Lisa Bøge Christensen

Oral health in children and adolescents with different socio-cultural and socio-economic backgrounds

Abstract Objectives. To describe the occurrence and severity of dental caries in children and adolescents and to relate these findings to the subjects socio-cultural and socio-economic backgrounds. Material and methods. A cross-sectional study in 12 706 children aged 5, 7, 12 and 15 years was conducted in 2006. Data on childrens caries experience were collected from public oral health registers and pooled with socio-cultural and socio-economic data obtained from official statistics. The study population represented 76% of all registered inhabitants. Results. Among 5- and 7-year-old children with non-Danish mothers, the mean caries experience was three to four times higher than among children of Danish mothers, and a doubled rate was seen among the adolescents (p < 0.001). Significant differences in caries experience were found in various ethnic minorities. Multiple regression analysis showed that the level of caries was highest among children in families where mothers were not Danish, with low income, where mothers’ educational levels were low, and in with a high number of children (p < 0.001). Conclusions. Although almost all children and adolescents attend the prevention-oriented, free public dental service, a social gradient still exists for dental health. In addition, in all age groups, major inequalities in dental health were found when families with Danish and non-Danish backgrounds were compared. The findings indicate a need for social action by policymakers. Furthermore, a change in the oral health preventive strategy is proposed to meet the needs of children in risk of caries, and appropriate oral health-promotion programmes should be organized in collaboration with leaders from different ethnic minorities.

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.

Findings from the oral health study of the Danish Health Examination Survey 2007-2008.

Abstract Objective. The aims of the oral part of the Danish Health Examination Survey (DANHES 2007–2008) were (1) to establish an oral health database for adult Danes and (2) to explore the influence of general diseases and lifestyle on oral health. This paper presents the study population, examination methods, questionnaire and baseline results. Materials and methods. The study population comprised 4402 subjects, aged 18–96, consecutively enrolled from 18 065 DANHES participants from 13 municipalities in Denmark. The oral part consisted of a validated questionnaire and a clinical examination, carried out in mobile units by three trained and calibrated dental hygienists. The data were processed with descriptive statistics and mono- and bivariate analyses. Results. The mean age was 54.1 years and 60% were women. The mean number of natural teeth was 26.6; the mean DMFT/DMFS values were 18.9 and 61.0, and varied with age (DMFT 8.7–24.3). A higher proportion of females suffered from dental erosion in the younger age groups. Forty per cent of all subjects had a mean clinical attachment loss ≥ 3 mm, varying from 4% among those aged 18–34 to 80% in those over 75. A sub-optimal saliva secretion rate was more common among females than males (17.7% vs 10.4%) and this was reflected by the reported frequency of dry mouth. Conclusion. This extensive cross-sectional study provides a platform for obtaining future knowledge of the impact of health- and lifestyle-related factors on oral diseases. The validated questionnaire and the clinical characteristics enable robust analyses, although the conclusions may be hampered by limited external validity.

Intake of Dairy Products in Relation to Periodontitis in Older Danish Adults

This cross-sectional study investigates whether calcium intakes from dairy and non-dairy sources, and absolute intakes of various dairy products, are associated with periodontitis. The calcium intake (mg/day) of 135 older Danish adults was estimated by a diet history interview and divided into dairy and non-dairy calcium. Dairy food intake (g/day) was classified into four groups: milk, cheese, fermented foods and other foods. Periodontitis was defined as the number of teeth with attachment loss ≥3 mm. Intakes of total dairy calcium (Incidence-rate ratio (IRR) = 0.97; p = 0.021), calcium from milk (IRR = 0.97; p = 0.025) and fermented foods (IRR = 0.96; p = 0.03) were inversely and significantly associated with periodontitis after adjustment for age, gender, education, sucrose intake, alcohol consumption, smoking, physical activity, vitamin D intake, heart disease, visits to the dentist, use of dental floss and bleeding on probing, but non-dairy calcium, calcium from cheese and other types of dairy food intakes were not. Total dairy foods (IRR = 0.96; p = 0.003), milk (IRR = 0.96; p = 0.028) and fermented foods intakes (IRR = 0.97; p = 0.029) were associated with reduced risk of periodontitis, but cheese and other dairy foods intakes were not. These results suggest that dairy calcium, particularly from milk and fermented products, may protect against periodontitis. Prospective studies are required to confirm these findings.

Smoking and Drinking as Risk Indicators for Tooth Loss in Middle-Aged Danes

Objectives: To investigate tobacco and alcohol consumption as risk indicators for missing teeth in late middle-aged Danes. Method: In all, 1,517 Copenhagen Aging and Midlife Biobank (CAMB) participants received a clinical oral examination that included number of teeth. Information on smoking, drinking, and various covariates was obtained using self-administered, structured questionnaires. Descriptive statistics and logistic regression (dependent variable: 6+ vs. <6 missing teeth) were used to investigate smoking and drinking in relation to missing teeth. Results: Current smokers, persons who currently or previously smoked >15 tobacco units/day, and persons who had smoked for 27+ years had elevated mean scores of missing teeth and associated odds ratios (OR) compared with never smokers. Relative to nondrinkers, alcohol consumption was associated with reduced odds of missing 6+ teeth. Discussion: Our findings suggest that smoking is positively associated, while alcoholic beverage consumption is inversely related to tooth loss in middle-aged Danes.

Association between body mass index and caries among children and adolescents

OBJECTIVE The aim of this article was to examine the relationship between childhood caries, body mass index (BMI) and subsequent changes in BMI over 6 years, and to investigate whether these associations were modified by social class. METHODS Data were from the European Youth Heart Study (EYHS) merged with data on caries experience from the Danish National Board of Health, (SCOR register). RESULTS At baseline, 26.2% of the children/adolescents were caries free and 39% at follow-up. A larger percentage of normal weight children/adolescents were caries free, compared with the overweight/obese group of children/adolescents. The linear regression analysis showed that childhood caries was generally not associated with either BMI or subsequent changes in BMI. However, among children whose mothers were well educated, there was an inverse association between caries at baseline and subsequent changes in BMI over a period of 6 years, for example, a high caries experience was associated with a smaller increment in BMI, compared with the group of children with a low caries experience. No association was found for those with lower SES. CONCLUSION An inverse association between caries and subsequent changes in BMI was found, but only among children with well-educated mothers, suggesting that high caries experience may be a marker for low future risk of overweight among the more advantaged. Associations did not appear to be significant among the less advantaged; however, numbers in this group were low, and an association may have been overlooked. Hence, more studies are needed to confirm these findings.

Dental health status and development trends among children and adolescents in Greenland.

Abstract Objectives. This paper describes the occurrence of dental caries in children and adolescents in Greenland and the disease pattern is analysed across districts and over time. Study design. Cross-sectional population surveys of children aged 6, 12 and 15 years. Methods. Data were stored in the oral health information system established for the Greenland Public Dental Health Services, recording the dental health status of children served by the programme. The participation rate is approximately 100%. In 2003, the study population counted 645 6-year-olds; 587 12-year-olds, and 488 15-year-olds. Dental caries is clinically recorded according to the criteria used by the Danish Public Dental Health Services. Results. About 80–90% of children in all age groups were affected by dental caries. In 2003, a mean of 13.1 tooth surfaces were affected by dental caries in children aged 6 years, about 6.1 tooth surfaces in 12-year-olds, and 10.2 surfaces at age 15. At all ages, high proportions of children had severe patterns of dental caries. Extensive variations by district in dental caries indices were observed for all age groups. The dental caries experience tends to increase with time in young children, while the dental caries level remained stable for adolescents. Conclusions. The dental caries burden is high in children in Greenland compared to Denmark and other Nordic countries. It is unrealistic to achieve international goals for oral health and, thus, the strengthening of oral health promotion and disease prevention is urgently needed.

Calcium, vitamin D, casein and whey protein intakes and periodontitis among Danish adults

OBJECTIVE To investigate whether intakes of Ca, vitamin D, casein and whey are associated with periodontitis and to investigate the possibility of interactions between them. DESIGN Cross-sectional study. An Internet-based, 267-item FFQ was used to assess dietary intake. Intakes of casein (32.0 g/d), whey proteins (9.6 g/d) and vitamin D (5.8 μg/d) were classified as within v. above the 50th percentile. Ca intake was classified as within v. below age-specific recommendations. Severe periodontitis was defined as having ≥2 inter-proximal sites with clinical attachment loss ≥6 mm (not on the same tooth) and ≥1 inter-proximal site with pocket depth ≥5 mm. Since vitamin D influences Ca absorption, models were stratified by lower and higher (<5.8 v. ≥5.8 µg/d) vitamin D intake. SETTING Danish Health Examination Survey (DANHES) 2007-2008. SUBJECTS Adult participants (n 3287) in the oral health study of DANHES 2007-2008. RESULTS Intakes of Ca within recommendations (OR=0.76; 95% CI 0.58, 0.99), whey ≥9.6 g/d (OR=0.75; 95% CI 0.58, 0.97) and casein ≥32 g/d (OR=0.75 95% CI 0.58, 0.97) were associated with lower likelihood of severe periodontitis after adjustment for age, gender, education, smoking, sucrose intake, alcohol consumption, number of teeth, daily brushing, regular visits to the dentist and chronic illness, irrespective of vitamin D intake levels. Intake of vitamin D alone was not associated severe with periodontitis. CONCLUSIONS Intakes of Ca, casein and whey protein were inversely associated with periodontitis. Consumption of foods rich in Ca, casein and whey (e.g. dairy foods) should be promoted, as they may contribute to the prevention of periodontitis. Further longitudinal studies are required to confirm these associations.

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark.

AIM To describe the oral health and the oral-health-related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health-care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. METHODS A cross-sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health-care programme. Clinical data and data from interviews comprising social factors, life-style, dental visit habits, oral hygiene practices and self-perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. RESULTS Sixty-eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1-9 teeth and tooth mobility. CONCLUSION OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.

Caries prevalence in Danish pre-school children delivered vaginally and by caesarean section.

Abstract Objective. The mode of delivery may significantly influence the diversity and composition of the oral microflora and facilitate early acquisition of mutans streptococci. The aim was to compare caries prevalence and experience in 3-year-old children delivered vaginally and by caesarean section (C-section). Materials and methods. The study had an observational cohort protocol based on extracted information from governmental databases and nationwide registers concerning birth, social and educational levels and dental status. Children born at the Copenhagen University Hospital in 2005 were eligible and the final study group with complete information consisted of 594 children, 443 delivered vaginally and 151 by C-section. Results. The total caries prevalence was 8% and no significant difference was displayed between the groups. When only the children with caries (dmfs > 0) were compared, those delivered by C-section had a higher mean value in comparison with those delivered vaginally (dmfs 6.8 vs 3.2), but the difference was not statistically significant. There was a significant relationship between caries prevalence and low family income in the total study group (OR = 5.8, p < 0.05). Conclusions. Within the limitations of this observational cohort study, caries prevalence in 3-year-old children was not related to the mode of delivery. However, the tendency of more severe caries in the C-section group justifies further studies, preferably with a prospective design.