Role of oral health-related behaviors in education inequalities in chronic periodontitis among Sri Lankan men.

AIMS: The aims of the present study were to determine education inequalities in chronic periodontitis (CP) among Sri Lankan men and whether oral health behaviors explain education inequalities in CP. METHODS: Data from 720 males who participated in a study to determine the prevalence of CP in 30-60-year-olds in Colombo district, Sri Lanka, were used for the present study. An interviewer administered a questionnaire obtained information about sociodemographics and oral health behaviors. Following the assessment of periodontal parameters, case definitions proposed by the Centers for Disease Control/American Academy of Periodontology were used to define periodontitis. RESULTS: Education gradients were observed in relation to CP, smoking, betel quid chewing, alcohol use, and dental utilization. Education gradients in CP remained, but attenuated after adjustments for smoking, betel quid chewing, alcohol use, and dental utilization. Current smoking and current alcohol use explained 4%-38% and 6%-15% of the associations between education and CP, respectively. The education gradient in CP remained following simultaneous adjustment for all behaviors, but lost significance for 11-13 years of education. CONCLUSION: Of the oral health behaviors considered, current smoking contributed the most to education inequalities in CP, explaining 4%-38% of the education differences in CP.

Risk factors for chronic periodontitis in Sri Lankan adults: a population based case-control study.

OBJECTIVE: To determine risk factors for chronic periodontitis in 30-60 year olds in Sri Lanka. Cases and controls for this population based unmatched case-control study were identified from a broader cross-sectional study which was conducted to determine the prevalence of chronic periodontitis in 30-60 year old adults in Colombo district Sri Lanka. The study included 694 cases and 706 controls. Data were collected by means of a pre-tested interviewer administered questionnaire to obtain information about socio-demographic and behavioural factors, a physical examination to record anthropometric measurements and an oral examination. RESULTS: Being a male, a Muslim, belonging to the 45-60 year old age group, having less than 12 years of education, using the finger to clean teeth, current smoking, current betel quid chewing, self-reported diabetes and hypertension emerged as risk factors for chronic periodontitis. CONCLUSIONS: Several socio-demographic and behavioural factors as well as co-morbid conditions emerged as independent risk factors for chronic periodontits in this population. The findings could be used for planning programmes to reduce the burden of chronic periodontits in Colombo district Sri Lanka.

Association between chronic periodontitis and oral health-related quality of life in Sri Lankan adults.

OBJECTIVE: To determine the impact of chronic periodontitis on oral health-related quality of life in Sri Lankan adults. METHODS: A cross-sectional study was conducted among 1,400 participants, 35-60 years of age, residing in the Colombo district of Sri Lanka. Data were collected using two interviewer-administered questionnaires and an oral examination. RESULTS: The prevalence, extent and severity of oral impacts increased with the increase in severity of chronic periodontitis. The most commonly experienced impacts were within the domain of physical pain. The adjusted Poisson regression model indicated that chronic periodontitis was significantly associated with the prevalence of oral impacts. The prevalence of oral impacts was 48% and 69% higher in those with moderate and severe periodontitis, respectively, compared with those with no/mild periodontitis. CONCLUSIONS: Oral health-related quality of life deteriorates with the increase in severity of chronic periodontitis.

Ethnic and socio-economic disparities in oral health outcomes and quality of life among Sri Lankan preschoolers: a cross-sectional study.

INTRODUCTION: The distribution and severity of dental caries among preschool children vary according to the socio-economic and ethnic differences within and between countries. Understanding socio-economic influences on child oral health could inform early interventions to reduce the oral health burden throughout the life-cycle. The aim of this study is to examine the socio-economic and ethnic influences on oral health among preschoolers in Kegalle, Sri Lanka. METHODS: The study involved 784 children aged between 48-72 months recruited from 84 pre-schools in the Kegalle district in Sri Lanka. Cross-sectional data were collected by means of an oral examination of the children and a self-administered questionnaire to their parents/caregivers. The Early Childhood Oral Health Impact Scale (ECOHIS) was used to assess Oral Health related Quality of Life (OHQoL). Univariate and multivariate models of Poisson regression were used to investigate the associations between the variables. RESULTS: Compared to children whose fathers had tertiary education, those whose fathers did not study beyond grade 5, had more caries measured in terms of decayed, missing and filled surfaces (dmfs) (IRR = 2.30; 95% CI: 1.30, 4.06; p < 0.01) and experienced poor OHQoL at child (IRR = 2.52; 95% CI: 1.20, 5.31; p < 0.05) and family (IRR = 1.59; 95% CI: 1.11, 2.27; p < 0.05) levels. However, lower educational attainment among mothers was associated with better OHQoL among children. Compared to the Sinhalese ethnic group, Tamils had more gingival bleeding (bleeding surfaces) (IRR = 3.04; 95% CI: 1.92, 4.81; p < 0.001) and poor OHQoL at child level (IRR = 2.07; 95% CI: 1.19, 3.60; p < 0.01), whereas Muslims had poor OHQoL at family level (IRR = 1.42; 95% CI: 1.10, 1.84; p < 0.01). Children of low-income families had more gum bleeding (IRR = 1.00; 95% CI: 0.99, 1.00; p < 0.05) compared to children of high-income families. CONCLUSIONS: Socio-economic and ethnic differences in oral health outcomes exist among this population of preschoolers. Interventions targeting children of fathers with low educational levels and ethnic minority groups are required to reduce inequalities in oral health in Sri Lanka and other similar countries.

Soft drink consumption in Sri Lankan adolescents.

OBJECTIVE: To determine the factors associated with sugar-sweetened soft drink consumption in adolescents from Sri Lanka. DESIGN: A cross-sectional study where the data were collected by means of a self-administered questionnaire. SETTING: Government, private and international schools in the Colombo district of Sri Lanka. SUBJECTS: Adolescents aged 17 years attending sixty-five schools. RESULTS: Overall 82 % consumed sugar-sweetened soft drinks once weekly or more often, while 77 % and 48 % consumed sugar-sweetened carbonated drinks and sugar-sweetened fruit drinks once weekly or more often. Being a boy (OR = 1·44; 95 % CI 1·02, 2·03), attending a private/international school (OR = 4·12; 95 % CI 1·94, 8·75), mother's level of education (OR = 1·53; 95 % CI 1·03, 2·28) and father's occupation (middle level: OR = 2·39; 95 % CI 1·63, 3·52; upper level: OR = 2·48; 95 % CI 1·35, 4·56) were independently associated with the consumption of sugar-sweetened soft drinks. CONCLUSIONS: The majority of adolescents in this sample consumed sugar-sweetened beverages once weekly or more often. It was evident that some sociodemographic factors were associated with the consumption of these drinks.

Number of natural teeth and oral impacts: a study on sri lankan adults.

The aim of the study was to determine the association between the number of natural teeth and oral impacts in Sri Lankan adults. The sample consisted of 476, 40-59 and 452, ≥60 year olds. Oral impacts were assessed using a validated Sinhalese translation of the Oral Health Impact Profile-14 scale. A receiver-operating characteristic (ROC) curve was plotted to determine the number of natural teeth that would best discriminate those with oral impacts from those without. Oral impacts were reported by 26% of the 40-59 year olds and 34% of the older individuals. In both groups there was a significant negative correlation between the number of teeth present and oral impacts. The ROC curve for the 40-59 year olds gave an area under the curve (AUC) of 0.758 (95% CI = 0.702-0.814; P < 0.001) with an optimal cut-off of 24/25 teeth while for the ≥60 year olds, the AUC of the ROC curve was 0.737 (95% CI = 0.684-0.790; P < 0.001) with an optimal cut-off of 18/19 teeth. Based on the ROC curves the optimal cutoffs of the number of natural teeth that best discriminated between those with and without oral impacts for 40-59 and ≥60 year olds were 24-25 and 18-19, respectively.

Tooth loss in Sri Lankan adults.

AIM: To determine the prevalence and correlates of tooth loss in Sri Lankan adults. DESIGN: A descriptive cross sectional study. SETTING: Colombo district of Sri Lanka. PARTICIPANTS: Adults aged 20 years and above. METHODS: Data were collected by means of an interviewer administered questionnaire and an oral examination. RESULTS: The overall prevalence of tooth loss was 81.6% while 1.9% of the sample was edentulous. The prevalence rates of tooth loss in the 20-39, 40-59 and ≥ 60-year-old were 71%, 93% and 96%, respectively, while 0%, 1.5% and 11.4% were edentulous in the three groups. Age (OR = 1.10; 95% CI = 1.08-1.11), having received 11 or more years of education (OR = 0.38; 95% CI = 0.15-0.97), use of fluoride toothpaste (OR = 0.44; 95% CI = 0.30-0.66), brushing frequency (OR = 0.62; 95% CI = 0.43-0.89) and use of dental services (OR = 2.08; 95% CI = 1.12-3.84) were significantly associated with having more than 12 missing teeth. CONCLUSIONS: The overall prevalence of tooth loss is high among Sri Lankan adults.

Influence of oral health-related behaviours on income inequalities in oral health among adolescents.

OBJECTIVES: To determine income inequalities in both perceived oral health and oral health-related behaviours and the role oral health-related behaviours in explaining income inequalities in perceived oral health among Sri Lankan adolescents. METHODS: The sample included 1,218 fifteen-year-olds selected from 48 schools in the Colombo district using a stratified cluster sampling technique. Data were collected by means of questionnaires to both adolescents and their parents. Perceived oral health status was the oral health outcome considered while oral health-related behaviours included brushing frequency, use of dental services in the preceding year and consumption of sugary food/drinks and fruit/vegetables. RESULTS: Tooth brushing frequency, use of dental services in the preceding year and consumption of fruit/vegetables were associated with perceived oral health status. Also, the trends in perceived oral health and all oral health behaviours across ordered income groups were statistically significant. However, it was evident from the Poisson regression models that the effect of income on perceived oral health did not attenuate significantly following adjustment for oral health behaviours. CONCLUSIONS: This study demonstrated that oral health behaviours were associated with perceived oral health and also the existence of income gradients in perceived oral health and oral health behaviours. However, oral health behaviours were not accountable for the observed income gradients in perceived oral health.

Prevalence and distribution of tooth wear among Sri Lankan adolescents.

PURPOSE: The aim of the present study was to assess the prevalence, distribution and sociodemographic factors associated with tooth wear among Sri Lankan adolescents. MATERIALS AND METHODS: A total of 1200 17-year-olds were selected from government, private and international schools in the Colombo district of Sri Lanka using a two-stage cluster sampling technique. The data were collected using a pretested, validated self-administered questionnaire and by conducting a clinical examination. Tooth wear was recorded using a modified version of Smith and Knight's tooth wear index. RESULTS: The prevalence of tooth wear among Sri Lankan adolescents was found to be 22.4%. In nearly 13.7%, tooth wear was confined to the enamel, whereas 8.7% had wear lesions extending up to the dentine. Occlusal surface was the most frequently affected surface, while the first molar was the most frequently affected tooth. Tooth wear was significantly associated with the type of school attended, father's occupational status and mother's level of education. CONCLUSIONS: The present study found that nearly one-fourth of the adolescents were affected by tooth wear. These findings are in agreement with those from developed countries where tooth wear has been shown to be an emerging oral health problem.

Relationship between dietary patterns and dental caries in Sri Lankan adolescents.

PURPOSE: The aim of the present study was to assess the relationship between dental caries and dietary patterns in Sri Lankan adolescents. MATERIALS AND METHODS: The sample consisted of 1218, 15-year-olds who were selected from 48 schools in the Colombo district of Sri Lanka using a stratified cluster sampling technique. Data were collected by distributing questionnaires among both adolescents and their parents and by conducting an oral examination of all adolescents. A validated 13 foods/food groups food frequency questionnaire was used to obtain dietary information. RESULTS: Factor analysis extracted three dietary patterns from the 13 foods/food groups, and these patterns accounted for 41.44% of variation in the dietary intake. They were labelled as sweet, healthy and affluent dietary patterns. From the multiple logistic regression analysis, the sweet dietary pattern, household income and oral hygiene status emerged as significant predictors of dental caries. CONCLUSIONS: It was concluded that dietary pattern labelled as sweet emerged as a significant predictor of dental caries.

Conventional versus asset approaches: comparative appraisal of socioeconomic indicators for oral health research among adolescents in a developing country.

The aim of the study was to assess the value of different indicators of socioeconomic status for oral health research among Sri Lankan adolescents. Six indicators of socioeconomic status were assessed in terms of their relationship to 2 oral health outcomes. The sample consisted of 15-year-old students (n = 1218) selected from 48 schools in the Colombo district using a stratified cluster sampling technique. Data collection included oral examinations of students and questionnaires to both students and their parents. The correlations between the 6 indicators were low to moderate. The indicators of household material assets and parental educational status emerged as significant predictors of the 2 oral health outcomes. Therefore, it is concluded that indicators of material assets-namely, the family affluence scale and the asset index-could be used as optimal measures of socioeconomic status in oral health research among adolescents in Sri Lanka.

Periodontal status and associated factors in 15-year-old Sri Lankans.

AIM: The aim of the present study was to determine the periodontal status and associated factors in 15-year-old Sri Lankans. METHODS: This was a cross-sectional study where the data were collected by means of a self-administered questionnaire and a clinical examination. A total of 400 15 year olds were selected using a two-stage cluster sampling technique from schools in the Nattandiya education division of the Puttalam district of Sri Lanka. RESULTS: The prevalence of gingival inflammation was 86%, and nearly 7% of the adolescents had chronic periodontitis. The mean gingival index, debris index, calculus index, and oral hygiene index scores of the sample were 0.47±0.3, 0.31±0.2, 0.46±0.3, and 0.78±0.5, respectively. A multiple logistic regression analysis revealed that the debris level, calculus level, frequency of toothbrushing, and the level of education of the mother were significantly associated with gingival status. CONCLUSION: The prevalence of gingival inflammation was high, and both the debris and calculus levels were strongly associated with gingival status in these adolescents.

Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka.

AIM: The aim of this study was to determine the pattern of traumatic dental injuries in children seeking care at the Division of Paediatric Dentistry, the Dental Hospital, University of Peradeniya, Sri Lanka. MATERIAL AND METHODS: The sample consisted of patients attending the Division Paediatric Dentistry, University Dental Hospital for traumatic dental injuries between February 2003 and May 2006. The data were collected by means of an interviewer administered questionnaire to parent/guardian and a clinical examination. RESULTS: A total of 197 children aged between 2 and 17 years had sought treatment for 304 traumatized teeth. Half of the patients had sought treatment more than 1 month after the trauma occurred. The most frequent cause for dental trauma was a fall (89%) whilst compromised aesthetics was the most common reason for seeking care (48%). Maxillary central incisors were the most affected teeth. Of the permanent teeth, 49% had sustained uncomplicated fractures involving only the enamel and dentine. Pulp therapy ranging from pulpotomy to root canal treatment was the treatment of choice for most of the traumatized permanent teeth (46%). In the deciduous teeth, a fracture involving enamel, dentine and the pulp was the most common (35%). CONCLUSIONS: As there was a considerable delay in seeking care for these injuries, it is recommended that educational programs be conducted for parents to create awareness about the importance of immediate management of traumatized teeth.

Factors influencing perception of oral health among adolescents in Sri Lanka.

AIM: To determine factors associated with perceived oral health status among adolescents in Sri Lanka. DESIGN: A descriptive, cross-sectional study where the data were collected by means of an oral examination and questionnaires to both children and their parents. SETTING: Schools in the Colombo district, Sri Lanka. PARTICIPANTS: 1,218, 15-year-old adolescents who were selected from 48 schools using a stratified cluster sampling techniques. RESULTS: Nearly 21% of the sample rated their oral health as poor. According to the hierarchical logistic regression models the percentage of variance in perceived oral health explained by the four groups of independent variables namely: socio-demographic variables, oral health behaviours, clinical oral health indicators and subjective measures of oral health status were 3, 1, 4 and 7% respectively. The final model indicated that poor perceived oral health was significantly associated with low household income, not using dental services, presence of gingivitis, being aware about the presence of oral disease, presence of toothache and other oral symptoms and perceived need for dental care. It accounted for 15% of the variation in perceived oral health. CONCLUSIONS: Subjective measures of oral health contributed most to the single-item perceived oral health rating of adolescents. Socio-demographic variables and normative measures of untreated caries, missing teeth and gingivitis had a limited role in explaining perceived oral health in Sri Lankan adolescents.

Perceived need for dental care among dentate older individuals in Sri Lanka.

The authors assessed the perceived need for dental care among 585 older individuals, of whom 235 received a clinical oral examination. Of the 235 participants, only 171 were dentate. The present analysis is limited to this group. Of these 171 dentate adults, 43 percent perceived a need for dental care. Of this sample section, 53 percent perceived a need for dentures. Age, perceived oral health status, presence of mobile teeth, three impact items of the Oral Health Impact Profile-14 (OHIP-14) scale--namely "had a painful aching in the mouth, had difficulty in eating and that the diet had been unsatisfactory due problems with teeth, mouth or dentures"--and the total OHIP-14 score showed significant associations with perceived need for dental care in bi-variate analysis. Poor perceived oral health status emerged as the strongest predictor of perceived need for dental care in logistic regression.

Source of drinking water and other risk factors for dental fluorosis in Sri Lanka.

This study was done to describe the association between source of drinking water and other potential risk factors with dental fluorosis. Prevalence of dental fluorosis among 518 14-year-old students in the south of Sri Lanka was 43.2%. The drinking water sources of the students were described and fluoride samples were taken. There was a strong association between water fluoride level and prevalence of fluorosis. Tea drinking before 7 years of age was also an independent risk factor in a multivariate analysis. Having been fed with formula bottle milk as an infant seemed to increase the risk although the effect was not statistically significant. No clear effects could be found for using fluoridated toothpaste, occupation of the father, and socio-economic status. Drinking water obtained from surface water sources had lower fluoride levels (median 0.22 mg l(-1)) than water from deep tube wells (median 0.80 mg l(-1)). Most families used shallow dug wells and these had a median fluoride value of 0.48 mg l(-1) but with a wide range from 0.09 to 5.90 mg l(-1). Shallow wells located close to irrigation canals or other surface water had lower fluoride values than wells located further away. Fluoride levels have to be taken into account when planning drinking water projects. From the point of view of prevention of dental fluorosis, drinking water from surface sources or from shallow wells located close to surface water would be preferable.

Self reported use of dental services among employed adults in Sri Lanka.

AIM: To determine the patterns and variables associated with self-reported use of dental services among employed adults in Sri Lanka. DESIGN: A cross sectional study using a self-administered questionnaire. SETTING: Five representative public sector institutions in the city of Kandy, Sri Lanka. PARTICIPANTS: A total of 210 employees. RESULTS: Ninety per cent of the employees had used dental services, the majority for symptomatic reasons. Of the respondents, 63% had visited a dentist in the preceding 24 months. According to the logistic regression analysis, gender and presence of pain within the past six months were significant predictors of dental utilisation. CONCLUSIONS: Andersen and Newman's behavioural model of health services utilisation was of limited value in explaining dental utilisation of this sample of employed adults as only one predisposing factor and a single factor related to need were significant predictors of the use of dental services.