Biomedical subjects

A Sheiham

Publications and source records attributed to A Sheiham.

At least 73 records · Page 4Linked to original sources

PubMed1998

Gingival ulceration in HIV infection. A case series and case control study.

All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-year period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.

Adult↗

PubMed1998

Can questionnaires replace clinical surveys to assess dental treatment needs of adults?

OBJECTIVE: The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK. METHODS: A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard. RESULTS: Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need. CONCLUSIONS: Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities.

Adult↗

PubMed1998

Oral examination: a screening tool for HIV infection?

OBJECTIVE: To estimate the predictive values for HIV infection of diagnosis of oral manifestations of the infection. METHOD: Prevalence of oral manifestations was compared in cross sectional blinded clinical examinations of homosexual men attending a genitourinary medicine clinic. Data were extrapolated to populations in England and Wales based on estimates of the prevalence of HIV infection. RESULTS: Data were analysed for 572 HIV infected and non-infected men (312 and 260 respectively). Positive predictive values for erythematous candidiasis, hairy leucoplakia and pseudomembranous candidiasis were greater than 0.96 at the genitourinary medicine clinic and are estimated to be greater than 0.72 among homosexual men in London. CONCLUSIONS: Clinical diagnoses of mucosal lesions alone are poor predictors of HIV infection but are useful when used in conjunction with a social history to establish if there are risk factors for infection.

Adolescent↗

PubMed1998

Burnout and issues of the work environment reported by general dental practitioners in the United Kingdom.

OBJECTIVE: To investigate causes of burnout among general dental practitioners. DESIGN: A cross-sectional investigation. SETTING: General dental practices in two areas of the UK and a group of continuing education sessions. SUBJECTS: 325 general dental practitioners, composed of two random samples recruited from two areas of the United Kingdom and an opportunistic sample, recruited from continuing education sessions. OUTCOME MEASURES: Levels of burnout, as measured by scores on one of the three burnout sub-scales--emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Respondents were more likely to report high levels of emotional exhaustion and low levels of personal accomplishment if they worked in practices with few other dentists. Those respondents reporting high levels of depersonalisation were more likely to provide a greater proportion of care through the National Health Service. CONCLUSIONS: Burnout in this sample of general dental practitioners was related to features of their work organisation structure rather than necessarily due to an involvement with patients or the respondents' personal characteristics. Levels of social support in the workplace, measured here by the number of dentists in a practice, appear to have a protective effect against some aspects of burnout.

Adult↗

PubMed1997

Decisions on diagnosis and management of approximal caries by final-year dental students.

OBJECTIVES: To investigate the decision-making processes for dental caries from bitewing radiographs of final-year dental students in Mexico City. METHODS: Five sets of radiographs were converted to slides and projected on a screen under standardized conditions. 143 students were asked to determine separately the presence of all proximal caries, of proximal lesions to be restored in the present course of treatment, and of unreadable surfaces due to technical deficiencies. A gold standard was obtained from two expert clinicians who examined the radiographs under similar conditions. RESULTS: Misdiagnoses were common. Overdiagnoses became evident at the treatment planning stage where many surfaces were incorrectly planned for restoration. Subjective appraisals of presence of lesions, unreadable surfaces, and surfaces planned for restoration showed substantial variation. CONCLUSIONS: Students' overall assessment of lesions detected did not differ between restored and unrestored surfaces. However, when compared with the gold standard, their decision-making was found to be better on surfaces which had not been restored previously as opposed to those already restored, both in terms of identification of lesions and in terms of treatment planned for deeper lesions.

Adult↗

PubMed1997

The relationship between life-events and periodontitis. A case-control study.

This case-control study (n = 100 dental patients, matched for age and sex) investigated the role of life-events in periodontitis. Data collected included life events, tobacco use, oral health behaviours and socio-demographics. The results of conditional simple logistic regression analysis showed that periodontitis was associated with the negative impact of life-events (p < 0.01), the number of negative life-events (p < 0.05), high levels of dental plaque (p < 0.01), tobacco smoking (p < 0.01) and being unemployed (p < 0.05). These associations remained statistically significant after adjusting for oral health behaviour and socio-demographic variables, but not tobacco smoking (p > 0.05). Marital status became statistically significant after adjusting for the other variables (p < 0.05). A model is suggested to explain the pathways through which life events may affect periodontal health. It was concluded that psychosocial factors and oral health risk behaviours cluster together as important determinants of periodontitis.

Adolescent↗

PubMed1997

Impact of dental treatment on the incidence of dental caries in children and adults.

A review of the literature on the impact of dental care on the incidence of dental caries in children and adults suggests that the effect is small. Dental services were relatively unimportant in explaining the recent decline in caries in 5- and 12-year-olds. An important contribution of the dental services to the decline in caries was a change in the diagnostic and treatment criteria. The role of dentistry in reducing dental caries may lie mainly in the non-personal health services. Knowledge of the life history and patterns of caries attack rates within populations and individuals could be used as a benchmark against which interventions can be assessed. Different teeth and tooth sites are affected differentially at different levels of dental caries. This truism may appear obvious but it is not used to evaluate the effectiveness and quality of dental treatment. A working rule is that "As caries prevalence falls, the least susceptible sites (proximal and smooth surfaces) reduce by the greatest proportion, while the most susceptible sites (occlusal) reduce by the smallest proportion." There is a specific relationship between the mean DMFT and mean DMFS, and the percentage of caries-free subjects and the frequency distribution of subjects with different levels of caries. Further more, the best predictor of caries at older ages is DMFT at a younger age. Caries levels follow trend lines for each level of caries. As the mean DMFT declines so post-eruptive time increases for initiation of caries and the progression rates of caries through enamel decreases. This is true regardless of the presence of fluoride.

Adult↗

PubMed1997

Understanding decision-making processes for sugar consumption in adolescence.

The mechanisms by which adolescents make food choices are not clear. The interaction and combination of the many social and psychological factors must be considered when examining adolescents' decision-making processes for sound food choices. The aim of this investigation is to examine one specific food choice, namely, the use of sucrose in hot drinks. One hundred and eighty-seven adolescents in their 16th year completed a questionnaire on the consumption of sugar using the method developed by AJZEN & FISHBEIN in their 'Theory of Reasoned Action'. The group was randomly divided into two groups so that decision-making processes with respect to two behavioural intentions-adding sugar to tea and coffee and excluding it-could be examined. The findings suggest that the immediate pleasurable taste of sugar outweighed and deferred the recognition of dangers associated with its consumption. Past dental health experiences, behaviours and education together with the role of parental figures acted as important influences. An awareness of these factors should assist dental health professionals to highlight the importance of sound food choices when negotiating dental health goals with adolescents.

Adolescent↗

PubMed1997

Radiographic criteria employed to diagnose and treat approximal caries by final-year dental students in Mexico City.

A total of 407 final-year dental students in Mexico City were asked about the radiographic criteria they employed when assessing treatment needs for caries in a standardized patient case. 45.2% of participants would restore lesions confined to enamel; 60.7% believed that a lesion which had not passed the dentino-enamel junction would cavitate; and 65.4% said it would take on average 6 months or less for a lesion to progress from outer enamel to the dentino-enamel junction. Radiographic criteria appeared to reflect fears of rapid, inevitable progression of lesions. While local caries experiences had been reported to be high, there seems to be room for re-evaluating some clinical criteria employed to manage caries.

Attitude of Health Personnel↗

PubMed1997

Caries progression in 12- to 16-year-old schoolchildren in fluoridated and fluoride-deficient areas in Brazil.

UNLABELLED: Water fluoridation may reduce the rate of caries initiation, but relatively little is known of its effect on rates of caries progression through the enamel and the dentin. OBJECTIVE: This longitudinal study was designed to compare rates of caries progression in fluoridated and fluoride-deficient areas. METHODS: Approximal caries progression was evaluated on two standardized sets of bitewing radiographs taken at a 12-month interval of 290 12- to 16-year-old Brazilian schoolchildren. Pitts' scoring system was used to measure caries progression on conventional bitewing images. Caries progression data on the occlusal, free-smooth, and approximal surfaces of the anterior teeth were collected via clinical visual examinations. RESULTS: The mean rate of approximal caries progression in school-children living in fluoridated areas (0.54) was found to be 62% lower than that in children from fluoride-deficient areas (1.41). When progression rates were adjusted for the initial number of decayed surfaces per subject, differences were statistically significant for lesions located at the inner half of the enamel at baseline (11% in the fluoridated areas vs. 16.5% in the fluoride-deficient areas). Multivariate logistic regression analysis revealed that residence in a fluoride-deficient area remained a significant risk factor for caries progression after controlling for caries prevalence (D1FS), number of cavitated carious lesions, whether tooth type was molar or premolar, and toothbrushing frequency. CONCLUSIONS: These results suggest that water fluoridation reduces the rates of caries progression through the enamel and dentin, but the effect was more pronounced for lesions in the inner enamel than for those in the dentin.

Adolescent↗

PubMed1997

Digital radiographic measurement of approximal caries progression in fluoridated and non-fluoridated areas of Rio de Janeiro, Brazil.

The effect of fluoridation on approximal caries progression was investigated using serial digitized bitewing images and conventional film images of 290 12-16-year-old schoolchildren who were lifetime residents of either Rio de Janeiro (a fluoridated area) or Mangaratiba and Angra dos Reis (non-fluoridated areas) in the state of Rio de Janeiro, Brazil. One examiner scored a maximum of 28 approximal surfaces of posterior teeth per subject using both methods. The intraexaminer reliability for rating lesion depth with digital images was comparable with that of the conventional bitewing films (namely, intraclass correlation of 0.99 and weighted Kappa scores of 0.82, respectively). Approximal surface D1S was 3.17 +/- 0.25 (sx) in fluoridated areas and 6.64 +/- 0.44 in non-fluoridated areas. After 1 year, the rate of caries progression in approximal surfaces was significantly lower in the fluoridated areas (0.54 +/- 0.14) as compared with the non-fluoridated areas (1.41 +/- 0.20) using Pitts' scoring system for conventional bitewing radiographs (P < 0.001). Similarly, the digital radiographic method was able to detect subtle differences in approximal caries progression in the enamel and the dentin (overall mean: 0.34 mm/year in fluoridated areas vs 0.49 mm/year in non-fluoridated areas, P < 0.05). The two radiographic methods were strongly correlated (rs = 0.7). Assuming a constant rate over time, these results indicate that lesion progression from the outer half of the enamel into the outer half of the dentin takes approximately 3-4 years in schoolchildren from the fluoridated areas compared to 2 1/2 years in the non-fluoridated areas.

Adolescent↗

PubMed1997

Is the chemical prevention of gingivitis necessary to prevent severe periodontitis?

Gingival inflammation seldom causes discomfort, social embarrassment or loss of function. As most sites with gingival inflammation do not progress to severe periodontal disease, gingivitis should not be considered a public health problem. Periodontitis is always preceded by gingivitis. But most gingivitis remains stable for years without progressing to periodontitis. The number of gingivitis sites that do convert is small. The levels of oral cleanliness achieved by the majority of populations in industrialized countries are below the threshold for severe destructive periodontal disease of personal and public health concern. Because methods of measuring the progression of periodontal disease are unreliable, definitive answers regarding conversion of gingivitis to severe periodontitis are lacking. Gingival inflammation frequently remains contained; most gingivitis remains stable for years without progressing to periodontitis. Decreasing gingivitis does reduce shallow pocketing, but the effect on severe periodontitis is not clear. Although the underlying justification for the reduction of plaque is to reduce gingival inflammation to prevent or reduce severe periodontitis and tooth loss, the basis for the approach is equivocal. A reasonably high level of plaque appears to be compatible with acceptably low levels of periodontal disease. Reducing nonspecific plaque levels to such levels is therefore a rational goal. The conventional methods of controlling periodontal disease involve mechanical removal of plaque and calculus. A complimentary ecological approach, using chemicals, would be to alter the environment of the pocket to prevent growth of putative pathogens. Any ecological approach should be sensitive to the dangers of disrupting the natural ecology of dental plaque. Some antimicrobial and antimetabolic agents such as fluoride, chlorhexidine and triclosan and zinc citrate can selectively suppress certain organisms or inhibit bacterial proteases implicated in tissue damage. The uncertainties about factors that convert gingival inflammation into periodontitis and periodontitis into severe periodontitis coupled with insufficient data from controlled clinical trials on the effectiveness of chemical reduction of gingivitis to prevent severe periodontitis leads one to conclude that more research is required before the need for the chemical prevention of gingivitis to prevent severe periodontitis can be justified.

Dental Plaque↗

PubMed1997

Is erythematous candidiasis associated with advanced HIV disease?

OBJECTIVES: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito-urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease. SUBJECTS AND METHODS: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm-3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%. RESULTS: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use. CONCLUSIONS: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.

AIDS-Related Opportunistic Infections↗

PubMed1997

Periodontal health and HIV infection.

Despite a large amount of research of periodontal health seen in HIV infection, much remains to be learned. Very few large controlled studies of infected people at settings not self-selected for oral disease have been reported, and few have investigated the necrotising periodontal diseases described in HIV infection. In this paper we present a brief review of three approaches to identify periodontal changes associated with HIV infection and identify possible aetiological factors for them. First, we summarise the methods and findings of a controlled blinded study of the periodontal health of homosexual men attending a genito-urinary medicine clinic. Second, we precis a case-control study of gingival ulceration among patients at a dedicated dental clinic. Finally, we outline how the validity of diagnostic criteria for HIV-associated periodontal changes were tested against the data collected in the controlled study.

AIDS-Related Opportunistic Infections↗

PubMed1997

Sweet preference, consumption of sweet tea and dental caries; studies in urban and rural Iraqi populations.

The objective of the present study was to explore the association between sweet preference and the levels of dental caries in a large sample of urban and rural children and young adults in Iraq. In addition, the relationship between caries levels and sweet tea consumption was investigated. Sweet preference was assessed using a free choice method while caries was measured by the DMFT index in 4,152 males and females of differing ages living in urban and rural areas. A positive significant correlation between sweet preference and dental caries was found for both urban and rural populations. This relationship was stronger in the rural groups (r = +0.58, P < 0.001) than in the urban groups (r = +0.24, P < 0.001). The number of cups of tea consumed was positively correlated with the DMFT scores as was the number of spoonfuls of sugar taken in each cup of tea. Both these correlations were greater for the rural groups. These findings, together with those showing that sweet preference changes with exposure to sugars; the more sugars people consumed the higher their threshold for sweetness, indicates that exposure to sugar increases the intake sugar and the risk of dental caries.

Adolescent↗

PubMed1996

Oral impacts affecting daily performance in a low dental disease Thai population.

The aim of the study was to measure incidence of oral impacts on daily performances and their related features in a low dental disease population. 501 people aged 35-44 years in 16 rural villages in Ban Phang district, Khon Kaen, Thailand, were interviewed about oral impacts on nine physical, psychological and social aspects of performance during the past 6 months, and then had an oral examination. The clinical and behavioural data showed that the sample had low caries (DMFT = 2.7) and a low utilization of dental services. 73.6% of all subjects had at least one daily performance affected by an oral impact. The highest incidence of performances affected were Eating (49.7%), Emotional stability (46.5%) and Smiling (26.1%). Eating, Emotional stability and Cleaning teeth performances had a high frequency or long duration of impacts, but a low severity. The low frequency performances; Physical activities, Major role activity and Sleeping were rated as high severity. Pain and discomfort were mainly perceived as the causes of impacts (40.1%) for almost every performance except Smiling. Toothache was the major causal oral condition (32.7%) of almost all aspects of performance. It was concluded that this low caries people have as high an incidence of oral impacts as industrialized, high dental disease populations. Frequency and severity presented the paradoxical effect on different performances and should both be taken into account for overall estimation of impacts.

Activities of Daily Living↗

PubMed1996

The periodontal health of homosexual men with HIV infection: a controlled study.

OBJECTIVE: Identify types, prevalence and severity of periodontal changes associated with HIV infection. DESIGN: Cross-sectional controlled blinded study. SETTING: Open access genito-urinary medicine clinic. PARTICIPANTS: Convenience sample of 794 homosexual men aged 18-65. OUTCOME MEASURES: Prevalence, extent and severity of probing attachment loss (PAL), pocketing, gingival ulceration, gingivitis, bleeding on probing (BOP), gingival red bands and diffuse and punctate erythema of the attached gingiva (selected a priori). RESULTS: Prevalences in men with (n = 312) and without HIV (n = 260) were: PAL (> or = 1 site > or = 4mm), 59.6% and 28.5% respectively (P < 0.001, chi 2); pocketing (> or = 1 site > or = 4mm) 51.0% and 31.9% (P < 0.001); BOP, 96.5% and 92.3% (P = 0.038); gingival ulceration, 3.2% and 1.0% (P = 0.031), red banding, 12.2% and 10.0% (P = 0.410); diffuse erythema, 12.5% and 3.1% (P < 0.001) and punctate erythema, 9.6% and 1.1% (P < 0.001). Decreased CD4 lymphocyte counts predicted the presence, extent and severity of PAL (P = 0.023, 0.027 and 0.060) but not pocketing. Oral candidiasis predicted the extent and severity of gingivitis and the presence of diffuse and punctate erythema. (P = 0.037, 0.011, 0.002 and < 0.001). CONCLUSIONS: Destruction of periodontal attachment is associated with progression of HIV disease whereas pocketing is associated with HIV infection but not disease progression. Gingival ulceration is associated with HIV but gingivitis and erythema of the attached gingiva are most strongly associated with oral candidiasis. Gingival red bands were not associated with HIV infection.

Adolescent↗

PubMed1996

Taste preference for sweetness in urban and rural populations in Iraq.

The consumption of sweetened foods is influenced by a variety of biological, psychological, sociological, and environmental factors. On an individual level, taste preference for sweetness has been shown to have an influence on food consumption, although this may be affected by social and environmental factors. The aim of this study was to assess the taste preference for sweetness in urban and rural populations in Iraq. The hypothesis was that sweet preference and the consumption of sugar increase with urbanization. The sample was composed of 4152 individuals who were divided into urban and rural subgroups based on their place of residence. Sweet preference was assessed by means of a tested Sweet Preference Inventory. Results revealed statistically significant differences between urban and rural populations in preference for sweetness and in actual sugar consumption. Individuals from urban locations showed a much higher preference for sweetness than their rural counterparts and consumed more sugar. Within the urban population, those individuals who had lived in the city longer and who were from families with lower educational qualifications preferred the highest levels of sugar. The findings support the hypothesis that urbanization influences sweet preference and sugar consumption.

Adolescent↗