Influence of children's oral health promotion on parents' behaviours, attitudes and knowledge.

Objective The aim was to compare the changes in parents' oral health-related behaviour, knowledge and attitudes in 2001-2003 and 2003-2005, during a 3.4-year-intervention in Pori and in the reference area Rauma, Finland. Materials and methods The study population consisted of parents of children who participated in the oral health promotion programme in Pori (all 5th and 6th graders who started the 2001-2002 school year in the town of Pori, n = 1691) and the parents of same-aged children in a reference town (n = 807). In 2001-2003, the promotion was targeted only to the children in Pori. In 2003-2005, the promotion was targeted also to parents, for example via local mass media. The statistical significances of the differences in parents' self-reported behaviour, knowledge and attitudes, and changes in these, were evaluated using Mann-Whitney U-tests and confidence intervals. Results In 2001-2003, the trend in changing behaviours was in favour of parents in Pori. Mothers in Pori also improved their knowledge and the attitude 'importance of brushing for health and appearance'. In 2003-2005, the trend in changing behaviours was rather similar in both towns, which may be due to diffusion of the oral health intervention to Rauma via the media. Conclusions The results suggest that health promotion targeted to children, which in previous studies has been shown to be successful in improving children's behaviours, also helped their parents in mending their habits.

Children's oral health-related knowledge, attitudes and beliefs as predictors of success in caries control during a 3.4-year randomized clinical trial.

OBJECTIVES: The aim of this study was to determine whether the baseline oral health-related knowledge, attitudes and beliefs of the participants in a randomized clinical trial (RCT) were associated with D(3)MFS increment. Additionally, the aim was to study whether the association was mediated by the two baseline behaviors, i.e. brushing teeth and eating candies. METHODS: Children in Pori, Finland (n = 493) aged 11-12 years, with active initial caries lesion(s) at baseline, were studied. The data were based on clinical examinations in 2001 and 2005 and on a questionnaire administered in 2001. Associations between success in caries control and baseline oral health-related knowledge, attitudes and the belief in keeping one's own teeth throughout life were evaluated using negative binomial regression analyses while considering the effects of the two baseline oral health behaviors. RESULTS: The degree of concern about getting decay in one's own teeth was associated with caries increment. The less concerned the child was about new caries lesions, the more likely he/she was to develop new cavities. This association was not mediated by the two behaviors. Those children who did not know whether or not their mother had cavities were more likely to fail in caries control than were children who knew about their mother's cavities. CONCLUSIONS: It is important to determine child's level of concern about getting cavities because children who are concerned about developing cavities are likely to succeed in caries control while the opposite is true for those children who do not share this concern.

Relationship between laser fluorescence values and visual evaluation of fissure caries in schoolchildren - a field study.

BACKGROUND: In our previous study of oral health intervention in children, laser fluorescence (LF) values of occlusal surfaces were reduced after 1 year. AIM: The aim of this study was to explore the relationship between DIAGNOdent pen values and clinical status of the occlusal surfaces. DESIGN: The study conducted in 2007 and 2008 in 700 children aged 13-14 included a clinical examination and LFpen measurement of the occlusal surfaces of first and second molars. Four teams consisting of a dental hygienist and a dental nurse performed the examinations on school premises. The dental hygienist scored the surfaces using the Nyvad criteria for caries assessment; the surfaces were then scanned using a DIAGNOdent pen(®) device. RESULTS: The more severe the visual caries category was, the higher the mean LFpen values were. Correlation coefficients between LF values and NY categories were 0.542 and 0.408 in years 2007 and 2008, respectively (all examiners combined). The LFpen values of active and inactive lesions did not differ significantly. CONCLUSIONS: The correlation between the mean LFpen values and the NY categories was significant. Fissures can be reliably examined with LF and by visual inspection on school premises if certain special arrangements are made.

Relationship between oral health-related knowledge, attitudes and behavior among 15-16-year-old adolescents: a structural equation modeling approach.

OBJECTIVE: The aim of this study was to confirm the previously observed attitudinal factor structure related to behavioral change and the knowledge-attitude-behavior model on dental health and hygiene among adolescents. MATERIALS AND METHODS: The study population consisted of all 8(th) and 9(th) graders (15-16 years) who started the 2004-2005 school year in Rauma, Finland (n = 827). Data on knowledge, attitudes, toothbrushing and using fluoride toothpaste were gathered by questionnaires. Hypothesized structure included four attitudinal factors related to dental health and hygiene: 'importance of toothbrushing when participating in social situations' (F1), 'importance of toothbrushing for health-related reasons and better appearance' (F2), 'being concerned about developing caries lesions' (F3) and 'importance of toothbrushing for feeling accepted' (F4). Structural equation modeling (SEM) was used to test the hypothesized model: pathways lead from knowledge to behavior both directly and via attitudes. The hypothesized model was also modified by removing non-significant pathways and studying the inter-relationships between attitudes. RESULTS: A confirmatory factor analysis revealed that factor F4 had to be removed. In the final model, knowledge influenced behavior directly and via two attitude factors, F1 and F2, which were inter-related. 'Concern about developing caries lesions' was a background factor influencing only knowledge. The final factor structure and SEM model were acceptable-to-good fit. Knowledge had a smaller effect on behavior than on attitudes. CONCLUSIONS: Our results support theories about the causal knowledge-attitudes-behavior chain, also for adolescents' oral health-related behaviors.

The role of sugar, xylitol, toothbrushing frequency, and use of fluoride toothpaste in maintenance of adults' dental health: findings from the Finnish National Health 2000 Survey.

We assessed the effect of certain oral health-related behaviours on adults' dental health. As part of the Finnish nationwide Health 2000 Survey, dentate subjects, 30-64 yr of age, reported their frequency of consumption of eight sugar- and xylitol-containing products, together with toothbrushing frequency and use of fluoride toothpaste, and underwent clinical oral examination (n = 4,361). The mean number of teeth present (NoT) was 24.2 and the mean numbers of sound teeth (ST), filled teeth (FT), and decayed teeth (DT) were 10.8, 12.1, and 1.1 for men and 9.6, 13.8, and 0.5 for women, respectively. Consumption of sugar-sweetened beverages was more frequent than that of other sugar-containing products, and greater in men than in women. Daily use of xylitol chewing gum was reported by 13% of the men and by 22% of the women. Toothbrushing at least twice daily was reported by 47% of the men and by 79% of the women; 86% and 96%, respectively, reported daily use of fluoride toothpaste. The frequency of consumption of sugar- and xylitol-containing products and of toothbrushing, as well as use of fluoride toothpaste, play a role in the dental health of dentate adults, with the impact being weak on NoT, ST, and FT, but stronger on DT, especially concerning toothbrushing frequency (relative risk = 1.5) and use of fluoride toothpaste (relative risk = 1.8). Understanding the impact of certain oral health-related behaviours on dental health in adults would facilitate better targeting of oral self-care messages.

Dietary and oral hygiene intervention in secondary school pupils.

BACKGROUND: To enhance the well-being of secondary school pupils by improving their eating habits, especially school-based eating, a joint project, including oral health intervention, was conducted during the academic year 2007-2008. AIM: The aim was to study the effect of a dietary intervention on schoolchildren's eating habits and laser fluorescence (LF) values of teeth. METHODS: Twelve schools in three cities, Finland, were randomly assigned to be intervention and control schools. Two of the intervention schools were further assigned in the instruction of oral hygiene. In 2007 and 2008, the pupils (n=739 and 647, respectively) answered a questionnaire on dietary and oral health habits, and LF values on the occlusal surfaces of molars and premolars were determined. RESULTS: The frequency of eating a warm meal and drinking water at school to quench thirst increased in the intervention schools but decreased in the control schools (P<0.001 and P=0.005, respectively). LF values in molars decreased in schools with dietary intervention only (P=0.024). CONCLUSIONS: The 1-year dietary intervention was long enough to show improvement in eating habits and in habits for quenching thirst, and some decrease in the LF values of molars.

Education level and oral health in Finnish adults: evidence from different lifecourse models.

AIM: To assess the relationship between education level and several oral health outcomes in Finnish adults, using three conceptual lifecourse models. MATERIALS AND METHODS: This study analysed data from 7112 subjects, aged 30 years or over, who participated in the nationally representative Finnish Health 2000 Survey. Parental and own education levels were the childhood and adulthood socioeconomic measures, respectively. Oral health was indicated by edentulousness, perceived oral health and levels of dental caries and periodontal disease. Three conceptual lifecourse models, namely critical period, accumulation and social trajectories, were separately tested in regression models. RESULTS: In line with the critical period model, parental and own education levels were independently associated with oral health after mutual adjustment. There was also a graded linear relationship between the number of periods of socioeconomic disadvantage and oral health, corresponding to the accumulation model. Gradual declines in oral health were evident between social trajectories from persistently high to upwardly mobile, downwardly mobile and persistently low groups. CONCLUSION: There was similar support for the lifecourse models of critical period, accumulation and social trajectories. They collectively contribute to a better understanding of oral health inequalities.

Patterns of oral cleaning habits and use of fluoride among dentate adults in Finland.

PURPOSE: The aim of the present study was to identify the underlying patterns of oral cleaning habits and the use of fluoride, and to investigate their variations by studying the socioeconomic characteristics among Finnish dentate adults aged 30 to 64 years. MATERIALS AND METHODS: Participants of the nationwide Health 2000 survey who were dentate, aged 30 to 64 years, and underwent a health interview and a clinical oral examination, were included in the present study (n = 4419). RESULTS: In total, 79% of the women and 46% of the men reported to have brushed their teeth twice or more daily; 16% of the women and 14% of the men reported daily use of an electric toothbrush and 14% of the women and 5% of the men reported daily use of dental floss or an interdental brush. Factor analysis revealed five oral cleaning habit patterns, which were named modern, rational, before-breakfast, social and irrational. The modern cleaning pattern was associated with higher levels of education, and the rational cleaning with younger age, female gender and higher levels of education. The before-breakfast cleaning pattern was associated with male gender and lower levels of education, and the social cleaning with older age, female gender and higher levels of education. The irrational cleaning pattern was associated with older age. CONCLUSIONS: Adults have various oral cleaning habit patterns, each of which is associated with the subjects' socioeconomic characteristics.

Post-trial costs, clinical outcomes, and dental service utilization after a randomized clinical trial for caries control among Finnish adolescents.

The aim of this study was to assess post-trial treatment costs, clinical outcomes [decayed, missing or filled surfaces (DMFS) scores], and utilization of dental services among adolescents who had participated in a randomized clinical trial (RCT) in Pori, Finland, in 2001-2005. At baseline the children were 11-12 yr of age and had had at least one active initial caries lesion. The children in the experimental group (n = 250) had been exposed to multiple measures for caries control, while those in the control group (n = 247) had received standard dental care. During the post-trial period (2005-2008), all participants received the standard dental care offered in public dental clinics in Pori. In both groups the costs of treatment procedures and outcomes for the post-trial period were calculated for each adolescent. Information from patient records was available for 487 adolescents (former experimental n = 246, control n = 241). The mean total costs per adolescent were lower and the clinical outcome was better among the former experimental-group participants. The differences in mean costs between the groups were statistically significant for preventive and restorative procedures. The utilization of dental services was significantly more regular among the former experimental-group participants.

Changes in toothbrushing frequency in relation to changes in oral health-related knowledge and attitudes among children - a longitudinal study.

The aim of this study was to determine the associations between changes in self-reported toothbrushing frequency and the knowledge and attitudes related to oral health. The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori (n = 1,691); of these, 1,362 were monitored throughout the 3.4-yr study. Data were gathered by questionnaires before, in the middle, and after the follow-up, which was divided into two periods. Associations between changes in toothbrushing frequency, sum score of knowledge items, and sum scores of items in attitudinal factors were studied. The attitudinal factor structure was determined by principal component analyses. The associations were evaluated using mean values and general linear models for repeated measures. Toothbrushing frequency and knowledge and attitudes related to oral health improved among the same children during the study, with the changes usually taking place in the same time-period. In different time-periods, different children's toothbrushing and oral health-related knowledge and attitudes improved. Based on our results, changes in knowledge, attitudes, and behavior are related, but children are ready for change at different times. Therefore, oral health promotion should be designed to be a continuous process rather than a short-term intervention.

Children's oral health-related behaviors: individual stability and stage transitions.

UNLABELLED: In 2001-2005 in Pori, Finland, a program of oral health promotion (OHP) was targeted to schoolchildren and people involved in their life to provide social support for participants of the experimental group of a randomized clinical trial (RCT) on controlling caries. OBJECTIVES: Our aim was to describe the individual stability and stage transitions for behaviors among children exposed to OHP in Pori and to ascertain whether these phenomena differed in the group that was also exposed to the experimental regimen of the RCT. METHODS: The study population consisted of all 5th and 6th graders who started the 2001-2002 school year in Pori (n = 1691); 1362 of them were monitored throughout the 3.4-year study. Of these children, 1138 were exposed to OHP and 224 to OHP and the experimental regimen of the RCT. Data on toothbrushing and use of xylitol products, candies, and soft- and sports drinks were gathered with questionnaires. Behavior variables were dichotomized into good and poor. The stability of behaviors and stage transitions was evaluated. RESULTS: Over half of the children had stable behaviors throughout the study. For those children whose behaviors changed, the behavior was more likely to improve than to worsen. For most behaviors, good behavior at baseline was associated with the ability to maintain the achieved good behavior and to recover from lapses to poor behaviors. CONCLUSION: In childhood, behaviors, especially good ones, are rather stable. If healthy behaviors are learned young, lapses into poor behaviors, for instance during the teens, are likely be temporary rather than permanent.

Dental fear and subjective oral impacts among adults in Finland.

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' and subjective oral impacts were measured using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP-14 items fairly often or very often, and the 'extent' and 'severity'. Those with high dental fear reported higher levels of prevalence, 'extent', and 'severity' of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP-14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.

Changes in children's oral health-related behavior, knowledge and attitudes during a 3.4-yr randomized clinical trial and oral health-promotion program.

The aim of our study was to compare the changes in children's oral health-related behavior, knowledge, and attitudes obtained using an oral health-promotion approach, a risk-strategy and promotion approach, and reference area, and to report changes in the behavior of children between the experimental and the control groups of a randomized clinical trial (RCT). The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori, Finland (n = 1,691), where the RCT and program of oral health promotion were implemented for 3.4 yr. Children with at least one active caries lesion were randomly assigned to experimental (n = 250) and control (n = 247) groups. Children in Rauma (n = 807) acted as the reference. Changes in children's self-reported behavior, knowledge, and attitudes were compared between groups. The subjects in the oral health-promotion group and in the risk-strategy and promotion group in Pori tended to show greater improvement in most of their oral health-related behaviors than those in the reference group, and children in the RCT experimental group showed greater improvement in most of their oral health-related behaviors than those in the RCT control group. Children can be helped to improve their oral health-related behavior by intervention, including oral hygiene and dietary counseling, or by implementing a multilevel-approach oral health-promotion program.

Factors associated with different measures of dental fear among children at different ages.

PURPOSE: This study's purpose was to determine the associations between 4 dental fear measures and treatment procedures, oral habits, and family characteristics at different ages. METHODS: Independent random samples of 6-, 9-, 12-, and 15-year-olds were drawn in 2 cities (N=180 per age group from both cities). The study group comprised 270, 283, 311, and 293 subjects who were 6, 9, 12, and 15 years old, respectively. The total inclusion rate was 80%. The data concerning dental treatment procedures during the 3 preceding years were collected from patient records. Four measures (treatment of dental decay, attending dentist, general dental fear, and peak value for dental fear) were drawn from the questionnaire, including 11 fear-related questions (a modified children's dental fear survey schedule). Oral health habits and family characteristics were also recorded. Age-specific logistic regression analyses were performed using different fear measures as dependent variables. RESULTS: The relationship between child's dental fear (CDF) and oral health habits, family characteristics, and earlier treatment procedures differed among different ages, even when the same CDF measure was used as the dependent variable. CONCLUSIONS: When evaluating children's dental fear, dentists should understand that CDF-related factors vary at different ages and according to the fear type.

Cost-effectiveness of an experimental caries-control regimen in a 3.4-yr randomized clinical trial among 11-12-yr-old Finnish schoolchildren.

The aim of this study was to assess the cost-effectiveness of an experimental caries-control regimen in a randomized clinical trial (RCT) conducted in Pori, Finland, in 2001-2005. Children (n = 497) who were 11-12 yr of age and had at least one active initial caries lesion at baseline were studied. The children in the experimental group (n = 250) were offered an individually designed patient-centered regimen for caries control. The children in the control group (n = 247) received standard dental care. Furthermore, the whole population was exposed to continuous community-level oral health promotion. Individual costs of treatment procedures and outcomes (DMFS increment score) for the follow-up period of 3.4 yr were calculated for each child in both groups. The incremental cost-effectiveness ratio was euro 34.07 per averted DMF surface. The experimental regimen was more effective, and also more costly. However, the total costs decreased year after year, and for the last 2 yr the experimental regimen was less expensive than the standard dental care. The experimental regimen would probably have been more cost-effective than standard dental care if the follow-up period had been longer, the regimen less comprehensive, and/or if dental nurses had conducted the preventive procedures.

Age-specific associations between dental fear and dental condition among adults in Finland.

OBJECTIVE: Our objective was to study whether dental condition, measured by numbers of sound, decayed, missing, and restored teeth, was associated with dental fear, and whether age, dental attendance, and/or gender modified this association. MATERIAL AND METHODS: The sample (n=8,028) comprised Finnish adults aged 30 years and older and the study included people (n=6,335) who participated in a home interview and a clinical dental examination. Dental fear was measured by the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analysis was used to determine the association between dental fear and dental condition variables, i.e. numbers of decayed, missing, sound, and restored teeth considering the effects of age, attendance, and gender. RESULTS: With the exception of number of restored teeth, all dental condition variables were associated with dental fear. The association between dental fear and number of decayed teeth was positive and was independent of age, gender, and attendance. Age modified the association between dental fear and number of missing and sound teeth. Among the oldest age group, the numbers of missing and sound teeth were positively associated with dental fear while being negatively associated among the youngest age group. CONCLUSIONS: People with high dental fear have poorer dental condition than those with lower fear. Neither gender nor dental attendance affects the association between dental fear and dental condition. The associations between dental fear and numbers of missing and sound teeth vary according to year of birth.

Dental fear and oral health habits among adults in Finland.

OBJECTIVE: The aim of our study was to evaluate the association between dental fear and oral health habits (tooth-brushing, use of toothpaste, dental floss and toothpicks, smoking and dental attendance), while simultaneously considering the effect of age, gender, and attained level of education. MATERIAL AND METHODS: The nationwide two-stage stratified cluster sample (n=8028) was representative of Finnish adults aged 30 years and older. The response rate was 88%. Dental fear was determined by the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and oral health habits, including age, gender, and attained level of education. RESULTS: Regular smokers were more likely to be very afraid of visiting a dentist than were those who smoked occasionally or not at all. Age modified the effect of dental attendance and tooth-brushing on dental fear. Among 65+-year-olds, those who brushed their teeth less than twice a day were more likely to be very afraid of visiting a dentist than were those who brushed at least twice a day. Irregular attenders were more likely to be very afraid of visiting a dentist than were regular attenders, the effect being strongest among 65+-year-olds. CONCLUSIONS: Birth cohort has to be taken into account when associations between dental fear and oral health habits are studied. Dental teams have to be aware of the associations between dental fear and smoking because of the adverse effects of smoking on oral health and the risk of irregular attendance among those with high dental fear.

Oral health-related behaviors predictive of failures in caries control among 11-12-yr-old Finnish schoolchildren.

The aim of this study was to determine whether the baseline oral health-related behaviors of the participants of the intervention group of a randomized clinical trial conducted in Pori, Finland, were predictive of failures in controlling caries. Three definitions of failure were considered, namely if the children developed one or more, three or more, or five or more new caries lesions, as evidenced by the change in number of decayed, missing or filled surfaces (Delta DMFS) during the follow-up period of 3.4 yr. Children (n = 497) aged 11-12 yr, with at least one active initial caries lesion at baseline, were studied. The data were based on clinical examinations in 2001 and 2005 and on a questionnaire on oral health-related behaviors that was administered in 2001. Associations between baseline behaviors and the measures of failure in caries control were evaluated using logistic regression analyses. Self-reported tooth brushing with fluoride toothpaste at least twice a day reduced the risk of failure. Children who, at baseline, reported eating candy at least once a day were more likely to experience failure at the levels of three or more and five or more new lesions.

Oral health impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures.

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data (n = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14-item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects >/= 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3-0.8) and 0.7 (0.5-0.9) for 30-34-yr-old and 34-74-yr-old subjects, respectively. The odds ratios for those with 1-9 teeth and for those who were edentate were 3.4 (2.4-4.9) and 4.0 (2.6-6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.

Effect of dietary habits on laser fluorescence values of visually sound occlusal surfaces among Finnish schoolchildren.

AIM: This study was designed to ascertain whether schoolchildren with unfavourable dietary habits have higher values for laser fluorescence on clinically sound occlusal tooth surfaces than do those who have favourable dietary habits. DESIGN: The study was conducted in two phases. In the first phase, 462 children aged 13-14 years answered a questionnaire on dietary habits. The children were ranked according to a total score based on the presumed harmfulness of their dietary habits. One hundred children with the lowest and highest dietary scores were invited to the second phase of the study consisting of a visual examination, laser fluorescence scanning of premolars and molars, and an oral self-care questionnaire. RESULTS: Seventy-four and 76 children with favourable and unfavourable habits, respectively, were examined. A total of 1221 sound occlusal surfaces were scanned. Children with unfavourable dietary habits had higher median laser fluorescence values than did those with favourable habits (P < 0.0246). The effect of dietary habits was strongest in molars. CONCLUSION: High laser fluorescence values on several clinically sound occlusal surfaces of a child may indicate unfavourable dietary habits.