Nina J. Wang

Reliability of Two Clinical Scoring Systems for Dental Erosive Wear

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (ĸw). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean ĸw values were found for VEDE (ĸw = 0.77) compared with BEWE (ĸw = 0.69). When scoring the surfaces in the clinical examination the mean ĸw values for the two systems were equal (ĸw = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

Factors associated with traumatic dental injuries among 12-year-old schoolchildren in South India

AIMS To assess the prevalence of, and correlates of traumatic dental injuries among 12-year-old schoolchildren in Kerala. MATERIAL AND METHODS A cross-sectional, two-stage cluster sampling technique was used. The sample size included 838 12-year-old school children. Traumatic dental injuries to the anterior teeth were evaluated clinically by one examiner. Teeth examined were maxillary and mandibular incisors and canines. The children answered a structured questionnaire on sociodemographics, subjective oral health assessments and behavioural aspects. RESULTS Six per cent of the 12-year-old school children had traumatic dental injuries to the anterior teeth. The right central incisors were most frequently affected. Multiple logistic regression analysis showed that boys (Adjusted Odds Ratio (Adj OR) = 2.2, 95% Confidence Interval (CI) = 1.1-4.1) and children who disagreed that good marks in school were important to them (Adj OR = 2.3, 95% CI = 1.2-4.3) had a higher probability of having traumatized teeth than other children. CONCLUSIONS The prevalence of traumatized anterior teeth among 12-year-olds in Kerala was low compared with other studies. Being male and negative about future career were associated with a higher probability of having a traumatized tooth.

Oral health-related quality of life and associated factors in Norwegian adults

Abstract Objective. To investigate associations between oral health-related quality of life assessed with the Oral Health Impact Profile (OHIP)-14 and demographic factors, number of teeth present, dental visits, dental health behaviour and self-rated oral health in a representative sample of 20–80-year-old Norwegians. Material and methods. The study was conducted in a stratified random sample of 3538 individuals. Questionnaires including questions on demographic factors, number of remaining teeth, dental visits, dental health behaviour, self-rated oral health and OHIP-14 were mailed to the sample. Bivariate and multivariate analyses were performed. Results. The response rate was 69%. The mean OHIP-14 score was 4.1 (standard deviation = 6.2). No problem was reported by 35% of the respondents. The most frequently reported problems were: physical pain (56%), psychological discomfort (39%) and psychological disability (30%). When the effect of all independent variables was analysed in multivariate analysis, self-rated oral health, frequency of dental visits, number of teeth, age and sex were significantly (P < 0.05) associated with the prevalence of having problems and frequent problems. Self-rated oral health had the strongest association with having problems [odds ratio (OR) 4.5; 95% confidence interval (CI) 3.4–6.0] and with having frequent problems (OR 4.0; 95% CI 2.7–5.8). Dental health behaviour, use of floss and toothpicks and oral rinsing were not associated with having problems related to oral quality of life in multivariate analyses. Conclusion. In this Norwegian adult sample, self-rated oral health, frequency of dental visits, number of teeth, age and sex were associated with having problems as estimated using the OHIP-14.

Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr

In this study, associations were explored between maternal health and lifestyle during pregnancy and in early motherhood, and preschool childrens caries experience. The study was based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and on data from the Public Dental Services. A total of 1348 children were followed from pregnancy to age 5 yr. A clinical dental examination was performed at age 5 yr. Questionnaires were completed by the mothers during pregnancy and in the first 18 months of their childs life, and as part of the dental examination. Results from the multivariate logistic regression analysis showed that having an obese mother (OR = 2.3, 95% CI: 1.3-4.1), a mother who consumed a diet containing more fat (OR = 1.6, 95% CI: 1.1-2.5) or sugar (OR = 1.5, 95% CI: 1.1-2.3) than recommended, a mother with low education (OR = 1.5, 95% CI: 1.1-2.3) or one or both parents of non-western origin (OR = 5.4, 95% CI: 2.8-10.6) were statistically significant risk indicators for caries experience at age 5 yr. In conclusion, maternal weight and intake of sugar and fat in pregnancy were associated with caries experience in preschool children. These characteristics may enable early referral to the dental services and preventive care to be delivered.

Variation in clinical time spent by dentist and dental hygienist in child dental care

In a field project in the Public Dental Service in Norway, 4000 children aged 5 to 18 years were examined and given preventive care by dental hygienists. The study describes the clinical time spent providing child dental care when hygienists examined all children and referred to dentists those children who required care hygienists were not qualified to deliver. Of all clinical time spent, 56% was dentist time and 44% was hygienist time. A high proportion of children without dental caries did not consume dentist resources at all. More than 40% of the dentist time was consumed by the 10% of the children with most new decayed teeth. In conclusion, the project showed that in a child population with low caries increment, a substantial proportion of children received all dental care from hygienists, so that dentist resources were saved for other groups. However, although hygienists were used as first-line personnel, a considerable quantity of dentist time was spent on dental care for children.

Oral health‐related quality of life among adults 68–77 years old in Nord‐Trøndelag, Norway

Dental health has mostly been measured by dental staff disregarding patients experiences. However, clinical conditions alone do not fully indicate how people feel affected by their oral status. The aim of this study was to investigate how clinical recorded dental health, self-rated dental health, satisfaction with dental health were related to oral health-related quality of life (OHRQoL) assessed by Oral Health Impact Profile (OHIP-14) in 68-77 years old. A total of 151 individuals completed a questionnaire on self-rated dental health, satisfaction with dental health and the short form of OHIP-14. Clinical examination was performed registering number of teeth and dental caries. In total 63% of the individuals rated their dental health as good, and 59% were satisfied with their dental health. Using the OHIP-14 42% reported no problems or oral discomfort at all. The proportion of individuals reporting problems or discomfort varied between 13% and 43% according to the dimensions of OHIP-14. The most frequently reported problems were physical pain (43%), psychological discomfort (28%) and psychological disability (28%). Individuals who rated their dental health as poor and those who were dissatisfied with their dental health had significantly lower OHRQoL than other individuals. The study showed relationship between self-evaluations of dental health and OHRQoL in 68-77 years old. Individuals with few teeth reported lower OHRQoL than others, but no association between clinical caries status and OHRQoL could be found.

Caries increment and prediction from 12 to 18 years of age: A follow-up study

Aim: This was to determine the increment of caries from 12 to 18 years of age and to explore the possibility of predicting caries increment in this period based on the caries experience at age12 years. Study design: Prospective longitudinal survey. Methods: A sample of 12-year-old children (n =159) were examined in 1993 and 70% of them re-examined at 18 years of age. Bitewing radiographs were taken and a diagnostic system using five caries grades (D1−D5) was used at both ages. Children at risk were defined as those who developed manifest caries lesions (D3−5FS) on approximal surfaces during the follow-up period. Possible predictors were analysed by calculation of sensitivity, specificity, and actual proportion of the population at risk. Results: The mean caries increment (D1−5MFS) from 12 to 18 years of age was 4.2 (SD±9.1). The percentage of caries-free adolescents at 12 and 18 years of age was 10% and 1% respectively; 25% had either a reversal or no increment in caries experience while the D1−5MFS increased in 65% of the adolescents. Of the increment of manifest lesions (D3−5FS), 18% were located in incisors/canines, 40% in premolars, 26% in first molars and 16% in second molars. Premolars had the largest proportion of the approximal surfaces with manifest caries increment. The best predictors of children at risk of approximal caries increment (D3−5FS) were caries experience (D1−5FS) on the approximal surfaces of premolars and second molars at the age of 12 years. The individuals that developed four or more manifest lesions on approximal surfaces between 12 and 18 years were the easiest to predict (sensitivity + specificity = 175%). Conclusions: There was a considerable increment of manifest caries lesions from 12 to 18 years of age in all tooth groups. The best predictors for increment of manifest caries on approximal surfaces during the age period were approximal caries in premolars and second molars at the age of 12 years.

Prevalence and correlates of self-reported state of teeth among schoolchildren in Kerala, India

BackgroundOral health status in India is traditionally evaluated using clinical indices. There is growing interest to know how subjective measures relate to outcomes of oral health. The aims of the study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India.MethodsCross-sectional survey data were used. The sample consisted of 838 12-year-old schoolchildren. Data was collected using clinical examination and questionnaire. The clinical oral health status was recorded using Decayed, Missing and Filled Teeth (DMFT) and Oral Hygiene Index – Simplified (OHI-S). The questionnaire included questions on sociodemographics, self reports of behaviour, knowledge and oral problems and a single-item measuring self-reported state and satisfaction with appearance of teeth. The Kappa values for test-retest of the questionnaire ranged from 0.55 to 0.97.ResultsTwenty-three per cent of the schoolchildren reported the state of teeth as bad. Multivariate logistic regression showed significant associations between schoolchildren who reported to have bad teeth and poor school performance (Odds Ratio (OR) = 2.5), having bad breath (OR = 2.4), food impaction (OR = 1.7) dental visits (OR = 1.6), being dissatisfied with appearance of teeth (OR = 4.2) and caries experience (OR = 1.7). The explained variance was highest when the variables dental visits, bleeding gums, bad breath, food impaction and satisfaction with appearance were introduced into the model (19%).ConclusionA quarter of 12-year-olds reported having bad teeth. The self-reported bad state of teeth was associated with poor school performance, having bad breath and food impaction, having visited a dentist, being dissatisfied with teeth appearance and having caries experience. Information from self-reports of children might help in planning effective strategies to promote oral health.

Children who break dental appointments

AIM: This was to assess factors associated with children’s non-compliance with regular dental appointments. The study used demographics, oral health behaviour, oral health and use of dental services for children with a recent history of broken appointments and compared them with children who kept recall appointments. STUDY DESIGN AND METHODS: Children (n=576) recalled for routine examination in the public dental services were studied. Information regarding failed dental appointments during the previous 2 years was collected from each child’s record. At examination, past history, clinical and radiographic information was recorded. STATISTICS: The data were analysed using multiple logistic regression analysis. RESULTS: During the previous 2 years 15% of the children had broken at least one appointment. No significant differences were found between children with and without failed appointments regarding demographic variables (age, gender, immigrant status and medical condition) or dental health behaviours. Compared with other children, those with a history of broken appointments had more enamel disturbances, higher caries experience and higher caries activity (more new caries at the examination), and more time was needed to complete their dental treatment. They were given shorter recall intervals to the next dental examination. CONCLUSIONS: The results suggest that children who break appointments are caries risk patients and need special attention.

Preventive dental care of children and adolescents in the 1990s: Denmark, Iceland, Norway, and Sweden

This article describes the provision of preventive care for children and adolescents in Denmark, Iceland, Norway, and Sweden in the 1990s. It includes information on personnel giving preventive care, administration of the dental care system, strategies and methods used for prevention, and resources allocated for preventive dental care. In all these countries comprehensive and systematic dental care, subsidized or free of charge, has been instituted for children and adolescents. However, comparisons between the countries show significant differences in the organization of the dental care for children, the time used for preventive care, the recall routines, and the implementation of risk-based and population-based preventive strategies. The relative importance of different caries-prevention methods (fluorides, hygiene, and diet) reported by the clinicians varied between Denmark, Iceland, Norway, and Sweden. While variation poses rather than answers questions concerning effectiveness, available data provide evidence of differences in the input of resources. Unless the dental profession addresses the issue of effectiveness of preventive dental care, politicians and administrators in a cost-containment context will easily conclude that least is best.