Outcome of a Community-Based Oral Health Promotion Project on Primary Schoolchildren's Oral Hygiene Habits.

The aim of this study was to evaluate the effect of a school-based intervention project conducted in a mid-sized Finnish city, Laukaa on schoolchildren's oral health behavior. Material and Methods. In the intervention, all children received dental education and some of the 7-12-year-old schoolchildren received individual tooth brushing instructions by a dental nurse in 2009-2010. Parents were present at the instruction sessions. In 2009 and 2010, all the children answered a questionnaire or an oral hygienist on their oral health behavior without identification. Results. Tooth brushing frequency increased significantly among the schoolchildren between the years 2009 (61.2%) and 2010 (65%) (P < 0.05); more so among younger children (7-10-year-olds) compared to the older ones (11-12-year-olds). The 2010 results showed a slight trend of decreasing tooth brushing frequency by age both among girls and boys. Younger children got significantly more often parental help or reminding. The girls brushed their teeth significantly more frequently (71.9%) than boys (57.0%). Conclusions. Our findings indicate that oral health intervention can be beneficial on health behavior especially for children at low grades. All children, 11 to 12 years of age, especially boys, need continuous health promotion.

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.

The effect of xylitol on the composition of the oral flora: a pilot study.

OBJECTIVES: Our aim was to investigate the effect of short-term xylitol consumption on the microbial composition of plaque and saliva. METHODS: Twelve volunteers (22-38 yrs) harboring mutans streptococci (MS) participated in the randomized, double-blind, cross-over study. The experimental chewing gum contained 65% xylitol while the control gum contained 63% sorbitol and 2% maltitol w/w. The polyol dose was approximately 6 g/day. Stimulated saliva and plaque samples were collected before and after the two four-week test periods. The samples were cultured for MS, total streptococci, lactobacilli, and total facultatives. A part of the samples were subjected to DNA-DNA hybridizations of 14 microbial plaque species: Actinomyces naeslundii, A. viscosus, Fusobacterium nucleatum, Lactobacillus acidophilus, L. fermentum, L. paracasei, L. rhamnose, L. plantarum, Streptococcus gordonii, S. oralis, S. parasanguis, S. salivarius, S. sanguinis, Veillonella parvula. RESULTS: The MS counts of the plaque samples collected from "caries-prone" tooth sites decreased significantly (P<.01) in the xylitol gum group but not in the sorbitol gum group. Also the plaque MS percentage decreased significantly in the xylitol gum group (P<.01). The salivary MS counts did not decrease either in the xylitol or in the sorbitol gum groups. Nor were changes detected in the salivary levels of total streptococci or lactobacilli. The DNA-DNA hybridization assay revealed no study-induced changes in the microbial composition of the dental plaque. CONCLUSIONS: Within the limitations of this pilot study, xylitol consumption reduced MS counts in plaque but appeared not to affect the microbial composition of plaque or saliva in general.

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.

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.

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.

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.

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.

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.

Oral health-related knowledge, attitudes, behavior, and family characteristics among Finnish schoolchildren with and without active initial caries lesions.

OBJECTIVE: The aim of this study was to determine whether the presence of active initial caries lesions among 11 to 12-year-old schoolchildren is associated with parental and child-related factors and whether there are gender differences in these associations. MATERIAL AND METHODS: The data were gathered by questionnaires from children and their parents, who replied without knowing the other's answers. All the children were invited to participate in a screening for the presence or absence of active initial caries lesions. Factors associated with children's initial caries were studied with logistic regression analyses. RESULTS: The parents' self-assessed poor dental health, the parents' and the child's poor oral health-related behavior, and the child's response "I don't know" to the question concerning his/her parents' possible dental caries were associated with the presence of active initial caries lesions. The results of logistic regression analyses were different between girls and boys. Among the girls, many parent-related factors were associated with the presence of initial caries. Among the boys, most factors were related to the child; and of the parent-related factors, only parents' poor self-assessed dental health was associated with initial caries; the effect was modified by the father's occupational level. CONCLUSIONS: Parental factors affect boys' and girls' dental health differently. Among boys, the effect of the fathers was seen as the father's occupational level; among girls, parental knowledge and behavior were important. When school interventions to promote health are planned, the important role of the parents should be emphasized.

Dental fear of Finnish children in the light of different measures of dental fear.

OBJECTIVES: The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the "peak value for dental fear" (PV), and "fear of dental treatment in general" (GF). METHODS: The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. RESULTS: The questionnaire was reliable. Two factors were revealed for each age: "treatment of dental decay" (TDD), which included fears related to invasive treatment, and "attending the dentist" (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. CONCLUSION: The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.

Dental fear and oral health and family characteristics of Finnish children.

OBJECTIVES: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. METHODS: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle-sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. RESULTS: Dental fear was higher among 12- and 15-year-old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12-year-olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six- and 12-year-olds who had experienced caries were more likely to report dental fear than were caries-free children. Among 6-year-olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. CONCLUSIONS: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

Fluoride varnishes in caries prevention.

The first fluoride varnishes were developed during the 1960s (Duraphat) sodium fluoride varnish) and 1970s (Fluor Protector) silane fluoride varnish) to prolong the contact time between fluoride and enamel. Fluoride varnishes adhere to enamel, and calcium fluoride formed after application acts as a long-term reservoir of fluoride. Currently Duraphat varnish is the most widely used topical fluoride for professional application in Europe, and the use of fluoride varnishes is increasing in the USA. Duraphat varnish has been effective in three decades of clinical studies, but the results of Fluor Protector varnish are inconclusive. The percent caries reductions found in the 1990s have generally been lower than those reported in earlier studies, probably because of the higher exposure to other preventive measures in the more recent studies. In studies comparing Duraphat varnish and APF gel, Duraphat varnish was equally or more effective than APF gel. Sealants were most effective in preventing occlusal caries. Four applications per year, or three weekly applications once a year, have been found to be effective. However, several studies have shown that two applications per year may provide comparable results. Application is fast and easy. Professional prophylaxis is not necessary, and the patient can leave immediately after the treatment. No acute toxicity has been reported after using any fluoride varnish.

Development of a standardized method for comparing fluoride ingested from toothpaste by 1.5-3.5-year-old children in seven European countries. Part 1: Field work.

OBJECTIVES: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites. METHODS: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. Variables measured were: type of toothpaste used, fluoride concentration of toothpaste used, weight of toothpaste used, frequency of brushing and body weight of the child. RESULTS: It was not possible to follow the agreed protocol in all seven countries and in three countries appropriate alternative methods were employed. There was considerable variation between countries in the variables investigated. Use of children's toothpaste ranged from 69% in Ireland to 98% in Portugal. In the Netherlands up to 60% of the children were using toothpaste containing <400 ppm F and in Finland up to 27% of children were using toothpaste containing >1200 ppm F. Over half of the children used <0.25 g of toothpaste per brushing and the majority of children brushed once or twice per day. CONCLUSION: Although adherence to the agreed protocol was not possible at all study sites there was a clear picture of considerable variation in the oral hygiene practices of young children throughout Europe.

Development of a standardized method for comparing fluoride ingested from toothpaste by 1.5-3.5-year-old children in seven European countries. Part 2: Ingestion results.

OBJECTIVES: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites. METHODS: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. The difference between the fluoride dispensed onto the toothbrush and the fluoride recovered after accounting for losses was deemed to be the fluoride ingested. Details of other oral health-care habits were collected by questionnaire. For each child, the fluoride concentration of the toothpaste used was measured in the laboratory, from which an estimate of total daily fluoride ingestion was made. RESULTS: There was considerable variation between countries in the types of toothpaste used and in the amounts of toothpaste applied and ingested. The amount of fluoride ingested ranged from 0.01 to 0.04 mg fluoride per kg of body weight per day. CONCLUSION: The amount of fluoride ingested that is likely to be a risk factor for the development of dental fluorosis during tooth formation is equivocal and was found to vary widely between European countries. There appears to be a need for clearer health messages regarding the use of fluoridated toothpaste by young children.

A European perspective on fluoride use in seven countries.

OBJECTIVES: The aim of this study was to collate data on national policies for the use of fluoride in the seven European countries participating in the FLINT project. METHODS: Policies on the use of fluoride were obtained for each of the study areas. Data collected included the presence of water fluoridation and regulations governing fluoride toothpaste and fluoride supplements. RESULTS: In Ireland 74% of the population had a fluoridated water supply but in all the other countries fluoride toothpaste was the principal form of delivering fluoride, usually recommended as a dose of a pea-sized amount. Fluoride supplement use varied considerably between countries. The Netherlands had the clearest regulations covering the use of fluoride supplements and definition of at-risk individuals. Most countries, even if they recognized particular caries-risk did not define the term clearly. In Iceland all children were regarded as being at high risk of developing caries. CONCLUSION: Considerable variation exists between European countries in their policies for fluoride use and no clear definitions of high-caries-risk individuals were found. The results show that there is even a lack of coherent thought and planning within the different countries, let alone between them.

Fluoride ingestion from toothpaste: conclusions of European Union-funded multicentre project.

An important challenge encountered in this multicentred project was the need to take account of the different cultural and legal differences between the seven sites when agreeing the protocol. Examples such as access to registers of births and subject consent dictated that there were some differences in the methods used in the different sites. The data presented showed that it was possible to train and calibrate a number of examiners in a standardized photographic method for recording enamel fluorosis. This method has a number of important advantages for the objective monitoring of enamel fluorosis over time. There were considerable differences between the seven sites in the formulations of the toothpaste used and in the pattern of their use. The results indicate that it is possible to agree and adopt a standardized method for measuring fluoride ingestion from toothpaste. The aesthetic impact of enamel fluorosis seemed low in the populations included in this project, but further work is required on this issue.