Embedding environmental sustainability within oral health professional curricula-Recommendations for teaching and assessment of learning outcomes.

The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

The association between caries related treatment needs and socio-demographic variables among young Israeli adults: a record based cross sectional study.

BACKGROUD: The need for dental treatments, especially those related to dental caries, may be associated with and influenced by a wide range of demographic variables. The aim of this study was to describe caries related treatment needs among young Israeli adults and the association with several socio-demographic factors, including socio-economic cluster (SEC), intellectual capabilities, ethnicity and other variables. METHODS: Data were collected from dental records of army recruits between 2012 and 2013. We cross-examined data regarding dental treatment needs with socio-demographic variables: age, gender, SEC, intellectual capability score (ICS), birth place of participant and parents, education and immigration. RESULTS: Data received regarding 13,398 combat recruits during their first four months of military training. Most subjects were males (92.4%), with a mean age of 18.9 years. 10.8% were immigrants, with 12.2 years living in Israel before their recruitment. Only 17.7% had no dental treatment needs. Mean number of teeth needing treatment was: for restorations 1.96 ± 2.59, for root canal therapies 0.07 ± 0.44 and for extractions 0.05 ± 0.28. Low ICS scores and low SEC group were significantly associated with higher treatment needs (P < 0.001). Statistically significant higher treatment needs were observed among participants who originated from immigrant families. In a multivariate analysis (Generalized Linear Model), gender, age, ICS score, SEC group and country of birth were found as independent predictors for number of restorations needed. CONCLUSION: Socio-demographic variables significantly influence dental treatment needs and should be taken into account when preparing intervention programs in this population.

Dental health among older Israeli adults: is this a reflection of a medical care model inadequately addressing oral health?

OBJECTIVES: Israel's health-care system is considered as one of the most efficient worldwide. The purpose of the present study was to assess oral health outcomes, dental care use and respective social inequalities among the older segment of the Israeli population. METHODS: Secondary analyses were conducted of recently available data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Israel, wave 2), which specifically includes information on chewing ability, denture wearing and dental care use obtained from more than 2,400 Israeli people, 50+ years of age. Multivariate logistic regressions and concentration indices were used to analyse determinants of oral health and dental care use. RESULTS: Seventy per cent of respondents reported being able to bite/chew on hard foods and 49% of respondents reported wearing dentures. Forty-three per cent of respondents had visited a dentist within the past 12 months, with about half of all dental visits being made for solely nonpreventive reasons. Significant income-related inequalities were identified, with higher income being associated with greater dental care use (particularly preventive dental visits), better chewing ability and less denture wearing. CONCLUSIONS: For the older segment of the Israeli population and compared with other countries, the findings of the present study suggest a relatively low level of chewing ability, a high extent of nonpreventive dental visiting, as well as considerable inequalities in oral health and care. It seems that the Israeli health-care system may be improved even further by more comprehensive inclusion of dental care into universal health coverage.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia.

OBJECTIVES: To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. METHODS: Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. RESULTS: Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. CONCLUSIONS: This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Dental students' attitudes and behavior toward smoking cessation as part of their professional education.

BACKGROUND: Dental professionals have a major role in promoting tobacco use cessation (TUC). PURPOSE: The objective is to assess dental students' knowledge, attitudes, behavior, and perception regarding their potential expected role. METHODS: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. RESULTS: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. CONCLUSIONS: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

Traumatic dental injuries and related factors among sixth grade schoolchildren in four Palestinian towns.

BACKGROUND: Traumatic dental injuries (TDI) are recognized as an important dental public health issue among children. The West Bank, a part of the Palestinian Authority, is in immediate neighborhood to Israel. There are inadequate epidemiologic data among the Palestinian people, on dental health issues. AIM: To determine the occurrence of TDI to permanent teeth among sixth grade Palestinian schoolchildren living in four large towns of the West Bank and to investigate associations with anatomic and demographic factors. MATERIAL AND METHODS: Eight hundred and four children were sampled and examined in Ramallah, Bethlehem, Hebron and Jericho. Data collection included clinical examinations in schools and questionnaires for demographic and socio-economic background. RESULTS: The prevalence of traumatic dental injuries was 17.7%. Enamel fractures and injuries involving dentine accounted for 41% and 42.5% of all injuries, respectively. The most affected teeth (89%) were upper central incisors. Only 5% of the injured teeth were treated. Results of multiple logistic regression confirmed that TDI were significantly (P < 0.001) more prevalent among boys, children presenting incisal overjet larger than 5 mm, and incompetent lip coverage. CONCLUSIONS: The relative high prevalence and very low levels of treated TDI identified in this study suggested that both prevention and treatment of TDI in the West Bank were inadequate.

Trends of oral and pharyngeal cancer in Israel, by gender, age, ethnic group, and country of origin: 1970-2006.

BACKGROUND: Oral and pharyngeal cancer is one of the few life-threatening oral diseases. Israel is recognized as a developed country, characterized by a heterogeneous population, a high level of sun exposure, and a large proportion of faired skinned inhabitants. The purpose of this study was to describe trends in incidence and survival rates of oral and pharyngeal cancer between 1970 and 2006. METHODS: The incidence and survival data were derived from the Israel National Cancer Registry between 1970 and 2006. Oral and pharyngeal cancer included cancers of the lips, tongue, oral mucosa, floor of the mouth, major salivary glands and pharynx. Results indicated trends, survival rates and associations by ethnicity, country of origin, age, and gender. RESULTS: The average age-world-standardized incidence rate, ASR(W), per 100 000, in 2001-2006 was 5.77 and 3.75 for Jews, and 5.99 and 2.30 for Arabs (males and females, respectively). The lip was the most common oral cancer site (36.8%). Over time, the rate (per 100 total cancer cases) decreased from 3.1 to 2.0, and male:female ratio decreased from 1.7 to 1.3. Kaplan-Meier survival plots demonstrated that patients under the age of 20 years had almost half the survival rate of older groups and lip cancer had almost twice the survival rate than other sites. CONCLUSIONS: Israel represents a developed country with relatively low percentage of alcohol consumption and high sun exposure. Data from this region demonstrated dissimilar distributions in comparison with other 'Westernized' countries. Public health programs need to utilize the present data in order to implement preventive strategies. Potential focus on specific high-risk populations should be investigated.

Changing dental caries and periodontal disease patterns among a cohort of Ethiopian immigrants to Israel: 1999-2005.

BACKGROUND: Dental epidemiology has indicated that immigrants and minority ethnic groups should be regarded as high risk populations on the verge of oral health deterioration. The objectives of this study were to measure the changing pattern of dental caries, periodontal health status and tooth cleaning behaviour among a cohort of Ethiopian immigrants to Israel between the years 1999-2005. METHODS: Increment of dental caries and periodontal health status was recorded among a cohort of 672 Ethiopian immigrants, utilizing the DMFT and CPI indices. Data were gathered during 1999-2000 and five years later, during 2004-2005. Participants were asked about their oral hygiene habits in Ethiopia and in Israel five years since their immigration. RESULTS: Regarding dental caries, at baseline 70.1% of the examinees were caries-free, as compared to 57.3% after five years. DMFT had increased from 1.48 to 2.31. For periodontal health status, at baseline, 94.7% demonstrated no periodontal pockets (CPI scores 0-2) and 5.3% revealed periodontal pockets (CPI scores 3&4), compared to 75.6% and 24.4%, respectively after five years. At baseline, 74% reported cleaning their teeth exclusively utilizing chewing and cleaning sticks common in Ethiopia. After five years, 97% reported cleaning their teeth exclusively utilizing toothbrushes. CONCLUSION: The deterioration in the oral health status, especially the alarming and significant worsening of periodontal health status, among this immigrant group, emphasizes the need for health promotion and maintenance among immigrants and minority groups in changing societies. An "acclimatizing and integrating" model of oral health promotion among minority and immigrant groups is suggested.

Dental trauma among 5th and 6th grade Arab schoolchildren in Eastern Jerusalem.

Dental trauma is an irreversible pathology which after occurrence is characterized by life long debilitating effects. The objective of the study was to measure the prevalence of trauma in anterior permanent teeth among children and associations with independent variables. A total of 453 5th and 6th grade Arab Eastern Jerusalem schoolchildren participated. Trauma, incisal overjet and lip competence were measured by one examiner in the schools. Reasons and location of trauma were assessed by telephone interviews with the parents. The total prevalence of dental trauma was 33.8%. Severe trauma prevalence (involving dentine) was 12.6%. Severe trauma was more prevalent among boys (OR = 2.03, P = 0.026); children with lip incompetence (OR = 2.71, P = 0.001); and those with an overjet of 4mm or more (OR = 3.73, P < 0.001). The main reported causes for dental trauma were falling (29.1%), sports (16.4%), violence (20%) and playing (20%). According to the parents' reports, more fall-related injuries were reported at home, more sport injuries at school, more 'playing' injuries 'outside' (P < 0.001). Combination of results with a previous study among Jewish schoolchildren demonstrated: severe dental trauma was related to overjet (OR = 1.73, P = 0.002), lip incompetence (OR = 2.19, P < 0.001), gender (OR for males = 1.54, P = 0.005), but not to ethnicity (Arab or Jewish). The reasons for trauma observed in this study were potentially preventable. A community effort should therefore be pursued, with the aim of educating sports teachers, teachers, health personnel and schoolchildren regarding awareness of dental trauma prevention, with emphasis on utilizing mouthguards and early orthodontic intervention, when financially possible.

Periodontal health status and smoking among young adults.

AIM: Our aim was to evaluate the periodontal status and present smoking habits among a representative sample of young adult Israelis and to investigate possible associations. MATERIAL AND METHODS: A representative sample of young adult Israelis was examined and interviewed on the day of release from compulsory military service. Collected data included demographic background (gender, education level, family size and father's country of origin) and current smoking habits. Clinical examination included the recording of periodontal health status according to the Community Periodontal Index (CPI). RESULTS: Seven thousand and fifty-six young adults were examined. Sixteen per cent were classified as CPI 0, 78% as CPI 1-2 and 6% as CPI 3-4. In total, 36% of the sample reported a current smoking habit. Periodontal status was significantly improved among non-smokers, females and children of fathers born in Israel or Western countries. CONCLUSION: Only 7% of the participants demonstrated signs of periodontitis and most young adults did not smoke; a dose-response association was revealed between present smoking habits and periodontal disease.

Pilot study of rapid caries treatment needs screening--a brief communication.

OBJECTIVE: To evaluate a newly developed screening method for caries-related treatment needs. METHODS: The Rapid Caries Treatment Needs Screening (RCTNS) Index includes five ordinal nominal scores. Comparisons with conventional examinations were conducted among 565 young Israeli adults (aged 23 +/- 5.3 years) by the same dentist. RESULTS: According to conventional examination, 79.5 percent demonstrated caries-related treatment needs as compared to 54.9 percent according to RCTNS. The sensitivity of RCTNS was 68.1 percent; specificity was 96.5 percent; positive predictive value was 98.7 percent; and negative predictive value was 43.9 percent. The calculated percentage of explained variance (R2) Of the conventional examination results according to RCTNS was 55.6 percent. CONCLUSIONS: The data reveal the relevance of a rapid visual screening method for caries-related treatment needs. This is a pilot study that demands further methodological refinement. Preliminary results revealed a potential, which should be further investigated.

The elmex SENSITIVE toothbrush: effect on plaque reduction and subjective satisfaction after two months.

OBJECTIVE: The elmex SENSITIVE extra soft toothbrush, with soft conical filaments designed for plaque removal specifically in the cervical area and interdental spaces, and gentleness for hypersensitive teeth with exposed dentine, was evaluated for plaque removal effectiveness, safety, and subjective satisfaction. METHODS: One-hundred and seven healthy adults participated in the clinical trial designed according to American Dental Association (ADA) guidelines, and were randomly divided into a test group (N = 54) using the elmex brush, and a control group (N = 53) using the ADA reference brush. Subjects were chosen with gingival recession resulting in exposed dental necks and reported sensitivity, and were given a pre-study cleaning by a hygienist. Clinical examinations included the Rustogi plaque index (before and after brushing), and an examination for any soft lesion adverse effects, at baseline, 30, and 60 days. A subjective questionnaire, measuring satisfaction, sensitivity, and painless brushing, was administered at 30 and 60 days. An ANCOVA model, with baseline level as the covariate, was employed for testing clinical differences between groups at one and two months. The Mann-Whitney test measured differences in the satisfaction questionnaires. RESULTS: The total plaque index, after brushing and at one and two months, demonstrated a significantly higher mean level for the control compared to the test group (3.05 vs. 2.16; p = 0.001 and 3.47 vs. 2.56; p = 0.0003, respectively). Similar significant differences were detected for plaque levels at the gingival margin and the proximal dental surfaces, after brushing at one and two months. No significant differences were found pre-brushing at any of the measurement points. Most subjective assessments of the two brushes at one and two months revealed significant differences in favor of the test brush. CONCLUSION: These results indicate an effective toothbrush for promoting oral health, and patient acceptance of a toothbrush with soft conical filaments intended specifically for sensitive teeth.

Oral health promotion for schoolchildren - evaluation of a pragmatic approach with emphasis on improving brushing skills.

BACKGROUND: Preventive dentistry has traditionally emphasized improvement of oral hygiene. School-based programs, often delivered by dental hygienists or other health educators, are usually limited to dental knowledge provision. The present study focused on promotion of health behavior. The objectives were to evaluate the effect of a pragmatic educational program on tooth brushing skills of young schoolchildren. METHODS: The population consisted of 196 first grade children in Jerusalem. One dentist interviewed the children and evaluated base-line brushing skills, applying simple visual index, based on dividing the dentition to eight different segments. a trained hygienist then educated the children, emphasizing brushing skills. A simple "scrubbing" brushing method was taught for all dental surfaces. Four months later a second examination was conducted, applying same evaluation methods. RESULTS: At base-line 92% of the children had brushed the labial surfaces of front teeth, but only 8% brushed the inner surfaces of posterior teeth. Only 32% brushed occlusal surfaces. These levels significantly increased after four months: 98% now brushed the labial surfaces; 43% brushed inner surfaces of posterior teeth, 87% brushed occlusal surfaces (p < 0.001). The average number of dental "areas" brushed had increased (among the eight areas recorded) from 2.8 to 5.7 (p < 0.0001). CONCLUSION: This method of behavioural instruction emphasized improvement of personal manual skills specifically for those areas of the dentition which demand most efforts in oral hygiene promotion. These results are of practical help in improving future health education programs by the health promotion team.

Early Childhood Caries among a Bedouin community residing in the eastern outskirts of Jerusalem.

BACKGROUND: ECC is commonly prevalent among underprivileged populations. The Jahalin Bedouin are a severely deprived, previously nomadic tribe, dwelling on the eastern outskirts of Jerusalem. The aim of this study was to assess ECC prevalence and potentially associated variables. METHODS: 102 children aged 12-36 months were visually examined for caries, mothers' anterior dentition was visually subjectively appraised, demographic and health behavior data were collected by interview. RESULTS: Among children, 17.6% demonstrated ECC, among mothers, 37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%) was found among large (10-13 children) families than among smaller families (1-5 children: 13.5%, 6-9 children: 15.6%) (p = 0.009); ECC was more prevalent among children of less educated mothers (p = 0.037); ECC was more prevalent among mothers with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor. CONCLUSION: ECC levels in this community were not very high but neither low. This changing population might be on the verge of a wider dental disease "epidemic". Public health efforts clearly need to be invested towards the oral health and general welfare of this community.

A review of a community program aimed at preventing early childhood caries among Jerusalem infants--a brief communication.

UNLABELLED: Early childhood caries (ECC) has not been adequately investigated in Israel. A previous Jerusalem study has demonstrated a potential effect on toothbrushing among infants. The present study was initiated in order to examine caries prevalence and the potential effect of a community intervention program. OBJECTIVES: This study aims to review an intervention program and assess ECC distribution and associated variables. METHODS: The study sample included 1,500 infants in matched "intervention" and "control" Mother and Child Health centers. The 2-year program, initially including all children at the age of 6 months, focused on the free distribution of toothbrushes and toothpastes. ECC prevalence was determined in a cross-sectional study. RESULTS: At 2.5 years, 596 children were examined (40 percent compliance). About half of the parents reported that they had participated once or not at all over the 2-year period, which demonstrated low program participation. Among the examined children, ECC prevalence was 15.3 percent. No difference in caries levels was found between the program and control groups. The reported level of brushing twice daily was 13.9 percent, while 26.8 percent reported not brushing at all. Eighty-one percent reported going to bed at night with a bottle. Children who drank sugar-sweetened beverages had ECC levels significantly higher than those who drank milk or natural juice (18.8 percent versus 8.9 percent). CONCLUSIONS: The dental health and behavior and lack of intervention success emphasized the need to seek a more effective strategy. Emphasis on toothbrushing might not be the only nor optimal solution for this serious public health problem.

A clinical evaluation of fixed partial denture impressions.

STATEMENT OF PROBLEM: Providing the dental laboratory with an accurate replication of the hard and soft tissue of a patient is important. Therefore, it is essential to examine whether clinicians critically evaluate impressions routinely before sending them to the laboratory. PURPOSE: This study evaluated the quality of impressions sent to commercial laboratories for the fabrication of fixed partial dentures (FPD) by describing the frequency of clinically detectable errors and by analyzing correlations between the various factors involved. MATERIAL AND METHODS: A total of 193 FPD impressions were evaluated, immediately after arrival at 11 dental laboratories, by 3 calibrated examiners. The impression technique and material used, tray type, and number of prepared units were recorded for each impression. Data relating to errors and faults, including defects in material polymerization, retention to tray, tissue contact by tray, crucial areas beyond tray borders, heavy-bodied material exposure through the wash material (for double-step impressions), inadequate union of materials, retraction cords embedded in impressions, and air bubbles, voids, or tears along the margin were also documented. The data were analyzed with the Pearson chi-square test (alpha = .05). RESULTS: Of the impressions, 89.1% had 1 or more observable errors. Significant correlations were found between material type and voids or tears at the finish line (Rv = 0.17, P < .025) and between material type and polymerization problems (Rv = 0.223, P < .004). CONCLUSIONS: Within the limitations of this study, impressions made with polyethers had the most detectable errors, followed by condensation-type silicones. The high frequency of detectable errors found in impressions sent for FPD fabrication is of concern.