Mimmi Tolvanen

Parental influence on children's oral health-related behavior

Objective. The aim of this study was to determine whether there are differences between oral health-related knowledge, attitudes, beliefs and behaviors of children and their parents, and to identify the family-related factors associated with childrens poor or good oral health-related behavior. Material and Methods. The data were gathered by means of questionnaires from 11–12-year-old schoolchildren and their parents who replied without having knowledge of the answers of the others. Differences between subgroups of children were analyzed by cross-tabulation, and the factors related to childrens good or poor oral health-related behavior by logistic regression analyses. Results. Parents of children who reported good oral health-related behavior had better knowledge and more favorable behaviors than those of other parents. Predictors for a childs poor oral health-related behavior were the childs poor knowledge, male gender, the parents frequent consumption of sweets, and the parents infrequent use of xylitol gum. When a less strict threshold for the childs poor oral health-related behavior was used, more predictors entered the model: the parents unfavorable use of fluoride toothpaste; among girls, the parents lack of knowledge; and among children whose mothers occupation level was high, the parents infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable were more likely to have a high level occupation and favorable oral health-related behaviors. Conclusions. Oral health-related knowledge of children and their parents seems to be associated with childrens oral health-related behavior. Parents’ behaviors, but not attitudes, were associated with childrens oral health behavior.

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.

Oral-health-related quality of life among children with and without dental fear.

OBJECTIVESnThis study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured.nnnMATERIAL AND METHODSnThe participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register (n = 51) and schoolchildren (n = 82). Dental fear was measured with Treatment of dental decay and Attending dentist dimensions of the modified Childrens Fear Survey Schedule-Dental Subscale and a single question. ORHQoL was measured with CPQ(11-14). Background variables were gender and the dental care experienced.nnnRESULTSnThe response rates were 87% and 51% in the schoolchildrens and CLP groups, respectively. Those who were afraid of Treatment of dental decay had higher mean CPQ(11-14 )total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics.nnnCONCLUSIONnDental fear may have a negative effect on a childs ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.

Oral health-related knowledge, attitudes, behavior, and family characteristics among Finnish schoolchildren with and without active initial caries lesions

Objective. The aim of this study was to determine whether the presence of active initial caries lesions among 11 to 12-year-old schoolchildren is associated with parental and child-related factors and whether there are gender differences in these associations. Material and Methods. The data were gathered by questionnaires from children and their parents, who replied without knowing the others answers. All the children were invited to participate in a screening for the presence or absence of active initial caries lesions. Factors associated with childrens initial caries were studied with logistic regression analyses. Results. The parents’ self-assessed poor dental health, the parents’ and the childs poor oral health-related behavior, and the childs response “I dont know” to the question concerning his/her parents’ possible dental caries were associated with the presence of active initial caries lesions. The results of logistic regression analyses were different between girls and boys. Among the girls, many parent-related factors were associated with the presence of initial caries. Among the boys, most factors were related to the child; and of the parent-related factors, only parents’ poor self-assessed dental health was associated with initial caries; the effect was modified by the fathers occupational level. Conclusions. Parental factors affect boys’ and girls’ dental health differently. Among boys, the effect of the fathers was seen as the fathers occupational level; among girls, parental knowledge and behavior were important. When school interventions to promote health are planned, the important role of the parents should be emphasized.

Quality of life in patients with severe malocclusion before treatment

The aim of this study was to determine the occurrence of oral health impacts among patients with severe malocclusions and dentofacial deformities before treatment. A further aim was to evaluate the effect of gender or the type of malocclusion on the oral impacts. The study comprised 151 adult patients who were referred for orthodontic or surgical-orthodontic treatment to the Oral and Maxillofacial Department, Oulu University Hospital, Finland during the years 2001-2004. The study group consisted of 92 females and 59 males with a mean age of 35.5 years [standard deviation (SD) 11.5 years, range 16-64 years]. A self-completed Oral Health Impact Profile (OHIP)-14 questionnaire was used to measure oral impacts during a 1 month reference period. The prevalence, extent, and severity scores were calculated from the OHIP-14. Malocclusions were registered at clinical examination. The prevalence and mean extent and severity scores were compared among malocclusion groups and between genders. Statistical significance was evaluated with Mann-Whitney, Kruskall-Wallis, Chi-squared, and Fishers exact tests. The prevalence of oral impacts perceived fairly or very often was 70.2 per cent. The mean severity and extent scores were 17.2 (SD 10.5, range 0-45) and 2.5 (SD 2.6, range 0-10), respectively. Physical pain as well as psychological discomfort and disability were the most commonly perceived oral impacts. Being self-conscious, feeling tense, having difficulties in relaxing, and being somewhat irritable with other people were more common in females than in males. No differences were observed in oral impacts among the malocclusion groups. Compared with a normal population, patients with severe malocclusions report high levels of oral impacts. Females reported oral impacts more often than males.

Changes in children's oral health-related behavior, knowledge and attitudes during a 3.4-yr randomized clinical trial and oral health-promotion program.

The aim of our study was to compare the changes in childrens oral health-related behavior, knowledge, and attitudes obtained using an oral health-promotion approach, a risk-strategy and promotion approach, and reference area, and to report changes in the behavior of children between the experimental and the control groups of a randomized clinical trial (RCT). The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori, Finland (n = 1,691), where the RCT and program of oral health promotion were implemented for 3.4 yr. Children with at least one active caries lesion were randomly assigned to experimental (n = 250) and control (n = 247) groups. Children in Rauma (n = 807) acted as the reference. Changes in childrens self-reported behavior, knowledge, and attitudes were compared between groups. The subjects in the oral health-promotion group and in the risk-strategy and promotion group in Pori tended to show greater improvement in most of their oral health-related behaviors than those in the reference group, and children in the RCT experimental group showed greater improvement in most of their oral health-related behaviors than those in the RCT control group. Children can be helped to improve their oral health-related behavior by intervention, including oral hygiene and dietary counseling, or by implementing a multilevel-approach oral health-promotion program.

Dental esthetics and quality of life in adults with severe malocclusion before and after treatment

OBJECTIVEnTo investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups.nnnMATERIALS AND METHODSnFifty-two patients (36 women, 16 men; age 18-61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need.nnnRESULTSnOral health-related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health-related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups.nnnCONCLUSIONnImprovement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health-related quality of life, particularly by decreasing psychological discomfort and psychological disability.

Occlusal characteristics and quality of life before and after treatment of severe malocclusion.

The aim of this study was to evaluate the relationship between occlusal characteristics and oral health-related quality of life in adults who underwent orthodontic or orthodontic-surgical treatment. The study group consisted of 51 adult patients (35 women, 16 men) with severe malocclusion and considerable functional disorders. Thirty-six of the patients underwent combined orthodontic-surgical treatment, while 15 underwent orthodontic treatment. Data were collected before and after treatment. Mean follow-up period was 5.0 years (range 2.2-6.7 years). Occlusal characteristics were measured from dental casts by using Peer Assessment Rating (PAR) index. A self-completed Oral Health Impact Profile (OHIP-14) was used to measure oral impacts. The changes in PAR and OHIP-14 were measured, and correlation between PAR and OHIP tested before and after treatment and in the changes during the follow-up. Statistical significance was evaluated with the paired samples t-test and Mann-Whitney U-test, and the correlation between PAR and OHIP scores assessed using Pearsons and Spearmans correlation coefficient. The occlusion was significantly improved in all subjects, mean PAR reduction being 78.1 per cent. The prevalences of oral impacts at threshold `fairly often or `very often before and after treatment were 70.6 per cent and 9.8 per cent, respectively (P < 0.001). The PAR and OHIP scores correlated after treatment but not before treatment or in the changes. The treatment of severe malocclusion reduced the reported oral impacts to the level of general population and significantly improved oral health-related quality of life.

Changes in toothbrushing frequency in relation to changes in oral health‐related knowledge and attitudes among children – a longitudinal study

The aim of this study was to determine the associations between changes in self-reported toothbrushing frequency and the knowledge and attitudes related to oral health. The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori (n = 1,691); of these, 1,362 were monitored throughout the 3.4-yr study. Data were gathered by questionnaires before, in the middle, and after the follow-up, which was divided into two periods. Associations between changes in toothbrushing frequency, sum score of knowledge items, and sum scores of items in attitudinal factors were studied. The attitudinal factor structure was determined by principal component analyses. The associations were evaluated using mean values and general linear models for repeated measures. Toothbrushing frequency and knowledge and attitudes related to oral health improved among the same children during the study, with the changes usually taking place in the same time-period. In different time-periods, different childrens toothbrushing and oral health-related knowledge and attitudes improved. Based on our results, changes in knowledge, attitudes, and behavior are related, but children are ready for change at different times. Therefore, oral health promotion should be designed to be a continuous process rather than a short-term intervention.

Pathways between temporomandibular disorders, occlusal characteristics, facial pain, and oral health-related quality of life among patients with severe malocclusion

The aim of this study was to examine the pathways between temporomandibular disorders (TMDs), occlusal characteristics, facial pain, and oral health-related quality of life in patients with severe malocclusion. The study comprised 94 (34 men and 60 women, mean age 38 years) adult patients who were referred for orthodontic or surgical-orthodontic treatment. All the patients had severe malocclusion. Oral health-related quality of life was measured with the Oral Health Impact Profile-14 scale (OHIP-14), the intensity of facial pain using a Visual Analogue Scale (VAS), TMD with Helkimos clinical dysfunction index (Di), and occlusal characteristics with the Peer Assessment Rating (PAR). A hypothetical model of the interrelationships between these factors was constructed based on the conceptual model of biological, behavioural, and psychosocial consequences of oral diseases. The associations were studied with path analysis. Women reported poorer oral health-related quality of life, higher pain levels, and had more severe TMD than men, but the gender difference was statistically significant only in pain and TMD. In contrast to the hypothetical model, among women the occlusal characteristics were not directly associated with oral health-related quality of life or facial pain. Among men, the occlusal characteristics were directly associated with oral health-related quality of life. In conclusion, patients with severe malocclusion who also have TMD and facial pain more often have impaired oral health-related quality of life. The associations of the occlusal characteristics with oral health-related quality of life differ between genders. Therefore, these associations should be studied separately among genders.