Oral Health in the State of Kuwait: An Appraisal.

BACKGROUND: Oral health issues have received significant attention from most global health agencies, which have integrated these issues into their noncommunicable disease, sustainable development, and universal health coverage objectives. METHODS: This paper provides an update on the progress made in the last 2 decades and aims to highlight some of the challenges faced by the oral health care system in Kuwait. RESULTS: Despite the nation's rising expenditure on oral health care, the prevalence of oral diseases remains high in Kuwait. The lack of reliable data on periodontitis and edentulism limits the ability of researchers to comment on the trends of these conditions. This emphasises the critical need for a nationwide household-level oral health survey in both pediatric and adult populations that would provide valuable information on the oral health status of these populations. CONCLUSION: In the future, Kuwait must invest more in oral disease prevention programs, especially among children and the high-risk communities of the population.

The salivary microbiome is altered in the presence of a high salivary glucose concentration.

BACKGROUND: Type II diabetes (T2D) has been associated with changes in oral bacterial diversity and frequency. It is not known whether these changes are part of the etiology of T2D, or one of its effects. METHODS: We measured the glucose concentration, bacterial counts, and relative frequencies of 42 bacterial species in whole saliva samples from 8,173 Kuwaiti adolescents (mean age 10.00 ± 0.67 years) using DNA probe analysis. In addition, clinical data related to obesity, dental caries, and gingivitis were collected. Data were compared between adolescents with high salivary glucose (HSG; glucose concentration ≥ 1.0 mg/d, n = 175) and those with low salivary glucose (LSG, glucose concentration < 0.1 mg/dL n = 2,537). RESULTS: HSG was associated with dental caries and gingivitis in the study population. The overall salivary bacterial load in saliva decreased with increasing salivary glucose concentration. Under HSG conditions, the bacterial count for 35 (83%) of 42 species was significantly reduced, and relative bacterial frequencies in 27 species (64%) were altered, as compared with LSG conditions. These alterations were stronger predictors of high salivary glucose than measures of oral disease, obesity, sleep or fitness. CONCLUSIONS: HSG was associated with a reduction in overall bacterial load and alterations to many relative bacterial frequencies in saliva when compared with LSG in samples from adolescents. We propose that hyperglycemia due to obesity and/or T2D results in HSG and subsequent acidification of the oral environment, leading to a generalized perturbation in the oral microbiome. This suggests a basis for the observation that hyperglycemia is associated with an increased risk of dental erosion, dental caries, and gingivitis. We conclude that HSG in adolescents may be predicted from salivary microbial diversity or frequency, and that the changes in the oral microbial composition seen in adolescents with developing metabolic disease may the consequence of hyperglycemia.

Relationship Between Oral Health Knowledge, Attitude and Practices of Primary School Teachers and Their Oral Health-related Quality of Life: A Cross-sectional Study.

PURPOSE: To measure oral health (OH) knowledge, attitude and practices (KAP) of primary school teachers and to evaluate the relationship between these measures and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: A total of 1013 school teachers from all regions of Kuwait were randomly selected in this cross-sectional study. A questionnaire on demographics, knowledge, attitude, practices and OHRQoL was used. Frequencies and means (SD) were used for data description. Correlations between KAP and OHRQoL were evaluated using Pearson's correlation coefficient. Associations between practice-specific knowledge and its corresponding practice as well as knowledge and practices and OHRQoL were determined using the chi-squared test. RESULTS: About 71% of the participants were females, 57% were 30-50 years old, and 75% had a college education. The mean (95%CI) knowledge score was 60.2% (57.2-62.0), ranging from 15.4% to 93%. The well-known OH facts were the importance of brushing twice a day with fluoridated toothpaste, the cariogenic effect of sticky, sugary foods and snacks, as well as the damage that soft drinks can cause to teeth. The least known facts were replacement frequency of toothbrush, parent's supervision of children's brushing and the benefit of regular flossing. Weak but significant correlations were found between KAP components and OHRQoL (p < 0.05). All practice-specific OH knowledge was significantly associated with its practice, except brushing and flossing (p > 0.05). Self-esteem was the mostly frequently affected OHRQoL construct by improper OH practices. CONCLUSION: Oral health knowledge by itself is not enough to change improper OH practices. Developing behaviourchanging interventions based on OHRQoL outcomes may be beneficial.

Unhealthy Phenotype as Indicated by Salivary Biomarkers: Glucose, Insulin, VEGF-A, and IL-12p70 in Obese Kuwaiti Adolescents.

OBJECTIVE: Here, we investigated the relationships between obesity and the salivary concentrations of insulin, glucose, and 20 metabolic biomarkers in Kuwaiti adolescents. Previously, we have shown that certain salivary metabolic markers can act as surrogates for blood concentrations. METHODS: Salivary samples of whole saliva were collected from 8,317 adolescents. Salivary glucose concentration was measured by a high-sensitivity glucose oxidase method implemented on a robotic chemical analyzer. The concentration of salivary insulin and 20 other metabolic biomarkers was assayed in 744 randomly selected saliva samples by multiplexed bead-based immunoassay. RESULTS: Obesity was seen in 26.5% of the adolescents. Salivary insulin predicting hyperinsulinemia occurred in 4.3% of normal-weight adolescents, 8.3% of overweight adolescents, and 25.7% of obese adolescents (p < 0.0001). Salivary glucose predicting hyperglycemia was found in only 3% of obese children and was not predictive (p = 0.89). Elevated salivary glucose and insulin occurring together was associated with elevated vascular endothelial growth factor and reduced salivary interleukin-12. CONCLUSION: Considering the surrogate nature of salivary insulin and glucose, this study suggests that elevated insulin may be a dominant sign of metabolic disease in adolescent populations. It also appears that a proangiogenic environment may accompany elevated glucose in obese adolescents.

Salivary Biomarkers in Pediatric Metabolic Disease Research.

The increasing prevalence of childhood obesity and obesity-related metabolic disorders is now considered a global pandemic. The main goal of the pediatric obesity research community is to identify children who are at risk of becoming obese before their body mass index rises above age norms. To do so, we must identify biomarkers of metabolic health and immunometabolism that can be used for large-scale screening and diagnosis initiatives among at-risk children. Because blood sampling is often unacceptable to both parents and children when there is no direct benefit to the child, as in a community-based research study, there is a clear need for a low-risk, non-invasive sampling strategy. Salivary analysis is now well recognized as a likely candidate for this purpose. In this review, we discuss the physiologic role of saliva and its strengths and limitations as a fluid for biomarker discovery, obesity screening, metabolic disease diagnosis, and response monitoring after interventions. We also describe the current state of the salivary biomarker field as it pertains to metabolic research, with a special emphasis on studies conducted in children and adolescents. Finally, we look forward to technological developments, such as salivary "omics" and point of service diagnostic devices, which have the potential to accelerate the pace of research and discovery in this vitally important field.

Five-year Sealant Retention and Efficacy in a Multi-operated School-based Oral Health Programme in Kuwait.

PURPOSE: To evaluate sealant retention in a multi-operator school-based oral health programme and sealant efficacy in preventing caries in a high caries-risk population. MATERIALS AND METHODS: Sealant retention and caries status in previously placed sealants on permanent first molars were evaluated in 503 children ages 6 to 8 years at 20 primary schools. A total of 2538 sealants were applied on 876 first permanent molars and evaluated for retention and efficacy in preventing caries from 2002 to 2007. These sealants were placed on occlusal and buccal or palatal surfaces using a standard protocol after isolation with rubber-dam or cotton roll. Caries was scored in teeth in which the sealants were partially or completely lost. RESULT: 1752 sealants (69%) were examined at the end of the fifth year, with 58.3% of the sealants completely retained, 7.4% partially lost, 19% completely lost, 6.2% resealed and 9.1% restored. Only 3.1% of the previously sealed teeth were carious and 87.8% of previously sealed teeth were caries free. In multivariate analysis, occlusal surfaces were 2.0 times more likely to retain a sealant than were the buccal and palatal pits (p < 0.0001). No differences in sealant retention vs caries by arch, or teeth isolated using rubber-dam vs cotton roll were seen. CONCLUSION: The present study shows the effectiveness of sealants in caries prevention in a multi-operator school sealant programme, and provides evidence supporting their use in such programmes for high-caries populations.

Continuous Metabolic Syndrome Scores for Children Using Salivary Biomarkers.

BACKGROUND: Binary definitions of the metabolic syndrome based on the presence of a particular number of individual risk factors are limited, particularly in the pediatric population. To address this limitation, we aimed at constructing composite and continuous metabolic syndrome scores (cmetS) to represent an overall measure of metabolic syndrome (MetS) in a large cohort of metabolically at-risk children, focusing on the use of the usual clinical parameters (waist circumference (WC) and systolic blood pressure (SBP), supplemented with two salivary surrogate variables (glucose and high density lipoprotein cholesterol (HDLC). Two different approaches used to create the scores were evaluated in comparison. METHODS: Data from 8,112 Kuwaiti children (10.00 ± 0.67 years) were used to construct two cmetS for each subject. The first cmetS (cmetS-Z) was created by summing standardized residuals of each variable regressed on age and gender; and the second cmetS (cmetS-PCA) was defined as the first principal component from gender-specific principal component analysis based on the four variables. RESULTS: There was a graded relationship between both scores and the number of adverse risk factors. The areas under the curve using cmetS-Z and cmetS-PCA as predictors for severe metabolic syndrome (defined as the presence of ≥3 metabolic risk factors) were 0.935 and 0.912, respectively. cmetS-Z was positively associated with WC, SBP, and glucose, but inversely associated with HDLC. Except for the lack of association with glucose, cmetS-PCA was similar to cmetS-Z in boys, but had minimum loading on HDLC in girls. Analysis using quantile regression showed an inverse association of fitness level with cmetS-PCA (p = 0.001 for boys; p = 0.002 for girls), and comparison of cmetS-Z and cmetS-PCA suggested that WC and SBP were main contributory components. Significant alterations in the relationship between cmetS and salivary adipocytokines were demonstrated in overweight and obese children as compared to underweight and normal-weight children. CONCLUSION: We have derived continuous summary scores for MetS from a large-scale pediatric study using two different approaches, incorporating salivary measures as surrogate for plasma measures. The derived scores were viable expressions of metabolic risk, and can be utilized to study the relationships of MetS with various aspects of the metabolic disease process.

Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up.

OBJECTIVES: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. METHODS: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. RESULTS: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. CONCLUSIONS: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

Impact of dental health on children's oral health-related quality of life: a cross-sectional study.

BACKGROUND: To assess the impact of children's dental health status (DHS) on their oral health-related quality of life (OHRQoL). METHODS: Participants were 11- and 12-year-old children attending public schools in the Kuwait Capital Region. Children's DHS was evaluated by clinical examinations and presented using decayed, missed, filled teeth/surface (DMFT/dmft, DMFS/dmfs); restorative (RI), plaque (PI); and pulp, ulcers, fistula, abscess (PUFA) indices. Children's OHRQoL was assessed using Child's Perception Questionnaire 11-14 (CPQ11-14). Means (SD) and frequencies were used for data description. Different factors were analyzed as predictors of OHRQoL by logistic regression analysis. RESULTS: A total of 440 children aged 11-12 years (50.7 % females) participated in this cross-sectional study. Mean (SD) DMFT/dmft, RI, PI, and PUFA scores were 2.91(2.75), 0.21 (0.34), 3.59 (1.63), 0.31 (0.85), respectively. The mean total CPQ11-14 was 20.72 (16.81). Mean scores of oral-symptoms, functional-limitations, emotional and social well-being were 4.26 (3.32), 5.40 (4.92), 5.48 (6.15), and 5.33 (6.05), respectively. Children with more than four fillings were 95 % less likely to have had oral symptoms than those with no fillings. Children with a DMFT/dmft of 2-3 were 2.8 times more likely to have functional limitation than those with a DMFT/dmft of 0, while children with a DMFT/dmft of more than 4 were 4.4 times more likely to experience limitations. Having two or three non-cavitated lesions reduced the odds of having functional-limitation by 58 %. Children with more than four missing teeth were 45 % more likely to experience emotional stress. Having more than four fissure sealants reduced the odds of having emotional stress by 46 %. CONCLUSIONS: The increase in the number of carious teeth was associated with a limitation in oral functions. Preventive treatment had a positive impact on children's emotional well-being and restorative treatments improved their oral function.

Children's perception of caries and gingivitis as determinants of oral health behaviours: a cross-sectional study.

AIM: To evaluate the relationship between children's perception of caries and gingivitis and their oral health behaviours. DESIGN: Participants in this cross-sectional study were children aged 11-14 years. A questionnaire for measuring children's perceptions and behaviours was developed, validated and applied. Perceptions were analysed as predictors for behaviours using multiple logistic regression analysis. RESULTS: A total of 434 children (57% males) participated in the study. Half of them perceived caries as a disease and believed in visiting the dentist regularly regardless of dental need. More than 60% were unaware that gum bleeding is a sign of disease and only 60.7% believed that it requires a management. Being aware that gum bleeding is a sign of disease and that it requires treatment increased the odds of brushing 2.83 (OR = 2.83, 95% CI:1.33-6.12) and 2.1 (OR = 2.1, 95% CI:1.05-5.55) times, respectively. Children aware of importance of dental visits even without dental decay were 2.9 times more likely to visit the dentist regularly (OR = 2.86, 95% CI:1.25-5.75) and were 77% more likely to never miss a dental appointment (OR = 1.77, 95% CI:1.03-3.37). CONCLUSION: Being aware that bleeding gum requires treatment was a determinant of toothbrushing habit. Improved perceived need for dental check-up regardless of dental problem may promote children's preventive dental attendance.

Salivary glucose concentration exhibits threshold kinetics in normal-weight, overweight, and obese children.

BACKGROUND: Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D) in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children. METHODS: Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL). Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured. RESULTS: Of the 65 children enrolled, there were two underweight children (3.1%), 30 normal-weight children (46.2%), 12 overweight children (18.4%), and 21 obese children (32.3%). The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body-weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma concentration were essentially zero. Diagnostic analysis indicated a positive predictive value of 50%, a negative predictive value of 90%, and a sensitivity and specificity both of approximately 75%. The salivary glucose concentration did not vary with saliva flow rate. CONCLUSION: Taking into account the threshold response characteristics of the salivary glucose concentration response, these results suggest that testing salivary glucose levels may be useful as a screening assay for high fasting plasma glucose levels. The low false positive value is important to assure a low fraction of missed diagnoses.

MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting.

OBJECTIVE: This prospective clinical study evaluated the success of vital pulpotomy treatment for permanent teeth with closed apices using mineral trioxide aggregates (MTA) in a dental public health setting. METHODS: Twenty-seven mature permanent first molars and 2 premolars (in 25 patients) with carious exposure were treated using MTA pulpotomy. Age of patients ranged from 10- to 15-years (mean=13.2±1.74-years). Four trained and calibrated practitioners performed the same clinical procedure for all patients. Following isolation and caries removal, the inflamed pulp tissue was completely removed from the pulp chamber. This was followed by irrigation with 2% sodium hypochlorite. Haemostasis was achieved using a cotton pellet damped in normal saline. A white MTA paste was placed against the pulp orifices. MTA was covered with a damped cotton pellet and a base of IRM. Patients were recalled after 1 day where a glass ionomer liner and a final restoration were placed. Teeth were evaluated clinically and radiographically for up to 47 months. RESULTS: Mean follow-up period for all teeth was 25±14 months. Twenty-six of the 29 teeth were clinically asymptomatic with no evidence of periradicular or root pathology during the follow-up period. The estimated success rate was 90%. Three teeth presented with clinical symptoms of pain and radiographic evidence of periradicular pathology that indicated root canal treatment (RCT) or extraction. CONCLUSION: When managing carious pulp exposures of permanent teeth with closed root apices in children, MTA pulpotomy showed a high success rate. CLINICAL SIGNIFICANCE: MTA pulpotomy for permanent molars in children is a viable alternative to RCT.

Metabolic disease risk in children by salivary biomarker analysis.

OBJECTIVE: The study of obesity-related metabolic syndrome or Type 2 diabetes (T2D) in children is particularly difficult because of fear of needles. We tested a non-invasive approach to study inflammatory parameters in an at-risk population of children to provide proof-of-principle for future investigations of vulnerable subjects. DESIGN AND METHODS: We evaluated metabolic differences in 744, 11-year old children selected from underweight, normal healthy weight, overweight and obese categories by analyzing fasting saliva samples for 20 biomarkers. Saliva supernatants were obtained following centrifugation and used for analyses. RESULTS: Salivary C-reactive protein (CRP) was 6 times higher, salivary insulin and leptin were 3 times higher, and adiponectin was 30% lower in obese children compared to healthy normal weight children (all P<0.0001). Categorical analysis suggested that there might be three types of obesity in children. Distinctly inflammatory characteristics appeared in 76% of obese children while in 13%, salivary insulin was high but not associated with inflammatory mediators. The remaining 11% of obese children had high insulin and reduced adiponectin. Forty percent of the non-obese children were found in groups which, based on biomarker characteristics, may be at risk for becoming obese. CONCLUSIONS: Significantly altered levels of salivary biomarkers in obese children from a high-risk population, suggest the potential for developing non-invasive screening procedures to identify T2D-vulnerable individuals and a means to test preventative strategies.

School Oral Health Program in Kuwait.

The School Oral Health Program (SOHP), Kuwait, is a joint venture between the Ministry of Health, Kuwait, and Forsyth Institute, Cambridge, Mass., USA. This program provides oral health education, prevention and treatment to almost 280,000 public school children in Kuwait. Services are delivered through a system of center- and school-based clinics and preventive mobile teams. One of the recent developments is the effective use of portable dental units for the delivery of preventive care to children in schools without the need for children to go to dental clinics. Preventive procedures performed under this program are the biannual application of fluoride varnish and the placement of pit and fissure sealants on newly erupted permanent molars and premolars. During recent years, the SOHP has improved its coverage of children, with prevention up to 80%. This has resulted in a considerable reduction in treatment needs, which is evident from the reduced number of composite restorations performed under this program during the last 6 years. This indicates that the disease level is on a decline, which can be confirmed from the results of the ongoing National Oral Health Survey on Kuwaiti school children.

Caries prevalence, oral hygiene, and oral health habits of Kuwaiti infants and toddlers.

OBJECTIVE: The purpose of this study was to describe the oral health, oral hygiene, and oral health habits of Kuwaiti infants and toddlers. SUBJECTS AND METHODS: This cross-sectional study of a convenience sample included 336 infants and toddlers (156 females and 180 males). The teeth of the infants and toddlers were examined using a mirror and a light source. Oral hygiene was recorded, and then all teeth were cleaned with gauze and examined for caries. Parents were interviewed regarding their children's feeding habits, brushing or tooth cleaning, and night feeding. The evaluation criteria for caries were sound teeth, noncavitated lesions, cavitated lesions, filled teeth, and missing teeth. RESULTS: The mean age was 11.1 ± 2.4 months (range 2-23). Of the 336 subjects, 247 (73%) had good oral hygiene, 64 (19%) had parents who brushed or cleaned their infants' and toddlers' teeth; 288 (86%) were bottle-fed, and 290 (86%) were also night fed. The mean number of teeth upon examination was 4.6 ± 2.7 (range 2-8). Three percent of the infants and toddlers had caries. Cavitated lesions were present in 6 patients (1.8%), while 4 (1.2%) had noncavitated lesions. The mean d1d2t (caries teeth: noncavitated lesions and cavitated lesions) was 0.03 ± 0.3, and the mean d1d2s (carious surfaces) was 0.07 ± 0.5. CONCLUSION: The caries prevalence and severity was low in infants and toddlers. However, poor oral health practices and habits as well as unhealthy feeding practices that could affect the future caries prevalence were noted.

Obesity and dental decay: inference on the role of dietary sugar.

OBJECTIVE: To evaluate the relationship of children's obesity and dental decay. METHODS: We measured parameters related to obesity and dental decay in 8,275 4(th) and 5(th) grade Kuwaiti children (average age = 11.36 years) in a cross-sectional study. First to determine body weight, height, age for computation of BMI . Second, to determine numbers of teeth, numbers of fillings and numbers of untreated decayed teeth to determine extent and severity of dental disease. From these measurements, we computed measures of dental decay in children from four body weight categories; obese, overweight, normal healthy weight and underweight children. RESULTS: The percentage of children with decayed or filled teeth varied inversely with the body weight category. The percentage of decayed or filled teeth decreased from 15.61% (n=193) in underweight children, to 13.03% (n=4,094) in normal healthy weight children, to 9.73% (n=1,786) in overweight children to 7.87% (n=2,202) in obese children. Differences between all groups were statistically significant. Male children in this population had more dental decay than female children but the reduction of tooth decay as a function of BMI was greater in male children. CONCLUSIONS: The finding of an inverse obesity-dental decay relationship contradicts the obesity-sugar and the obesity-dental decay relationship hypotheses. Sugar is well recognized as necessary and sufficient for dental decay. Sugar is also hypothesized to be a leading co-factor in obesity. If the later hypothesis is true, one would expect dental decay to increase with obesity. This was not found. The reasons for this inverse relationship are not currently clear.

Oral health-related quality of life among parents and teachers of disabled schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait. SUBJECTS AND METHODS: The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study. RESULTS: The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach's alpha (0.83) indicated a high degree of internal consistency between different GOHAI items. CONCLUSION: There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.

Parental attitude toward behavioral management techniques in dental practice with schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to evaluate the parental attitude toward different management techniques used during dental treatment of schoolchildren in Kuwait. SUBJECTS AND METHODS: One hundred and eighteen parents who accompanied their children to the clinics of Hawally School Oral Health Program in Kuwait participated in this study. The parents viewed a videotape which showed scenes of different behavioral management techniques (BMTs) and then completed a questionnaire. RESULTS: Positive reinforcement, effective communication, tell-show-do, distraction, modeling and nonverbal communication were considered as the most approved techniques. Hypnosis and parental separation were moderately approved techniques. Voice control, nitrous oxide sedation, protective stabilization (physical restraint), general anesthesia, hand-over-mouth technique and conscious sedation were the least approved techniques. A majority (99%) of parents regarded the use of various BMTs as a key factor for successful dental care for their children. Acceptance of each BMT was not related to parental age, gender, nationality, educational level or occupation. CONCLUSION: Most parents preferred the nonpharmacological techniques to pharmacological techniques. Techniques employing drugs and restraint were considered as least acceptable. Further studies comparing the effectiveness of various BMTs are required.

Effect of xylitol candies on plaque and gingival indices in physically disabled school pupils.

OBJECTIVE: To evaluate the effectiveness of xylitol candies on plaque and gingival index scores on physically disabled school pupils in Kuwait. METHODOLOGY: Altogether 145 school pupils (105 in the xylitol group and 40 in the control group), with ages ranging from 10 to 27 years (mean age = 14.7 +/- 3.1 years), participated in this 18-month intervention program. The school health nurses distributed xylitol candies to the pupils three times during the school day. Plaque was scored according to the Silness and Löe Plaque Index, and gingivitis according to the Löe and Silness Gingival Index. RESULTS: The mean Plaque Index score decreased from 1.73 to 1.14 (p < 0.001), and the mean Gingival Index score from 1.74 to 1.16 (p < 0.001) in the study group. Significant differences were found between the xylitol and the control groups in the reduction of Plaque (p = 0.037) and Gingival Index scores (p = 0.008). There was high correlation between the individual Plaque and Gingival Index scores at baseline (r = 0.93) and at the final examinations (r = 0.95). CONCLUSION: Consuming xylitol candies three times during school days seemed to reduce both the Plaque and Gingival Index scores. This school-based delivery system offered a practical way to distribute and use xylitol candies among these disabled pupils. The regular use of xylitol candies may, therefore, support oral hygiene routines in disabled pupils.

Dental caries experience of Kuwaiti schoolchildren.

OBJECTIVE: This study was designed to measure the dental caries experience of Kuwaiti schoolchildren. METHODS: A national epidemiologic survey of the 5-14 year old children (n = 4,588) was conducted in the 5 governorates of Kuwait in 2001. Eight trained and calibrated dentists examined the children. Dental caries was scored using WHO criteria. RESULTS: In the primary dentition, the percentage of 5- and 6-year-old children with dft = 0 was 12.6% and 14.4% respectively. The corresponding mean dft/dfs for 5- and 6-year-olds were 4.6/9.7 and 4.6/9.9. For the permanent dentition, the percentage of 12- and 14-year-old children with DMFT = 0 was 26.4% and 21.7% respectively. The corresponding mean DMFT/DFS figures for 12- and 14-year-olds were 2.6/3.4 and 3.9/4.2. The d/D component was the major contributor to these mean scores. Poor oral hygiene (OR = 2.0; 95% CI = 1.7 - 2.4) and increasing age (OR = 1.4; 95% CI = 1.3 - 1.5) were significantly associated with caries risk in the permanent dentition. CONCLUSIONS: Caries levels are similar to those in neighbouring and other Middle East countries. There is a clear need for expanding the national school oral health programme to reach those children who are not yet receiving systematic preventive and curative services. Further studies are required to monitor the effect of the extensive caries preventive programme now in place in Kuwait.