Composite indicators of dental health: functioning teeth and the number of sound-equivalent teeth (T-Health)

Abstract –This study investigated whether two new composite dental indicators -"the number of functioning teeth" and "the number of sound-equivalent teeth" are more efficient than the conventional DM FT index in revealing the social and behavioural factors which are significantly related to oral health status. The arbitrary set of weights given to the T-Health indicator was also evaluated. The number of functioning teeth was defined as the aggregate of filled (otherwise sound) and sound teeth. The T-Health was defined as a weighted average of sound teeth, filled (otherwise sound) teeth and teeth with some decay, the weights intended in principle to represent the relative amounts of sound tissue in these three categories of teeth. An arbitrary set of weights was used: 4, 2, and 1 for sound, filled, and decayed teeth, respectively. 164 families (father, mother and at least one 13-yr-old child) from Belo Horizonte, Brazil, were randomly selected from 13-yr-old children from private and state schools. The parents'ages ranged from 35 to 44 yr. Socio-economic status, area of residence, level of education, family income, sugar consumption, toothbrushing frequency and type of dental attendance were the social and behavioural oral health risk-factors considered in this study. The results indicated that the two new dental indicators are more sensitive to the influence of social and behavioural factors, such as those investigated here, than is the traditional DM FT index. A different set of weights (4, I, and I for sound, filled, and decayed) was suggested for the construction of the T-Health.     

A life course approach to assessing causes of dental caries experience: the relationship between biological,behavioural, socio-economic and psychological conditions and caries in adolescents

The objective of this study was to further elucidate the relationship between relevant biological, behavioural, socio-economic and psychological conditions, experienced in very early life and along the life course, and dental caries experience using the life course approach. A two-phase study was carried out in Brazil. In the first phase, 652 13-year-olds were clinically examined and interviewed. In the second phase, 330 families were randomly selected for interview to collect information on the teenagers' early years of life. Clinical assessment included dental caries, periodontal and traumatic dental injury status. The data analysis involved multiple logistic regression analysis. Adolescents born in a non-brick house, those with a low birth weight and those who were the second or later child in the family were statistically significantly more likely to have a high DMF-T. In conclusion, the results of this study show that there is an association between socio-economic and biological factors in very early life and levels of caries in adolescents.     

Integrating the common risk factor approach into a social determinants framework

The common risk factor approach (CRFA) has been highly influential in integrating oral health into general health improvement strategies. However, dental policy makers and oral health promoters have interpreted the CRFA too narrowly. They have focussed too heavily on the common behavioural risks, rather than on the broader shared social determinants of chronic diseases. A behavioural preventive approach alone will have minimal impact in tackling oral health inequalities and indeed may widen inequalities across the population. Based on recent WHO policy recommendations, this study presents the case for updating the CRFA in accordance with the social determinants agenda. The theoretical basis for a social determinants framework for oral health inequalities is presented, and implications for oral health improvement strategies are highlighted. Future action to address oral health inequalities in middle- and high-income countries requires a radical policy reorientation towards tackling the structural and environmental determinants of chronic diseases. In more equal and fairer societies, all sections of the social hierarchy experience better health and social well-being.     

Gradients in periodontal status in Japanese employed males

AIM: The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers. MATERIAL AND METHODS: Study participants were 15,803 Japanese male workers aged 20-69 years. There were seven groups classified by jobs. Oral examinations were conducted using community periodontal index (CPI). RESULTS: The percentages of sextants with a CPI score of 3 or 4 of professionals were significantly lower than for other job classes. The gradient also existed for the percentage of sextants with CPI score 4. After adjusting for age, a history of diabetes mellitus and smoking status, those lower on the gradient, namely, drivers, service occupations, salespersons and managers were 2.0, 1.5, 1.4 and 1.4, times, respectively more likely to have one or more sextants with CPI score 3 or 4 compared with professionals. Odds ratios of having more than one or more sextants with CPI score 4 after adjusting for age, clinical history of diabetes mellitus and smoking status for drivers, service occupations, salespersons and managers were 2.1, 1.5, 1.5 and 1.2, respectively, compared with professionals. CONCLUSIONS: There was a gradient in periodontal status by job classification. Professional and office workers had better periodontal status than salespersons, service occupations and drivers.     

Social and biological early life influences on the prevalence of open bite in Brazilian 6-year-olds

OBJECTIVE: Little is known about the effects of social and biological risk factors for open bite on the primary dentition. The aim of this study was to assess the early-life risk factors affecting anterior open bite. METHODS: A cross-sectional study using a birth cohort was carried out in Pelotas, Brazil. A sample of 400, 6-year-old children was employed. The Foster and Hamilton criteria were used to classify open bite. Data concerning social conditions, and perinatal and childhood health and behaviour were obtained from birth to 12 months of age and during the fifth year of the children's lives. Unconditional bivariate and multiple logistic regression analysis were performed. RESULTS: The prevalence of anterior open bite was 46.3%. Risk factors included: a maternal age of between 30 and 39 years, as compared with children whose mothers were younger; breast-feeding for < 9 months; dental caries experience; pacifier sucking between 12 months and 5 years, as compared to no sucking or a shorter duration of sucking; and the presence of finger-sucking at 6 years of age. CONCLUSION: Open bite in the primary dentition was associated with older mothers, early weaning, dental caries occurrence, long-term use of a pacifier and finger-sucking at 6 years of age. These findings support the common risk approach for intervention to prevent open bite in the primary dentition.     

Traumatic dental injuries and associated factors among Brazilian preschool children

Abstract –  The main objective of this study was to assess the epidemiology of traumatic dental injuries (TDI) to the primary teeth of preschool children and second, to investigate whether TDI were related to anterior open bite and, third, whether TDI are related to socio-economic circumstances in an urban Brazilian population. A clinical examination was performed during the National Day of Children's Vaccination. TDI were classified according to the modified classification proposed by Ellis. In addition to those criteria the presence of tooth discoloration was recorded. An interview was carried out with mothers or guardians. The data collected included mother's level of education and living conditions. The prevalence of TDI was 9.4%. The maxillary central incisors were the most affected teeth. Most children with a TDI experienced traumatic injuries to one tooth (6.3%), while 2.8% had two and 0.4% had three traumatized teeth. The most common crown fracture was in enamel only (68.8%), followed by crown fracture of enamel and dentin (13.8%). Missing teeth following trauma occurred in 10.9% of those with TDI. The prevalence of tooth discoloration was 5.1%. Children with anterior open bite had twice the level the level of TDI compared to those with normal occlusions ( P  = 0.001). Socio-economic factors were not statistically significantly associated with the occurrence of TDI. The prevalence of dental injuries in Brazilian preschool children was low. Children with anterior open bite experienced more dental injuries. Neither of the indicators of socio-economic status was related to the prevalence of TDI.     

Trends in the prevalence of traumatic dental injuries in Brazilian preschool children

Abstract –  Objective: The aim of this paper was to report trends in traumatic dental injuries (TDI) in preschool children in Brazil between 2002 and 2006, and assess whether gender, family structure, and socio-economic differences in TDI are significant, and confirm the relationship between TDI and anatomic predisposing factors such as overjet and lip coverage.
Methods:  Three cross-sectional surveys were conducted in 2002, 2004 and 2006 in Diadema using the same protocol. It was estimated that a minimum sample size of 778 5–59 months old children was required to achieve a level of precision with a standard error of <2% Participants were systematically selected from all children attending the National Day of Children's Vaccination carried out in the city of Diadema. The criteria used to assess TDIs were a modified version of Ellis' classification.
Results :  There was a significant increase in TDIs between 2002 and 2006 (47.9%, P  = 0.002). The prevalence of TDIs was 9.4% (95% CI 7.63, 11.42) in 2002, 12.9% (95% CI 11.06, 14.96) in 2004, and 13.9% (95% CI 12.03, 15.84) in 2006 in 5–59 months old children and the treatment of TDI was seriously neglected. There was no significant gender, family structure, and socio-economic differences in the prevalence of TDIs. The relationship between TDI and anatomic predisposing factors such as overjet, lip coverage, and anterior overbite was highly statistically significant ( P  < 0.01).
Conclusion :  The prevalence of TDIs in preschool children in Diadema increased between 2002 and 2006, the treatment of TDIs was neglected, thus it is crucial to generate considerable efforts to implement health promotion strategies to reverse the observed trends and to provide treatment to TDIs to prevent their biologic and psychologic consequences.     

Outlook of British dentists towards their profession

Dental practice in Britain has undergone significant changes in recent years. These changes have undoubtedly affected the outlook of dentists towards dentistry. This study was undertaken to examine the current outlook of general dental practitioners working in the General Dental Service. A representative sample of 1000 dentists was surveyed by mail. The response rate was 73.7 per cent. Most characteristic of the respondents' outlook on various aspects of their profession is the wide diversity of opinion. Neither respondent gender or practice location were associated with outlook. More preventively oriented dentists and those whose practices were most busy, however, were found to have a more positive outlook.