E Schwarz

Oral Health Status and Oral Health Behaviors in Chinese Children

The objectives of the study were to describe the oral health status and treatment needs of the 5- to 6-year-old and 12-year-old children in Southern China; to describe the patterns of oral health behaviors, knowledge, and attitudes among the 12-year-olds; and to assess the effects of socio-behavioral factors on the 12-year-old childrens dental caries experiences. The study sample was comprised of 1587 5- to 6-year-old and 1576 12-year-old urban and rual schoolchildren living in Guangdong Province. Three calibrated dentists clinically examined the children, and trained interviewers interviewed the 12-year-olds. Caries prevalence of the 5- to 6-year-old children was high (urban 78% vs. rural 86%); the mean dmft of the urban and rural children was 4.8 and 7.0, respectively. The caries prevalence and mean DMFT score of the 12-year-olds were 41% and 0.9 (urban) and 42% and 0.9 (rural). Only 2% of the 12-year-olds exhibited no calculus or gingival bleeding, while more than 70% had calculus. In conclusion, there is an urgent need for establishing caries-preventive activities for preschool children. The prevalence of caries among the 12-year-olds was not high, but their periodontal condition was unsatisfactory. Knowledge about gum bleeding and the use of fluoride was low. More oral health education activities should be organized, especially for the rural children.

Utilization of Dental Services in Southern China

A populations utilization of dental services is an important parameter in oral health care planning, which has rarely been studied in China. The objectives of this report were to describe the dental service utilization pattern of middle-aged and elderly Chinese and to analyze the influence of selected variables on the use of dental services. A Guangdong Province population of 1573 35- to 44-year-olds and 1515 65- to 74-year-olds recruited from urban and rural communities was interviewed in their local dialect. It was found that 23% of the middle-aged and 24% of the elderly subjects had visited a dentist within the preceding year. The two most commonly cited reasons for not having seen a dentist for at least 3 years were: no perceived need, and no serious dental problems. Among subjects who had visited a dentist within 3 years, the 3 most commonly received treatments were: fillings, extractions, and dental prostheses. Furthermore, a logistic regression analysis showed that women, subjects who lived in urban areas, were better educated, were wealthier, and had better oral health knowledge were more likely to be a recent dental service user. In conclusion, dental service utilization among the adult Southern Chinese was found to be low, problem-driven, and influenced by some socio-economic factors.

Oral health status of southern Chinese following head and neck irradiation therapy for nasopharyngeal carcinoma.

OBJECTIVE To investigate the oral health status of patients with nasopharyngeal carcinoma (NPC) after completion of radiotherapy. METHODS Thirty-three NPC patients (mean age 53 +/- 10 years) who had completed head and neck radiotherapy (3.6 +/- 3.1 years post-operation) were examined. Dental caries, periodontal status and oral mucosal lesions were recorded. Stimulated whole saliva (SWS) flow rate, pH, buffer capacity and carriage rate of carcinogenic micro-organisms were assessed. Jaw opening was measured. RESULTS Xerostomia was present in all patients, while 42% had candidiasis and 21% had limited jaw opening. The mean number of teeth present was 22, mean DMFT was 8.0, mean number of untreated root caries lesions was 1.4. Both saliva pH and buffering capacity were low while Streptococcus mutans and Lactobacillus spp. carriage were high. 52% of the patients had no dental care following radiotherapy. Although few patients expressed direct dissatisfaction, perceived level of information and of post-operative dental care was insufficient. CONCLUSIONS Post-irradiated NPC patients constitute a high-risk group for dental root caries and oral candidiasis. The carriage rate of Streptococcus mutans and Lactobacillus spp. in this NPC patient group was the highest among findings of other similar studies. This may be related to the inadequacy of dental care after radiotherapy. Head and neck radiotherapy was not associated with periodontal disease.

Coronal and Root Caries in Southern Chinese Adults

Southern China is the most prosperous part of China, but information useful for oral care planning is very limited. A large-scale epidemiological survey was conducted in 1996-97. The objectives of this report were to describe the coronal and root caries of the adult Southern Chinese and to analyze the influence of selected demographic and socio-economic factors on the disease pattern. A total sample of 1573 35- to 44-year-olds and 1515 65- to 74-year-olds from 8 urban and 8 rural survey sites in Guangdong Province participated in an oral health interview and underwent clinical examination. World Health Organization examination procedures and diagnostic criteria were used. The weighted mean DMFT scores of the middle-aged and the elderly subjects were 4.8 and 16.1, respectively. People living in rural areas had a higher DMFT score than those living in urban areas (4.9 vs. 4.3 in the 35- to 44-year-olds and 16.5 vs. 14.7 in the 65- to 74-year-olds). In both age groups, MT was the major component of the DMFT score. Analysis of covariance showed that women and those who were economically less well off had higher DMFT scores in both age groups. The weighted prevalence rates of decayed/filled roots were 12% and 37%, with a mean of 0.2 and 0.7 teeth affected, in the middle-aged and the elderly, respectively. In conclusion, socio-economic factors had a considerable effect on the dental caries status of adults in Southern China.

Oral health and dental care in modern-day China

The purpose of this paper is to present salient background information on the oral care situation and organization in China and to review epidemiological literature that has been published on adults in Chinese dental journals during the last 20 years as a context for understanding ongoing oral health research activities in China. Searches were conducted through Medline as well as Chinese language catalogues and around 30 Chinese dental journals. Most oral health surveys on adults were conducted after 1970 mainly on residents living in big cities, which are also the location of major medical universities. Surveys conducted among farmers were uncommon. Dental caries and periodontal disease were the major dental diseases studied. Only a few surveys on peoples oral health knowledge, attitudes and behavior were conducted. Papers concerning dental treatment needs and utilization of dental services among adults were scarce. Sample size was usually not a major problem in these surveys but the sampling methods and diagnostic criteria used were often poorly defined. Mean DMFT scores between 2 and 6 were reported in the 35-44-year-olds and between 9 and 16 in the elderly younger than 75 years. Calculus and gingivitis were reported to be common in adult Chinese; the proportion of subjects with shallow and deep periodontal pockets was not high. Complete edentulousness in the 60-69-year-olds was usually reported to be less than 10%. About 14% of the 35-44-year-olds and 19% of the 65-74-year-olds did not brush their teeth daily.

Dental anxiety in Danish and Chinese adults--a cross-cultural perspective.

The aim of this study was to correlate dental anxiety as reported by two different ethnic groups with socio-demographic factors, dental status, and dental behaviour. Two randomly selected populations aged 35-44 years and 65-74 years were interviewed. The populations comprised 214 and 99 Danes and 384 and 497 Hong Kong Chinese respectively. Dental anxiety was assessed by the Corah Dental Anxiety Score (DAS). Mean DAS scores were significantly higher in Chinese than in Danes (8.7-10.3 and 6.7-8.2, respectively) and higher in the younger than in the older groups. Moderate to phobic dental anxiety was reported by 15% of the Danes and 30% of the Chinese, the latter proportion far beyond what is usually reported in Western populations. Only in the Chinese group did women report more anxiety than men. Regression analysis indicated that only a few of the variables selected to explain anxiety determinants had significant explanatory value. Among Chinese, gender was the most predominant in both age groups followed by perceived condition of teeth in the younger age group. Among Danes, perceived condition of teeth had an explanatory value for both age groups and dental visit pattern was the strongest for the younger age group. In spite of statistical significance, all explanatory values were small and indicate that variables not included in this analysis may exert a greater influence on the variation in dental anxiety. DAS, seemingly, was able to highlight variations in dental anxiety in the populations in spite of their differences and made interpretations feasible with regard to contrasting dental care behaviour and dental status.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in demand for dental care among Danish adults, 1975-90.

The aims of this study were 1) to analyze changes in and determining factors for demand for dental care among Danish adults during 1975-90, and 2) to apply standard cohort analysis on sequential cross-sectional survey data, thereby enabling the separation and examination of age, period, and cohort effects. Samples of non-institutionalized Danes aged 15 years and more were interviewed in 1975 (n = 1204), 1980 (n = 1108), 1985 (n = 1123), and 1990 (n = 1003), in accordance with a standardized questionnaire. Overall demand for dental care increased from 59% in 1975 to 76% in 1990; the younger the respondents, the higher the demand. Standard cohort table analysis indicated that the main effect derived from cohort succession; that is, the higher demand of the new cohorts entering the population remained higher than that of previous cohorts. Logistic regression analysis indicated that from 1980 to 1990 the significant predictors for regular dental care shifted from being predominantly predisposing and need variables to predominantly enabling and need variables.

Changes in utilization and cost sharing within the Danish National Health Insurance dental program, 1975-90

The aims of the analysis were 1) to examine the development in utilization of dental care provided for adults in Denmark under the National Health Insurance during the period 1975-90; 2) to assess the appropriateness of available dental care statistics for studies of oral health trends; and 3) to analyze the price development of dental services during 1975-90 and its impact on patient and Insurance expenses, respectively. Utilization and economic data were retrieved from available registers and analyzed. Three trends were found. First, the utilization has increased more than what could be explained by the population increase; secondly, the panorama of dental services changed from predominantly restorative/extraction services to predominantly diagnostic/preventive services. Thirdly, the price paid by Danish adults for dental care increased disproportionately to other price developments in society. On the basis of traditional health economic theory this development could be expected to affect demand for dental services negatively.

An Oral Health Survey in Southern China, 1997: Background and Methodology

Relatively limited information is available about the oral health in the Guangdong Province of Southern China, the closest neighbor to Hong Kong. The study intended to explore the oral health status, knowledge, attitudes, and dental care utilization in the Guangdong population as a basis for formulating strategies for oral health prevention and treatment. Through multi-stage stratified and quota-sampling, individuals from urban as well as rural communities were selected (5- to 6-; 12-; 35- to 44-; and 65- to 74-year-olds; total N = 6251). Structured interviews and clinical examinations were performed. Inter-examiner reliability was high (K = 0.60-0.96). Samples of community water were taken for fluoride assessment. Overall, the sample surveyed was acceptably representative of the population, with some under-representation of rural residents and agricultural workers. Re-weighting was performed in appropriate analyses. The data analysis model used in the Second International Collaborative Study was used as a guide for the present data analysis. This approach has not previously been used on a Mainland Chinese population.