Trend in basic oral treatment needs in relation to taxation of sweets, ice cream, and sugar-sweetened beverages in Finland: a registry-based study.

OBJECTIVE: The aims were to explore the trend in basic oral treatment needs and total operating cost of public dental services (PDS) in relation to total excise tax revenue generated from sugary products during 2011-2020 and to evaluate the impact of tax policy in excise tax revenue of sugary products and average sugar consumption. METHODS: The study comprised longitudinal data retrieved from Finnish registries during the years 2011-2020. Basic oral treatment needs, and total operating cost of PDS, total excise tax revenue generated from sugary products and average sugar consumed (kg per capita) during the years 2011-2020 were obtained. Simplified panel analyses and sensitivity analyses were used to evaluate the effects of explanatory variables on outcomes.  Results: An approximate one EUR 1,000,000 increase in total excise tax revenue generated from sugary products corresponds to a 0.4% increase in total operating cost of PDS. There was a significant positive trend in total operating cost of PDS in Finland over the study period. Similarly, an approximate one EUR 1,000,000 rise in total excise tax revenue corresponds to a 0.2% increase in basic oral treatment needs. Additionally, there was a statistically significant difference in the average excise tax revenue for sugary products between the periods before and after 2017. CONCLUSION: No change in average sugar consumption was observed despite implementing the new sugar policy. Therefore, it may be worthwhile to reconsider the excise tax on sweets and ice cream as it will significantly increase the total national revenues.

Survival of endodontically treated teeth in public dental service in Northern Finland: a practise-based register study.

OBJECTIVE: The aim of this study was to explore the factors associated with the survival of root canal treated teeth in a practise-based study setting in a 5-year period. MATERIAL AND METHODS: This retrospective study used data from the electronic patient registration system of the public dental services of the City of Oulu, Finland. The inclusion criteria for this study were patients aged ≥ 20 years who had root canal treatment (RCT) that was initiated in 2014. One RCT per patient was included in the study. A total of 713 patients met the inclusion criteria. The outcome variable for this study was the extraction of the RCT tooth during the 5-year period. Explanatory variables included age, diagnosis, tooth type (incisive, canine, premolar, molar), RCT technique (manual, motorized), time from RCT initiation to final restoration and type of final restoration (composite, glass ionomer, fixed dental prosthesis). To evaluate the association between the outcome variable and explanatory variables, Cox regression analyses were performed. RESULTS: The overall survival rate was 91%. The middle-aged (40-59-years-old) and the oldest (60 and older) patients had a two-fold risk of extraction compared to younger (20-40-years-old) patients. Similarly, a short length of time from RCT initiation to final restoration (0-14 days) resulted in a nearly three times higher risk of extraction compared to a longer period (≥ 90 days). CONCLUSIONS: The 5-year survival rate of RCTs seems high. Extractions were more common among patients over 40 years of age and if the RCT was completed shortly after its initiation.

Dental fear among adolescents with cleft.

BACKGROUND: Dental fear is a prevalent phenomenon among children and adolescents globally. AIM: To investigate dental fear among 18-year-olds with cleft lip and/or palate (CLP) at their final follow-up cleft clinic visit, and to evaluate the association between dental fear and OHRQoL. DESIGN: This cross-sectional study included the cohort of children with CLP treated at the Oulu University Hospital Cleft Lip and Palate Center, in northern Finland since 1995. A total of 62 of 64 individuals participated in this study. The validated Finnish version of the Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. Dental fear was studied using the validated Modified Dental Anxiety Scale (MDAS) and cognitive vulnerability model (CVM). RESULTS: Almost two fifths of the participants reported moderate dental fear. Participants with cleft including lip and participants reporting impact on OHRQoL reported higher mean MDAS scores. In an unadjusted model, adolescents with cleft including lip had risk for higher dental MDAS scores compared with the ones with cleft including only palate. CONCLUSIONS: Dental fear is common among adolescents with CLP, specifically among those with clefts involving the lip. OHRQoL and dental fear seem to be associated.

National reference centiles of anthropometric indices and BMI cut-off values in a child population in Nepal.

BACKGROUND: There is a need for national- or ethnicity-specific growth reference values in developing countries like Nepal, where rapid urbanisation and consequential nutritional transition is taking place. AIM: To establish national growth reference percentiles for anthropometric indices and to propose body mass index (BMI) cut-off values for Nepalese schoolchildren. METHODS: This study comprised 1135 Nepalese schoolchildren of four World Health Organization (WHO) indexed age groups (5-, 6-, 12- and 15-year-olds). The age- and gender-specific smoothed percentile curves for anthropometric indices (height, weight, BMI, waist circumference, waist-to-hip-ratio and waist-to-height-ratio) were constructed using LMS method and the corresponding Z-scores were computed. The Receiver Operating Characteristic analysis was used to determine BMI cut-off values based on the International Obesity Taskforce (IOTF) and the WHO growth references. RESULTS: The age- and gender-specified smoothed percentile values of anthropometric indices at 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles were computed. The BMI cut-off values for thinness (-1.2 SDS/12th percentile), overweight (+1.2 SDS/88th percentile) and obesity (+2.1 SDS/98th percentile) had high discriminating power, and high sensitivity and specificity. CONCLUSION: The Nepali anthropometric cut-off values proposed here can be recommended to be applied into research, and to identify public health risks in Nepal among these age groups.

The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review.

BACKGROUND: Oral health is a significant part of general health. Poor oral health can influence an individual's appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry. OBJECTIVE: The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings. METHODS: A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021. RESULTS: The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores. CONCLUSIONS: According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential.

Different Risk Factors for Erosive Tooth Wear in Rural and Urban Nepal: A National Study.

BACKGROUND: Erosive tooth wear (ETW) is of growing concern, but data on ETW among Nepalese children are scarce. The main aim of the study was to investigate the prevalence and severity of ETW among Nepalese schoolchildren. We also aimed to analyse the risk indicators for ETW according to location (rural/urban) and the role of obesity in the risk for ETW. METHODS: This national study was conducted among 5-15-year-old Nepalese schoolchildren from different regions. Altogether, 1137 out of 1151 schoolchildren participated in both a clinical examination and a survey. ETW was recorded using the Basic Erosive Wear Examination. RESULTS: The prevalence of ETW was 65%. One-fifth of the examined subjects were in need of preventive or restorative treatment. Living in an urban area and studying in a private school were protective factors for ETW, whereas consuming fruits frequently and using charcoal for tooth cleaning increased the odds for ETW. Central obesity was the strongest risk indicator for ETW among urban residents. CONCLUSIONS: ETW of low severity is common among Nepalese children and adolescents. Socio-demographic factors influence the prevalence of ETW in Nepal and there seems to be different factors that play a role in the ETW process according to location of residence.

Maxillary Arch Dimensions in 6-Year-Old Cleft Children in Northern Finland: A Cross-Sectional Study.

The aim was to cross-sectionally examine the maxillary arch dimensions in 6-year-old children with cleft lip and/or palate and to compare them with the initial cleft sizes among patients with cleft palate. The study included 89 patients with clefts treated at the Oulu University Hospital. The subjects were divided into three groups: cleft palate, cleft lip, and cleft lip and palate. Study casts were scanned, and the maxillary arch dimensions were examined using a 3D program (3Shape Orthoanalyzer, Copenhagen, Denmark). The statistical methods Student's t-test and one-way ANOVA were used to compare the means (SD) between the groups. Spearman's correlation coefficient was used to determine the correlation between cleft severity and maxillary dimensions. A significant difference was found between different initial cleft sizes in terms of distance between the second deciduous molar and the first incisor on the right side. The intermolar width showed a negative correlation with the initial cleft size. The dimensions were shorter for clefts affecting the palate and largest for clefts affecting only the lip. Larger clefts resulted in a shorter maxilla on the right side. Many dimensions became shorter when the initial cleft was larger. Clefts of the palate resulted in smaller maxillas.

Acceptability of a Mobile Application in Children's Oral Health Promotion-A Pilot Study.

The aim of this pilot study was to investigate the acceptability of an oral health-related mobile application developed for young children based on the feedback given by the children and their parents. Another aim was to evaluate the self-reported change in children's oral health behaviors during a short test period. The application-a virtual pet integrated into a child's daily routines-aimed to promote oral hygiene and dietary behaviors in children. A total of 36 4-12-year-old voluntary children were given a mobile phone with the installed application. After the 5-week testing period, the feasibility of the application and possible changes in the children's oral health behaviors were asked using an electronic questionnaire. Most of the children considered the application clear (n = 34), amusing (n = 31), and useful (n = 29). The children's tooth brushing manners improved both qualitatively and quantitatively: the time used for tooth brushing increased and the children learned how to brush different tooth surfaces. Mobile applications can be fun and useful in oral health promotion; while playing, children can learn good oral health-related behaviors. Mobile applications integrate oral health promotion into children's daily environment and routines.

A Hands-On Exercise on Caries Diagnostics among Dental Students-A Qualitative Study.

According to current care practices, the aim is to prevent the onset of caries lesions and to stop the progression of incipient lesions. A visual lesion assessment system, International Caries Detection and Assessment System (ICDAS), has been developed to promote reliability and repeatability of assessment of different stage caries lesions. The aims of this study were to evaluate the experiences of a hands-on exercise with authentic teeth as an adjunct to lecturing among third-year dental students and to evaluate the learning process during the hands-on exercise measured by qualitative (inductive content) analysis of the given feedback. In 2018, 51 third-year dental students at the University of Oulu, Finland, participated in a hands-on exercise on caries detection, where they assessed the depth and activity of lesions in extracted teeth using the ICDAS classification. After the lecture, students evaluated the exercise, giving feedback according to five given topics, three of which were analyzed using inductive content analysis. The exercise was considered useful and necessary but, overall, also challenging. The diverse activities and materials, as well as observational methods, promoted learning. The classification of lesions, the diagnostic methods, and the fact that there was not enough time to adopt things during the exercise were found to be challenging. For developing the exercise, the students suggested that more time should be scheduled for it and there should be more individual teaching. This qualitative study showed that, despite the challenge in caries diagnostics, dental students perceive the hands-on exercise as both a communal and individual learning experience.

Regional Variation in Restorative Treatment Need among Finnish Young People.

AIM: To evaluate the regional variation in restorative treatment need among Finnish young people based on the socioeconomic factors. MATERIALS AND METHODS: This cross-sectional study was conducted in 20 garrisons of the Finnish Defence Forces in January and July 2011. The study population comprised 13,819 Finnish conscripts born in the beginning of 1990s, including females. A computer-based survey was done together with clinical oral examination to gather background information, e.g., educational status. Furthermore, average annual income of the conscript's residence municipality was achieved from the Statistics of Finland. The zip code of the place of residence of each conscript was later extracted from the Mildoc® system. Georeferenced place of residence and income status were merged as information on provinces' level in a dataset. The association between the outcome variable and explanatory variables was determined by using the generalized linear mixed model, and geomaps were constructed. RESULTS: Mean D value was 1.41 ranging from 0.89 (Kymenlaakso) to 2.33 (Kainuu). Higher education and high-income level were protective factors for restorative treatment need. Restorative treatment need was also low in those areas with high (OR: 0.70, 95% CI: 0.56-0.87) and medium (OR: 0.79, 95% CI: 0.70-0.89) yearly income compared to low yearly income. The high odds for the need of restorative treatment were discovered in Northern Ostrobothnia (OR: 2.26, 95% CI: 1.53-3.33) followed by Central Ostrobothnia (OR: 2.08, 95% CI: 1.17-3.70), Uusimaa (OR: 1.55, 95% CI: 1.16-2.08), and Central Finland (OR: 1.54, 95% CI: 1.10-2.16) compared to Varsinais-Suomi. CONCLUSION: In conclusion, there is a significant regional variation in restorative treatment need among Finnish young people in their twenties based on the socioeconomic factors.

Oral health-related quality of life among young adults with cleft in northern Finland.

OBJECTIVES: This study aimed to examine Oral Health-related Quality of Life (OHRQoL) among patients with cleft lip with or without palate (CLP) at their final scheduled follow-up visit at the age of 18 years. Another aim was to investigate the motivation to attend multiple follow-up appointments and the satisfaction with care given by the cleft team using inductive qualitative analysis. METHODS: This cross-sectional study was conducted among the cohort of children born with CLP who had undergone treatment at the Oulu University Hospital Cleft Lip and Palate Centre, in northern Finland since 1995. OHRQoL was assessed using the validated Finnish version of the short form of the Oral Health Impact Profile (OHIP-14). In addition to the OHIP-14, two open-ended questions were also included. These questions investigated the experience of each participant concerning their motivation to attend the Oulu University Hospital Cleft Lip and Palate Centre to receive complex treatments, and their satisfaction with care provided by the cleft team. Results were presented as proportions, means, and SD. Inductive content analysis method was performed for analysis of the open-ended questions. RESULTS: A total of 63 patients with CLP participated in this study. More than half of the participants had cleft palate. More than half of the participants reported an impact on OHRQoL (OHIP-14 score ≥ 3). All the participants with bilateral cleft lip and palate, three fourths of the participants with unilateral cleft lip and palate, and half of the participants with cleft palate reported impact on OHRQoL. Inductive content analysis showed that one fourth of the participants reported a good outcome as a motivation to attend cleft center despite of complex procedures. All the participants reported their appreciation of the cleft team. CONCLUSIONS: Despite the comprehensive treatment received by the patients born with a CLP, they still experienced lower OHRQoL, especially physical pain and psychological discomfort were more pronounced. However, good outcome, support, and oral health care being a normal routine were the motivating factors to attend a long and demanding oral health care regimen.

Influence of dental caries on oral health-related quality of life, school absenteeism and school performance among Nepalese schoolchildren.

OBJECTIVES: To evaluate the impact of untreated dental caries and its consequences on oral health-related quality of life (OHRQoL), school absenteeism and school performance in Nepal. METHODS: This is a population-based, national cross-sectional study. This study was conducted among three WHO index age groups (5-6, 12- and 15-year-olds) of schoolchildren from 18/75 randomly selected districts of Nepal. Clinical findings on untreated dental caries lesions (decay in primary and permanent dentition, dt/DT) and its consequences (pufa/PUFA) were recorded, and the participants were graded into four categories based on the severity of untreated dental caries (GUDC). The Nepali version of Child-Oral Impacts on Daily Performances (C-OIDP) was used to assess the information on OHRQoL. Similarly, school-related information (school absenteeism and school performance) was collected from the school registry. Generalized linear mixed models with random effects were used to evaluate the association between dental caries and OHRQoL, school absenteeism and school performance. RESULTS: Among the study sample, the mean (SD) C-OIDP score was 2.4 (5.0). It was observed that the 15-year-olds, those belonging to the Newari ethnic group, and children with high GUDC grades had poor OHRQoL. After adjusting for confounding factors, high dt + DT or pufa + PUFA was associated with higher impact on OHRQoL. Similarly, lower grades of GUDC (Grade 1 and Grade 2) also had less impact on OHRQoL than the most severe Grade 4. High dt + DT or pufa + PUFA were associated with maximum school absenteeism. Furthermore, high C-OIDP and a grade of GUDC ≥2 score were associated with poor school performance. CONCLUSION: Untreated dental caries and its consequences have a considerable impact on OHRQoL. These conditions may contribute to high school absenteeism and poor school performance.

Body mass index and dental caries experience in Nepalese schoolchildren.

OBJECTIVES: The aim was to investigate the severity of untreated dental caries among Nepalese schoolchildren and its association with their body mass index (BMI) using IOTF, WHO and Nepalese growth reference systems. METHODS: This school-based clinical cross-sectional study was conducted with three WHO index age groups (5- to 6-, 12- and 15-year-olds) in 18 out of 75 districts of Nepal, selected using stratified random sampling. A total of 1135 schoolchildren were included in the study. A validated structured questionnaire was used to assess the children's oral hygiene practices and dietary habits. Clinical oral examinations investigated the status of untreated dental caries in primary and permanent teeth (dt/DT) along with its consequences (pufa/PUFA). Later, the grade of severity of untreated dental caries (GUDC) was determined using both dt/DT and pufa/PUFA. Height (cm), weight (kg), waist circumference (cm) and hip circumference (cm) were measured, and the body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. The findings were presented as proportions, and the chi-square test was performed to compare differences between groups. Generalized linear mixed models with random effects assessed the association between the severity of untreated dental caries and the BMI. RESULTS: According to the IOTF, WHO and Nepalese growth reference systems, the overall proportions of children with a low BMI were 38.6%, 15.4% and 12.8%, and those with a high BMI were 7.9%, 4.6% and 8.4%, respectively. Untreated dental caries was common among the youngest age group and those with infrequent tooth brushing habits or frequent consumption of sweet bakery products, sweets or candy, or tea with sugar. Neither a low nor a high BMI was associated either with dt + DT or with pufa + PUFA, after adjusting for confounders. However, both a low and a high BMI (all three references) were associated with the severity of dental caries or GUDC. CONCLUSION: Regardless of the growth reference system used, children with either low or high BMI may be at risk of developing untreated dental caries lesions and related consequences. Both underweight and overweight/obese and dental caries share common risk factors, mostly dietary. Preventive and intervention approaches/strategies such as behavioural and dietary modifications should be implemented to improve both children's oral health and their nutrition in Nepal.

Oral health status associated with sociodemographic factors of Nepalese schoolchildren: a population-based study.

OBJECTIVES: The aim of this study was to investigate the oral health of Nepalese schoolchildren relative to their sociodemographic characteristics. METHODS: This school-based, cross-sectional study was conducted among 5-6-, 12- and 15-year-old Nepalese children in 18 randomly selected districts of the 75 in Nepal. Clinical parameters were recorded according to the World Health Organization (WHO) guidelines. Results were presented as mean (SD) and proportions; the chi-square test, t-test and one way-ANOVA were also performed. The risk of dental caries in association with the place of residence was presented according to the outcome of a binary logistic regression analysis. RESULTS: The mean d-value for the 5-6-year-old children was 5.0 (4.22), which was higher than the mean D-values for the 12- and 15-year-old subjects, of 1.3 (1.77) and 1.9 (2.28), respectively. The youngest children, as well as children from the Kathmandu Valley, were likely to have more untreated caries lesions than children in the other age groups. The mean number of teeth with severe consequences of dental caries (pulpitis/ulceration/fistula/abscess or pufa/PUFA) was 1.3 (1.91) for the 5-6-year-old children, 0.1 (0.35) for the 12-year-old children and 0.3 (0.75) for the 15-year-old children. All age groups had gingival bleeding on probing in more than 15% of teeth. Children from rural locations had significantly more gingival bleeding than urban children. The same was true for 15-year-old girls compared with boys of the same age. CONCLUSIONS: Among Nepalese children, oral diseases are common, and geographical variation is prevalent. The health policy should address the alarming oral health situation and need for urgent treatment and population-based preventive programmes that is evident in Nepal.