Marja-Liisa Laitala

Self-reported oral health and associated factors in the North Finland 1966 birth cohort at the age of 31

BackgroundThe Northern Finland 1966 birth cohort (NFBC 1966) is an epidemiological study where the participants have been controlled since pregnancy both in field tests and using questionnaires. This study aimed to evaluate cross-sectionally the association of self-reported oral symptoms (dental caries and bleeding of gums) with sociodemographic and health behavior factors among the subjects.MethodsOf the 11,541 original members of the cohort, 8,690 (75%) responded to the questionnaire on oral health (dental decay, gingival bleeding and self-estimated dental treatment need) and sociodemographic factors, general health and health behavior. Cross-tabulation and chi-squared tests as well as multiple logistic regression analysis were used to analyze the association between the outcome and explanatory variables.ResultsThe study group was equally distributed between the genders. One third of the subjects reported having dental decay, one fourth gingival bleeding and a half a dental treatment need. As compared to women, men reported significantly more frequently symptoms (p < 0.05). Logistic regression analysis revealed low tooth brushing frequency increasing the odds most for all oral symptoms ((OR 1.57 (1.39–1.78) for dental decay, 1.94 (1.68-2.24) for gingival bleeding and 1.42 (1.26-1.61) for dental treatment need). Frequent smoking was associated with dental decay (OR 1.63 (1.44–1.84)) and treatment need OR (1.39 (1.23–1.56)), whereas poor general health (OR 1.71 (1.48–1.96)) and high BMI (OR 1.19 (1.03–1.36)) both were associated with gingival bleeding.ConclusionsMales with single marital status, BMI over 25, poor general health and poor oral health behaviors are at risk for self-reported poor oral health and dental treatment need.

Evaluating performance of dental caries detection methods among third-year dental students.

BackgroundReliable caries detection is a cornerstone in the modern caries treatment schema. This study aimed to evaluate adopting traditional and new caries detection methods by third-year dental students.MethodsFifty-seven students were given lectures on caries detection, after which they evaluated 27 extracted carious teeth using traditional clinical assessment (CE), Nyvad’s, and ICDAS methods. On three teeth they also performed DIAGNOdent pen® (LF) scanning. Histological scores of the sectioned teeth (ICDAS, LF) and activity estimations of the lesions by the supervisors were used as golden standards (Nyvad, CE). For the ICDAS method , sensitivity and specificity were calculated using dentine caries (D3) as a cut-off point. Mean ICC and kappa values were calculated to evaluate interexaminer agreement for all lesions and methods. Spearman’s correlation coefficient evaluated LF scanning.ResultsICDAS method presented good sensitivity ( 0.78) and specificity (0.87). The inter-examiner agreement for different methods was fair or good (CE ICC = 0.69, κ = 0.53; Nyvad’s method ICC = 0.68, κ = 0.48, ICDAS ICC = 0.66, κ = 0.47). Variation in LF values was the greatest with lesions extending to middle third of dentin. In that case, the Spearman’s correlation coefficient was also the weakest.ConclusionsTo follow the guidelines by the European Core Curriculum on Cariology, the third year dental students are introduced to methods for detecting lesion depth and assessing lesion activity as well as using new caries detection methods. Their performance in estimating lesion depth is good, and fair to good in estimating lesion activity even after basic training only.

Influence of Intrinsic Factors on Erosive Tooth Wear in a Large-Scale Epidemiological Study

Objective: To assess the influence of self-reported intrinsic factors [gastroesophageal reflux disease (GERD), long-term alcoholism, long-term heavy use of alcohol and multiple pregnancies] on erosive tooth wear in a middle-aged cohort sample. Materials and Methods: Of the total Northern Finland Birth Cohort (NFBC 1966), a convenience sample (n = 3,181) was invited for an oral health examination in 2012-2013, of which 1,962 participated, comprising the final study group. Erosive tooth wear was assessed by sextants using the Basic Erosive Wear Examination Index (BEWE, 0-18). Clinical data were supplemented by questionnaires conducted in 1997/1998 and 2012/2013. The participants were divided into severe (BEWE sum ≥9) and no-to-moderate (BEWE sum 0-8) erosive wear groups, and the logistic regression model was applied. Results: Selected intrinsic factors were quite rare in this cohort sample and explained only 5.9% of the difference in the prevalence and severity of erosive wear. Daily symptoms of GERD [odds ratio (OR) 3.8, confidence interval (CI) 1.2-12.0] and hyposalivation (OR 3.8, CI 1.2-11.8) were the strongest risk indicators for severe erosive wear. Additionally, variables associated with an elevated risk for severe erosive wear were diagnosed alcoholism at any point (OR 2.5, CI 0.7-9.7) and self-reported heavy use of alcohol in both questionnaires (OR 2.0, CI 0.6-6.2). Even low-dose long-term consumption of alcohol was associated with erosive wear. Conclusions: In this cohort sample, intrinsic factors such as GERD or alcoholism alone are relatively uncommon causes of erosive tooth wear. The role of long-term use of alcohol in the erosion process may be bigger than presumed.

Self-reported oral health and use of dental services among asylum seekers and immigrants in Finland-a pilot study.

BACKGROUND The number of asylum seekers and immigrants arriving in European countries is growing explosively. The aim of this pilot study was to investigate self-reported oral health, oral health habits, dental fear and use of dental health care services among asylum seekers and immigrants in Finland. METHODS The interview study carried out in 2012 comprised 38 participants (18 males and 20 females) from 15 different countries, nine of whom were asylum seekers and 29 immigrants. The youngest participant was 17 and the oldest 53 years old. Each interview took approximately 30 min. RESULTS The participants reported high need for dental treatment. Compared with the immigrants, the asylum seekers reported significantly more frequently dental pain and other symptoms and were less satisfied both in getting a dental appointment and in the quality of treatment they had received. All the asylum seekers and almost half of the immigrants found it difficult to get an appointment. The immigrants were more aware of good oral health habits than the asylum seekers. The asylum seekers suffered from dental fear more often than the immigrants. CONCLUSION Despite the small number of participants, our interview-based study indicates that asylum seekers and immigrants have need for acute and basic dental treatment and health education.

Is a Basic Erosive Wear Examination (BEWE) reliable for recording erosive tooth wear on 3D models

OBJECTIVES To assess the reliability of the BEWE index on 3D models and to compare 3D-assessed erosive tooth wear scores with clinically detected scores. METHODS In total, 1964 members of the Northern Finland Birth Cohort 1966 participated in a standardized clinical dental examination including the Basic Erosive Wear Examination (BEWE) and dental 3D modelling at the age of 45-46 years. Of those examined, 586 were randomly selected for this study. 3D models were assessed using the same BEWE criteria as in the clinical examination. Calculated kappa values as well as the prevalence and severity of erosive wear according to the clinical examination and 3D models were compared. Re-examinations were performed to calculate intra- and inter-method and -examiner agreements. RESULTS The BEWE index on 3D models was reproducible; the mean intra- and inter-examiner agreement were 0.89 and 0.87, respectively, for sextant level, and 0.64 and 1, respectively, for BEWE sum scores. Erosive tooth wear was recorded as more severe in 3D models than in the clinical examination, and inter-method agreement was 0.41 for severe erosive wear (BEWE sum>8). The biggest inter-method differences were found in upper posterior sextants. CONCLUSIONS The BEWE index is reliable for recording erosive tooth wear on 3D models. 3D models seem to be especially sensitive in detecting initial erosive wear. Additionally, it seems that erosive wear may be underscored in the upper posterior sextants when assessed clinically. Due to the nature of 3D models, the assessment of erosive wear clinically and on 3D models may not be entirely comparable. CLINICAL SIGNIFICANCE 3D models can serve as an additional tool to detect and document erosive wear, especially during the early stages of the condition and in assessing the progression of wear. When scoring erosive wear clinically, care must be taken especially when assessing upper posterior sextants.

Oral health care-related beliefs among Finnish geriatric home care nurses

OBJECTIVES The aim was to investigate beliefs about oral health care tasks among nursing staff caring for home-dwelling older people using the Nursing Dental Coping Beliefs (nursing DCBS) index. METHODS The study population comprised nursing staff working at the homes and sheltered accommodations of older people in Ylivieska, Finland (N = 141). The data were collected using the nursing DCBS index (five-point Likert scale). RESULTS On average, the nurses held moderate to high Oral health care beliefs, Internal locus of control beliefs and External locus of control beliefs, but low beliefs about Self-efficacy. The nurses with an earlier adjunct education scored lower for Oral health care beliefs on the factor Knowledge about preventing gum diseases (OR = 0.3, 95% CI: 0.1-0.9) than did the others. Regarding beliefs about External locus of control, the age group 31-49 years scored lower on the factor Retaining teeth as one ages (OR = 0.2, 95% CI: 0.1-0.7), but scored higher on the factor How to prevent dental diseases (OR = 5.6, 95% CI: 1.1-29.3) than did younger nurses (≤30 years). The nurses with only a nursing education showed significantly higher mean scores on the Self-efficacy factor Confidence of the need for dental knowledge than did those with an earlier adjunct education (P = 0.034). CONCLUSIONS The nursing staff mostly believed that oral diseases are preventable and teeth can be retained in advanced age, but failed to recognize the value of dental knowledge and had little confidence in their ability to manage oral diseases. Improving the oral health-related knowledge and self-efficacy beliefs of nursing staff will require additional oral health education.

Genome-Wide Association Study of Erosive Tooth Wear in a Finnish Cohort

Erosive tooth wear is defined as irreversible loss of dental tissues due to intrinsic or extrinsic acids, exacerbated by mechanical forces. Recent studies have suggested a higher prevalence of erosive tooth wear in males, as well as a genetic contribution to susceptibility to erosive tooth wear. Our aim was to examine erosive tooth wear by performing a genome-wide association study (GWAS) in a sample of the Northern Finland Birth Cohort 1966 (n = 1,962). Erosive tooth wear was assessed clinically using the basic erosive wear examination. A GWAS was performed for the whole sample as well as separately for males and females. We identified one genome-wide significant signal (rs11681214) in the GWAS of the whole sample near the genes PXDN and MYT1L. When the sample was stratified by sex, the strongest genome-wide significant signals were observed in or near the genes FGFR1, C8orf86, CDH4, SCD5, F2R, and ING1. Additionally, multiple suggestive association signals were detected in all GWASs performed. Many of the signals were in or near the genes putatively related to oral environment or tooth development, and some were near the regions considered to be associated with dental caries, such as 2p24, 4q21, and 13q33. Replications of these associations in other samples, as well as experimental studies to determine the biological functions of associated genetic variants, are needed.

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.

National reference centiles of anthropometric indices and BMI cut-off values in a child population in Nepal

Abstract Background: There is a need for national- or ethnicity-specific growth reference values in developing countries like Nepal, where rapid urbanisation and consequential nutritional transition is taking place. Aim: To establish national growth reference percentiles for anthropometric indices and to propose body mass index (BMI) cut-off values for Nepalese schoolchildren. Methods: This study comprised 1135 Nepalese schoolchildren of four World Health Organization (WHO) indexed age groups (5-, 6-, 12- and 15-year-olds). The age- and gender-specific smoothed percentile curves for anthropometric indices (height, weight, BMI, waist circumference, waist-to-hip-ratio and waist-to-height-ratio) were constructed using LMS method and the corresponding Z-scores were computed. The Receiver Operating Characteristic analysis was used to determine BMI cut-off values based on the International Obesity Taskforce (IOTF) and the WHO growth references. Results: The age- and gender-specified smoothed percentile values of anthropometric indices at 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentiles were computed. The BMI cut-off values for thinness (−1.2 SDS/12th percentile), overweight (+1.2 SDS/88th percentile) and obesity (+2.1 SDS/98th percentile) had high discriminating power, and high sensitivity and specificity. Conclusion: The Nepali anthropometric cut-off values proposed here can be recommended to be applied into research, and to identify public health risks in Nepal among these age groups.

Oral health behaviors associated with dental general anesthesia amonghealthy children

Background: Background: The aim of this survey was to investigate family-related factors among healthy children treated under dental general anesthesia (DGA) compared to those treated in a normal dental setting. Methods: The survey comprised 87 children whose dental treatment was performed under DGA and 103 age-matched children who were treated in a normal setting. The children were healthy 3 to 11-year-olds, and their parents filled out the questionnaire on parental dental fear, DGA experiences in the family, and oral health behaviors. The data were collected in primary health care in the city of Oulu, Finland, during 2014– 2016. Results: In the DGA group, the proportion of fearful parents was three-fold higher and the proportion of siblings with DGA experience four-fold higher than in the comparison group; the differences between the groups were statistically significant. The dietary habits were statistically significantly poorer in the DGA group than among the comparison group when several indicators were considered. Linear regression analysis showed that treating a child in DGA was associated with harmful oral health behaviors like eating candy, drinking juice, and poor tooth brushing habits. Conclusions: Parental dental fear, DGA experiences of siblings, and harmful oral health behaviors were more common among children treated in a normal dental setting. Screening children and families for the risk indicators identified in this study may help prevent unnecessary DGAs among healthy control.