Delivery of Low-Diluted Toothpaste during Brushing Improves Enamel Acid Resistance.

Toothpaste viscosity decreases rapidly when diluted with saliva during brushing, potentially causing premature washout of high-risk caries areas and reducing the uptake of dental fluoride ions. However, no reports have examined the acid resistance of enamel from the perspective of the toothpaste's physical properties. This study aimed to elucidate the impact of toothpaste dilution on the acid resistance of the enamel, using bovine enamel as the subject. Five diluted toothpaste groups were created: a control group without toothpaste, and 100% (1.00×), 67% (1.50×), 50% (2.00×), and 25% (4.00×) dilution groups. Acid resistance was evaluated through pH cycling after toothpaste application. The results revealed a significant increase in substantial defects, compared to 67% (1.50×) at dilutions of 50% (2.00×) or higher, accompanied by a decrease in Vickers hardness. Moreover, the mineral loss increased with dilution, and a significant difference was observed between 67% (1.50×) and 50% (2.00×) (p < 0.01). This study revealed that the acid resistance of the enamel decreased when the dilution of toothpaste during brushing exceeded 67% (1.5×). Therefore, delivering toothpaste with a lower dilution to high-risk caries areas, including interproximal spaces and adjacent surfaces, could maintain a higher concentration of active ingredients in the toothpaste, thereby enhancing its medical effects.

Comparison of interproximal delivery and flow characteristics by dentifrice dilution and application of prepared toothpaste delivery technique.

In home care, the toothpaste technique, which can enhance the caries-preventive effect without changing the amount of dentifrice and fluoride ion concentration, is of great significance. This study aimed to construct a model and experimental system that reproduces the interdental part and to clarify the relationship between the change in dentifrice viscosity due to dilution and washout in the high-risk approximal area of caries. Additionally, the effectiveness of the toothpaste technique and appropriate devices for delivering dentifrice to the interdental area at a low dilution were investigated. Diluted toothpaste samples were prepared (: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, and ×4.00). An acrylic interproximal model was created for this experiment. The flow characteristics and viscosity by dentifrice dilution were measured. In the case of low dilution of 57% (1.75×) or more, it was shown that the dentifrice in the high-risk area may be washed out early because of the decrease in viscosity, and the caries-preventive effect may be reduced. It was also suggested that to keep the dentifrice in the interdental area for 120 s at the end of brushing, a dilution must be devised to a concentration of at least 50% (2.00×). The prepared toothpaste delivery (PTD) method of delivering dentifrice to the interdental area while maintaining it at a low dilution is an effective toothpaste technique in terms of dentifrice dilution and viscosity. The use of finger brushes in the PTD method could increase the efficiency of dentifrice delivery.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma.

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Prevalence, duration of exposure and predicting factors for snus use among young Finnish men: a cross-sectional study.

OBJECTIVE: The health hazards of tobacco products depend on the level of exposure, but little is known about the characteristics of snus use. The aim of this study was to investigate the duration of daily exposure to snus among occasional and daily users and its associated predictive factors among young Finnish men. DESIGN: Cross-sectional questionnaire study. SETTING: Three out of 16 Finnish Defence Forces units. PARTICIPANTS: 1280 young Finnish male conscripts starting their military service in 2016 chosen by simple random sampling. PRIMARY AND SECONDARY MEASURES: The prevalence, duration of use and the amount of daily usage of snus and cigarettes were investigated. The attitudes towards perceived harmfulness of snus and the predictive factors affecting the total time of snus consumption were examined. RESULTS: Almost a fifth (19.5%) of the conscripts reported daily snus use, and a further 16% reported occasional use. Daily snus use was associated with an earlier starting age, longer duration of use and higher daily exposure time compared with occasional use. On average, daily snus users consumed 10 portions and occasional users three portions per day (p<0.001). The daily total exposure time for daily users was 372 min (95% CI 344 to 401) and for occasional users 139 min (95% CI 106 to 171). Respondents with an upper secondary education had significantly less daily total exposure than those with basic comprehensive education (p=0.036). Perceptions of snus as a harmful substance resulted in a significantly lower duration of exposure. CONCLUSION: Snus use was very common among young Finnish men. High snus exposure duration was associated with an earlier starting age, a longer history of use and a careless attitude to its health hazards. A higher education level was a protective factor for total exposure time. Studies of the long-term health effects and dependency profile of snus use are needed.

Mandibular symphysis dimensions in different sagittal and vertical skeletal relationships.

BACKGROUND: The aim of this cross-sectional study was to compare the dimensions of mandibular symphysis (MS) between gender and the different sagittal and vertical skeletal relationships. MATERIAL AND METHODS: Pre-treatment records of orthodontic patients were divided according to gender, sagittal (Class I, II and III) and vertical (decreased, average and increased mandibular plane [MP] angle) skeletal relationships. Measurements of MS parameters were performed on lateral cephalograms using IMAGEJ software. Comparisons between MS parameters and gender and the different skeletal relationships was performed using multifactorial and one-way ANOVA, and independent sample t-tests. RESULTS: A total of 104 records (25 males and 79 females) fulfilled the inclusion criteria. Males had significantly greater MS surface area, dentoalveolar length, skeletal symphysis length, total symphysis length, vertical symphysis dimension and symphysis convexity (p < 0.05). Skeletal Class II patients had significantly greater dentoalveolar and skeletal symphysis lengths while Class III had greater chin length, vertical symphysis dimension and symphysis convexity (p < 0.05). Patients with decreased vertical dimension had greater skeletal symphysis length (p = 0.026) and those with an average vertical relationship had greater chin length (p < 0.001). CONCLUSIONS: The morphology of the mandibular symphysis is affected by gender, sagittal and vertical skeletal patterns. Males had increased mandibular symphysis surface area and linear dimensions. Class II patients had greater dentoalveolar length. Chin length was greater in patients with an average MP angle.

Role of matrix vesicles and crystal ghosts in bio-mineralization.

Matrix vesicles (MVs) are extracellular membrane-bound vesicles of about ~ 50-200 nm in diameter that play a role in the bio-mineralization process of hard tissue formation. The present review is based on the empirical phenomenon of primary mineralization process via matrix vesicle-mediated mechanism with special reference to crystal ghosts as well as the mechanism on the organic-inorganic relationship between matrix vesicles and crystal ghosts, and the transformation that these structures undergo during bio-mineralization.

Salivary fluoride concentration and retention after rinsing with 0.05 and 0.2% sodium fluoride (NaF) compared with a new high F rinse containing 0.32% NaF.

OBJECTIVE: To compare salivary fluoride (F) concentration and F retention after rinsing with a new 0.32% sodium fluoride (NaF) rinse and conventional 0.05 and 0.2% NaF rinses. METHODS: Seventeen subjects (aged 22-26 years), with normal salivary secretion rates, participated in a double blind, cross-over study. In three separate sessions with a minimum washout period of 48 h, they rinsed for 1 min with 10 ml of 0.05, 0.2 or 0.32% NaF mouthrinse. Unstimulated whole saliva was collected before (baseline: 0 min) and after 1, 3, 5, 10, 20, 30, 45 and 60 min. The F concentration was plotted against time, and the area under the curve (AUC) calculated. Salivary F concentration and F retention for the three mouthrinses were compared by a randomized block test, followed by Tukey's test and a paired 2-tailed test. RESULTS: There was a clear dose-response for AUC 3-60 min; 0.32% > 0.2% > 0.05% (p < .05). The mean F retention was 0.25 mg for 0.05% NaF, 0.86 mg F for 0.2% Na and 1.31 mg F for 0.32% NaF, (p < .05). CONCLUSIONS: The higher salivary F concentration over time and the higher F retention after rinsing with an 0.32% NaF solution suggests a potential application in prevention of caries and dental erosion.

Equine saliva components during mastication, and in vivo pH changes in the oral biofilm of sound and carious tooth surfaces after sucrose exposure.

BACKGROUND: The role of saliva composition and dietary sugar in development of infundibular caries in equine cheek teeth is not fully understood. This study analysed electrolyte and urea concentrations in saliva in relation to different forage and measured pH changes after sucrose application in vivo in sound and carious cheek teeth. RESULTS: Forage type had no effect on the equine saliva electrolyte concentrations, which varied considerably both intra- and inter-individually. Chewing resulted in increased values for all electrolytes except bicarbonate. Compared with stimulated human saliva, horse saliva after mastication, contained higher amounts of potassium, calcium and bicarbonate, and less phosphate. The in vivo pH measurements showed a lower resting pH and a more pronounced pH drop after sucrose application in carious teeth compared to sound teeth. CONCLUSIONS: No large differences were found between the composition of equine saliva and human saliva. A more pronounced acidogenicity was found for the carious than sound teeth. Thus, the caries process in equine cheek teeth seems to follow the same pattern as in human teeth, caused by acid production by oral microorganisms after sugar consumption.

Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults.

Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.

Visitors' experiences of public and private dental care in Sweden in 1992-2012.

AIM: The aim was to compare adult patients' experiences of public and private dental care in Sweden over time from the ages of 50 and 70 years, between 1992 and 2012. MATERIALS AND METHODS: Data on visiting patterns, oral health, fees and satisfaction were obtained from a questionnaire study every 5 years in 1992-2012 and analysed by using the Chi-square test and logistic regression. In the present study, the answers given by 6083 respondents in 1992 and 5220 in 2012 were included. RESULTS: Of the 50-year olds, 73.5% had visited the private sector and 26.5% the public sector. In 1992, patients in the public dental service (PDS) had visited their dentists less frequently and experienced having a slightly poorer dental status compared with private patients. After 20 years (2012), the distribution of patients between the two sectors was almost the same (71.4% and 28.8%) and the differences in visiting pattern and dental health persisted. During the study period, 21.6% of the patients changed treatment sector. A small proportion of patients had high treatment costs. A larger proportion of the private sector visitors than the PDS visitors were consistently satisfied with the dental care they had received. CONCLUSIONS: As a whole, most adult patients in Sweden were satisfied with their dental care at both public and private clinics.

Dental Caries and Risk Factors in Swedish Adolescents about to Start Orthodontic Treatment with Fixed Appliances.

AIM: The aim of this study is to investigate the caries situation in a group of Swedish adolescents, who were scheduled for orthodontic treatment with fixed appliances. MATERIALS AND METHODS: An age- and gender-matched control group was selected from the same city (Malmö, Sweden). Caries and fillings on smooth surfaces and fillings on occlusal surfaces were diagnosed clinically and caries and fillings on approximal surfaces by bitewings. Numbers of mutans streptococci (MS) and lactobacilli (LB) were analyzed in saliva. RESULTS: There were no significant differences regarding manifest caries lesions and fillings on smooth surfaces. Numbers of occlusal-filled surfaces (FS) and approximal decayed and filled surfaces were around 10%, but did not differ between the groups. However, 53% had approximal enamel caries lesions in the test group and 46% in the control group. The prevalence of approximal decayed surfaces (DS) and FS was low in both groups, 0.57 ± 1.41 in the test group and 0.65 ± 1.38 in the control group (p > 0.05), i.e., somewhat more DS in the control group (p < 0.05). Most individuals had low/medium counts of cariogenic bacteria in their saliva and less than 10% high counts in both groups. CONCLUSION: Most Swedish adolescents who have been scheduled for treatment with fixed appliances appear to have a low-to-medium caries risk nowadays. However, around 10% of all approximal tooth surfaces of premolars/molars had enamel caries and one-third of the individuals had medium/high counts of cariogenic bacteria in their saliva, which may be risk factors for future caries during orthodontic treatment. CLINICAL SIGNIFICANCE: Bitewing radiographs are important before starting orthodontic treatment and approximal caries and many cariogenic bacteria may be risk factors for orthodontic treatment.

Cytokine levels in gingival crevicular fluid during orthodontic treatment with aligners compared to conventional labial fixed appliances: a 3-week clinical study.

Objective: To test the hypothesis that the levels of IL-1ß and TNF-α increased more and IL-1α, IL-2, IL-6, IL-8 increased less, after 3 weeks of treatment with conventional labial fixed appliance and with aligners. Material and methods: Forty patients who were treated either with labial brackets (n = 20) or aligners (n = 20). Gingival crevicular fluid (GCF) samples were collected at baseline and after 21 days. Cytokine levels were evaluated by enzyme-linked immune sorbent assay (ELISA). Plaque index (PI), gingival index (GI), and bleeding on probing (POB) were also examined. Results: The levels of IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α in the GCF were significantly increased in both groups. The levels of IL-2, IL-6, IL-8 increased more in patients treated with aligners compared to those treated by labial fixed appliances. There was a statistically significant difference in change of the mean cytokine levels of IL-1α, IL-2, IL-6, IL-8 and TNF-α compared to labial fixed appliances and aligners. Conclusions: The levels of the six studied cytokines in GCF (IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α) increased after 3 weeks both after treatment with conventional labial fixed appliance and with aligners. IL-1ß and TNF-α showed a prominent increase compared to the other cytokines in the GCF of teeth by both the labial fixed appliance and aligners. However, there were only minor differences in the changes of the cytokine levels from baseline to 3 weeks between the two groups. There were no differences between the groups regarding PI, GI or POB.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ.

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each. Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+ rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day + brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography. Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p < .05). The NaF brush-on gel yielded the greatest mean depth of remineralization (168 µm), followed by the NaF mouth rinse (144 µm). Both depths were significantly greater than that of the NaF dentifrice (84 µm) (p < .05). Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.

Parental factors in early childhood are associated with approximal caries experience in young adults-A longitudinal study.

OBJECTIVES: To test the hypothesis that parental factors in early childhood influence approximal caries experience in young adults. METHODS: A cohort of 494 individuals was followed longitudinally from 1 to 20 years of age. Data were retrieved from parental interviews and questionnaires when the child was 1 and 3 years of age. At age 20, the participants underwent bitewing radiographic examination. Based on the number of approximal caries lesions (Da), stratified into initial (Di ) or manifest caries (Dm ) and approximal fillings (Fa), the participants were divided into two main groups: those with: (a) 0 Dim Fa (n = 244) and (b) >0 Dim Fa (n = 250). A subgroup was also created (≥8 Dim Fa; n = 33). RESULTS: Toothbrushing with fluoride toothpaste at 3 years of age less than twice a day (OR 1.6, 95% CI 1.0-2.6) and the participants' mothers' self-estimation of their oral health care as "less than optimal" were important risk factors for developing caries (>0 Dim Fa OR 2.0, 95% CI 1.3-3.1). An interaction effect between toothbrushing at 3 years of age less than twice a day and consumption of caries risk products > 3 times a day further increased the caries experience in young adults (≥8 Dim Fa OR 8.3, 95% CI 1.8-37.8) together with maternal anxiety about dental treatment (OR 7.4 95% CI 1.6-34.6). CONCLUSIONS: Parental factors in early childhood are associated with caries experience at 20 years of age.

The Public Dental Service in Sweden: An Interview Study of Chief Dental Officers.

OBJECTIVE: The aim of this study was to investigate how the Public Dental Service (PDS) in Sweden has managed to maintain a market position at a time of change in political ideologies and increased competition from a growing private sector. MATERIALS AND METHODS: All Chief Dental Officers (CDOs), who had held this leading position for at least 5 years (n = 22), were asked to participate in a semi-structured telephone interview. Sixteen of the 22 CDOs participated in this study. The questions were sent by mail in 2014 before the telephone interviews, which were audiotaped, transcribed and analyzed using a qualitative analytical approach. Since this was a quality study with just few participants, no statistical analysis was carried out. RESULTS: All the CDOs answered that they had influenced outcomes through brand building and core value work, related to both patients and employees, and to a lesser extent through competitor analysis. Some CDOs had a slightly different approach to the way they described visions, strategies and short-term goals. They used more business-oriented concepts, such as customers, market shares, and profits. Most CDOs regarded their actions as important for the successful development of their organization. CONCLUSIONS: The PDS appears to have a stable, strong position in the Swedish dental care market, and a great deal of effort has been put into consolidating this position.

Caries risk profiles in orthodontic patients: A 4-year follow-up study using the Cariogram model in governmental vs. private clinics.

OBJECTIVES: To (1) analyze caries-related factors and (2) evaluate caries risk using the Cariogram model for governmental and private orthodontic patients at de-bonding and 4 years after de-bonding. MATERIALS AND METHODS: Forty orthodontic patients with mean age of 26.4 years were recruited from a governmental (G) group (n = 20) and private (P) group (n = 20) and were examined at de-bonding (T1) and 4 years after de-bonding (T2). The examination included a questionnaire, plaque scoring, caries examination, bitewing radiographs, and assessment of salivary secretion rate, buffering capacity and cariogenic microorganisms. The data were entered into the Cariogram program to illustrate the caries risk profiles. RESULTS: The chance to avoid new cavities was higher in P-group compared to G-group at T1 (58% and 31%, respectively) (P < 0.01) and T2 (77% and 52%, respectively) (P < 0.001). Plaque index was significantly higher in G-group, and fluoride was used significantly more in P-group at T1 and T2 (P < 0.05). The chance to avoid new cavities was higher at T2 compared to T1 (64% and 44%, respectively) (P < 0.001). Saliva secretion rate and buffer capacity were significantly increased, and the plaque index was significantly decreased at T2 compared to T1 (P < 0.01). CONCLUSION: According to the Cariogram, orthodontic patients were less likely to avoid new cavities at de-bonding and 4 years after de-bonding in government clinics compared to private clinics, and the caries risk significantly decreased 4 years after orthodontic treatment for all patients, regardless of the location of treatment.

Interaction between chlorhexidine and fluoride in a mouthrinse solution-a 4-day and 6-week randomized clinical pilot study.

OBJECTIVE: The aim of the present investigation was to study if there is a reduced clinical effect and fluoride retention of a mouthrinse solution containing both chlorhexidine (CHX) and sodium fluoride (NaF). MATERIAL AND METHODS: Two clinical trials were designed as double-blind, randomized, cross-over studies. In study I, 16 healthy subjects were asked to rinse twice daily for 1 min during 4 days of no tooth brushing with four solutions: (1) 0.12% CHX + 0.2% NaF, (2) 0.2% NaF, (3) 0.12% CHX, and (4) placebo. In study II, another 16 healthy subjects rinsed with the same four solutions twice daily after tooth brushing during a 6-week period. Plaque formation, gingivitis, and microbiological samples from plaque and saliva, as well as fluoride retention, were analyzed. RESULTS: Both studies showed that both CHX + NaF and CHX mouthrinses had the same clinical effect with regards to plaque formation and microflora in plaque and saliva. Similarly, fluoride retention was not altered by the CHX + NaF mouthrinse compared to the NaF solution. CONCLUSION: The combination of CHX and NaF in a mouthrinse showed the same clinical effect as the CHX solution. The retention of fluoride in the oral cavity was not affected by the combination of NaF and CHX. CLINICAL RELEVANCE: A mouthrinse solution containing a mixture of CHX and NaF may be an interesting product for risk patients for caries and periodontal disease. However, this should be verified in further long-term clinical studies.

Profiling of smokers and snuffers among young Finnish men - cross-sectional epidemiological study.

OBJECTIVE: The purpose of this study was to get new information from several sources about the background factors of Finnish smokers, snuffers, and dual users. Profiles of young smokers and snuffers were investigated in association with restorative treatment need, oral hygiene, eating habits, physical activity, body mass index (BMI), psychological and socioeconomic factors. MATERIAL AND METHODS: The study group comprised 3420 conscripts. The data were collected from four different sources: a health examination including an oral health screening, a computer-based questionnaire for investigating individual background factors, a psychological test assessing cognitive skills, and the Cooper test. Statistical analyses comprised cross tabulation and binary logistic regression modelling. RESULTS: The odds for smoking were the greatest among those who had DT (Decayed teeth) > 0, used energy drinks or alcohol regularly, or whose parents were divorced. A score of ≥2900 m in the Cooper test, a higher physical exercise level, a higher own education level, and using sports drinks decreased the odds for smoking. The odds for snuffing were higher among those who ran >2500 m in the Cooper test, had a BMI of ≥25, used sports/energy drinks, or exercised regularly, and lower among those who achieved good results in the cognitive test. Using energy/sports drinks or alcohol was positively and a higher education level was negatively associated with dual use. CONCLUSIONS: Along with increasing prevalence of snuffing, heterogeneity is likely among snuffers. Good cognitive skills may prevent from smoking and snuffing.

Attitudes and behavioural factors relating to toothbrushing and the use of fluoride toothpaste among caries-active Swedish adolescents - a questionnaire study.

OBJECTIVE: The aim of this study was to identify attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents. MATERIALS AND METHODS: This cross-sectional study is based on an earlier clinical, two-year toothpaste intervention study. At the last appointment, 206 adolescents (of 211) answered a questionnaire comprising nine semi-closed questions. RESULTS: The majority (93%) brushed their teeth every day, while 7% did so only occasionally. Most participants (77%) brushed twice a day, while 12% brushed just once a day. About half of those brushing just once a day forgot to brush in the evening. Similarly, more than half of the adolescents (53%) used 1 cm of toothpaste or less on their toothbrush. Moreover, 49% brushed for less than 2 min, 41% brushed for 2 min and 10% for more than 2 min. The majority (73%) rinsed with water after toothbrushing. A difference between boys and girls was also observed; 87% of the girls brushed twice a day, whereas only 67% of the boys did so and boys more frequently forgot in the evening. CONCLUSIONS: Attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits among caries-active Swedish adolescents are still inadequate after two years of toothpaste intervention. There are several areas where improvements can be made, such as frequency of brushing, brushing time, amount of toothpaste and post-brushing procedures. The majority (81%) included 'fresh breath' as a reason for performing oral hygiene and this aspect can be used by dental staff in health promotion.

Patient-reported negative experiences related to caries and its treatment among Swedish adult patients.

BACKGROUND: It has been suggested that dental caries should be regarded as a chronic disease as many individuals repeatedly develop new caries lesions. How this is perceived by caries active patients is unclear. The aim of this study was to measure patient-reported attitudes and negative experiences related to caries and dental treatment. METHODS: A questionnaire was mailed to 134 caries active (CA) and 40 caries inactive (CI) adult patients treated at a Swedish public dental service clinic. The questionnaire included items regarding patient-reported oral health; attitudes towards caries and efforts to prevent them; and negative experiences related to caries and dental treatment. Questionnaire data were supplemented with data on caries and caries prophylaxis from patients' dental records. Exploratory factor analysis was conducted on items related to patients' perceptions of problems to see whether scales could be created. Experiences, perceptions and dental records of CA and CI patients were compared. RESULTS: The overall response rate was 69%. Dental records confirmed that CA patients had significantly more decayed teeth per year and a longer period of caries-active time than CI patients. Factor analysis resulted in 3 distinct scales measuring problems related to caries; 1) caries-related information; 2) negative experiences; and 3) negative treatment/staff attitudes. A fourth scale measuring perceived problems related to caries was also created. The CA group reported significantly more problems related to caries and dental treatment, received significantly more caries-related information, and reported significantly more negative treatment experiences compared to CI patients. CONCLUSIONS: Caries prophylaxis methods need to be improved in order to better meet the needs of caries active patients and to create a more positive experience with dental care.