Oral health inequalities in Italian schoolchildren--a cross-sectional evaluation.

OBJECTIVE: To evaluate which of the following indicators of socio-economic status (SES) has the strongest association with dental caries status in a 6-year-old population: the educational level of each parent (individual-level); the mean price of housing/m2 in the area where the family resides; or the mean per capita income in the area where the family lives (area-level). MATERIAL AND METHODS: Dental caries was recorded in 2,040 schoolchildren (42.5% boys, 57.5% girls) using decayed/missed/filled surface index (d3 level) in primary dentition. Parents filled in a standardised questionnaire regarding nationality, level of education, frequency of dental check-up and perception of child's oral health and child's oral hygiene habits. RESULTS: At the individual-level of SES, mothers' educational level was associated with their children's caries severity (chi2(9) = 147.51 p < 0.01): as educational level rose the proportion of children with high numbers of carious lesions fell. The two income indicators (area-level SES) were not associated. A multinomial logistic regression model was run for caries risk factors. Caries severity was used as dependent variable and the model was stratified by mothers' educational level. Mothers' perception of child's oral health was the only covariate that was always associated in every caries severity strata and for each level of mothers' education. CONCLUSIONS: The present study shows that mothers' educational level is a useful individual SES indicator for caries in Italian children living in a low-income population.

What do parents know about dental trauma among school-age children? A pilot study.

BACKGROUND: The Ministry of Health published in November 2012 the "National guidelines for the prevention and clinical management of dental trauma in individuals during their developmental age". The aim of this study is to verify the knowledge among parents of children of primary schools to plan corrective actions. METHODS: The study was carried out filling in an anonymous questionnaire distributed to parents enrolled in three primary schools. RESULTS: Despite the publication of the National guidelines, the survey results confirm parents' lack of awareness, knowledge and skills in relation to dental trauma. CONCLUSIONS: This survey will allow to plan a training on interventions aimed at the protection of oral health.

Prevalence of halitosis in children considering oral hygiene, gender and age.

BACKGROUND: To date, few studies have addressed halitosis in the paediatric population. As such, the aim of the present study was to investigate symptoms, signs and risk factors associated with halitosis in healthy children and to present a model based on the clinical data that predicts the presence of halitosis. METHODS: A total of 101 individuals were included. All patients received a questionnaire that queried on sociodemographic characteristics, self-reported halitosis and dental treatment history. Individuals received a thorough intra-oral examination, and the volatile sulphur compounds (VSC) were measured to test the presence of halitosis with a portable sulphide monitor (Halimeter(®); Interscan Co., Chatsworth, CA, USA). The distribution of the sociodemographic characteristics, self-reported halitosis, dental treatment history and other oral features was evaluated. Finally, a statistical model was constructed with the best set of features to predict halitosis in children. RESULTS: The median age was 12.0 years (mean: 11.7 ± SD 2.7) with 54.5% males. Halitosis (VSC > 100 parts per billion, or ppb) was objectively measured in 37.6% of patients. For comparison purposes, Bayesian network was obtained using clinical and demographic data. The model consisted of four variables (sex, age, oral hygiene status and self-reported halitosis) directly related to the presence of halitosis (VSC > 100 ppb). This model achieved 76.4% area under receiver operating characteristics curve (AUROC). Overall, female patients or individuals with dental plaque on more than 25% of the dental surfaces or patients older than 13 year old were more prone to present with halitosis. CONCLUSIONS: The results suggest that halitosis in the paediatric population is related to poor oral hygiene and may be more common in females and older individuals. This specific predictive model may be useful to identify subgroups to target for intervention to treat oral halitosis.

Generalized aggressive periodontitis in prepubertal age: description and comparison of two cases.

Aggressive periodontitis is a rare form of periodontal disease and it can involve both the deciduous dentition and the permanent one. It causes a rapid loss of periodontal attachment. The paper aims to describe two cases of severe generalized prepubertal periodontitis: the first child doesn't suffer from neither systemic diseases nor alteration of functionality of polymorphonuclear and periodontal disease involved both his deciduous dentition and the first permanent molars. The second child had a deficiency of functionality of polymorphonuclear but periodontal disease involved only primary dentition thanks to his immediate improvement of home dental hygiene. This comparison shows the importance of early diagnosis and especially of optimal dental oral hygiene. Infant healthcare professionals, as pediatric dentists and pediatricians, should have the necessary knowledge for early and correct diagnosis and clinical management of disease.

Does smoking increase risk for caries? a cross-sectional study in an Italian military academy.

BACKGROUND/AIMS: Traditionally, tobacco is considered as part of the military culture. A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in a sample of Italian adults attending a Military Academy. METHODS: Clinical examinations including dental caries and presence of bleeding at probing were carried out following WHO criteria. Related socio-behavioural factors were collected. Four calibrated examiners observed 763 subjects (men = 722; 94.6% and women = 41; 5.4%). RESULTS: One of the 763 subjects did not declare the smoking status and was excluded from the analysis. Hundred twenty-six (16.5%) subjects claimed to have never smoked, 200 (26.3%) were coded as light smokers and 436 (57.2%) as heavy tobacco users. Statistically significant linear trend across the educational level (p = 0.03), self-satisfaction with the appearance of teeth and gums (p = 0.04) and dental check-up in the past 6 months (p = 0.02) was found among the 3 subgroups. Almost the entire sample showed caries experience (84.1%). Mean DS ranged from 0.6 in the nonsmokers subgroup to 1.1 in the heavy smokers. Differences among means were statistically significant for DS, DMFS and Significant Caries Index (p = 0.01, 0.04 and 0.03, respectively). The zero-inflated regression model showed that caries severity was significantly associated with smoking habit (p = 0.02), dental check-up in the past 6 months (p = 0.01), self-satisfaction with the appearance of teeth and gums (p < 0.01) and healthy gums (p = 0.04). CONCLUSION: Heavy smokers attending a Military Academy showed a higher prevalence of caries, confirming a correlation between the disease and tobacco use.

Effect of a sugar-free chewing gum containing magnolia bark extract on different variables related to caries and gingivitis: a randomized controlled intervention trial.

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≥10(5) CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC(5.7) (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing.

Is a simple model based on two mixing reservoirs able to reproduce the intra-annual dynamics of DOC and NO3 stream concentrations in an agricultural headwater catchment?

Agriculture disturbs the biogeochemical cycles of major elements, which alters the elemental stoichiometry of surface stream waters, with potential impacts on their ecosystems. However, models of catchment hydrology and water quality remain relatively disconnected, even though the observation that dissolved organic carbon (DOC) and nitrate (NO3-) have opposite spatial and temporal patterns seems relevant for improving our representation of hydrological transport pathways within catchments. We tested the ability of a parsimonious model to simultaneously reproduce intra-annual dynamics of stream flow, DOC and NO3- concentrations using 15 years of daily data from a small headwater agricultural catchment (AgrHyS observatory). The model consists of an unsaturated reservoir, a slow reservoir representing the groundwater and a fast reservoir representing the riparian zone and preferential flow paths. The sources of DOC and NO3- are assumed to behave as infinite pools with a fixed concentration in each reservoir that contributes to the stream. Stream concentrations thus result from simple mixing of slow and fast reservoir contributions. The model simultaneously reproduced annual and storm-event dynamics of discharge, DOC and NO3- concentrations in the stream, with calibration KGE scores of 0.77, 0.64 and 0.58 respectively, and validation KGE scores of 0.72, 0.58 and 0.43 respectively. These results suggest that the dynamics of these concentrations can be explained by hydrological transport processes and thus by temporally variable contributions from slow (NO3- rich and DOC poor) and fast reservoirs (DOC rich and NO3- poor), with a poor representation of the biogeochemical transformations. Unexpectedly, using the concentration time series to calibrate the model increased uncertainty in the parameters that control hydrological fluxes of the model. The legacy storage of NO3- resulting from agricultural history in the studied catchment supports the assumption that the main DOC and NO3- sources behave as infinite pools at the scale of several years. Nevertheless, reproducing the long-term trends in solute concentration would require additional information about DOC and NO3- trends within the reservoirs.

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

This paper describes the dental health status of Italian 4-year-olds in 2004/2005 and analyzes the association between caries in preschool children and some background characteristics in children and parents. Caries was recorded according to WHO criteria. 5,538 subjects were examined. Information on the children's and their parents' social, behavioral, ethnic and demographic status was obtained through a series of closed questions. Bivariate analysis was performed to investigate the association between caries and background characteristics. The probability of being an extra zero for the dmfs index was estimated via the zero-inflated negative binomial regression model (ZINB). 78.4% (95% CI = 77.2-79.6) of the children were caries-free. The national mean dmfs index was 1.36 (95% CI = 1.15-1.57), ranging from 1.22 (95% CI = 1.03-1.42) in the Italian North-East to 1.73 (95% CI = 0.83-2.63) in the South section. Significant bivariate associations between caries experience and risk factors were observed for parents' nationality (not Italian vs. Italian: p < 0.001), parents' educational levels (low vs. high: p < 0.001), preterm birth (yes vs. no: p = 0.011), prolonged breastfeeding (13 months: p = 0.038) and early tooth eruption (<6 months as reference: p = 0.004). Multivariable analysis (ZINB) showed that children with a low caries risk level had a higher probability of being an extra zero; in particular, children from fathers with a high educational level showed a probability of being an extra zero of 0.22. The results suggest a need to plan preventive programs to reduce oral health disparities among Italian preschool children, based on educational intervention with parents and children concerning oral health and caries prevention.

Caries prevalence and need for dental care in 13-18-year-olds in the Municipality of Milan, Italy.

OBJECTIVE: To assess the relationship between caries prevalence and toothbrushing and dietary habits in adolescents in the city of Milan (Italy). RESEARCH DESIGN: The study consisted of a cross-sectional survey using clustering samples. DMFT was recorded following the WHO guidelines by three calibrated examiners. A dental health questionnaire was completed by the subjects to assess their toothbrushing and oral hygiene habits. Univariate and multivariate analysis were performed. PARTICIPANTS: A sample of 1,333 students (age-range 13-18 years, 648 males and 685 females) was studied. The students came from three secondary schools located in different socio-economic and cultural areas of the city. RESULTS: Caries experience (DMFT>0) was 59.11%. A significant linear trend (p<0.01) was observed for DT>0 among the three different schools selected. The mean DMFT was 1.94 +/- 2.46 and difference observed in DT, FT and DMFT among the three schools was statistically significant (p<0.05). Eating snacks more than once a day provided a significantly higher odds ratio for DMFT>0 and for DT>0 (OR=5.24, p<0.001 and OR= 1.46, p=0.01 respectively). CONCLUSIONS: A significant trend between caries experience and socioeconomic status was observed: adolescents, attending school in a low-socio-economic areas, showed higher caries prevalence and higher levels of untreated caries than their counterparts attending schools located in medium-high socio-economic areas.

Oral health problems and needs in nursing home residents in Northern Italy.

OBJECTIVE: To describe the oral health status and treatment needs of a sample of elderly people residing in nursing homes in Northern Italy. RESEARCH DESIGN: a sample of 595 elderly residents (mean age 83.2+/-9.2 yrs), with adequate cognitive skills were examined by six calibrated dentists. RESULTS: The sample (82% women) was divided into two groups: edentulous (43%) and dentate. In the edentulous group 58% wore dentures in both jaws, 8% in only one jaw and 34% had no dentures. The main problems were dirty or loose dentures and poor oral hygiene. In the dentate group the mean number of teeth was 8.4+/-7.4, 53% wore dentures (removable, fixed or a combination). Poor oral hygiene was found in 86%, root caries in 51% and coronal caries in 46%. Their main needs were professional cleaning (72%), oral hygiene instructions (62%) and tooth/root extractions (56%). While normative needs were noted for 82% of the whole sample, oral treatment needs were accurately perceived by only 20% of residents, poorly by 24%, while 46% indicated that they had no oral treatment needs.

National Pathfinder survey of 12-year-old Children's Oral Health in Italy.

No recent data on the experience of caries among Italian 12-year-olds are available. In 2004, an epidemiological survey called 'National Pathfinder among Children's Oral Health in Italy' was promoted and carried out. This study reports the actual oral health status of Italian 12-year-olds according to gender, residence area and geographical distribution. Clinical examinations were carried out from March 2004 to April 2005, according to WHO criteria, and included dental caries (decay at the dentinal lesion level) and Community Periodontal Index (CPI). 5,342 children (2,670 males, 2,672 females) were examined by 7 ad hoc calibrated raters. Dental caries experience was found in 43.1% (95% CI 41.8-44.4%) of the study population. The mean DMFT score was 1.09 (95% CI 0.98-1.21). Significant differences (p < 0.05) were observed among geographical sections for DT, FT and DMFT. An inverse relationship was observed between mean DMFT and gross national product per capita (p < 0.001). Gingival bleeding was observed in 23.8% of children, while 28.7% had calculus. Significant differences in CPI scores among sections were found throughout the sample in both males and females (p < 0.001). Over the past two decades, mean DMFT fell from over 5 to its present level, halving every decade; consequently, the recorded level of dental caries has become aligned with that in other Western European countries. Nevertheless, differences in DMFT values remain between children from different socioeconomic backgrounds.

Oral health indicators for children and adolescents: European perspectives.

AIM: The purpose of the European Global Oral Health Indicators Development Project (EGOHIDP) was to support the exchange of expectations and experiences among experts in the field of oral health statistics and their audience, in particular policy makers, resulting in recommendations for a list of essential oral health indicators. EGOHIDP was supported by the Health and Consumer Protection Directorate-General of the European Commission to point out a short list of essential indicators for Oral Health. METHODS: Systematic review of the existing indicators and consensus process between a group of experts in oral health related areas. RESULTS: The short list of 40 oral health indicators was determined (rate of agreement >70%) among the European experts members of the project. Twelve items focus on Oral Health of children and adolescents: they are described in the present paper. CONCLUSION: Further developing phases aimed to establish standardised methodological criteria for the collection of oral health data are also described.

[Epidemiologic survey of medical and non-medical personnel in a public dental clinic]. / Indagine epidemiologica sul personale medico e non medico di una struttura sanitaria odontoiatrica di terzo livello.

Hepatitis B and C and Mycobacterium tuberculosis infection represent an occupational problem for the dentist. Few data are available in literature about the situation in our country. An epidemiological survey was carried out to evaluate the prevalence of Hepatitis B (HbsAb) and C (HCVab) markers and the exposure to Mycobacterium tuberculosis (Tine test) of the whole population of a public dental clinic (247 dental care workers). Furthermore participants were asked to fill a questionnaire to assess their vaccination status. 67,2% of the subjects were found to be positive for HbsAb (77,4% of medical personnel and 28,8% of the auxiliary medical personnel). Only one subject was found positive for anti-HCV (0,4%). 12,5% of the population showed a positive Tine test (15,4% of medical personnel and 1,9% of the auxiliary medical personnel). Our data show a difference between the percentage of subjects who were vaccinated (2,4%) and those who were positive to the Tine test (12,5%).

The effect of storage in liquid nitrogen on the isolation of oral yeasts in human saliva.

Stimulated whole saliva samples were collected from a group of 127 6-yr-old schoolchildren. Each sample was divided into three parts. The first two, one of which contained added glycerol, were immediately frozen in liquid nitrogen and stored at -196 degrees C for 2 months. The third part was transferred to the laboratory and plated on selective medium for yeasts. Colony counts of the frozen and non-frozen samples were then compared. Statistical analysis showed a highly significant correlation between the counts for frozen and unfrozen samples. A high (40.1%) prevalence of yeast carriers was found, and Candida albicans was the most frequently recovered yeast.

Oral administration of fluoride in pregnant women, and the relation between concentration in maternal plasma and in amniotic fluid.

The aim was to measure the ionic fluoride concentration in maternal plasma and in amniotic fluid after oral administration of different doses of sodium fluoride (NaF) to 121 pregnant women. They were divided into six groups, according to the dose administered; 0 for the control group and 0.25, 0.50, 0.75, 1.00 or 1.25 mg of F- for the others. The subjects were instructed to take the corresponding NaF dose both 24 and 3 h before amniocentesis. Amniotic fluid (5 ml) and venous blood (5 ml) were obtained from each subject. Ionic fluoride concentration was measured with an expanded-scale potentiometer and a selective fluoride electrode. The results showed that F- concentration in amniotic fluid and, presumably, in fetal circulation, was not significantly different in groups taking 0.25, 0.50, 0.75 or 1.00 mg/day of F-. The F- concentration in amniotic fluid of the 1.25 mg/day group was, however, significantly higher than in all the other groups.

Caries prevention during pregnancy: results of a 30-month study.

The purpose of this 30-month study was to explore the effectiveness of a caries-preventive regimen in lowering the salivary mutans streptococci level in pregnant women and, subsequently, in inhibiting the growth of these bacteria in their young children. Beginning at the end of the sixth month of pregnancy and continuing until delivery, subjects rinsed daily with 0.05 percent sodium fluoride and 0.12 percent chlorhexidine. The authors monitored the salivary mutans streptococci levels during the last six months of pregnancy and every six months thereafter for 24 months. They also measured bacterial levels in the children every six months until they reached age 24 months. The results show that treatment significantly reduced salivary mutans streptococci levels in mothers and delayed the colonization of bacteria in their children for about four months.

Principles of diagnosis and treatment of high-caries-risk subjects.

The aim of this article is to highlight the main goals and to describe the clinical impact of the procedures used for the identification of high-caries-risk subjects. The techniques for the correction of caries risk level and their influence on restorative treatment are also described to enable the dental team to offer patients the most appropriate and successful treatment, and to meet an up-to-date and high-quality dental care standard.

Progression of periodontal pockets in the age cohort 35-44 years.

In 1985 the Health Department of the Italian Telephone Company decided to launch an oral health programme for all its employees and their relatives, with the collaboration of the WHO Collaborating Centre of the Clinica Odontoiatrica Ospedale S. Paolo, Milan. The programme started with an epidemiological survey of dental and periodontal condition; following data analysis, the company also contracted with private dentists to provide oral care. Four years later, in 1989, several studies were set up to evaluate the programme. The WHO Collaborating Centre Milan was requested to evaluate the periodontal care given to a sample of persons living in the Milan area. Seventy-seven individuals with established periodontal lesions were selected out of a group of 678 aged between 35 and 44 years examined in 1985. The same periodontal and dental indices used in 1985, CPITN (Community Periodontal Index of Treatment Needs) and DMFT (decayed, missing, filled teeth), were re-evaluated in these 77 persons and information about any periodontal care since 1985 was collected and checked against the reimbursement records of the Telephone Company. There was an increase in the percentage of persons with deep pockets (from 55.8 to 72.7 per cent), and of the mean of sextants affected (from 0.9 to 1.9). These individuals had been treated for dental problems, as demonstrated by an increase in the F component and a reduction of the D component of the DMFT, but had undergone virtually no treatment for periodontal problems. This may be considered as a longitudinal study on the natural progression of periodontal pathology in individuals with established periodontal lesions.

Oral health profile in an institutionalized population of Italian adults with mental retardation.

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4-5 mm); 61 had deep pockets (> or = 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.