The impact of priming on dentally induced social judgements: An experimental study.

OBJECTIVE: To ascertain the effects of priming to consider tooth appearance (i.e. exposure to a 'tooth whitening television advert') versus control (a 'non-dental' television advert) on social judgements of tooth colour in a group of Caucasians. METHODS: Two groups of Caucasians randomly assigned to watch either a tooth-whitening advert (experimental, N = 67) or a bread advert (control, N = 62). All rated the measures of social perceptions: friendliness, popularity, social life, success, intelligence, graduation, introversion/extroversion, happiness, self-confidence, attractiveness, age-estimation and satisfaction, after watching either of the adverts and viewing three digitally modified photographs (Darkened, natural and whitened teeth) of different Caucasian adults (males and females) separately. RESULTS: There were no statistically significant differences for all the measures of social perception between the groups. Nevertheless, the questions that inquired about popularity, friendliness, success, intelligence, happiness, self-confidence, attractiveness and satisfaction were consistently rated higher for all three tooth shades in the experimental than the control groups. Further, within the experimental and control groups, higher ratings were given to the faces with whitened teeth than the natural and darkened teeth. CONCLUSIONS: Priming has little impact on dentally induced social judgements as this study failed to demonstrate statistically significant differences. Nevertheless, both groups gave the highest subjective ratings for the faces with whitened teeth and the tooth-whitening advert group associated the faces in the photographs with higher subjective ratings than the non-dental advert group irrespective of the tooth shade. One reason for this could be the way media affects the psychological well-being. CLINICAL SIGNIFICANCE STATEMENT: The almost universal exposure to idealised tooth appearance in the media may increase demand for aesthetic treatments. Standardising the colour of the tooth plays a huge impact and making individuals to view a tooth whitening advert just prior to a procedure might influence patient choices.

Perception about tooth colour and appearance among patients seen in a tertiary hospital, South-West, Nigeria.

INTRODUCTION: patients´ satisfaction with their dental appearance and tooth colour is often influenced by certain factors which need to be addressed periodically among different populations. METHODS: a self-administered questionnaire consisting of sociodemographic data, questions on patients´ satisfaction with tooth colour, perceived malalignment of teeth, non-aesthetic anterior tooth-coloured restoration and presence of tooth fracture were distributed. Data collected was analysed using Statistical Package for Social Sciences (IBM, SPSS version 20). Chi square was used to test the statistical differences at a significance of p> 0.05. RESULTS: a total of 410 patients (M=147, F=263) participated in the study. About 73% had tertiary education while 36.3% were within the modified ISCO-08 Group 2. The respondents that were satisfied with the general dental appearance and tooth shade were 66.3% and 63.5% respectively. More males (65.1%) than females (62.7%) were satisfied with tooth colour while more females (69.1%) were satisfied with dental appearance. The older age group were more satisfied with dental appearance and tooth colour. Awareness of tooth whitening (Over 80%) and the desire to undergo tooth whitening was more among the post-secondary individuals. More of dental patients (73.1%) than medical (59.2%) were satisfied with teeth appearance (p=0.003). CONCLUSION: patients are increasingly aware of their dental appearance/tooth colour and the need to improve it with tooth bleaching and/or orthodontic treatment. Female were more dissatisfied with their tooth colour but more satisfied with their dental appearance than the male. Older people were more satisfied with their dental appearance and tooth colour compared to younger age group.

Aesthetic perceptions and social judgments about different enamel opacities.

This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Aesthetic perceptions and social judgments about different enamel opacities

Abstract This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Concerns about dental aesthetics are associated with oral health related quality of life in Southern Brazilian adults.

It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals' perceptions of aesthetics.

Concerns about dental aesthetics are associated with oral health related quality of life in Southern Brazilian adults / Preocupações sobre a estética dentária com qualidade de vida relacionada à saúde bucal em adultos no sul do Brasil

Abstract It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals' perceptions of aesthetics.

Resumo O objetivo do presente estudo foi avaliar a associação entre a aparência dos dentes com a qualidade de vida relacionada à saúde bucal. Quinze centros de atenção primária com serviços odontológicos foram selecionados em Porto Alegre, Brasil. Os indivíduos foram entrevistados a partir de uma amostragem aleatória de domicílios. O desfecho avaliado foi ter um escore de OHIP14 > 0. As exposições foram: cor e posição autorreferida dos dentes, percepção da saúde bucal e preocupação com a estética dental. Os dados foram analisados com regressão logística. De 1.943 indivíduos contatados, 433 utilizaram os serviços públicos odontológicos, dos quais 73% tinham algum impacto na qualidade de vida; 35,2% dentes manchados e 47,5% dentes apinhados. Além disso, 22,2% já haviam tentado clarear os dentes. Indivíduos preocupados com a cor tinham 2,56 vezes (IC 95%: 1.34-4.89) mais chances de relatar qualquer impacto após o ajuste para número de dentes, tabagismo e educação. Preocupações com a posição dos dentes, relato de dentes manchados ou apinhados, idade, sexo e renda não foram significativas (p > 0,30). Houve uma associação direta e independente entre as preocupações com a cor do dente e qualidade de vida. O efeito da cor do dente pode ser mediado pela percepção da estética.

Effectiveness and Impact of the Walking Bleach Technique on Esthetic Self-perception and Psychosocial Factors: A Randomized Double-blind Clinical Trial.

OBJECTIVE: This trial evaluates the impact of psychosocial and esthetic self-perceptions of patients undergoing nonvital tooth bleaching using the walking bleach technique. We also assessed the clinical effectiveness of bleaching tooth discoloration. METHODS: Fifty volunteers with nonvital tooth discoloration were enrolled. Teeth were randomized into two groups: 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Intracoronal bleaching was performed over four sessions using the walking bleach technique. Tooth color was evaluated at each session to measure total color variation. The shade guide was arranged from highest (B1) to lowest (C4) values to assess the color and calculate the color change in the number of shade guide units. Subjective and objective assessments were compared with the tooth counterpart. Esthetic self-perception and psychosocial factors were assessed before and after treatment. RESULTS: Color change was 15.48<5.17 for hydrogen peroxide and 14.02<4.85 for carbamide peroxide. There was no significant difference at any time point (p>0.05) except at sessions 3 and 4 (p<0.05). Overall, whitened teeth values were similar to those of counterpart teeth (p>0.05). There was a decrease in Oral Health Impact Profile and Psychosocial Impact of Dental Esthetics questionnaire scores after treatment compared with baseline (p<0.05). CONCLUSION: The walking bleach technique was highly effective on nonvital teeth and had a positive effect on self-esthetic perception and psychological impact for the patients.

Tooth colour and whiteness: A review.

OBJECTIVES: To review current knowledge concerning the application of colour science on tooth colour and whiteness description, measurement, distribution and its psychological impact. DATA SOURCES: "Scopus" databases were searched electronically with the principal keywords tooth, teeth, colour, white, whiteness. Language was restricted to English and original studies and reviews were included. Conference papers and abstracts were excluded. CONCLUSIONS: The appearance and colour of teeth are a common concern for patients across many populations and are associated with an increased desire for treatments that improve dental aesthetics, including tooth whitening. The application of colour science in dentistry has allowed the precise description of tooth colour and whiteness. Coupled with the advances in instrumental tooth colour measurement, such as spectrophotometers, colorimeters, spectroradiometers and digital imaging systems, these parameters are quantifiable in a reproducible and robust manner. These principles have been applied to the tooth colour distribution in many study populations, indicating, in general, differences in tooth colour for subject age and gender, but not for ethnicity. Psychophysical studies on tooth colour and whiteness via third party assessment of images indicate that whitened teeth lead to judgements that are more positive on personality traits such as social competence and appeal, intellectual ability and relationship satisfaction.

Effect of dark discolouration and enamel/dentine fracture on the oral health-related quality of life of pre-schoolers.

AIM: To determine the effect of different types of dental trauma on oral health-related quality of life (OHRQoL) among pre-school children. METHODS: Four hundred fifty-nine Brazilian pre-schoolers aged 3-5 years were submitted to an oral examination in the school environment for the evaluation of dental trauma using the criteria proposed by Andreasen et al. (2007). Parents answered a questionnaire on the OHRQoL of the children using the Early Childhood Oral Health Impact Scale (ECOHIS) and another one on socio-demographic characteristics of the children and their families. The questionnaires were sent to the parents to be answered at home. Descriptive statistics, Mann-Whitney test and Poisson regression were used for statistical analysis. RESULTS: Children with dark discolouration and enamel-dentine fracture without pulp exposure had higher mean ECOHIS scores than those without these alterations. The multivariate regression analysis demonstrated that pre-school children with dark discolouration (PR 1.79; 95% CI 1.24-2.58) and enamel-dentine fracture without pulp exposure (PR 1.89; 95% CI 1.22-2.92) had a higher impact on quality of life than those without these alterations. CONCLUSION: Dark discolouration and enamel-dentine fracture without pulp exposure were associated with a negative impact on the life of pre-schoolers.

Perception of adults' smile esthetics among orthodontists, clinicians and laypeople.

OBJECTIVE: Smile esthetics has become a major concern among patients and orthodontists. Therefore, the aim of this study was: (1) To highlight differences in perception of smile esthetics by clinicians, orthodontists and laypeople; (2) To assess factors such as lip thickness, smile height, color gradation, tooth size and crowding, and which are associated with smile unpleasantness. METHODS: To this end, edited photographs emphasizing the lower third of the face of 41 subjects were assessed by three groups (orthodontists, laypeople and clinicians) who graded the smiles from 1 to 9, highlighting the markers that evince smile unpleasantness. Kruskall-Wallis test supplemented by Bonferroni test was used to assess differences among groups. Additionally, the prevailing factors in smile unpleasantness were also described. RESULTS: There was no significant difference (P = 0.67) among groups rates. However, the groups highlighted different characteristics associated with smile unpleasantness. Orthodontists emphasized little gingival display, whereas laypeople emphasized disproportionate teeth and clinicians emphasized yellow teeth. CONCLUSION: Orthodontists, laypeople and clinicians similarly assess smile esthetics; however, noticing different characteristics. Thus, the orthodontist must be careful not to impose his own perception of smile esthetics.

Knowledge and behaviour of parents in relation to the oral and dental health of children aged 4-6 years.

AIM: To evaluate baseline knowledge and behaviour of parents with regard to the oral and dental health of their young children. METHODS: Following ethical approval, six urban and rural schools were identified. Questionnaires were distributed to the parents of pupils (children aged 4-6 years). The questionnaire included several questions evaluating parental knowledge and behaviour of oral and dental health issues in their children. Each question was assigned a score of either 0 or 1 being inconsistent or consistent with current paediatric guidelines giving a maximum score of 6 for knowledge and 7 for behaviour. Chi-square analysis was used to analyse associations among variables. RESULTS: Parental knowledge varied widely among parents and across questions; however, 70.2 % of parents had scores greater than 3 (range 0-6). The majority of parents (65.8 %) also had scores greater than 3 (range 0-7) for behaviour. Deficiencies were noted in oral hygiene practices; very few parents brushed their child's teeth and were not aware of the recommended age of the first dental visit at 1 year (Age 1 visit). Parents without free medical care demonstrated high levels of knowledge (P < 0.05). Almost half of the parents thought that the information available to them on the oral health of their young children was insufficient. CONCLUSION: Parents appeared to have limited knowledge regarding the dental and oral health of their young children. This study indicates a need for improved education for parents, particularly in toothbrushing behaviour and use of toothpaste. Education strategies tailored to the Irish population should be explored.

How do children view other children who have visible enamel defects?

BACKGROUND: Facial and dental appearance influences how individuals are perceived by others. AIM: This study aimed to determine whether young people make judgements about other young people with visible enamel opacities. DESIGN: Focus group findings were used to develop a social attribute questionnaire to capture young people's dental appearance-related judgements. 547 pupils (aged 11-15 years), from two different schools, participated in the study. Half the participants were given full-face photographs of a boy and girl without an enamel defect, and the other half were given the same two photographs with the subjects' incisors digitally modified to show enamel opacities. Participants completed the attribute questionnaire to rate the photographic subjects according to six positive and five negative descriptors using a four-point Likert scale. The total attribute score (TAS) could range from 11 (most negative) to 44 (most positive). RESULTS: TAS was significantly lower for photographic subjects with enamel defects compared to the same subject with normal enamel appearance (P < 0.001, one sample t-test). Gender had a significant impact on TAS, with boys making more negative judgements than girls. Age and socio-economic status did not have an effect. CONCLUSION: Young people may make negative psychosocial judgements on the basis of enamel appearance.

Contributions of dental colour to the physical attractiveness stereotype.

Dental appearance may play a key role on the way we develop a first impression of another person. To test whether relatively minor changes in the lightness of tooth colour would influence the perceived social appeal (social, intellectual, psychological and relational abilities) of an unknown male and unknown female, this cross-sectional study was performed on 555 Spanish adults. The two major independent variables related to the photograph were tooth lightness (computer-derived), divided into three levels that included lightened teeth, natural teeth and darkened teeth, and the gender of the observed face. Moreover, six independent variables related to the observer were assessed (age, gender, educational level, place of residence, frequency of brushing and self-reported health status). The dependent variables were scored on five-point Likert scales designed to quantify four domains (social, intellectual, psychological and relationship competences) of the Social Appeal Scale (SAS). Tooth lightness influences the perception of social appeal in all dimensions, as darkened smiles received significantly poorer scores than natural-colour smiles, but these were also worse than lightened smiles. A logistic regression analysis revealed that the major predictor of social appeal was tooth lightness, and for each increment in lightness (from darkened to lightened smiles), the odds ratio (OR) of positive values being perceived increased significantly in all items (from 2·3 in Popularity to 6·9 in Happiness). A perceptible change in dental lightness is the strongest factor associated with the dental attractiveness stereotype, affecting significantly the 12 traits assessed, but mainly the Happiness, Social Relations and Academic Performance.

Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial.

OBJECTIVES: This study aimed to assess changes in oral health-related quality of life (OHRQoL) in individuals enroled in a double-blind randomized clinical trial conducted to evaluate the efficacy and safety of two carbamide peroxide concentrations used in at-home vital bleaching in the city of Pelotas, Southern Brazil. METHODS: Ninety-two volunteers with a shade mean of C1 or darker for the six maxillary anterior teeth were randomized into two balanced groups (n=46) according to bleaching agent concentration: 10% or 16% carbamide peroxide. The patients were instructed to use the whitening agent in a tray for 2h once a day for three weeks. To assess changes in OHRQoL, participants completed the oral impact on daily performance (OIDP) at the start and one week after the completion of treatment. Because there was no difference with regard to whitening effect or tooth sensitivity during or after treatment the two groups were merged for the analyses of the current article. Before-and-after changes in OIDP scores were assessed by chi-square and McNemar tests (p<0.05). RESULTS: Mean pre- and post-treatment OIDP scores varied from 0.42 to 0.60. When the frequency of impacts for different activities were compared, there was an increase in difficulty in cleaning teeth (p=0.02) and a significant reduction in smiling and showing teeth with embarrassment (p=0.03). Regarding the symptoms and main oral conditions that generated impact, there was higher number of participants reporting pain (p=0.05) after treatment. In opposite, significant decrease was observed in individuals reporting being unhappy with their appearance (p=0.03). On the contrary, it was showed a decrease in impacts resulting from dental colour was observed after bleaching (p=0.03). CONCLUSION: Quality of life is complex and encompasses different domains. Although positive impact of the dental bleaching was detected, with patients showing more their teeth without embarrassment, difficult in dental hygiene and pain resulting from the treatment were also reported, and this can negatively impact daily performances. Dentists must consider these aspects when performing aesthetics procedures.

The relation between oral impacts on daily performances and perceived clinical oral conditions in primary school children in the Ugu District, Kwazulu Natal, South Africa.

UNLABELLED: Few studies have related the common oral health related quality of life (OHRQoL) impacts in children to perceived causes. OBJECTIVE: To assess the prevalence, extent and intensity of oral impacts in relation to perceived clinical conditions in primary school children in South Africa. METHODS: Cross-sectional study of a random sample of children attending 26 schools. The Child Oral Impacts on Daily Performance (Child-OIDP) index, administered through individual face-to-face interviews, was used. RESULTS: Sixty four per cent of the sample of 2610 children aged 11-13 years participated. 36.2% reported having one or more oral impacts on daily performances, 61.1% having one affected and 63.1% reporting impacts were of "very little" or "little" intensity. Eating was most commonly affected (22.8%) mainly related to decay (40%), followed by cleaning the teeth (17.2%). Toothache impacted on speaking (32.5%), whereas toothache (35.7%) and tooth decay (28.6%) influenced studying. Position of teeth impacted on smiling (19.2%), social (8.5%) and speaking (7.5%). Bleeding gums" and "tooth colour" affected cleaning teeth and smiling respectively. CONCLUSIONS: The prevalence of oral impacts on the quality of life in this South African population of schoolchildren was relatively modest, as was the extent and intensity of the impacts, affecting mainly eating, cleaning of teeth and smiling.

Using associations between oral diseases and oral health-related quality of life in a nationally representative sample to propose oral health goals for 12-year-old children in Thailand.

OBJECTIVES: This study was carried out to assess the associations between oral diseases and specifically oral health-related quality of life (OHRQoL) in a nationally representative sample of 12-year-old children in Thailand in order to classify children according to their levels of risk for adverse OHRQoL and to apply findings to formulate proposals for oral health goals. METHODS: Oral examinations and OHRQoL interviews using the Child-Oral Impacts on Daily Performances (Child-OIDP) schedule were conducted in 1,100 children as part of the Thailand National Oral Health Survey. The severity of oral impacts was categorised according to their 'intensity'. Associations of oral diseases and condition-specific (CS) OHRQoL impacts were investigated. RESULTS: Oral impacts were prevalent. Most were of low intensity; these were excluded from the analysis used to develop goals. At the threshold of moderate/high intensity, CS impacts attributable to dental caries, edentulous areas, periodontal disease and discolouration were reported by 18.5%, 0.2%, 8.7% and 2.6% of participants, respectively. Missing teeth was significantly related to CS impacts. Condition-specific impacts were 1.6 times and three to four times more likely to affect children with one decayed tooth and two or more decayed teeth, respectively. Children with gingivitis or calculus in three or more sextants were twice as likely and children with calculus and gingivitis in three or more sextants were 3.5 times more likely to report CS impacts. Based on these findings, these recommendations are proposed: all 12-year-old children should have fewer than two untreated decayed teeth; 60% of 12-year-old children should not have periodontal disease in any form in more than two sextants, and the proportion of 12-year-old children with calculus with gingivitis in three or more sextants should not exceed 5%. CONCLUSIONS: Measures of oral health and goals for oral health in children should include measures of OHRQoL.

Level of education and gender-specific self-reported oral health behavior among dental students.

PURPOSE: To identify the oral health attitudes/behaviour among dental students in Jordan, and analyse the variations in oral health attitudes based on gender and level of education. MATERIALS AND METHODS: Out of the 653 registered dental students at the faculty of dentistry, 580 students (455 females and 125 males, mean age = 20.1 ± 1.6 years) participated in the study (response rate 89%). The Hiroshima University-Dental Behavioural Inventory (HU-DBI) was used to assess oral heath attitudes and behaviour of the participants. Data were analysed using the chi-square test, and statistical significance was set at P < 0.05. RESULTS: Females had better oral health attitudes and behaviour, especially towards visiting the dentist, toothbrushing habits and oral hygiene practice (P < 0.05). Also, students from the higher years had better oral health attitudes, behaviour and knowledge, especially towards gingival health, oral hygiene practice, toothbrushing and visiting the dentist (P < 0.05). CONCLUSION: Dental students in Jordan had poor oral health attitudes and behaviour. Females had better oral health knowledge, attitudes and behaviour than males. With increasing years of study, some aspects of dental students' oral health behaviour and attitudes improved. However, this improvement was limited and students should be encouraged to become an example of oral health for their society. Better comprehensive dental education with early exposure to dental health and prevention was suggested to improve dental students' oral health attitudes and behaviour.

Dental fluorosis, dental caries, and quality of life factors among schoolchildren in a Colombian fluorotic area.

OBJECTIVE: To assess dental fluorosis, dental caries and quality of life factors associated with dental fluorosis among schoolchildren living in a Colombian endemic dental fluorosis area. METHOD: 110 12-year olds were visually examined for dental caries (ICDAS) and dental fluorosis (TF) and a self-administered quality of life and fluorosis questionnaire was applied. RESULTS: The prevalence of dental fluorosis reached 100% in this sample with most children falling within the TF 3 severity category. Varying degrees of severity were observed as follows for TF 1 to 6: 1%, 16%, 62%, 16%, 4%, 2%. The prevalence of caries experience (DF-S2) was 54%. The DF-S2 mean was 4.4 (sd 4.3). The principal contributor to the DF-S2 outcome was the decayed component. When initial caries lesions were included (ICDAS-scores 1-3) the mean DF-S1,2 increased to 10 (sd 5.1). The association between fluorosis and dental caries was not statistically significant (p > 0.05). Children not only detected the presence of something abnormal in their teeth but also reported feeling embarrassed, and worried due to their dental appearance. Almost 60% of the children reported avoiding smiling because of their teeth's appearance. CONCLUSIONS: The high prevalence of dental fluorosis and dental caries combined with the schoolchildren's negative perception about their dental health reflects the need to propose effective dental public health policies to regulate multiple exposures to fluoride at an early age, and to improve health outcomes in a highly vulnerable population.

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.