Satu Lahti

Noninvasive Control of Dental Caries in Children with Active Initial Lesions

The aim of this study was to investigate whether DMFS increment can be decreased among children with active initial caries by oral hygiene and dietary counseling and by using noninvasive preventive measures. Except for mentally disabled and handicapped children attending special schools, all 11- to 12-year-olds in Pori, Finland, with at least one active initial caries lesion were invited to participate in the study and were then randomized into two groups. Children in the experimental group (n = 250) were offered an individually designed patient-centered preventive program aimed at identifying and eliminating factors that had led to the presence of active caries. The program included counseling sessions with emphasis on enhancing use of the children’s own resources in everyday life. Toothbrushes, fluoride toothpaste and fluoride and xylitol lozenges were distributed to the children. They also received applications of fluoride/chlorhexidine varnish. The children in the control group (n = 247) received basic prevention offered as standard in the public dental clinics in Pori. For both groups, the average follow-up period was 3.4 years. A community level program of oral health promotion was run in Pori throughout this period. Mean DMFS increments for the experimental and control groups were 2.56 (95% CI 2.07, 3.05) and 4.60 (3.99, 5.21), respectively (p < 0.0001): prevented fraction 44.3% (30.2%, 56.4%). The results show that by using a regimen that includes multiple measures for preventing dental decay, caries increment can be significantly reduced among caries-active children living in an area where the overall level of caries experience is low.

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 impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data (n = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14-item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects >/= 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3-0.8) and 0.7 (0.5-0.9) for 30-34-yr-old and 34-74-yr-old subjects, respectively. The odds ratios for those with 1-9 teeth and for those who were edentate were 3.4 (2.4-4.9) and 4.0 (2.6-6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, fathers education modified the effect of a childs caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

A cross-national comparison of income gradients in oral health quality-of-life in four welfare states: application of the Korpi and Palme typology

Background: The extent to which welfare states may influence health outcomes has not been explored. It was hypothesised that policies which target the poor are associated with greater income inequality in oral health quality of life than those that provide earnings-related benefits to all citizens. Methods: Data were from nationally representative surveys in the UK (n = 4064), Finland (n = 5078), Germany (n = 1454) and Australia (n = 2292) conducted from 1998 to 2002. The typology of Korpi and Palme classifies these countries into four different welfare states. In each survey, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire, which evaluates the adverse consequence of dental conditions on quality of life. For each country, survey estimation commands were used to create linear regression models that estimated the slope of the gradient between four quartiles of income and OHIP-14 severity scores. Parameter estimates for income gradients were contrasted across countries using Wald χ2 tests specifying a critical p value of 0.008, equivalent to a Bonferroni correction of p<0.05 for the six pairwise tests. Results: Statistically significant income gradients in OHIP-14 severity scores were found in all countries except Germany. A global test confirmed significant cross-national differences in the magnitude of income gradients. In Australia, where a flat rate of benefits targeted the poor, the mean OHIP-14 severity score reduced by 1.7 units (95% CI −2.15 to −1.34) with each increasing quartile of household income, a significantly steeper gradient than in other countries. Conclusion: The coverage and generosity of welfare state benefits appear to influence levels of inequality in population oral health quality of life.

Oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old Finnish schoolchildren with different oral health behaviors

The aim of this study was to explore oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old schoolchildren with favorable, moderate, or poor behavior related to oral health. The data were gathered by questionnaire. Recommendations commonly used in Finland in oral health education were chosen as the criteria for selection of groups of children with favorable, moderate, and poor oral health behavior. Differences between groups were analyzed using cross-tabulations and factors related to unfavorable behavior using logistic regression analysis. The percentage of children with appropriate knowledge was higher in the good behavior group (GB) than in the other groups. The groups differed most in the childrens knowledge of the recommendation to use fluoride toothpaste at least twice a day. Most children in the GB group considered it important to brush their teeth for the fresh feeling this gave. The majority of children in all groups considered it important to brush their teeth when going to the dentist. The majority also considered brushing important for avoiding tooth decay and tooth discoloration as well as for having fresh breath. Unfavorable knowledge, attitudes, beliefs, and behavior tended to accumulate in the same children. Factors associated with unfavorable behavior were male sex, mothers low skill occupation level, and childs poor knowledge of oral health-related facts.

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.

Evaluating a single dental anxiety question in Finnish adults

Objective. To evaluate the psychometric properties (criterion validity, construct validity, sensitivity, and specificity) of a single-item question screening for dental anxiety in a Finnish adult population. Material and methods. A total of 823 subjects, ranging in age from 18 to 87 years, answered a questionnaire comprising sections assessing the respondents’ demographic profile and dental attendance patterns. A single dental anxiety question and the Modified Dental Anxiety Scale (MDAS) were included. The final response rate was 85%. Results. Eight percent of the sample was highly dentally anxious using the MDAS cut-off point of 19 or above. Twelve percent of the respondents rated themselves as “very scared” on the single-item question. The percentage agreement between the single-item question and the MDAS was 93; the Kappa coefficient was 0.63. Specificity of the single question was 0.95 while sensitivity was 0.80 using the MDAS dichotomous classification. The single-item question related to age (p<0.001), gender (p<0.001), and dental attendance (p<0.001), as predicted. Conclusions. The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.

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.