Association between acculturation, dental floss use, dental visits and unmet dental needs among Asians in the United States: Findings from National Health and Nutrition Examination Survey (NHANES) 2011-2018.

OBJECTIVES: The objectives of this study were to examine the associations between acculturation and dental floss, regular dental visits and unmet dental care needs among Asian Americans, as well as the moderating effects of these associations. METHODS: This study analysed national representative samples from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. A total of 2763 Asian Americans aged 20 and older were included in this analysis. The primary predictor, acculturation score, was determined by three questions: (i) language spoken at home (higher score for English), (ii) country of birth (higher score for United States) and (iii) length of time in the United States. Dental floss use, dental visits and unmet dental care needs were included as outcomes in this study. Descriptive statistics and logistic regressions were used to analyse the samples. RESULTS: Acculturation was significantly associated with dental health behaviours: Individuals with higher levels of acculturation were more likely than less acculturated individuals to use dental floss (81.0% vs. 63.9%, respectively) and visit the dentist regularly (76.7% vs. 66.9% respectively). Insurance status moderated the association between acculturation and dental visits: Acculturation was significantly associated with dental visits in the past year among insured individuals (OR = 1.70, 95% CI: 1.29-2.23), but not among uninsured individuals. Unmet dental care needs were present in 11.1% of participants. While costs and insurance were the top two determinants of access to care, individuals with and without insurance differed with regard to their third major reason for unmet dental care needs: Being 'too busy' and not wanting to spend money on dental care. CONCLUSIONS: Among the Asian population in the United States, those with high acculturation scores were more likely to engage in dental flossing and visit the dentist regularly compared to those Asians with lower acculturation scores. To encourage dental flossing and regular dental visits among Asians with lower acculturation scores, cultural adaptation and language accessibility suggests being considered. Future research is necessary to confirm the moderating effect of insurance status on the association between acculturation and regular dental visits. Additionally, our findings emphasize the impact of costs and insurance on access to dental care among Asians in the United States, highlighting the importance of future public health programmes in addressing these barriers.

Evidence-based strategies for interdental cleaning: a practical decision tree and review of the literature.

Objectives: Although several studies have investigated the effectiveness of various interdental cleaning devices, there is a need for an evidence-based synopsis for clinicians to customize interdental hygiene instructions and provide specific devices for each patient. This literature review aims to establish an evidence-based decision-making tree recommending individualized approaches to interdental cleaning based on embrasure size and patient-specific conditions.
Data sources: Specific keywords related to interdental cleaning were used to search and identify the existing literature in PubMed and the Cochrane Library. Through a series of review processes, qualifying studies were identified and assessed with respect to the inclusion criteria to establish the decision tree.
Results: A total of 27 studies were included to support a decision tree. Traditional dental floss continues to remain the first choice for individuals of high motivation and good ?manual dexterity with type I closed embrasures. For individuals with closed embrasures, but lack of motivation and/or dexterity, the use of easy flossers, soft picks, oral irrigation, and small (0.6 to 0.7 mm) interdental brushes are alternatives. For individuals with type II and type III open embrasure spaces, an interdental brush has the highest evidence for its effectiveness to remove interdental plaque. However, two studies showed that residual plaque could be found over lingual embrasur?es and thus lingual approach of the interdental brush is sometimes needed. The use of gum stimulators and/or woodsticks continues to be supported when significant gingival inflammation is present.
Conclusion: Each patient should be individually assessed and given tailored oral hygiene home care instructions for the most effective outcomes. The proposed decision tree provides clinicians with an evidence-based guideline to help customize the use of interdental cleaning devices for each patient.

Self-reported oral hygiene practices with emphasis on frequency of tooth brushing: A cross-sectional study of Mexican older adults aged 60 years or above.

The objective of the study was to characterize self-reported oral hygiene practices among Mexican older adults aged ≥60 years, and to measure the association between frequency of tooth brushing and a set of sociodemographic, socioeconomic, and dental variables.We conducted a cross-sectional study of 139 older adults aged ≥60 years in Pachuca, Mexico. A questionnaire and a clinical dental examination were administered to identify specific variables. We determined frequency of tooth brushing (or cleaning of dentures or prostheses) and use of toothpaste, mouthwash, and dental floss among respondents. Non-parametric testing was performed for statistical analysis and a multivariate logistic regression model was generated with Stata 11 software to determine frequency of tooth brushing.In our study sample, 53.2% of participants reported brushing their teeth at least once a day, 50.4% always using toothpaste, 16.5% using mouthwash and 3.6% using floss for their oral hygiene. In general, younger and female respondents used oral hygiene aids more than the others. Our multivariate model yielded an association (P < .05) between tooth brushing at least once daily and the following variables: having functional dentition (OR = 12.60), lacking health insurance (OR = 3.72), being retired/pensioned (OR = 4.50), and suffering from a chronic disease (OR = 0.43).The older adults in our sample exhibited deficient oral hygiene behaviors. The results suggest certain socioeconomic inequalities in oral health. The findings of this study should be considered when designing dental care instructions for older adults.

What explains socioeconomic inequalities in dental flossing? Cross-sectional results from the RaNCD cohort study.

INTRODUCTION: The magnitude and underlying determinants of socioeconomic inequality in dental flossing are poorly understood in Iran. This study aimed to measure and decompose socioeconomic inequalities in dental flossing in Ravansar, Iran. METHODS: Data of 10,002 individuals aged 35-65 years who participated in the Ravansar Non- communicable Diseases (RaNCD) cohort study in Kermanshah province, western Iran, were analyzed. Based on an asset-based method, socioeconomic status (SES) was measured using principal component analysis (PCA). The concentration index and curve were employed to measure socioeconomic inequality in dental flossing. Decomposition analysis was used to estimate the contribution of each determinant to the overall inequality. RESULTS: Of 10,002 participants, 11.74% were found to practice dental floss. The normalized CI for dental flossing was 0.327 in the entire population, 0.323 in females and 0.329 in males, indicating that the use of dental floss is more concentrated among high-SES individuals. The decomposition analysis indicated that SES (50.58%) and level of education (44.90%) respectively contributed the most to this inequality. Place of residence (10.55%) and age group (2.7%) were the next main contributors, respectively. CONCLUSIONS: We found a low prevalence of dental flossing among participants in RaNCD study. We also observed a relatively high degree of pro-rich inequality in dental flossing. The observed inequality was mainly explained by socioeconomic status, level of education and place of residence. Policy interventions should consider these factors to reduce inequalities in dental flossing.

Relationship between oral hygiene knowledge, source of oral hygiene knowledge and oral hygiene behavior in Japanese university students: A prospective cohort study.

The aim of this prospective cohort study was to examine whether oral hygiene knowledge, and the source of that knowledge, affect oral hygiene behavior in university students in Japan. An oral exam and questionnaire survey developed to evaluate oral hygiene knowledge, the source of that knowledge, and oral hygiene behavior, such as the frequency of tooth brushing and regular dental checkups and the use of dental floss, was conducted on university student volunteers. In total, 310 students with poor tooth brushing behavior (frequency of tooth brushing per day [≤ once]), 1,963 who did not use dental floss, and 1,882 who did not receive regular dental checkup during the past year were selected. Among these students, 50, 364, and 343 in each respective category were analyzed in over the 3-year study period (follow-up rates: 16.1%, 18.5%, and 18.2%, respectively). The odds ratios (ORs) and 95% confidence intervals (CIs) for oral hygiene behavior were calculated based on oral hygiene knowledge and the source of that knowledge using logistic regression models. The results showed that dental clinics were the most common (> 50%) source of oral hygiene knowledge, and that a more frequent use of dental floss was significantly associated with dental clinics being a source of oral hygiene knowledge (OR, 4.11; 95%CI, 1.871-9.029; p < 0.001). In addition, a significant association was seen between dental clinics being a source of oral hygiene knowledge and more frequent regular dental checkups (OR, 13.626; 95%CI, 5.971-31.095; p < 0.001). These findings suggest the existence of a relationship between dental clinics being the most common source of oral hygiene knowledge and improved oral hygiene behavior in Japanese university students.

Effect of environmental and socioeconomic factors on the use of dental floss among children: a hierarchical approach.

The aim of this study was to evaluate the association of environmental and socioeconomic characteristics with the use of dental floss in preschool children. This cross-sectional study was conducted with a sample of 402 preschool children aged 1-5 years, from Santa Cruz do Sul, a Southern city in Brazil. Mothers answered questions about environmental, demographic, and socioeconomic characteristics. Behavior variables as use of dental floss (study outcome) and dental attendance were also evaluated. Poisson regression analysis with robust variance through a hierarchical approach was used to investigate the association of explanatory variables for use of dental floss. Prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. The mean sample age was 3.32 years (standard deviation [SD] 1.10). Of the included children, 291 (73.12%) did not use dental floss. The environmental model indicated that children who attended daycare (PR 2.53; 95%CI 1.39-4.60) and those whose parents were members of volunteer networks (RP 1.58; 95%CI 1.02-2.46) were more likely to use dental floss. Children from families with higher income (PR 1.55; 95%CI 1.07-2.24) and maternal schooling (PR 2.21; 95%CI 1.31-3.74) presented a higher prevalence of dental floss use. Older children and those who attended dental services were also related to higher dental floss use. Our findings suggest that children who live in a supporting environment and those with a higher socioeconomic status are more likely to use dental floss.

The use of an interdental brush mitigates periodontal health inequalities: the Korean National Health and nutrition examination survey (KNHANES).

BACKGROUND: The purpose of this study was to evaluate the mitigating effect of the use of interdental brushes on periodontal health inequality. METHODS: This study was based on the data acquired in the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI; 2013-2015). A total of 17,583 participants (7,633 males and 9,950 females)) aged 19 years or older completed the KNHANES VI between 2013 and 2015. Multivariable logistic regression analysis was performed using socioeconomic characteristics (sex, age, level of education, individual income), personal health practice (smoking, toothbrushing, dental flossing, interdental brushing, dental clinic visiting), systematic medical factors (diabetes mellitus, hypercholesterolemia, hypertension, obesity) and the community periodontal index. We confirmed differences in the prevalence of periodontal disease with the use of an interdental brushes stratified according to individual income. RESULTS: Three logistic regression models adjusted for covariates hierarchically. In all models, individuals who used an interdental brush were not significantly different from individuals who did not use an interdental brush. The adjusted odds ratio (OR) for interdental brushing was 0.918 with a 95% confidence intervals (CIs) of 0.797-1.057. When periodontal disease was the outcome of the model, the lowest income group had 1.266 (95% CIs 1.066 to 1.502) times the odds of having periodontal disease than the highest income group. In interdental brush nonusers, the lowest income group had 1.276 (95% CI 1.061-1.533) times the odds of having periodontal diseases than the highest income group. However, in the interdental brush users, there were no significant differences in periodontal disease prevalence among income groups. CONCLUSIONS: The results suggest that the use of interdental brushes could alleviate periodontal health inequality.

An assessment of oral prophylaxis in patients with myocardial infarction diagnosed by means of coronary angiography.

AIM: The aim of this study was to assess oral prophylaxis in patients with myocardial infarction diagnosed by means of coronary angiography compared with a control group. MATERIALS AND METHODS: The participants were recruited from patients who had undergone coronary angiography in the Cardiology Department. The study included 128 patients - 68 patients in a study group with acute coronary syndrome diagnosed by means of coronary angiography (ACSgroup) as well as 60 patients in a control group in whom coronarography revealed no lesions in coronary arteries (H-group). A detailed clinical dental examination was performed. The level of oral prophylaxis was assessed for both groups. The following factors were considered: the frequency of dental visits per year, the regularity of dental care, the frequency of toothbrushing per day, dental flossing, rinsing with a mouthwash, the use of an irrigator, and the use of single-tuft and interdental toothbrushes. RESULTS: Oral hygiene in the case of the study group was characterised by irregular dental care and inadequate hygiene procedures, with the exception of the use of an irrigator as well as single-tuft and interdental toothbrushes, where no statistically significant differences were noted between the groups. CONCLUSIONS: The oral hygiene of patients from the ACS-group was poorer than in the case of the H-group and the difference was statistically significant.

Effect of environmental and socioeconomic factors on the use of dental floss among children: a hierarchical approach

Abstract The aim of this study was to evaluate the association of environmental and socioeconomic characteristics with the use of dental floss in preschool children. This cross-sectional study was conducted with a sample of 402 preschool children aged 1-5 years, from Santa Cruz do Sul, a Southern city in Brazil. Mothers answered questions about environmental, demographic, and socioeconomic characteristics. Behavior variables as use of dental floss (study outcome) and dental attendance were also evaluated. Poisson regression analysis with robust variance through a hierarchical approach was used to investigate the association of explanatory variables for use of dental floss. Prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. The mean sample age was 3.32 years (standard deviation [SD] 1.10). Of the included children, 291 (73.12%) did not use dental floss. The environmental model indicated that children who attended daycare (PR 2.53; 95%CI 1.39-4.60) and those whose parents were members of volunteer networks (RP 1.58; 95%CI 1.02-2.46) were more likely to use dental floss. Children from families with higher income (PR 1.55; 95%CI 1.07-2.24) and maternal schooling (PR 2.21; 95%CI 1.31-3.74) presented a higher prevalence of dental floss use. Older children and those who attended dental services were also related to higher dental floss use. Our findings suggest that children who live in a supporting environment and those with a higher socioeconomic status are more likely to use dental floss.

Utilisation of Oral Health Services and Economic Burden of Oral Diseases in China.

OBJECTIVE: To evaluate the use of oral health services, the economic burden of oral diseases and related influential factors in China. METHOD: Using the multistage, stratified, equal proportion, random sampling method in the 4th National Oral Health Survey of China conducted in 2015 to 2016, residents aged 3 to 5 years, 12 to 15 years, 35 to 44 years, 55 to 64 years, and 65 to 74 years respectively were recruited, clinically examined and answered a questionnaire. Utilisation of oral health services were assessed in all the age groups and the economic burden of oral diseases in the past 12 months were assessed in the 3 to 5 years and 35 to 74 year-old groups. Chi-squared tests, t tests, correlation analysis and a one-way ANOVA were used to determine the relationships of different factors with utilisation of oral health services and the economic burden of oral diseases. RESULTS: In the subject groups - 3 to 5 years, 12 to 15 years and 35 to 74 years - the prevalence of the utilisation of oral health services in the past 12 months was 14.6% (5,876/40,353), 23.6% (27,936/118,592), and 20.1% (2,708/13,461), respectively. In all three groups, receiving dental treatment was the most common reason for subjects' recent dental visit. The average dental cost in the past 12 months was 403.43 CNY (median = 100) for 3 to 5-year-old children and 850.83 CNY (median = 300) for adults aged 35 to 74 years old. Area, education and annual household income per person were the socio-economic influential factors. Oral health status, oral hygiene and attitudes to and knowledge of oral health affected the utilisation of oral health services and the economic burden of oral diseases. CONCLUSION: The percentage of dental service utilisation was relatively low, and the economic burden was high. The related factors for both utilisation of oral health services and the economic burden of oral diseases included living in area, educational attainment, household income, perceived oral health status, and oral hygiene.

Saúde bucal: dos hábitos e conhecimento de higiene ao comportamento e acesso a serviços odontológicos de universitários brasileiros e estrangeiros / Oral health: from the hygiene habits and knowledge to the behavior and access to dental services of Brazilian and foreing university students

Objetivo: o estudo objetivou investigar os hábitos, o conhecimento sobre higiene oral e o comportamento em saúde bucal bem como o acesso aos serviços odontológicos de estudantes brasileiros e principalmente estudantes africanos, recém-ingressos à universidade.Sujeitos e método: trata-se de estudo exploratório, descritivo,transversal e quantitativo, conduzido em universidade pública brasileira. Após assinatura do termo e consentimento livre e esclarecido, foi aplicado um questionário aos acadêmicos. Os dados foram tabuladose analisados. Resultados: entre os brasileiros, 90%escovavam os dentes no mínimo 3 vezes ao dia, 50%não utilizavam fio dental, 55% não faziam uso de colutório,e 80% higienizavam a língua. Entre os estrangeiros,55% escovavam 2 vezes ao dia, 85% não usavamfio dental, 80% não utilizavam colutório, e 65%higienizavam a língua. Todos os brasileiros conheciam fio dental e colutório, enquanto que 70% dos acadêmicos estrangeiros sabiam o que era fio dental, e 60%desconheciam o que era colutório. Observou-se uma associação entre ser estudante estrangeiro e não utilizar fio dental. Dos participantes, 95% dos brasileiros e 50%dos estrangeiros já tinham buscado atendimento odontológico.Sobre a autopercepção de higiene bucal, 95%dos brasileiros e 60% dos estrangeiros consideravam-na boa. Constatou-se ainda uma relação entre ser acadêmico recém-ingresso e ter uma boa percepção de higiene oral sem utilizar fio dental. Conclusão: concluiu-se que há diferenças entre hábitos, conhecimento e comportamento em saúde bucal de acadêmicos de acordo com anacionalidade. A pesquisa contribuiu para caracterização,comparação e relação de importantes variáveis em saúde bucal nos contextos universitário e étnico. (AU)

Objective: the study aimed to investigate the oral hygiene habits and knowledge, and the oral health behavior, as well as the access to dental services of Brazilian and international students recently admitted to the university. Subjects and method: this is an exploratory, descriptive, cross-sectional, and quantitative study conducted in a Brazilian public university. After signing the Informed Consent Form, a questionnaire was applied to the students. The data were tabulated and analyzed. Results: among the Brazilian students, 90% brushed their teeth at least 3 times a day, 50% did not use dental floss, 55% did not use mouthwash, and 80% cleaned their tongue. Among the international students, 55% brushed their teeth 2 times a day, 85% did not use dental floss, 80% did not use mouthwash, and 65% cleaned their tongue. All Brazilians were aware of dental floss and mouthwash, while 70% of international students knew dental floss and 60% were unaware of the mouthwash. There was an association between being an international student and not using dental floss. From the participants, 95% of Brazilians and 50% of international students had already sought dental care. Regarding oral hygiene self-perception, 95% of Brazilians and 60% of international students considered it satisfactory. Additionally, being a newly enrolled student and having a good perception of oral hygiene were associated with not using dental floss. Conclusion: it was concluded that there are differences between oral health habits, knowledge, and behavior of students according to nationality. The research contributed to the characterization, comparison, and association of major oral health variables in the university and ethnic context. (AU)

Identification of barriers and beliefs influencing engagement by adult and teen Mexican-Americans in oral health behaviors.

OBJECTIVE: To identify barriers and beliefs influencing oral health and dental care-seeking among Mexican-Americans. RESEARCH DESIGN: Interviews and Likert-scale survey questions were utilized to explore urgent and preventive dental care-seeking, oral hygiene habits and lifestyle practices. Thirty-three interviews were conducted with 16 adults (ages 33-52), and 17 adolescents (ages 14-19). RESULTS: Teens identified the same main barriers to accessing dental care as adults: high cost, financial limitations and lack of insurance. Most Mexican-Americans agreed with the belief that everyone will need urgent dental treatment and the majority believed that going to a dentist in private practice instead of the Emergency Room was important. Although adults recognized the importance of preventive dental care, half reported being unlikely to seek such care while half of teens reported that they were likely to do so. Adults reported relying equally on themselves and on peers to make dental care decisions, while teens mostly depended on others to make decisions about urgent and preventive care. Virtually all respondents believed regular brushing to be important and many flossing too. A major barrier to flossing was being unsure of the proper technique. Another barrier to better oral health was not having seen messages encouraging changes in lifestyle. CONCLUSIONS: This study found that Mexican-American teens and adults may experience oral health similarly. Teens do not have more positive oral health beliefs and encounter mostly the same barriers to care as adults.

Sense of coherence modifies the association between untreated dental caries and dental pain in low-social status women.

UNLABELLED: Evidence of the link between sense of coherence (SOC), dental caries and dental pain is scarce. OBJECTIVE: To explore the relationship of SOC and dental caries with dental pain prevalence in low-social status women. BASIC RESEARCH DESIGN: A cross-sectional study. PARTICIPANTS: A convenience sample of 190 women whose children attended a selected school in São João de Meriti, Brazil. METHOD: Socioeconomic, demographic and oral health behaviour data were collected through interviews. SOC was assessed using the Antonovsky scale. Dental caries was evaluated through oral examinations. Multivariate logistic regression models were used to obtain Odds Ratio (OR) and 95% Confidence Intervals (CI). MAIN OUTCOME VARIABLE: Dental pain in the past 6 months. RESULTS: Dental pain prevalence was 26% (95% CI 20, 33). DMFT and decayed teeth means were 14.3 (SD 7.2) and 2.4 (SD 2.6), respectively. The odds of having dental pain was higher for women with moderate dental caries and low SOC (OR 3.3, 95%CI 1.1, 9.3) and women with high caries and low SOC (OR 4.0, 95% CI 1.7, 9.5) compared with women with low caries and high SOC. CONCLUSIONS: Dental caries and lower SOC were factors associated with dental pain. SOC appeared to buffer the effect of dental caries on dental pain in women from low-socioeconomic status.

Factors affecting patients' adherence to orthodontic appointments.

INTRODUCTION: Studies show that attendance at orthodontic appointments affects treatment outcomes, treatment duration, and the probability of side effects. The aim of this study was to predict factors that influence patients' attendance at orthodontic appointments. METHODS: We conducted a face-to-face guided interview survey of 153 participants from orthodontic clinics in the Greater Boston area. Attendance at scheduled orthodontic appointments was self-reported as always, sometimes, or rarely. Participants' characteristics, including demographics, dental insurance, and oral hygiene practices, were self-reported. Moreover, from dental records, we collected the time that the participants spent undergoing active orthodontic treatment. Multivariable ordered logistic regression was used to report proportional odds ratios and attendance probabilities. A likelihood ratio test was performed to ensure that the proportional odds assumption held. RESULTS: For overall appointment attendance, 76% of the participants reported always attending, 16% reported sometimes attending, and 8% reported rarely attending. Based on multivariable logistic regression (adjusted for age, race, and sex), the participants with optimal oral hygiene practices were almost 6 times (5.9) more likely to attend appointments than those who did not (P = 0.002). The odds of attending appointments decreased significantly (by 23%) for every 6-month increase in treatment duration (P = 0.008). Participants covered by non-Medicaid insurance were 4 times (P = 0.018) more likely to attend appointments than were those with Medicaid insurance. CONCLUSION: Our findings indicate that adherence to orthodontic treatment follow-up visits was strongly correlated to insurance type, treatment duration, and oral hygiene practices. Unlike previous studies, sex was not a significant predictor of adherence.

Relationship Between Social and Behavioural Factors and Caries Experience in Schoolchildren in Italy.

PURPOSE: The aims of this study were to: 1) determine the oral health status of Campanian (Italy) 5- and 12-year-old schoolchildren; 2) establish an oral health baseline prior to introducing promotion and prevention strategies and appropriate healthcare for specific groups; 3) provide the starting point for monitoring changes over time according to the World Health Organization 2020 global goals for oral health. MATERIALS AND METHODS: A cross-sectional observational study was performed on schoolchildren from public schools. 828 children were clinically evaluated, recording DMFT, dmft and SiC (Significant Caries Index). A questionnaire investigating demographic and oral health behaviour was completed by parents. RESULTS: 56.6% of the 5-year-old children were caries free (deciduous dentition) and the mean dmft value was 1.44 ± 2.13. In 12-year-old children, caries prevalence was 35.8%. The mean DMFT value was 1.17 ± 1.96, while the SiC was 3.42 ± 1.97. There were significant relationships between dmft/DMFT (caries experience) and family income level (p < 0.001), mother's educational level (p < 0.001) and history of recent dental visits (p < 0.01). CONCLUSION: Information drawn from this study can be helpful to describe future and specific dental prevention programmes in order to reduce caries incidence and promote better oral health in the Campania region of Italy.

Impact of providing free preventive dental products without health workers' counselling on infants' tooth-brushing and bottle-feeding termination practices: a randomised controlled trial.

OBJECTIVE: To investigate the impact of an integrated oral health promotion intervention, within the Syrian national immunisation programme, which provided free preventive dental health products, without health workers' counselling, on one-year-old infants' tooth-brushing and bottle-feeding termination practices. RESEARCH DESIGN: a randomised controlled parallel-group trial. SETTING: A maternal and child health centre in Sweida city, Syria. PARTICIPANTS: 92 mothers of one-year-old infants, attending an infant vaccination clinic, were allocated into three groups: Test, Control One and Control Two. INTERVENTIONS: The Test group received an oral health promotion package including an infant oral health pamphlet, a baby toothbrush, fluoride toothpaste (1,000 mg/L) and a trainer cup, without health workers' counselling. Control One received only the pamphlet, whilst Control Two received no intervention. MAIN OUTCOME MEASURES: after one month, the presence of old plaque on infants' primary teeth was checked, to assess tooth-brushing behaviour. Also, a mothers' self-completed questionnaire was administered to assess bottle-feeding use. RESULTS: The response rate was 100% and the attrition rate was zero. There were differences in tooth-brushing and bottle-feeding termination practices between the three groups (P⟩0.001). Infants in the Test group were less likely to have old plaque and more likely to stop bottle-feeding than their counterparts in the two control groups. There were no differences in the abovementioned outcomes between the two control groups. CONCLUSIONS: Providing free preventive dental health products, without health worker's counselling, in an integrated oral health promotion intervention, was an effective measure to promote infants' tooth-brushing and bottle-feeding termination practices. These findings should be supported by long-term follow up studies.

Avaliação da percepção pessoal em relação à condição de halitose e confirmação clínica / Personal perception of assessment for the condition of halitosis and clinical confirmation

Introdução: A halitose é uma condição em que o hálito se apresenta de forma desagradável, acometendo milhares de pessoas e causando impacto negativo para as mesmas. Objetivo: A presente pesquisa em campo buscou avaliar a percepção pessoal em relação à condição de halitose por meio de aplicação de questionário específico e confirmação clínica. Material e método: A amostra foi composta por 59 indivíduos entre 20 e 60 anos de idade, usuários de Unidades Básicas de Saúde de Araraquara, que foram selecionados de forma aleatória. A metodologia empregada constituiu-se de: i) Assinatura do Termo de Consentimento Livre e Esclarecido; ii) Aplicação de questionário especialmente elaborado para esta pesquisa; iii) Confirmação clínica, com a aplicação do teste com halímetro (Tanita Breath Alert CHC-212S). Após o experimento, todos receberam folhetos informativos com dados gerais sobre halitose. Os resultados obtidos foram agrupados em tabelas de contingência, construídas pelo Microsoft Excel, sendo então analisados pelo teste do Qui-quadrado. Resultado e conclusão: Após análises, conclui-se que as pessoas perderam a capacidade de perceber o próprio hálito quando tinham halitose; não tiveram condições de se autoavaliarem de forma eficaz; os fatores de riscos que influenciaram na halitose foram: idade superior aos 40 anos, uso de alguns tipos de medicamentos, algumas patologias, frequência de visita ao Dentista e falhas em procedimentos de higiene bucal, tais como escovação dentária, uso do fio dental, limpeza da língua e limpeza de próteses. Os outros fatores pesquisados não se mostraram estatisticamente suficientes para estabelecerem relação de influência na halitose.

Introduction: Halitosis is a condition characterized by unpleasant breath,affecting thousands of people and causing a negative impact on them. Objective: The aim of this study was to evaluate self-perception of halitosis condition by applying a specific questionnaire and having clinical evaluation. Material and method: The sample was composed by 59 randomly selected voluntaries between the ages of 20 and 60 years old who were users of Basic Health Units of Araraquara. The methodologies applied were: 1. Signature of informed consent; 2. Application of standardized questionnaire specially designed for this research; 3. Clinical confirmation through halimeter (Tanita Breath Alert CHC-212S). After the experimental phase, all the volunteers received a document with general information about halitosis (causes and treatment). The results were grouped in Microsoft Excel tables and analyzed by Chi-square test. Result and conclusion: After the analyses, it was concluded that people had lost the ability to perceive their own breath when they had halitosis and they are unable to evaluate themselves effectively; the risky factors that influenced the halitosis were: people over the age of 40, the use some types of drugs, some diseases, frequency of visit to the dentist and poor oral hygiene including bad-technique procedures such as teeth brushing, flossing, tongue cleaning and dentures cleaning. Other factors studied were not statistically sufficient to influence halitosis.

Dental Caries Status, Socio-Economic, Behavioral and Biological Variables among 12-Year-Old Palestinian School Children.

UNLABELLED: There are currently inadequate data regarding the prevalence of dental caries and its associated variables, among Palestinian children. AIM: To determine the current prevalence of dental caries and related variables, among Palestinian children in East Jerusalem. STUDY DESIGN: A stratified sample of 286 East Jerusalem Palestinian children was selected, employing randomly chosen sixth grade clusters from three pre-selected socio-economic school groups. Dental caries was recorded according to WHO recommendations. Salivary flow, pH, buffer capacity and microbial parameters, were recorded according to previously employed methodologies. RESULTS: The mean level of caries experience, by DMFT, was 1.98 ± 2.05. This level was higher than those found among Israeli children, but lower than several other Middle Eastern countries. In uni-variate analysis, significant associations were revealed between caries and school categories, which indicated lower, middle and higher socio-economic position(SEP), mothers' employment, home densities, dental visits, tooth brushing, Streptococci mutans (SM), Lactobacilli (LB), and saliva pH. CONCLUSION: According to a linear logistic regression model, children learning in lower SEP schools, with higher SM levels and more acidic saliva, had a higher chance of experiencing dental caries. These findings should be considered in the planning of services and dental health care programs for Palestinian children.

School-Based Educational Intervention to Improve Children's Oral Health-Related Knowledge.

OBJECTIVE: To evaluate a brief oral health promotion intervention delivered in schools by a primary care dental practice, aimed at changing oral health care knowledge and oral health-related behaviors in children. DESIGN: Cohort study with pretest-posttest design. SETTING: Three primary schools. PARTICIPANTS: One hundred and fifty children (aged 9-12 years). INTERVENTION: Children received a 60-minute theory-driven classroom-based interactive educational session delivered by a dental care professional and received take-home literature on oral health. MAIN OUTCOME MEASURES: All children completed a questionnaire on oral health-related knowledge and self-reported oral health-related behaviors before, immediately after, and 6 weeks following the intervention. RESULTS: Children's dental knowledge significantly improved following the intervention, with improvement evident at immediate follow-up and maintained 6 weeks later. Significantly more children reported using dental floss 6 weeks after the intervention compared with baseline. No significant differences were detected in toothbrushing or dietary behaviors. CONCLUSIONS: School-based preventative oral health education delivered by primary care dental practices can generate short-term improvements in children's knowledge of oral health and some aspects of oral hygiene behavior. Future research should engage parents/carers and include objective clinical and behavioral outcomes in controlled study designs.

[Association between periodontal pockets and health-related behaviors of workers].

OBJECTIVE: Periodontal disease is a chronic disease caused by bacterial infection, and frequently develops in adulthood. As the disease is closely related to lifestyle, it is important to clarify its relationship with health-related behaviors to provide effective health instructions targeting its prevention. In this study, we focused on periodontal pockets with advanced periodontal disease to clarify the health-related behaviors associated with the presence or absence of periodontal pockets. METHODS: The subjects were 3,142 employees (male: N=2,429, female: N=713; 42.4 ± 10.5 years, Range 20-59 years) of one company, which had provided all employees with an oral health program in 2002. Participants with a Community Periodontal Index code of ≤2 and ≥3 were classified as those without and with periodontal pockets, respectively. To clarify the health-related behaviors associated with the presence or absence of periodontal pockets, we conducted multivariate logistic regression analysis, with presence/absence of periodontal pockets as the dependent variable, and items of health-related behavior investigated in 2002 as independent variables, and calculated the odds ratios (OR) and 95% confidence intervals (95%CI) adjusted for sex, age group and occupation. RESULTS: The factor most strongly correlated with the presence of periodontal pockets was non-use of dental floss (OR=1.95 (95%CI: 1.57-2.41)), followed by smoking (OR=1.71 (95%CI: 1.44-2.03)), and tooth-brushing habits (≤once a day: OR=1.33 (95%CI: 1.10-1.61)). CONCLUSIONS: Our results suggest that, to promote oral health program at the worksite, it is important to provide health education and instructions to encourage the use of dental floss, a daily tooth-brushing habit, and smoking cessation.