An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

Increased salivary buffering in association with a low caries experience in children suffering from cystic fibrosis.

The mean pH and buffering capacity of stimulated saliva collected from young cystic fibrosis patients were measured and were found to be significantly higher than were the values for the controls (p less than 0.01). In addition, the caries experience of the cystic fibrosis children would appear to be considerably less than that of the controls. The association of these salivary alterations with a decreased caries experience is discussed.

Study of the dental health of children in remission from acute lymphoblastic leukaemia in Northern Ireland.

The dental health of 54 children in remission from acute lymphoblastic leukaemia was compared with a similar number of matched healthy control subjects. Frequency of dental attendance was similar in both groups but most children in remission from leukaemia attended a hospital dentist, whereas children in the control group visited a dentist in general practice or in the public health service. Children in remission from leukaemia used fluoride supplements significantly more frequently than their controls. There was no difference in plaque or gingivitis scores between groups. Children in remission from leukaemia had a significantly lower number of decayed primary teeth (d) than their matched controls but there were no significant differences between study and control groups of m, f or dmft values. There was a significantly greater number of extracted teeth (M) and a significantly greater overall decay experience (DMFT) in the permanent dentition of children in remission from leukaemia compared to their controls. There were no significant differences between study and control groups for D or F values. The mean number of sealed teeth per patient was significantly higher in the study than in the control group.

Dental caries and dental registration status in nursery school children in Newry, Northern Ireland.

294 children aged 2-4 yr attending nursery schools in Northern Ireland were examined for dental caries and dental registration status under the capitation system in general dental practice. Their mean age was 3 yr 10 months. Sixty eight per cent were caries free, mean dmft was 1.10 and dt, mt and ft scores were 0.74, 0.28 and 0.09, respectively. With increasing age the prevalence of caries increased, though the very low care index (d/dmft) did improve in the older children. Seventy per cent reported being registered for dental care and their levels of dental caries were significantly higher than those who were not yet enrolled (P < 0.001). For those not enrolled for dental care the main perceived barriers to seeking care related to lack of symptoms (33.6%) and apathy (31.6%) while few reported fear as a barrier (4.5%).

Dental caries prevalence and treatment status of 12-year-old children in a non-fluoridated area.

424 12-year-old children were examined in Mallow, a non-fluoridated town in North Cork, to ascertain the dental status of children finishing first level education. Both the caries prevalence and the treatment pattern were examined. The DMF was found to be 6.58 and the RI was 52.5%. A new index of restored and sound teeth (RSI) was applied and a value of 38.6% was obtained.

Factors affecting levels of untreated caries in a sample of 14-15-year-old adolescents in Northern Ireland.

UNLABELLED: Dental caries experience in children in Northern Ireland is the highest in the United Kingdom. OBJECTIVE: The aims were to examine the levels of untreated decay in a sample of 14-15-year-old children from an area known to have high dental needs and to relate them to factors which affect dental attendance. METHOD: A sample of 470 pupils aged 14-15 years who attended the 4th form of second level schools in North and West Belfast was obtained and closed questionnaires were distributed 2 weeks prior to the dental examination. RESULTS: 417 pupils were included in the analysis (inclusion rate 88.7%). The mean D value was 1.52 and the D/DMFT mean was 0.31. Individual factors which had significant associations with untreated decay were social class, time since the last dental visit, dental anxiety ratings and the type of dentist attended (mean D of 2.78 for those attending community service dentists and 1.24 for those attending general dental practitioners). Stepwise multiple regression models were constructed with dependent variables of D and the D/DMFT ratio, and the above independent variables remained significantly related to the outcome variables, with the exception of the type of dentist attended. Those attending the community service had higher social needs and longer intervals since dental treatment. CONCLUSION: Factors related to dental attendance are important in relation to the level of untreated decay but exclusive analysis of the type of dental service attended can be misleading. An active approach is required in order to improve the status of pupils with the highest needs.

Colour perception of laboratory-fired samples of body-coloured ceramic.

The objective of this investigation is to test by common perception, the colour fidelity of laboratory-fired samples of ceramic. Thirty-two ceramic discs were constructed in a thickness similar to that used for ceramic veneers using eight shades from each of four different manufacturers. A group of 20 'adept' observers colour matched the samples in strictly controlled viewing conditions using a Vita Lumin (Vita Zahnfabrik) shade guide. Samples were categorised as 'positive matches'(matching the expected shade), 'agreed shades' (matching an unexpected shade), or as 'unidentified shades' (no match). The Vita Lumin (Vita Zahnfabrik) colour 'value' index was used as a reference to categorise colour 'value' differences between observed and expected shade. Colour 'value' selection was divided into three groups: (1) matching colour 'value', (2) shades of higher colour 'value' than expected or (3) shades of lower colour 'value' than expected. Only six of the 32 samples examined were perceived to be 'positive matches' with the recommended shade guide. Fourteen 'agreed shades' were found while the remaining 12 shades were regarded as 'unidentified shades'. The vast majority of observations disagreed with the manufacturers' designated shade. A significant trend was found favouring higher 'value' (lighter) shades than those specified by the manufactures. Significant differences in the pattern of shade matches and disagreements between brands were also found. Alternative shade determination systems and/or ceramic colour modifications are required if colour fidelity between the shade guide and the materials tested is to be improved.

Dental health of patients suffering from cystic fibrosis in Northern Ireland.

131 patients suffering from cystic fibrosis were compared with a similar number of matched healthy control subjects. The cystic fibrosis patients had significantly lower levels of gingivitis and plaque and a significantly higher prevalence of calculus. They had significantly less caries in the deciduous dentition than their controls. There was also a lower experience of caries in the permanent dentition although the difference between the two groups was not so marked in this case.

A study of the barriers to dental care in a sample of patients with cerebral palsy.

The study examined the potential barriers to dental care for a selected sample of 57 adults suffering from cerebral palsy. The majority (60 per cent) were regular dental attenders and they received dental care in general dental practice and community dental practice in almost equal numbers. Those with mobility or communication difficulties were significantly more likely to attend the community or hospital dental services (P < 0.05). Their most common perceived barriers to dental care were fear, the need to be accompanied and negative attitudes, while cost was a rarely stated barrier. A dislike of dental treatment was significantly related to irregular attendance (P < 0.05) but neither anxiety nor the need to be accompanied were significantly related to attendance pattern.

The attitudes and experience of community dental officers in Northern Ireland in treating disabled people.

The views of community dental officers working in Northern Ireland were obtained concerning the difficulties they experience in treating disabled people. A closed questionnaire was used and a response rate of 84 per cent was achieved (60 officers). Thirty-seven per cent of the officers had received postgraduate training in this area. Lack of experience and knowledge concerning the treatment of the disabled was the commonest reason for not offering comprehensive dental care. Emotional upset and embarrassment or the length of time for treatment were the least cited. One-fifth perceived no barriers, a slight majority indicated two or less and only two officers indicated more than five. Those who were qualified ten years or longer, had greater difficulty than the more recently qualified in providing treatment for mentally and physically disabled children and medically compromised patients.

Dental health of young insulin dependent diabetic subjects in Northern Ireland.

The present study was undertaken to establish the dental disease and treatment levels in 101 young insulin dependent diabetic patients in Northern Ireland. There was a significantly greater proportion of children from the higher social classes in the diabetic group. Their dental caries experience was lower than that reported for the general population and the restorative indices were high. However, those whose diabetes was diagnosed at a late stage had a higher caries experience. There was significantly more gingivitis detected in older diabetic patients, but oral hygiene status did not significantly differ with age. There was a pattern of regular dental attendance in the majority of diabetic subjects.

Choice of sugar-free medicines by a sample of dentists, doctors and pharmacists in Northern Ireland: the views of parents and health professionals.

OBJECTIVE: To determine the sources of learning and the levels of support concerning sugar-free medicines by doctors and pharmacists, to examine the provision of choice from the viewpoints of professionals and the parents, and to test the sugar-free status of medication in tests of prescribing. DESIGN: Samples of health professionals comprising 47 general medical practitioners, (87% response rate) 29 pharmacists (94%) and 25 general dental practitioners (100%) completed closed questionnaires as did 209 parents (72%) of 4-year-old children. SETTING: Newry and Mourne Health Trust Area, Northern Ireland. OUTCOME MEASURES: Proportions of respondents citing various learning sources and the levels of support for the use of sugar-free medicines were obtained and the proportions of doctors and pharmacists claiming to offer various frequencies of choice were compared to the proportions of parents recalling receiving such choices. Test prescriptions were examined and the sugar-free status of the prescribed medication was determined. RESULTS: Markedly different sources of learning were cited by different groups. Ninety per cent of pharmacists and 88% of dentists believed that medication should be in sugar-free form in all cases, while only 66% of doctors thought so. Forty three per cent of doctors claimed to always offer a choice while 17% of parents recalled receiving this. The equivalent figures for pharmacists and parents were 69% and 11%. The majority of test prescriptions by doctors and dentists were for sugar containing medicines.

Adolescents' knowledge of common foods and drinks and the importance of the pattern of consumption: a study undertaken in an area of high dental needs.

OBJECTIVE: To assess the knowledge of adolescents concerning the cariogenic status of a range of foods and drinks. To determine the associations between this knowledge and their awareness of the importance of the ways sugars may be consumed in order to reduce tooth decay. DESIGN: Self-complete questionnaires assessing the above factors in a cross sectional study. PARTICIPANTS: Four hundred and fifteen 14-15-year-old young people attending second level schools. SETTING: North and West Belfast area, Northern Ireland. OUTCOME MEASURES: Students rated the dental safety of common foods and drinks, and their views on the necessity of reducing all sugars, and avoiding them between meals were recorded. RESULTS: Correct assessment of harmful items ranged from 96.9% for chocolate and 92.8% for cola to 39.0% for orange squash and 17.8% for plain biscuits. For non-harmful products there were high levels for most items and somewhat lower levels for crisps (57.6%). Significant links were established between this knowledge and children's awareness of the role of eating patterns, although the items involved varied. A majority recognised the importance of eating patterns in relation to dental caries. CONCLUSION: Health educators should be aware that many adolescents have poor knowledge of the cariogenic status of some of the foods and drinks they consume and some are unsure of the importance of eating patterns.

The pattern of sugar consumption in social class groups of young adolescents in Northern Ireland.

The pattern of sugar consumption in a sample of 350 11-12-year-old adolescents was examined. Their knowledge of the sugar content of a range of common foodstuffs was also investigated. There were only small differences between the social class groups in mealtime sugar consumption. The frequency of total food and drink was significantly higher in the low social class groups and this was mainly explained by significantly higher between meal consumption of solid food which contained sugar. The level of knowledge of the sugar content of foods was significantly higher in the higher social class groups. Fifty-two per cent of the questions were answered correctly, with a range of 9-91 per cent for individual foodstuffs.

A programme of clinical attachment in community dentistry for final year dental students in Northern Ireland.

The activities of the Community Dental Service still remain something of a mystery to many dental practitioners and recent developments broadening the remit of the community service are not universally known. There have been some schemes to introduce dental students to the care of patients by the CDS, but its role continues to develop with responsibilities which take community dental officers into a wide variety of settings in the community in order to reach priority groups such as the elderly and disabled.

Traumatically intruded permanent incisors: a study of treatment and outcome.

Twenty-nine traumatically intruded permanent maxillary incisors from 20 patients were examined, treated and monitored for 2 years. There was a higher proportion of males than females. The teeth intruded furthest were more frequently extracted. Those which were surgically repositioned were more frequently retained and were associated with marginal bone loss significantly less frequently than those which were passively observed, while external root resorption occurred in similar proportions in both groups. A significantly higher proportion of those teeth that were delayed in presentation were subsequently extracted, and a similar trend was found for those with immature roots at the time of the initial examination.

Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption.

OBJECTIVE: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption. SETTING: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne. DESIGN: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome. RESULTS: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29. CONCLUSION: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Outcomes for root-fractured permanent incisors: a retrospective study.

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.

Use of a common shade guide to test the perception of differences in the shades and value by members of the dental team.

PURPOSE: Commercial shade guides are frequently used for treatments where the shades of teeth are being reproduced or altered. Where differences between shade tabs and the natural teeth are small, difficulty is often experienced in determining the closest match. The purpose of this investigation is to discover whether the claimed colour differences between individual shades of one commonly used guide can be determined subjectively in clinical circumstances. BASIC PROCEDURES: Seventy dental team professionals made shade comparisons in an idealized colour-matching environment using shade guides as supplied by the manufacturer. Their arrangements by 'value' were recorded and unidentified shade tabs were matched with those on a complete guide. MAIN FINDINGS: The results showed that discrepancies existed between nominated and perceived colours, for the shade determination system tested. The shade-guide manufacturer's recommended arrangement of shade tabs ranked according to colour 'value' did not correspond to subjective perception of 'value' ordering under the conditions of the study. PRINCIPAL CONCLUSIONS: There may be no practical clinical advantage in having shades which cannot be distinguished. This study indicates that colour differences between shade tabs are not clearly perceived by members of the dental team. A careful reduction of the number of tabs in the guide tested might simplify shade selection procedures and help to standardise shade-taking.