Ola Haugejorden

Tooth loss and associated risk indicators in an adult urban population from south Brazil

The aim of the present study was to assess the prevalence, extent, and risk indicators of tooth loss in a representative adult, urban population in the Brazilian state of Rio Grande do Sul. A sample of 974 subjects (ages 30 to 103 years, mean 48.7, SD 13.4) representative of the metropolitan area of Porto Alegre, Brazil was selected by a multi-stage probability cluster sampling strategy. In all, 94% of the subjects had experienced tooth loss. The mean tooth loss was 11.2 teeth, and varied between 5.5 and 20.2 teeth in the 30–39 and 60+ years age groups, respectively. The multivariable analysis, adjusted for age, showed that subjects who had lost 7–13 or ⩾14 teeth were more likely to be females (odds ratio (OR)=1.4, 2.4), of low (OR=2.8, 5.1) or middle socio-economic status (OR=2.3, 3.4), and heavy smokers (OR=2.0, 2.3) than those with 6 or fewer missing teeth. Furthermore, loss of ⩾14 teeth was associated with presence of >50% teeth with attachment loss ⩾5 mm (OR=5.7), and loss of 7–13 teeth was associated with presence of >50% teeth with attachment loss ⩾5 mm (OR=2.4) and having 15–30% or >30% decayed-filled teeth (OR=2.7 and 4.1). In conclusion, tooth loss is highly prevalent in this urban Brazilian population. Gender, socio-economic status, cigarette smoking, caries experience, and attachment loss are important risk indicators. A reduction in the populations tooth loss may be achieved by the implementation of community programs for the prevention and treatment of dental caries and periodontal diseases.

Change in oral health status among the institutionalized Norwegian elderly over a period of 16 years

Objective. To assess the oral health status of elderly residents living in nursing homes, and to determine whether there have been any changes between 1988 and 2004. Material and methods. The dental, periodontal, prosthetic, and oral mucosal status was recorded for 155 elderly long-term residents in five nursing homes. The results were compared with those of an identical cross-sectional study from 1988, using the same nursing homes, examination procedures, and evaluation criteria. The participation rate was 89.6%. Results. Edentulism was less frequent in 2004 (43%) than in 1988 (71%), and the mean number of teeth among the dentate participants had increased from 10.7 to 14.6. The proportion of subjects with decayed teeth increased from 55% in 1988 to 72% in 2004, and the mean DMFT (decayed, missing, and filled teeth) increased from 19.4 to 23.2. The frequency of subjects with periodontal pockets of 4 mm or more increased from 43% to 65% during the 16-year period. More participants had crowns or bridges. Of the denture-wearing subjects, more were affected by stomatitis in 2004 than in 1988; however, a decrease in the degree of severity was evident. Conclusions. As more people retain their own teeth throughout life and the prevalence of oral diseases increases among the institutionalized elderly, their objective need for dental treatment is even greater than before. This underscores the necessity for developing effective and oral care programs for the elderly.

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study.

OBJECTIVE To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. METHODS Data were collected by Norways Central Bureau of Statistics in November-December 2003. A two-stage, proportional random sample comprising 2000 persons aged 16-79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25-79 years (response rate 66%, mean age 47.9 years). RESULTS Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio-economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerkes R(2)) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. CONCLUSION Socio-economic inequality in dental status persists among Norwegians aged 25-79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.

ALTITUDE AS A RISK INDICATOR OF DENTAL FLUOROSIS IN CHILDREN RESIDING IN AREAS WITH 0.5 AND 2.5 MG FLUORIDE PER LITRE IN DRINKING WATER

The purpose of this study was to assess the association between altitude and dental fluorisis among Ugandan children in two fluoride (F) districts while controlling for other factors related to fluorosis. A random sample of 481 children aged 10–14 years was examined for fluorosis using the Thylstrup and Fejerskov (TF) index. The prevalence and severity of dental fluorosis increased significantly with increase in altitude (900 vs. 2,200 m in the low– and 1,750 vs. 2,800 m in the high–F district) and in F concentration in the drinking water. In bivariate correlation analyses, F exposure from liquid (FEL), altitude, infant formula, vegetarianism and storing of drinking water in earthenware pots were significantly associated with the tooth prevalence of fluorosis (TPF), i.e. at a severity of TF score ≥1 (p<0.05); age and gender were not. The stepwise multiple linear regression explained 35 and 55% of the variance in TPF within the low– and high–F districts, respectively. The change in R2 due to FEL was 28 and 51% points compared with 5 and 4% points due to altitude. The significant effect of FEL and altitude was confirmed by multiple logistic regression analyses. Thus, although most of the variation in the prevalence and severity of dental fluorosis was explained by the F intake from liquid, altitude was a significant risk indicator after controlling for potential confounders.

Analyses of the caries decline and incidence among Norwegian adolescents 1985-2000.

Since most studies of caries decline are descriptive time-trend analyses, the purpose of this article was to identify factors statistically associated with the caries decline among Norwegian adolescents after 1985. The DMFT scores for the age groups 12 and 18 years reported annually by 19 counties were analysed. The average caries-free proportions of 18-year-olds increased from 2% to 15% between 1985 and 2000, while the DMFT declined by 49%; 10.2 - 0.75 to 5.2 - 0.78. The decline for the 12-year-olds was 53%. The mean DT at the dentinal level remained at about 0.8 for 12-year-olds and 1.5 for 18-year-olds throughout the observation period. There was no significant difference in DMFT increment from age 12 to 18 between the birth cohorts 1973 (3.8 - 0.46) and 1982 (3.0 - 0.52) when controlling for counties. The variables migration and children per dentist were significantly associated with the DMFT decline in multivariate analyses. The caries decline for 18-year-olds was significantly steeper before than after 1990. The decline among the 18-year-olds may be attributed to fluoride and more restrictive criteria for placement of fillings in teenagers in the 1980s and fewer filled teeth before the age of 12 years in the 1990s.

Some Factors Associated with the Caries Decline among Norwegian Children and Adolescents: Age–Specific and Cohort Analyses

The purpose of this study was to evaluate factors related to the caries decline in children between 1966 and 1983. The decline started in the late sixties for the 8– to 11– and the 17–year–olds, and after 1971 for the remaining age groups. Regression analyses confirmed a significantly different start of the decline. Fluorides in school–based programmes, lozenges, and toothpaste, as well as education and sale of antibiotics were significantly (p≤0.01) related to the caries decline in partial correlation analyses. Fluoride toothpaste was only significantly related to the decline in the last part of the period of observation. Supervised fluoride rinsing and brushing programmes at school may explain most of the decline before 1971. The later decline may be related to all fluoride agents and to education. Use of fluorides and other preventive efforts aimed at pre–school children may have contributed to the continual decline in the number of fillings in the permanent teeth of the youngest cohorts.

Parental beliefs and attitudes towards child caries prevention: assessing consistency and validity in a longitudinal design

BackgroundExploring the stability of self-reports over time in observational studies may give valuable information for the planning of future interventions. The aims of the present study were: 1) to explore the consistency of parental self-reports of oral health habits, beliefs and attitudes towards child oral health care over a two-year period; 2) to evaluate possible differences in item scores and consistency between parents with different immigrant status; and 3) to assess the construct validity of items measuring parental beliefs and attitudes towards child oral health care.MethodsThe sample (S1, n = 304) included parents of 3-year-old children in Oslo, Norway; 273 mothers of western origin (WN-group) and 31 of non-western origin (IM-group). They were surveyed in 2002 (child age 3 years) and in 2004 (child age 5 years). Two additional samples of parents were also included; one with 5-year old children in 2002 (S2, n = 382) and one with 3-year-old children in 2004 (S3, n = 427). The questionnaire included items measuring child oral health habits and parental beliefs and attitudes towards child oral health care.ResultsIn 2002, 76.8% of the parents reported that they started to brush their childs teeth before the age of 1 year. Eighty-five percent of them reported the same in 2004; 87.0% of the WN-group and 33.3% of the IM-group (P < 0.001). For 17 of 39 items measuring beliefs and attitudes the responses were more positive for the WN-compared to the IM-group. Parents of caries-free children in 2004 reported significantly more positive beliefs and attitudes towards child oral health care in 2002 compared to parents of children with caries in 2004 (P < 0.05, P < 0.01 and P < 0.001). No differences in mean item scores were found between the three samples S1, S2 and S3.ConclusionThe results showed a fair to good consistency of parental self-reports from 2002 to 2004. They also indicate that parents with different cultural backgrounds should be evaluated separately and in a cultural context.

Ecological time-trend analysis of caries experience at 12 years of age and caries incidence from age 12 to 18 years: Norway 1985–2004

Objectives. The purpose of the present investigation was to report on caries experience among Norwegian 12-year-olds from 1985 to 2004 and to assess caries incidence from 12 to 18 years of age for birth cohorts 1973 to 1986. Material and methods. Aggregated data from the Norwegian Public Dental Services and from official statistics were employed. Information was available about the number of subjects, the proportion receiving treatment, sales of fluoride tablets, socio-demographics, caries prevalence, and the number of decayed, missing, and filled teeth (DMFT). Results. An almost linear decline in caries prevalence and mean D3MFT (dentine level) occurred among 12-year-old children from 1985 until the year 2000, but from 2000 to 2004 an increasing trend was observed. The highest mean 6-year D3MFT increment (age 12–18 years) was 4.1 (cohort 1976), while the lowest was 3.2 (cohorts 1982 and 1983). In multiple linear regression analyses of trend, baseline D3MFT accounted for more than 91% of total explained variance in D3MFT increment (Models I and III). Without baseline D3MFT as predictor (Models II and IV), there was a significant association between education, social assistance, mobility, infant mortality, percentage examined, and the additive interaction terms year + income and year + education and D3MFT increment after controlling for confounding and multicollinearity. Conclusions. Four consecutive years of increase in caries experience among 12-year-old children after 15 years of decline and evidence of stability or increase of the caries increment from 12 to 18 years of age among Norwegian teenagers give cause for concern.

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corahs Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.

Trends in reasons for tooth extractions in Norway from 1968 to 1998.

The aims of this study were (i) to determine the reasons for extraction of permanent teeth in Norway in 1998 and (ii) to describe changes in reasons for extraction in time-trend and quasi-longitudinal perspectives over 30 years based on three cross-sectional studies. The 1998 data were obtained from questionnaires distributed to a national random sample of 1,500 dentists, of whom 1,008 responded (67%). A total of 1,495 teeth were extracted for 1,164 patients (age 10±92 years) during a period of 2 weeks. Caries accounted for 40% of the extractions and periodontal diseases for 24%. Caries was the primary reason in patients 10±45 years old, while periodontal diseases dominated among adults >45 years old. In a time-trend perspective, among patients ≤21 years, a significant decrease in the proportion of extractions because of caries was observed between 1968 and 1988, while non-significant changes were found between 1988 and 1998. Extractions because of periodontal disease accounted for about 26% in all surveys. Followed longitudinally, the three cohorts born 1923±32, 1933±42, 1943±52 showed a decrease in the proportion of extractions due to caries, and an increase in the proportion of periodontal extractions during the period, more so between 1968 and 1988 than between 1988 and 1998. The three cohorts showed a variable trend of change, which may indicate that period and age effects do not necessarily operate in the same direction.