A program review of a community-based oral health care program for socially vulnerable and underserved citizens in Denmark.

OBJECTIVES: To describe the oral health and oral health-related quality of life among social vulnerable adults enrolled in a special oral care program, and to evaluate the effect of oral care on their oral health-related quality of life. METHOD: Social workers identified social vulnerable persons in social centres and referred them to the program. Dental clinics were arranged including a well-motivated staff to be special responsive to these clients. The participants, (n = 235, mean age 43.5 years) with drug abuse, being homeless, permanently unemployed, or with mental problems were offered low-cost treatment services. Data collection was made by clinical registration and questionnaires. Oral health-related quality of life was measured by means of the Oral Health Impact Profile-14 index (OHIP-14). RESULTS: 94% of the participants had actual decayed teeth (mean 9.5). Forty-four per cent had not visited a dentist within 5 years and less than one-third reported tooth brushing twice a day, 17% even less frequent. One hundred and forty-six completed the dental program within the program period. Mean OHIP-14 score was 28.6 at baseline. Among those who fulfilled the program, the OHIP-14 score was reduced to 9.9 (p < .001). CONCLUSION: Oral health among the study population was very poor. However, oral problems in this group can be solved, and their oral health-related quality of life can be increased although it requires special arrangements and special clinical environment.

A randomized clinical trial of the anti-caries efficacy of 5,000 compared to 1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents.

Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5,000 versus 1,450 ppm of fluoridated toothpaste (F-toothpaste) for controlling root caries in nursing home residents. The duration of the study was 8 months. Elderly disabled residents (n = 176) in 6 nursing homes in the Copenhagen area consented to take part in the study. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff. A total of 125 residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. No differences (p values >0.16) were noted in the baseline examination with regards to age, mouth dryness, wearing of partial or full dentures in one of the jaws, occurrence of plaque and active (2.61 vs. 2.67; SD, 1.7 vs.1.8) or arrested lesions (0.62 vs. 0.63; SD, 1.7 vs. 1.7) between the 5,000 and the 1,450 ppm fluoride groups, respectively. Mean numbers of active root caries lesions at the follow-up examination were 1.05 (2.76) versus 2.55 (1.91) and mean numbers of arrested caries lesions were 2.13 (1.68) versus 0.61 (1.76) in the 5,000 and the 1,450 ppm fluoride groups, respectively (p < 0.001). To conclude, 5,000 ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1,450 ppm F-toothpaste.

Oral health in children in Denmark under different public dental health care schemes.

PURPOSE: To describe and analyse oral health of children and adolescents under two types of dental health care schemes under the Public Dental Health Service in Denmark, and to analyse possible influence of socio-economic and socio-cultural factors. METHODS: Data on children's oral health status was obtained from public oral health registers and were pooled with data from questionnaires sent to parents of the children and adolescents. The study comprised individuals aged 5, 12 and 15, in total 2168 persons, randomly drawn from four municipalities with dental care provided by salaried dentists in public dental clinics and three municipalities with dental care provided by dentists in private practice. 70% of the parents completed a questionnaire including questions on socio-economic and socio-cultural background, lifestyle-related factors, self assessment of parents' oral- and general health. After the data were merged, the final study population represented 60% of the original target population. RESULTS: The mean caries experience (DMFS+dmfs) was 2.2 and further analysis of caries experience in each age group showed no variations in relation to type of provider of dental care. However, multiple dummy regression analyses demonstrated that low education, poor general health, foreign citizenship and smoking habits of the parents were important determinants for high level of caries in their children. CONCLUSION: Occurrence of dental caries as well as changes over time in levels of dental caries of Danish children did not vary by scheme of Public Dental Health Service, i.e. whether dental health care was provided by public employed dentists or by private practitioners. However, social inequalities still relate to caries experience in children and adolescents. Adjustment of preventive oral health activities strategy seems to be needed.

A one-year follow-up of an oral health care programme for residents with severe behavioural disorders at special nursing homes in Denmark.

OBJECTIVES: To describe a one-year follow-up study of an oral health care programme in special nursing homes for citizens with severe behavioural disorders. METHODS: An oral health care programme for residents (n = 264) at special nursing homes, which included an initial oral examination, subsequent dental treatment based on the principles of realistic treatment need and visits by a hygienist every three months, was evaluated one year after implementation. RESULTS: The follow-up data revealed a significant decrease in the mean number of teeth with primary decay and periodontal treatment need. Also less calculus and visible plaque were present. Regarding denture related conditions, a decrease was found in the presence of traumatic ulcers, denture stomatitis and the need for prosthodontic treatment. Finally, an improvement in denture hygiene was observed. A high rate of participation in the programme was obtained. CONCLUSION: Professional dental intervention has an effect on oral health indicators even when introduced to rather unapproachable recipients of dental care services.

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.

Dental health behavior and self-reported dental health problems among hospitalized psychiatric patients in Denmark.

The purpose of the present study was to describe dental health behavior and self-reported oral health problems among hospitalized psychiatric patients. Two hundred and forty dentate patients were interviewed with regard to participation in school dental care, dental visiting habits, self-assessment of oral health, dental anxiety, and oral hygiene habits. Dental visiting habits were associated with gender, psychiatric diagnosis, duration of mental disorder, and fear of dental care. Moreover, toothbrushing habits varied with gender, status as inpatient or day-hospital patient, number of admissions, and psychiatric diagnosis. Constant regular dental visits were observed among 31% of the participants, whereas regular toothbrushing was reported by 55%. Compared with reference figures of the general population, these figures reflect a relatively poorer dental health behavior among the study participants. The study underlines the need for specific preventive dental programs, which aim at improving the poor dental health behavior among psychiatric patients.

Oral health in Danish hospitalized psychiatric patients.

The purpose of the present study was to describe oral health status in a group of hospitalized mental patients, and to study the association between dental caries and mental illness. A total of 278 psychiatric patients admitted to a regional Danish hospital were described with respect to the number of teeth present, DMFS, gingival and periodontal status and presence of removable dentures. The oral health status of the hospitalized mental patients was relatively poor compared with the general population of the area. For instance, actual decayed surfaces were found among 55% of the participants compared to the reference figure of 23% in the general population. A multiple regression analysis demonstrated that DMFS was related to duration of mental illness and to psychiatric diagnosis. Furthermore, a multiple logistic regression analysis revealed that the presence of actual decayed surfaces was associated with neglect of toothbrushing, subjective symptoms of xerostomia and participation in the hospital dental program. To conclude, variables of mental illness and psychiatric treatment and care were demonstrated to influence oral health. This underlines the need of special preventive programs aimed at hospitalized psychiatric patients.

Self-assessment of dental health among Danish noninstitutionalized psychiatric patients.

This survey provides a description of the living conditions, dental health self-assessment, dental health behavior, and knowledge and attitudes to dental care in a population of noninstitutionalized psychiatric patients. A total of 84 individuals (70% of the persons selected) were interviewed using a pretested structured questionnaire. One of five participants did not perform oral hygiene as a daily routine and 45% had no regular dental visit habits. A proportion of about 40% reported symptoms from teeth or gingiva within the previous year. Despite an acceptable level of general knowledge on caries and periodontal problems, only a small proportion were aware of the caries-inducing potential of psychotropic drugs. People with more than five admissions to the psychiatric ward more often reported symptoms from teeth and gingiva; irregular dental visit habits were also related to number of admissions and to manic-depression. The survey indicates poor oral health among psychiatric patients compared with the general population and the need for specific oral care programs leveled at noninstitutionalized psychiatric patients is stressed.

[Dental health among homebound mental (psychiatric) patients]. / Tandforholdene hos hjemmeboende kroniske psykiatriske patienter.

The purpose of the present study was to describe the dental health behavior, oral health and dental treatment needs in a group of chronic, homebound mental patients. 84 patients were interviewed with regard to oral hygiene and utilization of dental services, by means of a standardized questionnaire. Furthermore, 56 patients were examined clinically. About 20% did not brush their teeth regularly. A similar group had not payed regular dental visits for the last 3 years although they were not edentulous. The dental examinations showed an average DMFS of 84.6. One out of four persons were edentulous and 45% of the dentate participants had periodontal pockets deeper than 5 mm. Restorative need was found for 71%, 12% were in need of fillings of more than 15 surfaces, whereas 45% were in need of scaling or advanced periodontal treatment. Finally, 15% exhibited need of their first removable denture. An index for the overall dental treatment need showed that 63% were in great need for dental treatment. The findings indicate significant dental needs in non-institutionalized persons with mental disease. A hospital based dental team combined with mobile primary dental health care are proposed as a possible solution to the dental health problems of deinstitutionalized psychiatry.