Prevalence and simultaneous occurrence of periodontitis and dental caries.

AIM: The aim of the study was to evaluate the prevalence and simultaneous occurrence of periodontal disease and dental caries in Finnish adults. MATERIAL AND METHODS: The study was performed as part of the nationally representative Health 2000 Survey. The study population was 5255 subjects aged 30 years and older. Probing pocket depth (PPD) and untreated dentinal caries were recorded by tooth. Teeth with PPD 4mm and deeper indicated periodontal disease, and teeth with PPD 6mm and deeper indicated a severe periodontal disease. RESULTS: Sixty-four percent of persons had periodontal disease, 21% had a severe periodontal disease, and 29% had dental caries. Persons having periodontal disease had significantly more often dental caries (33%) compared with those without periodontal disease (23%). This was even more evident in persons having severe periodontal disease (44%). Accordingly, persons having dental caries had significantly more often severe periodontal disease (31%) compared with those without dental caries (16%). The mean number of teeth with dental caries or periodontal disease per person was greater when the mean number of teeth with the other disease was also greater. CONCLUSIONS: These data indicate that especially severe periodontal disease and dental caries tend to accumulate in the same subjects.

Sense of coherence as a determinant of toothbrushing frequency and level of oral hygiene.

BACKGROUND: Antonovsky's salutogenic theory seeks to find general health-promoting factors in individuals as distinct from characteristics that function as risks for specific diseases. A central construct of the theory is sense of coherence (SOC). Individuals with a strong SOC have the ability to define events as less stressful (because of comprehensibility); to mobilize resources to deal with encountered stressors (manageability); and to possess the motivation, desire, and commitment to cope (meaningfulness). Our aim is to investigate whether SOC, self-reported toothbrushing frequency, and objectively assessed levels of oral hygiene are related. METHODS: The sample of the present study consisted of 4,131 30- to 64-year-old dentate Finns belonging to a large nationally representative sample. The questionnaire and home interview included information about socioeconomic and demographic factors, behavioral variables, such as oral health behaviors (toothbrushing frequency), and a 12-item SOC scale, used here as a unidimensional measure categorized into quintiles. The level of oral hygiene was measured during clinical oral examination. Chi-square test, ordinal, and ordinary logistic regression analyses were used. RESULTS: Subjects belonging to the strongest SOC quintile were found to be significantly more often two, or more, times a day brushers compared to those with less strong SOC. After controlling for toothbrushing frequency, sociodemographic and socioeconomic factors, smoking habits, and number of teeth, both strong and moderate levels of SOCs were also found to be related to a good level of oral hygiene compared with moderate and poor levels of oral hygiene. Furthermore, subjects within the weakest SOC quintile were found to have significantly more often than others poor levels of oral hygiene. CONCLUSIONS: Our results suggest that a weak sense of coherence increases both the probability of having a poor level of oral hygiene and a frequency of toothbrushing of less than once a day. This and the theory concerning the development of SOC suggest that sense of coherence may be taken as a determinant of both the frequency and the quality of toothbrushing.

The theory of reasoned action in describing tooth brushing, dental caries and diabetes adherence among diabetic patients.

OBJECTIVES: Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin-dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence. MATERIAL AND METHODS: Cross-sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records. RESULTS: The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015). CONCLUSIONS: Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.

Metabolic control as a modifier of the association between salivary factors and dental caries among diabetic patients.

The aim here was to analyze the role of metabolic control as a modifier of the association of salivary factors with dental caries among diabetic patients. Cross-sectional data were gathered from 149 insulin-dependent diabetes mellitus patients by means of clinical examination, a quantitative questionnaire and patient records. Dental caries was measured as the number of decayed surfaces. The data were analyzed using negative binomial regression models. HbA1(c) level appeared not to be associated with dental caries. Of the salivary factors, only high levels of mutans streptococci (MS) and lactobacilli were associated with dental caries. Among the subjects with HbA1(c) > or =8.5, the presence of dental caries was more distinctly associated with higher levels of MS (RR = 3.86, CI: 1.39-11.96) and lactobacilli (RR = 3.59, CI: 1.44-9.33) compared to those with HbA1(c)<8.5. It can be concluded that poor glycemic control strengthens the positive association of MS and lactobacilli with dental caries.

Role of smoking and HbA1c level in periodontitis among insulin-dependent diabetic patients.

OBJECTIVES: The aim was to analyse the role of smoking and HbA1c level in attachment loss (AL) and probing depths (PDs) among insulin-dependent diabetic patients. MATERIAL AND-METHODS: The study subjects were selected from a group of 149 insulin-dependent diabetic patients and included 64 patients (39 men and 25 women) aged 30 years or older. Data were obtained from patient records and by clinical examination. The outcome variables were the number of sites with AL and PDs of 5-9 mm. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated using Poisson regression models. RR was adjusted for the number of teeth, dental calculus and age. RESULTS: RR for AL among the smokers was 4.15 (95% CI: 2.30-7.63) and that for PD among the smokers was 7.96 (95% CI: 4.91-13.19). HbA1c was not related to AL or PD. Among smokers with HbA1c > 8.5, RR for AL was 12.34 (95% CI: 4.14-39.35), but RR was not elevated for PD. CONCLUSIONS: It can be concluded that the poor metabolic control together with smoking is extremely detrimental for AL.

Relation of different measures of psychological characteristics to oral health habits, diabetes adherence and related clinical variables among diabetic patients.

Among diabetic patients, oral health status and oral health behavior have been found to relate to metabolic control. The aim was to analyse which psychological characteristics, i.e. intention, self-efficacy, locus of control or self-esteem related to health behavior most comprehensively explain oral health habits, diabetes adherence, dental caries, deepened periodontal pockets, and the metabolic parameter HbA1c (glycosylated hemoglobin). The study subjects consisted of a group of 149 insulin-dependent diabetic patients. Data were obtained from self-completed questionnaires. The proportions of variance explained by the linear regression model were used as measures in the comparisons. It was found that oral health habits and diabetes adherence correlated. Both dental and diabetes self-efficacy scores were related to oral health habits and diabetes adherence. This indicates that self-efficacy is the best overall determinant of various health behavior practices. The ability of psychological characteristics to explain oral health was limited. Improvement of self-efficacy therefore may have a positive effect on various aspects of health behaviors.