Assessment of the reliability and validity of the Dental Neglect Scale in Norwegian adults.

AIMS: To evaluate the reliability and construct validity of the Dental Neglect Scale (DNS) and to estimate the level of dental neglect in the adult Norwegian population. METHODS: A questionnaire containing socio-demographics, oral health attitude variables, self-reported service use and a translated version of the original DNS was tested in two samples: 1) a convenience sample of University employees (n=263) and 2) a proportionate random sample (n=2000) drawn from the national population register (age 16-79 years). The reliability assessment of the instrument was by internal consistency (Cronbach's alpha) and factor analysis (principal component) (n=1309). The test-retest comparisons (n=108) were analyzed by Spearman's rho for the sum-scores, and kappa statistics for single items. Logistic regression analyses were used to evaluate the construct validity of the DNS. RESULTS: The Cronbach's alpha coefficient for the overall construct of DNS was 0.67 (n=173) and 0.57 (n=1301). Only one factor was extracted, explaining a total of 36% of the scale variance (n=1301). Cohen's kappa for the test-retest comparisons ranged from 0.21-0.79 (n=108), and Spearman's rho for the test-retest sum-scores was 0.60. Higher neglect scores were positively related to a negative opinion about own dental health (OR=3.3), last dental appointment because of pain or other problems (OR=2.3), less than 20 teeth (OR=2.2), drinking soft drinks with sugar every day (OR=2.1), non-regular dental service use (OR=2.2) and using floss or toothpicks seldom or never (OR=1.6). The prevalence of high dental neglect was 20%. CONCLUSIONS: The analyses indicated construct validity for the Dental Neglect Scale but low reliability for some of its items. One fifth of this representative sample of Norwegian adults reported a high level of dental neglect.

Oral Impacts on Daily Performance in Norwegian adults: the influence of age, number of missing teeth, and socio-demographic factors.

This study investigates the relationships among socio-demographic factors, dental status, and impaired oral health-related quality of life (OHRQoL) using a translation into Norwegian of the Oral Impacts on Daily Performance (OIDP) inventory. Data were collected as part of the Central Bureau of Statistics (CBS) OMNIBUS survey in Norway. The CBS drew a two-stage proportionate random sample, comprising 2,000 residents aged 16-79 yr, from the national population register. Information was available for 1,309 individuals (response rate 66.0%) who completed telephone interviews in November and December 2003. A total of 18.3% (95% confidence interval: 16.2-20.4) reported that an oral problem had affected at least one daily oral performance during the 6 months preceding the survey. The proportion of adults who confirmed impacts varied from 11.3% (eating) to 2.1% (social contact). Multiple logistic regression analysis revealed statistically significant disparities regarding respondents' age, residential area, dental attendance, and number of remaining teeth. The prevalence of OIDP in the Norwegian population was modest, but varied systematically with both socio-demographic and oral health-related factors. The consistently declining OIDP with increasing age after controlling for dental status suggests age-related changes of participants' values and expectations.

Oral Impacts on Daily Performance in Norwegian adults: validity, reliability and prevalence estimates.

The Oral Impacts on Daily Performance (OIDP) instrument was translated into Norwegian and reviewed for cultural and conceptual equivalence by a group of bilingual academics. A sample of employees from the University of Bergen completed the Norwegian OIDP frequency questionnaire twice. A total of 173 and 108 subjects participated in the first and the second administration, respectively, of this questionnaire. A two-stage proportionate random sample, comprising 2,000 residents (age-range 16-79 yr), was drawn from the national population register by the Central Bureau of Statistics. Information became available for 1,309 persons who completed telephone interviews. The Norwegian OIDP preserved the overall concept of the English version. Test-retest reliability, in terms of Cohen's kappa, was 0.65, and Cronbach's alpha was high (> or = 0.80). In both samples, variations in the OIDP scores were apparent in relation to self-reported oral health and number of remaining teeth, supporting construct and criterion validity of the inventory. Only three of the OIDP interviews were discarded, which supports face validity. A total of 18.3% confirmed that they had at least one oral impact. Age-specific rates were 17.5%, 19.0%, 17.9% and 18.4% among 16-24, 24-44, 45-66 and 67-79-yr-old participants. The satisfactory psychometric properties provide evidence for the cross-cultural use of the OIDP. The presence of a distinct floor effect indicates poor sensitivity of the OIDP to detect improvements of oral health-related quality of life at a population level. Prevalence estimates were low, suggesting that the current oral health status has little impact on the daily performance of the Norwegian adult population.

Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient.

The prevalence of dental anxiety in the general population seems to be fairly stable, and the incidence is not reduced in spite of more modern treatment methods. Intensive fear often leads to avoidance of care and consequences like poor oral health, psychosocial problems and reduced quality of life. The aetiology of dental anxiety is complex, but is often associated with direct traumatic dental experiences during childhood. These negative experiences are reported as painful/unpleasant and are influenced by the patient's perception of lack of coping and control. The theory of latent inhibition indicates that several positive dental appointments before any invasive or painful treatment sessions may act as a barrier to these perceptions of lack of coping. This paper is presenting a short overview of behavioural science in dentistry and discussing the role of the dental hygienists as potential key personnel in prevention and treatment of dental anxiety.

Factors related to severe untreated tooth decay in rural adolescents: a case-control study for public health planning.

OBJECTIVES: In this case-control study of rural adolescents we identified factors to discriminate those who have high levels of tooth decay and receive treatment from those with similar levels who receive no treatment. METHODS: The sample was drawn from all 12-20-year-olds (n = 439) in a rural high school in Washington State, U.S. The criterion for being included was 5 or more decayed, missing or filled teeth. The questionnaire included structure, history, cognition and expectation variables based on a model by Grembowski, Andersen and Chen. RESULTS: No structural variable was related to the dependent variable. Two of 10 history variables were related: perceived poor own dental health and perceived poor mother's dental health. Four of eight cognition variables were also predictive: negative beliefs about the dentist, not planning to go to a dentist even if having severe problems, not being in any club or playing on a sports team and not having a best friend. No relationship was found for the expectation variable 'usual source of care'. CONCLUSIONS: These data are consistent with the hypothesis that untreated tooth decay is associated with avoidance of care and point to the importance of history and cognition variables in planning efforts to improve oral health of rural adolescents.

Symptoms prevalence among office employees and associations to building characteristics.

A cross-sectional study was performed in eight companies, comprising 32 buildings without previously recognized indoor air problems. Engineers filled in a technical questionnaire on building characteristics, floor surface materials, ventilation, cleaning procedures, heating and cooling. A total of 3562 employees returned questionnaires on individual factors, workload, perceived physical work environment, allergy and symptoms. Frequent symptoms were feeling of fatigue or heavy-headedness, eye irritation, and dry facial skin. Women reported symptoms more frequently than men. Employees with allergy had a 1.8-2.5 times risk of reporting a high score for general, skin, or mucosal symptoms. The risk of a high symptom score increased with daily visual display unit (VDU) work time. Passive smoking and psychosocial load were also relatively strong predictors of symptoms. Weekly cleaning as compared with a frequency of cleaning two to four times a week increased the risk of symptoms. Adjusted odds ratio for a high general symptoms score from infrequent cleaning was 1.5 (95%CI 1.1-2.0). A high ventilation flow or central ventilation unit filter EU7 vs. EU8 seemed to be associated with an increased risk of general symptoms. Absence of local temperature control increased the risk of mucosal symptoms.

An intervention program to reduce dental avoidance behaviour among adolescents: a pilot study.

AIM: To develop and test the methodology of an intervention to reduce avoidance of dental care among adolescents, and to measure the respondents' beliefs regarding the intervention (credibility and cognitions). METHODS: Based on a group comparison design a sample of 18 year olds (n=50) with dental non-attendance behaviour was randomly selected to three experimental and one control group. Subjects were surveyed with one baseline questionnaire and one post-intervention questionnaire, to evaluate their beliefs regarding the program. Two different instruments were tested: 1) cards representing different statements related to previous dental experiences, possible reasons for attending (pros) and not attending (cons) dental appointments, and preferences for future treatment. Cards were selected based on individual priority; 2) a brief, structured telephone interview based on Motivational Interviewing. The instruments were tested separately (groups I and II) and in combination (group III). Subjects in the control group (group IV) were given conventional health education. RESULTS: Subjects in the experimental groups had significantly higher credibility scores to the statement "How much easier do you perceive dental treatment to be for you, based on this program", compared with the control group (p<0.05). They had also more positive beliefs to the statement "I think the interviewer liked to talk to me" (p<0.05) than controls. CONCLUSION: A questionnaire sent to non-attending adolescents followed by a brief telephone call based on Motivational Interviewing appears to be a credible intervention for adolescents avoiding dental care.

A case report: arresting dental caries.

PURPOSE: To arrest dental caries in the dentin in a patient that had been refractory to other attempts at caries control. METHODS: Repeated applications of fluoride varnish (5%, Duraflor, Pharmascience Laboratories, Montreal) in the clinic every three months along with two daily two-minute rinses with sodium fluoride at home. RESULTS: Results over five years are presented. None of the lesions identified five years earlier had been restored. The teeth were monitored with frequent bitewing radiographs and clinical exams; the interproximal decay appears inactive clinically. CONCLUSION: This present case report shows that fluoride varnish may be a good addition to preventive therapy for arresting caries in adult patients in general practice. Surgical intervention may be avoided in patients whose risk has shifted to a lower level.

Factors influencing whether low-income mothers have a usual source of dental care.

Mothers are both the source of dental caries and the managers of children's use of dental care. This is particularly important for the low-income population. The objective of this research was to explore predictors of having a usual source of dental care among low-income women. Eight-hundred-ten mothers (82 percent white, mean age twenty-seven years), drawn from among participants in an ABCD program in one Washington State County completed a study questionnaire. The study examined predisposing, enabling and illness level variables in relation to whether the mother reported a usual source of dental care for herself. Fifty-two percent of the subjects gave positive answers to the dependent variable Do you now have a dentist you can go to if you have a problem? The analysis suggests that mothers that report good oral health and believe in care for their children are five times as likely to have a usual source of care for themselves than mothers who report both poor oral health and more negative attitudes about dental care for children. The results suggest that interventions aimed at child health that ignore the welfare of the mother are likely to be less successful than those that also address the mothers' needs.

Reliability and validity of the Dental Indifference Scale in a population of 18-year-olds in Norway.

OBJECTIVES: The aims of this study were to estimate the reliability and validity of the Dental Indifference Scale (DIS) (Nuttall, 1996) in a population of 18-yr-olds in Norway. METHODS: The DIS-scale was mailed to a sample of 1119 18-yr-olds in two Norwegian counties. Nearly 87% completed the questionnaire and consented to the collection of data from their dental records. Ten percent of the sample, drawn at random, was asked to complete the questionnaire a second time, after a time delay of 15 weeks (response rate 83%). The reliability estimation of the sum-scores of DIS was based on Pearson's correlation between test-retest scores and internal consistency (Cronbach's alpha). The frequency of missed appointments from age 12, recorded in the dental treatment records, was used as the validating criterion. The validity was analyzed by Pearson's correlation, and step-wise multiple regression. RESULTS: The correlation coefficient (Pearson) for the test-retest comparison was 0.43. The correlation coefficient between the DIS-scores and the frequencies of missed dental appointments was 0.24. The Cronbach's Alpha coefficient for the eight DIS-questions was 0.35 (n=868). Only two of the eight DIS-questions entered the stepwise regression model and explained 15% of the variance of the frequency of missed appointments. CONCLUSIONS: The Dental Indifference Scale (DIS) was found to have a low reliability and validity in this study population, and it is recommended that it should not be used without further investigation. It may be necessary to design an alternative instrument if further work into the hypothesized trait of dental indifference is to be undertaken.

Factors related to missed and cancelled dental appointments among adolescents in Norway.

The aim of this study was to explore possible explanatory factors related to high frequency of missed/cancelled dental appointments during the age group 12-18 yr. A total of 754 20 yr olds completed a questionnaire including variables measuring demographics, occupation (school/job), attendance pattern, attitudes to dentists, opinion about importance of dental treatment, and the psychometric scales Dental Fear Scale (DFS), Dental Beliefs Survey (DBS) and Geer Fear Scale (GFS). Based on written consents, the following data were recorded from their dental records: the total number of scheduled appointments, the number of missed and cancelled appointments and the individual caries experience of those in the age group 12-18 yr. A total of 124 subjects who had missed/cancelled 20% or more of their dental appointments during this age were defined as a target group. A stepwise regression model indicated that the likelihood of being included in the target group increased by a factor of 6.0 if the subject had forgotten dental appointments during the last 5 yr, by a factor of 3.5 for working or without specified occupation (as opposed to attending school), by a factor of 2.7 for negative beliefs of dentists, and by a factor of 2.1 for high caries experience.

Dental anxiety and dental avoidance among 12 to 18 year olds in Norway.

The aim of this study was to explore the prevalence and possible explanatory factors of dental avoidance due to dental anxiety among 12 to 18 year olds treated within the Norwegian Public Dental Service. A total of 754 20-yr-olds completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), and gave their consent to collect data from their dental records. A total of 169 subjects (22.4%) had high dental anxiety (DFS>59 or DBS>47 at age 20 yr), and 124 subjects (16.4%) had high frequency of missed/cancelled appointments (20% or more) during the period 12-18 yr. Forty-seven subjects (6.2%) fulfilling both of the above criteria constituted the dental avoidance group. An analysis using a stepwise regression model indicated that having had more than one painful or unpleasant treatment experience increased the risk of being included in the avoidance group by a factor of 10.9. Equally, adolescents who were not attending school (working or without specified occupation) increased the risk by a factor of 6.9, having a high caries experience by a factor of 5.0, and not having their dental treatment completed at the age of 18 yr by a factor of 4.4.

Dental anxiety among 18-yr-olds in Norway. Prevalence and related factors.

The aims of this study were to determine the prevalence of dental anxiety at the time when adolescents are leaving the public dental service, and to explore the relationship at this stage between dental anxiety and some possible etiologic factors. The sample consisted of 571 18-yr-olds in high school who completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), in the classroom. The relationship between dental anxiety (DFS and DBS) and a total of nine possible etiologic factors was explored by the use of stepwise regression analyses, and risk estimates (odds ratio) were calculated in cross-tables. There were significant sex differences for DFS and for GFS, but not for DBS. Nineteen percent of the total sample were classified as having high dental anxiety (DFS > 59). Previous experiences of pain, phobic anxiety indexed by GFS and pain at the last dental visit entered into the stepwise regression models of both dental anxiety indices explaining 50% of the variance of DFS, but only 18% of DBS. Students who reported more than one previous experience of pain were 9.9 times more likely to report high dental anxiety as recorded by DFS than the rest of the group. The corresponding risk factor for DBS was 3.4.

Missed and cancelled appointments among 12-18-year-olds in the Norwegian Public Dental Service.

The aims of this study were to evaluate the prevalence and distribution of missed and cancelled dental appointments in the Norwegian Public Dental Service during the age period from 12 to 18 yr, and to explore possible relationships with demographics and individual caries experience (DMFT). A total of 968 patients (86.5% of the sample) gave their consent to collect data from their dental records. Forty-seven % of the group had missed and 26% had cancelled one or more dental appointments. A total of 13.6% had missed more than 20% of their appointments. Missed and cancelled appointments were to a great extent related to different individuals. The frequency of individuals with missed and cancelled appointments showed an almost linear increase from age 12 to 18 yr, and the mean individual frequency increased from 1.1 to 11.8% for missed appointments and from 0.7 to 4.8% for cancelled appointments. Subjects with missed appointments had a significantly higher mean DMFT at the age of 18 compared with the rest of the group. Individuals with missed and cancelled appointments may represent a risk group for future dropout from dental care which should be further analyzed.

Smoke control in hospitals.

Full scale fire tests have been carried out in order to study the influence of different ventilating principles on the time point of fire detection and the smoke filling of a four-bed room. Using conventional mechanical ventilating systems as "smoke exhaust systems" the time difference left for evacuation of the fire room can be positively influenced. With the conventional ventilating system operating there is a significant difference between time points of detection of the ionization and optical smoke detectors, for both flaming and smoldering fire. Using the "low momentum displacement ventilation" this difference is reduced, resulting in possibilities for the ionization smoke detector to be optimized for both flaming and smoldering fires.