Longitudinal association of smoking-related attitude to oral health with adolescents' smoking onset.

OBJECTIVE: The negative oral health effects of smoking, such as stained teeth, gum infection, and bad breath may be more salient to adolescents, and therefore, more important expectancies for adolescent smokers and nonsmokers alike. Informed by the social cognitive theory, this prospective study sought to determine the role of smoking-related attitude to oral health on smoking onset among adolescents over a 12-month interval. METHOD: This prospective study involved a community sample of 422 nonsmoking eighth graders selected from three public schools in the capital city of South Africa. Data were collected through a questionnaire, which included a 5-point Likert-scale-type question on dental disease belief related to smoking (smoking causes plaque and bad breath) and an affective evaluation of this effect (bad breath causes peer rejection). The product of these two later variables was used to compute an attitude score. Higher scores represent a more favorable oral health attitude. Health-risk behaviors recorded included past month smoking and alcohol use. RESULTS: The mean age of the participants was 13.9 years at baseline. At 1-year follow-up, 11.4 percent (n = 48) of nonsmokers at baseline had initiated smoking. Compared to nonsmokers, current smokers were more likely to report frequent bleeding gums (51.2 versus 33.1 percent; P = 0.02), but there was no significant difference in proportions brushing twice daily (64.4 versus 56.5 percent; P = 0.30). In addition to the independent influence of peers and binge drinking, smoking-related attitude to oral health significantly influenced smoking onset. CONCLUSION: The study findings support the development of smoking prevention programs that include restructuring of cognitions about the oral health outcomes of smoking.

Socio-demographic correlates of early childhood caries prevalence and severity in a developing country--South Africa.

OBJECTIVES: To describe Early Childhood Caries (ECC) severity in South Africa and examine the association between ECC and socio-demographic factors, area-based measures of sugar consumption and water fluoride levels. METHODS: Children, aged 36-71 months, were examined during the 1999/2002 South African National Children's Oral Health Survey (n=5822). ECC severity was described using Wyne's ECC classification (adapted) and the Significant Caries Index (SIC). Socio-demographic factors, area-based fluoride levels in water supplies, and the area-based per capita sugar expenditure obtained from the 2000 Household Expenditure Survey were examined using bivariate and multivariate analyses. RESULTS: The mean population SiC was 7.6 and 32% presented with the severe forms of ECC. Increased per capita sugar expenditure and decreasing water fluoride levels, were significantly associated with an increased risk for any ECC, but was not significantly associated with the severe forms of ECC. Compared to blacks, being of mixed race and white were respectively associated with an increased and a decreased risk for ECC. Unemployment increased the risk for the severe forms of ECC. CONCLUSIONS: The study findings support the implementation of an integrated primary oral health care strategy in order to address the underlying socio-economic determinants of ECC in South Africa.

Household smoking as a risk indicator for caries in adolescents' permanent teeth.

This study investigated the association between household member's (HHM) smoking or secondhand smoke exposure and caries, using a cross-sectional sample of adolescents who had both dental examination and data on HHM smoking (n = 1,873). The results suggest that HHM smoking may be a risk indicator for caries in adolescents' permanent teeth.

Evaluation of a fissure sealant program as part of community-based teaching and training.

Since 1995 the Department of Community Dentistry of the University of Pretoria has been involved in the rendering of mobile primary oral health care services to children in the Hammanskraal area of Gauteng, South Africa, as part of their students' community-based training. Mokonyama Primary School was identified as the first school where a primary oral health care service could be rendered. The objective of this study was to evaluate the impact (outcomes) of a fissure sealant program on the dentition status of the school children. Seven years after the implementation of the program, the dentition status of children at Mokonyama was compared with that of a comparable group of children from the same area who were not exposed to the program. The results showed that the decayed, missing, and filled teeth in the primary dentition (dmft) in the six-year-old group in Mokonyama (1.74) did not differ significantly from the dmft (1.43) of the control group (p = 0.49). The decayed, missing, and filled teeth in the permanent dentition (DMFT) of 0.59 for the fifteen-year-old group in Mokonyama, however, differed significantly (p = 0.0001) from the DMFT of the control group (2.38). Fifteen-year-old children in Mokonyama had 75.2 percent fewer caries than their counterparts in the control group.

Oral health in South Africa.

This study describes the oral health status of the inhabitants of, and reflects on possible trends in oral diseases in South Africa. During the past 20 years, three national oral health surveys were conducted in South Africa, the most recent, a national Children's Oral Health Survey, was conducted between 1999 and 2002. The results of this study show that 39.7% of the 6-year-old children were caries free, which is below the goal of 50% set by the Department of Health (DoH) for the year 2000. The DMFT of 1.1 for the 12-year-old group, however, was below the 1.5 set by the DoH for this group for the year 2000. Based on the Unmet Treatment Need Index more than 80% of caries in children is not treated. The greatest need for the treatment of dental caries in South African children was for preventive services, restorations and extractions. The DMFT for the 12 year-old-group in South Africa decreased from 2.5 in 1982 to 1.1 for the current survey. Of the same group, 20.2% of the children presented with definite signs of dental fluorosis. The Dental Aesthetic Index was used to assess the prevalence of malocclusion and 32.3% of 12-year-old children needed definitive orthodontic treatment. The results of national surveys showed a reduction in dental caries severity of the permanent dentition of 12-year-old South African children.