Oral health and oral health risk behaviour in children with and without externalising behaviour problems.

AIM: This was to study children with early detected externalising behaviour problems compared to matched controls regarding oral health, oral health risk behaviour and the parental evaluation of the child's oral health and dental care. METHODS: Children aged 10-13 years and with externalising behaviour problems, were compared to matched controls. Behavioural characteristics were based on the Strength and Difficulties Questionnaire. The children and their parents completed questionnaires regarding dental fear, tooth brushing, dietary habits and evaluation of oral health and dental care. Data on dental caries risk assessments, caries, behaviour management problems and dental trauma were obtained from dental files. RESULTS: There were no differences in caries prevalence in children with early detected externalising behaviour problems, compared to controls. However, the former group consumed more sweet drinks when thirsty and brushed their teeth fewer than twice daily; they also had more dental trauma in both dentitions and a higher risk range for dental fear, compared to controls. CONCLUSIONS: This study points out potential oral health risk factors in children with early-detected externalising behaviour problems. Although no difference in caries prevalence was observed, externalising behaviour may affect oral health. Therefore, dental professionals should support the families and the children to preserve dental health by offering increased prophylactic measures. There were no differences between children with externalising behaviour problems, compared with controls, regarding the parent evaluation of their child's dental health. However, more parents in the study group evaluated the dental care as poor or not functioning.

Factors Affecting Older Persons' Ability to Manage Oral Hygiene: A Qualitative Study.

A great challenge for the dental service is to support the growing group of elderly people with preserving good oral health throughout their lives. Limitations in the ability to manage oral hygiene and an increased number of risk factors are often reflected by poor oral health. Thus, the need for individualized support and oral health procedures based on the older person's condition is significant. Deficiencies in the motor skills needed to manage oral hygiene are well known, but other factors that affect the ability are not well studied. The aim of the present study was to identify factors that may affect an elderly person's ability to perform oral hygiene self-care, which is the first step to develop a more comprehensive "oral hygiene ability index." The design of the study was qualitative. Data were collected from 4 focus group interviews with a total of 23 participants. Three of the groups consisted of dental hygienists, occupational therapists, and assistant nurses, all working with elderly persons. The fourth group was made up of elderly people (72-89 years). Content analysis was used to analyze the data. The latent content was formulated into the core category, "oral hygiene-a complex activity." Three categories emerged: "psychological," "environmental," and "functional" dimensions. The psychological dimension described attitude/motivation, emotions, and cognitive factors. The environmental dimension included practical conditions and social context. The functional dimension dealt with bodily and oral function as well as the senses. In conclusion, self-care with respect to oral hygiene is a complex activity for elderly persons and includes a large number of factors. These factors should be taken into consideration when developing a future oral hygiene ability index. Knowledge Transfer Statement: Various factors may affect the ability to manage oral hygiene self-care. Impaired ability to manage oral hygiene, in combination with an increased number of risk factors, often results in deteriorating oral health and impaired quality of life in older persons. Factors necessary to manage oral hygiene were identified in a qualitative study of dental hygienists, occupational therapists, and assistant nurses, all working with elderly patients, and a group of elderly persons. The results of this study may be important for clinical oral health work with older patients and for the planning of oral health and social care interventions for the growing group of older people.

Behavioural characteristics in externalising children with low and elevated risk for dental caries.

AIM: To compare two groups of children with externalising behaviour problems, having low and elevated caries risk, respectively. Those parameters were assessed in relation to behavioural characteristics and family structure, and to compare the caries risk assessment and gender differences in relation to children in general in the Region of Västra Götaland, Sweden. METHODS: Families (228) with children, aged 10-13 years, participating in parent training programmes, were recruited. Parents provided information through questionnaires regarding parental knowledge and monitoring, family warmth and conflict and family structure. Children's behavioural characteristics, based on the Strength and Difficulties Questionnaire and the Disruptive Behaviour Disorder rating scale, were used as outcome. Data about caries risk assessment were obtained from dental records. RESULTS: Children in the elevated caries risk group showed higher mean values for conduct problems as well as impulsivity. Parents of the children in the elevated caries risk group reported more parental solicitation and less family conflicts. Children with an elevated caries risk lived more often in households with more than two children and had more often a father from a non-Nordic country. CONCLUSION: There were statistically significant more children with an elevated caries risk in the study group compared to children in general in the Region of Västra Götaland, both totally and within gender. Differences were observed with regard to behavioural characteristics in externalising children with an elevated risk for caries. Increased knowledge regarding behavioural characteristics in externalising children is an important parameter to be considered in caries risk assessment.

Prevalence of halitosis in elderly living in nursing homes.

OBJECTIVES: Halitosis is a concern for many people, but has sparsely been studied in elderly living in nursing homes. The aim of this investigation was to study the prevalence of halitosis in this particular group and factors that could be associated with this condition. METHOD AND MATERIALS: One hundred and twenty-four residents at three different nursing homes were included in the study. The level of halitosis was assessed using an organoleptic method based on a 6-graded scale. Oral status, including registrations of plaque, gingivitis and assessment of hyposalivation, was performed by two investigators who both examined all patients. Medical history, that is medication, neurological conditions, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD)/asthma, dementia and mental illness, was obtained from the patient files. Registrations of the use of oral hygiene aids, ADL (Activity of Daily Life) and the frequency of contact with dental services were included in the clinical examination. RESULTS: Halitosis occurred in over 50% of residents living in nursing homes and was found to be associated with the presence of hyposalivation, periodontal disease, calculus, fixed prosthodontics and dementia. CONCLUSION: Halitosis was a common finding in the elderly living in Swedish nursing homes.

Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region.

UNLABELLED: In 2003, 19 public dental clinics in Västra Götaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region. OBJECTIVE: To evaluate caries increment and to perform a cost analysis of the programme. BASIC RESEARCH DESIGN: A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n = 3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n = 13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n = 11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (≈ 44€) per adolescent. RESULTS: Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15. CONCLUSIONS: This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Västra Götaland Region in Sweden.

Effectiveness of screening for diabetes mellitus in dental health care.

AIMS: The aim of the present study was to test the effectiveness of opportunistic blood glucose screening in a cooperational framework between dental and primary health care. METHODS: Altogether, 1568 subjects, age 20-75 years, with no previous history of diabetes, who came for a regular dental examination, had their non-fasting blood glucose measured with a portable blood glucose meter. Subjects with a concentration of ≥ 6.7 mmol/l (121 mg dl(-1) ) were referred to their primary healthcare centre for follow-up. The outcome, a diagnosis of diabetes mellitus, was obtained from primary healthcare centre and hospital patient records, during 3 years after screening. RESULTS: Of the 155 (9.9%) subjects who screened positive, 139 (89.7%) came to their primary healthcare centre within the 3-year follow-up period and nine (5.8%) were diagnosed as having diabetes mellitus according to the World Health Organization criteria. Of the 1413 subjects who screened negative, 1137 (80.5%) came to the primary healthcare centre and eight (0.6%) were found to have diabetes mellitus. Screening sensitivity was 52.9%, specificity 90.6% and positive predictive value 5.8%. The number of subjects needed to screen to find one case of diabetes was 196. Delineating the study population to those 40- to 75-year-olds with a BMI ≥ 25 kg/m(2) , and 30-to 75-year-olds with a BMI ≥ 30 kg/m(2) , the numbers needed to screen was reduced to 96. CONCLUSIONS: Cooperation between dental and primary care for high blood glucose screening and follow-up appears to be a feasible method for early diagnosis of diabetes.

Fluoride retention of a mucosa adhesive paste compared with other home-care fluoride products.

Home-care use of fluoride (F) requires a motivated individual and several F products rely on a person's ability to follow instructions and to cooperate with the treatment. The aim of this crossover study was to investigate concentrations, distribution in the oral cavity and duration of the elevated F concentrations after using four F products: (1) a mucosa adhesive paste with 0.1% F, (2) a mouth rinsing solution with 0.2% NaF, (3) toothpaste containing 0.5% F and (4) a tablet with 0.75 mg F. Fourteen subjects used the four products in randomized order either during the daytime or just before going to bed. The F concentration was measured both in saliva and at interproximal sites. After 6 h of sleep, the F concentration after using the mucosa adhesive paste and the mouth rinse solution was high in saliva. In the interproximal area, the adhesive paste showed the highest values. During daytime use, all the products increased the F concentration, but only the mucosa adhesive paste and the rinsing solution elevated F in saliva for up to 2 h. In the interproximal area, the paste increased the F concentration most. In conclusion, this study showed that the mucosa adhesive paste and the mouth rinse solution led to higher F concentrations and for a longer time than tablets and toothpaste. For patients who are unable to comply with traditional F treatment, an F-containing adhesive paste therefore has the potential to be a useful vehicle. For individuals who are able to cooperate, a mouth rinse with an F solution is a simple, efficient and well-known method for preventing dental caries.

Move of adults with mental retardation from institutions to community-based living: changes in the oral microbiological flora.

In the Western world, the policy of deinstitutionalization and integration of individuals with mental retardation is generally accepted. We tested the hypothesis that de-institutionalization may lead to changes of habits with a potential to influence oral health. When 57 adults with mental retardation moved from an institution to community-based living, their oral hygiene habits, gingival bleeding, and a three-day food record were registered one month before and 9 and 21 months after the move. Mutans streptococci and lactobacilli in saliva, P. intermedia/P. nigrescens, P. gingivalis, and A. actinomycetemcomitans in supragingival plaque, and C. albicans on mucous membranes were analyzed. After 21 months of community-based living, fewer persons showed high classes of mutans streptococci, growth of P. intermedia/P. nigrescens, and high frequency of sucrose intake, and more subjects showed growth of C. albicans. In a short perspective, the indicators of oral diseases suggest an unchanged or lower risk of oral diseases after the de-institutionalization of individuals with moderate or severe mental retardation.

Longitudinal study of dental caries, tooth mortality and interproximal bone loss in adults with intellectual disability.

The investigation focused on longitudinal changes of oral health in a group of adults with intellectual disability. A number of 124 individuals, aged 21-40 yr in 1990, were followed during 8.5 yr. The incidence and prevalence of caries, incidence of tooth mortality, and interproximal bone loss were registered from clinical examinations and bite-wing radiographs. The subjects visited the dental clinic for preventive dental care on average every third month during the period. The caries incidence was low, on average 0.51 new lesions per yr. Persons with mild intellectual disability experienced more caries than other subjects. During the 8.5 yr, the subjects had lost on average 1.82 teeth, with periodontitis dominating as the reason for tooth mortality. Individuals who cooperated poorly with dental treatment had lost the most teeth. The average annual bone loss in all subjects was 0.03 mm. Subjects with Down syndrome had a higher bone loss compared to those with other diagnoses of intellectual disability. Thus, the major part of the persons with intellectual disability showed satisfactory oral health. However, subjects with poor ability to cooperate with dental treatment and subjects with Down syndrome showed an increased risk for impaired oral health.

Simplified sampling methods for estimating levels of lactobacilli in saliva in dental clinical practice.

The aim of the present study was to evaluate whether estimation of lactobacilli was possible with simplified saliva sampling methods. Dentocult LB (Orion Diagnostica AB, Trosa, Sweden) was used to estimate the number of lactobacilli in saliva sampled by 3 different methods from 96 individuals: (i) Collecting and pouring stimulated saliva over a Dentocult dip-slide; (ii) direct licking of the Dentocult LB dip-slide; (iii) contaminating a wooden spatula with saliva and pressing against the Dentocult dip-slide. The first method was in accordance with the manufacturer's instructions and selected as the 'gold standard'; the other 2 methods were compared with this result. The 2 simplified methods for estimating levels of lactobacilli in saliva showed good reliability and specificity. Sensitivity, defined as the ability to detect individuals with a high number of lactabacilli in saliva, was sufficient for the licking method (85%), but significantly reduced for the wooden spatula method (52%).

Incidence of, and reasons for, tooth mortality among mentally retarded adults during a 10-year period.

The aim of the study was to investigate the reasons for, and incidence of, tooth mortality over a 10-year period in mentally retarded adults receiving regular dental care. The number of teeth present in 115 individuals (mean age in 1984 was 41.0, range 19-83 years) was registered in 1984 and 1994. The reasons for tooth mortality, medication utilization, frequency of dental care visits and cooperation during dental treatment were registered and related to tooth loss. The average incidence of tooth mortality was 3.72 teeth during the 10-year period. The mean number of dental care visits per year was 6.6. Most of the 428 teeth (58%) were lost due to periodontal disease. The preventive dental care given was not sufficient to arrest oral diseases. The data indicate, however, that achievement of cooperation in dental care situations not only makes dental treatment possible, but also leads to a decreased incidence of tooth mortality.

A comparison of four home-care fluoride programs on the caries incidence in the elderly.

OBJECTIVE: To estimate the caries preventive effect of 4 fluoride programs over 2 years in the elderly. SETTING: The Public Dental Clinics of Bålsta and Knivsta and the Faculty of Odontology in Göteborg, Sweden. SUBJECTS: One hundred and sixty-four individuals, aged 60 years and older (mean age 71.5 years) who were considered to be at risk from caries. DESIGN: The participants were randomly assigned either to: 1) rinse twice a day with a 0.05% NaF solution (n = 49; rinsing group), 2) suck twice a day on a 1.66 mg NaF tablet (n = 51; tablet group), 3) brush their teeth three times a day using a toothpaste slurry rinsing technique (n = 32; slurry group), or 4) brush their teeth in their usual manner (n = 32; control group). The participants in all 4 groups used a fluoride toothpaste (containing 0.32% NaF) at least twice daily. RESULTS: No new carious lesions were found in 67% of the participants in the rinsing, 43% in the tablet, 25% in the slurry and 16% in the control group over the 2 years. The mean (+/- SD) 2-year caries increment was 0.8 +/- 1.4, 1.4 +/- 1.7, 1.9 +/- 1.9 and 2.3 +/- 2.1 DFS in the rinsing, tablet, slurry and control groups, respectively; it was significantly lower in the rinsing than in the control group (p < 0.01). A lower incidence of DFS was also found in the tablet group than in the slurry group, but only for the lingual surfaces (p < 0.05). CONCLUSION: The type of fluoride program may be of importance in the reduction of new caries lesions in an older population.

Tobacco preventive measures by dental care staff. An attempt to reduce the use of tobacco among adolescents.

The purpose of the present study was to investigate the tobacco habits of children and adolescents within the catchment area of a public dental clinic before and after information about tobacco was given by dental care staff. The study was carried out over a three-year period on all 12- to 19-year-olds who came to the clinic for check-ups, 919, 933 and 859 individuals during each respective year. In the first year epidemiological data regarding use of tobacco were registered. Starting with the second year of the study coordinated information was given about the detrimental health effects of tobacco use. This consisted of individual information during the check-up, waiting-room information, and tobacco information in connection with dental health education in school. Use of tobacco was observed from the age of 14. Use was similar among boys and girls and increased with age. The proportion of tobacco users was 10.3%, 11.5%, and 7.3% for the respective years of the study. Statistical analysis shows that the reduction between the second and third year of the study is significant (p < 0.05). The result supports the hypothesis that tobacco information conveyed by dental care staff can influence the tobacco habits of children and adolescents.

Inter-relationship among degree of mental retardation, living arrangements, and dental health in adults with mental retardation.

The aim of the present investigation was to study the inter-relationship among the degree of mental retardation, the way of living, and dental health in adults with mental retardation. One hundred and thirty-two adults between the ages of 21 and 40 years who were mentally retarded were examined on two occasions, one year apart. All subjects had had regular dental care for at least 10 years. The clinical examinations included bite-wing radiographs and were made by the same dentist. The degree of mental retardation was assessed by a professional psychologist. The results show that the degree of mental retardation as well as living arrangements are factors influencing the dental health of persons with mental retardation. Subjects who were mildly retarded had higher caries incidence and caries prevalence compared with subjects with moderate or severe mental retardation. From a preventive dental health perspective, special attention should be focused on subjects with mild mental retardation who are not living in institutions.

Effect of chlorhexidine gel treatment on the prevalence of mutans streptococci and lactobacilli in patients with impaired salivary secretion rate.

The potential pathogenic role of mutans streptococci in the etiology of dental caries is well-documented. Mutans streptococci are sensitive to chlorhexidine (CHX), and several methods for the clinical use of CHX have been described. An important target group for caries-preventive measures is patients with impaired salivary secretion due to the use of therapeutic drugs such as psychotropics. The aim of the present study was to compare two methods for antimicrobial treatment in such patients. Twenty-four volunteering patients at a hospital clinic were randomly divided into three groups: Group A, in which each participant was treated with 10% CHX gel in gel trays on two consecutive days, followed by application of a fluoride varnish; Group B, in which the patients were treated with the same CHX gel as above; and Group C, which was used as a control. After treatment, there was a reduction of mutans streptococci in the two groups treated with CHX. In group A, the sames collected one, three, and five weeks after the treatment were significantly lower than baseline values. No clearcut reduction of the number of mutans streptococci was observed in the subjects not treated with CHX. These data indicate that treatment with CHX gel in gel trays is superior to polishing the teeth with CHX gel. From a clinical point of view, our observations suggest that it is important to monitor the effect of antimicrobial treatment individually in order to optimize preventive programs in patients with impaired salivary secretion.

Dental health status of mentally retarded adults with various living arrangements.

During the last few years in Sweden, there has been a change in the way of living for the mentally retarded. There has been a gradual movement away from institutions toward a more integrated life within society. The aim of the present study was to examine the dental health of mentally retarded adults with different ways of living. Forty-two subjects lived in an institution, 50 lived in integrated units, and 40 stayed in their own apartments or with their parents. All subjects had had regular dental care for at least ten years. The clinical examination was made by one dentist. The use of fluoride and chlorhexidine was recorded in addition to a microbiological examination. The results showed a higher caries prevalence and incidence in subjects with integrated living. Compared with other studies where the mentally retarded had had no regular dental care, the caries incidence and prevalence were lower in this study, and the number of missing teeth was lower. The prevalence of mutans streptococci was related to caries prevalence and incidence. High scores of mutans streptococci could be observed, even among subjects with a frequent use of chlorhexidine gel. The loss of alveolar bone was more pronounced for individuals living in the institution compared with that in individuals with other ways of living.

Periodontal disease and dental caries in relation to primary IgG subclass and other humoral immunodeficiencies.

22 females and 3 males with primary hypogammaglobulinaemia (n = 6) or IgG subclass deficiencies with (n = 3) or without (n = 16) concomitant IgA deficiency were examined for periodontal disease and dental caries. Only 1 patient showed more tooth loss than that found in the normal Swedish population. 1 patient demonstrated advanced periodontal disease. No patient exhibited more severe dental caries than that of comparable normal Swedes. Microbiological samples from periodontal pockets and saliva showed recovery of potential periodontopathic and cariogenic bacteria within normal ranges. This study could not support the notion that immunodeficient subjects exhibit an increased risk of developing periodontal disease or dental caries.

Crevicular IgG antibodies and recovery of Streptococcus mutans implanted by mouthrinsing.

After challenge with a streptomycin-resistant strain of Streptococcus mutans (S. mutans), a tendency to higher recovery of S. mutans was found in gingival crevicular fluid (GCF) from surfaces with a low IgG antibody activity against S. mutans than in GCF from surfaces with a high antibody activity. This suggests that antibodies in GCF may interfere with the establishment of S. mutans on gingival tooth surfaces. In GCF collected from some sites, considerably higher IgG antibody activity was observed than in homologous serum, indicating that part of the IgG response to S. mutans was locally derived.

Crevicular IgG antibodies and recovery of locally implanted Streptococcus mutans in humans.

This study was undertaken with the aim of examining the effect of highly different IgG antibody activities in gingival crevicular fluid (GCF) on the elimination of a streptomycin-resistant strain of Streptococcus mutans (S. mutans) topically implanted on the tooth. Two groups of people were selected for the study, one with high and one with low specific IgG antibody activity (IgG antibody activity against S. mutans) in GCF. During an experimental period of 15 d the specific IgG antibody activity in GCF in the same individual stayed on a relatively constant level. Between individuals, however, the specific IgG antibody activity varied considerably. The number of indigenous mutans streptococci and the number of implanted bacteria on the same tooth surface were strongly correlated. The implanted S. mutans strain was rapidly eliminated in all subjects. No difference in the elimination of the implanted strain of S. mutans could be demonstrated between the groups of high and low specific IgG antibody activity.

Crevicular IgG antibodies and Streptococcus mutans on erupting human first permanent molars.

The specific IgG antibody activity against indigenous Streptococcus mutans in gingival crevicular fluid (GCF) was determined in 25, 6-7-yr-old children. Samples of plaque and GCF were collected from all erupting first permanent molars. Plaque samples were also collected from the adjacent second primary molars. The presence of clinical caries was scored as defs. In the same individual a highly significant correlation (p less than 0.005) was found between the level of specific antibody activity in GCF when comparing first permanent molars with each other. No correlation was found between the specific antibody activity in GCF and the number of indigenous Strep. mutans colonizing the buccal surfaces of the first permanent molars. Caries-free children had significantly less specific antibody activity in GCF than children with caries experience (p less than 0.05). In the same child a highly significant correlation (p less than 0.0001) was found between the level of colonization by mutans streptococci on the permanent molars and the adjacent second primary molars.