Assessment of oral hygiene trends among dental patients in relation to chronic medical conditions by dental students. A cross-sectional study.

INTRODUCTION: There is a lack of information about knowledge, attitude and behavior regarding oral hygiene and dietary habits of adult patients attending dental clinical settings. Hypertension, diabetes, obesity and caries are increasing among different populations, resulting in the deterioration of the quality of life related to oral and general health. OBJECTIVES: To involve second year dental students in assessing oral health knowledge, attitude, behavior, dietary habits and general health of dental patients, and screening for blood pressure, blood glucose level and obesity. PARTICIPANTS AND METHODS: A convenient sample of 652 adult subjects participated in the study. They were screened, and involved in an interviewer - led questionnaire, led by the students over the period of two successive academic years (2013-2014 and 2014-2015). RESULTS: Subjects with high blood pressure and /or blood glucose levels were more likely to disagree regarding the presence of a relation between general health and dental health [(correlation coefficient (r) = - 0.159, probability value P < 0.001) (correlation coefficient (r) = - 0.257, probability value P < 0.001) respectively]. Subjects with high BMI were less aware of the importance of using the tooth brush in prevention of gingival inflammation. The overall students' satisfaction score was 71.5%. The practical part of the research had the highest satisfaction score (83.7%). CONCLUSIONS: There is scarcity of data regarding dental healthcare knowledge and attitudes in dental clinical settings. Additional clinical training for dental students would increase their willingness to play a preventive and educational role in the oral care of patients.

Effect of feeding Acacia nilotica pods to sheep on nutrient digestibility, nitrogen balance, ruminal protozoa and rumen enzymes activity.

This study was conducted to evaluate the effect of supplying two levels of Acacia nilotica (A. nilotica) pods to rations of sheep on nutrient digestibility, nitrogen balance and rumen liquor parameters (pH, total protozoa count, protein concentration and enzymes activity). Twelve mature rams (50 ± 1.25 kg B.W.) were distributed into three groups, each with four rams. Animals in group one were considered as a control which fed a basal diet, consisting of concentrate mixture and Egyptian clover. The second group and the third one received the same basal diet with supplying the concentrate mixture by 1.5% and 3.0% of A. nilotica pods meal respectively. The experiment lasted for 3 weeks. It was found that supplementation of A. nilotica pods to the concentrate mixture at a rate of 1.5% and 3.0% significantly improved the total feed intake compared to the control. The digestibility of dry matter and crude fibre was significantly reduced with A. nilotica supplements, whereas the digestibility of crude protein was significantly improved. All of nitrogen intake and N-retained were significantly increased in rams fed on concentrates with 1.5% and 3.0% A.  nilotica pods when compared to the control. The pH of ruminal fluid was not affected by the dietary treatments. Nevertheless, the total rumen protozoa count was significantly decreased in A. nilotica pods supplemented groups. Also, the rumen protein concentration and the ruminal enzymes activity, especially α-amylase, cellulase and protease, were lower in A. nilotica pods supplemented treatments. In conclusions, inclusion of low levels of A. nilotica pods (1.5% and 3.0%) in the concentrates can be used as a natural protein protectant in ruminants by forming tannin protein complexes in the rumen to maximize the amino acids available in the lower digestive tract. Also, these levels can increase the protein digestibility as well as the N-retained in the body .

Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city.

OBJECTIVES: To assess the knowledge, attitude and behaviour in relation to periodontal health status among Saudi intermediate and high school students living in Jeddah, Kingdom of Saudi Arabia. METHODS: A dental health questionnaire was distributed to a random sample of a total of 2586 Saudi students from intermediate and high school, aged 12-18 years residing in Jeddah. RESULTS: While about 87.1% knew that tooth brush helps prevent periodontal disease, only 33.1% knew that using dental floss helps in preventing periodontal disease. Females used brushing and flossing more than males, while males used miswak more than females. Tooth brushing (P<0.001) and dental floss (P<0.015) were used more frequently among private subjects, while miswak was utilized more frequently among governmental school students (P<0.005). Dental pain was found to be the main reason for visiting the dentist among the target group. CONCLUSIONS: It appears that knowledge, attitude, and behaviour concerning periodontal health among young Saudi school students living in Jeddah city are in need of improvement.

Infection after laparoscopic cholecystectomy: effect of infected bile and infected gallbladder wall.

OBJECTIVE: To assess the incidence of infected bile and gallbladder wall infection at the time of laparoscopic cholecystectomy, and find out if they influenced the rate of postoperative infective complications. DESIGN: Prospective study. SETTING: District hospital, Kuwait. SUBJECTS: All 279 patients who had their gallbladders removed laparoscopically for gallbladder disease between September 1995 and August 1998. INTERVENTIONS: Samples of bile and gallbladder wall were taken from all patients and cultured separately for aerobic and anaerobic bacteria. Patients with complicated gallbladder disease (n = 80) were given preoperative therapeutic antibiotics for five days (cephalosporin plus metronidazole), and other high-risk patients (n = 138) were given prophylactic ceftriaxone either 1 g x 3 starting at induction of anaesthesia (n = 42), or a single dose at induction (n = 96). MAIN OUTCOME MEASURES: Incidence of infected cultures, and infective morbidity. RESULTS: 26 specimens of bile (9%) and 56 specimens of gallbladder wall (20%) were infected. Two patients in whom neither specimen had shown any growth developed minor infections at the umbilical port. No patient in whom either specimen was infected developed an infective complication. CONCLUSIONS: The overall rate of infective complications was negligible, and did not correlate with the presence of bacteria in the bile or gallbladder wall. This is probably a reflection of our aggressive antibiotic regimen in the management of high-risk patients.

Acute renal failure, compartment syndrome, and systemic capillary leak syndrome complicating carbon monoxide poisoning.

CASE REPORT: Five Indian labourers sharing one room were found lying on the floor unconscious. A coal fire had been lit to provide heat during the cold night and was still burning inside the room. Two of the men were pronounced dead at the scene. The other three were transferred to the hospital in critical condition. This paper contains the case reports of the three patients who were transferred to the hospital. One of the patients died 60 h after admission. The other two patients were successfully treated and released. The three patients developed severe rhabdomyolysis complicated by compartment syndrome. The patient who died developed compartment syndrome in three extremities. Two patients required blood transfusion due to very severe hemolysis. The hemolysis in the third patient was less severe and did not require blood transfusion. Two patients developed anuric acute renal failure due to acute tubular necrosis as shown by renal biopsy. Two patients developed the full blown picture of systemic capillary leak syndrome. Gross and microscopic examination of specimens taken at autopsy showed extensive necrosis of all skeletal muscles, myocardial necrosis and acute tubular necrosis affecting both kidneys.

Preventive behaviors as correlates of periodontal health status.

OBJECTIVES: This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status. METHODS: Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals. RESULTS: On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss. CONCLUSIONS: Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

A comparison of periodontal disease among rural Amish and non-Amish adults.

Periodontal disease can be more efficiently studied within a homogeneous population where genetic influences and lifestyles are similar enough to negative their effect on the disease process. This study focuses on an Amish population in southern Michigan who isolate themselves from outside influences and their non-Amish neighbors. A total of 425 Amish and 290 non-Amish were contacted resulting in 330 Amish and 215 non-Amish who were examined in their homes giving a participation rate of 76.2%. Ages ranged from 18 to 82 years. Prevalence of periodontal disease tended to be higher among males and increased with age. There were slightly more Amish females (52%) than non-Amish (49%). Means of periodontal conditions for Amish were 1.35 mm for attachment loss, 2.59 mm for pocket depth, 0.24 for calculus, 0.77 for plaque and 0.74 for gingivitis. For non-Amish, the means were 1.03 mm for attachment loss, 2.38 mm for pocket depth, 0.40 for calculus, 0.95 for plaque and 0.87 for gingivitis. It is of interest that the Amish do not practice routine oral hygiene. Only 36.8% of Amish reported brushing at least 1 x a day compared to 84.6% of non-Amish. Similarly, only 8.2% of Amish reported flossing at least 1 x a week compared to 40.8% of non-Amish.

Preventive oral health behaviors among Detroit-area residents.

PURPOSE: It has been recommended that adults brush and floss their teeth daily and have periodic oral health checkups. A study was conducted to determine if those recommendations are followed. METHODS: Data were collected during face-to-face interviews with a probability sample of 662 dentate adults residing in the Detroit metropolitan area from August to November 1989. Participants were asked how frequently they brushed, flossed, and had checkups. They were also asked about the thoroughness with which they brushed and flossed, and about the advantages and disadvantages of all three behaviors. Descriptive statistics were calculated. RESULTS: The response rate was 72%. While 97% of subjects reported brushing at least once a day and 32% reported flossing at least once a day, 13% indicated they did not brush all teeth or all parts of teeth, and one-third of those who said they flossed daily did not floss all teeth. Seventy-three percent of respondents reported getting dental checkups at least once a year. For brushing, insufficient thoroughness was more commonly a problem than insufficient frequency. CONCLUSIONS: Patient education efforts related to brushing will probably be more effective if they focus on thoroughness rather than frequency. Interventions to increase flossing should probably focus on overcoming skill deficits.

The relation of preventive dental behaviors to periodontal health status.

Current recommendations for periodontal health maintenance emphasize toothbrushing, flossing and periodic dental checkups. The purposes of this study were to examine (1) the effects of these practices on periodontal health and (2) the relationships of demographic and socioeconomic variables with these behaviors and with periodontal health. Adults (n = 319) in the Detroit, Michigan tri-county area were asked how frequently they performed the 3 preventive behaviors. Levels of plaque, gingivitis, calculus, and periodontal attachment were then assessed during in-home dental examinations. There were no statistically significant differences in these health measures between those with acceptable and unacceptable brushing behavior. About 20% of the subjects reported acceptable flossing behavior, and these individuals had significantly less plaque and calculus than other participants. Over 3/4 of subjects reported having a dental checkup at least 1 x a year, and these persons were found to have significantly less plaque, gingivitis, and calculus compared to less frequent attenders. Acceptable brushing behavior was not associated with any particular demographic or socio-economic characteristic, while differences in acceptable flossing behavior were found among age groups. Frequencies of yearly dental checkups varied significantly within every demographic and socioeconomic characteristic.

Periodontal disease in an Amish population.

Epidemiological studies of periodontal disease have attempted to focus on defined groups in which the variables thought to be responsible for disease could be controlled or more easily identified. This study documents periodontal disease parameters in a unique population of Amish farmers. A total of 371 Amish were contacted and 282 were examined in their homes giving a participation rate of 76%. Ages ranged from 18 to 79 years. Overall means for periodontal conditions were 1.54 mm for attachment loss, 2.63 mm for pocket depth, 0.17 for calculus, 0.63 for plaque and 0.61 for gingivitis. One dental examiner conducted all examinations. Prevalence of periodontal disease tended to be higher among males and increased with age. The majority of Amish examined had little evidence of destructive periodontal disease; about 3.4% of teeth examined had attachment loss of 6 mm or more. These findings indicate a modest level of periodontal disease among the Amish. It is of interest that this population does not generally seek routine dental care. Preliminary analyses of health behavior data collected indicate a lack of regular oral hygiene practices. It appears that the Amish may have protective factors which affect their level of disease.

Tooth brushing, flossing, and preventive dental visits by Detroit-area residents in relation to demographic and socioeconomic factors.

A survey was conducted to identify (a) factors that influence preventive dental behaviors and (b) target groups for interventions. Data were collected in face-to-face interviews with a probability sample of 662 dentate adults living in the Detroit tricounty area. The interviews included questions about demographic and socioeconomic variables and about three preventive behaviors: brushing, flossing, and preventive dental visits. All behaviors were positively associated with socioeconomic status. Females were more likely than males to perform each of the behaviors at the recommended frequency. The behaviors were only weakly associated with age. Whites were more likely than nonwhites to make regular dental visits, but frequency of brushing and flossing did not vary substantially across racial groups. The impact of race on frequency of dental visits was reduced when socioeconomic status was statistically controlled. Findings suggest that socioeconomic status, race, and sex remain important considerations when planning dental health education or other interventions.

Factors associated with fissure sealant delegation: dentist characteristics and office staffing patterns.

The purpose of this research was to identify dentist characteristics and dental office staffing patterns related to delegation of sealant applications. Results from a 1989 mailed survey were used to characterize Michigan general dentists (N = 300) who did or did not delegate sealant applications to auxiliaries and to identify factors associated with delegation. Nearly 50 percent of respondents were applying all sealants themselves. In offices that delegated the procedure, the mean proportion of sealants being applied by dentists was 39.9 percent. Registered dental hygienists were applying 51 percent, while registered dental assistants were applying 6.5 percent. Delegating dentists were more knowledgeable about sealant procedures, held more favorable attitudes, treated more young patients, placed more sealants, and were better informed about the legality of delegation according to the state practice act. Logistic regression analysis found that employing a registered dental hygienist was the most significant factor associated with sealant delegation, followed by employing a registered dental assistant. Findings suggest that dental auxiliaries, and particularly registered dental assistants, are underutilized for applying sealants. Approaches to increasing delegation of sealants may include changing dentists' traditional hiring patterns, highlighting the skills of auxiliaries such as the registered dental hygienist (RDH) and the registered dental assistant (RDA), and increasing awareness of legally allowable procedures that RDHs and RDAs can perform.

Educating dentists about fissure sealants: effects on knowledge, attitudes, and use.

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

Streptococcus mutans levels and biotypes in Egyptian and Saudi Arabian students during the first months of residency in the United States.

Several studies indicated that serotype/biotype c strains are the most common on a global basis, but that regional differences may occur relative to other serotype/biotypes. Of particular interest is the observation that individuals residing in the Middle East have higher incidences of serotype e and d strains relative to their levels in American citizens. This could reflect exposure to different Streptococcus mutans serotypes during the period in which the teeth are colonized, or might reflect other factors local to the region, such as diet. The purpose of the present study was to observe Egyptian and Saudi Arabian students during the first four months after their arrival in the United States, in order to determine whether this change in habitat affected the levels and biotypes of S. mutans. The results of this study showed that biotype c strains were the most prevalent in saliva and plaque of these Egyptians and Saudi Arabian students, followed by biotype e and biotype d. There was a drop in the number of S. mutans in the saliva and the proportions of S. mutans in the plaque after two months of residence in the United States, followed by a significant increase after four months of residence. This increase was most noticeable in subjects who had a higher number of decayed surfaces. In these subjects, the percentage of S. mutans in pooled occlusal plaque increased significantly, from 6.1 to 13.2%.

Microbial degradation of trifluralin by Aspergillus carneus, Fusarium oxysporum and Trichoderma viride.

3H-Trifluralin was synthesized by condensation of 3H-4-chloro-3,5-dinitro-alpha, alpha, alpha-trifluorotoluene with di-n-propylamine. After incubation of trifluralin with Aspergillus carneus, Fusarium oxysporum and Trichoderma viride for 10 days, a small percentage (less than 10%) of unchanged herbicide was recovered in the extractable fraction. This indicates a fairly rapid degradation of the herbicide by the fungal species. Other than trifluralin, the culture medium contained at least five labelled products: 2,6-dinitro-N-n-propyl-alpha, alpha, alpha-trifluoro-p-toluidine; 2,6-dinitro-alpha, alpha, alpha-trifluoro-p-toluidine; 2-amino-6-nitro-alpha, alpha, alpha-trifluoro-p-toluidine, 2,6-dinitro-4-trifluoromethyl phenol and a major polar product which constituted more than 50% of the total extractable transformation products. A pathway, which simulates that of aerobic degradation of the herbicide in soil, is suggested for the microbiological degradation of trifluralin.