Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark.

BACKGROUND: Few studies have examined the development of geographic and socioeconomic inequalities in caries over time or have simultaneously assessed individual-level socioeconomic position (SEP) and neighborhood-level factors as a multi-layered phenomenon influencing caries inequalities. This study examined (i) the trends in geographic inequalities in caries among adolescents in Denmark and (ii) how the association between SEP and caries has progressed over time, when accounting for individual and neighborhood-level confounding factors. METHODS: This nationwide repeated cross-sectional study included 15-year-olds in Denmark from 1995, 2003, and 2013 (n = 149,808). The outcome was caries experience (measured by the decayed, missing, and filled tooth surfaces [DMFS] index). The exposure of interest was SEP, indicated by the previous year's parental education, occupational social class, and (equivalized) disposable household income. Covariates included individual-level factors (immigration status, country of origin, number of children and persons in the family, and household type) and neighborhood (residence municipality)-level factors (Gini index; proportion of unemployed, low-educated, and unmarried/non-cohabiting individuals; proportion of single-parent households and households with overcrowding). Data sources included the Danish national dental and administrative social registers and Statistics Denmark's statistics database (StatBank). Data were analyzed using spatial and spatiotemporal modelling utilizing zero-inflated negative binomial regressions and integrated nested Laplace approximations for Bayesian parametric inference. Observed caries experience geo-maps of the Danish municipalities for 1995, 2003, and 2013 were created. RESULTS: Between 1995 and 2013, caries prevalence in the 15-year-olds declined sharply (1995, 71%; 2013, 45%). Caries experience declined in nearly all socioeconomic subgroups and municipalities. However, geographic inequalities persisted with higher caries levels largely concentrated in the relatively deprived areas of Denmark. Increasing relative socioeconomic inequalities in caries over time were observed with significant graded associations between SEP and caries despite adjustment for the various individual and neighborhood-level covariates and the effect of assessment year (e.g., 15-year-olds with parents having basic education had 1.91-fold [95% CI: 1.86-1.95] higher caries experience than those having parents with high education). CONCLUSIONS: Reducing these enduring inequalities will likely require additional resources and targeted supportive and preventive measures for adolescents from lower SEP backgrounds and those residing in municipalities with higher caries prevalence.

Periodontal care attendance in Denmark in 2012-2016 - a nationwide register-based study.

OBJECTIVE: Planning and evaluation of oral healthcare systems rely on monitoring of care patterns. Monitoring periodontal care patterns provide information on the burden and occurrence of periodontitis in the population and on the direct financial cost. The aims of the study were to describe patterns in periodontal care among dental care attenders that might incite subsequent investigation and revised treatment guidelines. Secondly, to estimate the direct societal costs of periodontal care. MATERIAL AND METHODS: A retrospective register-based study utilising data from the Danish Public Health Insurance which includes all dental care attenders in 2012-2016, three years before and one year after a national risk-based recall maintenance program was rolled out in Denmark. RESULTS: The 2.7 million yearly dental care attenders corresponded to ∼60% of the eligible population and in the range of 20-24% received periodontal care. Total expenditure for periodontal care in Denmark increased by 13% from 2012 to 2016, from €78 to €88 million. The proportion of total healthcare funding spent on periodontal care was 0.61% in 2016. CONCLUSIONS: Patients with periodontitis have large out-of-pocket yearly expenses for periodontal care. Despite small changes in periodontal clinical practice that may indicate improved targeting of patients in need of periodontal care, challenges of reaching non-attenders and non-adherence to care are unsolved. More research into outcomes from periodontal therapy in daily practice, seen from both normative and patient perspectives, would help establish knowledge of the efficiency of existing periodontal care systems and help identify barriers and facilitators for attending care in Denmark.

Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes.

Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.

Associations between tooth loss, prostheses and self-reported oral health, general health, socioeconomic position and satisfaction with life.

OBJECTIVES: To investigate whether the location of tooth loss and prosthesis are associated with self-reported oral health, general health, socioeconomic position and satisfaction with life. METHODS: From the Copenhagen Aging and Midlife Biobank (CAMB) investigation, 1517 persons had their oral status ranked (full dentition, fixed prosthesis in the masticatory zone, tooth loss in the masticatory zone, fixed prosthesis in the aesthetic zone, removable prosthesis, tooth loss in the aesthetic zone). Self-reported oral health, general health, socioeconomic position and satisfaction with life were obtained. Information on gender, normative socioeconomic position, frequency of seeing a dentist, acute dental treatment within the last 5 years and general diseases was also recorded. RESULTS: Patients with tooth loss in the aesthetic zone and removable prosthesis showed high odds ratios for reporting poor rather than good oral health compared to patients having a full dentition. Having a removable prosthesis was further associated with rating socioeconomic position as low rather than high (odds ratio = 27.7 [95% CI: 5.07; 151.6]) compared to a full dentition after controlling for normative socioeconomic position and gender. In the bivariate analyses, a tendency towards poorer general health and poorer satisfaction with life was found with worse oral status, meanwhile the multiple regression analyses did not show significant associations between oral status and general health and satisfaction with life. CONCLUSIONS: Missing teeth and having prostheses are associated with worse self-reported oral health compared to having a full dentition. Removable dental prosthesis may be associated with a worse self-perception of socioeconomic status.

Utilization of etoricoxib in dental patients in the Nordic countries: a population-based register study.

Background: Etoricoxib is a second-generation cyclooxygenase-2-inhibitor approved in 2012 for short-term treatment of pain associated with dental surgery. Objectives: To evaluate etoricoxib utilization in dental patients in the Nordic countries, including its off-label use. Methods: The entire populations of Denmark, Finland, Sweden and Norway with etoricoxib prescriptions written by dentists and dispensed in 2012-2014 were evaluated using national register data. Nationwide estimates of etoricoxib utilization were generated according to year, gender, age, dose and package size. Off-label use in paediatric patients, prescribed doses >90 mg/day or for dental contacts not associated with surgical procedures, and concomitant administration with anticoagulants were evaluated. Results: Utilization of etoricoxib for dental pain was low (1615 prescriptions: Finland, 907; Sweden, 359; Norway, 337; Denmark, 12). Overall, 70% of the prescriptions were without an associated dental procedure. Moreover, 58%, 55%, 10% and 58% of the prescriptions in Denmark, Finland, Sweden and Norway, respectively, were for >90 mg/day doses. Few paediatric prescriptions were dispensed (n < 10), and only a small overlap (n = 21) was observed between etoricoxib and anticoagulant prescriptions. Conclusions: Given the low overall number of prescriptions, it is unlikely that off-label use of etoricoxib within dentistry in the Nordic countries is an important public health concern.

Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study.

BACKGROUND: Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail. OBJECTIVES: To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013. METHODS: Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates. RESULTS: Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate showed statistically significant graded associations between each covariate and DMFS count at all time points. Similarly, in the ZINB models, in all 3 years, clear gradients were observed in terms of caries differentials in all three SEP categories, with statistically significant associations (Type 3 P values, <.0001) even after adjustment for all other covariates. For instance, in 2013, even among adolescents with positive caries experience, being of lower occupational social class was associated with up to 2.4-fold (95% confidence interval [CI]: 2.2-2.6) higher caries experience. Between 1995 and 2013, relative inequalities increased in all SEP categories, while absolute inequalities decreased in the education and occupation categories. CONCLUSION: Considerable progress has been made in reducing dental caries rates among Danish adolescents; however, this progress has benefited the disadvantaged social groups less than the better-off groups.

Impact of Periodontitis Case Criteria: A Cross-Sectional Study of Lifestyle.

BACKGROUND: Associations of risk factors/indicators with periodontitis may depend on the included case criterion. The objective of the current study is to evaluate differences in outcome by applying five periodontitis case definitions for cross-sectional associations with lifestyle factors among participants of the Danish Health Examination Survey (DANHES). METHODS: A total of 4,402 adults aged 18 to 96 years from the general health examination of DANHES had a periodontal examination consisting of half-mouth registration at six sites per tooth including probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to severe periodontitis, European Workshop of Periodontology (EWP)-specific, meanCAL ≥2.55 mm, CAL-tertile, and PD-CAL definitions. Multivariable logistic regression models fitted the association of age, sex, smoking status, diabetes mellitus, educational level, alcohol consumption, body mass index, physical activity, body fat percentage, waist circumference, triglycerides, total cholesterol, and C-reactive protein with periodontitis. RESULTS: Number of cases captured by the five periodontitis case definitions ranged from 337 (9.2%) to 1,136 (31.0%). A total of 224 participants were defined as periodontitis cases by all five criteria. Analyses on 3,665 participants with complete data revealed statistically significant associations of age and smoking with all periodontitis case definitions and of male sex with severe periodontitis and EWP-specific definitions. Educational level (two lowest groups) was related to three periodontitis criteria. Among obesity and hyperlipidemia measures no factors were related to periodontitis. CONCLUSION: Regression analyses showed little difference in odds ratio across the five periodontitis case definitions; however, the level of significance did show some variation.

A register-based study of variations in services received among dental care attenders.

OBJECTIVES: To investigate whether receipt of dental services, among attenders, reflects variations in dental health or whether and to what degree it is associated with socioeconomic status, with irregular or regular dental attendance and with the availability of dentists in residential areas. MATERIALS AND METHODS: This retrospective register-based study followed two Danish cohorts, aged 25 and 40, with a dental examination in 2009 (n = 32,351). The dental service data were registered during 2005-2009. The number of dental examinations, individual preventive services (IPS), tooth extractions, root fillings and composite fillings were analyzed in relation to socioeconomic status, irregular/regular dental attendance, inhabitant/dentist ratio and to DMFT at age 15 (DMFT15) and change in DMFT (ΔDMFT) from age 15 to age 25 and age 40, respectively. Poisson regression and negative binomial regression analyses were used. RESULTS: The variations in number of services received in the study population were small (SD = 0.2-2.7). However, with a few exceptions, high levels of DMFT15 and ΔDMFT were associated with receipt of more dental services. Socioeconomically-privileged individuals received more dental examinations but fewer tooth extractions, root fillings and composite fillings compared to disadvantaged persons, when controlled for dental health levels. Irregular attenders received fewer IPS and composite fillings but had more extractions compared to regular attenders. CONCLUSIONS: Variations in dental care services were found to reflect variations in dental health, but the variations were also related to individual socioeconomic status, residential area and dental attendance patterns.

Root caries, root surface restorations and lifestyle factors in adult Danes.

AIM: To investigate selected lifestyle factors in relation to active caries and restored root surface lesions in adults. MATERIALS AND METHODS: Based on clinical examinations and questionnaires, data on root caries, socioeconomic status, body mass index, dietary habits, alcohol consumption, tobacco use and oral hygiene routines were collected from 4369 adults aged 21-89 who took part in a survey covering 13 municipalities across Denmark. Uni- and multivariate logistic regression analyses were applied to analyse the relationship between the independent lifestyle variables and active caries and restored root surface lesions, respectively. RESULTS: The prevalence of active root caries was 4%, while 26% displayed restored root surfaces. The sugar intake was not related to root caries. A multivariate logistic regression analysis revealed that, in subjects aged 45 or over, smoking and wearing dentures were significantly associated with presence of active root caries (p<0.01). The intake of 15 drinks or more per week was associated with higher odds of root surface restorations compared with no alcohol intake (OR=1.7; p<0.001). CONCLUSIONS: Lifestyle factors such as tobacco use and alcohol consumption, as well as wearing dentures, were significantly associated with the occurrence of untreated caries and restored root surface lesions, especially in persons over 45. Thus, such lifestyle factors should be taken into consideration, identifying persons with a need of preventive dental services. In addition, oral health education should focus on the possible risks of smoking and a high alcohol intake.

Smoking and drinking as risk indicators for tooth loss in middle-aged Danes.

OBJECTIVES: To investigate tobacco and alcohol consumption as risk indicators for missing teeth in late middle-aged Danes. METHOD: In all, 1,517 Copenhagen Aging and Midlife Biobank (CAMB) participants received a clinical oral examination that included number of teeth. Information on smoking, drinking, and various covariates was obtained using self-administered, structured questionnaires. Descriptive statistics and logistic regression (dependent variable: 6+ vs. <6 missing teeth) were used to investigate smoking and drinking in relation to missing teeth. RESULTS: Current smokers, persons who currently or previously smoked >15 tobacco units/day, and persons who had smoked for 27+ years had elevated mean scores of missing teeth and associated odds ratios (OR) compared with never smokers. Relative to nondrinkers, alcohol consumption was associated with reduced odds of missing 6+ teeth. DISCUSSION: Our findings suggest that smoking is positively associated, while alcoholic beverage consumption is inversely related to tooth loss in middle-aged Danes.

Findings from the oral health study of the Danish Health Examination Survey 2007-2008.

OBJECTIVE: The aims of the oral part of the Danish Health Examination Survey (DANHES 2007-2008) were (1) to establish an oral health database for adult Danes and (2) to explore the influence of general diseases and lifestyle on oral health. This paper presents the study population, examination methods, questionnaire and baseline results. MATERIALS AND METHODS: The study population comprised 4402 subjects, aged 18-96, consecutively enrolled from 18 065 DANHES participants from 13 municipalities in Denmark. The oral part consisted of a validated questionnaire and a clinical examination, carried out in mobile units by three trained and calibrated dental hygienists. The data were processed with descriptive statistics and mono- and bivariate analyses. RESULTS: The mean age was 54.1 years and 60% were women. The mean number of natural teeth was 26.6; the mean DMFT/DMFS values were 18.9 and 61.0, and varied with age (DMFT 8.7-24.3). A higher proportion of females suffered from dental erosion in the younger age groups. Forty per cent of all subjects had a mean clinical attachment loss ≥ 3 mm, varying from 4% among those aged 18-34 to 80% in those over 75. A sub-optimal saliva secretion rate was more common among females than males (17.7% vs 10.4%) and this was reflected by the reported frequency of dry mouth. CONCLUSION: This extensive cross-sectional study provides a platform for obtaining future knowledge of the impact of health- and lifestyle-related factors on oral diseases. The validated questionnaire and the clinical characteristics enable robust analyses, although the conclusions may be hampered by limited external validity.

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark.

AIM: To describe the oral health and the oral-health-related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health-care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. METHODS: A cross-sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health-care programme. Clinical data and data from interviews comprising social factors, life-style, dental visit habits, oral hygiene practices and self-perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. RESULTS: Sixty-eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1-9 teeth and tooth mobility. CONCLUSION: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.

Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section.

OBJECTIVE: The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section). MATERIALS AND METHODS: The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section. RESULTS: The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05). CONCLUSIONS: Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.

Clustering of obesity and dental caries with lifestyle factors among Danish adolescents.

PURPOSE: To assess any clustering between obesity, dental health, and lifestyle factors (dietary patterns, physical activity, smoking, and alcohol consumption) among adolescents. MATERIAL AND METHODS: A cluster sample of 15-year-old Danish adolescents (DA) from eight municipalities was selected. Self-reported questionnaires for adolescents and their mothers to assess body-mass index (BMI), socioeconomic and lifestyle factors, and clinical examinations to examine adolescents' dental status (DMFT) were used. Descriptive statistics, chi-square tests, and factor analysis were applied. RESULTS: The mean DMFT was 2.03 and mean BMI was 21.30 among DA.Of the whole sample, 62% experienced caries (DMFT > 0) and 16% were classified as obese. No association appeared between obesity and DMFT (p > 0.05). Most adolescents were likely to have breakfast every day (76%), but their daily consumption of fruit was lower (38%). More than half of adolescents reported having physical exercise (66%) and no alcohol consumption (57%). Smokers were more likely to consume alcohol (80%) but less likely to exercise (44%) than nonsmokers (alcohol consumption, 55%; exercise, 68%), (P < 0.05). Principal component analysis revealed that DMFT and obesity were interrelated in DA. CONCLUSION: In line with earlier studies, obesity and dental caries share common lifestyle factors among adolescents, regardless of nationality and different health-care systems. Thus, it seems that dental health is a global health concern. There is a need for collaboration between dental and general health-care providers to manage both obesity and dental caries in adolescents by using a holistic approach.

Oral health in children and adolescents with different socio-cultural and socio-economic backgrounds.

OBJECTIVES: To describe the occurrence and severity of dental caries in children and adolescents and to relate these findings to the subject's socio-cultural and socio-economic backgrounds. MATERIAL AND METHODS: A cross-sectional study in 12 706 children aged 5, 7, 12 and 15 years was conducted in 2006. Data on children's caries experience were collected from public oral health registers and pooled with socio-cultural and socio-economic data obtained from official statistics. The study population represented 76% of all registered inhabitants. RESULTS: Among 5- and 7-year-old children with non-Danish mothers, the mean caries experience was three to four times higher than among children of Danish mothers, and a doubled rate was seen among the adolescents (p < 0.001). Significant differences in caries experience were found in various ethnic minorities. Multiple regression analysis showed that the level of caries was highest among children in families where mothers were not Danish, with low income, where mothers' educational levels were low, and in with a high number of children (p < 0.001). CONCLUSIONS: Although almost all children and adolescents attend the prevention-oriented, free public dental service, a social gradient still exists for dental health. In addition, in all age groups, major inequalities in dental health were found when families with Danish and non-Danish backgrounds were compared. The findings indicate a need for social action by policymakers. Furthermore, a change in the oral health preventive strategy is proposed to meet the needs of children in risk of caries, and appropriate oral health-promotion programmes should be organized in collaboration with leaders from different ethnic minorities.

Dental health status and development trends among children and adolescents in Greenland.

OBJECTIVES: This paper describes the occurrence of dental caries in children and adolescents in Greenland and the disease pattern is analysed across districts and over time. STUDY DESIGN: Cross-sectional population surveys of children aged 6, 12 and 15 years. METHODS: Data were stored in the oral health information system established for the Greenland Public Dental Health Services, recording the dental health status of children served by the programme. The participation rate is approximately 100%. In 2003, the study population counted 645 6-year-olds; 587 12-year-olds, and 488 15-year-olds. Dental caries is clinically recorded according to the criteria used by the Danish Public Dental Health Services. RESULTS: About 80-90% of children in all age groups were affected by dental caries. In 2003, a mean of 13.1 tooth surfaces were affected by dental caries in children aged 6 years, about 6.1 tooth surfaces in 12-year-olds, and 10.2 surfaces at age 15. At all ages, high proportions of children had severe patterns of dental caries. Extensive variations by district in dental caries indices were observed for all age groups. The dental caries experience tends to increase with time in young children, while the dental caries level remained stable for adolescents. CONCLUSIONS: The dental caries burden is high in children in Greenland compared to Denmark and other Nordic countries. It is unrealistic to achieve international goals for oral health and, thus, the strengthening of oral health promotion and disease prevention is urgently needed.

Public dental health care program for persons with disability.

The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means of self-administered questionnaires completed by the person responsible locally for the program in each municipality. The response rate was 84%. The following topics were included: (1) Number of persons attending the program, (2) procedure for identification of persons eligible for the program, (3) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population attended the program, ranging from 0.03% to 1.53%. In large municipalities, and where internal providers delivered oral health care, relatively more persons were enrolled in the program (p < 0.001). Overall, more than 20 categories of personnel were involved in the selection procedure; attitude and lack of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large municipalities. To secure equal access for persons with disability, it is recommended that joint collaboration between smaller municipalities should be made regarding procedures of such programs. Special training of dental personnel and of the staff responsible for selecting persons for the program should be systematically organized at a higher administrative level. The pattern of dental services delivered justifies further involvement of oral hygienists in the program.

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000.

OBJECTIVES: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. METHODS: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. RESULTS: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. CONCLUSIONS: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35-44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health.

Self-reported oral hygiene practices among adults in Denmark.

OBJECTIVES: To assess the present level of oral hygiene practices in the Danish adult population aged 16 or above, in particular to analyse how self-care practices in terms of oral hygiene habits and cleaning of dentures are affected by socio-economic factors, dental status, actual dental visiting habits, and the experience of oral health care during school years. BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross-sectional study of 5802 persons, randomly sampled amongst the Danish population aged 16 years or above. Data were collected by means of personal interviews and self-administered questionnaires. The response rate was 66%. RESULTS: Toothbrushing twice-a-day was reported by 68% of the dentates while 32% brushed their teeth once-a-day or less frequent. Daily use of toothpicks was reported by 28% while daily use of dental floss was reported by 11%. Oral hygiene habits were more frequent amongst women. Toothbrushing twice-a-day was related to regular dental visits, dental care during school years, and a high level of education. Daily use of toothpicks was more common among females and older persons. Regular dental visits, having 20 or more teeth in situ, and regular dental service through school years were predictors for daily use of toothpicks. Amongst denture wearers, one-third cleaned their dentures twice-a-day. Frequency of denture cleaning was significantly associated with gender, age, number of teeth left, and educational level. CONCLUSION: Intensive population-directed strategies for oral health education should be considered in order to further improve the oral hygiene practices of the entire population.

Oral health and oral health behaviour among 11-13-year-olds in Bhopal, India.

OBJECTIVES: To assess the prevalence of dental caries, to describe the periodontal conditions, and to assess the level of attitude, knowledge and practice in relation to oral health and oral health behaviour among 11-13 year-old children in Bhopal, India. The data would aim to provide a baseline for planning and evaluation of oral health education programmes for children in the region. BASIC RESEARCH DESIGN AND OUTCOME MEASURES: A cross sectional study of 599 children 11-13 years was conducted. Random sampling procedures were used to obtain representative samples of children in rural (n = 181) and urban areas (n = 277). In urban slum areas convenience sampling was applied (n = 141). The data were collected through clinical examinations by means of WHO standard method, and a sub-sample completed a self-administered questionnaire on oral health behaviour, knowledge, and attitude. RESULTS: The caries prevalence proportion in both dentitions was 57% with a mean DMFT+dmft of 1.6. The caries experience was 2.5 times higher among children in slum areas compared to children living in rural areas. Fifteen per cent of the children had healthy gingiva and 91% of rural children had maximum CPI score 2. Mean number of sextants with CPI score 0 was 3.5 among children in urban areas and 0.6 for children in slum areas. Seventy-five per cent of the children reported toothbrushing once a day, 31% used a plastic toothbrush and the general level of knowledge on oral health was low. Intake of sugary food and soft drinks were more frequent in the slum areas compared to rural areas. CONCLUSION: Implementation of community-oriented oral health promotion programmes is needed in order to increase the level of knowledge and to change attitudes and practices in relation to oral health among children. Essential care should be provided to control oral disease symptoms.