categorized according to scores on each component of health‐related behaviour for statistical analyses by frequency distributions, regression analyses and factor analyses. Results: Oral health‐related behaviours among adolescents were associated with socioeconomic status of parents, school performance and peer relationships. The odds of a dental visit was 0.63 in adolescents of poorly educated parents and the corresponding figure for regular oral hygiene practices was 0.62. Odds of tobacco use was 3 for adolescents with poor performance in school while odds of consuming sugary foods/drinks was 1.3. Adolescents with high levels of preventive oral health practices also demonstrated general health‐promoting behaviours. In factor analysis of general and oral health‐related behaviours, three factors were isolated: (a) risk behaviours (loadings 0.48–0.66), (b) health‐promoting behaviours (loadings 0.60–0.64) and (c) help‐seeking behaviours (loadings 0.56–0.67). Conclusion: The findings support a multidimensional model of health behaviour. Several approaches and multiple methods should be applied in oral health education in order to modify behaviours that affect oral health.     

Influence of oral health-related behaviours on income inequalities in oral health among adolescents

Perera I, Ekanayake L. Influence of oral health‐related behaviours on income inequalities in oral health among adolescents. Community Dent Oral Epidemiol 2011; 39: 345–351. © 2011 John Wiley & Sons A/S Abstract – Objectives: To determine income inequalities in both perceived oral health and oral health‐related behaviours and the role oral health‐related behaviours in explaining income inequalities in perceived oral health among Sri Lankan adolescents. Methods: The sample included 1218 fifteen‐year‐olds selected from 48 schools in the Colombo district using a stratified cluster sampling technique. Data were collected by means of questionnaires to both adolescents and their parents. Perceived oral health status was the oral health outcome considered while oral health‐related behaviours included brushing frequency, use of dental services in the preceding year and consumption of sugary food/drinks and fruit/vegetables. Results: Tooth brushing frequency, use of dental services in the preceding year and consumption of fruit/vegetables were associated with perceived oral health status. Also, the trends in perceived oral health and all oral health behaviours across ordered income groups were statistically significant. However, it was evident from the Poisson regression models that the effect of income on perceived oral health did not attenuate significantly following adjustment for oral health behaviours. Conclusions: This study demonstrated that oral health behaviours were associated with perceived oral health and also the existence of income gradients in perceived oral health and oral health behaviours. However, oral health behaviours were not accountable for the observed income gradients in perceived oral health.     

Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city

OBJECTIVES: To assess the knowledge, attitude and behaviour in relation to periodontal health status among Saudi intermediate and high school students living in Jeddah, Kingdom of Saudi Arabia. METHODS: A dental health questionnaire was distributed to a random sample of a total of 2586 Saudi students from intermediate and high school, aged 12-18 years residing in Jeddah. RESULTS: While about 87.1% knew that tooth brush helps prevent periodontal disease, only 33.1% knew that using dental floss helps in preventing periodontal disease. Females used brushing and flossing more than males, while males used miswak more than females. Tooth brushing (P<0.001) and dental floss (P<0.015) were used more frequently among private subjects, while miswak was utilized more frequently among governmental school students (P<0.005). Dental pain was found to be the main reason for visiting the dentist among the target group. CONCLUSIONS: It appears that knowledge, attitude, and behaviour concerning periodontal health among young Saudi school students living in Jeddah city are in need of improvement.     

Preventive oral health behaviors among African-Americans and whites in Detroit

OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.     

Epidemiology of clinical attachment loss in adolescents.

BACKGROUND: Relatively little is known about the prevalence, severity, and determinants of clinical attachment loss among adolescents. METHODS: A multi-stage random sampling procedure was used to obtain a sample of 9,203 high school students aged 12 to 21 years from the Province of Santiago, Chile. All but 41 students were examined for clinical attachment loss in 6 sites of first and second molars and incisors. The students were interviewed with respect to tooth brushing habits, smoking habits, dental visits, and diabetic status. Logistic regression analyses were used to assess the relative strength of the associations between age, gender, smoking, tooth brushing habits, dental attendance patterns, diabetic status, and governmental school support and the occurrence of clinical attachment loss. RESULTS: Overall, clinical attachment loss > or = 1 mm was seen in 69.2% of the students; > or = 2 mm in 16% of the students; and > or = 3 mm in 4.5%. The distribution of clinical attachment loss was markedly skewed, but followed a continuum of disease severity. Logistic regression analyses showed that attachment loss was associated with higher age, female gender, infrequent tooth brushing, infrequent dental visits, and attending a high school receiving governmental support. CONCLUSIONS: No sharp distinction exists between periodontal health and disease among Chilean adolescents. Higher age, poor oral hygiene, and a lower socioeconomic background play a role in the occurrence of clinical attachment loss.     

Periodontal awareness and knowledge,and pattern of dental attendance among adults in Jordan

AIMS: To provide baseline data on periodontal awareness and health knowledge, and to assess patterns of dental attendance behaviours among 20 to 60 year-old Jordanian adults. METHODS: A questionnaire incorporating items related to personal and socio-demographic data, periodontal awareness and health knowledge, and self-reported dental attendance behaviours. One-thousand questionnaires were distributed among adults attending dental clinics. RESULTS: 743 questionnaires were completed and statistically analysed. About one-quarter of adults reported 'gum bleeding' on brushing, but more subjects (40.4%) believed that they had periodontal disease. Also, 47% of the participants thought that they had a 'rough tooth surface', 16% had 'gum irritation' and 25% had 'bad breath'. There were no statistically significant differences between genders with regard to responses on periodontal awareness (P >0.05). The majority of adults incorrectly defined the meaning of dental plaque and did not know its role in the aetiology of gingival disease. Conversely, the majority of participants (60.8%) were aware that gingival bleeding upon brushing indicated the presence of periodontal disease that can be prevented by brushing and flossing (63.4%), mainly before going to bed (73.9%). The overwhelming majority of subjects (81.4%) were irregular attenders. 'Treatment not necessary' and 'cost' were found to be the common barriers for regular dental attendance. The most common treatment received by the subjects at their last visit was restorative therapy. CONCLUSION: Knowledge and awareness concerning periodontal disease is still poor in Jordan, therefore, more dental health education is needed to improve oral health.     

Self-concept and dental health behaviours in adolescents

The purpose of this investigation was to examine the relation between some dental health behaviours and 2 measures of self-concept in adolescents. Data from a survey of 41142, 12–16–year-old children from 244 secondary schools though out England were analysed to obtain information about their frequencies of toothbrushing. use of dental floss and dental attendance, and whether they recalled advice about toothbrushing. in relation to self-esteem and health locus of control (HLOC). Subjects completed a questionnaire, anonymously, in school class. The results showed a significant positive correlation (Spearman) between the frequencies of flossing and toothbrushing, in both sexes, and between social group and toothbrushing frequency, where brushing frequency increased as socio- economic status improved. Some association between use of floss and social group emerged, but this was smaller and less consistent than that observed with toothbrushing brushing frequency. Self-esteem was positively correlated with toothbrushing frequency at ages 12–15 years, while HLOC showed correlations at some ages but not others. Use of dental floss showed no relation to self-concept. Subjects with more favourable self-concept were more likely to make more frequent dental visits than those with a poorer self-view. There was a strong and consistent correlation between recalled advice about toothbrushing and lower self- esteem and external locus of control. The results are in agreement with our earlier reports and suggest that self-concept may play a significant role in mediating changes in dental health behaviour.     

Investigating the relationship between self-reported oral health status, oral health-related behaviours and self-consciousness in Romania

PURPOSE: The aim of the present study was to investigate whether self-consciousness, self-reported oral health status and oral-health-related behaviours were associated. MATERIAL AND METHODS: The present study sample consisted of 253 first year medical students in Romania. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status and three self-consciousness subscales (Private Self-Consciousness, Public Self-Consciousness, and Social Anxiety). RESULTS: Significant differences were found in Public Self-Consciousness and Social Anxiety according to several variables: anxiety, stress, depression and current non-treated caries. There were significant differences in Social Anxiety for the variables of gender, smoking, perceived dental health, self-reported gum bleeding and reason for dental visit (p < 0.05). A significant difference was found in Public Self-Consciousness for the reason for dental visits (p < 0.05). Total Self-Consciousness is correlated with anxiety, stress, depression, current non-treated caries, gingival bleeding and reason for dental visit. Oral health behaviours such as tooth brushing, flossing, mouth washing and last dental visit were not influenced by each of the self-consciousness subscales. CONCLUSIONS: The results suggest that self-consciousness might be a psychosocial risk marker that influences self-reported oral health status.     

A cross-cultural comparison of dental health attitudes and behaviour among freshman dental students in Japan, Hong Kong and West China

OBJECTIVE: To clarify the differences in dental health attitudes/behaviour among freshman dental students. DESIGN: Cross-cultural differences. SETTING: Japan, Hong Kong and West China. PARTICIPANTS AND METHODS: The original version of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) was written in Japanese. After testing the validity of both English and Chinese versions, the original version of the HU-DBI was administered to 58 freshman Japanese dental students, the English version to 43 Hong Kong Chinese peers and the Chinese version to 39 West Chinese peers. RESULTS: Significant cultural differences were found for 16 items out of 20. The most striking result was that the Japanese students were more likely to have used a dye to see how clean their teeth were, compared to their Chinese peers (P<0.001). The Chinese students were less likely to have a belief that they could clean their teeth well without using toothpaste (P<0.001), whereas higher percentages of the Chinese students worried about having bad breath (P<0.001). A higher percentage of the Hong Kong students reported that they regularly checked their teeth in a mirror than did their West Chinese or Japanese peers (P<0.05). CONCLUSIONS: There were considerable differences in dental health attitudes/behaviour among freshman dental students in the three cultural groups.     

Dental service utilization among junior secondary school students in Ibadan,Nigeria

The study was carried out to determine factors affecting oral health care service utilization among a representative sample of junior secondary school children in Ibadan, Nigeria. The study was a cross sectional one in which self administered questionnaire was filled by each student. Data were collected on their socio-demographic characteristics, previous visit(s) to the dental clinic and reasons for the visit(s), reasons for non dental visits for those who have never visited the dentist, the students’ beliefs in regular dental visits and reasons for these beliefs. Only 457 students completed their questionnaires reasonably well and their responses were analysed. Their mean age was 13.04±1.10 years. Over 80% of the children claimed they have never visited the dentist and lack of perceived need accounted for 82.8% of the various reasons given for the non visit. Sixty eight point nine percent of the children believed in regular dental visits while 27.8% of them did not believe in regular dental visits. Equity in access and opportunity for disease prevention among young adolescents may be achieved by school oral health program whereby regular oral health talks/education is instituted.     

Dental health behaviour in relation to caries status among medical and dental undergraduate students of Udaipur district,India

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2008.00346.x
Kumar S, Motwani K, Dak N, Balasubramanyam G, Duraiswamy P, Kulkarni S. Dental health behaviour in relation to caries status among medical and dental undergraduate students of Udaipur district, India. Abstract: Objective: To compare the caries status and oral hygiene behaviour of dental and medical students and to assess the influence of oral hygiene behaviour on the caries status. Methods: A questionnaire survey was conducted to assess the knowledge, attitudes and behaviour along with clinical examination to asses the caries status. A total of 403 dental and medical students enrolled with Rajasthan University of Health Sciences of Udaipur district, India were recruited in the study. Results: 56.4% of dental students brushed their teeth twice daily compared to 38.5% of medical students. There was no significant difference between the mean decayed components of males and females of dental stream, whereas among medical subjects, males had a higher decayed score than females (P = 0.012). The mean behaviour score obtained by dental students (19.38) was greater than that of medical students (18.34). Moreover, medical students presented a higher decayed, missing and filled teeth (DMFT) score (1.96) than dental students (1.16). Subjects who had a habit of brushing after every meal showed lower DMFT score (1.4) than those who brushed only once a day (1.64). Step‐wise linear regression analysis revealed that course of education and final behaviour score were the best predictors for the DMFT status. Conclusion: This study revealed significant differences between the oral hygiene behaviour and caries status of dental and medical students; furthermore, caries status was significantly influenced by the oral hygiene behaviour.     

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.     

Sociodemographic and dietary factors in relation to dental health among Greek adolescents

Abstract In the context of a project aiming to assess risk factors affecting health status of Greek adolescents, 380 adolescents aged 12–17 years were randomly selected from two rural high schools of similar socioeconomic status, and from two urban schools of different socioeconomic level, namely urban/lower and urban/higher. Dental examinations were carried out according to WHO diagnostic criteria: oral hygiene habits were recorded through personal interviews; and diet was assessed through interviewer-administered, semi-quantitative food frequency questionnaires. The percentage of caries-free adolescents varied from 24.3 in the age group of 12–13 years to 13.2 in the age group 16–17 years: mean (SE) DMFT values were 3.7 (0.3) in the younger age group and 5.9 (0.4) in the older age group whereas mean (SE) DMFS values were respectively 5.6 (0.5) and 9.9 (0.9). Multiple regression analysis-derived results showed that dental health, measured through either DMFT or DMFS indices, was significantly better among younger and male adolescents: among higher socioeconomic class urban residents; among those brushing their teeth at least once per day: and among those who had better school performance. There was evidence that intake of vegetables and milk products was associated with lower DMFS and DMFT indices, whereas there was a non-significant tendency for sugar intake to be associated with higher values of these indices. In contemporary Greek society there-are substantial social inequalities with respect to dental health: these are due, in part, to differences in oral hygiene habits and patterns of dietary intakes. High risk groups should be identified among the underprivileged for targeted health education efforts and delivery of more intensive dental care services.     

Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants

Objectives: To assess the role of the individual determinants on the inequalities of dental services utilization among low‐income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. Methods: A cross‐sectional population‐based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Results: Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. Conclusions: The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low‐income children. The individual determinants seem to be important predictors of access.     

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care

da Silva AN, Mendonça MH, Vettore MV. The association between low‐socioeconomic status mother’s Sense of Coherence and their child’s utilization of dental care. Community Dent Oral Epidemiol 2011; 39: 115–126. © 2010 John Wiley & Sons A/S Abstract – Objectives: The objective of this study was to investigate the relationship of low‐socioeconomic status mother’s Sense of Coherence (SOC) and their child’s utilization of dental care services in a city of Southeast Brazil. Methods: A cross‐sectional study was conducted on a sample of 190 schoolchildren aged 11–12 and their mothers in Sao João de Meriti‐RJ, Southeast Brazil. The outcome variables were children’s use of dental care services and visiting dentists mainly for check‐ups. Demographic and socioeconomic characteristics and data regarding children’s dental care use were collected through interviews with mothers. Children’s oral health‐related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother’s SOC was assessed through the validated short version (13‐item) of Antonovsky’s scale. Multiple logistic regression was used in the data analysis. Results: Of the mothers, 81.1% reported on their child’s utilization of dental care services. Of them, 42.9% considered check‐ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR = 2.08 95%CI = 1.17–3.64) and visit a dentist mainly for check‐ups (except for dental treatment) (OR = 2.02 95%CI = 1.06–3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children’s oral health‐related behaviours and oral health measures. Conclusions: Mother’s SOC was a psychosocial factor associated with their child’s pattern of use of dental care services in low‐socioeconomic status families.     

Caries and background factors in Norwegian and immigrant 5-year-old children

Wigen TI, Wang NJ. Caries and background factors in Norwegian and immigrant 5‐year‐old children. Community Dent Oral Epidemiol 2010; 38: 19–28. © 2009 John Wiley & Sons A/S Abstract – Objectives: The purpose of this study was to assess the caries status of 5‐year‐olds in a low caries area, and study associations between dental caries and parent‐related factors: parents’ education, national origin, oral health behaviours and attitudes. Methods: The material consisted of 523 children and was a stratified random sample. Clinical and radiographic examination was performed in 2007. Enamel and dentine caries were recorded at surface level. Parents filled in questionnaires regarding socioeconomic status, their own oral health behaviours and attitudes. Results: Most participants (66%) had no caries experience and 16% had enamel caries only. Dentine caries experience was present in 18% of the children, and 5% had dentine caries experience in five or more teeth. Surfaces with enamel caries constituted half of all surfaces with caries experience. In multiple logistic regression, statistically significant risk indicators for the child having dentine caries experience at the age of five were: having one or both parents of non‐western origin (OR = 4.8), both parents (OR = 3.0) or one parent (OR = 2.1) with low education, parental laxness about the child’s tooth brushing (OR = 2.8), parents’ brushing their own teeth less than twice a day (OR = 2.2) and having parents with frequent sugar intakes (OR = 1.8). Conclusion: Caries prevalence in 5‐year‐olds was strongly associated with parent‐related factors signifying that information on parents’ socioeconomic status, dental behaviours and attitudes should be considered when planning dental services for young children. Our results suggest that the real high risk group is non‐western children whose parents have low education.     

Social capital and self-rated oral health among young people

Furuta M, Ekuni D, Takao S, Suzuki E, Morita M, Kawachi I. Social capital and self‐rated oral health among young people. Community Dent Oral Epidemiol 2012; 40: 97–104. © 2011 John Wiley & Sons A/S Abstract – Objectives: A few studies have revealed the impact of neighborhood social capital on oral health among young people. We sought to examine the associations of social capital in three settings (families, neighborhoods, and schools) with self‐rated oral health among a sample of college students in Japan. Methods: Cross‐sectional survey of 967 students in Okayama University, aged 18 and 19 years, was carried out. Logistic regression was used to examine the associations of poor self‐rated oral health with perceptions of social capital, adjusting for self‐perceived household income category and oral health behaviors. Results: The prevalence of subjects with poor self‐rated oral health was 22%. Adjusted for gender, self‐perceived household income category, dental fear, toothbrush frequency, and dental floss use, poor self‐rated oral health was significantly associated with lower level of neighborhood trust [odds ratio (OR) 2.22; 95% confidence interval (CI): 1.40–3.54] and lower level of vertical trust in school (OR 1.71; 95% CI: 1.05–2.80). Low informal social control was unexpectedly associated with better oral health (OR 0.54; 95% CI: 0.34–0.85). Conclusions: The association of social capital with self‐rated oral health is not uniform. Higher trust is associated with better oral health, whereas higher informal control in the community is associated with worse oral health.