Oral Health-Related Risk Factors Among Students in Southeast Serbia.

BACKGROUND An association between insufficient or irregular oral hygiene with the occurrence of dental caries, gingival/periodontal diseases, and consequently general diseases has been established. The null hypothesis that there is no difference in the oral health status among students in a preclinical medical program and those who went through a clinical medical program was tested. The main objective of the study was to analyze oral health risk factors (oral hygiene practices, attitudes, and behavior) as well as their impact on oral health by using convenience sampling. MATERIAL AND METHODS We investigated risk factors for oral health conditions by examining oral hygiene practices, attitudes, and behaviors among the students in the medical program of the University of Nis, collecting data using questionnaires. The study included 396 students of medicine, dentistry, pharmacy, and vocational studies. Participants filled out the anonymous questionnaire. RESULTS In both groups, parents were mostly employed, with the representation of employed fathers significantly higher in student group 1 (P<0.05), which is also the only statistically significant difference between the groups. In terms of oral hygiene practices, students were most often trained by parents (68.69%). A very high percentage of students brushed their teeth every day (97.22%), and 54.55% did this twice a day. Of the total number of students, 78.28% thought that it was necessary to use interdental brushes/floss/toothpick. The duration of teeth cleaning was 3 minutes in 39.39%, whereas 55.30% thought that it should be longer than 3 minutes. The most common brushing movements were combined movements and were used by 60.35% of all students. Of all students, 253 (63.89%) never smoked, 182 (49.96%) regularly went to the dentist, and 141 (35.61%) visited the dentist 6 months ago. The majority of students, 265 (66.92%), obtained the greatest amount of information about oral and tooth care from their dentist, which was the case in both age groups. CONCLUSIONS This study highlights oral health risk factors among students at the University of Nis. It is essential to determine their oral health knowledge, as it is of great significance both to patients and to students. Also, these students will be the major providers of health services and will be responsible for public oral health promotion. It could help in reformation of the oral health education program. The results of this research indicate that it is necessary to educate preclinical students to solve oral health issues.

President's Message.

This is the last Editorial for me as President of IFDH. It has been an unforgettable time during the last 6 years on the Board and I am very grateful for all the support from colleagues around the world and from my Executive team. Corrie Jongbloed, our President Elect from the Netherlands will be assuming the role and I wish her the very best in her future endeavour.I recently read an article "The 100-year evolution of the science and practice of dental hygiene"1 which caused me to investigate and reflect on where our profession has come from and what will be the future. This article is protected by copyright. All rights reserved.

Impact of systemic lupus erythematosus on oral health-related quality of life.

Oral symptoms in systemic lupus erythematosus (SLE) patients are often unexplored and affect the health-related quality of life. The aims of this study were: (a) to evaluate the oral health condition of SLE patients compared to control subjects without rheumatic diseases; (b) to determine the consequences of oral health condition in the quality of life of these two groups. Individuals with SLE ( n = 75) and without SLE ( n = 78) (control group), paired for gender and age, underwent complete oral examination. Sociodemographic and clinical information was obtained, and interviews were conducted using the Brazilian version of the oral health impact profile. The activity and damage of SLE disease were assessed, respectively, by the systemic lupus erythematosus disease activity index 2000 and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. When we analysed the oral health condition and hygiene habits of the participants, SLE patients exhibited an increased number of missing teeth despite their higher frequency of tooth brushing. No significant differences were verified in other habits and clinical parameters evaluated such as smoking, flossing, salivary flux, periodontitis, decayed and filled teeth. Patients with SLE presented with worse oral health-related quality of life than controls ( P = 0.011). The significant difference was on individuals' physical disability ( P = 0.002). The determinant of the negative impact on the oral health-related quality of life was prosthesis wearing ( P < 0.05). Overall, the oral health impact profile score was higher in individuals with moderate SLE damage compared to SLE individuals with no damage ( P = 0.043). Patients with SLE had a negative impact of oral condition on their quality of life. The evaluation of the oral health-related quality of life might be useful to monitor the effects of SLE on oral condition.

Can probiotics be an alternative to chlorhexidine for oral care in the mechanically ventilated patient? A multicentre, prospective, randomised controlled open trial.

BACKGROUND: Pathogenic enteric bacteria aspirated from the oropharynx are the main cause of ventilator-associated pneumonia (VAP). Using chlorhexidine (CHX) orally or selective decontamination has been shown to reduce VAP. In a pilot study we found that oral care with the probiotic bacterium Lactobacillus plantarum 299 (Lp299) was as effective as CHX in reducing enteric bacteria in the oropharynx. To confirm those results, in this expanded study with an identical protocol we increased the number of patients and participating centres. METHODS: One hundred and fifty critically ill patients on mechanical ventilation were randomised to oral care with either standard 0.1% CHX solution (control group) or a procedure comprising final application of an emulsion of Lp299. Samples for microbiological analyses were taken from the oropharynx and trachea at inclusion and subsequently at defined intervals. Student's t test was used for comparisons of parameters recorded daily and Fisher's exact test was used to compare the results of microbiological cultures. RESULTS: Potentially pathogenic enteric bacteria not present at inclusion were identified in oropharyngeal samples from 29 patients in the CHX group and in 31 samples in the probiotic group. Considering cultures of tracheal secretions, enteric bacteria were found in 17 and 19 samples, respectively. Risk ratios show a difference in favour of the Lp group for fungi in oropharyngeal cultures. VAP was diagnosed in seven patients in the Lp group and in 10 patients among the controls. CONCLUSIONS: In this multicentre study, we could not demonstrate any difference between Lp299 and CHX used in oral care procedures regarding their impact on colonisation with emerging potentially pathogenic enteric bacteria in the oropharynx and trachea. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01105819 . Registered on 9 April 2010. First part: Current Controlled Trials, ISRCTN00472141 . Registered on 22 November 2007 (published Critical Care 2008, 12:R136).

[Caries prevention in historical perspective. Oral hygiene]. / Serie: Cariëspreventie in historisch perspectief. Mondhygiëne.

Since the beginning of the twentieth century, the ability to prevent caries has greatly improved. This is due to both increased knowledge about the origin of dental caries, and to the availability of effective aids to oral hygiene, such as fluoride toothpaste. The effect of oral hygiene on the general population has also risen because more and more people brush their teeth.

[Efficiency of preventive dental care in school dentistry system].

Ways of development of Russian school dentistry are defined and justified based on the analysis according to logistics, personnel, legal, financial and economic basis for the reorientation of the service for preventive direction, which should be a priority in the current conditions. The implemented model of school dental care based on team work of the dentist and dental hygienist proved to be highly efficient and may be recommended for wide introduction in practice.

[Relationship between oral health status and life behavior in junior and senior high school students in Japan].

A survey of dental diseases carried out by the Ministry of Health, Labour and Welfare in 2003 revealed that more than 40% of people aged between 5 and 25 suffer from periodontal diseases and the average number of DMFT has been decreasing. The lifestyle of junior and senior high school students in particular has changed drastically. This study investigated the relationship between dietary habits and oral diseases in junior and senior high school students in Tokyo. Survey responses were received from 813 of 848 students. There was a significant correlation between the presence of untreated teeth and student's dietary habits, or the presence of periodontal diseases. These results suggest that dental hygienists need to consider providing advice on appropriate eating habits during dental hygiene instruction to students.

Impact of oral care with versus without toothbrushing on the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component of oral care on the prevention of VAP in adult critically ill patients. METHODS: A systematic literature search of PubMed and Embase (up to April 2012) was conducted. Eligible studies were randomized controlled trials of mechanically ventilated adult patients receiving oral care with toothbrushing. Relative risks (RRs), weighted mean differences (WMDs), and 95% confidence intervals (CIs) were calculated and heterogeneity was assessed with the I(2) test. RESULTS: Four studies with a total of 828 patients met the inclusion criteria. Toothbrushing did not significantly reduce the incidence of VAP (RR, 0.77; 95% CI, 0.50 to 1.21) and intensive care unit mortality (RR, 0.88; 95% CI, 0.70 to 1.10). Toothbrushing was not associated with a statistically significant reduction in duration of mechanical ventilation (WMD, -0.88 days; 95% CI, -2.58 to 0.82), length of intensive care unit stay (WMD, -1.48 days; 95% CI, -3.40 to 0.45), antibiotic-free day (WMD, -0.52 days; 95% CI, -2.82 to 1.79), or mechanical ventilation-free day (WMD, -0.43 days; 95% CI, -1.23 to 0.36). CONCLUSIONS: Oral care with toothbrushing versus without toothbrushing does not significantly reduce the incidence of VAP and alter other important clinical outcomes in mechanically ventilated patients. However, the results should be interpreted cautiously since relevant evidence is still limited, although accumulating. Further large-scale, well-designed randomized controlled trials are urgently needed.

Approaches to caries prevention and therapy in the elderly.

The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population. This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.

What is new in the prevention of ventilator-associated pneumonia?

PURPOSE OF REVIEW: Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in endotracheally intubated patients. Strict adherence to preventive measures reduces the risk of VAP. The objective of this paper is to review what has come forward in recent years in the nonpharmacological prevention of VAP. RECENT FINDINGS: It seems advantageous to implement care bundles rather than single prevention measures. A solid basis of knowledge seems necessary to facilitate implementation and maintain a high adherence level. Continuous educational efforts have a beneficial effect on attitude toward VAP. Intermittent subglottic secretions drainage, continuous lateral rotation therapy, and polyurethane cuffed endotracheal tubes decrease the risk of pneumonia. In an in-vitro setting, an endotracheal tube with a taper-shaped cuff appears to better prevent fluid leakage compared to cylindrical polyurethane or polyvinylchloride cuffed tubes. Cuff pressure control by means of an automatic device and multimodality chest physiotherapy need further investigation, as do some aspects of oral hygiene. SUMMARY: New devices and strategies have been developed to prevent VAP. Some of these are promising but need further study. In addition, more attention is being given to factors that might facilitate the implementation process and the challenge of achieving high adherence rates.

A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards.

BACKGROUND: Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life. AIMS: We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings. METHODS: Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque. RESULTS: We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42). CONCLUSIONS: Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect. TRIAL REGISTRATION: NCT01954212.

The Seychelles Dental Service.

The Seychelles Dental Service dates back to the 1920s, growing from rudimentary dentistry to the evidence-based dentistry of today. Until the 1970s, dental care was provided by a small number of dentists. However, since the establishment of the School Dental Service (SDS) in the 1980s, child oral health has been the responsibility of Dental Therapists (DTs). Today Seychelles has a well organised oral health care system in place with modern infrastructure and equipment and trained personnel. Locally trained DTs constitute 85% of the SDS workforce. A national oral health plan serves as a guide to ensure that programmes are developed in accordance with WHO global oral health goals, guided by periodic reviews. We present a resume of the major strengths and challenges of the Seychelles Dental Service, concluding with recommendations for staff development. Findings and recommendations of reviews and assessments of various dental health issues conducted in the country between 1977 and 1999 are summarised in the appendix.

[The dental aspects of public health in Hungary. Review article]. / Magyarország népegészségügyi helyzetének fogorvosi vonatkozásai. Osszefoglaló közlemény.

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.

Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease.

AIM: The present investigation presents findings of the prevalence and distribution of gingivitis and periodontitis in a Swedish population over the 30 years 1973-2003. MATERIAL AND METHODS: Four cross-sectional epidemiological studies in 1973, 1983, 1993, and 2003 were performed in Jönköping, Sweden. Random samples of individuals aged 20, 30, 40, 50, 60, 70, and 80 years were examined clinically and radiographically. Diagnostic criteria were edentulousness, number of teeth, plaque, gingival status, probing pocket depth, gingival recession, alveolar bone level, and classification according to periodontal disease status. RESULTS: In all age groups, the number of edentulous individuals decreased dramatically and the number of teeth increased. Oral hygiene improved considerably. Over the 30 years, the proportion of periodontally healthy individuals increased from 8% in 1973 to 44% in 2003 and the proportion of individuals with gingivitis and moderate periodontitis decreased. There was a non-significant trend for the proportion of individuals with severe periodontal disease experience (Group 4) to decrease, while the proportion of individuals with advanced periodontitis (Group 5) remained unchanged. CONCLUSION: Oral hygiene and periodontal health improved significantly in the 20-80-year age groups over the 30 years 1973-2003.

Re-architecting oral healthcare for the 21st century.

The convergent forces of rising costs, growing consumerism, expensive new treatments, sociodemographic shifts and increasing health disparities are exerting intense and unsustainable pressures on healthcare systems. As with the other health domains, these disruptive forces demand new approaches and delivery models for oral healthcare. Technological innovations and practices borrowed from the e-commerce and tech sectors could facilitate the move to a sustainable 21st century oral healthcare system, one that delivers high-quality, value-based care to wider groups of patients. The broad reach of mobile technologies and changing digital lifestyles provide unique opportunities for using remote monitoring and self-care tools to reinforce preventive oral hygiene behaviours. By leveraging big data analytics and insights gleaned from the use of sensor-enabled oral care devices, providers will be able to engage patients more effectively and deliver timely, personalized behavioural nudges to support optimal oral health. Dental insurers and payers will need to reinvent their business models to incentivize dental providers and patients who embrace the digital-dentistry paradigm. This could involve increasing reimbursements for mHealth-delivered preventive dental services and holding individuals accountable for behaviours that put them at higher risk for dental disease. While Dentistry 1.0 was defined largely by the treatment of established dental disease, Dentistry 2.0 portends a new era of patient-centric, technology-enabled, outcomes-driven, and prevention-focused oral healthcare delivery with significant individual, provider and societal benefits.

Oral health beliefs in adolescence and oral health in young adulthood.

According to theory, health beliefs are related to health behaviors. We investigated whether individuals who hold favorable oral-health-related beliefs over time have better adult oral health than those who do not. Beliefs about the efficacy of water fluoridation, keeping the mouth clean, avoiding sweet foods, visiting the dentist, using dental floss, and using fluoridated toothpaste were assessed in a birth cohort at ages 15, 18, and 26 years. At each age, the majority of participants endorsed the importance of each practice. However, there was also evidence of instability across time. Individuals who held stable favorable dental beliefs from adolescence through adulthood had fewer teeth missing due to caries, less periodontal disease, better oral hygiene, better self-rated oral health, and more restorations. Dental beliefs can change between adolescence and young adulthood, and these changes are related to oral health. In particular, unfavorable dental health beliefs are related to poorer oral health.

High-Tech Hygiene: Technologies Making a Difference in Oral Care.

Technology has greatly influenced all phases of the dental hygiene process of care. Chairside diagnostic tools and self-monitoring devices improve early detection of lesions and previously undetected oral/systemic diseases, facilitate assessment of systemic health status, and support patient engagement in self-care. Collectively, improved patient assessment reduces risks for medical emergencies and promotes patient safety. Technological advances enable better visualization of hard and soft tissues during the assessment phase, aid decision-making with planning and delivery of appropriate oral care interventions, and facilitate evaluation of patient outcomes related to dental hygiene treatment. Additional research is needed to support the benefits of patient-centered technologies designed to affect behavioral change.

Trends in oral hygiene, gingival status and dental caries experience in 13-14-year-old Jordanian school children between 1993 and 1999.

AIMS: The aim of this survey was to describe the trends in oral hygiene, gingival condition and dental caries prevalence in 13-14-year-old northern Jordanian school children. METHOD: A dental survey was conducted in 1999, similar to one carried out in 1993, utilising 10 schools (666 pupils) and 20 schools (1,695) with children of 7th grade, respectively. These schools were chosen by a simple random method from the five geographic areas of the city. All participants had dental examinations for oral hygiene, gingival condition and dental caries experience using the Silness and Löe plaque index (Pl.I), Löe and Silness gingival index (GI) and decayed (D), missing (M) and filled (F) teeth (DMFT) and surfaces (DMFS) codes, respectively. RESULTS: Boys had higher plaque and gingival scores than girls in both groups. The mean Pl.I and GI scores of males and females were significantly higher in the 1993 survey than in 1999 (P < 0.05). Also, male and female children examined in 1993 had significantly higher caries experience, as measured by DT, DS, DMFT and DMFS scores than in 1999 (P < 0.01). No differences were found between M and F values of both groups. It is concluded that oral hygiene, gingival condition and dental caries has improved since 1993.

Dental health status and caries pattern of preschool children in Al-Kharj, Saudi Arabia.

OBJECTIVE: The objective of this study was to assess dental caries and its relation to plaque, tooth brushing habit and past dental attendance, and to determine the caries pattern in primary dentition of preschool children. METHODS: One hundred and three, 5-year-old children, from preschool nurseries in Al-Kharj, Kingdom of Saudi Arabia were studied in 1994. The World Health Organization criteria was used to determine caries. RESULTS: Only 16.5% were caries free. The mean decayed missing filled teeth (dmft) was 7.1, and by excluding caries free children it was 8.5. The decay component of dmft was predominant (82%). Almost 90% of the children had plaque present on their teeth and one-third never brushed their teeth while two-thirds had never been to a dentist. All children who never brushed their teeth had plaque and caries. Molars were the teeth, which were most frequently carious, and caries among all teeth was always bilateral. CONCLUSION: There was high prevalence of untreated caries and high dental needs with concomitant poor dental health among these preschool children.

[The Ivory Cross: past, present and future. Promotion of oral health in the Netherlands by a national information organization]. / Het Ivoren Kruis: verleden, heden en toekomst. De bevordering van mondgezondheid in Nederland door een landelijke voorlichtingsorganisatie.

In this article a description is given of the role of Dutch National Association for the Promotion of Oral Hygiene (Ivoren Kruis), the Dutch organisation of oral health education. In this review attention is paid to the past and to the recent working method of the association by which it tries to realise the improvement of the dental health on the population and individual level. Special attention is paid to the evaluation of all sort of activities and programmes on oral health education. The article concludes with a short view on the future of the organisation.