Socio-behavioral factors, oral hygiene level and periodontitis prevalence in a 35-44-year-old Greek adult population: A cross-sectional survey.

BACKGROUND: Sub-optimal oral hygiene is considered as a primary risk factor for periodontitis occurrence. Various socio-behavioral determinants may contribute either independently or by influencing adversely the oral hygiene (OH) level. The aim of the present study was to examine the periodontal status of 35-44-year-old Greek adults and determine the contribution of risk indicators, including the socio-behavioral aspects and the population's oral hygiene level, on disease prevalence. MATERIAL AND METHODS: In 1218 participants, Community Periodontal Index (CPI), Loss of Attachment (LoA) and simplified Oral Hygiene Index (OHI-S) were calculated. Multivariable regression models examined the effect of socio-behavioral factors with/without the inclusion of OHI-S level on pocket depth (PD)≥4mm and LoA≥4mm presence. RESULTS: 11.8% of the participants had healthy periodontium, whereas 37.3% and 5.6% presented with shallow and deep pocketing, respectively. 60.4%, 28.8%, and 10.8.% of the adults demonstrated LoA≤3mm, 4-5mm, and ≥6mm, accordingly. Fair and poor oral hygiene significantly increased the likelihood for PD≥4mm (OR=4.8-20.3) and LoA≥4mm (OR=3.3-6.0) presence. 'Emergency-oriented dental visiting pattern' significantly elevated the chance for PD≥4mm presence (OR=1.7). 'Lower education level' 'urban location', and 'using an interdental brush' were significantly independently linked to LoA≥4mm occurrence (OR=1.7-2.1, 1.5, and 2.0, respectively). Lower educated individuals demonstrated inferior oral hygiene status, which in turn elevated significantly the chances of PD≥4mm presence. Smoking more than 10 cigarettes/day, emergency-oriented dental attendance pattern and not flossing were linked to worse oral hygiene levels, which consequently increased significantly the likelihood of LoA≥4mm occurrence. CONCLUSIONS: Fair and poor oral hygiene contribute strongly to periodontitis occurrence. Various socio-behavioral factors may influence adversely oral hygiene maintenance, leading to periodontitis manifestations. Key words:Community periodontal index, periodontal attachment loss, oral hygiene, adults 35-44, cross-sectional survey, socio-behavioral indicators.

Effect of toothpastes containing different NaF concentrations or a SnF2/NaF combination on root dentine erosive lesions, in vitro.

BACKGROUND: Fluoride toothpastes presumably offer some protection against acid erosion. However, uncertainty exists towards fluoride's efficacy relatively to the concentration and the type of chemical compound used. This in vitro study evaluated the relative efficacy of toothpastes containing sodium fluoride in different concentrations or a stabilized stannous fluoride/sodium fluoride system on root dentine erosion. MATERIAL AND METHODS: Bovine dentin specimens were allocated into four groups (n=10): control (no F), 1450ppm F (as NaF), 5000ppm F (as NaF) and 1450ppm F (1100ppm as stabilized SnF2 and 350ppm as NaF)/sodium hexamethaphosphate. The specimens were submitted to 6 daily cycles of erosion (0.3% v/v citric acid, pH=3.2, 20 min) and remineralization (~22h), interspersed by 2-min immersions in 1:3 w/v of dentifrice/distilled water slurries. Subsequently, they were subjected to a 24-h acid resistance test (0.3% v/v citric acid, pH=3.2) without any further treatments. Surface loss was quantified by contact profilometry. Data were analysed through one-way ANOVA and Bonferroni's tests (p≤0.05). RESULTS: In both experiments, all fluoride groups, showed significantly less tissue loss compared to the control (p<0.001-p=0.018). During erosion cycling, no significant differences were found among the fluoride groups. During the acid resistance test, the 5000ppm F toothpaste produced significantly superior effect than both 1450ppm F products (p=0.010, (p<0.001), which performed similarly. CONCLUSIONS: Under less aggressive erosive conditions, fluoride toothpastes did not differ in their ability to protect dentine surfaces. However, in severely erosive environment, the 5000ppm F toothpaste performed superiorly to the other tested products. Key words:Dentine, sodium fluoride, stannous fluoride, tooth erosion, toothpaste, contact profilometry.

The short-term effects of television advertisements of cariogenic foods on children's dietary choices.

OBJECTIVE: To investigate the short-term influence of the advertising of cariogenic foods on children's dietary preferences, and the possible moderating effect of several factors on this influence. METHODS: One-hundred and eighty-three children, 11-12 years of age, were exposed to advertisements showing sugary food and non-food items, in a within-subject counterbalanced design. Their preferences for unhealthy and healthy foods, and their ability to recall or recognise the advertisements, were measured following both sessions. Information on their dietary habits, leisure activities and sociodemographic details were obtained through a questionnaire completed by their parents. Their decayed, missing and filled teeth (DMFT) index, body weight and height were also recorded. A generalised linear mixed model was used to examine the differences in food preferences between experimental conditions, and the associations between children's preferences and the other factors assessed. RESULTS: Exposure to food advertisements significantly decreased the selection of healthy foods. Children with a higher DMFT index chose a higher percentage of unhealthy foods, and children who spent more time watching television chose an increased number of healthy foods, after their exposure to food advertisements. Regardless of condition, girls selected fewer foods than boys. Children with a higher DMFT index selected more unhealthy foods than children with a lower DMFT index. Obese children chose an increased number of healthy foods than those who were overweight and normal weight. CONCLUSIONS: Food advertisements can divert, for a short time, children's preference over healthy food choices, and could lead to changes in their eating habits, which may put them at higher risk of dental diseases and obesity.

Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data.

BACKGROUND: The aim of this study was to investigate the oral health status and behavior of Greek dental students over time, and to meta-analyze these findings to test the widely documented hypothesis that women have better oral health behavior, oral hygiene, and periodontal status but higher dental caries rates than men. MATERIALS AND METHODS: A total sample of 385 students was examined using identical indices to assess oral health and behavioral data initially in 1981 while the years 2000 and 2010 were selected due to significant changes that took place in the dental curriculum in the 1990s and 2000s. Data by gender concerning the outcome variables recorded in every one of the three surveys were analyzed using Mantel-Haenszel and continuous outcomes methods. RESULTS: A significant improvement in the oral health status and behavior of students was observed over time. The meta-analysis of data by gender showed that females brushed their teeth significantly more often than males [summary odds ratio (OR): 1.95 and 95% confidence interval (CI): 1.08-3.54]. Males and females were found to have a similar risk of developing dental caries. CONCLUSION: The hypothesis that young women have better oral hygiene habits compared to men was confirmed. However, the hypothesis that women have better oral hygiene and periodontal status but exhibit higher dental caries experience than men was not supported by the findings of the study.

Prevalence of dental caries in 5-year-old Greek children and the use of dental services: evaluation of socioeconomic, behavioural factors and living conditions.

OBJECTIVES: To assess dental caries and use of dental services experience in 5-year-old children attending public kindergartens in Attica, Greece and to examine the influence of certain socioeconomic factors and living conditions as well as dental behaviours and attitudes. METHODS: In this cross-sectional study, a random and stratified sample of 605 Greek children was examined using decayed, missing, filled tooth surfaces and simplified debris indices. The use of dental services was measured by children's dental visits (any dental visit up to the age of 5 years). Care Index was also calculated. Risk indicators were assessed by a questionnaire. Zero-inflated Poisson and Logistic Regression Analysis were generated to test statistical significant associations. RESULTS: The prevalence of dental caries was 16.5%. Care Index was 32% and dental visits were reported for the 84% of the children. Medium Socio-Economic Level (SEL) was associated with no detectable caries. High SEL was related to decreased decayed, missing, filled teeth values, while female gender and rented houses had the opposite effect. The age of the mother (35-39 years) and the higher SEL were related to higher levels of dental services use. CONCLUSIONS: It is suggested that there are differences in the experience of dental caries and use of dental services among preschool children in Attica, which are related to demographic, socioeconomic factors and living conditions. Dental public polices should focus on groups with specific characteristics in order to improve oral health levels of disease-susceptible populations.

Dental erosion prevalence and associated risk indicators among preschool children in Athens, Greece.

OBJECTIVES: The aims of the study were to investigate dental erosion prevalence, distribution and severity in Greek preschool children attending public kindergartens in the prefecture of Attica, Greece and to determine the effect of dental caries, oral hygiene level, socio-economic factors, dental behavior, erosion related medication and chronic illness. MATERIAL AND METHODS: A random and stratified sample of 605 Greek preschool children was clinically examined for dental erosion using the Basic Erosive Wear Examination Index (ΒΕWE). Dental caries (dmfs) and Simplified Debris Index were also recorded. The data concerning possible risk indicators were derived by a questionnaire. Zero-inflated Poisson regression was generated to test the predictive effects of the independent variables on dental erosion. RESULTS: The prevalence of dental erosion was 78.8 %, and the mean and SE of BEWE index was 3.64 ± 0.15. High monthly family income was positively related to ΒΕWE cumulative scores [RR = 1.204 (1.016-1.427)], while high maternal education level [RR = 0.872 (0.771-0.986)] and poor oral hygiene level [DI-s, RR = 0.584 (0.450-0.756)] showed a negative association. CONCLUSIONS: Dental erosion is a common oral disease in Greek preschool children in Attica, related to oral hygiene and socio-economic factors. CLINICAL RELEVANCE: Programs aimed at erosion prevention should begin at an early age for all children.

Apical periodontitis in association with the quality of root fillings and coronal restorations: a 14-year investigation in young Greek adults.

PURPOSE: To examine the possible association between the presence of apical periodontitis (AP) and the quality of endodontic treatment and coronal restoration over a time period of 14 years. MATERIALS AND METHODS: 1781 panoramic radiographs of freshmen cadets, taken between the years 1995-2008 were included in this study. The periapical status was evaluated using the Periapical Index (PAI) scoring system. The chisquare test and logistic regression analysis were used to examine associations between apical disease and the quality of both the root filling and the coronal restoration. RESULTS: 62.3% of the examined teeth demonstrated AP. The number of root-filled teeth and the prevalence of AP were found to be higher in OPGs taken between 1995 and 2001 than those taken between 2002 and 2008. Both the quality of the coronal restoration and the quality of the root filling (length and lateral seal) were found to be correlated with the presence of AP, but the factor most significantly associated seemed to be the coronal restoration (OR = 0.404, 95% CI: 0.174-0.940). CONCLUSION: The quality of the endodontic treatment in young Greek adults was poor but improved over the years. Both the quality of the endodontic treatment and coronal restoration appeared to affect the periapical status of the treated teeth. The factor that probably most determined the periapical health was the quality of the coronal restoration.

Risk indicators of coronal and root caries in Greek middle aged adults and senior citizens.

BACKGROUND: Dental caries is the result of a complex interplay of multiple determinants which may change overtime. Therefore, periodic surveys of caries experience and redetermination of the risk indicators of the disease are needed. The aim of this study was to assess the prevalence and severity of coronal and root caries in Greeks aged 35-44 and 65-74-year-old in relation to socio-demographic parameters. Furthermore, trends in coronal caries experience of the 35-44-year-olds were investigated. METHODS: A sample of 1188 35-44-year-old and 1093 65-74-year-old individuals was selected in 2005 according to WHO guidelines for national pathfinder surveys. Caries was assessed in dentate subjects using the DMFT, DMFS, RDFS and RCI indices. Socio-demographic data were also collected. Univariate and multivariate regression analyses were performed to identify the effect of socio-demographic parameters. RESULTS: The mean DMFT and DMFS scores of the adults were 14.06 and 45.78 respectively, while those of the senior citizens were 20.63 and 89.82. Among the 35-44-year-ods, men and those having a higher educational attainment had significantly lower DMFS values (women OR = 1.679, CI: 1.243-2.267 and >12 years of education OR = 0.321, CI: 0.193-0.535 respectively), while educational level was the only predictor of DMFS in senior citizens (OR = 0.279, CI: 0.079-0.992). The mean DMFT score of the 35-44-year-olds has not improved since 1985, but there was a remarkable reduction in the number of DT related to a simultaneous increase in the number of FT. The mean RDFS rose from 0.39 in adults to 2.66 in senior citizens. The mean RDFS score of the middle aged adults was significantly correlated with education (OR = 0.346, CI: 0.180-0.664). The RCI was almost four times greater in seniors (9.73) than in adults (2.53). There were significant differences in caries experience between the surveyed regions. MS and RDS were the major components of the DMFS and RDFS indices respectively, in both age groups. CONCLUSIONS: Caries experience in Greek adults is similar to what is observed in most industrialized countries. The mean DMFT score of the 35-44-year-olds has not improved since 1985, but a great improvement in restorative care has been observed. Senior citizens had a high percentage of untreated coronal and root surfaces. Region and education were the strongest predictors of caries experience. An increase in oral care utilization and effective prevention over the whole lifespan are needed to improve the dental health of the Greek adult population.

Tooth loss and oral rehabilitation in Greek middle-aged adults and senior citizens.

PURPOSE: The aims of this study were to investigate the prevalence of tooth loss in Greek individuals aged 35 to 44 and 65 to 74 years in relation to sociodemographic parameters and to describe their prosthetic status and needs. MATERIALS AND METHODS: A stratified cluster sample of 1,188 middle-aged adults and 1,093 senior citizens was selected according to World Health Organization (WHO) guidelines for national pathfinder surveys. Tooth loss and prosthetic status and needs were recorded according to WHO criteria. Sociodemographic data were collected through face-to-face interviews. RESULTS: Complete edentulism affected 0.3% of individuals aged 35 to 44 years and 31.5% of those aged 65 to 74 years. Most middle-aged adults (92.1%) had ≥ 21 natural teeth, while the corresponding percentage for the senior citizens was 23.1%. The mean number of missing teeth was 5.2 in middle-aged adults and 21.6 in senior citizens. The multivariate analysis showed that education level was the only predictor of tooth loss in both age groups. Approximately 38% of those aged 35 to 44 years and 80% of those aged 65 to 74 years had dental prostheses, while 47.6% of middle-aged adults and 66.3% of senior citizens did not need any prosthetic treatment. The need for complete dentures was relatively low in both age groups. Comparisons of the present results with those of 1985 indicate that the dentate status of Greek adults aged 35 to 44 years has not improved. Furthermore, the prevalence of tooth loss in the elderly population was high compared with internationally reported findings. CONCLUSION: The replacement of missing teeth with fixed or removable prostheses will continue to be common in Greece for the foreseeable future.

An in vitro study of the effect of aluminum and the combined effect of strontium, aluminum, and fluoride elements on early enamel carious lesions.

The purpose of this in vitro study was to evaluate the effect of aluminum and of combined strontium, aluminum, and fluoride treatments on enamel demineralization and remineralization. During a 6-day pH-cycling protocol, pre-softened bovine enamel slabs were immersed twice daily for 1 min in the following experimental solutions: (a) distilled water [W] (negative control); (b) 1,000 ppm F [F] (positive control); (c) 1,000 ppm Al [Al]; (d) 1,000 ppm Al,1,000 ppm F applied interchangeably [Al-F]; (e) 1,000 ppm Al, 1,000 ppm F, applied in sequential order [Al+F]; (f) combined 1,000 ppm Al and 150 ppm Sr [Al+Sr]; and (g) combined 150 ppm Sr and 1,000 ppm F [Sr+F]. Subsequently, the specimens were subjected to a 5-day acid resistance test. Lesions were evaluated quantitatively by performing surface microhardness and qualitatively by using polarized light microscopy. According to the results, solutions [Sr+F] and [Al-F] enhanced remineralization and inhibited demineralization as effectively as the [F] solution and significantly superiorly compared to [Al+Sr] and [Al] solutions. All tested solution groups, except for the [Al+Sr] group, presented significantly increased resistance to acidic attack, compared to [W]. PLM examination revealed that all solution groups, except for the [W] group, developed an acid-resistant zone at lesion surfaces. In conclusion, under the present experimental conditions, the combined strontium-fluoride and aluminum-fluoride treatments presented similar anti-caries efficacy compared to fluoride treatment alone, but they did not show evidence of synergistic activity on pre-softened enamel.

Tooth wear in the deciduous dentition of 5-7-year-old children: risk factors.

This study was conducted to investigate the distribution and severity of tooth wear in deciduous dentition and its relationship with possible risk factors. A stratified cluster sample of 243 5-7-year-old children was examined using the tooth wear index of Smith and Knight, and their exposure to intrinsic and extrinsic risk factors was retrospectively investigated through a structured questionnaire. The severity of wear was quantitatively estimated by the number of surfaces with affected dentine and by the cumulative score of the sextants, based on the Basic Erosive Wear Examination scoring system. Only 1.6% of the children were tooth wear free, whereas 45.6% had moderate to severe wear involving dentine. Maxillary canines were the most affected teeth (83.2%), and occlusal/incisal the most affected surfaces (52.7%). The likelihood of tooth wear involving dentine was greater in boys than girls (OR = 1.72), in immigrants than in Greeks (OR = 1.93), and in 6- and 7-year olds than in 5-year olds (OR = 2.78 to 2.93). After adjustment for age, gender, and nationality, exposure to several dietary factors and especially to soft drinks was found to significantly affect the prevalence (OR = 1.27) and the severity of tooth wear. Every additional serving/week of consumption of soft drinks increases the number of surfaces with dentine affected by 0.03 per year (p < 0.05) and the cumulative score of sextants by 0.04 (p < 0.05). The cluster of children with the higher prevalence and severity of tooth wear had an average exposure to soft drinks of 10 servings/week for a duration of 4 years. The cumulative score of sextants was better predicted by the assessed risk factors, in comparison with the number of surfaces with affected dentine. Tooth wear is a common condition in children, related both to the physiological process of aging of dentition and to the erosive effect of dietary factors. Strategies to reduce the intake of soft drinks in children are expected to have multiple benefits preventing tooth wear in childhood and in later life, as well as many other general and oral health diseases.

In vitro evaluation of fluoride and calcium sodium phosphosilicate toothpastes, on root dentine caries lesions.

OBJECTIVES: The aim of this in vitro study was to assess the effect of toothpastes containing three different sodium fluoride concentrations and a calcium sodium phosphosilicate system, on root dentine demineralization and remineralization. METHODS: During a fourteen-day pH-cycling protocol, pre-softened bovine root dentine specimens were immersed twice daily, before and after the demineralization periods, for 2 min, in the following toothpaste slurries: (a) non-fluoridated (control), (b) 7.5% calcium sodium phosphosilicate, (c) 1450 ppm F, (d) 2800 ppm F, and (e) 5000 ppm F. Subsequently, the slabs were subjected to a fifty-hour acid resistance test. Knoop microhardness at different lesion depths was assessed in specimen cross-sections and KHN values were converted to vol.% mineral. Comparisons between the groups were performed at each lesion depth through ANOVA-based tests and furthermore, regression analysis of the derived statistic of "integrated vol.% mineral loss" was carried out. Also, lesions were evaluated qualitatively using transmission and polarized light microscopy. RESULTS: The 5000 ppm F toothpaste group, during pH-cycling, presented significantly less total vol.% mineral loss and subsequently exhibited considerably increased surface acid resistance, compared to all the other tested groups. The calcium sodium phosphosilicate toothpaste, during pH-cycling, inhibited demineralization and/or promoted remineralization of the surface layers significantly more effectively than the control group nevertheless, subsequently, the acid resistance of the calcium sodium phosphosilicate dentifrice group was similar to that of the control group. These observations were confirmed by microscopic examination of the lesions. CONCLUSIONS: Under the present experimental conditions, the 5000ppm F toothpaste, promoted remineralization and inhibited demineralization more effectively, than the other tested toothpastes.

Dental caries prevalence and treatment needs of 5- to 12-year-old children in relation to area-based income and immigrant background in Greece.

OBJECTIVES: To investigate the association between certain socio-demographic characteristics and dental health status of 5- to 12-year-old children attending public kindergarten and primary schools in Piraeus, Greece. METHODS: Gender, age, place of residence, immigrant background and area-based income were associated with dental caries prevalence, treatment needs and oral hygiene level in 5,116 children. RESULTS: The mean number of decayed, missing and filled deciduous teeth (dmft) and Unmet Restorative Treatment Needs Index (UTN) at 6-year-olds were 1.54 and 84.6% respectively, and the DMFT and UTN at 12-year-olds were 1.35 and 71.8%. Caries experience/severity significantly increased with age, whereas treatment needs and oral hygiene level decreased (P<0.001). Immigrant background and low area-based income was associated with poorer oral health outcomes. The above associations retained statistical significance after multivariate analysis. Children who live in areas with lower average income present 1.20 to 2.14 greater risk of having higher caries severity and poorer oral hygiene in comparison to those living in more affluent areas, and children with an immigrant background have 1.68 to 4.34 higher likelihood to present higher dmft and DMFT values, higher unmet treatment needs, and poorer oral hygiene levels compared to their Greek counterparts above and beyond the effect of the other risk factors assessed. CONCLUSIONS: The present study revealed a socio-demographic gradient in oral health status and treatment needs of children in Piraeus, Greece.

Novel methods of balancing covariates for the assessment of dental erosion: a contribution to validation of a synthetic scoring system for erosive wear.

OBJECTIVES: The purpose of the study was to balance several potential erosive covariates, using traditional and novel epidemiological approaches, in order to assess the relative risks of dental erosion more precisely. METHODS: Traditional (univariate and logistic regression analysis) and novel techniques (propensity scores and Inverse Probability Weighting-IPW) were applied for evaluating the effect of twenty covariates on dental erosion among 502 adolescents. RESULTS: Different approaches gave different estimates of the relative risks of dental erosion. The increased consumption of carbonated soft drinks had the major erosive effect, when traditional analyses were used (unadjusted: OR=3.475 and CI: 1.499-8.052, logistic regression: OR=3.219 and CI: 1.373-7.547). On the other hand, IPW method indicated that the consumption of erosion drinks immediately after intense physical exercise had the highest odds ratio (OR=1.363 and CI: 0.963-1.929), followed by the increased consumption of citrus fruit juice (OR=1.326 and CI: 1.004-1.752). This method also demonstrated a marked improvement in balance, with the 95% CIs for each OR being considerably narrower than those reported in the initial analysis. CONCLUSIONS: Standardization of the potential aetiological criteria of erosive wear is a considerably difficult process. Nevertheless, novel methods revealed that the increased consumption of carbonated soft drinks and citrus fruit juices could be included as aetiologic factors in a synthetic scoring system for erosion. Parameters which are related to salivary protective mechanisms (e.g. consumption of erosion drinks immediately after intense physical exercise) could also be a part of such an index. Further research is required in order to achieve the maximum validation of the potential erosive risk factors.

Prevalence of sealants in relation to dental caries on the permanent molars of 12 and 15-year-old Greek adolescents. A national pathfinder survey.

BACKGROUND: The use of sealants as an effective measure for the prevention of pit and fissure caries in children has been well documented by several studies; either they are used on an individual or on a public health basis. In order to plan and establish a national preventive program with sealants in a community, it is mandatory to know the epidemiological pattern of caries along with other variables influencing their use and effectiveness. AIMS: To assess the utilization and distribution pattern of pit and fissure sealants on the first and second permanent molars of Greek adolescents and to evaluate whether the existing usage of sealants and some socio-demographic factors are correlated to caries prevalence on the population examined METHODS: A stratified cluster sample of 2481 Greek adolescents was selected according to WHO guidelines (1224 twelve and 1,257 fifteen-year-old), living in urban and rural areas in 11 districts within the country. Five calibrated examiners carried out clinical examinations, recording caries experience at the dentine threshold (BASCD criteria) and presence or absence of sealants along with Socio-demographic indicators associated with oral health. Mann Whitney and Pearson's chi-square non parametric tests were utilized for assessing the data. The level of significance was p < 0.05. RESULTS: Sealants utilization varied considerably within the different districts, with 8,3% of the 12 and 8,0% of the 15-year-old adolescents having at least one sealed molar. Sealants reduced DMFS scores by 11% in the 12-year-olds and by 24% in the 15-year-olds, while 15-year-old adolescents from rural areas had a statistically significant (p = 0.002) less chance of having sealants (71%) compared to children from urban areas. Girls had higher chance to receive sealants in both age groups (26% for the 12 and 19% for the 15-year-old) as well as patients that visited the dentist for prevention compared to those visiting the dentist because they thought they needed a restoration or because they were in pain. CONCLUSIONS: The finding that sealants reduced DMFS scores despite their very low utilization, along with the high prevalence of dental caries found on the occlusal surfaces of the posterior teeth of Greek adolescents, is calling for a national preventive program with sealants which could eliminate caries to a larger extent.

Evaluation of three different scoring systems for dental erosion: a comparative study in adolescents.

OBJECTIVES: The purpose of the study was to evaluate and compare three scoring systems for dental erosion representing different approaches: the recently proposed Basic Erosive Wear Examination (B.E.W.E.), the Simplified Tooth Wear Index (S-T.W.I.), and the Evaluating Index of Dental Erosion (EV.I.D.E.), which are introduced and calibrated in the present study, in order to contribute to the development of a standardised and validated erosion index. METHODS: A cross-sectional study was conducted, in which a random and stratified sample of 502 adolescents aged 14-16 years was examined using the aforementioned scoring systems. RESULTS: A significant number of Greek adolescents had experienced dental erosion: 58%, 51.6% and 45.2%, according to the B.E.W.E., S-T.W.I. and EV.I.D.E. scores, respectively. Additionally, 22.7-24.3% of the subjects had lesions into dentine (according to the EV.I.D.E. and S-T.W.I. scores respectively), whereas the B.E.W.E. classified all subjects with erosion in the "none" and "low" risk level categories. However, the use of the B.E.W.E. cumulative scores was important for avoiding the overestimation of the prevalence of erosion. The aetiological criteria of the EV.I.D.E. seemed to reduce the false positive cases. CONCLUSIONS: The S-T.W.I. appeared to have the lowest content validity, while the B.E.W.E. was a convenient to use index, with sufficient sensitivity and specificity. Nevertheless, the B.E.W.E. cut-off values have to be reconsidered in order to reflect the severity of the erosive lesions. The B.E.W.E. could also be supplemented with a group of sufficient validated aetiological criteria, which are necessary to establish a more accurate differential diagnosis of dental erosion.

Periodontal diseases in Greek adults between 1985 and 2005--risk indicators.

AIM: This study provides data on the periodontal status of Greek adults aged 35-44-years-old in relation to socio-demographic and behavioural parameters and compares these data with those of 1985. MATERIAL AND METHODS: A stratified cluster sample was selected according to WHO guidelines for national pathfinder surveys. Periodontal and oral hygiene status were assessed using the CPI index and the OHI-S index respectively. Socio-demographic and behavioural data were collected through face-to-face interviews. RESULTS: In 2005, 9.5% of the participants had healthy periodontium, 16.2% bleeding on probing, 46.8% calculus, 24.2% shallow pockets and 3.3% deep pockets. Half of the individuals (52.1%) had good oral hygiene status, 39.8% fair and 8.1% poor. Most of them (79%) brushed their teeth at least once a day, but only 25.4% used dental floss. Higher CPI scores were associated with living in rural areas, having a lower educational attainment and brushing and flossing teeth less frequently. Better oral hygiene status was associated with having a higher educational attainment and income, as well as brushing and flossing teeth more frequently. Comparisons with the 1985 findings indicate that severe periodontal diseases may be declining in Greece, whereas gingivitis may be increasing. CONCLUSIONS: The prevalence of severe periodontal diseases in Greek adults is not high and their periodontal health has improved since 1985. As long as their oral hygiene status and preventive dental behaviour cannot be considered as satisfactory, there is room for further improvement.

Physical and psychological nicotine dependence in Greeks: an epidemiological study.

PURPOSE: Smoking is the most widespread addictive behaviour in the world, as it causes physical and psychological dependence on nicotine. The objective of the present study was to discern the prevalence and the relative risks of nicotine dependence of adult people in Athens, Greece, as this country holds first place in cigarette consumption in the European Union. MATERIALS AND METHODS: A random sample of 202 current smokers (82 men and 120 women) was drawn from residents aged v 18 years in Athens, the capital of Greece. A questionnaire on the physical (Fagerstrom Test of Nicotine Dependence) and psychological (American Psychiatric Association's diagnostic criteria of nicotine abuse) nicotine dependence was used. RESULTS: According to the results of the present study, 12.4% of the sample reported null physical nicotine dependence, and 31.7% had low, 25.7% had moderate and 30.2% had high nicotine dependence. Multiple logistic regression analysis revealed that younger people (aged 18 to 24 and 25 to 34, odds ratio [OR] = 0.047, P < or = 0.033 and OR = 0.096, P < or = 0.038, respectively) were less prone to developing physical dependence. Women tended to be systematically less dependent than men (25% and 37.8% high dependence, respectively). Furthermore, 75.7% of the sample had psychological nicotine dependence. Binary logistic regression analysis and chi-square test revealed that younger people (18- to 24-year-olds, OR = 0.081, P < or = 0.008) and individuals of inferior education (v2 = 7.826, P < or = 0.05) were less prone to develop psychological dependence. In addition, women showed a higher percentage of withdrawal symptoms compared with men (80% and 68%, respectively). CONCLUSIONS: The results of the present study provided compelling evidence that physical and, in particular, psychological nicotine dependence of adult people in Athens, Greece, was significant, and this calls for a course of action that should be taken by public health policy-makers to reduce smoke consumption.