Oral health for healthy ageing.

Over the past 70 years, the global population and age structure have been changing rapidly. Analyses from the 2017 Global Burden of Diseases, Injuries, and Risk Factors Study forecasted a continuation of global ageing throughout the remainder of the 21st century, creating major challenges for health-care systems to ensure healthy longevity for ageing societies. Oral health is an intrinsic constituent of general health and wellbeing; however, oral health is largely overlooked on the global health agenda. Oral conditions are mostly preventable or treatable, yet older people often do not receive the necessary routine care to maintain a good standard of oral health. The neglect of oral health constitutes a failure of global health policy and a failure to deliver the basic human rights of older people. The aim of this Personal View is to encourage a refreshed vision of oral health, enabling policy makers to recognise the implications of poor oral health in older adults. We call for urgent action to manage the projected challenges throughout the coming decades, to ensure that additional years of life are spent in a state of good health and to help mark global ageing, not as a burden, but as a major anthropological achievement.

Clinical effect of toothpaste and mouth rinse containing zinc lactate on oral malodor reduction.

BACKGROUND: This study aimed to investigate the effect of toothpaste and mouth rinse containing 0.14% zinc lactate on the reduction of three volatile oral malodor gases. MATERIAL AND METHODS: Ten subjects with good health were recruited to take part in a crossover design study with a 7-day washout period. They were randomly assigned to use the test (toothpaste and rinse containing 0.14% zinc lactate) or placebo (negative control) treatment regimens within the two-week period. All subjects were asked to refrain from tooth brushing and eating in the morning prior to the gas collection periods. The assessment of malodor measured the quantity of three volatile sulphur compounds (VSCs) using an OralChromaTM device. Oral gas collecting was divided into four time periods; before breakfast and the morning oral hygiene practice (baseline); after oral hygiene at 30 minutes, 1 hour and 2 hours. After the baseline assessment, each subject used the test or placebo treatment regimen for 7 days. After 7 and 14 days, subjects returned to the study site to repeat the same procedures with different products. Kruskal-Wallis was used to analyze the mean differences of malodor gases between the two test regimens. RESULTS: The baseline mean of total VSCs in test and control groups was 6.5±3.7 and 1.7±9.3 ng/10 ml, respectively. The percent reduction of H2S at 30 minutes, 1 hour and 2 hours was statistically significant (p<0.005) in both treatments. The percent reduction of (CH3)2S and total VSCs in both treatments after 1 hour was statistically significant (p<0.005). CONCLUSIONS: The test treatment regimen was more effective than the placebo treatment regimen. Key words:Zinc lactate, molodor, volatile sulphur compound, mouth rinse, toothpaste.

The Prevalence and Severity of Tooth Wear in Type 2 Diabetic Patients.

OBJECTIVE: To assess the prevalence and severity of tooth wear in type 2 diabetic patients. METHODS: Attendees at a diabetic clinic at Wiang Pa Pao Hospital in Chiang Rai province, Thailand, were invited to take part in this cross-sectional study. All participants were aged 35-74 and had type 2 diabetes. Participants were required to have been diagnosed with diabetes for at least three months. 179 subjects accepted a clinical oral examination and completed the questionnaire. Tooth wear was assessed clinically using the Smith and Knight Tooth Wear Index. RESULTS: The mean age of diabetic patients was 56.5 ± 7.8 years. The majority (44.1%) had diabetes more than 5 years. The average years of having had diabetes was 6.5 ± 6.3 years. The most prevalent type of tooth wear was attrition (99.4%). The prevalence of erosion, abrasion, and abfraction were 64.8%, 31.3%, and 7.3%, respectively. The majority of the tooth wear was moderate to high severity (62.1%). Erosion and abfraction showed significant association with age group (p < 0.05). Age group was significantly associated with the severity level (p=0.017). Mild tooth wear severity was the highest in age groups 35-44 and 45-54 (53.8% and 41.2%, respectively). Moderate tooth wear was the highest proportion in age groups 55-65 and 65-74 (52.2% and 44.0%, respectively). There were no significant differences between specific diabetic symptoms and types of tooth wear. CONCLUSION: There was a high prevalence of tooth wear among diabetic patients. The role of prevention is vital in maintaining the integrity of the teeth and to avoid treating these worn teeth in diabetic patients.

Trends over Time in Dental Caries status in Urban and Rural Thai Children.

BACKGROUND: Historically, the prevalence of dental caries was higher in urban areas than rural areas of Thailand. This study aim to examine the time trends in caries status in children in Thailand. MATERIAL AND METHODS: Linear regression was used to examine trend of dental caries prevalence and mean number of teeth with caries, filled and missing due to caries (dmft/DMFT) in urban and rural, of 3-, 5-6 and 12-year olds from seven Thailand National Oral Health Surveys conducted approximately every 5 years from 1977 to 2012. RESULTS: There were declines in the caries prevalence and mean dmft/DMFT in every age group. Significant results were observed in the mean dmft of 3 year-olds and the mean DMFT of 12 year-olds (p= 0.03 and p=0.05, respectively). A significant trend of declining prevalence of dental caries was observed in urban children ages 5-6 (p=0.002), along with urban 12 year-olds (p<0.001). A declining trend of mean dmft for 3 and 5-6 year-olds, and mean DMFT for 12 year-olds was observed in both rural and urban areas, but significant results were shown in urban 3 and 5-6 year-olds (P=0.04, and p<0.001, respectively), and urban 12 year-olds (p=0.001). For restoration outcome, both urban and rural of all age groups have an increasing trend of mean ft/FT index. CONCLUSIONS: There have been differences over time in the prevalence and quantity of dental caries between urban and rural school children. A significant reduction was observed in urban areas. More effort needs to be given to supply rural areas in order to have fair and equal access of all citizens to oral health care. Key words:Dental caries, prevalence, children, Thailand, rural, urban, time trend, national survey.

Oral healthcare systems for an ageing population: concepts and challenges.

Oral healthcare systems (OHCS) are designed to maintain the health and function through Communication (Health promotion and education), Prevention, Assessment and Diagnosis, and Treatment. The complexity of these OHCS functions for the ageing are described utilizing the spectrum of dependency of the Seattle Care Pathway framework. Barriers and disparities which challenge the development of OHCS for the ageing can be universal but often vary between developed and developing countries. Recognizing that oral diseases are largely preventable, strategies to improve OHCS must be targeted locally, nationally, and internationally at oral health policy, education, research, and clinical care.

Estimate of Impact on the Oral Health-Related Quality of Life of Older Thai People by the Provision of Dentures through the Royal Project.

Purpose. To estimate the impact of the provision of dentures to Thai older people by the Royal Project on their oral health-related quality of life. Methods. A purposive cross-sectional study of a sample of 812 subjects was conducted. The Oral Impacts on Daily Performances (OIDP) measure was used to assess the oral health-related quality of life. Results. Four groups of older people with different tooth types were studied. 216 (26.6%) had natural teeth (NT). 189 (23.3%) had natural and replaced teeth (NRT). 167 (20.6%) had below the minimum number of teeth but had no dentures (Edent) and 240 were edentate with complete dentures provided by the Royal Project (ECD) (29.6%). Overall, 36.5% had at least one oral impact. Eating was the most affected oral impact. When compared to the group with natural teeth (NT), the Edent group was significantly more likely to report having impacts on eating OR = 6.5 (3.9-10.9), speaking clearly OR = 43.7 (12.7-15.07), emotional stability OR = 16.5 (6.0-45.6), and social contacts OR = 4.6 (2.2-9.5) (p < 0.001). Conclusion. Those who are edentulous are much more likely to have an oral impact on their daily performances than those provided dentures. Provision of dentures may lead to improvement of considerable oral impacts.

Development of a community-based oral healthcare model for Thai dependent older people.

OBJECTIVE: The objective of this study was to develop a community-based oral healthcare model for Thai dependent older people in Tambon Tha Pla Duk, Amphur Mae Tha, Lamphun Province, in the north of Thailand. MATERIALS AND METHODS: Participatory action research was conducted, taking an interdisciplinary approach. Data were collected through focus group discussions with key stakeholders in health care of older people in Amphur Mae Tha. Supplementary data were also collected with the stakeholders through a triangulation of in-depth interviews, a self-administered questionnaire, participant observations with field notes and a literature review. The model was subsequently refined and checked by the stakeholders. The data from all processes were coded, grouped, interpreted and thematically analysed for emerging themes and patterns, independently by the researcher (TP). RESULTS: This model consists of two key components: (i) primary care and (ii) other related factors. Primary care: This model provides a strong linkage between home, community and healthcare services to foster strong collaborations with dependent older people. This is the central focus of the model. Other related factors consist of the following: (i) Thai social norms and culture, (ii) the need for equity, (iii) the need for effectiveness, (iv) the need for efficiency and (v) the need for quality (that is, holistic, integrated and continuous). Finally, interdisciplinary collaboration was a strategy used to achieve improved quality of oral health care. CONCLUSION: A community-based care model to enhance oral health of dependent older people was developed for potential implementation and submitted to the stakeholders at the location of the study.

Associations between social inequality and tooth loss in a household sample of elderly Thai people aged ≥60 years old.

OBJECTIVE: To assess the relationship between social inequality and the number of remaining teeth in an elderly Thai population. BACKGROUND: Having twenty or more remaining teeth is an important indicator of optimal oral health in the elderly. METHODS: The data for this study were derived from the Survey of Older Persons in Thailand, conducted by the National Statistical Office, based on face-to-face interviews with people aged ≥60. The total sample was 30 427. The oral health measure was self-reported remaining number of teeth. Income, education and possession of durable goods were utilised as measures of social inequality. RESULTS: More than half of the sample (57.0%) was women. The majority (73.2%) was in the age range 60-74 years old. Less than a fifth (15.5%) had 7 or more years of education. A third earned <20 000 Thai Baht (THB) per annum (defined as poor). More than half (52.8%) of the sample had <20 remaining teeth. There was a link between social inequalities and tooth loss. In the adjusted model, elderly people, who were older than 75, who were not under a married status, had a lower level of education, had a lower income, and who did not own luxury goods, were 2.84 (CI 95% 2.66-3.03), 1.31 (CI 95% 1.21-1.41), 1.44 (CI 95% 1.34-1.56), 1.12 (CI 95% 1.13-1.29) and 1.21 (CI 95% 1.13-1.29) times more likely to have 19 or fewer teeth remaining, respectively. CONCLUSION: Social inequality is related to the number of remaining teeth in elderly Thai people.

Oral health status of dementia patients in Chiang Mai Neurological Hospital.

OBJECTIVE: Investigate the oral health of patients with dementia and examine the association between the type and severity level of dementia on their dental caries sta tus. MATERIAL AND METHOD: Cross-sectional study conducted on outpatients referred to the memory clinic. Clinical examinations were based on WHO criteria. Socio-demographic data, functional ability, and dementia level were obtained from hospital medical records. The Thai version of the Mini Mental State Examination (MMSE-Thai 2002) was used as a cognitive testing instrument. The ability to perform oral care derived from an interview. RESULTS: Sixty-nine subjects were included in the present study. The mean age was 75.5 (+/- 7.0) years. Patients with Alzheimer's disease (AD) constituted the largest dementia group. More than half (60.9%), had dementia for less than two years and were functionally independent (66.7%). The majority (56.50%) had moderately severe dementia. More than half (52.50%) had at least 20 functional teeth. The mean number of teeth was 19.5 (+/- 8.4). Mean decayed, missing, and filled teeth (DMFT) were 14.9 (+/- 9.2). More than half (54.7%) had periodontal disease (pocket depth > or = 4 mm). Dementia severity was the only characteristic which showed a significant difference in dental caries experience (> or = 0.009). CONCLUSION: Dementia patients who attended the memory clinic had considerably better oral status compared to the national data. Dementia severity was the only characteristic that showed a significant difference in dental caries experience.

Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 2: the ability of fluorescence imaging to detect differences in fluorosis prevalence and severity for different fluoride intakes from water.

BACKGROUND: To assess the ability of fluorescence imaging to detect a dose response relationship between fluorosis severity and different levels of fluoride in water supplies compared to remote photographic scoring in selected populations participating in an observational, epidemiological survey in Chiang Mai, Thailand. METHODS: Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of cooking water samples (CWS) was assessed to create categorical intervals of water fluoride concentration. Fluorescence images were taken of the maxillary central incisors and analyzed for dental fluorosis using two different software techniques. Output metrics for the fluorescence imaging techniques were compared to TF scores from blinded photographic scores obtained from the survey. RESULTS: Data from 553 subjects were available. Both software analysis techniques demonstrated significant correlations with the photographic scores. The metrics for area effected by fluorosis and the overall fluorescence loss had the strongest association with the photographic TF score (Spearman's rho 0.664 and 0.652 respectively). Both software techniques performed well for comparison of repeat fluorescence images with ICC values of 0.95 and 0.85 respectively. CONCLUSIONS: This study supports the potential use of fluorescence imaging for the objective quantification of dental fluorosis. Fluorescence imaging was able to discriminate between populations with different fluoride exposures on a comparable level to remote photographic scoring with acceptable levels of repeatability.

Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 1: assessing fluorosis risk, predictors of fluorosis and the potential role of food preparation.

BACKGROUND: To determine the severity of dental fluorosis in selected populations in Chiang Mai, Thailand with different exposures to fluoride and to explore possible risk indicators for dental fluorosis. METHODS: Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of drinking and cooking water samples were assessed. Digital images were taken of the maxillary central incisors for later blind scoring for TF index (10% repeat scores). Interview data explored previous cooking and drinking water use, exposure to fluoride, infant feeding patterns and oral hygiene practices. RESULTS: Data from 560 subjects were available for analysis (298 M, 262 F). A weighted kappa of 0.80 was obtained for repeat photographic scores. The prevalence of fluorosis (TF 3+) for subjects consuming drinking and cooking water with a fluoride concentration of <0.9 ppm was 10.2%. For subjects consuming drinking and cooking water >0.9 ppm F the prevalence of fluorosis (TF 3+) rose to 37.3%. Drinking and cooking water at age 3, water used for infant formula and water used for preparing infant food all demonstrated an increase in fluorosis severity with increase in water fluoride level (p < 0.001). The probability estimate for the presentation of aesthetically significant fluorosis was 0.53 for exposure to high fluoride drinking (≥0.9 ppm) and cooking water (≥1.6 ppm). CONCLUSIONS: The consumption of drinking water with fluoride content >0.9 ppm and use of cooking water with fluoride content >1.6 ppm were associated with an increased risk of aesthetically significant dental fluorosis. Fluoride levels in the current drinking and cooking water sources were strongly correlated with fluorosis severity. Further work is needed to explore fluorosis risk in relation to total fluoride intake from all sources including food preparation.

Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting.

BACKGROUND: To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods. METHODS: Subjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean's and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean's and TF indices by raters and fluorescence images were automatically scored using software. RESULTS: Data from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean's and TF index. Agreement (measured by weighted Kappa's) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92. CONCLUSIONS: The study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

A qualitative study of health-related quality of life and psychosocial adjustments of Thai adolescents with repaired cleft lips and palates.

OBJECTIVE: The purposes of the present study were (1) to study the meaning of Health-Related Quality of Life (HRQoL) from the insider's perspective and (2) to explore the relevant psychosocial adjustments involved in the HRQoL of Thai 12-to-17-year-old adolescents with repaired cleft lip and cleft palate (CLP). MATERIAL AND METHOD: The study included a sample of 18 adolescents with non-syndromic repaired CLP and 6 parents of these adolescents. The participants were recruited from an orthodontic clinic in the Faculty of Dentistry, Mahidol University, and all were in-depth interviewed. RESULTS: HRQoL can be categorized into four domains: physical symptoms,functional limitations, emotional well-being and social well-being. In the affected group they were striking differences in psychological assets, psychosocial resources and socioeconomic disparities. The majority of these participants were well-adjusted and able to cope with the adversities they experienced as a result of their conditions; hence it was noted that, participants with consistent support from parents,friends and professionals were likely to have a positive health status and satisfaction with treatment. CONCLUSION: These findings have important implications in measuring a multidimensional HRQoL construct, and will enhance issues regarding adaptation strategies which have an impact on HRQoL of adolescents with CLP.

Education of dentists in Thailand.

Thailand is geographically located in southeast Asia and its population is 63 million. Little has been published on dental education in Thailand. This paper provides information about Thailand regarding its dental history, dental school system including curriculum and dental licensure. There are eight public and one private dental school in Thailand. A six-year dental education leads to the DDS degree. On graduation from the public dental schools, dentists are required to work in the public system for three years. Currently, there are approximately 8000 active dentists, with a dentist: population ratio of approximately 1:7000.

Opinions of parents, teachers and school board members regarding healthy eating: a qualitative investigation of lay Thai people's perspectives.

BACKGROUND: The prevalence of overweight, obesity, and dental caries is increasing in Thai preschool children. Parents and teachers influence the diet of young children. OBJECTIVE: To inform on, and be aware of what foods and drinks the children have consumed MATERIAL AND METHOD: The present qualitative study investigated attitudes and practices among parents, school board members and teachers regarding preschool children's eating behaviors and regarding factors influencing children to purchase snacks and beverages. One hundred and fifty five persons took part in 14 focus group discussions. RESULTS: Regarding healthy eating in school, the participants were concerned only with the nutritional aspects of healthy eating and the specific foods eaten by the children. Factors influencing children 's food choices included children 's classmates, social factors, socioeconomic status, advertising, packaging, and marketing techniques. CONCLUSION: These results made parents, teachers, and school board members realize that their children faced problems regarding their diet and health, and need to seek out their own strategies about how to promote healthy eating among preschool children.

The hierarchical cluster analysis of oral health attitudes and behaviour using the Hiroshima University--Dental Behavioural Inventory (HU-DBI) among final year dental students in 17 countries.

OBJECTIVE: To explore and describe international oral health attitudes/ behaviours among final year dental students. METHODS: Validated translated versions of the Hiroshima University-Dental Behavioural Inventory (HU-DBI) questionnaire were administered to 1,096 final-year dental students in 17 countries. Hierarchical cluster analysis was conducted within the data to detect patterns and groupings. RESULTS: The overall response rate was 72%. The cluster analysis identified two main groups among the countries. Group 1 consisted of twelve countries: one Oceanic (Australia), one Middle-Eastern (Israel), seven European (Northern Ireland, England, Finland, Greece, Germany, Italy, and France) and three Asian (Korea, Thailand and Malaysia) countries. Group 2 consisted of five countries: one South American (Brazil), one European (Belgium) and three Asian (China, Indonesia and Japan) countries. The percentages of 'agree' responses in three HU-DBI questionnaire items were significantly higher in Group 2 than in Group 1. They include: "I worry about the colour of my teeth."; "I have noticed some white sticky deposits on my teeth."; and "I am bothered by the colour of my gums." CONCLUSION: Grouping the countries into international clusters yielded useful information for dentistry and dental education.

Assessing prosthodontic dental treatment needs in older adults in Thailand: normative vs. sociodental approaches.

The authors compared the estimated prosthodontic treatment needs of edentulous older adults when using normative and sociodental approaches. This cross-sectional study involved a non-random sample of 158 edentulous adults, aged 60 to 74 years, who were living independently in metropolitan Chiang Mai, Thailand. Each subject was given an oral examination and was interviewed. The dental questionnaire and the clinical criteria were adapted from the National Diet and Nutritional Survey for People Aged 65 and Older and included the Oral Impacts on Daily Performances sociodental indicator. Of the 158 subjects, we found using a normative assessment that 79.7% had a treatment need for complete dentures; 60.5% of those adults had impact-related treatment needs. Estimated treatment need dropped by about 40% when subjects were assessed using the sociodental approach. We concluded that large reductions in normative need estimates for complete dentures were apparent using a sociodental approach to assess prosthodontic dental treatment needs of older people.