Jolanta Aleksejuniene

Oral health behavior and attitudes of adults in Lithuania

In Lithuania, the oral health system is currently in transition and systematic data are needed for public oral health care planning. The objectives of this study were (i) to describe the self-assessment of oral health status in Lithuanian adults, the oral hygiene practices, and dental visiting habits; (ii) to assess the attitudes towards teeth and oral health, dental care and oral health services; (iii) to determine whether oral health attitudes and behavior are affected by socio-economic factors; and (iv) to analyse the association between self-care practices and use of oral health services. The study comprised random samples of 35-44-year-olds (n = 381) and 65-74-year-olds (n = 302). Data were collected during 1997-98 by means of self-administered questionnaires and the response rate was 53%. Nearly all persons of ages 35-44 had natural teeth, whereas 14% of 65-74-year-olds were edentulous. Among the dentate persons, 45% of the young adults against 36% of the elderly claimed having poor teeth, and 66% and 55%, respectively, had experience of pain from teeth or mouth during the past year. At ages 35-44, 33% of participants reported toothbrushing at least twice a day and this was the case for 21% of 65-74-year-olds. Dental visits within the past year were indicated by 60% of young adults and 43% of the elderly; 83% of all participants reported that their last visit to the dentist was due to acute oral symptoms. In general, the participants had positive dental knowledge and attitudes; however, 56% were unaware of any effect of fluoride. The bivariate analyses showed that perceived oral health status and oral self-care practices were related to use of dental services. The multivariate analyses of dental visiting habits revealed the effects of gender, urbanization, presence of natural teeth, experience of dental problems, attitudes to dental care and dentists, and education. In conclusion, preventive dental services should be introduced and the establishment of community-based oral health promotion programs is urgently needed for Lithuania.

Dental caries in adult Lithuanians

There are few data on the incidence of dental caries in Lithuanian adults. The aim of the present study was to describe caries and treatment experience among 35-44 and 65-74-year-olds, and to relate this to certain selected independent variables (gender, urban/rural residence, drinking water fluoride levels, and years of education). A total of 680 subjects selected based on a stratified random sampling procedure (response rate 52%) were examined by one examiner. Dental caries was recorded as DMFT following the WHO recommendations. The results showed that the median DMFT scores were 18 for the 35-44-year-olds (n = 380) with median DT = 2, MT = 5, FT = 7. For the 65-74-year-olds (n = 300) the median DMFT was 24, with DT = 1, MT = 18, FT = 2, respectively. One percent of all 35-44-year-olds and 11% of 65-74-year-olds were edentulous. In the younger age group, statistically significant differences in the DMFT scores were related to gender, urbanization and drinking water fluoride levels. Participants from areas with high fluoride content in the drinking water (>1.5 ppm F/l) had lower DT, MT, and FT values. Females and participants from urban areas had higher numbers of FT. Participants with more years of education had lower DT, MT, and higher FT values. In the elderly, DMFT scores were related to water fluoride levels and years of education. Individuals with more years of education had higher numbers of FT and lower MT values in this age group. Poor oral hygiene was associated with high numbers of DT in both age groups. The data indicate that dental caries is widespread among adult Lithuanians.

Dental health and disease determinants among 35-year-olds in Oslo, Norway

Objective. The aim of the present study was to identify non-biological determinants associated with the number of sound teeth (ST) and presence of decayed surfaces (DS) among 35-year-old Oslo citizens. Material and methods. Randomly selected participants (n=149, response rate 64%) completed a self-administered questionnaire and were examined clinically and radiographically. Dental caries was registered clinically following World Health Organization (WHO) diagnostic criteria for caries registration, and the findings were combined with radiographic caries recordings. The number of sound teeth and the presence of two or more dentine caries lesions (D3S≥2) were selected as dependent variables. Associations between selected dependent variables and possible determinants were assessed by linear and logistic regression analyses, taking into account the hierarchical relationships between the independent variables. Results. On average, 35-year-olds had 17.1 (SD=5.6) ST. Half of the participants had no DS and 26% had D3S≥2. Non-Western region of birth, being single, and having a university education were significantly associated with higher numbers of ST. Low family income, presently a smoker, and irregular dental visits were significantly associated with the presence of dentine caries. Conclusions. The results of this study indicate that several non-biological determinants operating at different levels are important for health and disease in this adult population.

Caries prevalence and oral hygiene in Lithuanian children and adolescents

Contrary to what is observed in many Western societies, the caries prevalence among children and adolescents in the Baltic States remains high. The aims of the present study were to describe the caries prevalence and oral hygiene among 7-, 12-, and 15-year-old Lithuanians and to correlate the caries prevalence with fluoride content in the drinking water, oral hygiene, gender, ethnicity, and pattern of sugar consumption. The investigation was based on cluster samples, and the clinical investigation was performed in accordance with criteria defined by WHO. High DMFT values were registered (mean DMFT = 1.3 among 7-year-olds; DMFT = 4.9 among 12-year-olds and 7.0 among 15-year-olds) and were associated with low fluoride content in the drinking water and poor oral hygiene. Girls showed higher DMFT values than boys. No correlation between pattern of sugar consumption and caries prevalence could be disclosed.

Dental health and disease in patients with haemophilia – a case‐control study

Management of patients with hereditary bleeding disorders in dentistry causes considerable problems. This study examined different aspects of dental health or disease of Lithuanian children and adults with haemophilia and compared them with the general population. Two study groups of cases and controls were formed. Cases were recruited through census sampling and controls were randomly chosen from the general population matched for gender, age and place of residence. Dental health of permanent and deciduous dentitions was assessed by one examiner employing the WHO Criteria for Oral Health Surveys. The following aspects of dental health/disease were considered: overall caries experience, treatment experience, unmet dental treatment needs and the presence of functional dentition. Data were collected from 76 patients with haemophilia among which 27 were children and 49 were adults and a control group of 76 subjects comprising 30 children and 46 adults. Children with haemophilia had a significantly lower overall caries experience and less unmet dental treatment needs in deciduous teeth as compared to healthy children. In permanent dentitions, overall caries experience, unmet dental treatment needs or treatment experience did not differ between cases and controls either in older children or adult cohorts. There were no differences between the study groups regarding the functional dentition‐related indices. Healthier deciduous teeth were observed in children with haemophilia than in children without haemophilia, but other dental health or disease‐related outcomes did not differ between cases and controls.

Student ePortfolios to develop reflective skills and demonstrate competency development: Evaluation of a curriculum pilot project.

INTRODUCTION The University of British Columbia Faculty of Dentistry developed a longitudinal curriculum pilot project to assess the usefulness of portfolios for dental students to develop reflective skills and demonstrate competency development, and to examine relationships between portfolio grades and clinical success. MATERIALS AND METHODS Students in one dental class created portfolios with reflections on examples relevant to eight selected competency statements each year of the program. As part of our program evaluation, we set out to look at trends in portfolio grades, meta-reflection skills, student and faculty views of the project, and relationships among portfolio grades, 4th year clinical grades and faculty rankings. RESULTS Portfolio grades improved from years 1 to 3, dropping off slightly in year 4. The highest level of internal consistency for grades within and between years occurred with Competency 42, while the lowest level occurred with Competency 4. Most students were able to demonstrate meta-reflection by 4th year. Students generally agreed with portfolios and reflection in concept, but suggested a looser structure, and they shared concerns with faculty about the workload involved. Portfolio grades did not correlate with clinical course grades (P = 0.092), but they did correlate significantly with faculty rankings except for year 1. CONCLUSION While portfolio grades for reflections were not consistent, and they did not quite correlate with clinical course grades, they correlated strongly with faculty rankings. Future use of portfolios at UBC Dentistry will be enhanced by increasing curricular support regarding both competency development and the importance of reflection for professionals, decreasing workload by focusing on five Key Competencies, incorporating more formative and face-to-face feedback, and providing greater opportunities for peer sharing.

Oral lichen planus: a 4-year clinical follow-up study

BACKGROUND/AIM This study aimed to examine oral lichen planus (OLP) cases histopathologically and cytologically, describe different clinical aspects of OLP manifestations, and associate different OLP clinical forms with self-reported oral health and with local and systemic risk factors. MATERIALS AND METHODS All patients with a referral diagnosis of OLP received biopsies. The histological evaluation assessed infiltration with lymphocytes, epithelial hyperplasia, and hyperkeratosis. Histology was used to validate the OLP diagnosis and to evaluate the malignant transformation of OLP lesions. Clinical manifestations of OLP and potential local oral environment-related risks were clinically assessed. Systemic risks were evaluated by a structured questionnaire. RESULTS A total of 133 patients with a histologically confirmed OLP diagnosis were followed. There were more females (N = 109) than males (N = 24) and the majority of patients were older than 50 years. The reticular form (45.1%) was the most prevalent clinical form followed by the erosive-ulcerative form (33.8%). The histological characteristics were most pronounced in the erosive-ulcerative form. Of the OLP cases, 2.3% had a malignant transformation. CONCLUSION Reticular and erosive-ulcerative were the most prevalent OLP forms. There were more female than male OLP patients. Except for medication use, there were no statistically significant differences among different clinical OLP forms in either local or systemic risk factor distributions.

Mandibular changes secondary to serial extractions compared with late premolar extractions and controls

INTRODUCTION Variations in treatment times for serial extraction and late premolar extraction patients may be due to differences in the time needed to flatten the occlusal curves. In this study, we compared tooth tipping and occlusal curves in patients treated by serial extractions or late premolar extractions with untreated controls. METHODS Mandibular dental casts and cephalometric radiographs were collected from 90 subjects (30 Class I control subjects, 30 patients with serial extractions, and 30 with late premolar extractions) at 3 time points: T0, baseline for the controls and serial extraction patients; T1, after natural drift and preorthodontics for the controls and the serial extraction patients, and pretreatment for the late premolar extraction patients; and T2, after comprehensive orthodontic treatment for the serial extraction and the late premolar extraction groups. The long axes of the central incisor, canine, and first molar to the palatal plane were measured on digitized headfilms to determine the direction and the amount of tipping between the time points. Three occlusal curves were measured by sphere fitting cusp-tip landmarks on digitized mandibular casts. RESULTS From T0 to T1, incisors and canines in the patients with serial extractions tipped distally. Molars at T1 in the patients with serial extractions were tipped forward more than in the late premolar extraction patients and the controls. From T1 to T2, canines and molars in the patients with serial extractions were uprighted. CONCLUSIONS Serial extractions produce steeper occlusal curves and distal tipping of the incisors and canines after drift (T1). Posttreatment (T2) occlusal curves in the patients with serial extractions are steeper than in the late premolar extraction patients and controls (except for the curve of Spee). After the serial extractions, orthodontic treatment included incisor and canine proclination, with molar uprighting and occlusal curve flattening.