Miira M. Vehkalahti

Association between dental fear and dental attendance among adults in Finland

Objective. Our aim was to evaluate the association between dental attendance and dental fear while considering the simultaneous effects of perceived oral health and treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. Material and methods. The two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The response rate to this nationwide sample was 88%. Dental fear was measured with the question: “How afraid are you of visiting a dentist?” Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, including the following independent variables: perceived oral health, perceived treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. Results. Among all ages, except 30 to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. The association was stronger the older the age group. Only age modified the association between dental fear and attendance. Irregular dental attendance can be attributed to high dental fear (etiologic fraction among exposed) in 41% of cases. Conclusion. Reducing dental fear would increase the number of regular attenders, especially among older age groups. Individuals for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly despite high dental fear.

Occurrence of Root Caries in Relation to Dental Health Behavior

We studied the relationship between the occurrence of untreated root caries and a subjects dental health habits, such as the frequency of tooth-brushing, the avoidance of sugar, and regularity of dental visits. A representative sample of 5028 adults was examined. Information on dental health habits was collected by professional interviewers one to six weeks before the clinical examination. A high frequency of tooth-brushing was strongly related to a low occurrence of root caries. The use of sugar in coffee or tea was strongly associated with root caries occurrence among men. The use of sweets was related to root caries occurrence moderately in men but not at all in women. Regular dental check-up behavior was strongly related to an infrequent occurrence of root caries. It was concluded that dental health behavior influences root caries occurrence and that caries on root surfaces is associated with poor dental health habits. Age and gender differences in root caries occurrence, reported earlier, may relate to different dental health behavior of women and men.

Salivary Findings, Daily Medication and Root Caries in the Old Elderly

Root caries is one of the main dental problems among the dentate old elderly. The aim of our study was to evaluate the occurrence of root caries in 196 dentate elderly (mean age 79.3) in relation to their salivary flow rate, buffering capacity and salivary microbial counts. These subjects participated in the oral health component of the Helsinki Aging Study in 1990–1991. Clinical oral examinations included assessment of the state of root surfaces and salivary flow rates, both paraffin-wax-stimulated and unstimulated. Salivary buffering capacity and the growth of salivary mutans streptococci, lactobacilli and yeasts were determined by means of commercially available kits. Root caries occurred in 52% of men and in 35% of women (p < 0.05). Number of decayed (DRS) and decayed or filled (DFRS) root surfaces correlated (r = 0.16 to 0.26) with salivary microbial counts. No correlation appeared between DRS and subjects’ salivary flow rates. Basic estimates on the association between DRS and salivary findings showed that microbial counts only produced significant odds ratios, from 2.0 to 3.5. However, in a log-linear model high salivary mutans streptococci and yeast counts together with male gender were associated with greater occurrence of root caries.

Education level and oral health in Finnish adults: evidence from different lifecourse models

AIM To assess the relationship between education level and several oral health outcomes in Finnish adults, using three conceptual lifecourse models. MATERIALS AND METHODS This study analysed data from 7112 subjects, aged 30 years or over, who participated in the nationally representative Finnish Health 2000 Survey. Parental and own education levels were the childhood and adulthood socioeconomic measures, respectively. Oral health was indicated by edentulousness, perceived oral health and levels of dental caries and periodontal disease. Three conceptual lifecourse models, namely critical period, accumulation and social trajectories, were separately tested in regression models. RESULTS In line with the critical period model, parental and own education levels were independently associated with oral health after mutual adjustment. There was also a graded linear relationship between the number of periods of socioeconomic disadvantage and oral health, corresponding to the accumulation model. Gradual declines in oral health were evident between social trajectories from persistently high to upwardly mobile, downwardly mobile and persistently low groups. CONCLUSION There was similar support for the lifecourse models of critical period, accumulation and social trajectories. They collectively contribute to a better understanding of oral health inequalities.

Evaluation of Salivary Tests and Dental Status in the Prediction of Caries Increment in Caries-Susceptible Teenagers

We evaluated caries increment in connection with salivary caries-related findings and dental status in teenagers by carrying out a retrospective follow-up, lasting on average 28 months. A total of 66 adolescents, mean age 15.2 years, were selected by their susceptibility to caries, as clinically defined at a routine checkup. Their baseline DMFT was 5.7, compared to 4.3 in the root population of 230 patients. Increment of caries on selected surfaces (delta DFSs) included new caries reaching the dentine and new fillings done due to such caries. Delta DFSs > 0 was taken as the validation criterion to define a caries case. Screening criteria for salivary tests were set as follows: flow rate of unstimulated saliva less than 0.2 ml/min, and of stimulated saliva less than 1.0 ml/min; buffering capacity: final pH below 4.5, mutans streptococci (SM) score of 2 or 3 (> or = 10(5) CFU/ml), and lactobacilli (LB) score of 5 or 6 (> or = 10(5) CFU/ml). Mean delta DFSs per subject was 1.1, with 70% of these new DF findings being on occlusal surfaces. Delta DFSs was correlated with LB (0.31) for both genders, for boys only with buffering capacity (-0.34), and for girls only with flow rate of stimulated saliva (-0.28) and DMFT (0.35). The highest sensitivities of salivary tests for caries were shown by LB (0.82) and SM (0.64), their specificities being 0.63 and 0.59, respectively. Positive predictive values of the five tests varied between 0.69 and 0.89. Predictions based on DMFT showed a sensitivity of 0.87 for DMFT > 3, but only of 0.33 for DMFT > 7, the corresponding specificities being 0.44 and 0.81.

Dental fear among population aged 30 years and older in Finland

Objective. The aim of the study was to examine how the percentage of subjects reporting dental fear varied in accordance with age, gender, level of educational attainment, and marital status in a nationally representative sample of the adult population in Finland. Material and Methods. The two-stage stratified cluster sample (n=8028) represented the population aged 30 years or older living in Finland. Of this nationwide sample, 88% participated. Dental fear was measured with the question: “How afraid are you of visiting a dentist?” The reply alternatives were: “Not at all”, “Somewhat”, and “Very much”. Age-specific multiple logistic regression analyses were used to explore the associations between dental fear and age, gender, marital status, and level of educational attainment. Results. Overall prevalence of being somewhat or very afraid of visiting a dentist among adults in Finland was high (37%), particularly among 30 to 34-year-olds (47%). Among men and women of different ages, 5% to 19% were very afraid and 16% to 59% at least somewhat afraid of visiting a dentist. Female gender was the best determinant of dental fear. Those with higher educational attainment were about half as likely to be very much afraid of dentistry compared to those with secondary educational attainment. Among the youngest age group, non-singles were more likely to report being very much afraid of dentistry than single subjects. Conclusions. The fairly high prevalence of reported dental fear among adults, especially in the youngest age group, presents a challenge to dental personnel in Finland.

Early childhood caries and dental plaque among 1-3-year-olds in Tehran,Iran

The association between plaque and caries in older children and adults has been poor, however, some studies show that there may be a relationship in younger children. The aim was to study the relationships between dental caries and dental plaque among 12-36-month-olds in Tehran, Iran. A cross-sectional study among a stratified random sample of 504 children aged one to three years from 18 public health centres in Tehran. Mothers were interviewed about their childs date and order of birth, gender, primary caregiver, the mothers age and the educational level of both parents. Dental examination was carried out according to the WHO criteria. Early childhood caries (ECC) was defined as the presence of any dmf teeth. Dental plaque was visually inspected on the labial surfaces of upper central incisors. Data analysis included Chi-square test, t -test, anova and logistic regression modelling. The prevalence of ECC ranged from 3 to 33% depending on age group, with a mean dt of 1.1 for 26- to 36-month-olds. No gender-differences existed in ECC prevalence and mean dt. Dental plaque was visible on at least one index tooth for 65-75% of the children. Presence of ECC was related to the presence of dental plaque (OR = 1.5; 95% CI 1.0-2.3) when controlling for background factors by means of logistic regression. The high occurrence of visible plaque and rather high ECC prevalence call for improvement in oral health promotion programs of the children.

Study motives and career choices of Iranian dental students.

Objectives: To investigate the study motives and career choices of Iranian senior dental students in relation to their background factors. Subjects and Methods: During the spring term 2005, a questionnaire survey was administered to 327 senior dental students in seven randomly selected state dental schools in Iran. The questionnaire requested information on age, gender, parents’ employment in dentistry, previous education and employment in dental hygiene, study motives, and career choices. Statistical analyses were made using independent sample t test, factor analysis, and binary logistic regression model. Results: Based on the factor analysis, which explained 73% of the total variance, five motive dimensions were identified: altruism and intellectual challenges, characteristics of the profession, social status and security, other person’s recommendation, and failure to be admitted to other study programmes. The mean for the ‘characteristics of the profession’ dimension was lower among the students with at least one parent employed in dentistry (p = 0.03). The ‘altruism and intellectual challenges’ dimension was reported to be more influential by the students with background in dental hygiene (32 students) compared to the others (p < 0.001). Engaging in postgraduate studies was the first career preference of 189 (70%) of the respondents. Those with a background in dental hygiene were less inclined to enter postgraduate courses (p < 0.001), but more eager to be employed in either the public or the private sector (p < 0.001), and to enter the community oral health and research field (p < 0.001) than the others. Conclusion: Personal characteristics and motives of the students play a major role in shaping their career preferences.

Malignant oral tumors in iran: ten-year analysis on patient and tumor characteristics of 1042 patients in Tehran.

This study analyzed characteristics of oral cancer patients from Tehran, Iran, and their tumors. Data came from the patient records of 30 major hospitals in Tehran. Patients (n = 1042), diagnosed with invasive oral cancer in 1993-2003, were classified by primary tumor site according to ICD-10 (C00-C10). Data were analyzed separately for lip, oral cavity and salivary gland tumors. Statistical evaluation included &khgr;2 and t-test. Of all cases, 59% were male. Age for all cases ranged from 6-103 years, mean age was 58.8 years (SD 16; median 62); 89% were older than 40. Tumor site breakdown was 65% oral cavity, 21% major salivary glands and 14% lip. A clear gender difference (P < 0.001) appeared regarding the primary tumor sites: women dominated in oral cavity cancers and men in lip cancers. The most common cancer site was the tongue (32%), accounting for 50% of the oral cavity cancers. Histologically, 88% of all oral cavity and lip cancers were squamous cell carcinomas, 10% of those were in age ≤40, 42% in ages 41-64 and 48% ≥ age 65. At the time of diagnosis, 59% of oral cavity cancers and 29% of lip cancers were at stage III or IV (P < 0.001). The results emphasize an urgent need for a national program focusing on early detection of oral cancers, including educational information addressed to oral health professionals.

Sense of coherence and oral health in dentate adults: findings from the Finnish Health 2000 survey.

AIM To assess the relationship between sense of coherence (SOC) and oral health, and the role of oral health-related behaviours in this relationship. MATERIALS AND METHODS This is a cross-sectional study of 5401 dentate adults who participated in the nationally representative Health 2000 Survey in Finland. The survey gathered information on SOC, demographic characteristics, education, income, pre-existing diabetes, daily smoking, dental attendance, toothbrushing frequency and sugar intake frequency. Oral health was assessed through clinical outcomes, such as number of teeth, number of decayed teeth and extent of periodontal pockets and perceived oral health. RESULTS A strong SOC was related to having more teeth, fewer decayed teeth, lower extent of periodontal pockets and good perceived oral health after adjustment for confounders, such as demographic and socioeconomic factors (all p0.003). These associations were attenuated but remained significant after further adjustment for potential mediators (oral health-related behaviours), except for the association of SOC with the extent of periodontal pockets, which was fully accounted for by pre-existing diabetes, oral health-related behaviours and dental plaque (p=0.549). CONCLUSION SOC is positively associated with various aspects of adult oral health, in part because of the better oral health-related behaviours among people with a strong SOC.