Socio-behavioural risk factors for early childhood caries (ECC) in Cambodian preschool children: a pilot study.

AIM: This was to explore the socio-behavioural risk factors for ECC in Cambodia. Early childhood caries (ECC) is a significant health problem in Cambodia. METHODS: A convenience sample of 362 primary caregiver-child dyads were selected. The children were aged between birth and 6 years old and participated in a structured interview and intra-oral examination. RESULTS: ECC was diagnosed in 244 of 362 (65.6%) children and 178 (50.6%) had severe early childhood caries (sECC). There were significant associations between caries experience and tooth brushing, dietary, and nursing habits. The odds ratio (OR) for sECC in those children who started brushing before the age of 18 months was 0.41 (CI 0.18, 0.93). However, for those children who continued to breast-feed after the age of 2 years the OR was 5.31 (CI 1.50, 18.79). CONCLUSIONS: The most prominent risk factors for ECC in the present study were lack of tooth brushing and breast-feeding past the age of 2 years.

All-cause mortality risk of metabolically healthy obese individuals in NHANES III.

Mortality risk across metabolic health-by-BMI categories in NHANES-III was examined. Metabolic health was defined as: (1) homeostasis model assessment-insulin resistance (HOMA-IR) <2.5; (2) ≤2 Adult Treatment Panel (ATP) III metabolic syndrome criteria; (3) combined definition using ≤1 of the following: HOMA-IR ≥1.95 (or diabetes medications), triglycerides ≥1.7 mmol/L, HDL-C <1.04 mmol/L (males) or <1.30 mmol/L (females), LDL-C ≥2.6 mmol/L, and total cholesterol ≥5.2 mmol/L (or cholesterol-lowering medications). Hazard ratios (HR) for all-cause mortality were estimated with Cox regression models. Nonpregnant women and men were included (n = 4373, mean ± SD, age 37.1 ± 10.9 years, BMI 27.3 ± 5.8 kg/m², 49.4% female). Only 40 of 1160 obese individuals were identified as MHO by all definitions. MHO groups had superior levels of clinical risk factors compared to unhealthy individuals but inferior levels compared to healthy lean groups. There was increased risk of all-cause mortality in metabolically unhealthy obese participants regardless of definition (HOMA-IR HR 2.07 (CI 1.3-3.4), P < 0.01; ATP-III HR 1.98 (CI 1.4-2.9), P < 0.001; combined definition HR 2.19 (CI 1.3-3.8), P < 0.01). MHO participants were not significantly different from healthy lean individuals by any definition. While MHO individuals are not at significantly increased risk of all-cause mortality, their clinical risk profile is worse than that of metabolically healthy lean individuals.

Improving the provision of the Basic Package of Oral Care (BPOC) in Cambodia.

UNLABELLED: Since 1992, 330 medical nurses have been trained to provide basic oral health care (including ART restorations and dental extractions) in remote areas of Cambodia. However, a range of barriers prevent dental nurses from providing these services, especially a lack of dental materials and instruments. OBJECTIVES: To increase dental nurse (DN) outputs through the regular provision of dental materials and instruments. To improve cross-infection control procedures through the provision of necessary equipment, supplies and training. METHODS: Six health centres with active DNs participated; three (experimental) health centres received sufficient supplies of dental instruments and materials for one year, and 3-monthly visits by a dentist from the Ministry of Health. The other three health centres (control) did not. RESULTS: During the project period, the experimental group extractions increased to an average of 119 extractions per quarter (a three-fold increase compared to the baseline), 51 ART restorations, and improved compliance with cross-infection infection control protocols. In the control group the number of extractions remained similar to baseline and no ART restorations were placed. CONCLUSIONS: The provision of the BPOC increased in the health centres when sufficient supplies of dental materials and instruments were provided. Increased monitoring and communication with MOH dental colleagues was also associated with the increased outputs and resulted in improved compliance with cross-infection control protocols. The MOH should increase supplies to DNs and provide ongoing monitoring and support in order to improve the access to and quality of dental care provided in rural Cambodia.

Space maintenance in the primary and mixed dentition.

The maintenance of arch length in the primary, mixed and early permanent dentition is important for the normal development of the occlusion. Premature loss of primary teeth can result in the loss of arch length leading to malocclusion. Space maintenance can often prevent space loss and either prevent the development of a later malocclusion or reduce its severity. The pattern of space loss depends on many factors including age, stage of development, which teeth have been lost, the presence of crowding or spacing, and occlusal relationships. Careful consideration of many factors is required when deciding whether space maintenance is indicated. Radiographs and space analysis can be helpful. Space maintainers can be fixed or removable. Band and loop space maintainers have fewer problems than other types. Frequent follow-ups to check for any problems following space maintainer insertion is recommended.

Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement.

UNLABELLED: Several recent studies have demonstrated the success of the ART (atraumatic restorative treatment) technique under field conditions in developing countries. The ART technique involves removal of caries using only hand instruments, and placing a glass ionomer cement (GIC) restoration. OBJECTIVES: To estimate the longevity of Fuji II GIC ART restorations placed in permanent teeth by dental nurse students under field conditions in rural Cambodia. DESIGN: Clinical field trial. SETTING: One high school in rural Cambodia. SAMPLE AND METHODS: 53 subjects between the ages of 12 and 17 who had dental caries were selected to participate. Subjects were randomly assigned to a dental nurse student for cavity preparation and placement of ART restorations (without cavity conditioning). RESULTS: 92.1% of the carious lesions required class I or class V restorations, and 85.4% were in the lower molars. 89 teeth were filled. At 1 and 3 years 86.4% and 79.5% of restorations were still present. Restorations were assessed by one dentist according to standard criteria. 76.3% of the restorations were judged to be successful at 1 year, and 57.9% at 3 years. CONCLUSIONS: Factors which may have affected the success rates included: the material used, technical factors, failure to condition the cavity prior to restoration, and inexperience of the operators. The results suggest that ART restorations in permanent teeth using Fuji II GIC are only moderately successful after 3 years. Better results could be expected by using a dentine conditioner in conjunction with one of the newer stronger glass ionomer cements.

Dental nurse training in Cambodia--a new approach.

In 1993 a 4-5 month programme to train rural dental nurses in Cambodia was introduced. Courses have now been conducted in 12 of Cambodia's 22 provinces. The dental nurses are trained to provide simple treatment, including local anaesthetic, extractions, ART restorations, and scaling, for all age groups, and also learn how to introduce prevention and oral health promotion activities within their communities. On completion of training nurses are supplied with a set of basic instruments and some materials. Evaluation has shown the programme to be meeting the oral health needs of the rural people where there are no dentists and a number of unique strengths were identified. A recent planning workshop on oral health care in Cambodia to 2005 decided to set up a dental nurses training school in two provincial capitals, and to increase the number of nurses in training. At the same time the annual number of new dentists being trained will be limited to ten. The expansion of the dental nurses training programme will ensure that increasingly more of the population have access to basic preventive and curative dental care, and at a cost which the country can afford.

Dental caries and sugar-containing liquid medicines for children in New Zealand.

Children who are taking long-term sugar-containing liquid medicines have an increased risk of developing dental caries. A recent survey of paediatric liquid medicines in New Zealand revealed that over half of the prescribed and over-the-counter (OTC) medicines for children contain sugar. Only one-third of the sugar-free medicines were labelled as such, and only one-quarter were stated to be sugar-free in the New Ethicals Catalogue. Recommendations for limiting caries in these children include: where possible, taking the medicine in tablet form; brushing with toothpaste or chewing sugar-free gum after taking the medicine; home and dental-office fluoride applications; where possible, taking medicines at meal-times rather than between meals; avoiding ingestion of the medicine before bed; and seeking regular preventive dental care. Awareness of the danger posed by these medications should be promoted among prescribers, pharmacists, manufacturers, regulatory authorities, and the public in order to bring about increased availability and use of sugar-free liquid medicines.

Techniques used by traditional dentists in Vietnam and Cambodia.

One of the largest ethnic minorities in the UK, and especially London, is people of Chinese descent. A dental practitioner treating these people may encounter restorations that have been performed by traditional practitioners in their country of origin. These restorations are likely to be very different from anything else a practitioner in the UK will have come across, and in order to treat these patients it is important to have an understanding of how and why the restorations were made.

Survey of anomalies in primary teeth and their correlation with the permanent dentition.

The purpose of the study was to investigate primary and permanent tooth anomalies of 5-year-old children in Taranaki; 1,680 children were examined by school dental therapists, and the presence of hypodontia, hyperdontia, and double teeth recorded. Panoramic radiographs were taken of those children with anomalies of the primary teeth. Anomalies of the primary teeth were detected in 23 children (1.4 percent). Six children (3 boys and 3 girls) had hypodontia, 3 children (2 boys and 1 girl) had a supernumerary tooth, and 14 children (9 boys and 5 girls) had double teeth. Six of the affected teeth (in 4 boys and 2 girls) were diagnosed as fusion, and 8 (5 boys and 3 girls) as gemination. The panoramic radiographs of the 23 children with anomalies of the primary teeth revealed that 14 (60.9 percent) also had anomalies of the succedaneous permanent teeth. Children with hypodontia in the primary dentition all had corresponding permanent teeth missing. In all but three children, only one tooth was involved. Nineteen of the 30 primary teeth (63 percent) and 12 of the 15 permanent teeth (80 percent) affected by hypodontia, gemination, or fusion were lateral incisors. For each type of anomaly, boys were affected more often than girls. The results of the study confirm that, when there is hypodontia, hyperdontia, gemination, or fusion of teeth in the primary dentition, there is an increased likelihood of anomalies of the succedaneous permanent teeth. Because of this close relationship between the dentitions, early identification of anomalies of the primary teeth can allow the dentist to investigate further and plan for treatment at the appropriate time.

Prevalence study of oral mucosal lesions in a selected Cambodian population.

The aim of this study was to investigate the epidemiology of oral mucosal lesions in a selected Cambodian population to obtain pilot data useful in planning an oral health data base for the country. Due to unstable conditions in Cambodia, the validity of population data related to present census information is highly questionable. Therefore, prior to this investigation a census registration was carried out using local health workers as registrars in nine villages of a commune. In the period July 4-31, 1991, a total of 1319 individuals (953 women, 366 men, 15-99 yr) were examined by one oral surgeon in the nine villages of Kok Trop Commune, Kandal Stung District, southwest of the capital Phnom Penh. Clinical diagnoses were based on WHO criteria. Information on smoking habits, betel nut chewing habits, and alcohol use was collected by 4 Khmer dental personnel. In total, 71 lesions were recorded in 64 (4.9%) individuals. Leukoplakia was found in 1.1%, lichen lesions in 1.8%, candidosis in 1.4%, submucous fibrosis in 0.2%, cancer in 0.1% and other diagnoses in 0.8%. The prevalence of leukoplakia was 2.2% and 0.6% among men and women respectively, a statistically significant difference (P < 0.05). There were significantly more smokers (P < 0.01) among subjects with leukoplakia (64.3%) than among those without this lesion (28.6%). All subjects with lichen lesions were women. The age-adjusted relative risk for developing lichen among betel nut chewers as compared to non-chewers was 3.3.(ABSTRACT TRUNCATED AT 250 WORDS)

The dental caries experience, oral hygiene and dietary practices of preschool children of factory workers in Phnom Penh, Cambodia.

Two hundred and thirty-seven children attending four Ministry of Industry nursery schools in Phnom Penh, Cambodia, were examined. Dental caries experience, oral cleanliness and soft tissue abnormalities were determined. 149 mothers of these children were interviewed and information was gathered about infant-feeding practices, weaning age, diet after weaning, toothbrushing and dental attendance. Dental caries experience was high, and only 36% of children aged 1-4 years and 4% of those aged 5-6 years were caries free. Only 15% of mothers reported bottle-feeding, but 70% of these used sweetened canned milk in the bottle. Oral hygiene was rated as poor in 80% of children and only 10% were reported to use a toothbrush. 43% of children were reported to have experienced toothache, but only 5% had been to a dentist.

A survey of the training, practice and dental health knowledge of traditional dentists practising in Phnom Penh, Cambodia.

Interviews with 50 traditional dentists practising in Phnom Penh, Cambodia showed that the majority had been trained as an apprentice of either their father or a relative. The most frequently undertaken treatment procedures were tooth coloured fillings, and cast, preformed metal or acrylic crowns and bridges. Knowledge of dental pathology was poor. With the recommencement of dental training in the University of Phnom Penh restriction on the training and practice of traditional dentists needs to be considered, together with the possible retraining of these practitioners as dental technicians.

Utilisation of dental services in Cambodia and the role of traditional dentists.

Cambodia has a small, but growing number of qualified dentists, as well as about 300 traditional dentists. This study describes the current level of utilisation of dental services in Cambodia in Phnom Penh and in 6 provincial areas. 548 adults aged 35-45 and 60-80 years of age were interviewed concerning previous dental attendance, type of service used and preference for qualified or traditional practitioner services. Only 38 per cent had ever had dental treatment, with 87 per cent of attenders last visiting the dentist because of toothache. Although 34 per cent of attenders received their last course of treatment from a traditional dentist, 77 per cent of all subjects said they would prefer to visit a qualified dentist if they had the choice. The role of traditional practitioners may therefore diminish as numbers of qualified dentists increase.

The Cambodian National Oral Health Plan 1992-2000.

The reconstruction of dental services and training in Cambodia following the devastation of the country during the reign of the Khmer Rouge has been limited by minimal help from other countries for political reasons. Following the recent signing of a peace treaty, a National Conference on Oral Health has been held, and a National Oral Health Plan formulated, outlining goals for the year 2000, and strategies to improve the oral health status in the country.

Rebuilding the ruins: dental services and manpower in Cambodia.

Between 1975 and 1979 Cambodia suffered a massive destruction of its social structures under the Khmer Rouge. The dental profession was almost annihilated and the dental school in Phnom Penh stripped bare. Dental training has now begun again and the long process of restoration is in progress. The ratio of dentists to the population is still pitifully low and public services are concentrated in Phnom Penh and in provincial towns. Traditional dentists provide the only accessible dental care in many places. A primary oral health care system has yet to be developed.