An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

Outcomes for root-fractured permanent incisors: a retrospective study.

PURPOSE: The objective of this study was to assess the outcomes for treated root-fractured permanent incisors with respect to pulp vitality, root tissue union, and tooth survival and to examine the effects of clinical and radiographic parameters and rigid splinting on the outcome. METHODS: Eighty-four teeth were identified and data extracted from case notes prior to transfer to an SPSS data base for analysis. The odds ratios for each factor were calculated and the significance of differences was determined. Tooth loss and relevant risk variables were examined using Cox's regression model and Kaplan-Meyer survival curves. RESULTS: Fourteen (17%) had fractures in the apical third, 47 (56%) in the middle third, and 23 (27%) in the coronal (gingival) third. Twenty-four (29%) also had crown fractures involving enamel and dentine. Crown fractures were identified as significant risk factors for pulp vitality. Loss of pulp vitality, horizontal displacement, and extrusive displacement of the coronal fragment were significant risk factors for hard root tissue union. Survival was poorest with gingival third fractures with 14 (61%) of these teeth being lost. Splinting rigidly had no significant effect on pulp vitality and type of root tissue healing. CONCLUSIONS: Loss of pulp vitality was significantly associated with enamel-dentine crown fracture. Hard root tissue union was significantly affected by pulp necrosis and luxation of the coronal fragment. Survival was poorest for root fractures within the gingival third of the root. Splinting with rigid fixation had no significant effect on pulp vitality and type of root tissue union.

Factors affecting the time of onset of resorption in avulsed and replanted incisor teeth in children.

Resorption is the main reason for loss of replanted teeth. The outcome examined in this study is the timing of the onset of resorption. The effect of dichotomised dry and wet time intervals as well as the presence of additional crown damage and of contamination were determined. Of 84 replanted teeth, 67.5% developed resorptions. Twenty-eight had detectable additional crown damage with a more rapid onset being seen in these cases (P=0.009). The critical limit for dry time was 15 min (P=0.038) and significant differences persisted for greater limits also. Serial analysis of the association between the time of onset of root resorption and dichotomised wet time variables failed to yield any significant associations. There was visible contamination detected in 32 teeth and these exhibited a more rapid onset of resorption than the other cases (P=0.030). Teeth with inflammatory root resorption (12.8%) had a more rapid onset of resorption than those that developed replacement resorption (54.7%) (P<0.001). It is concluded that the risk of early resorption is increased in teeth that have additional damage or have contamination, or are kept in dry conditions for longer than 15 min.

A study in two centres of variations in the time of apical barrier detection and barrier position in nonvital immature permanent incisors.

OBJECTIVES: To study barrier formation in nonvital, immature permanent incisors being treated using the apexification technique in two centres, and to establish the effect of the frequency of change of calcium hydroxide (CaOH) on barrier detection times. DESIGN: A retrospective study of the time of detection and the position of barriers. RESULTS: There were no significant differences between the two centres in terms of the average frequency of change of each CaOH dressing, the distribution of barrier detection times or the position of barriers (P > 0.05). There was a total of 107 teeth and the time of barrier detection was significantly earlier in more frequently dressed teeth (P = 0.013). Of the teeth with a barrier detection time of less than 9 months, 60.7% were dressed more frequently than every 3 months, as opposed to 39.1% of teeth with longer barrier times (P = 0.027). The mean time of barrier detection for all cases was 43.3 weeks. The majority of barriers were located at or near the apex. CONCLUSION: The frequency of change of CaOH can increase the speed of barrier detection but does not appear to affect the position.

Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption.

OBJECTIVE: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption. SETTING: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne. DESIGN: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome. RESULTS: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29. CONCLUSION: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

A prospective study of factors affecting survival of replanted permanent incisors in children.

OBJECTIVE: To examine the factors associated with the onset of resorption in replanted avulsed permanent incisor teeth and to demonstrate their patterns of survival free of resorption. SETTING: Department of Paediatric Dentistry, Belfast. DESIGN: Prospective recording of the timing of the injury and of replantation, the storage media, the degree of root development and contamination, and the completion of root treatment. Clinical and radiographic reviews at 3-month intervals. Root resorption classified as replacement and inflammatory. Logistic regression and survival curves with freedom from resorption as outcomes. RESULTS: In 50 avulsed incisors in children aged 6-16 years the best predictor of overall resorption was total time of dryness, and that for replacement resorption was total extra-oral time. The timing of detection of resorption varied from 102 days to 997 days. CONCLUSION: Both total extra-oral time and time stored dry are important factors for the onset of resorption in replanted avulsed teeth in children.

Individualized mouth prop for dental professionals and carers.

Maintaining a high standard of dental health in children with special needs, particularly those who are unable to control mandibular activity, can prove difficult and time consuming for parents, carers and dental professionals. This article describes the construction of an individually made and relatively unobtrusive finger guard mouth prop, designed to facilitate intraoral examination and oral hygiene care for these children. An initial evaluation by a number of users found these mouth props were simple to fit, stable and provided adequate finger protection. All users planned to continue using their mouth prop after the trial period. It is concluded that similar finger mounted mouth props may help facilitate dental care and oral hygiene for children requiring special care.

Pharmacists' knowledge, attitudes and practices concerning sugar-free medicines.

AIMS: To examine the attitudes of pharmacists to sugar in medicine and sugar-free preparations and their levels of knowledge concerning sugar-free preparations and the implications for dental health. DESIGN: A questionnaire was designed with a mixture of closed and open-ended questions. SETTING: Pharmacists practising in the Greater Belfast area of Northern Ireland. METHOD: Seventy pharmacists were randomly chosen from the list of pharmacists practising in the area and were asked to participate in the study. RESULTS: Responses were obtained from 52 of the 70 selected pharmacists, representing a response rate of 74%. Seventy-five per cent of the pharmacists stated that they had not received formal education concerning sugar in medication and it's effect on dental health. Their main source of information on the subject was dental health literature. Eighty-seven per cent felt that all medication should be available in sugar-free form. Forty-six per cent stated that sugar in medication was definitely an important cause of dental caries in children and 44% felt that it was a possible factor. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising. Thirty-nine per cent of the pharmacists always offered a sugar-free preparation for over-the-counter medication (provided that a sugar-free alternative was available), and 56% sometimes did so. Fifty per cent always offered a sugar-free form for prescribed items wherever possible, the remainder depended on it being specified by the prescriber. CONCLUSION: There is a high level of interest in this issue among pharmacists, but there is a need for an increased educational input on a continuous basis.

Colour perception of laboratory-fired samples of body-coloured ceramic.

The objective of this investigation is to test by common perception, the colour fidelity of laboratory-fired samples of ceramic. Thirty-two ceramic discs were constructed in a thickness similar to that used for ceramic veneers using eight shades from each of four different manufacturers. A group of 20 'adept' observers colour matched the samples in strictly controlled viewing conditions using a Vita Lumin (Vita Zahnfabrik) shade guide. Samples were categorised as 'positive matches'(matching the expected shade), 'agreed shades' (matching an unexpected shade), or as 'unidentified shades' (no match). The Vita Lumin (Vita Zahnfabrik) colour 'value' index was used as a reference to categorise colour 'value' differences between observed and expected shade. Colour 'value' selection was divided into three groups: (1) matching colour 'value', (2) shades of higher colour 'value' than expected or (3) shades of lower colour 'value' than expected. Only six of the 32 samples examined were perceived to be 'positive matches' with the recommended shade guide. Fourteen 'agreed shades' were found while the remaining 12 shades were regarded as 'unidentified shades'. The vast majority of observations disagreed with the manufacturers' designated shade. A significant trend was found favouring higher 'value' (lighter) shades than those specified by the manufactures. Significant differences in the pattern of shade matches and disagreements between brands were also found. Alternative shade determination systems and/or ceramic colour modifications are required if colour fidelity between the shade guide and the materials tested is to be improved.

Use of a common shade guide to test the perception of differences in the shades and value by members of the dental team.

PURPOSE: Commercial shade guides are frequently used for treatments where the shades of teeth are being reproduced or altered. Where differences between shade tabs and the natural teeth are small, difficulty is often experienced in determining the closest match. The purpose of this investigation is to discover whether the claimed colour differences between individual shades of one commonly used guide can be determined subjectively in clinical circumstances. BASIC PROCEDURES: Seventy dental team professionals made shade comparisons in an idealized colour-matching environment using shade guides as supplied by the manufacturer. Their arrangements by 'value' were recorded and unidentified shade tabs were matched with those on a complete guide. MAIN FINDINGS: The results showed that discrepancies existed between nominated and perceived colours, for the shade determination system tested. The shade-guide manufacturer's recommended arrangement of shade tabs ranked according to colour 'value' did not correspond to subjective perception of 'value' ordering under the conditions of the study. PRINCIPAL CONCLUSIONS: There may be no practical clinical advantage in having shades which cannot be distinguished. This study indicates that colour differences between shade tabs are not clearly perceived by members of the dental team. A careful reduction of the number of tabs in the guide tested might simplify shade selection procedures and help to standardise shade-taking.

Inflammatory and replacement resorption in reimplanted permanent incisor teeth: a study of the characteristics of 84 teeth.

Avulsion is a serious injury which can cause damage to some or all of the dental and surrounding tissues. This study examined the profiles of teeth showing inflammatory resorption, in terms of time prior to reimplantation, contamination, pulp extirpation time and period of splinting and compared them to teeth without resorption. There were a total of 71 children in the present study (mean age 9.8 years, range 6-16 years) with a total of 84 reimplanted teeth. Inflammatory resorption was present in 22 teeth. There was a significant relationship between the presence of inflammatory resorption and the time the teeth were dry prior to reimplantation, with a lesser effect for total delay time. There were slightly later pulp extirpation times for teeth with inflammatory resorption, with median delays of 16 and 11 days respectively and increased inflammatory resorption in teeth extirpated at 20 days or later. Replacement resorption was present in 40 teeth. There was a significantly longer splinting time in teeth with replacement resorption and more resorption in teeth splinted for longer than 10 days. It was concluded that pulp extirpation time was not critical unless the delay exceeded 20 days and that splinting time should not exceed 10 days.

Non-vital immature permanent incisors: factors that may influence treatment outcome.

This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification technique. The objectives of the present study were to determine the speed and location of barrier formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8-12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34.2 weeks (range 13-67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P = 0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (36.4%) varied from 1 mm to 5 mm. The number of placements of calcium hydroxide varied from 1 to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex.

Provision of sugar-free medicines for young children: the views of a sample of parents in Northern Ireland.

Sugar in liquid medicines is a factor in dental caries for many children. There has been an increase in the availability of sugar-free medicines in recent years, but they need to be prescribed specifically, because most generic liquid medicines still contain sugar. The object of the present study was to examine parental and child factors which may be linked to the provision of sugar-free alternatives by their medical practitioner. A random sample of 291 parents of children aged four years was obtained. A questionnaire was used to ascertain the extent of their knowledge concerning liquid medicines and their effect on dental health and the frequency with which such medicines are requested by them was assessed. The levels of provision of sugar-free medication and the frequency of used common types of medication were recorded and long term users identified. There was a total of 212 children in the study representing an inclusion rate of 73 per cent of the original sample. Just more than 17 per cent were always provided with a sugar-free liquid medicine, 58.3 per cent sometimes received this form of medication and 24.6 per cent never received it. The strongest individual predictor of a high frequency of provision of the medication in sugar-free form was the frequency of parents requesting this type of medication from their medical doctor and the next strongest predictor was the frequency of use of antibiotics. Parental awareness or knowledge of the importance of the issue for dental health did not affect the outcome in the present study. It is concluded that there is a need for specific campaigns to promote the use of sugar-free medications and further increases in their availability should be sought from manufacturers.

Choice of sugar-free medicines by a sample of dentists, doctors and pharmacists in Northern Ireland: the views of parents and health professionals.

OBJECTIVE: To determine the sources of learning and the levels of support concerning sugar-free medicines by doctors and pharmacists, to examine the provision of choice from the viewpoints of professionals and the parents, and to test the sugar-free status of medication in tests of prescribing. DESIGN: Samples of health professionals comprising 47 general medical practitioners, (87% response rate) 29 pharmacists (94%) and 25 general dental practitioners (100%) completed closed questionnaires as did 209 parents (72%) of 4-year-old children. SETTING: Newry and Mourne Health Trust Area, Northern Ireland. OUTCOME MEASURES: Proportions of respondents citing various learning sources and the levels of support for the use of sugar-free medicines were obtained and the proportions of doctors and pharmacists claiming to offer various frequencies of choice were compared to the proportions of parents recalling receiving such choices. Test prescriptions were examined and the sugar-free status of the prescribed medication was determined. RESULTS: Markedly different sources of learning were cited by different groups. Ninety per cent of pharmacists and 88% of dentists believed that medication should be in sugar-free form in all cases, while only 66% of doctors thought so. Forty three per cent of doctors claimed to always offer a choice while 17% of parents recalled receiving this. The equivalent figures for pharmacists and parents were 69% and 11%. The majority of test prescriptions by doctors and dentists were for sugar containing medicines.

Factors affecting levels of untreated caries in a sample of 14-15-year-old adolescents in Northern Ireland.

UNLABELLED: Dental caries experience in children in Northern Ireland is the highest in the United Kingdom. OBJECTIVE: The aims were to examine the levels of untreated decay in a sample of 14-15-year-old children from an area known to have high dental needs and to relate them to factors which affect dental attendance. METHOD: A sample of 470 pupils aged 14-15 years who attended the 4th form of second level schools in North and West Belfast was obtained and closed questionnaires were distributed 2 weeks prior to the dental examination. RESULTS: 417 pupils were included in the analysis (inclusion rate 88.7%). The mean D value was 1.52 and the D/DMFT mean was 0.31. Individual factors which had significant associations with untreated decay were social class, time since the last dental visit, dental anxiety ratings and the type of dentist attended (mean D of 2.78 for those attending community service dentists and 1.24 for those attending general dental practitioners). Stepwise multiple regression models were constructed with dependent variables of D and the D/DMFT ratio, and the above independent variables remained significantly related to the outcome variables, with the exception of the type of dentist attended. Those attending the community service had higher social needs and longer intervals since dental treatment. CONCLUSION: Factors related to dental attendance are important in relation to the level of untreated decay but exclusive analysis of the type of dental service attended can be misleading. An active approach is required in order to improve the status of pupils with the highest needs.

Adolescents' knowledge of common foods and drinks and the importance of the pattern of consumption: a study undertaken in an area of high dental needs.

OBJECTIVE: To assess the knowledge of adolescents concerning the cariogenic status of a range of foods and drinks. To determine the associations between this knowledge and their awareness of the importance of the ways sugars may be consumed in order to reduce tooth decay. DESIGN: Self-complete questionnaires assessing the above factors in a cross sectional study. PARTICIPANTS: Four hundred and fifteen 14-15-year-old young people attending second level schools. SETTING: North and West Belfast area, Northern Ireland. OUTCOME MEASURES: Students rated the dental safety of common foods and drinks, and their views on the necessity of reducing all sugars, and avoiding them between meals were recorded. RESULTS: Correct assessment of harmful items ranged from 96.9% for chocolate and 92.8% for cola to 39.0% for orange squash and 17.8% for plain biscuits. For non-harmful products there were high levels for most items and somewhat lower levels for crisps (57.6%). Significant links were established between this knowledge and children's awareness of the role of eating patterns, although the items involved varied. A majority recognised the importance of eating patterns in relation to dental caries. CONCLUSION: Health educators should be aware that many adolescents have poor knowledge of the cariogenic status of some of the foods and drinks they consume and some are unsure of the importance of eating patterns.

Dental caries treatment pattern in 14-15-year-old school pupils attending high caries schools in north & west Belfast and their ability to recognise untreated disease.

The study examined the dental caries treatment profile of 186 14-15-year-old children in schools known previously to have a high overall caries experience, the schools being located in a high caries area of Northern Ireland. The children had a high mean number of decayed and untreated teeth. The majority of children who had untreated decay were unaware of this status and had a mean D value of 3.85. There was a significantly higher number of untreated carious teeth for children who had not attended a dentist within the past year when compared with those who had attended (mean values 4.08 and 2.54 respectively). While there were high levels of unmet needs overall it is concluded that children who had not attended the dentist for the past year had very high levels of untreated decay.

Dental caries experience of children in remission from acute lymphoblastic leukaemia in relation to the duration of treatment and the period of time in remission.

The dental condition of 54 children aged 3-19 years who were in remission from acute lymphoblastic leukaemia was examined in relation to the duration of their chemotherapy and their period of time in remission. There were no significant differences in the number of early ('white spot') lesions or in the total dental caries experience in relation to the duration of chemotherapy. Children who were longest in remission had significantly more white spot lesions in permanent teeth but not in primary teeth, and there was no significant difference in dental caries experience. Children who had received nystatin treatment for more than a year had significantly more white spot lesions in permanent teeth than those who had received nystatin for shorter periods.

Dental caries and dental registration status in nursery school children in Newry, Northern Ireland.

294 children aged 2-4 yr attending nursery schools in Northern Ireland were examined for dental caries and dental registration status under the capitation system in general dental practice. Their mean age was 3 yr 10 months. Sixty eight per cent were caries free, mean dmft was 1.10 and dt, mt and ft scores were 0.74, 0.28 and 0.09, respectively. With increasing age the prevalence of caries increased, though the very low care index (d/dmft) did improve in the older children. Seventy per cent reported being registered for dental care and their levels of dental caries were significantly higher than those who were not yet enrolled (P < 0.001). For those not enrolled for dental care the main perceived barriers to seeking care related to lack of symptoms (33.6%) and apathy (31.6%) while few reported fear as a barrier (4.5%).