Jari Päkkilä

Geographical Distribution of Dental Caries Prevalence and Associated Factors in Young Adults in Finland

Oral health of the young has been reported to be associated with the place of residence, due to differences in socio-economic status. The results of studies on the effect of fluoride in drinking water on caries prevalence have been contradictory. The main aim of our study was to investigate the geographical distribution of dental caries prevalence in Finland and analyse possible regional, associated factors. Oral health of 13,564 men born between 1990 and 1992 was screened using a method based on criteria of the World Health Organization for epidemiological studies by 15 calibrated dentists in 20/24 garrisons of the Finnish Defence Forces in 2011. Mean DMFT and DT values in provinces were calculated. Multilevel analysis was applied to the data using generalized linear mixed models and a logit link function. The binary outcome variable was the cariological treatment need (yes/no) and the garrison was treated as random effect. Mean DMFT and DT values varied significantly between provinces in Finland. Increased levels of fluoride in drinking water, Swedish as the main language in the municipality, and living in urban areas were protective factors against cariological treatment need. Dentist density did not affect caries prevalence. The geographical distribution of dental caries further supported estimates of the protective effects of high fluoride levels in drinking water, Swedish as the main language in the municipality, as well as living in urban areas. Effect of fluoride on caries prevalence still exists, and association with the socio-economic status was confirmed.

Prevalence and polarization of dental caries among young, healthy adults: Cross-sectional epidemiological study

Abstract Objective. Oral health of young people has improved in the industrialized countries during past decades. However, stagnation of this progress has been reported recently. The main aim of this epidemiological study was to investigate the level of cariological treatment history and need (DMFT, DT) and polarization of dental caries among a healthy young male population born in the early 1990s. Materials and methods. Oral health of 13,564 men and 255 women born in 1990, 1991 or 1992 was screened based on the WHO criteria for epidemiological studies by 15 calibrated dentists in 20 garrisons (of a total 24) of the Finnish Defence Forces in January and July 2011. Mean DMFT and DT (SD) values and their distribution were calculated excluding wisdom teeth. Polarization was investigated using the Lorentz analysis. Results. Mean DMFT, DT and FT values were DMFT = 4.1 (SD = 4.2), DT = 1.4 (SD = 2.5) and FT = 2.7 (SD = 2.9). Almost half of the men (45.1%) and one third of the women (37.3%) had at least one tooth needing restorative treatment. About 30% of the conscripts had 90% of all caries lesions and ∼ 10% of the conscripts had half of all lesions. Conclusions. Oral health of young males has not improved since the previous study among conscripts 15 years ago. Polarization of dental caries still exists. About half of the young male population still has manifested dental caries. Oral health promotion must not be neglected, even in countries with low caries prevalence.

Review of 36,537 patient records for tooth health and longevity of dental restorations.

To develop an automatic system for utilizing electronic dental records, a data mining system to extract the diagnostic and treatment codes from the records for an intermediate file and automatic drawing of Kaplan-Meier-type survival curves was first created. Then this intermediate file was analyzed with SAS software for the scientific determination of Kaplan-Meier survival of tooth/surface-specific healthy time and survival of restorations in each permanent tooth, health center, and age cohort and also combined. All patients born in 1985, 1990 or 1995 in 28 health centers in Finland were analyzed. Patients classified as caries-active were those who had caries in any first permanent molar under the age of 8 years, while resistant patients did not have caries in these teeth before 10 years. In the younger age cohorts, a shortening of survival of caries-free teeth was seen. The shortest caries-free survival was seen in mandibular and maxillary molars in the youngest age cohort. Occlusal surfaces of molars determined their caries onsets and proximal caries occurred equally in molars, incisors and premolars, whereas canines or mandibular incisors did not have caries in these age cohorts. Caries-prone subjects had the shortest survival in all their teeth. The median longevity of all restorations was 11.7 years, with great variation between health centers and teeth. Because of the great variation between individual teeth, the tooth-specific approach seems appropriate in both caries epidemiology and material sciences.

Smoking, alcohol use, socioeconomic background and oral health among young Finnish adults

OBJECTIVES The aim of this study was to investigate the prevalence of smoking and alcohol use in association with dental caries experience and signs of periodontal disease in a Finnish male group born in the early 1990s. The impacts of health behaviour and socioeconomic factors were included in the analyses. METHODS Oral health of 8539 conscripts was screened in a cross-sectional study (DT, DMFT and CPI). They also answered a questionnaire covering their habits of smoking and alcohol use as well as other behaviours and background factors. The bleeding on probing index (BOP) was available on 6529 conscripts. Cross-tabulation together with a chi-squared test and generalized linear mixed models were used in the analyses. A mosaic figure was used to illustrate associations of smoking frequency, use of dental services and toothache. RESULTS Majority (80.9%) in the study group consumed alcohol at least once a month, and 39.4% were daily smokers. Smoking was statistically significantly associated with high caries experience and high bleeding values of gums. Consumption of alcohol was not associated with dental caries and periodontal disease. The high BOP value had the strongest association with infrequent tooth brushing and smoking. The participants own education level was the main protective factor of oral health. The smokers used dental services more frequently compared to the non-smokers mostly for acute care. CONCLUSIONS Young mens health behaviour, especially of those with low education, does not promote oral health, which may indicate need for extensive healthcare services in the future. Health promotion should not be neglected.

Association of smoking and snuffing with dental caries occurrence in a young male population in Finland: A cross-sectional study

Abstract Objective. The aim of this study was to investigate the prevalence of smoking and snuffing habits in association with dental caries occurrence in a male cohort born in the early 1990s in Finland. The impact of health behaviours and factors related to the place of residence were included in analyses. Materials and methods. Oral health of 8537 conscripts was screened in a cross-sectional study. In the same occasion they also answered a questionnaire covering their smoking and snuffing habits and other background factors. The residence-related factors were obtained from the Defence Forces’ database. Cross-tabulation together with chi-squared test and generalized linear mixed models were used for analyses. Results. Almost forty per cent (39.4%) of the men reported smoking daily and 9.0% reported daily snuffing. Restorative treatment need of those who reported frequent smoking was more than 2-fold (mean DT = 2.22) compared to the non-smokers (mean DT = 1.07). Smoking was statistically significantly associated with other harmful health behaviours. The snuffers reported more snacking than the non-smokers, but were most frequent brushers. The result from the statistical modelling showed that smoking, low tooth brushing frequency, eating sweets and consuming energy drinks frequently were significantly associated with restorative treatment need. Conclusion. In this cross-sectional study, association between smoking and dental caries was distinct. The high rate of restorative treatment need among smokers may be explained by their poor health behaviours. Dietary habits of the snuffers seem harmful too, but are compensated by good tooth brushing frequency.

A methodological pilot study on oral health of young, healthy males

Introduction: This study aimed to investigate the indications for an epidemiological survey on the oral health of young males, and the possibility of conducting it during their military service. Settings and Design: Despite the excellent oral health of young Finnish people in the past, there is concern about its degradation today. About 80% of young Finnish males enter the mandatory military service annually. The draftees have obligatory health inspection, with oral health screening, in the first two weeks of their service. Subjects and Methods: Self-reports on oral health were analyzed. Dental screening of conscripts performed by military dentists was timed and evaluated in two garrisons in 2010 (n = 256). Results: Over 40% of the conscripts reported having either dental symptoms or sensitivity after eating or drinking sour food or due to changes in temperature. Toothache was reported as having been the reason for the latest dental visit by 17% of the respondents. Clinical inspection took on an average almost three minutes and answering the questionnaire, almost 11 minutes. For evaluation of the process, the need for randomization of the study sample was emphasized as well as for specific guidelines, radiological education, and calibration of the dentists performing future survey to increase inter/intra examiner reliability. Moreover, the need for three computers per dentist for the questionnaires was pointed out. Discussion: The need for an epidemiological survey was indicated by a high number of respondents reporting dental symptoms and the need for treatment. An epidemiological survey is possible to be conducted by the existing military dental personnel, but they must be educated radiologically and calibrated. A specific protocol is essential.

Prevalence of Temporomandibular Disorders in the Northern Finland Birth Cohort 1966

AIMS To investigate the prevalence of temporomandibular disorders (TMD) in the 46-year-old cohort subjects from the Northern Finland Birth Cohort 1966 (NFBC 1966). METHODS Altogether, 1,962 subjects (1,050 women, 912 men) participated in a clinical medical and dental examination and responded to questionnaires in 2012 to 2013. The stomatognathic examination was performed according to a modified protocol of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Pearsons chi-square test and Fishers exact test were used to analyze the signs of TMD between genders, and logistic regression models were used to analyze the relationship between self-reported pain associated with TMD and modified DC/TMD protocol (P < .05). RESULTS Of the subjects available for analyses, 18.5% responded positively to the self-reported screening question for pain related to TMD. The most common signs of TMD were clicking in the temporomandibular joint (TMJ) (26.2%) and palpation pain in the masticatory muscles (11.2%). Women had signs of TMD more often than men (P < .05). The most common diagnosis was disc displacement with reduction (7.0%). Myalgia, arthralgia, disc displacement with reduction, and degenerative joint disease diagnoses were statistically significantly more common in women than in men (P < .05). The prevalence of TMD signs among the cohort subjects was 34.2%. CONCLUSION The most common sign of TMD was clicking in the TMJ and the most common TMD diagnosis was disc displacement with reduction. The prevalence of TMD signs among the examined cohort subjects was 34.2%. TMD was diagnosed in women more often than in men. The results are comparable with other corresponding population-based studies in adults.

Prevalence of Temporomandibular Disorder Symptoms and Their Association with Alcohol and Smoking Habits

AIMS To evaluate the prevalence of temporomandibular disorder (TMD) symptoms and their associations with alcohol consumption and smoking habits among young Finnish adults. METHODS The total sample consisted of 8,678 conscripts (8,530 men and 148 women, response rate 62.8%). Data on TMD symptoms, health behavior, and background/demographic factors were acquired by using a questionnaire. Self-reported facial pain and symptoms of TMD were used as outcome variables. The frequency of smoking and consumption of alcohol and snuff were used as explanatory variables. Chi-square tests, as expressed by odds ratios (OR) and 95% confidence intervals (95% CI), were used as statistical methods in the analysis. Statistical significance was determined at P < .05. RESULTS The prevalence of different self-reported, at least occasional TMD symptoms varied between 5.8% (difficulty in jaw opening) and 27.8% (temporomandibular joint [TMJ] clicking) in the male population, with higher prevalences for all symptoms in the female population except for TMJ clicking. Smoking was significantly associated with TMD symptoms, except TMJ clicking. Consumption of alcohol at least once a week was associated significantly with facial pain, TMJ pain, TMJ pain at jaw rest, TMJ pain on jaw movement, and TMJ clicking. Use of snuff was associated significantly with facial pain. CONCLUSION Daily smoking and increased frequency of alcohol consumption are associated with TMD symptoms among young Finnish adults. Dentists should be prepared to influence alcohol and tobacco consumption among young males to improve their health and quality of life.

The role of occlusion in temporomandibular disorders (TMD) in the Northern Finland Birth Cohort (NFBC) 1966

Abstract Objective To investigate the role of occlusion in temporomandibular disorders (TMDs) in the Northern Finland Birth Cohort 1966 (NFBC 1966). Methods Subjects (n = 1962) participated in clinical medical and dental examinations. The association between TMD signs and diagnoses with occlusal disturbances, i.e. malocclusions and occlusal interferences, was examined. Pearson’s chi-square test, as expressed by odds ratios (OR) and 95% confidence intervals (CI) and logistic regression models, were used in the analysis. Results A statistically significant association was found between myalgia and lateral scissor bite and also between arthralgia and lateral deviation in the retruded contact position and intercuspal contact position (RCP-ICP) slide. Pain in the masticatory muscles was associated with negative overjet and the amount of RCP-ICP slide. Discussion Occlusal factors showed a statistically significant association with TMD. The TMD signs were associated with unstable occlusion, especially the amount and lateral deviation in RCP-ICP slide, as well as negative overjet.

Oral health status associated with sociodemographic factors of Nepalese schoolchildren: a population-based study

OBJECTIVES The aim of this study was to investigate the oral health of Nepalese schoolchildren relative to their sociodemographic characteristics. METHODS This school-based, cross-sectional study was conducted among 5-6-, 12- and 15-year-old Nepalese children in 18 randomly selected districts of the 75 in Nepal. Clinical parameters were recorded according to the World Health Organization (WHO) guidelines. Results were presented as mean (SD) and proportions; the chi-square test, t-test and one way-ANOVA were also performed. The risk of dental caries in association with the place of residence was presented according to the outcome of a binary logistic regression analysis. RESULTS The mean d-value for the 5-6-year-old children was 5.0 (4.22), which was higher than the mean D-values for the 12- and 15-year-old subjects, of 1.3 (1.77) and 1.9 (2.28), respectively. The youngest children, as well as children from the Kathmandu Valley, were likely to have more untreated caries lesions than children in the other age groups. The mean number of teeth with severe consequences of dental caries (pulpitis/ulceration/fistula/abscess or pufa/PUFA) was 1.3 (1.91) for the 5-6-year-old children, 0.1 (0.35) for the 12-year-old children and 0.3 (0.75) for the 15-year-old children. All age groups had gingival bleeding on probing in more than 15% of teeth. Children from rural locations had significantly more gingival bleeding than urban children. The same was true for 15-year-old girls compared with boys of the same age. CONCLUSIONS Among Nepalese children, oral diseases are common, and geographical variation is prevalent. The health policy should address the alarming oral health situation and need for urgent treatment and population-based preventive programmes that is evident in Nepal.