Arne Halling

GENDER DIFFERENCES IN KNOWLEDGE, ATTITUDE, BEHAVIOR AND PERCEIVED ORAL HEALTH AMONG ADOLESCENTS

A cross-sectional dental questionnaire census survey was conducted in classrooms of 17,280 students aged 13-18 years in Skaraborg County, Sweden. The overall response rate, based on school attendance on the test day, was 91% with no gender differences at the senior level, and 86% (boys 87%, girls 85%) at the upper secondary level. The aim was to examine gender differences in knowledge, attitude, behavior and perceived oral health. A retest study showed good agreement. Thirty-one percent of the girls and 21% of the boys flossed regularly. Eleven percent reported daily candy consumption, with no significant gender difference. Girls, however, more often than boys considered their own consumption to be too high. This gender difference in attitude was most pronounced among older daily consumers (odds ratio (OR) = 5.8 [3.7-9.2]). Oral health was regarded as important by a majority of the students (95%). Girls considered sound teeth to be more important than did boys, both among the younger (OR = 1.7 [1.4-2.1]) and the older (OR = 2.4 [1.9-3.1]) adolescents. It is concluded that most adolescents had a positive dental attitude and perceived their own oral health to be good. Poorer knowledge and behaviors concerning oral health were demonstrated. Gender differences existed in most issues. Girls scored more favorably on behavioral measures, showed more interest in oral health, and perceived their own oral health to be good to a higher degree than did boys.

Associations between social and general health factors and symptoms related to temporomandibular disorders and bruxism in a population of 50 year-old subjects

The aim of this epidemiological study was to examine associations between temporomandibular (TMD)‐related problems and variables from three domains: (1) socio‐economic attributes, (2) general health and health‐related lifestyle, and (3) dental attitudes and behaviors. The overall response rate to a questionnaire mailed to the total population of 50‐year‐old subjects in two Swedish counties (8,888 individuals) was 71%. Among the 53 questions in the questionnaire, those related to social, general health, and health‐related factors were used as independent variables in logistic regression models. Three TMD‐related symptoms and reported bruxism were used as dependent variables. Impaired general health was the strongest risk factor for reported TMD symptoms. Along with female gender and dissatisfaction with dental care, impaired general health was significantly associated with all three TMD symptoms. A few more factors were associated with pain from the TMJ only. In comparison, reported bruxism showed more significant associations with the independent variables. In addition to the variables associated with TMD symptoms, being single, college/university education, and daily tobacco use were also significantly correlated with bruxism. Besides female gender, impaired general health, dissatisfaction with dental care, and a few social and health‐related factors demonstrated significant associations with TMD symptoms and reported bruxism.

Quality of reporting randomised clinical trials in dental and medical research

Objective To assess 1) the quality of reporting randomised clinical trials in dental (RCT-Ds) and medical research (RCT-Ms), 2) the quality of RCT reports in relation to the journal impact factor, 3) the source of funding, and 4) the quality of RCT-Ds in different areas of dental research.Design Random samples of 100 RCT-Ds and 100 RCT-Ms published in 1999 were evaluated for quality of reporting under blinded conditions with the Jadad quality assessment scale. In addition, correlation between the quality scores and journal impact factor or source of funding, as well as area of dental research were analysed.Results The quality of RCT-Ds and RCT-Ms published in 1999 was generally inadequate. The quality was largely equivalent in RCT-Ds and RCT-Ms. There was no correlation between the quality scores and the journal impact factor or the source of funding. Some differences were found in the quality scores between different areas of dental research.Conclusions The results from these RCT-Ds and RCT-Ms show that most of them were imperfect in the reporting of methodology and trial conduct. There is a clear need to improve the quality of trial reporting in dental and medical research.

Explanatory models for clinically determined and symptom-reported caries indicators in an adult population.

The aim of the present study was to analyze possible indicators of: (i) relative number of decayed and filled teeth, (ii) relative number of decayed teeth, (iii) subjectively reported toothache, and (iv) sensitive teeth, and to find explanatory models for these phenomena. Independent variables from three domains were used: (i) socio-economic factors, (ii) general health and health-related lifestyle, and (iii) dental attitudes and behaviors. The study basis was validated questionnaires from all 50-year-olds in 2 Swedish counties (n = 8888), response rate 71% (n = 6343). For a 20% subsample (58% participation) the DFT and DT were determined by calibrated dentists. Analyses were done with logistic and multiple regression. The variables born outside Sweden, gender, education, shift work, satisfaction with dental care, fear and care utilization were associated with DFT/number of teeth. For DT/number of teeth, the direction of association was reversed for the variables born outside Sweden and gender. Social class, education, general health, and use of tobacco were further covariates. Good oral hygiene gave a lower ratio of DT. For the logistic regression model of toothache, residence in cities and satisfaction with dental care had lower probability for toothache reports, while born outside Sweden, mouth dryness, use of pharmaceuticals, tobacco, fear, and high utilization increased this probability. In general, the association pattern was as could be expected: immigrants, working class, low education, smoking, dissatisfaction with dental treatment and low utilization all appeared as risk factors for both the clinically determined caries indicators, but not necessarily for subjective symptom reports. Only fear of dental treatment showed a consistent positive association with all the indicators.

Comparison of three indices in evaluation of orthodontic treatment outcome

Three indices measuring outcome of orthodontic treatment were evaluated and compared in 39 specialist-treated individuals (group 1) and in 20 specialist-treated individuals who had undergone orthognathic surgery (group 2). The outcome was evaluated in accordance with the modified Indication Index, the modified ISMHB (Index of the Swedish Medical Health Board), and the PAR (Peer Assessment Rating) Index. Pre- and post-treatment need scores on the basis of the three indices were estimated. The ranking order of the individuals by the different indices was compared in the two groups separately, before and after treatment. Associations between the Indication Index and the ISMHB were consistently stronger than associations between the PAR Index and the two other indices, for which the variations were great. The reasons for the great variations seemed to be the different bases for assessment used and the different constructions of the indices: the PAR Index estimates deviations from an ideal occlusion, and the other indices evaluate treatment need. The outcome describe by the indices differed with regard to the pre- and post-treatment scores and the ranking order of the individuals. Of the three indices, the Indication Index was found to be the one most suitable for estimating treatment outcome in terms of decrease of treatment need, and the PAR Index was unsuitable for estimating treatment need.

Differences in four reported symptoms related to temporomandibular disorders in a cohort of 50-year-old subjects followed up after 10 years

Objective. To assess possible changes in the prevalence of four temporomandibular disorder (TMD) symptoms reported by subjects at age 50 and again 10 years later. Material and methods. Identical questionnaires were sent out in 1992 and in 2002 to all subjects born in 1942 and living in two Swedish counties. Of those who answered the four questions on TMD symptoms in 1992, 74% responded in 2002 (n=4639). The response alternatives were dichotomized into two groups: 1) No problems and 2) some, rather severe and severe problems. Results. The mean prevalence of TMD-related symptoms reflected small and mainly non-significant changes, whereas the prevalence of reported bruxism was significantly greater at age 60 than at age 50. Among those with no TMD symptoms at age 50, 5–7% of the men and 8–9% of the women reported symptoms at age 60. Of those reporting one or more TMD symptoms at age 50, 47–65% of the men and 40–48% of the women had no symptoms 10 years later. There was a significant and markedly increased risk of reporting TMD symptoms and bruxism (OR>10) at age 60 among those who had symptoms at age 50. Conclusions. The mean prevalence of reported TMD symptoms was relatively consistent from age 50 to age 60. The group reporting symptoms at the first examination were highly likely still to have the symptoms 10 years later. However, approximately half of the subjects with TMD symptoms at age 50 reported no symptoms at age 60.

Changes in reported orofacial symptoms over a ten-year period as reflected in two cohorts of fifty-year-old subjects

Objective. The study presents changes in reported orofacial symptoms over the course of a 10-year period. It was hypothesized that there was an increase of temporomandibular disorder (TMD) and orofacial pain symptoms during the period concurrent with social and demographic changes. Material and Methods. All 50-year-old subjects living in two Swedish counties were asked to answer a mail questionnaire in 1992 and 2002. In the two cohorts, 6,343 and 5,798, respectively, responded (response rate 71.3% and 70.2%). Results. Striking differences in demographic, occupational, general, and oral health conditions were found. General health was reported to be less good, utilization of dental care decreased, whereas number of teeth increased. The prevalence of a number of intra-oral symptoms and orofacial symptoms increased significantly between 1992 and 2002. Reported bruxism increased from 18% in 1992 to 28% in 2002. Conclusion. The observed increase in reported orofacial pain symptoms during the 10-year period, concurrent with changes in society, deserves further attention by society and the dental community.

Medline search validity for randomised controlled trials in different areas of dental research.

Objective To determine the validity of Medline searches for randomised controlled trials in dental research (RCT-Ds), using the medical subject headings (MeSH-terms).Design The Medline database was searched for randomised controlled trials in dental research (RCT-Ds) published in 1999 and with MeSH-terms corresponding to different areas of dental research. All RCT-Ds were manually examined for relevance to the different areas of dental research and cross-tabulated against the Medline search results. The sensitivity, specificity, positive (precision) and negative predictive values, as well as the accuracy of the search results were calculated.Results The highest validity in the Medline searches for RCT-Ds was seen for endodontics, followed by orthodontics, whereas the lowest validity was seen for pediatric dentistry and public health dentistry. For pediatric dentistry the MeSH-term searches had too low a sensitivity for adequate location of RCT-Ds.Conclusions MeSH-term searches on Medline are a useful tool for rapid location of RCT-Ds in most areas of dental research. However, there is a vast variation in the search validity. More refined search strategies are required to locate RCT-Ds in areas of dental research with low search validity.

Trends in dental and medical research and relevance of randomized controlled trials to common activities in general dentistry.

The aim was to study publication trends in dental and medical research as well as the proportion of randomized controlled trials in dental research (RCT-Ds) of relevance to common activities in general dentistry. The study was based on Medline searches, 1969-99 (MeSH terms). Data from Public Dental Services (county of Östergötland, Sweden) were used to find the most common activities in the practice of general dentistry. In dental research the annual number of publications had decreased from 5,900 in 1969 to 4,400 in 1999, corresponding to 9,100 and 14,000, respectively, in medical research. Clinical trials in dental research had increased to 7% and RCT-Ds to 5% of all dental research during 1969-99. In medicine, clinical trials and randomized controlled trials had increased to 2% and 1%, respectively. In dental and medical research, meta-analyses (MAs) totalled 0.1-0.2% in 1994 and 1999. One out of 200 dental research publications in 1979-99 was an RCT-D of relevance to the most common activities in general dentistry. These activities contributed to more than 80% of the dental care of children and adolescents and to more than 60% of the dental care of adults in 1999.

Does Having Children Affect Adult Smoking Prevalence and Behaviours at Home

BackgroundSmoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.MethodsQuestionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.ResultsParenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.ConclusionAs smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when childrens risk for ETS exposure is estimated.