Oral self-care and periodontal health indicators among adults with diabetes in Finland

We assessed the effects of oral self-care on periodontal health indicators among adults with diabetes. The sample consisted of 120 dentate individuals, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic in southwest Finland. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN). A questionnaire focused on self-treatment, self-prevention, and self-diagnosis of oral diseases, utilization of dental services, and patients' knowledge and attitudes towards oral health. The New Century model of oral health promotion was used as a theoretical framework for analysis of determinants of oral self-care. Although individuals aged 40 years or older were more frequent interdental cleaners, significantly better oral health indicators were found among younger patients. Women reported brushing their teeth more frequently, and differences in plaque and calculus indices were significantly lower than those of men. Self-reported good oral condition was strongly associated with frequent dental visits and less plaque and calculus. No missing teeth and age less than 40 years were predictors of lower plaque, calculus, and CPITN scores. A significant association was found only between frequent dental visits and reduced amount of calculus. Self-reported frequency of oral health habits among adults with diabetes seemed to have little effect on periodontal health indicators. Adults with diabetes should benefit from comprehensive oral selfcare, and more attention is needed for improving the quality and outcome of these habits.     

Oral self-care among adults with diabetes in Finland

OBJECTIVES: The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland. METHODS: The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion. RESULTS: The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed. CONCLUSIONS: A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.     

Oral health promotion among adults with diabetes in Finland

OBJECTIVES: In the present community trial, changes in oral health among adults with diabetes in Finland were assessed in three differing intervention groups and in a control group. The goal of intervention was to promote periodontal health. METHODS: The study population comprised of 120 adults with diabetes, who were regular patients at the Salo Regional Hospital Diabetes Clinic in Salo, Finland. All underwent periodontal examination in 1999 and 2001. The percentage of dropouts was 4%. Outcome measures were visible plaque, presence of calculus, and the Community Periodontal Index of Treatment Needs (CPITN) index calculated for each tooth separately. Oral-health-related factors were determined by a questionnaire. Intervention based on the recommended treatment interval was carried out in the following groups: diabetes nurse-letter-reminder group (n = 26), diabetes nurse-reminder group (n = 31), letter-reminder group (n = 30), and a control group (n = 28). RESULTS: A significant decrease occurred in the visible plaque index between 1999 and 2001 in all groups, and in calculus index in the diabetes-nurse-reminder group and in the letter-reminder group. During the study period, only in the control group, the CPITN index codes 3 and 4, calculated for each tooth separately, increased. CONCLUSION: These positive results emphasize the potential of existing health-care actions for promoting periodontal health. With minimal recourse demands, it was possible to increase oral health behaviors and periodontal health among patients with diabetes.     

Assessment of periodontal treatment needs among adults with diabetes in Finland

OBJECTIVES: People with diabetes have a high risk for periodontal disease, which can be considered one of the complications of diabetes. We evaluated periodontal treatment needs using the Community Periodontal Index of Treatment Needs (CPITN) in relation to diabetes-related factors and oral hygiene. DESIGN: The sample consisted of 120 dentate diabetics, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. The nurses, who interviewed the patients, collected data on duration and type of diabetes, complications, and HbA1c level. Clinical periodontal examination included identification of visible plaque, the presence of calculus and use of the CPITN. RESULTS: The CPITN score 3 was the most prevalent. According to the logistic regression model, poor metabolic control was significantly related to pathologic pockets. No significant association was found between diabetes-related factors and the highest individual CPITN score of 4, which was, in turn, significantly associated with extensive calculus. CONCLUSIONS: Excessive periodontal treatment needs found, indicate that current dental care may be insufficient in adults with diabetes. Oral health among high-risk groups, especially those with poor metabolic control, should be promoted by collaboration between dental and health care professionals involved in diabetes care.     

Dental fear and oral health habits among adults in Finland

A previous clinical trial showed that long-term use of saliva-stimulating polyol (xylitol and sorbitol) chewing gums was associated with arrest of dental caries in young subjects. After a 20-22-month intervention (when the subjects were 8 years old), a total of 23 primary teeth with extensive dentin caries lesions whose surface in clinical examination was found to be totally rehardened (remineralized) could be removed because the teeth were near their physiologic exfoliation time. These teeth were subjected to histologic, microhardness, and electron microscopic tests. The majority of the specimens had been remineralized from the surface by a non-cellular-mediated process within the remaining collapsed, organic extracellular matrix associated with the remaining dentinal surface. Many of the underlying dentinal tubules were filled with a matrix that had been subsequently mineralized. Dental microanalyses showed that the topmost (outer) 20-mm-thick rehardened layer of the lesions exhibited the highest Ca:P ratio, which leveled off at a depth of approximately 150 mm. The rehardened surface layer (normally <0.1 mm in thickness) was significantly (P < 0.001) harder than sound dentin and nearly as hard as sound enamel. Although the main source of the mineral present in the rehardened layer was most likely of salivary origin, some extracellular remineralization was probably mediated by odontoblasts. The results complete the clinical diagnoses of the original trial and suggest that regular use of polyol chewing gums may induce changes in dentin caries lesions, which in histologic and physiochemical studies show typical characteristics of rehardening and mineralization.     

Periodontal treatment needs in a follow-up study among adults with diabetes in Finland

We assessed changes in periodontal treatment needs among patients with diabetes and the risk factors involved in this phenomenon. The sample consisted of 120 dentate subjects, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. They underwent periodontal examination in 1999 and were re-examined in 2001. The drop-out rate was 4%. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN) index. Diabetes-related factors consisted of information about duration of diabetes, complications, and HbA1c values. Oral health-related factors were collected by questionnaire. The CPITN index proved to be insensitive to change. Pathological pockets (CPITN 3 or 4) were found in 80% of subjects (n = 115) and 48% of sextants (n = 627); in 1999, the corresponding rates were 77% and 49%. The tooth-based individual CPITN index (code 3 or 4) revealed periodontal deterioration in 38 patients. Smoking and infrequent interdental cleaning were significant factors explaining periodontal deterioration in logistic regression. Risk factors should be taken into account when planning prevention, treatment, and supportive periodontal therapy strategies. In diabetes care, the common risk factor approach can be implemented to promote oral health among individuals with diabetes.     

Periodontal treatment needs in a follow-up study among adults with diabetes in Finland

We assessed changes in periodontal treatment needs among patients with diabetes and the risk factors involved in this phenomenon. The sample consisted of 120 dentate subjects, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. They underwent periodontal examination in 1999 and were re-examined in 2001. The drop-out rate was 4%. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN) index. Diabetes-related factors consisted of information about duration of diabetes, complications, and HbA1_c values. Oral health-related factors were collected by questionnaire. The CPITN index proved to be insensitive to change. Pathological pockets (CPITN 3 or 4) were found in 80% of subjects (n = 115) and 48% of sextants (n = 627); in 1999, the corresponding rates were 77% and 49%. The tooth-based individual CPITN index (code 3 or 4) revealed periodontal deterioration in 38 patients. Smoking and infrequent interdental cleaning were significant factors explaining periodontal deterioration in logistic regression. Risk factors should be taken into account when planning prevention, treatment, and supportive periodontal therapy strategies. In diabetes care, the common risk factor approach can be implemented to promote oral health among individuals with diabetes.     

Oral self-care behaviours in older dentate adults

Defining oral self-care as activities undertaken by individuals to maintain or promote dental health, this paper examines the distribution of oral self-care behaviours in a sample of dentate adults, age 50 and over, living in Ontario, Canada (n = 713). Results are presented separately for two older cohorts, respondents ages 50-64 and those 65 and older, and for females and males. Six oral self-care behaviours were examined: toothbrushing, flossing, use of an interdental device, extra fluoride use, frequency of between meal snacks and ingestion of cariogenic foods. High rates of self-care occurred only for toothbrushing. Age groups differed significantly for use of interdental devices, consumption of cariogenic foods and snacking between meals while gender differences were found for toothbrushing, flossing and consuming sweet foods. The need to target older adults and especially older males for oral hygiene information and instruction in order to counteract possible misleading beliefs learned before the advent of current dental hygiene practices is apparent from these data.     

Oral health and obesity indicators

Background

In western Sweden, the aim was to study the associations between oral health variables and total and central adiposity, respectively, and to investigate the influence of socio-economic factors (SES), lifestyle, dental anxiety and co-morbidity.

Methods

The subjects constituted a randomised sample from the 1992 data collection in the Prospective Population Study of Women in Gothenburg, Sweden (n?=?999, 38-?>?=78 yrs). The study comprised a clinical and radiographic examination, together with a self-administered questionnaire. Obesity was defined as body mass index (BMI)?>?=30 kg/m², waist-hip ratio (WHR)?>?=0.80, and waist circumference >0.88 m. Associations were estimated using logistic regression including adjustments for possible confounders.

Results

The mean BMI value was 25.96 kg/m², the mean WHR 0.83, and the mean waist circumference 0.83 m. The number of teeth, the number of restored teeth, xerostomia, dental visiting habits and self-perceived health were associated with both total and central adiposity, independent of age and SES. For instance, there were statistically significant associations between a small number of teeth (<20) and obesity: BMI (OR 1.95; 95% CI 1.40-2.73), WHR (1.67; 1.28-2.19) and waist circumference (1.94; 1.47-2.55), respectively. The number of carious lesions and masticatory function showed no associations with obesity. The obesity measure was of significance, particularly with regard to behaviour, such as irregular dental visits, with a greater risk associated with BMI (1.83; 1.23-2.71) and waist circumference (1.96; 1.39-2.75), but not with WHR (1.29; 0.90-1.85).

Conclusions

Associations were found between oral health and obesity. The choice of obesity measure in oral health studies should be carefully considered.

     

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.     

Oral health, related behaviors and oral health impacts among homeless adults

OBJECTIVE: To assess the oral health needs, related behavior and oral health impact among homeless persons in Newark, New Jersey. METHODS: Participants represented a convenience sample of adults (n=46) participating in Homeless Services Day, an annual event sponsored by the Homeless Services Division of the Newark, NJ Department of Health and Human Services. Their mean age was 40.4 yr (SD=10.0), and 51.1% were female. The majority (76%) reported African-American ethnicity; remaining participants self-identified as Hispanic, White or Asian. Participants reported being homeless for a median of 11 months, with a range of 1 to 108 months. RESULTS: The 46 participants had 745 teeth (averaged 16.2 per person) that were either missing, had fillings or had untreated decay. Diseased teeth averaged 3.8 per person; missing teeth averaged 8.6 per person; and filled teeth averaged 3.7 per person. Only 28.3% had a dental visit in the past year. Approximately 87% reported negative oral health impacts impact: over half (55.6%) had current oral facial pain and two-thirds of our participants reported having dental-related face pain during the past year. Additional oral health impacts included: eating (42%), smiling (33%), concentrating (18%) and talking (16%). CONCLUSIONS: Consistent with other studies, this homeless sample presented with considerable oral health needs. Newark's homeless, like other homeless cohorts, face access to care and negative oral health impacts. This study informs the need for future research that can provide substantive evidence for care providers and policy makers.     

Oral hygiene habits among adolescents in Finland

Abstract The aim of this study was to analyze oral hygiene habits among Finnish adolescents with regard to age, sex, residence, socioeconomic factors, school career and success. A representative sample of 3209 Finnish adolescents, 13–19 years of age, was drawn. The data were collected by mail surveys in February and September 1977. Participation percentages were 88 and 79. The proportions of daily brushers were 89 % in girls and 57 % in boys. Toothpicks were used sporadically by every second adolescent but daily by 3% only. Dental floss was used sporadically by 10% of the adolescents but daily by 1 %only. In this respect girls were more assiduous than boys. Frequency of toothbrushing clearly increased with age. Girls brushed their teeth significantly more often than boys. The influence of socioeconomic factors was consistent in boys but almost nonexistent in girls. Children of white-collar workers reported better oral hygiene habits than children of blue-collar workers and farmers. Urban adolescents reported better habits than rural adolescents. School success correlated positively with toothbrushing frequency in the younger age groups. Dental health education given by a dentist, a teacher, a hygienist or a nurse had poor correlation with the oral hygiene habits of Finnish adolescents. It was concluded that dental health education should be more directed towards boys, especially at ages 13–15. The education should be planned so that the dental health education better reaches youth of rural areas and lower social classes.     

Dental fear and alexithymia among adults in Finland

population sample, controlling for age, gender, education and marital status as well as depressive and anxiety disorders. An additional aim was to evaluate whether gender modified this association. MATERIAL AND METHODS. The two-stage stratified cluster sample (n = 8028) represented the Finnish population aged 30 years and older. Participants (n = 5241) answered the question 'How afraid are you of visiting a dentist?' They also filled out the 20-Item Toronto Alexithymia Scale (TAS-20), which included three sub-scales, i.e. difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF) and externally oriented thinking (EOT). Anxiety and depressive disorders were assessed with a standardized structured psychiatric interview according to DSM-IV criteria. To evaluate the association between dental fear and alexithymia, multiple logistic regression analyses were performed, adjusting simultaneously for the effects of possible confounding variables. RESULTS. Gender modified the association between dental fear and alexithymia. Among women, those reporting higher scores for TAS-20, DIF and EOT sub-scale scores were more likely to have high dental fear than were those reporting lower scores. Among men no such association was observed. Those participants who reported high DDF sub-scale scores were more likely to have high dental fear than were those reporting lower scores. CONCLUSIONS. Alexithymics are more likely to have high dental fear than non-alexithymics are. The findings support the suggestion that some people with dental fear may have internal personality vulnerability to anxiety disorders.     

Risk indicators of periodontal disease in older Thai adults

BACKGROUND: The aim of this study was to identify risk indicators for periodontitis using cross-sectional data from a group of older Thai adults. METHODS: The study group consisted of 2,005 individuals, aged 50 to 73 years old. They received detailed medical examinations and periodontal examinations including plaque score, probing depth, and clinical attachment level. These individuals were categorized into mild, moderate, or severe periodontitis if mean clinical attachment level was <2.5 mm, 2.5 to 3.9 mm, or > or = 4.0 mm, respectively. The degree of association between the severity of periodontitis and various independent variables was investigated using multinomial logistic regression analysis. RESULTS: The percentage of subjects classified as mild, moderate, and severe periodontitis was 30.5, 53.6, and 15.9, respectively. The prevalence of severe periodontitis was higher in males and increased with age. In univariate analysis, older subjects, males, less educated persons, persons with lower income, persons with higher plaque score, smokers, drinkers, and diabetics were more likely to have both moderate and severe periodontitis. In multivariate analysis, males, less educated persons, persons with higher plaque score, and current smokers were more likely to have moderate periodontitis. Three additional factors including older age, former smokers, and diabetes significantly increased the odds for having severe periodontitis. Income, alcohol consumption, body mass index, and waist circumference had no significant effects on periodontal disease severity in the multivariate model. CONCLUSIONS: Our data suggest that age, gender, education, oral hygiene status, smoking, and diabetes are significantly associated with periodontal disease severity in this study group. Longitudinal studies will establish whether these variables are true risk factors.     

Oral hygiene, periodontal health and need for periodontal treatment among institutionalized mentally subnormal persons in Norway.

Oral hygiene, periodontal health and periodontal treatment needs were studied in the dentulous patients (n = 328) of a sample selected to be representative of all institutionalized mentally subnormal persons in Norway aged 5--45. The average oral hygiene and periodontal health was poor except for patients in a few institutions where the nurses were trained to clean teeth regularly. Increased age, epilepsy, Down's syndrome and a high degree of mental deficiency were all elements that apparently contributed to impairment of periodontal health and to increased treatment requirements. The preventive programs used in some institutions seemed to be effective. Still better results, however, could probably be obtained by the use of dental hygienists.     

Oral self-care behavior among dental school students in Greece

The purpose of this study was to determine the oral health attitudes/behavior of Greek dental students. The subjects (n = 539) were officially registered students at the University of Athens Dental School. Their oral health behavior was assessed with the use of a 12-graded-item questionnaire. A significant increase per year of study was observed in the number of students reporting careful brushing of the teeth [OR: 1.1 (1.0-1.3)] and being able to clean their teeth well without the use of toothpaste [OR: 2.5 (2.0-3.1)]. Each year of education significantly increased the probability of disagreement with statements such as: "I think my teeth are getting worse despite my daily brushing" [OR: 1.5 (1.2-1.9)], "It is impossible to prevent gum disease with tooth-brushing alone" [OR: 1.3 (1.1-1.5)], and "I put off going to the dentist until I have a toothache" [OR: 1.3 (1.2-1.6)]. Examination of the summary questionnaire score revealed that females presented significantly higher total scores. All scores increased significantly in the fourth and fifth years of dental studies. During the years of university study, the score variation and favorable attitudes/ behavior toward oral health appear to reflect the variation in the students' educational training experience.