Evaluation of dental plague removal procedure in adult population from the Lomza region.

INTRODUCTION: The National Health Fund guarantees to insured persons free dental treatment as part of a catalog of scopes and benefits, such as dental treatment. Among the services included in the appendix there is a dental plaque removal procedure, which can be performed in adults once every 12 months or once every 6 months in the case of pregnant and puerperal women. This procedure involves breaking down the bacterial biofilm above and below the gingiva, rinsing it in vases with water from the periodontal area, and additionally, through the cavitation effect, it causes the implosion of air bubbles, directly destroying bacterial cells. MATERIALS AND METHODS: The analysis covered 2,114 patients aged 18-89 who visited the dentist from 01/01/2019 to 31/12/2019. The dental clinic was located in a medium-sized town in the Podlaskie Voivodeship. The dental plaque removal procedures were performed on patients by dentists and then coded in accordance with the ICD9 Basic Edition Dictionary ICD9 CM (5.18) "23.1601 - Removal of plaque from 1/2 of the dental arch", respectively. The visits analyzed for this study were performed in the period from 01/01/2019 to 31/12/2019. In the following epidemiological descriptive study, secondary sources of information were used, in the form of collective reports generated from electronic records, which are stored in the dental clinic that provides dental care for patients under an agreement with the National Health Fund for general dental treatment. RESULTS: The total number of women undergoing the plaque removal procedure was significantly higher than the number of men. The distribution of patients in different age groups was uneven. The highest percentage of patients undergoing the dental plaque removal procedure occurred in the age groups of 18-29 and 30-39 years - 21% and 29% of all respondents, respectively. The lowest number of patients was found in the age group of 80-89 years (1%).There is a statistical difference in the total number of dental procedures and in each age group in favor of women in each group, except the 60-79 age group. The greatest number of dental plaque removal procedures, compared to other procedures, was performed in men aged 30-39 years. Among men, along with the increase in age up to the age of 60, the number of dental plaque removal procedures decreased by an average of 10%, a drastic decrease occurred at the age of 70-79 - only 10% of procedures were dental plaque removal procedures. Among women aged 30-59 who were patients of the clinic, the percentage of women with dental plaque removal was about 30%, only in the age group over 80 the percentage of women who underwent the procedure fell to less than 10%. CONCLUSIONS: The results of the study show that the sex and age of the inhabitants of the Lomza region are significant variables related to the procedures of removing plaque in a dental office. Observation showing a decrease in the number of these procedures with increasing age of patients and their more frequent occurrence in women generally requires detailed studies identifying the main determinants of existing relationships.

Feasibility of a sensory-adapted dental environment for children with autism.

OBJECTIVE: To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD). METHOD: Twenty-two children with ASD and 22 typically developing children, ages 6-12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3-4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost. RESULTS: We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition. CONCLUSION: Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.

Psychometric properties of the faces version of the Malay-modified child dental anxiety scale.

BACKGROUND: To evaluate the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDASf) Malay version in 5-6 and 9-12 year-old children. METHODS: The MCDASf was cross culturally adapted from English into Malay. The Malay version was tested for reliability and validity in 3 studies. In the Study 1, to determine test-retest reliability of MCDASf scale, 166 preschool children aged 5-6 years were asked to rank orders five cartoons faces depicting emotions from 'very happy' to 'very sad' faces on two separate occasions 3 weeks apart. A total of 87 other 5-6 year-old children completed the Malay-MCDASf on two separate occasions 3 weeks apart to determine test-retest reliability for Study 2. In study 3, 239 schoolchildren aged 9-12 years completed the Malay-MCDASf and the Malay-Dental Subscale of the Children Fear Survey Schedule (CFSS-DS) at the same sitting to determine the criterion and construct validity. RESULTS: In study 1, Kendall W test showed a high degree of concordance in ranking the cartoon faces picture cards on each of the 2 occasions (time 1, W = 0.955 and time 2, W = 0.954). The Malay-MCDASf demonstrated moderate test-retest reliability (Intraclass correlation coefficient = 0.63, p <0.001) and acceptable internal consistency for all the 6 items (Cronbach's alpha = 0.77) and 8 items (Cronbach's alpha = 0.73). The highest MCDASf scores were observed for the items 'injection in the gum' and 'tooth taken out' for both age groups. The MCDASf significantly correlated with the CFSS-DS (Pearson r = 0.67, p < 0.001). CONCLUSIONS: These psychometric findings support for the inclusion of a cartoon faces rating scale to assess child dental anxiety and the Malay-MCDASf is a reliable and valid measure of dental anxiety in 5-12 year-old children.

Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety.

AIM: To compare the effectiveness of inhalation sedation with nitrous oxide/oxygen (N2O/O2) and cognitive behavioural therapy (CBT) in reducing dental anxiety in preschool children. STUDY DESIGN: Randomised controlled clinical trial. METHODS: This study was conducted on 45 preschoolers with moderate to severe dental anxiety (determined by the Children's Fear Survey Schedule Dental Subscale), who required pulp treatment of at least one primary mandibular molar. Baseline anxiety and cooperation levels were determined using Venham Clinical Anxiety and Cooperation Scales (VCAS and VCCS) and Venham Picture Test (VPT) at the first dental visit (dental prophylaxis and fluoride treatment). Before the second dental visit (pulp treatment), the children were randomly assigned to one of three groups--1: control, 2: N(2)O/O(2) and 3: CBT. In group 1, the usual behaviour management techniques were used, in group 2, nitrous oxide/oxygen gas was used and in group 3, unrelated play, Benson's breathing and positive self-talk and modelling were used. Anxiety and cooperation levels were determined at three periods: injection, rubber dam placement and the application of a high-speed handpiece with VCAS and VCCS and VPT. Finally, anxiety and cooperation differences between the two dental visits were compared within the three groups. STATISTICS: Chi square, ANOVA and Kruskal-Wallis and Mann-Whitney U tests were used. RESULTS: N(2)O/O(2) and CBT significantly resulted in lower anxiety and higher cooperation in the second visit (at all three periods) compared to the control, although there was no significant difference between these two treatment methods. CONCLUSION: Both test methods were effective in reducing dental anxiety in preschoolers. Considering the adverse effects and necessity of equipment and trained personnel when using nitrous oxide and oxygen inhalation sedation, cognitive behavioural therapy is preferable because of its better applicability.

Parent-reported distress in children under 3 years old during preventive medical and dental care.

PURPOSE: This study examined factors related to young children's distress during preventive oral health visits. Additionally, associations between parent-reported child behaviour during the dental visit and during previous medical visits were tested. METHODS: One hundred twenty-two children under 3 years of age enrolled in a government insurance programme for low-income children were seen for examination, prophylaxis, and fluoride application at a university-based dental clinic. Child distress was rated by parents on a numerical rating scale. RESULTS: The average age of children enrolled was 23.5 ± 7.3 months. The majority (55.7 %) were judged to have little or no distress pre-examination. Mild or no distress during the examination was reported for 42.6 % of the children and severe distress was reported for 39.4 %. Intensity of distress during the examination was not associated with the child's age, gender, dental health, or previous experience with dental care. Distress was also unrelated to the caregiver's education level or own dental health. Intensity of distress was associated with the child's pre-dental examination distress and distress during prior medical examinations and injections. CONCLUSIONS: Dental professionals can better anticipate child distress by assessing children before a dental examination and enquiring about previous medical experiences. Strategies to prepare parents and alleviate distress may help children cope with the preventive dental visit.

Characteristics of dental fear among Arabic-speaking children: a descriptive study.

BACKGROUND: Dental fear has not only been linked to poor dental health in children but also persists across the lifespan, if unaddressed, and can continue to affect oral, systemic, and psychological health. The aim of this study was to assess the factor structure of the Arabic version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and to assess the difference in factor structure between boys and girls. METHODS: Participants were 220 consecutive paediatric dental patients 6-12 years old seeking dental care at the Faculty of Dentistry, King Abdulaziz University, Saudi Arabia. Participants completed the 15-item Arabic version of the CFSS-DS questionnaire at the end of the visit. Internal consistency was assessed using Cronbach's alpha. Factor analysis (principal components, varimax rotation) was employed to assess the factor structure of the scale. RESULTS: The Cronbach's alpha was 0.86. Four factors with eigenvalues above 1.00 were identified, which collectively explained 64.45% of the variance. These factors were as follows: Factor 1, 'fear of usual dental procedures' consisted of 8 items such as 'drilling' and 'having to open the mouth', Factor 2, 'fear of health care personnel and injections' consisted of three items, Factor 3, 'fear of strangers', consisted of 2 items. Factor 4, 'fear of general medical aspects of treatment', consisted of 2 items. Notably, four factors of dental fear were found in girls, while five were found in boys. CONCLUSIONS: Four factors of different strength pertaining to dental fear were identified in Arabic-speaking children, indicating a simple structure. Most items loaded high on the factor related to fear of usual dental procedures. The fear-provoking aspects of dental procedures differed in boys and girls. Use of the scale may enable dentists to determine the item/s of dental treatment that a given child finds most fear-provoking and guide the child's behaviour accordingly.

Assessment for the children's fear survey schedule-dental subscale.

OBJECTIVES: Child dental fear causes a significant management problem. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is the most widely used measure of dental fear in children. This study was undertaken to develop and test reliability and validity for the Arabic version of the CFSS-DS. STUDY DESIGN: the English CFSS-DS was translated to Arabic language and its reliability and validity were evaluated by distributing it to 6-12 year old Arabic pediatric dental patients (n=220). Of whom 144 children were assigned for test- retest reliability. To test criterion validity; 44 children were subjected to behavior rating during treatment and compared with their CFSS-DS. Fear of returning to the dentist was evaluated for all the children to test construct validity. RESULTS: the Arabic version of the CFSS-DS showed good internal consistency (alpha = 0.86) and test-retest reliability (0.86, P<0.001). Treatment with or without local anesthesia did not affect the children's behavior or fear scores. Significant correlations were found between total fear scores and both Frankl rating scale (r=-0.54, p<0.001) and willingness to return to the dentist (r=0.50, p<0.001). CONCLUSION: the Arabic version of the CFSS-DS appears to be a reliable and valid method for evaluating child's dental fear in Arabic cultures.

Dental anxiety among Israeli children and adolescents in a dental clinic waiting room.

PURPOSE: The purpose of this study was to evaluate dental anxiety among children and adolescents using self-reported questionnaires. METHODS: One hundred thirty 7- to 18-year-old patients (mean age=11.37 ± 2.84) who attended a clinic were asked to complete the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) in the waiting room. RESULTS: Females demonstrated higher dental anxiety than males. Higher anxiety was observed among patients who had their last dental visit over a year prior to the current visit and among patients who expected operative procedures. Extraction was the most anxiety-producing item. While in the dental chair, teeth cleaning produced significantly more anxiety than restoration. A significant correlation existed between the DAS and the DFS. CONCLUSIONS: Pediatric dentists can expect high dental anxiety among: females; patients who wait long periods between visits; and patients expecting operative procedures. Teeth cleaning should not be considered an absolutely non-anxiety producing procedure for the patient.

Dental anxiety in children with cleft lip and palate: a pilot study.

PURPOSE: To investigate the level of dental fear and anxiety of children who have cleft lip and palate (CLP). MATERIALS AND METHODS: The study was performed at Cukurova University, Faculty of Dentistry. A total of 32 7- to 12-yearold children, 17 of them with CLP (8 girls and 9 boys) and 15 of them without CLP (7 girls and 8 boys) participated in the study. The children were evaluated by using the Facial Image Scale (FIS) and Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) methods. The anxiety state of the children was assessed twice using FIS: first in the dental hospital waiting room (FIS-WR) and after, while sitting in the dental chair (FIS-DC). CFSS-DS was administered to all participants in order to assess the dental anxiety while they were sitting in the dental chair. RESULTS: According to the FIS results, there was no difference between CLP and control group in the waiting room (P = 0.682). However, the CLP group showed lower scores than the control group while they were sitting in the dental chair (P = 0.030). The FIS scores of the CLP group were significantly higher in the waiting room than while sitting in the dental chair (P = 0.007). In the control group, there was no significant difference between FIS-WR and FIS-DC values (P = 0.664). The total CFSS-DS scores of children with CLP were lower than those of the control group, but these differences were not statistically significant (P > 0.05). CONCLUSION: Children with CLP showed more anxiety in the FIS-WR than in the FIS-DC, but they showed lower scores than the control group in the FIS-DC. The positive previous experience of meetings with dentists of the CLP children could explain these results. Positive previous experiences with dentists and a short time in the waiting room could be key elements in the care of CLP children.

Premedication intake behavior--does it predict behavior during dental treatment?

OBJECTIVES: To investigate whether behavior during hydroxyzine administration predicts children's behavior during dental treatment and whether behavior during treatment is affected by the complexity of treatment. MATERIALS AND METHOD: 118 children aged 2 to 6.5 years old were treated under conscious sedation with oral premedication (3.7 mg/kg of hydroxyzine in a concentration of 50 mg/5 cc. hydroxyzine) and 50% nitrous oxide/oxygen sedation. Children were divided in two age groups: aged 2 to < or = 4 years old, and aged 4 > to 6 years old. Behavior during first examination; cooperation during premedication administration, cooperation during nitrous oxide nose-mask placement, behavior during dental treatment, treatment duration and complexity of treatment were recorded. RESULTS: More children in the older group took the premedication willingly (p = 0.026). Significant correlation (p = 0.002) between behavior during examination and nitrous oxide mask acceptance was found in the older age group. No correlation was found regarding the cooperation during premedication intake and behavior during treatment within and between age groups. No statistical differences within the groups and between the groups were found between complexity of treatment and behavior during treatment. CONCLUSIONS: Premedication intake is not a reliable predictive tool for behavior during treatment in children aged 2-6.5 years. Complexity of treatment does not influence behavior during treatment in children aged 2-6.5 years.

A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial.

AIM: To evaluate the effect of a single session of motivational interviewing (MI) on self-performed periodontal infection control. MATERIAL AND METHODS: A randomized, examiner masked, controlled clinical trial of 6-month duration was performed involving 44 patients with chronic periodontitis, referred for periodontal treatment. At baseline, all subjects were examined concerning marginal gingival bleeding (MBI) and plaque (PI). Test subjects received a single MI-session before initiation of the periodontal treatment. Otherwise, all patients followed the same treatment protocol for conventional educational intervention and non-surgical periodontal therapy. Efficacy variables for evaluation of self-performed periodontal infection control were MBI (primary variable) and PI. RESULTS: The MI intervention resulted in a negligible decrease (3-4%) in MBI and PI that was not significantly different from the changes observed in the control group without any intervention. Neither was any additive effect of the initial MI-session found on the standard of oral hygiene subsequent to conventional treatment. A desirable MBI score of ≤20% at the end of treatment was associated with being a female patient, whereas high plaque scores at baseline counteracted a corresponding desirable final PI of ≤20%. CONCLUSION: A single freestanding MI session as a prelude to conventional periodontal treatment had no significant effect on the individuals' standard of self-performed periodontal infection control in a short-term perspective.

Treatment experience, frequency of dental visits, and children's dental fear: a cognitive approach.

Cognitive elements play a key role in dental anxiety. Nevertheless, relatively little is known about how dental treatments and frequency of visits to the dentist are related to dental fear and its cognitive antecedents. This study aimed to explore the relationships between dental visits, past treatment experiences, expectations on the aversiveness/probability of negative dental events, and dental fear in children. The participants were 147 children (60% female; mean age = 12.0 yr) who completed a questionnaire comprising measures of dental treatment-related experience (attendance, fillings, and extractions), perceived aversiveness and probability of dental events, and dental anxiety. Bivariate correlations and multiple linear regression analyses were used to analyze the data. A higher frequency of dental visits was associated with less dental fear and a decreased belief in the probability of negative events occurring during treatment. The type of treatments received was not directly linked to dental fear. However, having received fillings was significantly associated with the perceived probability of negative dental events, whereas extractions were positively associated with these expectations but negatively associated with the perceived aversiveness of possible dental events. Regular dental visits, as well as dental treatments, can influence, in different ways, cognitive elements associated with dental anxiety in children.

Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children.

OBJECTIVE: Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). STUDY DESIGN: In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after and one ten minutes later. Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wilcoxon (alpha = 0.05). RESULTS: Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. CONCLUSIONS: In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after the event; moreover a significant correlation between amylase levels and heart rate was observed Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

A comparison of two questionnaires measuring oral health-related quality of life before and after dental hygiene treatment in patients with periodontal disease.

AIM: The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx). METHODS: A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment. RESULTS: No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found. CONCLUSION: No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.

Confirming the factor structure of modified CFSS-DS in Finnish children at different ages.

OBJECTIVE: The aims were to determine whether means of different fear-related items were similar in 1998 and 2001 and to find a common factor structure of the modified CFSS-DS for children at different ages. MATERIALS AND METHODS: Independent random samples of 6-, 9-, 12- and 15-year olds were drawn in two cities in 1998 and 2001 (n = 180 per age group from each city). The study group in 2001 comprised 282, 265, 281 and 234 subjects aged 6, 9, 12 and 15 years, respectively. Each child received a modified CFSS-DS form to be filled out at home. Mean scores of different fear-related items were reported for each age group for both data sets. Confirmatory factor analyses (CFA) were performed to test whether the three factor structures revealed for 6-, 9- and 12-15-year olds in 1998 fitted the 2001 data. Multiple group CFA was used to test for the equivalence of the factorial structure across age groups (configural invariance). RESULTS: The age-specific patterns of the means for individual fear-related items in 2001 corresponded to the mean values for 1998. When age-specific factor structures were tested separately for each age group, the factor structure for 9-year-olds was, in general, the best-fitting overall structure. The factor structure had a good fit for all age groups, but the loadings differed at different ages. CONCLUSIONS: The modified CFSS-DS provides consistent factor structures for children at different ages and reflects the changes in manifestations of dental fear during growth.

The relationship between self-reported oral health, self-regulation, proactive coping, procrastination and proactive attitude.

OBJECTIVES: This cross-sectional study investigated the relationship between self-regulation, proactive coping, procrastination and proactive attitude, perceived oral health and self-reported oral-health behaviours. METHODS: The study sample consisted of 198 first year medical students. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status, proactive coping (proactive coping subscale of the Proactive Coping Inventory), procrastination (Procrastination Scale) and proactive attitude (Proactive Attitude Scale). RESULTS: Significant differences were found on self-regulation, proactive coping, procrastination and proactive attitude scales between participants who rated their gingival condition as very good/excellent and those who evaluated it as being poor, very poor or normal (p < 0.05). Results revealed significant differences in procrastination level among individuals who never visit their dentist and those who visit their dentist for check-up or for tooth cleaning and scaling (p = 0.001) or when treatment is needed or when in pain (p < 0.05). In multiple linear regression analyses, proactive coping was associated with toothbrushing frequency and reason for dental visiting. CONCLUSIONS: The result suggested that procrastination and proactive coping are important determinants of perceived oral health and self-reported oral-health behaviours.

Association between patients' chief complaints and their compliance with periodontal therapy.

AIM: To evaluate the association between patients' chief complaints (CCs) and their compliance with basic periodontal therapy. MATERIALS AND METHODS: Data on CCs and periodontal diseases were obtained from patients attending a periodontal clinic. Patient compliance with basic periodontal therapy was studied in relation to their CCs. RESULTS: The mean age of the 1196 subjects was 47.7±11.6 years. Among them, 36.9% of the subjects had chronic symptomatic CCs; 22.4%, acute symptomatic CCs; and 40.7%, asymptomatic CCs. Four hundred eighty subjects completed basic periodontal therapy; 209, incomplete treatment; and 507, no treatment. The subjects with acute symptomatic CCs were 60% more likely to receive periodontal treatment [odds ratio (OR)=1.661; 95% confidence interval (CI): 1.203-2.293] than chronic symptomatic subjects, as did the asymptomatic subjects (OR=1.669; 95% CI: 1.252-2.223). However, subjects with acute symptomatic CCs were 60% less likely to complete periodontal treatment (OR=0.420; 95% CI: 0.267-0.660). The OR of completing treatment for the copayment requirement was 1.944, while that for being treated by an experienced periodontist was 1.695. CONCLUSIONS: Patients' CCs were associated with their compliance to basic periodontal therapy. Acute symptomatic CCs may be a positive predictor to initiate periodontal treatment but a negative predictor to complete the treatment.

Treatment of chronic periodontitis and its impact on mastication.

BACKGROUND: The aim of the present study is to assess the impact of conventional periodontal treatment of chronic periodontitis on the perception of mastication. METHODS: The patients (n = 28; age range: 23 to 56 years, mean age: 37.9 years) were evaluated on two occasions (before and after treatment) with a 45-day interval using the Oral Impact on Daily Performance questionnaire. An electromyography system was used for the determination of activity in muscles of mastication and bite force. Masticatory performance was assessed using a test material. The median particle size of the masticated material was determined using a sieve method and the Rosin-Rammler equation. The clinical criteria were the number of teeth and probing depth, both determined by a single calibrated observer masked to the treatment phase. The data were analyzed in the pretreatment and post-treatment periods using Wilcoxon test; Spearman correlation coefficient; and two multiple linear regression models (backward stepwise procedure). RESULTS: There was a significant negative correlation between the number of teeth (number of mastication units) and difficulty eating (P <0.05) before and after treatment. Probing depth had a positive relationship with the total Oral Impact on Daily Performance score before treatment (P <0.01). CONCLUSIONS: The subjective perception of the impact of oral health on mastication diminished after periodontal treatment. The number of teeth had considerable importance in the perception of impact on mastication in the sample studied.

Factors that limit access to dental care for adults with spinal cord injury.

This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.

Salivary cortisol response to psychological stress in children with early childhood caries.

AIMS AND OBJECTIVES: Early Childhood Caries (ECC) is a multi-factorial disease and has numerous biological, psychological, and behavioral risk factors. In this study, we have attempted to study psychological stress as a risk factor for early childhood caries by investigating and comparing the response of event-related stress on salivary cortisol level in children with ECC and those without ECC and also compared the adaptability to various dental procedures in children with early childhood caries and without early childhood caries. MATERIALS AND METHODS: One hundred children aged between four and five years were examined in the school and 16 pairs of children with caries and without caries were selected after cross-matching them on various risk factors for Early Childhood Caries. Oral prophylaxis and topical fluoride treatment procedures were used as stressors and salivary samples were collected at the time of arrival for the treatment, after Oral Prophylaxis and Fluoride treatment. The salivary samples were analyzed by radioimmunoassay for an unbound plasma cortisol level. RESULTS: Statistical analysis was performed using a paired t-test, on the collected data, to compare the mean values of the salivary cortisol across the group and within the groups to evaluate the cortisol response to stress. No significant differences were found between the salivary cortisol levels prior to treatment, post oral prophylaxis, or post fluoride treatment at the first and second appointments of both groups. At the first appointment, the fluoride treatment caused a significant increase in the salivary cortisol level over the pretreatment level, in both the groups, but it was not evident in either of the two groups studied at the second appointment. CONCLUSION: We have concluded that the stress produced by different dental procedures was similar in children from the two groups studied, and the coping ability of the children was also similar in both the groups. Small sample size may be one of the reasons why no significant differences were found between the groups. Similar study needs to be repeated with a larger sample size.