Areej K. Al-Khabbaz

Self-reported oral hygiene habits and oral health problems of Kuwaiti adults.

Objective: The aims of this study were to examine self-reported oral hygiene habits and oral health problems of a sample of adult Kuwaitis. Materials and Methods: A self-administered, anonymous, structured questionnaire was distributed to 2,400 adult Kuwaiti nationals from all 6 governates of Kuwait assessing socio-demographic variables, oral hygiene habits, and oral health problems. Results: Of the 2,400 questionnaires, 1,925 (80.25%) responded. Of these, 62% reported brushing their teeth at least twice daily, while daily use of dental floss was uncommon (11.8%). Adequate toothbrushing habits were significantly associated with female gender, educational level, non-smoking status, and history of recent preventive dental visits (p = 0.001). The majority of subjects reported multiple oral health problems (64.7% with 2 or more and 41.8% with 3 or more). Factors associated with multiple oral health complaints included younger age, smoking, not having a recent preventive dental visit, and brushing the teeth less than twice daily. Conclusions: Less than two-thirds of the sampled adult Kuwaitis followed the recommended toothbrushing frequency of twice daily or more, and the majority of subjects have not had a preventive dental visit in the previous 6 months. Furthermore, most subjects reported multiple oral health problems that are mostly preventable through adequate oral hygiene habits and regular preventive dental visits.

Reasons for tooth extraction in Kuwait.

Objectives: To investigate reasons for tooth extraction and its association with age and gender in Kuwait. Subjects and Methods: A record of all tooth extractions performed in 21 general dental practice centers during a 1-month period was logged on specially designed study forms. The patient’s age and gender, number of teeth extracted, and the reason(s) for the extraction were recorded. Results: A total of 2,783 teeth were extracted in 1,604 patients (1.73 ± 0.07 teeth per patient). Caries and periodontal disease were responsible for 43.7 and 37.4% of extractions, respectively. Caries was the principal cause for extraction in patients ≤40 years old (60.7%), while periodontal disease was the main cause of extractions in patients ≧40 years of age (63.0%). Extractions for caries and orthodontic reasons were more common in females, while extractions for periodontal disease were more prevalent in males. Molars and maxillary premolars were more commonly extracted due to caries, while mandibular premolars, and maxillary and mandibular anterior teeth (canines and incisors) were more commonly extracted due to periodontal disease. Conclusions: The data show that caries is the principal cause for extractions in younger patients, while periodontal disease accounts for the majority of tooth extractions in patients older than 40 years. Furthermore, this study indicates that more teeth per patient are lost to periodontal disease than for any other reason.

Knowledge About the Association Between Periodontal Diseases and Diabetes Mellitus: Contrasting Dentists and Physicians

BACKGROUND There is a strong body of evidence that supports the relationship between periodontal diseases and diabetes mellitus (DM). Many patients are unaware of the effects of diabetes on oral health. Whether health care providers are applying the information about the link between DM and periodontal diseases in their practices depends on the levels of their knowledge of such valuable information. Therefore, the aims of this study are to evaluate the knowledge of dental and medical practitioners concerning the effects of diabetes on periodontal health and to find out if the practitioners are aware of the bidirectional relationship between periodontal diseases and DM. METHODS This was a cross-sectional survey of randomly selected general practitioners practicing in Kuwait. Participants were asked about specific periodontal complications that they believed patients diagnosed with diabetes were more susceptible to, and their awareness of the bidirectional relationship between diabetes and periodontal diseases was evaluated. RESULTS A total of 510 general practitioners (232 physicians and 278 dentists) participated in the study. There were no significant differences between the two groups regarding mean ages, sex distributions, and years in practice. Only 50% of all study participants believed that patients with diabetes were more susceptible to tooth loss because of periodontal diseases than were individuals without diabetes. Dentists were significantly more aware of gingival bleeding, tooth mobility, and alveolar bone resorption than were physicians. Factors significantly associated with having knowledge about the effects of diabetes on periodontal health in logistic regression analyses were older age, female sex, and the dental profession. CONCLUSION The knowledge about the association between periodontal diseases and DM should be increased among dental and medical practitioners to effectively prevent, manage, and control diabetes and periodontal diseases.

Periodontal Health of Children with Type 1 Diabetes Mellitus in Kuwait: A Case-Control Study

Objective: The aim of this study was to evaluate periodontal health in children diagnosed with type 1 diabetes mellitus. Subjects and Methods: Periodontal health was clinically examined and compared in 95 children diagnosed with type 1 diabetes and 61 healthy control subjects (4–14 years old). Plaque index, gingival index, clinical attachment loss and bleeding on probing were assessed on the 6 Ramfjord index teeth. Diabetes history was recorded based on information provided by the physician from the medical record of each diabetic child. Diabetes history included date of diagnosis, diabetes duration, age at diagnosis, latest reading for glycosylated hemoglobin and any existing diabetes complications. Data were analyzed using the Statistical Package for Social Science software, version 18. ‘Periodontitis’ was defined as at least one site with clinical attachment loss >2 mm on at least 2 teeth. Results: Sixty-two of the diabetic children (65%) had poor compliance with dental care, and 42 of them (44%) had never visited the dentist before. The children with type 1 diabetes mellitus had a significantly higher plaque index and gingival index and more bleeding on probing than control subjects (p < 0.001). In the diabetic group, periodontitis was significantly associated with longer duration of diabetes (odds ratio 2.230, confidence interval 1.308–3.801; p = 0.003) and older age at diagnosis of diabetes (odds ratio 1.838, confidence interval 1.091–3.096; p = 0.022). Conclusions: Periodontal disease in young patients with type 1 diabetes was more evident than in those without diabetes. These data showed that diabetes duration may play a significant role in the progression of periodontal disease in diabetic children.

Barriers to Seeking Preventive Dental Care by Kuwaiti Adults

Objective: The aim of this study was to assess the prevalence of preventive dental visits and to identify self-reported barriers for this practice among Kuwaiti adults. Materials and Methods: A self-administered, anonymous, structured questionnaire was distributed to a random sample of Kuwaiti nationals 18 years of age or older recruited from all six health districts of Kuwait. A total of 2,400 questionnaires were distributed. Multiple logistic regression analysis was performed to identify factors independently associated with not having a preventive dental visit for more than 1 year. Results: Of the 2,400 questionnaires, 1,925 (80.2%) were completed. Of these, 620 (32.2%) had a dental visit within the previous 6 months, 504 (26.2%) between 6 and 12 months and 801 (41.6%) more than 12 months ago. The most common reasons for the last dental visits were pain or a dental emergency, need for restorative treatment, and an examination/prophylaxis. The strongest factors for not having preventive visits were not using a mouthrinse daily, flossing less than once a day, dental fear, belief that there is no need for visits unless pain was present, brushing the teeth less than twice a day, and believing that appointments are too far ahead. Also older respondents (>30 years), female gender, and those having only high school education or less were less likely to visit a dentist for preventive reasons. Conclusion: More than half of the studied population reported not having had a preventive visit for more than 1 year. Unfavorable self-care habits, dental fear and belief that visiting a dentist is necessary only for pain relief were the strongest factors for the nonattendance behavior.

Diabetes mellitus and periodontal health: dentists' knowledge.

Objectives: There is a strong body of evidence to support the relationship between periodontal diseases and diabetes mellitus. Unless dental practitioners are aware of this link, they cannot apply the information to their daily practice. The aim of the study was, therefore, to evaluate the knowledge of dental practitioners concerning the effect of diabetes on periodontal health. Subjects and Methods: This was a cross-sectional survey of randomly selected dental practitioners in Kuwait. Participants were asked about specific periodontal complications which they believed that patients diagnosed with diabetes were more susceptible to. Results: A total of 220 dental practitioners (133 general dental practitioners and 87 dental specialists) participated in the study. Less than 60% of all study participants reported that tooth loss due to periodontal reasons and periodontal abscess were frequent among diabetic patients. Dental specialists, especially periodontists, were significantly more aware of periodontal complications associated with diabetes. Factors significantly associated with having knowledge about the effect of diabetes on periodontal health in logistic regression analysis were dentists who were older and those who were specialists. Conclusions: The results of this study indicate that knowledge about the effects of diabetes on periodontal health among this sample of dental practitioners is generally low, and dentists may underestimate the outcomes of periodontal diseases in diabetic patients.

Factors Associated with Implant Recommendation for Single-tooth Replacement

The use of dental implants for single-tooth replacement has been established as a predictable treatment option; yet, limited data are available as to how frequently this option is recommended to patients. The aim of the present study was to examine the frequency of implant recommendation by general dental practitioners after single-tooth extraction and factors influencing their decision to recommend an implant. All single-tooth extractions performed in 26 general dental practice clinics in Kuwait over a 30-day period were examined. Dentists in these centers used the study form to record demographic data, the type of tooth extracted, reason for extraction, and replacement options presented to the patients. Univariate and logistic regression analyses were used to examine associations between background factors and decisions to recommend implant therapy. A total of 1367 patients (mean age, 37.9 ± 11.8 years) had an extraction of one tooth during the study period. Forty-three patients were offered implants as a replacement option (3.3% of the total sample; 8.6% of patients who were offered tooth replacement options). Factors associated significantly with the recommendation of an implant by Kuwaiti dentists to their patients included younger age, regular dental maintenance visits, and adequate oral hygiene practices (P <0.05; binary logistic regression). Dental implant recommendation for single-tooth replacement in the present sample of dentists was low. Factors associated significantly with dentist recommendation of an implant for single-tooth replacement included age, history of dental maintenance, and oral hygiene practices.