Orthodontic management of traumatic dental injuries in Norway and orthodontists' perceptions of referral routines: A quality assurance survey.

BACKGROUND/AIM: Orthodontic treatment of patients with traumatic dental injuries is challenging, with limited evidence of routines and outcomes. The aims of this study were: (i) to describe how orthodontists perceive the information on traumatic dental injuries received by referral from the Public Dental Health Service before orthodontic treatment and (ii) to assess orthodontists' knowledge and working routines in managing traumatic dental injuries. MATERIALS AND METHODS: Data were obtained through a survey of all practicing orthodontists registered as members of the Norwegian Association of Orthodontists (n = 203). RESULTS: Eighty-three orthodontists were enrolled, most of whom had received their dental degree (73.0%) and specialist orthodontic training (88.5%) in Norway. They reported examining patients with a history of traumatic dental injury at weekly (34.2%) or monthly (38.0%) basis. In 85.5% of cases, they obtained a history of traumatic dental injury from patients. Half of the respondents (51.3%) favoured two-phase early orthodontic treatment for patients with an overjet ≥6 mm. The observation time and treatment strategy showed considerable discrepancies across traumatic dental injury diagnoses. Most (59.1%) orthodontists considered the information on previous traumatic dental injuries provided by the Public Dental Health Services referral 'inadequate', more commonly in cases of mild (83.5%) than severe (57.5%) traumatic dental injuries. CONCLUSIONS: Orthodontic management of patients with traumatic dental injuries was characterised by lack of uniformity in both recommended observation time before orthodontic treatment and management strategy. The referral routines by the Public Dental Health Services for patients with traumatic dental injuries were perceived as 'inadequate' in terms of frequency and quality. The results indicate the requirement of standardisation of routines related to orthodontic management of traumatic dental injuries and referral routines by the Public Dental Health Services.

Dental caries at enamel and dentine level among European adolescents - a systematic review and meta-analysis.

BACKGROUND: In contrast with the last century, caries epidemiology has begun integrating enamel caries into determinations of caries prevalence and experience. The objective of the present systematic review and meta-analysis was to assess the caries status including estimations of enamel caries, of European adolescents. METHOD: Four databases (Medline Ovid, Embase, CINAHL, and SweMed+) were systematically searched from 1 January 2000 through 20 September 2021 for peer-reviewed publications on caries prevalence and caries experience in 12-19-year-olds; that also included evaluations of enamel lesions. Summary estimates were calculated using random effect model. RESULTS: Overall, 30 publications were selected for the systematic review covering 25 observational studies. Not all studies could be used in the meta-analyses. Caries prevalence was 77% (n = 22 studies). Highest prevalence was reported in the age groups 16-19 years, and in studies where caries examinations were done before 2010. The overall mean DMFT score was 5.93 (n = 14 studies) and it was significantly lower among Scandinavian adolescents than among other European adolescents (4.43 vs. 8.89). The proportion of enamel caries (n = 7 studies) was 50%, and highest in the lowest age group (12-15 years). Results from the present systematic review reflected the caries distribution to be skewed at individual-, tooth- and surface levels; at tooth and surface level, also changed according to age. CONCLUSIONS: Although studies in which the caries examinations had been done in 2010 or later documented a reduction in caries prevalence, caries during adolescence still constitutes a burden. Thus, the potential for preventing development of more severe caries lesions, as seen in the substantial volume of enamel caries during early adolescence, should be fully exploited. For this to happen, enamel caries should be a part of epidemiological reporting in national registers.

Traumatic dental injuries and pulp sequelae in an adolescent population.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) occur frequently and may result in pulp sequelae. This includes pulp necrosis with infection, pulp canal obliteration and root resorption. The aim of this study was to assess the prevalence and risk factors of pulp sequelae after TDI among Norwegian adolescents. MATERIAL AND METHODS: A retrospective longitudinal study, including historical clinical data, was conducted with 16-year-old pupils in western Norway. All first-grade pupils, born in 1997 (n = 5184), attending public high schools, were invited to participate and to respond to an electronically administered closed-ended questionnaire (response rate 39.6%, n = 2055). Consent was given to access the dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs were interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible). Outcome variables of TDI were registered and analysed using logistic regression, Kaplan-Meier survival estimates and log-rank test. RESULTS: The prevalence of TDI in the sample population was 16.4% (338 pupils), with a total of 637 teeth involved. The number of included teeth for analysis was 571 (90.5%). The prevalence of pulp necrosis with infection was 7.5%. Moderate and severe TDI was associated with a higher frequency of pulp necrosis with infection. Pulp canal obliteration and root resorption were found in 2.8% and 2.3% of teeth with TDI, respectively. Dental hard tissue injuries were more prone to the development of pulp necrosis than luxation injuries and combination injuries. The relationship between root development stage and development of pulp necrosis with infection was not statistically significant. CONCLUSIONS: Occurrence of different pulp sequelae among teeth affected with TDI was low. Moderate and severe TDI were more at risk of developing pulpal complications and hard tissue injuries were at higher risk of developing pulp necrosis with infection.

Traumatic dental injuries and experiences along the life course - a study among 16-yr-old pupils in western Norway.

The study assessed risk factors for traumatic dental injuries (TDI) using experiences along the life course. A retrospective longitudinal study, including historical clinical data, was conducted on 16-yr-old pupils in western Norway. All first-grade pupils born in 1997 and attending public high schools were invited to participate (n = 5,184). Participants responded to an electronically administered closed-ended questionnaire (39.6%, n = 2,055). Information on the occurrence of TDI and events during the life course (categorized as socio-economic, biological, psychosocial, and behavioural indicators) was collected. Variables with a significant bivariate association with three different dependent variables (TDI, severity of TDI, and multiple episodes of TDI) were tested in a hierarchical logistic regression analysis. Traumatic dental injuries were more frequent among boys, adolescents of higher socio-economic status, and adolescents with adverse psychosocial and behavioural scores. Moderate and severe TDIs were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in the sport of wrestling. Multiple episodes of TDI were more frequent among adolescents with adverse psychosocial and behavioural scores and among adolescents participating in sports activities. Incorporation of different life-course indicators is important in evaluating TDI severity and repeated incidents.

Traumatic dental injuries-Prevalence and severity among 16-year-old pupils in western Norway.

BACKGROUND/AIMS: Published data on prevalence and severity of traumatic dental injuries (TDI) in Norway are limited. The aims of this study were to assess prevalence, distribution and severity of TDI in the permanent dentition of 16-year-old pupils in western Norway. MATERIAL AND METHODS: A retrospective longitudinal study, including historical clinical data, was conducted among 16-year-old high school pupils in the County of Hordaland, western Norway. First-grade pupils attending high school, born in 1997, were invited to participate (n = 5184). Consent was given to access their dental records in the Public Dental Health Service in Hordaland, where information regarding TDI (diagnosis and treatment) and radiographs was interpreted. Only TDIs to anterior teeth were recorded (canine to canine in the maxilla and mandible) and classified using a modified version of the WHO's classification. RESULTS: A total of 2055 participants were included (response rate 40%). TDI prevalence was 16.4% (338 pupils), with the maxillary central incisors most affected (64.7%). A total of 637 teeth were involved. Boys were more prone to injury than girls (P < 0.05). Severity of TDI was divided into 3 groups (mild, moderate and severe), with the following distribution: 563 mild (88.4%), 39 moderate (6.1%) and 35 severe (5.5%). Peak age for TDI was 8-10 years (50.9%). CONCLUSIONS: Prevalence of TDI among Norwegian adolescents was moderate. Milder injuries were more frequent than moderate and severe injuries. Age and gender were risk factors with regard to TDI. Seasonal influence on the occurrence of TDI was not statistically significant.

Dental caries prevention strategies among children and adolescents with immigrant - or low socioeconomic backgrounds- do they work? A systematic review.

BACKGROUND: This systematic review was designed to uncover the most reliable evidence about the effects of caries preventive strategies in children and adolescents of immigrant or low socioeconomic backgrounds. METHODS: According to pre-determined inclusion and exclusion criteria, relevant articles focusing on underprivileged groups were electronically selected between January1995 and October 2015. The literature search was conducted in five databases; PubMed, Embase, CINAHL, SweMed+ and Cochrane Library. Accepted languages for included articles were English, German and Scandinavian languages. Abstracts and selected articles in full text were read and assessed independently by two review authors. Systematic reviews and meta-analyses were not included. Also articles with topics of water fluoridation and fluoride toothpaste were excluded, this due to all existing evidence of anti-caries effect for disadvantaged groups. The key data about the main characteristics of the study were compiled in tables and a quality grading was performed. RESULTS: Thirty-seven articles were selected for further evaluation. Supervised toothbrushing for 5-year-old school children was found to be an effective prevention technique for use in underprivileged groups. Also a child/mother approach, targeting nutrition and broad oral health education of mothers showed effectiveness. For older children, a slow-release fluoride device and application of acidulated phosphate fluoride (APF) gel showed to be effective. CONCLUSION: On the basis of this review, we maintain that in addition to studies of water fluoridation and fluoride toothpaste, there are other preventive intervention studies providing scientific evidence for caries reduction among children and adolescents with immigrant or low socioeconomic backgrounds.

Exploring the association of dental care utilization with oral impacts on daily performances (OIDP) - a prospective study of ageing people in Norway and Sweden.

OBJECTIVES: To explore the association of dental health care utilization with oral impacts on daily performances (OIDP) across time focusing ageing Norwegian and Swedish adults adjusting for predisposing, enabling, and need related-factors as defined by Andersen's model. METHODS: Data were based on Norwegian and Swedish 1942 birth-cohorts conducted in 2007 (age 65) and 2012 (age 70). In Norway, the response rates ranged from 54% to 58%. Corresponding figures in Sweden were from 72% to 73%. Self-administered questionnaires assessed OIDP, dental care utilization and predisposing, enabling and need related factors. Logistic regression with robust variance estimation was used to adjust for clustering in repeated data. RESULTS: Significant covariates of OIDP were satisfaction with dental services, dental care avoidance due to financial constraints, frightening experience with dental care during childhood and patient initiated dental visiting. Frequency and regularity of dental attendance were associated with OIDP in the Swedish cohort, only. CONCLUSIONS: In spite of country differences in the public co-financing of dental care, dental care utilization indicators were associated with OIDP across time in both cohorts. Encouraging regular and dentist initiated visiting patterns and strengthening beliefs in keeping own teeth could be useful in attempts to reduce poor oral health related quality of life in ageing people.

Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management.

BACKGROUND: Recording reliable oral health data is a challenge. The aims were a) to outline different Scandinavian systems of oral health monitoring, b) to evaluate the quality and utility of the collected data in the light of modern concepts of disease management and to suggest improvements. MATERIAL AND METHODS: The information for in this study was related to (a) children and adolescents, (b) oral health data and (c) routines for monitoring such data. This meant information available in the official web sites of the "KOSTRA-data" (Municipality-State-Report) in Norway, the Swedish National Board of Health and Welfare ("Socialstyrelsen") and Oral Health Register (the SCOR system, National Board of Health) in Denmark. RESULTS: A potential for increasing the reliability and validity of the data existed. Routines for monitoring other oral diseases than caries were limited. Compared with the other Scandinavian countries, the data collection system in Denmark appeared more functional and had adopted more modern concepts of disease management than other systems. In the light of modern concepts of caries management, data collected elsewhere had limited utility. CONCLUSIONS: The Scandinavian systems of health reporting had much in common, but some essential differences existed. If the quality of epidemiological data were enhanced, it would be possible to use the data for planning oral health care. Routines and procedures should be improved and updated in accordance with the modern ideas about caries prevention and therapy. For appropriate oral health planning in an organised dental service, reporting of enamel caries is essential.

Radiological evaluation of single implants in maxillary anterior sites with special emphasis on their relation to adjacent teeth: a 3-year follow-up study.

AIM: The aim of this study was to measure, in adults, changes in crest bone level around single dental implants in the anterior maxilla and continuous eruption of adjacent teeth. MATERIAL AND METHODS: In this prospective study, 50 patients received single-implant-supported crowns in the maxillary anterior region. Enrolled patients lacked maxillary anterior teeth as a sequel to trauma or agenesis in the maxillary anterior region. Participants were followed during a 3-year period. Baseline radiographs were taken at the time of loading and then repeated at one- and 3-year recalls. Radiographic parameters were recorded to assess changes in the skeletal bone structure and crest bone level. RESULTS: Twenty-six patients attended for all recalls. Three patients were excluded owing to difficulties related to identifying the same radiographic landmark on the radiographs throughout the recall period. All implants were successfully integrated with no sign of peri-implantitis. The mean crest bone loss was 0.45 mm at the mesial aspect of the implant and 0.56 mm at the distal aspect. In smokers, there was significant bone loss on the distal aspect. Mean change between reference points on implant and adjacent tooth (continuous eruption of adjacent tooth) over the 3-year period was 0.67 mm. In women, mean change (0.79 mm) was statistically insignificantly higher, compared with men (0.59 mm). CONCLUSIONS: Radiographic evaluation of crest bone level showed slight bone loss after 3 years of functional loading. Some changes in the eruption of neighbouring teeth were seen. Being a smoker was associated with significant negative changes related to the crest bone level.

A biobank of primary teeth within the Norwegian Mother and Child Cohort Study (MoBa): a resource for the future.

The Norwegian Mother and Child Cohort Study (MoBa) is a prospective population-based cohort study including >100 000 pregnancies and following the children through childhood, using questionnaires and collecting biological samples. The aim of MoBa is to test specific aetiological hypotheses by estimating the association between exposure and disease, aiming at prevention. A biobank for exfoliated primary teeth collected from the children participating in MoBa has been established (MoBaTooth Biobank). Samples of tooth tissues from the primary dentition can give information about exposure to toxic and essential elements during fetal life and early infancy. Prenatally and postnatally formed tooth tissues permanently document early exposures unlike other biomarkers, as teeth form incrementally at a known rate. Results from tooth analyses will be coupled with corresponding information in the multiple questionnaires and data from analysis of other biological samples collected by MoBa. Invitations to donate one or more teeth are sent to all mothers/children in the period 2008-2016, when the child is 6.75 years old. By August 2011, 7400 participants had been recorded into the MoBaTooth database donating altogether 9798 teeth (1.3 teeth per child). The response rate was 24%, but there is a lag of >1 year in the response. Data from the tooth biobank can supply MoBa with important additional information on the uptake of trace elements during fetal life and early infancy. This information can illuminate possible causal factors of health and disease in the future.

Oral health of 65-year olds in Sweden and Norway: a global question and ICF, the latest conceptual model from WHO.

OBJECTIVE: The aims of this study were to identify explanatory factors of satisfaction with oral health among Norwegian and Swedish 65 year olds in terms of items from four different domains of ICF and to compare the strengths of the various ICF domains in explaining satisfaction with oral health. Further it was to assess whether the explanatory factors of ICF domains vary between Norway and Sweden. MATERIALS AND METHODS: In 2007, standardized questionnaires were mailed to all the residents in certain counties of Sweden and Norway who were born in 1942. Response rates were 73.1% (n = 6078) in Sweden and 56.0% (n = 4062) in Norway. RESULTS: In total, 33 questions based on four different ICF domains were chosen to explain satisfaction with oral health. Logistic regression showed that four different ICF domains in terms of body function, body structure, activity/participation and environmental factors explained, respectively, 53%, 31%, 12% and 34% of the explanatory variance in the satisfaction with oral health. In the final analysis, only nine items were statistically significant (p < 0.05). CONCLUSION: This study indicates that ICF as a conceptual model could cover a broad spectrum of factors embedded in OHRQoL measured by a global question in Sweden and Norway. Nine items, representing four ICF domains, were important in the final model for explaining satisfaction with oral health.

Aesthetics of implant-supported single anterior maxillary crowns evaluated by objective indices and participants' perceptions.

AIM: The objective of this study was to evaluate the aesthetics of implant-supported single crowns in the anterior maxilla using objective indices and patients' perception. METHODS: Fifty participants, former patients (mean age 31.3 years) at the Dental Hospital, University of Bergen, or at Haukeland University Hospital in Bergen, Norway, who had implant-supported single crowns replacing upper anterior teeth lost due to trauma or agenesis during 2006, were included. One year after placement of the crown, an evaluation was carried out using the Pink Aesthetic Score (PES), the Implant Crown Aesthetics Index (ICAI), a modified version of the ICAI (mod-ICAI), and the index of the Californian Dental Association (CDA). The participants rated their satisfaction with the crowns and adjacent soft tissue. RESULTS: The form of the crown was satisfactory for 88% and the colour for 84% of participants, while 72% were satisfied with the adjacent mucosa. A statistically significant bivariate correlation was found between the PES and the ICAI and mod-ICAI. A weaker association was found between the CDA and the ICAI, mod-ICAI and PES. A positive correlation was found between the mod-ICAI index and satisfaction with the form and colour of the crowns and with the sum of ratings of responses to the questions about the form and colour of the crowns and the form and colour of the adjacent mucosa (P<0.05). Although most participants were satisfied, objective evaluation showed that a good aesthetic outcome for single implants was related to the quantity of the peri-implant mucosa. CONCLUSION: The mod-ICAI index correlated with responses to questions about the form and colour of the mucosa. Other significant correlations were found between the participants' aesthetic perceptions and the ICAI and the mod-ICAI. The mod-ICAI combined best objective and subjective assessment of aesthetics related to implant-supported crowns.

Satisfaction with teeth and life-course predictors: a prospective study of a Swedish 1942 birth cohort.

This study aimed to assess the stability or change in satisfaction with teeth among Swedish adults between the ages of 50 and 65 yr, and to identify the impact of socio-demographics and of clinical and subjective oral health indicators on participants' satisfaction with teeth during that period. Self-administered standardized questionnaires were used as part of a longitudinal study. In 1992, 1997, 2002, and 2007 all residents (born in 1942) of two Swedish counties were invited to participate in the study. A total of 63% women and 66% men reported being satisfied with their teeth between 50 and 65 yr of age. The corresponding figures, with respect to dissatisfaction, were 7% and 6% respectively. Generalized estimated equation models revealed a decline in the odds of being satisfied with advancing age, which was particularly important in subjects with lower education, tooth loss, and smokers. Consolidation in oral health perceptions starts before age 50, suggesting early intervention before that age. Promotion of a healthy adult lifestyle and improved access to quality oral healthcare might increase the likelihood of people being satisfied with their teeth throughout the third age-period in both genders.

Tracking of parents' attitudes to their children's oral health-related behavior-Oslo, Norway, 2002-04.

OBJECTIVES: To investigate dental beliefs and attitudes of a diverse group of parents from their children when they were aged 3 and 5 years old and to identify possible mediators for a group composed of the parents with the most negative dental attitudes. MATERIAL AND METHODS: Data were collected by parental questionnaire when the children were aged 3 years in 2002 and again 2 years later. The inclusion criteria were children with mothers from Norway (N group) or non-Western countries (IM(1) group). Questionnaires were extensive and had previously been used in a multicenter study. Three composite attitudinal variables relating to oral hygiene, diet and parental indulgence were calculated and an "attitudinal risk group" identified. The association between those variables and the assignment to the group was measured by odds ratio (bivariate and multiple logistic regression). RESULTS: The N parents' dental attitudes were significantly more positive in 2004 when their children were 5 years old than when they were 3 years old (p < 0.0001), but this was not the case among immigrant parents. "Education" and "Immigrant status" [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-7.0; and OR 2.8, CI 1.1-7.3, respectively] were significantly associated with the defined "attitudinal risk group". CONCLUSIONS: Only dental attitudes among N parents were significantly more positive in 2004 than in 2002. Not having higher education and being of non-Western background were associated with belonging to the "attitudinal risk group". Culturally tailored programs of dental health education are needed to promote more positive attitudes to oral health.

Variation in subjective oral health indicators of 65-year-olds in Norway and Sweden.

OBJECTIVE: Guided by the conceptual framework of Gilbert and co-workers, this study assesses satisfaction with oral health as reported by 65-year-olds in Sweden and Norway, the relationship of socio-demographic factors, clinical and subjective oral health indicators with satisfaction of oral health, and the consistency of those relationships across countries. MATERIAL AND METHODS: In 2007, standardized questionnaires were mailed to all the residents in two counties in Sweden and three in Norway who were born in 1942. Response rates were 73.1% (n=6078) in Sweden and 56.0% (n=4062) in Norway. RESULTS: Totals of 76.8% of the Swedish and 76.5% of the Norwegian participants reported satisfaction with oral health. Corresponding figures for toothache were 48.1% (Sweden) versus 51.5% (Norway), and for temporomandibular joint symptoms, 10.9% (Sweden) versus 15.1% (Norway). Multiple logistic regression analysis revealed that subjects who perceived they had bad health, smoked daily, had missing teeth, experienced toothache, had problems with chewing, bad breath, and oral impacts were less likely than their counterparts in the opposite groups to be satisfied with their oral health status. The corresponding odds ratios (ORs) ranged from 0.08 (problems chewing) to 0.2 (oral impact). No statistically significant two-way interactions occurred and the model explained 46% of the variance in satisfaction with oral health across the two countries (45% in Sweden and 47% in Norway). CONCLUSIONS: The oral condition of 65-year-olds in Norway and Sweden produced impacts in oral symptoms, functional limitations, and problems with daily activities that varied to some extent. Satisfaction with oral health varied by socio-demographic factors and subjective oral health indicators. A full understanding of the oral health and treatment needs of 65-year-olds cannot be captured by clinical measures alone.

Self-perceived oral health among 19-year-olds in two Swedish counties.

The primary purpose of the present study, which focused on a census of 19-year-olds (2006) attending dental clinics in two Swedish counties, was to describe the frequency distribution of clinically- and self-perceived oral health indicators in terms of DSa (Decayed Surfaces approximal), four global dimensions of oral health and one'all-embracing' oral health measure, according to county of residence and gender. A second purpose was to examine to what extent the clinical indicator of oral health and the global dimensions of self-perceived oral health contribute to the explainable variance of the global single-item indicator. Finally, the study examined whether or not the association of clinically- and self-perceived oral health indicators with the single global oral health indicator varied as a function of gender and place of residence. The study base was 46.5% (n=3658) of all children attending for dental checks (n=7866). The questionnaire included thirteen questions, divided into four global dimensions. These were Knowledge, Quality of life, Social and Function. There was also one 'all-embracing' oral health question, one question about gender and finally information about clinically-registered disease. The findings of this study were that females reported more serious problems than males in the Social and Quality of life dimensions and there were differences between counties in knowledge about oral diseases. The group with poor self-reported oral health in the 'all-embracing' oral health question had significantly more problems with all global dimensions, especially Quality of life and Social dimensions. Statistically-significant two-way interactions occurred between county and Knowledge and between county and Quality of life. This study supports the idea of one or several questions concerning self-perceived oral health to be used as a complement to the traditional epidemiological clinical registration of oral diseases.

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study.

OBJECTIVE: To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. METHODS: Data were collected by Norway's Central Bureau of Statistics in November-December 2003. A two-stage, proportional random sample comprising 2000 persons aged 16-79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25-79 years (response rate 66%, mean age 47.9 years). RESULTS: Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio-economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerke's R(2)) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. CONCLUSION: Socio-economic inequality in dental status persists among Norwegians aged 25-79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.

Caries increment in children aged 3-5 years in relation to parents' dental attitudes: Oslo, Norway 2002 to 2004.

OBJECTIVES: To assess the relationship between parents' dental attitudes and the caries increment in their children from the age of 3 to 5 years. METHODS: Data based on parental questionnaires and dental examinations were collected from children participating in a follow-up study from age 3 years (n = 354) in 2002 to 5 years (n = 304) in 2004. The children were categorized as western-native (WN) and immigrants (IM). The items used were significantly related to caries experience in a multicentre study [Pine et al. (2004)Community Dent Health, vol. 21, pp. 121-30]. The responses to attitudinal items were weighted as positive if they would promote good dental health, and negative if not. Composite attitudinal variables relating to hygiene, diet and indulgence were calculated as a summation of the weighted responses to selected items. Regression analyses (bivariate and multiple) were performed to assess associations during the period between the attitudinal predictors/other control variables and caries increment (Deltad(3-5)mfs). RESULTS: Bivariate logistic regression analyses revealed that 'Attitude to Diet' and 'Parental Indulgence' were clearly related to caries increment. The more exposed children were to negative parental attitudes, the higher the OR. 'Attitude to Diet' also persisted in a multiple logistic regression model, showing a higher OR value than caries experience. 'Immigrant Status' was the most potent predictor of caries increment. Parents were found to be more indulgent among IM than among WN groups. CONCLUSION: Parental dental attitudes are clearly shown to be associated with caries increment in early childhood. The relationship is of such strength that it deserves to be taken into account in future preventive dental strategies.

Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo.

OBJECTIVES: Immigrant children make up a large proportion of the school populations in many western cities. It is likely that their parents have different attitudes and knowledge of dental health than resident populations, and thus provide a challenge to public dental services. This study sought to map existing disparities in oral health among immigrant and western native children in Oslo and to identify differences in parental, cultural and ethnic beliefs and attitudes towards oral health and caries-related behaviours. METHODS: Caries was recorded of 735 children (3- and 5-year olds), supplemented with radiographs among 5-year olds. Their parents responded to a questionnaire. RESULTS: Immigrant background, consumption of sweet drinks at bed and social status were the dominant caries risk indicators among the 3-year olds. Among the 5-year olds, the caries risk indicators were immigrant background, parental indulgence, attitude to diet, attitude to oral hygiene, social status and age starting toothbrushing. Being an immigrant was closely associated with higher caries prevalence and experience. Parental attitudes to oral hygiene, diet and indulgence, and caries-related behaviours distinguished immigrants from western natives. CONCLUSIONS: The results suggest that immigrant groups in western societies require different information packages, modified strategies for forming oral hygiene habits and attitudes related to dental care of children, and encouragement to exercise discipline on factors known to be risks for oral health. These strategies must recognize that immigrants and western natives attach different levels of importance to oral health and dental parameters. It should be paid extra attention to some caries high-risk subgroups.