Yuval Vered

Self – perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys

BackgroundClinical (normative) and subjective (self-assessment) evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self–perceived assessment) as compared to clinical examinations (normative assessment) and to evaluate the implications of the results in understanding the publics perception of oral health.MethodsThe investigation was performed on 4920, 21 year-old Israeli adults upon release from compulsory military service between 1996 and 1998. Participants were asked to fill in a questionnaire inquiring how they would rate their personal dental and periodontal health levels. Clinical examinations, employing the DMFT and CPITN indices, were performed to determine normative oral health status. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values and overall proportions using the clinical examinations as a gold standard.ResultsThe sensitivity (disease perception) for dental status was found to be 0.34, while the specificity (health perception) was found to be 0.83. The positive predictive value for perceived dental status was found to be 0.68, whereas the negative predictive value was found to be 0.54. The sensitivity for perceived periodontal status was found to be 0.28, while the specificity was found to be 0.83. The positive predictive value for perceived periodontal status was found to be 0.05, whereas the negative predictive value was found to be 0.97. Regarding the overall proportions, a large discrepancy was found between self–assessment and professional assessment for both dental and periodontal health status.ConclusionsSelf-assessment questionnaires were of low value in evaluating oral health status both in the individual and public levels, though perception levels of health were higher than that of disease. Findings reflects a low level of awareness of the public that may influence care-seeking behavior and highlight the importance of oral health promotion and the crucial need for public health action.

A 6‐month study of the effects of 0.3% triclosan/copolymer dentifrice on dental implants

AIM Supportive therapy to maintain dental implants is increasingly important. This study examined the effect of a 0.3% triclosan/2% copolymer dentifrice on oral biofilms and gingival inflammation (GI) on dental implants and peri-implant tissues. MATERIALS AND METHODS One hundred and twenty adults with a dental implant and contra-lateral tooth were enrolled in this 6 month, double-blind, two-treatment, parallel group study. Sixty subjects were randomly assigned to a triclosan/copolymer dentifrice test group and 60 subjects to a fluoride dentifrice control group and instructed to brush twice daily for 6 months. At baseline, 3, and 6 months, a calibrated dentist assessed dental plaque, GI and collected supragingival dental plaque for microbiological analysis. RESULTS Subjects in the triclosan/copolymer group demonstrated significantly lower levels of dental plaque, gingivitis, and bleeding on probing at 3 and 6 months at both the implant and contra-lateral tooth compared with the fluoride group (p<0.05). There were significantly fewer Gram-negative anaerobes in the triclosan/copolymer group (p<0.05) including >90% reductions in Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Eubacterium saburreum, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella melaninogenica, Solobacterium moorei, and Tannerella forsythia. CONCLUSIONS Twice daily use of a triclosan/copolymer dentifrice may enhance dental implant maintenance by reducing dental plaque and GI.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

OBJECTIVES To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. METHODS Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. RESULTS Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. CONCLUSIONS This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Periodontal health status and smoking among young adults

AIM Our aim was to evaluate the periodontal status and present smoking habits among a representative sample of young adult Israelis and to investigate possible associations. MATERIAL AND METHODS A representative sample of young adult Israelis was examined and interviewed on the day of release from compulsory military service. Collected data included demographic background (gender, education level, family size and fathers country of origin) and current smoking habits. Clinical examination included the recording of periodontal health status according to the Community Periodontal Index (CPI). RESULTS Seven thousand and fifty-six young adults were examined. Sixteen per cent were classified as CPI 0, 78% as CPI 1-2 and 6% as CPI 3-4. In total, 36% of the sample reported a current smoking habit. Periodontal status was significantly improved among non-smokers, females and children of fathers born in Israel or Western countries. CONCLUSION Only 7% of the participants demonstrated signs of periodontitis and most young adults did not smoke; a dose-response association was revealed between present smoking habits and periodontal disease.

Oral and pharyngeal cancer among the Arab population in Israel from 1970 to 2006.

BACKGROUND Israeli Arabs are considered as a developing society characterized by poverty and high levels of smoking among men. The purpose of this study was to describe their incidence, mortality and survival rates for oral and pharyngeal cancer between the years 1970-2006. Studies such as this in the Arab world, where the population is almost the same as the Arab population in Israel, are rare. METHODS The incidence and survival data were derived from all relevant registered data at the National Cancer Registry. The group of lesions included cancer of the lips, tongue, buccal mucosa, floor of the mouth, salivary glands, gums, palate and pharynx. Morphological description was according to WHO classification. RESULTS Most diagnosed patients were male. The mean age was 54.4 years, and mean years of survival were 3.83. The oropharynx was the most common site (28.3%) while the palate was the least frequent (3.12%). Squamous cell carcinoma (SCC) was the most common histological feature (66.3%), while basal cell carcinoma (BCC) was the least (3.9%). The overall 5 years survival rate was 59.4%, this being highest for BCC (82.1%), while SCC was significantly lower (56.2%) (p<0.001). Lip cancers survived better than other sites. CONCLUSIONS Data from this society are similar to other developing societies in the majority of the results. The incidence of oral and pharyngeal cancer is lower among the Arab population, in comparison to the Jewish population in Israel.

The association between demographic and oral health-related quality of life factors and dental care attendance among underprivileged older people.

Aim:  In order to identify whether demographic and oral health‐related quality of life factors are associated with dental care attendance among an underprivileged older population, a comparison was performed between people who have and have not attended dental care.

Psychological distress and self-perception of oral health status among an immigrant population from Ethiopia.

Objectives. To examine the association between psychological distress (PD) and perception of oral health status among a group of Ethiopian immigrants compared to the ‘gold standard’ of clinical diagnosis. Design. Three hundred and forty Ethiopian immigrants, aged 18 years or more, were interviewed using a version of the Self-Reporting Questionnaire (World Health Organization) for the assessment of psychological status and perceived dental and periodontal health status. Clinical data for dental and periodontal health status were used as the ‘gold standard’ against the self-perceived assessment scores among the PD and no psychological distress (NPD) groups. These were compared for sensitivity and specificity. Results. One hundred and thirty-five subjects (40%) presented PD. Seventy-eight percent of the PD subjects reported a negative dental health status, as compared to 42% of the NPD subjects. Seventy-three percent of the PD subjects reported a negative periodontal health status, as compared to 44% of the NPD subjects (p<0.001). The sensitivity for self-perceived dental health status among the PD subjects was found to be 0.78 and the specificity was found to be 0.40, as compared to 0.59 and 0.69, respectively, among the NPD subjects (p<0.001). The sensitivity for self-perceived periodontal health status among the PD subjects was found to be 0.78 and the specificity was found to be 0.40, as compared to 0.59 and 0.58, respectively, among the NPD subjects (p<0.001). Conclusion. Results demonstrate that PD may modify self-perception of health status. Self-perceived health and disease should be an integral element in the continuum of professional clinical health assessment and subsequent health care planning. The relevance of PD is evident in this immigrant ethnic group and should be considered and further studied in other at-risk minority communities.

Dental Students’ Attitudes and Behavior Toward Smoking Cessation as Part of Their Professional Education

Background: Dental professionals have a major role in promoting tobacco use cessation (TUC). Purpose: The objective is to assess dental students’ knowledge, attitudes, behavior, and perception regarding their potential expected role. Methods: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. Results: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. Conclusions: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

Professional occupation and the number of teeth retained among older adults aged 50 and above

OBJECTIVE To examine the association between occupational characteristics and number of natural teeth retained among older adults aged 50 and above. BACKGROUND Despite the integral part of the professional occupation of a persons time, few studies have examined the effect of the occupational environment on ones oral health. MATERIAL AND METHODS Self-administered questionnaires were randomly distributed among 280 participants, who had at least one professional occupation over a period of 10 years or more. Data from the questionnaire were collected concerning variables related to professional occupation and the self-reported number of natural teeth retained. The data were analysed using a logistic regression analysis with stepwise-backward selection. RESULTS Significant risk factors for the number of natural teeth being ≤25 were age (p < 0.001), years of education (p = 0.019) and a hospital/commercial environment of work (p = 0.021). The odds ratio for the number of natural teeth ≤25 increased with each year by 1.109, decreased with each additional year of education by 0.881, and was 2.693 folds higher for individuals working in a hospital/commercial environment compared to those in an office environment. CONCLUSIONS These findings suggest the importance of operating community-based oral health programmes for these occupational risk groups. The results from this study also implicate the need for further studies of this subject to find the underlying reasons for these occupational environmental risks.

Burnout Level among General and Specialist Dentists: A Global Manpower Concern

Introduction: Professional burnout is considered a risk to the dental profession. In order to measure the professional burnout levels among Israeli dentists, an initial survey was conducted in 2010 among purposive cluster sample of 320 dentists. Methods: Professional burnout level was measured by the burnout measure short version questionnaire. Independent variables included sex, age, specialization (general or specialist dentist), and years of professional experience. Univariate and multivariate analysis were performed testing the relationship of these independent variables to each of the 10 separate items in the burnout instrument. Results: 144 dentists (45%) were found to be experiencing burnout, 10 dentists (3%) demonstrated severe burnout level. The most prevalent burnout items were physical exhaustion (76%) and negative attitude towards patients (60%). The multiple logistic regression model revealed that general dentist were more likely than specialist dentists to report a burnout score for feeling tired, feeling physically weak and sickly, feeling helpless, and feeling worthless and like a failure. Conclusions: As general dentists are the majority of the dental manpower worldwide, our findings are relevant to the general dental practice and to the efforts to prevent and cope with professional burnout.