Oral health of people experiencing homelessness in London: a mixed methods study.

BACKGROUND: Those experiencing homelessness have significant health and oral health needs and are at the extreme of health inequalities. The aim of the study was to conduct an oral health needs assessment for those experiencing homeless in London and impacts on their oral health-related quality of life. METHODS: The oral health needs assessment consisted of quantitative and qualitative methods. This included a survey questionnaire to assess perceived oral health needs, and oral health related quality of life. In addition, a focus group was conducted with 13 peer advocates. RESULTS: Findings from the focus group revealed numerous challenges for homeless populations to maintain good oral health and access to dental care including mental ill-health, stigma, costs, and chaotic lifestyles. A response rate of 79% (n = 315) was achieved for the questionnaire survey. Results showed high levels of unmet dental needs and risky health behaviours including 60% reporting being smokers, 39% consuming high amounts of sugar and 52.4% brushing their teeth less than twice a day. More than a third (32.1%) had experienced toothache. The majority of respondents 80% (n = 224) were very or fairly concerned about their dental health. There were significant associations between perceived oral health status and oral health-related quality of life. CONCLUSION: Those experiencing homelessness in London were found to have high levels of unmet oral health needs, which significantly impacted on their oral health-related quality of life. Focusing on changing behaviours alone is insufficient and therefore addressing the structural determinants of homelessness is vital in improving oral and health outcomes of this vulnerable population.

Dimensional Structure of the Early Childhood Oral Health Impact Scale.

Background: Detecting the latent dimensions of quality of life as affected by oral diseases is essential for promoting oral health in children. This study aimed to test the Early Childhood Oral Health Impact Scale (ECOHIS) via an appropriate method to detect its dimensions of quality of life as affected by oral diseases. Methods: An analytical cross-sectional study was carried out in Shiraz, Iran, between 2014 and 2015. A multistage stratified design was used to select 830 parents or the guardians of primary school children aged six years. The Farsi version of the Early Childhood Oral Health Impact Scale (F-ECOHIS) was used to evaluate the children's oral health-related quality of life. The parents were interviewed to collect data on ECOHIS. Mplus, version 7, was employed for descriptive and analytical analyses in the present study. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to extract and verify the latent dimensions of ECOHIS. Results: Out of the 830 invited parents or guardians, 801 participated in this study. The mean ECOHIS score was 21.95±7.45. The mean child impact score and the mean family impact score were 14.25±5.72 and 7.70±3.62, respectively. EFA yielded a 3-factor model: symptom and function, social interaction, and family impact. CFA confirmed the 3-dimensional model (root mean square error of approximation=0.045). The fit indices of the 1- and 2-dimensional models (the child and family domains) were not within the acceptable range. Conclusion: F-ECOHIS is a 3-dimensional model rather than the hypothetical 6-dimensional model. ECOHIS appears to be a useful scale for measuring the multidimensional impact of oral diseases in children.

The Change in DMFT of Six-Grade Primary School Children in Shiraz two Years after Implementation of the National Oral Health Reform Plan.

STATEMENT OF THE PROBLEM: The oral health reform plan has been added to the Iran's health reform plan since the beginning of 2015. Evaluation of Iran's oral health reform plan has rarely been conducted. PURPOSE: The aim of this study was to evaluate the change in DMFT among the six-grade primary school children of the city of Shiraz, two years after implementation of oral health reform plan. MATERIALS AND METHOD: A repeated cross-sectional study was conducted on six-grade primary school children of Shiraz in 2015 and 2017. About four hundred children were selected each year by cluster randomization sampling. The schools were randomly selected from three socioeconomically different types of schools including private schools, state schools in affluent areas, and state schools in deprived areas. The DMFT Index of selected children was compared between 2015 and 2017, and among three socioeconomically different areas. One-way ANOVA and Poisson regression tests were used for statistical analysis. RESULTS: The mean DMFT of children was 1.47±1.83 in 2015 and 1.29±1.79 in 2017. There was significant difference in mean DMFT value between years 2015 and 2017 (p= 0.048). The percentage of children with untreated dental caries was 46% and 36.7% in 2015 and 2017 respectively. There was no statistically difference in DMFT of the three socioeconomically different schools. CONCLUSION: There has been significant improvement in DMFT of sixth grade school children of Shiraz two years after implementation of oral health reform plan.

Designing a customized clinical practice guideline regarding antibiotic prophylaxis for Iranian general dentists.

BACKGROUND: Clinical practice guidelines produced by developed countries seemed to be not completely feasible for developing countries due to their different local context. In this study, we designed a customized guideline about antibiotic prophylaxis before dental procedures for Iranian general dentists. METHODS: This study was conducted of two parts, including a qualitative part and a cross-sectional analytic part. A multidisciplinary team searched for related guidelines and other documents, selected the most updated and high quality ones, customized their recommendations based on available antibiotics in Iran, prepared a draft adapted guideline and summarized its recommendations in 3 flowcharts. An expert panel (20 specialists of four Iranian dental universities) participated in a consensus process, afterwards to determine the relevance and clarity of the flowcharts and their items. Then the Content Validity Indices (CVIs) were calculated and any items with CVI higher than 0.79 remained. RESULTS: The adapted recommendations were summarized in flowcharts A to C. Two separate groups of patients who need antibiotic prophylaxis were presented in flowchart A; including those with high risk for distant-site infection (infective endocarditis and prosthetic joint infection) and those at risk for poor healing and orofacial infection (due to impaired immunologic function). Flowcharts B and C described antibiotic regimen and also the dental procedures where antibiotic prophylaxis was needed for mentioned groups. The content validity indices and the percentages of agreement between the expert panel members were considerably high. CONCLUSIONS: A localized, clear and straight forward guideline that addresses all groups of dental patients who need antibiotic prophylaxis has been produced for Iranian general dentists.

A qualitative study of children's quality of life in the context of living with cleft lip and palate.

BACKGROUND AND OBJECTIVE: Quality-of-life measures have been expanded to help in assessing the physical and psychosocial effects of oral health. Although, in the case of children undergoing oral surgery, the oro-facial status is generally measured by studies, it is essential to carry out investigations into the level of quality of life (QoL) after surgery to assess the actual effect of these surgeries on children's lives. Hence, our study is aimed at evaluating the QoL in these children. METHODS: The study was performed using qualitative content analysis method. Eighteen caregivers of 4-6 year old children with a history of unilateral cleft lip and palate participated in in-depth interviews about the children's experiences with different problems affecting their daily lives. The results were divided into codes, sub-categories and categories through an inductive process in which the researchers moved from the specific to the general. RESULT: A number of problems were identified, particularly insufficient functional and socio-emotional well-being including, difficulty in eating and speaking, dento-facial problems, shame, anxiety, insufficient peer interaction and dissatisfaction with their own appearance. CONCLUSION: The most critical problems derived from the participants' experiences were insufficient functional and socio-emotional well-being that contributed to the reduced QoL among these children. Long term multidisciplinary interventional strategies such as psycho-social supportive programs are required to improve the QoL of these children. These interventions should be considered from the early stages of treatment, or even early stages of diagnosis.

Do Different Modes of Delivering Postoperative Instructions to Patients Help Reduce the Side Effects of Tooth Extraction? A Randomized Clinical Trial.

PURPOSE: Postoperative instructions that are properly delivered can decrease postextraction side effects, such as stress, anxiety, and pain, in patients undergoing dental extraction. This study examined the role of the mode of delivering postoperative instructions in decreasing the side effects of dental extraction and increasing patient satisfaction after the procedure. MATERIALS AND METHODS: This randomized clinical trial was conducted on a population of 120 patients presenting to the oral and maxillofacial outpatient clinic affiliated with the Shiraz University of Medical Sciences (Shiraz, Iran) in 2015. The patients were randomly assigned to 3 groups of 40 per group. The first group received only verbal instructions after their surgical procedure. The second group received only written instructions. The third group received verbal and written instructions. Details on the patient's age, gender, and formal education were recorded before the operation using a questionnaire. The second part of the questionnaire was completed by patients 1 week after their tooth extraction and recorded their postoperative pain, bleeding, swelling, and satisfaction. Data were analyzed using the Mann-Whitney test, Kruskal-Wallis test, χ2 test, and analysis of covariance at a significance level of 95%. RESULTS: Of the 120 participants, 77 were women and 43 were men; the participants' mean age was 36.45 ± 10.69 years. The results showed that the mode of delivering instructions had a marked relation with pain and patient satisfaction. Pain intensity was significantly higher in the verbal instructions group compared with the written instructions (P = .002) and verbal plus written instructions (P = .000) groups. CONCLUSION: The mode of delivering postoperative instructions meaningfully affected pain intensity and general patient satisfaction. Patients who received verbal instructions reported the most intense pain and the least satisfaction, and patients who received verbal and written instructions were the most satisfied.

Relationship between Physicochemical Properties of Saliva and Dental Caries and Periodontal Status among Female Teachers Living in Central Iran.

OBJECTIVES: There are inconsistent data about the association between saliva properties, dental caries, and periodontal status. In this study, we tried to examine the association between dental caries and periodontal status with salivary viscosity, flow rate, pH, and buffering capacity in adults. METHODS: In the present cross-sectional study, 450 female teachers were randomly selected from schools located in Yazd, Iran. Oral examinations were conducted, and unstimulated saliva samples were collected. Salivary viscosity, flow rate, pH, and buffering capacity were assessed. The salivary physicochemical properties were compared among teachers with different types of oral health. Analyses were done using the Statistical Package for the Social Sciences version 16. RESULTS: In total, 431 female teachers aged 40.45 ± 8.18 years were included in the study. Salivary flow rate, buffering capacity, pH, and viscosity, community periodontal index status were not significantly different in participants with and without tooth caries. There was a reverse linear association between salivary pH and flow rate with the decayed, missed, and filled teeth index (P < 0.05). The saliva buffering capacity was not significantly related to dental properties. Those with bleeding on probing had lower salivary pH, and buffering capacity compared to those with healthy gum. However, the salivary resting flow rate was not different in participants with bleeding on probing and healthy participants. CONCLUSION: Based on our results, saliva properties might be important predictors in oral health status. This means that any change in saliva combination might affect periodontal and dental diseases. Future prospective studies are recommended to confirm these results.

The relation of preoperative stress and anxiety on patients' satisfaction after implant placement.

BACKGROUND: There are some factors which can affect preoperative patient anxiety such as the necessity of procedure, postoperative pain, and patient's conception of his body image. The aim of this study was to assess the relation of patients' preoperative anxiety and postoperative patients' satisfaction in dental implant surgery. MATERIALS AND METHODS: Dental implants were placed in 40 patients (19 male and 21 female) who were referred to Dental Implant Surgery Department in Imam Reza clinic, during March-December of 2014 in Shiraz. The procedures were performed with or without bone regeneration. Preoperative anxiety was evaluated using Corah Dental Anxiety Scale, and postoperative satisfaction was determined on the basis of pain intensity, bleeding tendency, inability to eating, and overall satisfaction by filling a questionnaire in the 2nd or 3rd week after surgery. Data were collected and analyzed using Mann-Whitney test. RESULTS: Preoperative anxiety was detected as high in 10%, mild in 85%, and moderate in 5% of patients. Anxiety and depression score did not differ in both genders. There was no statistical difference between neither level of anxiety nor depression in both high and low educated patients. Postoperative bleeding, difficulty in eating, and overall satisfaction was nearly the same in both genders. Statistical analysis demonstrated a lower pain level and higher pain threshold in men than women (P = 0.007). Patients' age was not related to anxiety, depression, amount of bleeding, pain, and difficulty in eating. Overall dental care satisfaction was similar in both men and women. CONCLUSION: The results of the study indicated that while anxiety does play a role in the perception of pain by patients undergoing implant surgery, overall patient satisfaction and post surgical outcomes did not significantly differ.

Denture Stomatitis and Candida Albicans in Iranian Population: A Systematic Review and Meta-Analysis.

STATEMENT OF THE PROBLEM: Denture stomatitis is the common form of oral candidiasis, which is seen in the form of diffused inflammation in the areas covered by dentures. Many primary studies report the prevalence of denture stomatitis and candida albicans among patients in the Iranian population; therefore, using meta-analysis is valuable for health policy makers. PURPOSE: The purpose of the present study is to determine the prevalence of denture stomatitis and candida albicans in Iran. MATERIALS AND METHOD: Using relevant keywords, national and international databases were searched. After limiting the search strategy and deleting the duplicates, the remaining papers were screened by examining the title and abstract. In order to increase the sensitivity of search reference lists of papers were examined. Finally the index of heterogeneity between studies was defined using Cochran test (Q) and I-squared (I2). According to heterogeneity, the random effects model was used to estimate the prevalence of denture stomatitis and candida albicans in Iran. RESULT: The prevalence of denture stomatitis in 12 studies, and the prevalence of candida albicans in patients with denture stomatitis have been reported in 6 studies. The number of sample under investigated and its age range among primary studies included meta- analysis was 2271 individuals and 32.7 till 87.5 years respectively. The prevalence of denture stomatitis in preliminary studies imported to a meta-analysis varied from 1.9% to 54.6%, and its rate in Iran using the meta-analysis was estimated 28.9 % (CI 95%: 18.2-39.6). Also the overall prevalence of candida albicans in patients with denture stomatitis in Iran was estimated 60.6% (CI 95%:50.1-71.2). CONCLUSION: This study showed that the prevalence of denture stomatitis and candida albicans among patient infected denture stomatitis is relatively significant in Iran.

The prevalence of pathologic tooth migration with respect to the severity of periodontitis.

AIM: Pathologic tooth migration (PTM) has been defined as tooth displacement that occurs when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease. The aim of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration among patients with periodontitis. MATERIALS AND METHODS: Recorded documents of 370 patients (72.4% females, 27.6% males) within the age range of 17 to 70 years (mean 37.77 ± 11.46) were studied. Statistical analysis was carried out using t-test and Chi-square test. RESULTS: Pathologic migration prevalence was 11.4% (35/314 patients), however, there was no pathologic migration in patients with mild chronic periodontitis. The Chi-square test showed that there was no statistically significant difference between males and females. CONCLUSIONS: The results of this study confirm that pathologic tooth migration is relatively common among periodontal patients and its prevalence is increased by the severity of periodontal disease.

Socioeconomic gradients in general and oral health of primary school children in Shiraz, Iran.

BACKGROUND: Health status is largely determined by socio-economic status. The general health of individuals at higher social hierarchy is better than people in lower levels. Likewise, people with higher socio-economic status have better oral health than lower socio-economic groups. There has not been much work regarding the influence of socio-economic status on the health conditions of children in developing countries, particularly in Iran. The aim of this study was to compare the oral and general health conditions of primary school children of three different socio-economic areas in the city of Shiraz, Iran. METHODS: This cross-sectional study was conducted on 335, 8- to 11-year-old primary schoolchildren in Shiraz. The children were selected by a three-stage cluster sampling method from three socio-economically different areas. Tools and methods used by the United Kingdom's Medical Research Council were used to obtain anthropometric variables as indicators of general health. The Decay, Missing, Filled Teeth (DMFT) Index for permanent teeth, dmft Index for primary teeth, the Modified Developmental Defects of Enamel (DDE) Index, the Gingival Index (GI) and the Debris Index-Simplified (DI-S) were used for oral health assessment.  RESULTS: Height (P<0.001), weight (P<0.001), and BMI (P=0.001) significantly increased as the socio-economic status of area increased. GI score (P<0.001), DI-S score (P<0.001), number of permanent teeth with DDE (P=0.008), and number of DDE lesions in permanent teeth (P=0.008) significantly decreased as the socio-economic status of area increased. DISCUSSION: Findings of this study generally confirmed that social gradients exist in both general and oral health status of the primary schoolchildren of Shiraz. The influence of socio-economic status on health condition means children have different life chances based on their socio-economic conditions. These findings emphasize the significance of interventions for tackling socio-economic inequalities in order to improve the health status of children in lower socio-economic areas.

The impact of an educational pamphlet on the awareness of parents about 4‒6-year-old children's oral habits and dentofacial discrepancies.

Background. This study aimed to evaluate whether the parents' knowledge about the adverse effects of oral habits and dentoskeletal discrepancies would improve by an educational pamphlet. Methods. A parallel-group randomized clinical trial was conducted on parents in kindergartens of Shiraz, Iran, 2013. The parents completed a designed questionnaire to determine the pre-intervention score. The study group received an educational pamphlet on the oral habits and dentoskeletal discrepancies, in contrast to the control group. Three weeks later, the parents in both groups took the questionnaire again (post-intervention score). The primary outcome was a change in the parents' knowledge about oral habits and dentoskeletal discrepancies, which was measured by 13 questions of the questionnaire. Each correct answer was given a positive point and each incorrect answer a negative point. The total pre- and post-intervention scores were calculated by summing up the points and compared using Mann-Whitney U test. Results. A total of 550 subjects were assessed for eligibility and 413 were randomized. Of the study group, 203 subjects (98.56%), and of the control group, 204 parents (98.54%) completed the questionnaire for the second time. The score of the study group in the "normal occlusion" section of the questionnaire had significantly improved (P < 0.001) and in the "oral habits" section the score of both groups had improved but in the study group the improvement was significantly higher (P < 0.001). Conclusion . The educational pamphlet can be effective in increasing the level of parents' knowledge about normal occlusion and complications of oral habits.

Distinguishing between enamel fluorosis and other enamel defects in permanent teeth of children.

Background. The inconsistent prevalence of fluorosis for a given level of fluoride in drinking water suggests developmental defects of enamel (DDEs) other than fluorosis were being misdiagnosed as fluorosis. The imprecise definition and subjective perception of fluorosis indices could result in misdiagnosis of dental fluorosis. This study was conducted to distinguish genuine fluorosis from fluorosis-resembling defects that could have adverse health-related events as a cause using Early Childhood Events Life-grid method (ECEL). Methods. A study was conducted on 400 9-year-old children from areas with high, optimal and low levels of fluoride in the drinking water of Fars province, Iran. Fluorosis cases were diagnosed on the standardized one view photographs of the anterior teeth using Dean's and TF (Thylstrup and Fejerskov) Indices by calibrated dentists. Agreements between examiners were tested. Early childhood health-related data collected retrospectively by ECEL method were matched with the position of enamel defects. Results. Using both Dean and TF indices three out of four dentists diagnosed that 31.3% (115) children had fluorosis, 58.0%, 29.1%, and 10.0% in high (2.12-2.85 ppm), optimal (0.62-1.22 ppm), and low (0.24-0.29 ppm) fluoride areas respectively (p < 0.001). After matching health-related events in the 115 (31.3%) of children diagnosed with fluorosis, 31 (8.4%) of children had fluorosis which could be matched with their adverse health-related events. This suggests that what was diagnosed as fluorosis were non-fluoride related DDEs that resemble fluorosis. Discussion. The frequently used measures of fluorosis appear to overscore fluorosis. Use of ECEL method to consider health related events relevant to DDEs could help to differentiate between genuine fluorosis and fluorosis-resembling defects.

Photographic Facial Soft Tissue Analysis by Means of Linear and Angular Measurements in an Adolescent Persian Population.

OBJECTIVE: To obtain objective average measurements of the profile and frontal facial soft tissue to be used as a guide for aesthetic treatment goals. Methods and Materials : This observational study included 110 females and 130 males high school students aged 16-18 years. None of the subjects had any facial deformities. All of them and their parents gave consent to take part in this study. In each case, two standard photographs of profile and frontal views were taken 27 landmarks were digitized on photographs. The mean, standard deviation, and range for a total of 43 facial indices were calculated digitally by computer software. The Student's t-test was used to compare males and females. Results : The ratio between the lower and middle facial thirds was one to one, but the height of the upper facial third was proportionally smaller than the other two-thirds in both sexes. Boys had greater nasal length, depth, and prominence than girls with statistically significant differences. Both upper and lower lips were more prominent in girls than in boys. All measurements of the chin showed sexual dimorphism characterized by greater chin height and prominence and deeper mentolabial sulcus. Boys had greater facial dimensions than girls. Mouth width, nasal base width, and intercanthal distance were significantly greater in boys. Conclusion : The labial, nasal, and chin areas showed sexual dimorphism in most of the parameters used in this study. Boys had larger faces, greater facial heights, longer nasal, labial, and chin lengths, and greater nasal, labial, and chin prominence.

Utilization of Orthodontic Services in the Fars Province, Iran: The Reasons People Travel to the Capital for Orthodontic Treatment.

STATEMENT OF THE PROBLEM: The first step towards appropriately planning orthodontic treatment and prevention services is to understand the needs and demands of the target population. However, this is ignored in most developing countries. PURPOSE: This study aims to evaluate the attitudes of patients in Fars province towards travelling to the provincial capital (Shiraz) to receive orthodontic treatments. MATERIALS AND METHOD: This cross-sectional study randomly selected 420 patients referring to two public and four private orthodontic centers in Shiraz, coming from other regions of Fars province. The patients were interviewed about their demographic status, residing area and the reasons of deciding to receive orthodontic treatment in Shiraz. Data were analyzed by SPSS software, using Chi-square and ANOVA statistical tests. RESULTS: The response rate was 96% (N=403). Near half of the patients (176; 43.7 %) lived 100-200km, and 80 (19.9%) patients lived farther than 200km from Shiraz. Having no orthodontist (54.8%) and no dentist providing orthodontic treatment (39.2%) in their region were the most important factors bringing the patients to provincial capital for orthodontic treatments. High costs of treatment in their home county and hoping to receive treatment of higher quality were the other important motives for lower and higher socio-economic backgrounds, respectively. Friends'/relatives' recommendation was a more important factor in patients using public clinics for choosing their therapist, while referral from dentists was more important for patients going to private clinics. The patients who lived in counties farther than 200km from Shiraz were more concerned about quality of treatment results than those who lived closer (p= 0.010). CONCLUSION: A multifactorial approach is needed to provide the desired orthodontic services for people in Fars province so that they would not need to travel to the capital for such treatments.

Occupational Exposure of Shiraz Dental Students to Patients' Blood and Body Fluid.

STATEMENT OF THE PROBLEM: Exposure to patients' blood and body fluids would prone the dental students to the risk of blood borne infections. Several studies have shown a high prevalence of these exposures in dental settings particularly in developing countries. However, few studies have evaluated the epidemiology of these exposures in dental students in Iran. PURPOSE: To assess the epidemiology of occupational exposures among dental students and consequently designing the appropriate interventions in order to prevent these exposures. MATERIALS AND METHOD: In this cross-sectional study performed during March to June 2011, all 191 Shiraz clinical dental students were asked to complete a self-administered questionnaire. This questionnaire included demographic information and experience of sharp injuries and mucocutaneous contaminations. Chi square and t-test were employed to evaluate the risk factors of exposure. RESULTS: 80%of the participants were exposed to the patients' blood or body fluids during their clinical course. No association was found between the exposure and demographic factors. Injection needle and recapping were the most common causes of these injuries. The most common sites that were injured and caused mucocutaneous contamination were finger and face, respectively. The most frequent activity causing contamination was using high-speed rotary instruments. Only 6.4% of the exposures had been reported to the related authorities and the remains were underreported. CONCLUSION: Blood and body fluid exposure in dental setting is common and a lot of them are not reported. To reduce the hazards of these exposures, infection control authorities should design interventions especially for mentioned high-risk conditions. They should change dental students' behavior especially regarding not recapping injection needles and using eyewear. Dental schools seem to need a management center and a standard protocol for following up the exposures.

Association of characteristics of delivery and medical conditions during the first month of life with developmental defects of enamel.

BACKGROUND: Developmental defects of enamel (DDE) may be influenced by health problems and illness in children. The aim of the study was to identify the main characteristics of birth (delivery) and adverse medical conditions during the first month of life that may be related to DDE in permanent teeth. METHODS: 1000 schoolchildren between the ages of 9 and 11 years were selected for this cross-sectional study by multistage randomization from four educational zones in Shiraz in 2013. Intraoral examination was used to diagnose DDE according to World Health Organization screening guidelines and the Modified DDE Index. The data on seven birth factors as well as health and nutritional conditions during the first month of life were collected by a questionnaire completed by the parents, and were analyzed with the chi-squared test, Spearman's correlation and binary logistic regression. RESULTS: 469 (48.2%) out of 974 schoolchildren had at least one permanent tooth with DDE. The defects were significantly related with Apgar score at birth <7 (p = 0.003) and illness during the first month (p = 0.035). The frequency of DDE was significantly lower in the third child in families compared to the first and second child (p = 0.005). However, DDE showed no significant relationship with gestational age, delivery type, birth weight, gender or type of feeding during early infancy. CONCLUSIONS: Three associated factors were identified (birth Apgar score, illness during the first month of life, birth order) for DDE in permanent teeth. No specific illness was found to be significantly associated with DDE.

The public attitude towards selecting dental health centers.

STATEMENT OF THE PROBLEM: No published literature was found studying the people's reasons on why to choose or not to choose a dental care setting in south Iran, while understanding their attitude towards choosing their dental care center is consequential for planning a successful oral health care service system.    PURPOSE: To determine the factors affecting how people of the city of Shiraz choose their dental health services. MATERIALS AND METHOD: A cross-sectional analytic study was designed. A self-administered questionnaire was produced, tested and then distributed among 570 multistage randomly selected parents of schoolchildren of the city of Shiraz. Independent t-test, paired t-test and Spearman correlation were used to analyze the factors influencing participants in choosing clinics for their esthetic and non-esthetic dental treatments. RESULTS: 400 questionnaires were complete and analyzed. The recommendation from others was found to be the most encouraging factor to choose a dentist or a dental clinic. More importance was reported for various factors affecting participants' choice of dental clinic when seeking non-esthetic treatments, while recommendation and reputation of dentist/dental clinic played a vital role in esthetic treatments. The cost was more important for respondents living in more deprived districts (p= 0.05), for unemployed group (p< 0.001) and for those with less education (p< 0.001). CONCLUSION: Factors affecting people's choice for dental care proved to be highly complicated. Recommendation was found playing an important role. Dental patients consider various factors when looking for non-esthetic treatment but would go for the best possible when seeking esthetic treatments. Findings of this study indicate that patients' choice and utilization of dental service can be improved if dental clinics provide high quality of dental care with reasonable fees.

Tooth eruption sequence and dental crowding: a case-control study.

UNLABELLED: When cases of dental crowding are identified and diagnosed promptly, interceptive orthodontics is particularly successful. AIM: To assess the differences in the eruption sequence of the mandibular canine and first premolar teeth in children with and without dental crowding. MATERIALS AND METHODS: Children who attended the Shiraz Dental School's orthodontic clinic (Iran) from September to December 2012 were enrolled in this case-control study. Tooth size arch length discrepancy (TSALD) of all 8-10 year olds was calculated from patients' dental models. Thirty-six children were randomly selected from those with TSALD of equal or less than 4mm (those with crowding). Each selected case was matched for sex and age with another child (as control) with TSALD>-4mm attending the same clinic, in the same time period. The existing panoramic radiographs were traced and the eruption percentages were measured for mandibular canine and first premolar teeth. The mean difference between canine and first premolar eruption percentages was compared between the case and control groups using the SPSS (version PASW 18) software and a paired sample t-test. RESULTS: Canine and first premolar eruption percentages in the case group were 65.82±13.00 and 78.92±10.15 percent, respectively. The mean eruption percentages for canines and first premolars of the control group were 74.12±14.55 and 75.47±11.60 percent, respectively. There was a significant difference in pre-eruptive positions of canine and first premolar teeth in those with moderate to severe crowding when compared to the control group (p<0.001). CONCLUSION: These findings may improve the early diagnosis of children with high risk of developing moderate to severe crowding during mixed dentition.

Tooth loss assessment during periodontal maintenance in erratic versus complete compliance in a periodontal private practice in Shiraz, Iran: a 10-year retrospective study.

BACKGROUND: Several studies have demonstrated the efficacy of periodontal maintenance (PM), but there are conflicting data regarding tooth loss following patient compliance. METHOD: Seventy-two periodontal patients (52 women, 20 men), 86% of whom had been diagnosed with chronic moderate to severe periodontitis, were included in this retrospective study. Clinical variables such as tooth loss, bleeding on probing (BOP), plaque index and probing depth were collected from patients after 10 years of PM. The periodontal status of regular compliers (RCs) and erratic compliers (ECs) were compared in a private practice. RESULTS: The statistical analysis showed that clinical variables were not significant between RCs and ECs except for BOP (p = 0.038). During PM, 24 teeth (a mean of 1.5 teeth per participant) were lost in the RC group, and 80 teeth (a mean of 1.43 teeth per participant) were lost in the EC group. Molars were the most frequently lost teeth and canines the least. In general, those patients with less BOP lost fewer teeth (p = 0.002) and attended more recall visits (p = 0.001). CONCLUSIONS: In the present sample, RCs and ECs did not show significant differences in rates of tooth loss. However, a significant difference between RCs and ECs in regard to BOP was observed at the final examination (p = 0.038). There was also a strong relationship between BOP and recall visits: the patients with less BOP attended more recall visits (p = 0.001).