Oral health knowledge, attitudes and behaviour of adults in China

OBJECTIVES: To describe oral health behaviour, illness behaviour, oral health knowledge and attitudes among 35-44 and 65-74-year-old Chinese; to analyse the oral health behaviour profile of the two age groups in relation to province and urbanisation, and to assess the relative effect of socio-behavioural risk factors on dental caries experience. METHODS: A total number of 4,398 35-44-year-olds and 4,399 65-74-year-olds were selected by multistage stratified cluster random sampling which involved 11 provinces in China. Data were collected by self-administered structured questionnaires and clinical examinations (WHO criteria). RESULTS: 32% of the 35-44-year-olds and 23% of the 65-74-year-olds brushed at least twice a day but only 5% used fluoridated toothpaste; 30% and 17% respectively performed 'Love-Teeth-Day' recommended methods of tooth brushing. A dental visit within the previous 12 months was reported by 25% of all participants and 6% had a dental check-up during the past two years. Nearly 15% of the subjects would visit a dentist if they experienced bleeding from gums; about 60% of the subjects paid no attention to signs of caries if there was no pain. Two thirds of the urban residents and one fifth of the rural participants had economic support for their dental treatment from a third party, either totally or partially. Significant variations in oral health practices were found according to urbanisation and province. At age 35-44 years 43% of participants had daily consumption of sweets against 28% at age 65-74 years. Dental caries experience was affected by urbanisation, gender, frequency, time spent on and method of tooth brushing. Knowledge of causes and prevention of dental diseases was low with somewhat negative attitudes to prevention observed. CONCLUSION: Systematic community-based oral health promotion should be strengthened and preventive-oriented oral health care systems are needed, including promotion of further self-care practices and the use of fluoridated toothpaste.     

湖北省黄石市12岁儿童口腔健康状况、行为、态度的系统分析

目的：本研究旨在对湖北省黄石市12岁儿童的口腔健康状况、态度和行为进行系统调查和全面的分析。方法：调查对象为湖北省黄石市城区和农村4所中小学12岁儿童。结果：12岁儿童的恒牙患龋率22．0％，龋均0．40。31％的儿童每天至少刷牙两次以上，17％的学生在一年内拜访过牙医。和居住在农村的学生相比，居住在城市里的学生拥有更积极的口腔保健态度，使用含氟牙膏、每天刷牙两次和在一年内拜访牙医的人数更多。结论：在中小学校应该开展口腔健康教育和口腔保健项目。     

Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa

OBJECTIVES: To assess the level of dental knowledge and attitudes among 12 year-old children and 35-44 year-olds in Burkina Faso; to evaluate the pattern of oral health behaviour among these cohorts in relation to location, gender and social characteristics and; to evaluate the relative effect of social-behavioural risk factors on caries experience. DESIGN: Across sectional study including urban and rural subgroups of population. Sample and methods: Multistage cluster sampling of households in urban areas; in rural areas random samples of participants were based on the recent population census. The final study population covered two age groups: 12 years (n = 505) and 35-44 years (n = 493). RESULTS: For both children and adults, levels of oral health knowledge, attitudes and self-care were low; 36% of 12-year-olds and 57% of 35-44-year-olds carried out toothcleaning on a daily basis. Pain and discomfort from teeth were common while dental visits were infrequent. Tooth cleaning was mostly performed by use of chewsticks. Use of toothpaste was rare, particularly fluoridated toothpaste was seldom; 9% of 12-year-olds and 18% of 35-44-year-olds reported use of fluoride toothpaste. Significant differences were found in oral health knowledge, attitudes and practices according to location and gender. At age 12, important factors of high caries experience were location (urban), and consumption of soft drinks and fresh fruits. In 35-44-year-olds, gender (female), high education level, dental visit and occupation (government employee) were the significant factors of high dental caries experience whereas adults using traditional chewing sticks had lower DMFT. CONCLUSIONS: Health authorities should strengthen the implementation of oral disease prevention and health promotion programmes rather than traditional curative care. Community-oriented essential care and affordable fluoride toothpaste should be encouraged.     

Risk factors for impaired oral health among 18‐ to 34‐year‐old Australians

Objectives: The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18‐ to 34‐year‐olds in Australia. Methods: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three‐stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self‐perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR). Results: The estimated percent of 18‐ to 34‐year‐olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7‐47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13‐1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03‐1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a $100 dental bill (PR 1.37, 95 percent CI 1.12‐1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15‐1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16‐1.85), and dental fear (PR 1.43, 95 percent CI 1.18‐1.73). Conclusions: Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.     

Oral health behaviour and its determinants amongst Iranian dental students.

OBJECTIVES: To study the oral health behaviour (OHB) of Iranian senior dental students in relation to their gender, background characteristics, knowledge of preventive care, and attitudes towards preventive dentistry. MATERIALS AND METHODS: Using a cluster random sampling approach, a questionnaire survey was conducted with 327 senior dental students in seven dental schools. The questionnaire covered age, gender, parents' employment in dentistry, previous academic education in dental hygiene, oral self-care, most recent dental check-up, knowledge of preventive dentistry and attitudes towards it. Attending a dental check-up by a dentist or a classmate within the last year was defined as preventive care use. Chi-square test and logistic regression models were used for statistical analyses. RESULTS: Women reported significantly higher frequencies of tooth brushing (P < 0.001), fluoridated toothpaste use (P = 0.001) and flossing (P < 0.001) compared with men. Respondents who had been previously educated as dental hygienists had lower frequencies of eating sugary snacks (P < 0.001) and paid more attention to preventive care (P = 0.03) than others. Those with more extensive knowledge of preventive care reported higher frequencies of using fluoridated toothpaste (P = 0.05). Reported frequencies of brushing were higher amongst those with more positive attitudes (P = 0.03). In logistic regression models, having at least one parent employed as a dentist was significantly associated with higher frequencies of eating sugary snacks (P = 0.047, OR = 0.3) and more frequent preventive care use (P = 0.048, OR = 2.9). CONCLUSION: Education and training in preventive measures should be effective enough to overcome background characteristics. There is room for improving the OHB of Iranian dental students.     

Oral health attitudes and behaviours of final‐year dental students

Objectives: The objectives of this study of final‐year dental students in 10 classes (1997, 2001—2009) were to examine their self‐reported oral health attitudes and behaviours and describe any trends in these attributes. Participants and methods: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude–behaviour associations were examined. Results: Of 583 students, 459 responded (79%). All tooth‐brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1—2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1—3/year. Between‐meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. Conclusions: Final‐year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.     

武汉市东西湖区5岁儿童口腔健康行为调查

目的:了解东西湖区5岁儿童的基本口腔健康行为及其家长的儿童口腔卫生知识水平,为东西湖区儿童口腔卫生保健工作提供信息支持。方法:按照第三次全国口腔健康流行病学调查方案设计的5岁儿童家长问卷,对东西湖区8所幼儿园529名5岁儿童家长进行问卷调查,了解儿童饮食行为,口腔卫生行为、利用口腔医疗行为,家长口腔保健知识知晓情况。结果:30%的儿童经常有睡前进食甜食的习惯。5%的儿童在3岁前开始刷牙,每日刷牙2次者仅占10%。有5%的儿童使用含氟牙膏刷牙。在过去1年中,90%的儿童没看过牙医。结论:东西湖区5岁儿童口腔健康行为低于全国平均水平,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,建立正确的儿童口腔健康行为。     

Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand

AIM: To describe the level of oral disease in urban and rural schoolchildren in Southern Thailand; to analyse self-care practices and dental visiting habits of 12-year-olds, and to assess the effect of socio-behavioural factors on dental caries experience. DESIGN: A cross sectional study of 6- and 12-year-old children, urban and rural schools chosen at random from 19 districts of one province. SETTING: Suratthani Province, Southern Thailand. PARTICIPANTS: A total of 1,156 children of grade 1 (6 yrs) and 1,116 children of grade 6 (12yrs). METHODS: Clinical recordings of dental caries and periodontal CPI scores 0, 1 or 2 according to WHO; structured interviews of 12-year-olds (n=1,084) concerning oral health behaviour and attitudes. RESULTS: At age 6, 96.3% of children had caries and mean dmft was 8.1. In 12-year-olds, 70% had caries in permanent teeth and the level of DMFT was 2.4. Experience of pain during the previous 12 months was reported by 53% of 12-year-olds, 66% saw a dentist within the previous year and 24% reported that visits were due to troubles in teeth. Toothbrushing at least once a day was claimed by 88%. Significant numbers of the children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%). Important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls) whereas lower risk was observed in children with positive oral health attitudes. CONCLUSIONS: Systematic health education may further improve the oral health of Thai children and the primary school provides a unique setting for such programmes.     

儿童乳牙患龋状况及其家庭口腔健康行为的差异

目的研究家庭口腔健康行为对辽宁省城乡儿童乳牙患龋状况的影响。方法采用多阶段、分层、等容量、随机抽样的方法,运用世界卫生组织《口腔健康调查基本方法》诊断标准对辽宁省城乡792名5岁儿童进行乳牙龋病检查,并随机抽取50%受检者的家长进行问卷调查。结果1）辽宁省5岁儿童乳牙患龋率为73.86%,龋均（dmft）为4.38;其中城市儿童乳牙患龋率为64.14%,农村儿童乳牙患龋率为83.59%,城乡之间儿童乳牙患龋率具有统计学差异（P<0.01）。2）口腔健康行为分析表明,农村儿童进食糖果、巧克力、糖水、碳酸饮料、果汁等的频率高于城市。城市儿童开始刷牙时间、频率、用含氟牙膏的比例均高于农村。城市家长普遍学历高,收入多,儿童定期检查和采取预防措施的人数高于农村。结论辽宁省,尤其是农村地区应加强对家庭口腔健康行为的教育。     

State-level differences in the oral health of Australian preschool and early primary school-age children

Background: This study compares oral health outcomes and behaviours for young Australian children by residential state or territory to determine whether state differences arise from individual exposures to risk factors. Methods: Cross‐sectional data for 4606 2–3 year olds and 4464 6–7 year olds were obtained from the Longitudinal Study of Australian Children. Outcome measures were parent‐reports of children’s caries experience, frequency of toothbrushing and dental services use. Results: For 2–3 year olds, children from the Australian Capital Territory were less likely to have parent‐reported caries than children from other states, and more likely to brush their teeth twice daily and to have used dental services. For 6–7 year olds, optimal outcomes were observed in New South Wales for lowest caries experience, Western Australia for highest toothbrushing, and South Australia for highest dental services use. Adjustments for socio‐demographic predictors did not eliminate state differences in oral health. Conclusions: Large state differences in the oral health of young children persisted after adjustment for individual socio‐demographic determinants, suggesting these arise from variations in the systems to promote and care for children’s oral health. Several states would benefit from a stronger emphasis on oral health promotion in young children, and disparities from a young age suggest the need for better engagement of early childhood professionals in oral health promotion.     

Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand

Abstract – Objectives: This epidemiological study aims to investigate the developmental enamel defects and dental caries among 9‐year‐old children resident in fluoridated and nonfluoridated regions in Auckland, New Zealand. Methods: A stratified, two‐stage random selection design where strata were defined by fluoridation status, school size, and school decile. After informed consent was obtained, parents completed oral health questionnaires and children underwent dental examinations at school clinics. Results: 612 children from 38 schools participated in the study. Overall, 175 (29%) children had lived continuously in fluoridated areas, 149 (24%) had lived continuously in nonfluoridated areas, and 288 (47%) had resided intermittently in fluoridated areas. Diffuse opacities were present in 117 (19%) children and deciduous teeth dental caries was seen in 370 (60%) children. After adjustment for covariates, a strong dose–response relationship between diffuse opacity and fluoridation status was found, with children who lived continuously in fluoridated areas being 4.17 times as likely to have diffuse opacities as children who lived continuously in nonfluoridated areas (P < 0.001). Conversely, a strong protective dose–response relationship between caries experience and fluoridation status was seen, with children who lived continuously in fluoridated areas being 0.42 times as likely to have dental caries as children who lived continuously in nonfluoridated areas (P < 0.001). Conclusions: Reticulated water fluoridation in Auckland reduces the risk of dental caries but increases the risk of diffuse opacities in 9‐year‐old children. Guidelines and health‐promotion strategies that enable children to minimize their risk to diffuse opacities yet reduce their risk of dental caries should be reviewed.     

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children

Aim : This study assesses disparities in the oral health status of Brazilian black and white children. Participants : 11‐and 12‐year‐old schoolchildren living in 131 cities of the State of São Paulo, Brazil. Methods : Spatial data analysis of city‐level indexes of oral health, socio‐economic status and provision of dental services. Main outcome measures : Ethnic ratios of the DMFT and the care index. Results : White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio‐economic status. Cities with higher per‐capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care. Conclusion : The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per‐capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.     

城乡3～5岁儿童家庭口腔健康行为与乳牙患龋状况对比观察

目的：探讨城乡3～5岁儿童家庭口腔健康行为与乳牙患龋状况的相关性。方法：采用多阶段、分层、随机抽样的方法,在北京、吉林4个地区幼儿园（城乡各2个）抽取3～5岁儿童共512例,城市儿童268人,农村儿童244人进行乳牙龋病检查,并对受检者的家长进行家庭口腔健康行为问卷。结果：①3～5岁儿童乳牙患龋率为71.23%,龋均4.16;城市儿童乳牙患龋率62.26%,农村81.41%,城乡儿童之间乳牙患龋率具有统计学差异（P〈0.01）。②农村儿童进食甜点心、碳酸饮料、果汁、糖果/巧克力等的频率高于城市。城市儿童开始刷牙时间、频率、用含氟牙膏的比例高于农村。城市家长对儿童定期检查和采取预防措施的人数高于农村。结论：加强对农村儿童家庭口腔健康行为的教育至关重要。     

大学新生口腔健康知识和健康行为抽样调查报告

目的　调查大学新生口腔健康知识和健康行为。方法　采用全国口腔健康流行病学调查方案统一问卷, 对四川大学1 035名大学新生进行口腔健康知识和健康行为问卷调查。结果　(1)口腔疾病就医行为:1 035名大 学新生中仅13·1%的学生定期接受口腔健康检查;(2)口腔卫生措施:每天刷牙两次的占74·4%,刷牙时间达到 3 min以上的仅7·7%,坚持使用含氟牙膏的16·6%,使用过牙线的人仅6%;(3)饮食习惯:51·9%的学生不常吃零 食,94·7%的学生不吸烟;(4)龋齿与牙周疾病的防治知识及口腔保健知识测试结果普遍较差。结论　大学新生对 口腔卫生知识认识有限,采取的口腔卫生措施不够认真彻底。     

The decline in dental caries among Belgian children between 1983 and 1998

OBJECTIVES: to investigate cross-sectionally a probable dental caries decline in Belgian 12-yr-olds and to analyse some factors that may be associated with dental caries during the study period. METHODS: In the region of Brussels, children in the 7th grade at the same schools were sampled in 1983 (n=533) and 1998 (n= 496). DMFT, DMFS and dental fluorosis were clinically recorded. Data on children's home-based and professional dental health care habits were registered. RESULTS: Caries-free children increased from 4% to 50%. A reduction of the mean number of teeth attacked by dental caries from 7.5 to 1.6 and of tooth surfaces from 11.5 to 2.5 (P<0.001) was observed. Early signs of dental fluorosis were identified in 5% in 1983 and 30% of the subjects in 1998. Multiple linear regression analyses revealed that tooth brushing with fluoridated toothpaste, dental appointments and dental fluorosis were significantly related to dental caries reduction. CONCLUSIONS: A remarkable decline in dental caries was observed during the 15-yr period. The factors related to the children's home-based and professional dental health care were associated with the observed decline.     

Oral health‐related quality of life of 12‐ and 15‐year‐old Thai children: findings from a national survey

Abstract – Objective: To assess the prevalence and characteristics of oral impacts on daily life, and the relationship between certain dental conditions and impacts attributed to them, in a nationally representative population of Thai school children aged 12 and 15 years. Methods: A cross‐sectional study on a representative sample of children in Sixth Thailand National Oral Health Survey. Sample included half the children aged 12‐ and 15‐year‐old selected in Bangkok and all participants in 8 of 16 provinces included in national survey. Children were individually interviewed using the Child‐OIDP (12‐year‐old) and OIDP indices (15‐year‐old), and two questions for overall subjective assessments. Results: A total of 1066 12‐year‐olds and 815 15‐year‐olds were interviewed. Some 85.2% of 12‐year‐olds reported experiencing oral impacts during the past 3 months. Child‐OIDP scores ranged from 0 to 68.0 (mean = 7.83, SD = 7.8). Eating was the most commonly affected performance (64.4%), followed by cleaning teeth (51.7%) and maintaining emotional state (49.1%). Among 15‐year‐old children, 83.3% had oral impacts during the past 6 months. OIDP scores ranged from 0 to 39.5 (mean = 5.47, SD = 6.0). The three most commonly affected performances were eating (64.0%), cleaning teeth (55.3%) and maintaining emotional state (53.1%). Toothache and oral ulcers were the two most important perceived causes in 12‐year‐olds. Impacts from toothache were the most prevalent (39.2%) and had a condition‐specific (CS) Child‐OIDP score of 7.0, while oral ulcers affected 24.7% of children; mean CS‐score of 8.0. Among 15‐year‐olds, oral ulcers ranked first in terms of both prevalence (36.2%) and CS‐score (6.0), followed by toothache (prevalence 33.9% and CS‐score 5.0). For both age groups, problems with gums were of less concern. Conclusions: Oral impacts were common but not severe in Thai children and adolescents. For both age groups, impacts were mostly on eating performance; toothache and oral ulcers were the two important perceived causes reflecting needs for oral health promotion and treatment of dental caries and oral ulcers.     

Assessing the effectiveness of a school-based oral health promotion programme in Yichang City, China

Abstract – Objectives: To assess the outcome of oral health promotion in schoolchildren over a 3‐year period in Yichang City, Hubei, China. Methods: In a cluster randomized controlled trial, the concept of the World Health Organization Health Promoting Schools Project was applied to primary schoolchildren. Seven intervention schools and eight control schools were randomly selected from one district by stratified cluster sampling. The study was conducted as a 3‐year follow‐up study. After 3 years, 661 children remained in the intervention group and 697 children in the control group. Data on dental caries, plaque accumulation, and sulcus bleeding were collected by clinical examination, while behavioural data were gathered by self‐administered questionnaires. Results: The 3‐year net mean DMFS increment score was 0.22 in the intervention schools and 0.35 in the control schools (P < 0.013). A statistically significant difference in mean plaque (P < 0.013) and sulcus bleeding (P < 0.005) increment scores after 3 years was found between the two groups. Statistically significant higher scores were observed in restorations received and sealants placed, and a lower score in untreated dental caries, in children from the intervention group than the control group after 3 years (P < 0.01). In addition, more children in the intervention schools adopted regular oral health behavioural practices such as brushing their teeth at least twice a day, visiting the dentist within the past calendar year, and using fluoride toothpaste. Conclusion: The study suggests that the school‐based oral health promotion was an effective way to reduce new caries incidence, improve oral hygiene and establish positive oral health behavioural practices in the targeted schoolchildren.     

Assessing the prevalence of dental caries among elementary school children in North Korea: a cross-sectional survey in the Kangwon province

Objectives: The lack of epidemiological studies has made it difficult to assess the extent of public health problems in North Korea. In the absence of empirical data, less intrusive study designs acceptable to the North Korean government could be developed to gauge the public's health. To this end we developed a basic oral health survey in order to assess the prevalence of untreated dental caries among children. Methods: A cross‐sectional survey of 854 elementary school students was conducted in the city of Wonsan, North Korea. Students were screened and classified into one of three states of oral health: no caries, minor caries or severe dental caries. Verbal surveys were concurrently administered on children to collect basic information on oral health behaviours and demographic characteristics. Statistical analyses were performed to determine if any variables were significant predictors of oral health status category. Results: Among the 854 students screened, we found 255 students with no caries (29.9%), 316 students with minor caries (37.0%), and 283 students with severe caries (33.1%). The majority of students (70.1%) screened had dental caries. Almost all of the students (98.5%) claimed to brush their teeth daily and 71.2% of students visited a dentist in the past year. There were no significant predictors of oral health status. Conclusions: The oral health of children in Wonsan, North Korea is comparable if not slightly better than the oral health status of children of similar age in countries with similar Social‐Economic Status (SES). Basic oral health screens are useful to produce a snapshot of general oral health status among children in North Korea and may provide insight as to the general health of these children.