[Interprofessional collaboration, the key to better oral healthcare for frail older people]. / Interprofessionele samenwerking; de sleutel tot betere mondzorg voor (kwetsbare) ouderen.

Globally, oral health diseases are a major problem that can have serious consequences at both the individual and social level. Despite sufficient knowledge about the prevention of oral health diseases, putting it into practice does not seem obvious, particularly not in a target group of frail older people. Inequality of health, partly increased by society becoming more multicultural and the ageing of the population, must be tackled. Diversity in the provision of care tailored to the care needs of different target groups is necessary. Another challenge lies in removing the barriers that (oral) healthcare providers experience when offering oral healthcare to frail older people. In order to provide a solution to the issues mentioned above, reorientation of oral healthcare services is needed. A more prevention-orientated approach to care, with methods of financing that support this, should be the goal. In addition, health literacy must be improved through health education and promotion. A model has been developed for interprofessional collaboration to optimise (oral) healthcare. This approach would lead to an increase in patient-centred care and in this way takes important steps forwards towards a healthier society.

Social gradient in caries experience of Belgian adults 2010.

OBJECTIVE: This study aims to explore the caries experience of the Belgian population in relation to social indicators. BASIC RESEARCH DESIGN: Data collection (2009-2010) consisted of an oral health questionnaire and examination during a home visit. PARTICIPANTS: Representative sample of the Belgian population (⟩5 years old). Only the economically active population was included for final analyses. MAIN OUTCOME MEASURES: ANOVA and multivariable regression analyses were used to reveal associations between social indicators, oral hygiene, untreated decay, DMFT and edentulousness. RESULTS: 2742 participants completed the questionnaire, of whom 2563 were examined clinically. Most (53%) were female and mean age was 43.3 years (95% CI= 41.2-45.4). In the total population, 11.1 % were caries-free (DMFT = 0) and mean DMFT was 10.8 (95% CI = 10.0-11.5). In the analysed subsample, higher educated participants had lower DMFT scores than those with low or no educational qualifications (p = 0.003). Employment status was associated with the presence of untreated tooth decay, especially in the youngest age group (p = 0.015), and with edentulousness (p = 0.02), with a higher risk among unemployed women of being completely edentulous (OR = 5.32; 95% CI = 1.75-16.12). Untreated tooth decay was related to frequency of tooth brushing and plaque index (p ⟨ 0.002 and ⟨ 0.001 respectively). CONCLUSIONS: Caries experience in Belgium, expressed as mean DMFT and proportion of untreated tooth decay, is more associated with level of education and employment status than with family income, which is still the main criterion for larger government allowances for healthcare in Belgium.

Effect of an oral healthcare programme on care staff knowledge and attitude regarding oral health: a non-randomised intervention trial.

OBJECTIVES: The objective of the study was to evaluate the effect of an oral healthcare programme in nursing homes on care staff knowledge and attitude regarding oral health. METHODS: The study sample consisted of the nurses and nurses' aides from 63 nursing homes, which either received an oral healthcare programme including mobile dental care or were on a waiting list to receive this programme. A validated questionnaire completed at baseline and again after the study period assessed the care staff knowledge and attitude. Paired t test, independent t test, general linear and linear mixed models were used to examine the changes in attitude and knowledge scores. RESULTS: In total, 546 questionnaires were completed by the same people from 36 nursing homes at baseline and on completion of the study. After the intervention period, knowledge significantly improved in both study groups (I p < 0.001; C p < 0.001), the intervention group significantly showing the largest increase (p < 0.001). The outcome variable attitude only showed a significant improvement in the intervention group (p < 0.001). The mixed models confirmed the impact of some aspects of the intervention on the attitude and the knowledge of the caregivers. CONCLUSIONS: The oral healthcare programme including a mobile dental team resulted in a significant increase of the care staff knowledge and attitude regarding oral health. CLINICAL RELEVANCE: The integration of a dental professional team in nursing home organisations should be encouraged because it could be valuable to tackle barriers for the provision of daily oral hygiene and to support the continuous integration of oral health care into general care.

The oral health condition and treatment needs assessment of nursing home residents in Flanders (Belgium).

OBJECTIVES: A study was conducted of nursing home residents with limited access to regular oral health care services to evaluate their oral health status, to perform an assessment of the need for oral treatment and to determine the possible predicting value of age, gender, care dependency and income level on their oral health status and treatment needs. MATERIALS AND METHODS: Three experienced dentists collected clinical oral health data with a mobile dental unit in 23 nursing homes. Socio-demographic data were extracted from the residents' records in the nursing home. Besides the descriptive and bivariate analysis, a general linear mixed model analysis was also performed with the nursing home as random effect. RESULTS: The study sample consisted of 1,226 residents with a mean age of 83.9 years, of which 41.9% were edentulous. The mean D3MFt in the dentate group was 24.5 and 77% needed extractions or fillings. In the group of residents wearing removable dentures, 36.9% needed repair, rebasing or renewal of the denture. The mixed model analysis demonstrated that with each year a resident gets older, the oral health outcomes get worse and that men have worse oral health and higher treatment needs than women. However, the level of income and care dependency had a less extensive role in predicting the oral health outcomes. CONCLUSIONS: The nursing home residents presented a poor overall oral health status and high dental and prosthetic treatment needs. Gender and age were important predicting variables for the oral health outcomes.

A pilot assessment tool of the need for oral health care and cost prediction in institutionalized elderly people.

OBJECTIVE: To assess the dental treatment backlog and associated costs among institutionalized elderly people using a novel composite index, called the oral health index. BACKGROUND: Despite numerous reports about oral health of old individuals, there is still lack of a systematic and practical method to estimate their treatment need covering all relevant aspects of oral health. In addition, little has been published on associated treatment costs and prediction of such costs. MATERIALS AND METHODS: An observational study was performed on 143 dentate institutionalized elderly people, whereby several clinical parameters were registered. The collected data were included in the oral health index representing the need for oral health care. This covered the number of caries lesions, number of residual roots, periodontal health condition, plaque score and denture condition with a final score of 0-9. To investigate the validity of the index, the treatment costs were estimated using the measured clinical parameters and later compared with the actual expenditure of the patients for the following 2 years. RESULTS: The average score of the index was 4.6 (SD 1.4) with 65.1% of the individuals having a score between 3 and 6 and 27.3% having a score of 6 and more, exhibiting medium and high need for oral health care, respectively. Only 30% of the patients underwent all the indicated treatments. The major reason of non-completion of the treatment was patient's refusal. From the fully treated group, 61.5% of the subjects actually spent within the predicted range while 38.5% of them spent more than estimated. The underestimation was related to yearly calculus removals leading to repeated calculation of the same costs and newly emerging dental problems (33% developed new caries and 20% was confronted with tooth fracture within the 2-year period). CONCLUSION: The novel index can be helpful to determine oral treatment needs and associated costs. Further research is needed to extend the clinical applicability of the index.

Validation of the Oral Survey-B System for Electronic Data Capture in National Oral Health Surveys.

The aims of the present study were to incorporate and to validate the electronic capture of participant-related outcomes into the Oral Survey-B System, which was originally developed for the electronic capture of clinical data. The validation process compared the performances of electronic and handwritten data captures. The hypothesis of noninferiority would be established if participants performed electronic data capture of the questionnaire survey with an effectiveness of at least 95% of that of handwritten data capture. In this multicenter, randomized, one-period crossover study design, participants (n = 261) were allocated to start with either electronic or handwritten data capture. The incorporation of the electronic self-completed questionnaire into the Oral Survey-B System was successful. The validation of the electronic questionnaire was performed by participants aged from 18 to 75 years. The interrater reliability of participants performing electronic and handwritten data capture of nonclinical assessments per questionnaire and per entry showed a kappa value of 0.72 (95% CI: 0.53-0.94). The noninferiority of electronic data capture in relation to that of the handwritten data capture and transfer was shown (p < 0.0001; 95% CI: 1.47-2.99). In conclusion, the electronic capture of participant-related outcomes with the Oral Survey-B System, originally designed for capture of clinical data, was validated. The electronic data capture was accurate and limited the number of errors. The participants were able to perform electronic data capture effectively, supporting its implementation in further National Oral Health Surveys. With the consideration of participant preference and time savings, this could lead to the implementation of electronic data capture worldwide in National Oral Health Surveys.

Endodontic performance by Flemish dentists: have they evolved?

AIM: To gather information on aspects of endodontic practice and referral behaviour by Flemish (Dutch-speaking Belgian) dentists and to compare the results with an earlier investigation. METHODOLOGY: A postal questionnaire was distributed to 4468 active Flemish dentists. It consisted of multiple-choice questions on endodontic practice and endodontic referral need. Basic information on age, gender, year of qualification and clinical specialty was also obtained. The questionnaire was free of charge to return. Data were imported in a database, subjected to descriptive and analytical statistics and compared to those of an earlier, comparable survey. RESULTS: The response rate was 18.5%. Of all respondents, 95% were general practitioners. More than half (56%) of the respondents never or seldom used rubber dam during endodontic treatment. The use of sodium hypochlorite as an irrigant was well established (80% of respondents using it), whereas the use of EDTA was limited. Female respondents were more likely to refer to an endodontist than male (70 versus 49%). Referrals for treatment of root canal obstruction (48%), perforations and root resorption (42%) and retreatment (39%) were rated 'very important'. Younger respondents more frequently made use of magnification, rotary instruments and rubber dam. Activation of irrigants was incorporated by a small number of respondents (50% never, 12.6% seldom). Cold lateral condensation was used by most GDPs (35.3% always, 19.5% frequently). CONCLUSIONS: Endodontic practice of general dentists in Flanders did not always comply with quality guidelines. However, when comparing the present data with those of a previous study, an obvious trend towards a more present-day treatment protocol is noticeable, as well as an increased appeal for endodontic referral.

The influence of reflection on portfolio learning in undergraduate dental education.

INTRODUCTION: Disparity exists between the growing consensus about the positive effects of reflection on performance and the scarcity of empirical evidence demonstrating this effect. Portfolios are considered a useful instrument to assess and supervise competence-based education and to stimulate reflection. The present study describes the introduction of a portfolio in a social dentistry and oral health promotion course and investigates student reflection as a predictor for the acquisition of the other competences in the course. METHODS: Fourth year undergraduate dental students (n = 110) in the course 'Society and Health' between 2008 and 2011 collected evidence in their portfolios, demonstrating the acquisition of five competences: the ability to (1) assess the oral health profile of a target group; (2) integrate theoretical models in health promotion; (3) search for and apply scientific evidence; (4) work trans-, multi- and/or trans-disciplinarily; (5) reflect on personal development. Linear regression analysis was used to investigate the predictive value of reflection on the other course related competences. RESULTS: Reflection scores proved to significantly predict other course-related competences, when analysing all students between 2008 and 2011 and for each year separately, explaining between 10.7% and 25.5% of the variance in the other competences. CONCLUSION: Undergraduate dental students' competences related to social dentistry and oral health promotion were significantly predicted by the reflection scores obtained in a portfolio-based context. In line with the growing consensus about the benefits of reflection for dental students and professionals, results suggest the value to further develop the integration of reflection in dental education and practice.

Meta-analysis of dysphagia and aspiration pneumonia in frail elders.

As part of a systematic literature review, a comprehensive literature search was carried out to identify risk factors for aspiration pneumonia in frail older people. A prominent risk factor found was dysphagia with evidence level 2a, according to the Oxford Centre for Evidence-based Medicine Levels of Evidence. Subsequently, a meta-analysis of 4 cohort, 1 case-cohort, and 1 case-control study on dysphagia as a risk factor of aspiration pneumonia in frail older people was performed. Using a random effects model, we found a positive correlation between dysphagia and aspiration pneumonia: OR = 9.84; 95%CI = 4.15 - 23.33 (test for statistical homogeneity: p < 0.001). Then, a subgroup meta-analysis was performed with 4 cohort studies, all including patients with a cerebrovascular disease. Once again, a positive correlation was found between dysphagia and aspiration pneumonia: OR = 12.93; 95%CI = 8.61 - 19.44. The test for statistical homogeneity revealed no statistically significant result (p = 0.15). It was concluded that dysphagia is a serious risk factor for aspiration pneumonia in frail older people, particularly in those suffering from a cerebrovascular disease.

Validity of an information and communication technology system for data capture in epidemiological studies.

The Belgian National Institute of Health Insurance is implementing an oral health data registration and surveillance system. This study aimed to develop and validate a system of electronic data capture for oral health surveys at a national level - Oral Survey-B - and to identify the advantages and disadvantages of the electronic system in comparison with the traditional handwritten data capture. Six series of full-mouth recordings simulating the clinical examination of 6 patients were set up in a Powerpoint presentation. The validation was undertaken by 52 general practitioners. A randomized one-period crossover design was used with two formats of data capture, i.e. electronic followed by handwritten or handwritten followed by electronic system. Further, 6 benchmarked handwritten forms were transferred to the electronic format. For the electronic data capture, 86.5% of the practitioners had a correct completion rate of ≥95%. The corresponding value for the handwritten data capture and transfer was 78.8% (p = 0.25, McNemar test). The overall accuracy of forms without any error was 73.4% for the electronic and 62.5% for the handwritten data capture (p < 0.001, signed-rank test). Significantly lower percentages of errors and less time were observed for the electronic data capture (p < 0.001, signed-rank test). Practitioners considered the electronic data capture as being much more difficult to carry out (p < 0.001). As information technology has turned into an ever more necessary working tool in epidemiology, there should be an important potential for uptake of further improvements in electronic data capture in the future.

Evaluation of the implementation of an 'oral hygiene protocol' in nursing homes: a 5-year longitudinal study.

OBJECTIVES: To explore the long-term effects of the implementation of an oral hygiene protocol in nursing homes. METHODS: Out of 14 nursing homes (Flanders) seven nursing homes were randomly allocated to the intervention group and confirmed to implement an 'oral hygiene protocol'. The remaining nursing homes (the control group) continued to perform oral hygiene as usual. Oral hygiene levels were scored and factors related to plaque levels were recorded. Mixed model analysis with random institution effect, were performed to explore differences in oral hygiene levels owing to the intervention, and the predictive value of explanatory variables. RESULTS: At baseline, no significant differences were found between plaque levels in both study groups. In an unadjusted analysis, different effects were observed on denture and dental plaque. The lowest denture plaque levels were found 2 years after the start of the study, while the lowest dental plaque levels were found at the end of the study. The effect of the intervention could not be confirmed in an adjusted mixed model, where significant indicators for dental plaque were resident's dependency (P<0.01) and presence of mouth rinse (P<0.01). Capacity of the nursing home (P<0.05) and the presence of toothpaste (P<0.01) were dominant influencing factors for denture plaque. CONCLUSIONS: After 5 years of implementation obtained plaque levels were unsatisfactory. A lot of uncertainties remained on the impact of characteristics of individual nursing homes. Obtaining adequate oral hygiene levels in nursing homes remain an important ongoing challenge and needs further research.

Sociodemographic determinants for oral health risk profiles.

The present study aimed to explore the association between caries risk profiles and different sociodemographic factors . The study sample (n = 104) was randomly selected within an urban population in Flanders, Belgium. Caries risk was assessed by anamnesis, clinical examination, salivary tests, and a questionnaire. Age, gender, and socio-economic status were extracted from social insurance data files. Social indicators were "occupational status," "being entitled to the increased allowance for health care interventions" and having access to the "Maximum Bill" (MAF), initiatives undertaken to protect deprived families. In the bivariate analysis there were significant differences in risk profiles between occupational groups (P < .001), between entitled and non-entitled individuals to the increased allowance (P = .02), and between access or no-access to the MAF (P < .01). The multiple logistic model showed a significantly higher chance of being in the low risk group for individuals with no-access to the MAF compared to those with access (OR:14.33-95% C.I. 2.14-95.84).

The impact of undergraduate geriatric dental education on the attitudes of recently graduated dentists towards institutionalised elderly people.

OBJECTIVE: The aim of the study was to assess the impact of undergraduate geriatric dentistry education on knowledge of ageing and on attitudes towards institutionalised elderly people, as perceived by recently graduated dentists. METHODS: A validated questionnaire was sent by mail to all dentists of the study group (n = 357). The questionnaire collected socio-demographic data, motives for pursuing a dental career, knowledge of ageing, attitude towards institutionalised elderly people using the Aging Semantic Differential (ASD), and aspects of geriatric dentistry education. RESULTS: Great variability between the six dental schools involved was observed in respect of the undergraduate education received in geriatric dentistry. Dentists' knowledge of ageing was also low. The mean value of ASD-total indicated that in this study there was a negative attitude towards the institutionalised elderly. The covariate 'financial motive for pursuing a dental career' was the only item that seemed to have any significant influence on the ASD. Age was the only significant variable for knowledge. All other covariates were found not to have any influence. CONCLUSIONS: From this study it would appear that the attitude of recently graduated dentists in Belgium towards the institutionalised elderly is rather negative and their knowledge of ageing is poor. The actual level of geriatric dentistry education in the undergraduate curriculum did not appear to influence this attitude, but Belgian dental schools are challenged to reorientate their provision of geriatric dentistry education to include activities that help to develop positive perceptions towards the elderly, with an empathic positive and caring attitude.

[Oral health care guidelines for elderly people in long-term care facilities. Effectiveness and implementation in The Netherlands and Flanders]. / De richtlijn mondzorg voor ouderen in zorginstellingen. Effectiviteit en implementatie in Nederland en Vlaanderen.

Oral health care includes self-care, volunteer care, and professional care for maintaining or advancing appropriate oral health. It has been demonstrated that the oral health care in long-term care facilities for elderly people in The Netherlands and Flanders (Belgium) is not adequate. Daily oral hygiene care, carers' knowledge and skills providing adequate oral health care, (co)morbidity, and drug usage are points of special interest in realizing an improvement of oral health care and oral health. The Dutch Association of Nursing Home Physicians has formulated oral health care guidelines for elderly people in long-term care facilities. A research project on the effectiveness and implementation will be carried out, determining the guidelines'quality. The aim of the project is improving the quality of oral health care for and the quality of oral health and life of elderly people in long-term care facilities in The Netherlands and Flanders.

[The guideline Oral Health Care for dependent residents in long term care facilities, 2007: dire necessity!]. / De Richtlijn Mondzorg voor zorgafhankelijke cliënten in verpleeghuizen, 2007: bittere noodzaak!

The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of) their natural teeth, the need for good oral health care is increasing even more. Therefore a specific guideline was developed. The ultimate aim of the guideline "Oral health care for dependent residents in long term care facilities" is to improve the oral health of nursing home residents. Oral health care needs to be incorporated in daily nursing home care routine and in the integral care plan of every resident. Attention is given to the importance of an adequate implementation of this guideline as well as to the necessity of research evaluating the effects of it's implementation.

Evidence-based care and the curriculum.

An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.

The influence of social indices on oral health and oral health behaviour in a group of Flemish socially deprived adolescents.

AIM: To investigate the impact of social indices on oral health and oral health behaviour in socially deprived adolescents and young adults in Flanders. METHOD: The study design was cross-sectional and included 68 subjects aged 12 to 26, who called for help by "Habbekrats", a non-profit organisation rendering assistance to adolescents and young adults living on the fringes of our society. The clinical oral examination was performed using criteria based on the diagnostic criteria for caries prevalence surveys published by BASCD. Information on parental occupational level, educational level, living condition and oral health behaviour was gained using questionnaires completed by the participants themselves and their social workers. RESULTS: The mean age was 16.2 years. Within the sample 92% and 90.8% respectively had a father or mother belonging to a low social level. For 68% of the sample the educational level was low. Concerning oral health behaviour 67% reported nutritional habits conducive to poor oral health whereas 64% reported good oral hygiene habits. The mean DMFS was 11.42 (SD = 14.33) and the mean care-index equalled 0.60 (SD = 0.39). Statistical analysis by means of a logistic regression model revealed that only the 'living condition' had a statistically significant influence on oral health behaviour (p < or = 0.05) and care-index (p < or = 0.05). There was no significant correlation between the parents occupation and subjects' educational level and the oral health behaviour and oral health status of the study group. CONCLUSION: From this analysis it is clear that 'living condition' had a significant influence on the oral health behaviour and care indices of the studied population of socially deprived adolescents.

Dental students' attitude towards anti-smoking programmes: a study in Flanders, Belgium.

OBJECTIVE: The aim of the study was to assess the dental students' attitude towards tobacco cessation counselling in the dental setting and to explore the influence of knowledge, belief in effectiveness, smoking status, gender and curriculum. MATERIAL AND METHODS: The study group consisted of all undergraduate students from the 2002-2003 classes of the Ghent University (n = 96). A validated questionnaire was administered to all students involving four different sections: demographic characteristics, attitude related to tobacco cessation programmes in the dental setting, belief in their effectiveness and knowledge concerning tobacco health effects. Statistical analysis included simple univariate nonparametric tests for evaluating differences in attitude towards tobacco cessation programmes, belief in effectiveness of tobacco cessation programmes in the dental setting and knowledge of students concerning tobacco health effects by year of graduation, smoking status and gender. Multiple logistic regression was chosen to calculate adjusted odds ratios and 95% confidence intervals. RESULTS: Students view willingness to advise individual patients to quit using tobacco. Yet only 51.3% are willing to co-operate in anti-tobacco programmes at the community level, and the perception of students of the effectiveness of smoking cessation counselling in the dental setting is low. The variance of attitude towards tobacco cessation programmes was significantly affected by knowledge and the belief in effectiveness of tobacco cessation programmes in the dental setting. Better knowledge and belief in effectiveness of tobacco cessation counselling was associated with an increasing positive attitude towards tobacco cessation programmes expressed by an odds ratio of 3.12 (95% CI 1.00-9.67) and 1.17 (95% CI 1.00-1.37) respectively. CONCLUSION: Belief in effectiveness and knowledge seem to influence the attitude of students towards tobacco cessation counselling. PRACTICE IMPLICATIONS: Besides imparting knowledge, the attitude of newly graduated dentists could be improved by stressing the effectiveness of smoking cessation activities during lectures and integrated training modules in the undergraduate education.

Caries patterns in primary dentition in 3-, 5- and 7-year-old children: spatial correlation and preventive consequences.

This study aimed to contribute to the descriptive information of oral health status in the primary dentition, especially concerning the distribution and spatial correlation of lesions. Data were obtained from two surveys. In the Signal-Tandmobiel project 4,468 7-year-old children in Flanders (Belgium) were selected by a stratified clustered random sample. In the Tandje de Voorste - Smile for Life (TDV) project, data were obtained from 1,291 3-year-old and 1,315 5-year-old children. The children were examined by trained dentists, using standardized and widely accepted criteria, based on the British Association for the Study of Community Dentistry criteria. At the population level, symmetry in the prevalence of caries experience across the midline was tested at the tooth and tooth surface levels using generalized estimating equations and alternating logistic regression (ALR) approaches. Individual symmetry was tested using an approach described by Hujoel et al. [J Dent Res 1994;73:1575-1580]. Descriptive observations suggested a symmetrical distribution of caries experience at the population level. The null hypothesis of symmetry could not be rejected at a 0.05 level, suggesting that caries experience might be symmetric in the deciduous dentition. Based on the ALR approach, 2 x 2 associations of caries experience at the tooth and surface levels, both in 5- and 7-year-olds, appeared to be strongest for the left-right pairs in the mandible, followed by the left-right pairs in the maxilla. At the individual level the hypothesis of random caries pattern was rejected (p < 0.0001). In conclusion, at the population level the null hypothesis of left-right symmetry could not be rejected, while at the individual level lesions tended to cluster on one side of the mouth.

Oral health and habits in children with asthma related to severity and duration of condition.

AIM: This study was designed to examine the oral health status of asthmatic children and to compare the oral health condition and habits of different groups of asthmatic children. METHODS: 140 asthmatic children were involved in the present study. Of those, 30 were younger than 7 years of age, 73 were between 7 and 12, 37 were older than 12. Dental caries was scored according to the guidelines of the BASCD. No radiographs were taken. The gingival health and the amount of plaque were assessed using the bleeding index described by Mühleman and Son [1971] and the plaque index of Silness and Löe [1964] respectively. To differentiate between the asthmatic children three explanatory variables were used: the time the asthmatic symptoms had lasted, the exposure time to the medication and the severity of the asthmatic condition. Finally the parents and children were asked to fill in a questionnaire referring to oral health habits. RESULTS: The mean dmft was 1.99 (SD+/-2.74) and the mean DMFT was 1.10 (SD+/-1.98). Non-parametric correlation and multiple logistic regression analyses showed no significant difference between the caries (dmft/s, DMFT/S), the gingival health (bleeding index) and plaque indices and the three explanatory variables. The impact of possible compensatory factors as oral hygiene and dietary habits was of no significant importance. CONCLUSION: This analysis revealed that neither the period (of the disease and the medication) nor the severity of the asthma had a significant influence on the risk of caries and gingivitis in asthmatic children. No reported oral health and dietary habits could explain this lack of correlation.