Chronic conditions policies: oral health,a felt absence

The global health scenario shows an epidemic of non‐communicable diseases that lead to long‐term chronic conditions, some of which are incurable. Many infectious diseases, owing to their development and length, also generate chronic conditions. Similarly, non‐morbid states, such as pregnancy, and some life cycles such as adolescence and ageing, follow the same logic. Among all these chronic conditions there is a significant interrelationship with oral health, both in parallel events and common risk factors. This article presents cross‐sectional qualitative research into World Health Organisation recommended health policies to address chronic conditions. Several documents published by the organisation were analysed to verify the presence of references to oral health in relation to chronic conditions, particularly cardiovascular diseases and diabetes as these most frequently have oral manifestations. The analysis showed no significant references to oral health or its indicators within the published texts. The study recognises the value of the work developed by the World Health Organisation, as well as its worldwide leadership role in the development of health policies for chronic conditions. This article proposes a coalition of dentistry organisations that could, in a more forceful and collective way, advocate for a greater presence of oral health in drafting policies addressing chronic conditions.     

An epidemiologic survey of oral health in Swaziland

An epidemiologic survey of oral health was conducted on 480 schoolchildren and 400 adults in Swaziland. Age groups 7, 14, 20-24 and 35-44 were selected, and nine sampling sites were chosen in various parts of the country. Oral hygiene was generally poor, visible soft deposits being prevalent in all age groups and calculus in adults. Advanced periodontal disease was present in most people over 35 years of age, and intense gingivitis was widespread in all age groups. Dental caries was found to be a common problem, affecting practically every person, in many cases quite severely. There was a tendency towards accumulation of the disease in children. Some geographic variation was found in the prevalence and severity of dental caries and periodontal disease. An additional sample of privileged children was examined, and among these children 14-year-olds showed significantly higher DMFS values than their age mates in the rest of the country. Tooth defects, including fluorosis, and oral mucosal diseases did not seem to constitute severe problems of oral health in Swaziland. On the basis of these data a public dental health program has been initiated which emphasizes prevention.     

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目的 调查医科大学新生口腔健康状况以指导大学生口腔保健.方法 于2010年6月按照世界卫生组织《口腔健康调查基本方法》(第4版)的原则并参考第三次全国口腔健康流行病学调查方案,对中国医科大学723名新生的口腔健康状况进行普查,应用SPSS13.0统计软件对新生的患龋及牙周疾病情况进行统计分析.结果 (1)723名大学生的患龋率为56.98％,龋均为2.19,龋充填率为29.40％;女性大学生、城镇大学生的患龋情况较男性大学生、农村大学生严重.(2)723名大学生的牙石检出率、牙龈出血检出率和牙周袋检出率分别为78.28％、64.32％和6.22％;男性大学生、农村大学生的牙石检出率、牙龈出血检出率情况较女性大学生、城镇大学生严重.结论 医科大学新生口腔健康状况不佳,需加强对大学生口腔疾病预防及口腔保健的宣传,提高大学生口腔健康状况水平.     

Measuring conceptual health knowledge in the context of oral health literacy: preliminary results

Objectives: Health literacy encompasses several abilities including word recognition, reading comprehension, communication skills, and conceptual knowledge. To date, conceptual knowledge has not been included in oral health literacy research. This study assesses the validity and reliability of a new instrument and describes conceptual oral health knowledge among a sample of low‐income adults. Methods: One hundred Baltimore adults were administered the Rapid Estimate of Adult Literacy in Medicine (REALM), Short Test of Functional Health Literacy in Adults (Short‐TOFHLA), and a new survey of conceptual oral health knowledge. Respondents were also asked about sociodemographics, dental health, and utilization. Results: Psychometric analysis was used to identify a subset of oral health knowledge questions from the new survey instrument. The resulting Comprehensive Measure of Oral Health Knowledge (CMOHK) was categorized into three levels of knowledge (poor, fair, good). Nearly one‐third of Baltimore adults exhibited the lowest level. CMOHK scores were significantly associated with age, education level, and word recognition (REALM). CMOHK scores were not associated with reading comprehension (Short‐TOFHLA) or dental care visits. Instrument reliability was good (Cronbach alpha = 0.74). Conclusions: This preliminary study yielded a new measure of oral health conceptual knowledge, available for use in future oral health literacy studies. The author presents a conceptual framework of oral health literacy that separates health literacy into four unique components and places decision‐making at the center. Future studies are needed to determine whether this framework is supported by empirical data and leads to improvements in oral health and reductions in health disparities.     

Epidemiologic oral health survey of Argentine children

Abstract An epidemiologic oral health survey of 2279 children aged 7–8 and 12–13 was carried out in eight different regions of Argentina using methods and criteria recommended by the WHO. The children examined lived in rural or urban areas and were of Caucasian or Amerindian extraction. Periodontal status showed that 75% of this population had soft deposits, while calculus and gingivitis increased with age. Calculus: 0.4 at 7 yr to 16.1 at 13: gingivitis: 2.7% at 7 yr to 27.2% at 13. At age 8, the mean number of DMF per child was 3.9. The percentage of caries-free children with permanent dentition dropped from 60% at age 7 to 32% at age 13. In Amerindian children, all these parameters were higher. Both the mean DMF and DMF per child were substantially lower in natural fluoride areas than in non-fluoride areas. Data from this first nationwide epidemiologic study in this country provide baseline data for further investigations. According to the data obtained in this study, Argentine regions may be classified as high, medium or low risk areas, although a lack of adequate dental care was found in all regions. With these risk priorities as a guideline, we propose an initial strategy consisting of a carefully planned and selective program of primary dental health care.     

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目的评价孕期妇女口腔保健宣教措施的临床效果。方法选择2008年3—4月妊娠后第1次来湖北省妇幼保健院做孕期检查且怀孕期不超过3个月的孕妇30人,随机分为试验组(接受口腔保健宣教)和对照组(未接受口腔保健宣教),比较孕妇接受与不接受口腔保健宣教5个月后的牙周与龋病情况。结果接受口腔保健宣教的孕妇较未接受宣教孕妇的牙龈指数、牙石指数差异均有统计学意义(P<0.05),但龋病的新发生率差异无显著性意义(P>0.05)。结论孕期口腔保健宣教措施可有效改善孕妇口腔健康水平。     

Associations between socio-economic circumstances at two stages of life and adolescents' oral health status

There is a consistent association between unfavourable socio-economic circumstances and oral health. Although the effects of poor social circumstances in childhood are known to have lasting influences on general health, there is little information on their effects regarding chronic oral diseases. OBJECTIVE: To assess the relationship between oral health status and socio-economic circumstances at two different periods of adolescents' life. METHODS: A two-phase cross sectional study was carried out in Brazil. In Phase I, 652 13-year-olds were clinically examined and interviewed. In the second phase, 311 families were randomly selected for in-depth interviews. Information was collected on several indicators of socio-economic circumstances, family related variables, school grade level, and oral health behaviour, at two different life stages, at birth and at 13 years of age. The outcome variable was oral health status at the age of 13. It was constructed by counting the worst scores of DMFT, gingival bleeding, calculus and dental plaque. The data analysis used stepwise logistic regression. RESULTS: The response rates for phases I and II were 85% and 94%. Boys, those at a lower grade level at school for their age, and those who experienced high levels of material deprivation at birth and at the age of 13 were more likely to have high levels of oral diseases; the odds ratios were 4.12 (1.86-9.16), 2.41 (1.01-5.76) and 4.61 (1.30-16.3), respectively. CONCLUSION: Brazilian adolescents experiencing adverse socio-economic circumstances at birth and at the age of 13 had high levels of oral diseases.     

Eating disorders and oral health: a matched case-control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.     

Intellectual disability and impact on oral health: a paired study

The objective was to assess the oral health status, the treatment needed, and the type of dental health services access of intellectually disabled (ID) subjects in Teresina, Brazil. The sample consisted of 103 ID subjects matriculated in centers for special needs people and 103 siblings. Results were analyzed using paired t‐test, chi‐square test, and odds ratio. ID subjects had fair (63.1%; p < .001) and their siblings had a good oral hygiene (n = 103 [55.3%]; p < .005). ID had more decayed (3.52; p < .005), and missing teeth (1.17; p = .001), fewer dental restorations (1.67; p = .012) and had a greater need for tooth extraction (21.4%; p = .002) than their siblings. Thirty percent of ID subjects had never received dental treatment and had difficulty accessing public health services. Their treatment needs were, therefore, higher than non‐ID subjects. The access to oral health services was unsatisfactory, thus it is important to implement educational and health promotion inclusion policies for people with ID.     

"摩梭人"龋病流行状况及口腔保健知识的调查

目的 :本调查旨在了解“摩梭人”龋患情况及对龋病相关知识的认识。方法 :选择“摩梭人”886人 ,男 389人 ,女 4 97人。口腔专业人员进行问卷和口腔内检查 ,用WHO(1997)口腔健康调查表 ,记录每户家庭内受检者的龋、失、补牙数 (DMFT)以及对龋病相关知识的认识。采用龋均 (XDMFT)和患龋率 (cariesprevalencerate)来描述受检人群龋病的严重程度。结果 :调查发现龋病常在家族中流行 ,该人群的龋患率为 4 8% ,龋均为 4 .9。其中女性的患龋率明显高于男性 (P <0 .0 0 1)。女性龋均为 6 .95± 0 .5 ,患龋率 86 .9% ;男性龋均为 1.6 5± 0 .3,患龋率为 11.4 % ,男女之间每天刷牙及饮食习惯无明显差异。调查群体大部分缺乏对龋病病因及如何预防等知识的认识。结论 :“摩梭人”口腔卫生状况很差 ,龋患情况较严重 ,龋病的发生有明显的性别特征。在该地区应积极开展防龋工作 ,重视口腔卫生保健知识宣传教育工作 ,提高“摩梭人”的口腔自我保健意识。     

Determinants of oral health in a group of Danish alcoholics

The purposes of this survey were to describe dental health in a group of alcoholics and to analyze the influence of social background, dental health behavior and alcohol-related variables on dental health among alcoholics. The dental health in a group of consecutively admitted alcoholics ( n =195) was described with respect to number of teeth present, DMFS. DS and the prevalence of dental erosion, removable dentures, edentulousness, and untreated dental decay. No major differences were found with respect to number of teeth and dental caries (DMFS). when compared to reference figures of the general population. As to untreated decay, however. 3-5 x more actual decayed surfaces were found among the alcoholics. In the multivariate analyses, neither DMFS, nor untreated decay were found to be associated with alcohol-related indicators. These variables were, however, related to variables of social background and dental health behavior. As to number of teeth present, an association was found with duration of alcoholism, but this relationship was eliminated, when the analysis was controlled with respect to social situation. In contrast, dental erosion was related to duration of alcoholism irrespective of confounding control of dental health behavior and social situation. Hence, the study indicates that oral health in alcoholics can be explained mainly by social situation and dental health behavior and not by variables associated directly with alcohol consumption. An exception was the presence of dental erosion, which was associated with the exposure to alcohol.     

A survey on oral health status and treatment needs of life-imprisoned inmates in central jails of Karnataka, India

Background: The prison population is a unique and challenging one with many health problems, including poor oral health. In a developing country like India, oral health problems of the prisoners had received scant attention. Objectives: To assess the oral health status and treatment needs of life imprisoned inmates and to know the existing oral health care facilities available in central jails of Karnataka. Materials and methodology design: Cross sectional survey Participants: A systematically selected sample of 800 life imprisoned inmates, were interviewed and examined using modified WHO oral health assessment proforma (1997). Results: The prevalence of caries was 97.5% mean Decayed Missing Filled Teeth(DMFT) was 5.26; Majority of the study population had Community Periodontal Index(CPI) score of 2, whereas 21.6% had at least one sextant with a CPI score of 4. 41.1% prisoners were severely affected with loss of attachment. 8.8% inmates had dentures. Oral sub mucous fibrosis was observed among 9.9% of prisoners. 97.4% of the subjects needed oral hygiene instruction, 87.6% needed restoration, 62.1% extraction of teeth and 32.2% needed prosthesis. Bangalore and Mysore central jail had oral health care facilities on regular basis. Conclusion: This study emphasises the need for special attention from government and voluntary organisations to improve the oral health of inmates.     

Asthma and oral health: a review

Asthma is a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises bronchodilators, corticosteroids and anticholinergic drugs. Most of these drugs are inhaled using various forms of inhalers or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients with bronchial asthma on medication should receive special prophylactic attention. This article reviews the correlation between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.     

Role of lactoferrin and lactoferrin‐derived peptides in oral and maxillofacial diseases

The oral cavity harbors different taxonomic groups, the evolutionary coexistence of which develops the oral ecosystem. These resident microorganisms can alter the balance between the physiologic and pathologic conditions that affect the host, both locally and systemically. This highly sophisticated nature of the oral cavity poses a significant therapeutic challenge. Numerous human and animal studies have been conducted to potentiate the efficacy and competence of current treatments of pathologic conditions as well as to develop novel therapeutic modalities. One of these studies is the use of the potent antimicrobial agent lactoferrin (LF), which was originally derived from the host immune system. LF is an 80‐kDa glycoprotein that has a free iron sequestration mechanism with evident antimicrobial, anti‐tumor, and immunomodulatory properties. A wide range of active peptides have been isolated from the N‐terminal region of LF, which possess antimicrobial activities. In this review, we discuss the role of LF and LF‐derived peptides under a heterogeneous group of oral and maxillofacial conditions, including bacterial, fungal, viral infections; head and neck cancers; xerostomia; and implantology‐bone‐related manifestations.     

Basic oral health goals for Spain 2015/2020

Aim/Objective : To define the basic oral health goals for Spain 2015 (children)/2020 (adults). Methods : The Spanish Society of Epidemiology and Oral Public Health commissioned a six‐member Expert Panel, which worked over the period 2006–2007 and reached consensus according to the EuropeAid Evaluation Guidelines. The Panel's work included three meetings and a presentation at the Society's annual conference in 2007. Since each autonomous region/city in Spain has control over its health policy, only basic goals for the country as a whole were defined. The variables used to set goals were caries history and gingival health according to the World Health Organisation criteria, and tooth brushing frequency and health perception according to the European Global Oral Health Indicators Development Project. Results and Conclusions : A total of 16 targets were defined, 8 for children and 8 for adults. For example, the number of permanent decayed, missing and filled teeth should be ≤1.0 at 12 years of age by 2015, or the percentage of edentulous persons should be ≤15% at 65–74‐years by 2020. In order to achieve the proposed goals, the Expert Panel recommends involving all health system personnel in the maintenance and/or development of new oral health programmes and strategies.     

Engaging a state medical society in oral health: a community action report

Increasingly, the medical community is recognizing how oral health relates to overall health and engaging in oral health promotion. In 2012, the Massachusetts Medical Society set out to explore how to prioritize oral health as a part of its public health agenda. It began with an Oral Health Forum, which evolved into a Committee on Oral Health. This committee is the first of its kind in a state medical society and is comprised of a diverse group of medical and dental professionals. In this article, we review the process by which the committee was established, report on projects, and reflect on lessons learned.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.