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PubMed2001

Dental health knowledge and attitudes of regularly attending mothers of high-risk, pre-school children.

AIM: The aims of this study were to discover the knowledge of and attitudes towards dental health of a group of regularly attending mothers of young children at high-risk of caries, and to evaluate their toothbrushing techniques. METHOD: As part of the baseline examination of a randomised controlled trial to test the influence of dental health counselling on the caries increment of at-risk pre-school children, 268 mothers of 334 children completed a questionnaire enquiring about their dental health knowledge and attitudes, and were also observed brushing their children's teeth. RESULTS: Although most mothers (71%) knew that they should brush their children's teeth twice a day using a small toothbrush (94%) only 52% knew that they should use only a small pea-sized amount of paste, and only 3% knew the recommended level of fluoride in toothpaste for these at-risk children. 40% of the children insisted on brushing their own teeth and 40% of the mothers brushed their children's teeth inadequately. Although three-quarters of the mothers knew that sugary foods and drinks should be consumed only at mealtimes, only 7% knew the four foods and drinks supplying most sugar to a child's diet. Although three-quarters of mothers thought that dental decay in milk teeth was very important, only half wanted their children's carious teeth restored. CONCLUSION: Knowledge, attitudes and behaviour about dental health among these regularly attending mothers of at-risk, pre-school children were superficial. Their attitudes to dental health of primary teeth were equivocal and their demonstrated brushing behaviour on the part of their children was inadequate.

Attitude to Health↗
PubMed2006

Sonic tooth brushing reduces gingival overgrowth in renal transplant recipients.

Cyclosporine (CSA) is a commonly used immunosuppressive medication in pediatric transplantation. Drug-induced gingival overgrowth (DIGO) is a frequent side effect associated with CSA use and can impair the patient's ability to achieve good oral hygiene. This study tested the hypothesis that sonic tooth brushing and oral hygiene instruction can reduce the occurrence or severity of DIGO in CSA-treated pediatric renal transplant recipients. Twenty-three pediatric renal transplant patients with DIGO were randomly allocated to treatment or control groups. The treatment group received oral hygiene instruction and use of a sonic toothbrush, while the control group continued their usual home care with manual brushes. Dental impressions and photographs of all subjects were taken at baseline and every 3 months for a year. The casts and photographs were evaluated by a dental panel to compare the DIGO levels from baseline until the end of the study. After 12 months the control group had significantly more severe DIGO than did the sonic tooth brushing and oral hygiene instruction group (OR=4.5, 95%CI=1.2-16.0, P=0.03). Of the risk factors considered, only male gender was significantly associated with worse outcome (OR=6.1, 95%CI=2.3-16.1, P=0.03). The use of a powered toothbrush, together with oral hygiene instruction, may be an important component of health maintenance for pediatric transplant patients on CSA.

Adolescent↗
PubMed2003

The rational use of oral care products in the elderly.

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.

Aged↗
PubMed1980

Behavior modification for orthodontic patients: an exploratory approach to patient education.

The purpose of this project was to explore the usefulness of a behavior modification approach in changing oral hygiene habits of orthodontic patients. Two orthodontists identified patients in their practice who exhibited excessive plaque formation and inflammation and referred them to a health educator/dental hygienist. The health education program was subsequently presented to fifty-three patients, 8 to 18 years of age. Three counseling sessions with parental participation were scheduled approximately 2 weeks apart. The program consisted of a model for counseling, a rising and retiring survey to identify home routines, a list of "possible reinforcers" geared toward preteen interests, a monitoring card to record toothbrushing behavior, and a contract signed by both parent and child. Behavioral change in oral hygiene habits was measured through general assessment of toothbrushing technique, plaque accumulation, and soft-tissue appearance. Change in frequency of brushing was measured by patient self-monitoring. Patient and parental comments, as well as educator reactions, were considered in the over-all evaluation of the project.

Adolescent↗
PubMed1984

Surface resistance to abrasion of preformed laminate resin veneers.

Preformed laminate resin veneers should be adapted closely to the teeth to reduce the thickness of the composite layer. Minimal voids at the composite, veneer, and tooth junctional margin will result. Composite resins are difficult to finish, but laminate veneer can be highly polished. Poorly finished veneer surfaces appear to abrade to a smoother surface with toothbrushing while poorly finished composite surfaces remain rough. To reduce material loss from abrasion, the veneer restoration should be highly polished. Polishing the veneer at the gingival margin is particularly important to gingival health. Only rough veneer surfaces will be improved by toothbrushing abrasion. Special instructions should be given to patients with laminated veneers to reinforce proper oral hygiene and to discourage use of highly abrasive dentifrices. Continued monitoring of plaque accumulation should minimize problems related to oral hygiene.

Adolescent↗
PubMed1992

Laboratory wear investigation of resin posterior denture teeth.

This investigation compared the wear resistance of three "improved" resin posterior denture tooth formulations with two conventional products on a mechanical toothbrush abrasion machine. The ability of the teeth to resist this type of abrasion was evaluated by determination of the weight loss during 339 hours of brushing with firm nylon bristle toothbrushes. All brands exhibited negligible loss, with the conventional brands performing better than the "improved" formulations.

Acrylic Resins↗
PubMed2004

A preliminary study of experimental polyacid-modified composite resins ('compomers') containing vinyl phosphonic acid.

OBJECTIVES: The aim of this investigation was to determine the properties of two novel compomers formulated with the monomer vinyl phosphonic acid (VPA). The setting properties, mechanical strength, wear characteristics and fluoride release of two experimental unshaded compomers containing VPA were determined, and compared with the commercial compomer Dyract A (shade C3). METHODS: Two novel compomers were prepared, containing, respectively, 0.24% (A) and 2.31% (B) by mass of VPA, and an appropriate amount of reactive glass filler. Their properties were compared with those of Dyract AP (shade A3). Depth of cure was determined according to the method of ISO 4049. Polymerization of model mixtures of bisGMA, TEGDMA and VPA was studied using FT Raman spectroscopy, by comparing the absorption at 1608cm(-1) (aromatic C-C bond) with that at 1313cm(-1) (CC aliphatic). Compressive and biaxial flexure strengths were determined for sets of 6 specimens stored either wet or dry. Wear was determined using a toothbrushing machine and an abrasive slurry, and fluoride release was determined following up to 6 weeks storage in aqueous media, using a fluoride-selective electrode. RESULTS: Of the model monomer mixtures, the one with the greater quantities of VPA showed lowest degrees of polymerization after irradiation for 40s. Compomer A had an acceptable depth of cure, and similar properties to Dyract AP in terms of compressive and biaxial flexure strength, and also fluoride release. Resistance to toothbrush abrasion of both of the experimental compomers was superior to that of Dyract AP. SIGNIFICANCE: These studies demonstrate that VPA can be used as the active monomer in experimental compomers, and is capable of yielding materials with properties equivalent to a commercial material, but with improved resistance to toothpaste abrasion. The level of VPA in the formulation is critical, because this monomer inhibits addition polymerization, hence must be used only in small amounts.

Analysis of Variance↗
PubMed2006

Effect of selected mouthwashes on the surface roughness of resin modified glass-ionomer restorative materials.

OBJECTIVES: It is known that the use of mouthwashes and toothbrushing can affect some restorative dental materials. The purpose of this laboratory study was to investigate the effect of four commercially available mouthwashes on the surface roughness of a number of resin modified glass-ionomer restorative materials when used with and without tooth brushing. METHODS: Specimens of the restorative materials in the study (Vitremer, Compoglass and Dyract) were prepared. Half of the specimens were only exposed to a mouthwash (Plax, Macleans, Listerine, Corsodyl or deionised water as control). The remaining specimens were exposed to one of the mouthwashes in conjunction with tooth brushing. The initial surface roughness and the subsequent changes in surface roughness were assessed by scanning electron microscopy (SEM) and profilometry. The assessment times were: baseline, 4, 12 and 24 weeks. RESULTS: Initial SEM observations of the surface morphology of the specimens revealed a rougher surface for Vitremer in comparison to the other two materials. Assessments at increasing time intervals showed that specimens exposed to a mouthwash only appeared to become rougher. The appearance of specimens exposed to mouthwash and brushing seemed to become even rougher with increasing time. The results of the profilometric assessment showed that at 24 weeks, specimens exposed to mouthwash only, had an overall increase in the surface roughness values for all three materials investigated. The differences between groups allocated to different mouthwashes were not however statistically significant (P>0.05). Exposure to mouthwash and toothbrushing over the same time period resulted in an increase in roughness values in all groups. The differences between mouthwash groups were not statistically significant at this stage (P>0.05). SIGNIFICANCE: Exposure of the materials investigated to the mouthwashes included in the study had adverse effects on surface roughness. The adverse effects were more pronounced with tooth brushing.

Compomers↗
PubMed1996

The association of tooth lead content with dental health factors.

The purpose of this study was to determine the relationships of lead content in the human tooth with the prevalence of caries, dental plaque, pH of saliva, levels of Salivalis lactobacilli (SL) and Mutans streptococci (MS), degree of dental abrasion, tooth colour and toothbrushing frequency. A total of 220 teeth (one per person) were analysed using a microwave oven digestion procedure and lead content was measured by atomic absorption spectrometry. Tooth lead content followed a logarithmic-normal distribution and it increased with the prevalence of caries. Tooth lead concentrations were positively correlated with all the considered dental health factors except the pH of saliva, for which there was a significant negative correlation. Coloured teeth and teeth subject to abrasion showed the highest lead content. The highest number of colonies of SL and MS in saliva paralleled the highest lead tooth levels. Teeth obtained from irregular brushers presented higher tooth lead contents than subjects with a regular toothbrushing frequency. Multiple logistic regression analysis showed a significant association between tooth lead levels and dental plaque surface, Salivalis lactobacilli number, dental abrasion and dental colour. We conclude that accumulation of lead in teeth is associated with those dental health factors.

Adolescent↗
PubMed2000

Analysis of composite type and different sources of polymerization light on in vitro toothbrush/dentifrice abrasion resistance.

OBJECTIVES: This study examined toothbrush/dentifrice abrasion of a photo-activated prosthetic composite (dentin and enamel variations) for the purpose of evaluating the influence of polymerization sources on abrasive wear. METHODS: A photo-activated prosthetic composite material (Artglass) was assessed. Dentin and enamel variations were polymerized using a proprietary photo-curing unit with two xenon stroboscopic lamps (UniXS), and other enamel specimens were polymerized either with a laboratory photo-curing unit with three fluorescent tubes or with a high intensity unit with two metal halide lamps. All specimens were stored in water for 14days and subjected to toothbrush/dentifrice abrasion (350g vertical load) using an abrasive slurry (Colgate Fluoriguard) and a toothbrush (Oral-B 40). The amount of vertical loss and the surface roughness of the specimens after 20,000 strokes were determined by profilometer. Average values of groups of five specimens were compared using analysis of variance (ANOVA) and Sheffe's S intervals (p<0.05). RESULTS: When polymerizing with the proprietary unit, the abrasion and surface roughness of the enamel material required respective means of 34.08microm (+/-3.66) and 1.00microm (+/-0.08), and the those of the dentin material required means of 42.02microm (+/-5.62) and 1.23microm (+/-0.20). Both abrasion and surface roughness after toothbrushing of the enamel material were significantly smaller than were those of the dentin material. The abrasion of specimens polymerized with the metal halide unit required a mean of 23.89microm (+/-6.17) and demonstrated minimal wear. CONCLUSIONS: The use of a high intensity metal halide photo-curing unit effectively enhanced the abrasion resistance of the composite. Surfaces of restorations should be covered with the enamel material in order to achieve smoothness and wear resistance.

Analysis of Variance↗
PubMed1995

A rationale for mouth care: the integration of theory with practice.

Mouth care is a commonly performed nursing procedure in which the aim is to ensure that patients' mouths are cared for. However, there is evidence that unless dental plaque is removed from the tooth surfaces and the gingival margin, the mouth is in danger of becoming unhealthy and, therefore, uncared for. It appears from the dental literature that the use of a toothbrush is one of the best and most widely used tools in the Western world for removing dental plaque (Addy, Slayne & Wade 1992), other methods being ineffective, dangerous, or poorly researched (Trenter-Roth & Creason 1986). However, a review of the nursing literature indicates that toothbrushes are not the tools of choice for mouth care by nurses (Howarth 1977, Harris 1980). Thus, there appears to be a gulf between the knowledge base from the dental literature and the reality of nursing practice resulting in 'mouth care' becoming a misleading misnomer. The aim in this paper is to present a rationale for mouth care based upon the dental literature and to apply such knowledge to nursing practice, especially in intensive therapy units (ITUs), so that nurses may be in a better position to provide 'mouth care' which lives up to its name.

Clinical Nursing Research↗
PubMed1999

The development and validation of an occlusal site-specific plaque index to evaluate the effects of cleaning by tooth brushes and chewing gum.

These studies sought to develop and validate an occlusal site-specific plaque index to be used to measure plaque removal by brushing or chewing gum. The index divides the occlusal surfaces into imaginary zones from which scores are apportioned on a 0-4 basis dependent on the perceived % plaque coverage of each zone. Examiner calibration was conducted over 2 studies assessing inter-examiner reproducibility and intra-examiner repeatibility, respectively. Study 1 involved 2 examiners who recorded scores from the same 3 groups of subjects who had suspended tooth cleaning for 4 days. Analyses for inter-examiner reproducibility showed no significant mean differences between examiners or no significant differences between variances of the 2 examiners scores. Study 2 involved the same 2 examiners individually scoring 3 groups of subjects 2 x (approximately 60 min apart) for occlusal plaque. Analysis for intra-examiner repeatability showed no significant mean differences between the 2 scorings of each examiner. Furthermore, there were no significant differences between the variances of each examiner's scores except for 1 examiner in the repeatability exercise for the 1st group of subjects. Study 3 involved groups of subjects at 2 separate clinical sites (Bristol, England and Berne, Switzerland) being scored for occlusal plaque before and after toothbrushing with water or after no toothbrushing. Data from individual examiners and examiners combined revealed a significant reduction in occlusal plaque with brushing compared to no brushing. Study 4 was the same as study 3 but occlusal plaque was scored before and after chewing gum or not chewing gum. The Bristol examiner recorded a significant reduction in plaque by chewing gum compared to not chewing gum but the Berne examiner did not. The latter may have resulted from a considerable disparity in the number of evaluable occlusal surfaces between the two study sites. The index could be employed as part of the overall assessment or oral hygiene or used in clinical trials to study mechanical and chemical plaque control agents.

Adult↗
PubMed2001

PCR detection of 5 putative periodontal pathogens in dental plaque samples from children 2 to 12 years of age.

BACKGROUND, AIMS: The purpose of this study was to detect the presence of Prevotella intermedia, P. nigrescens, Bacteroides forsythus, Treponema denticola, and Campylobacter rectus in plaque samples from 119 children, collected from their toothbrushes using a polymerase chain reaction (PCR). METHOD: The subjects were 24, 83, and 12 children with healthy gingiva, gingivitis, and periodontitis, respectively, ranging in age from 2-12 years old. Plaque samples were collected from all erupted teeth sites using a sterile toothbrush. The mean concentration of DNA recovered from the plaque samples was approximately 640 microg/ml, which was deemed sufficient for performing a PCR-based survey. RESULTS: The prevalence by PCR in healthy, gingivitis, and periodontitis subjects was 0.0%, 6.0% and 25.0% for P. intermedia, 45.8%, 79.5% and 50.0% for P. nigrescens, 33.3%, 63.9% and 58.3% for B. forsythus, 0.0%, 18.1% and 16.7% for T. denticola, and 100% in duplicate for C. rectus, respectively. CONCLUSION: Our survey indicated that P. intermedia and T. denticola were more associated with periodontal diseases, B. forsythus and P. nigrescens had a moderate prevalence in all clinical groups, while C. rectus were the most commonly detected species in the oral cavities of children suggesting establishment in their early years.

Age Factors↗
PubMed2003

Early childhood caries in northern Philippines.

OBJECTIVES: To determine prevalence and severity of early childhood caries (ECC) among children in northern Philippines. Further, to describe and determine the impact of child-rearing practices and dental visits on caries status. METHODS: Cross-sectional survey of 993 children aged 2-6 years. Caries was diagnosed based on WHO recommendations. Additional behavioral information was obtained from 452 children aged 3-6 years. RESULTS: Caries prevalence and mean dmft (+/-SD) by age were as follows: 2 years = 59% (4.2 +/- 5.3); 3 years = 85% (7.4 +/- 5.5); 4 years = 90% (8.8 +/- 5.6); 5 years = 94% (9.8 +/- 5.5); and 6 years = 92% (10.1 +/- 5.5). Caries rates mirrored those of developing countries with untreated lesions dominating all ages. Mixed breast and bottle feeding was the norm. Almost half were weaned at more than 2 years old. Majority had toothbrushing practices, but mostly without parental assistance. Toothbrushing was initiated at an average age of 2 years. Only a small proportion had a dental visit, mostly for emergency reasons. Among 3-4-year-old children, a significant increase in caries levels were noted for those who started brushing at a later age, had frequent snacks, and had a dental visit for emergency reasons. For children aged 5-6 years, those who went for emergency visits also had significantly more caries. Results indicated an urgent need to (i) increase awareness that ECC is a public health problem in these areas, (ii) advocate use of fluoride as a public health measure, and (iii) increase access to preventive dental services for preschool children.

Age Factors↗
PubMed1997

The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors.

OBJECTIVE: To examine a possible relationship between reported toothbrushing habits in infancy and fluorosis of permanent maxillary incisors at age 8-9 years. DESIGN: Comparison of clinical findings with retrospective survey data. SETTING: Five primary schools in the City of Birmingham where the water is fluoridated at 1.0 mg F/l. SUBJECT AND METHODS: Results of clinical examinations were compared with historical data collected via parental questionnaires. Maxillary central incisors of 325 consecutive children were examined for fluorosis clinically and photographically according to the criteria of the Modified Thylstrup and Fejerskov Index. 112 children had fluorosis and 213 did not. Information concerning toothbrushing habits in infancy was obtained via a questionnaire to parents who were also asked to add paste to a brush in a similar way to when the children were small. From a combination of questionnaire replies and paste weights the amount of fluoride that each child may have ingested from toothpaste each day was then estimated. RESULTS: Highly significant associations were found between estimated fluoride ingestion from toothpaste and fluorosis. The mean DMF score of the fluorosis group was half that of the fluorosis-free children. The prevalence of fluorosis among children in ACORN group A-C was significantly greater than in groups D-F. CONCLUSIONS: The results of the study suggest that toothpaste swallowing may be a factor in the production of fluorosis.

Child↗
PubMed2003

A cluster randomised, controlled trial of the value of dental health educators in general dental practice.

AIM: To test the effectiveness of dental health educators in general dental practice. OBJECTIVE: To evaluate the effectiveness and cost of primary care trusts seconding dental health educators free of charge to suitable general dental practices to provide dental health counselling to mothers of regularly attending pre-school children at risk to caries. METHOD: Two-cell, parallel group, cluster randomised, controlled clinical trial of two years' duration. CLINICAL SETTING: 30 general dental practices in North-West England. PARTICIPANTS: 269 mothers of 334 pre-school children. INTERVENTIONS: Those in the test group were given visits to a dental health educator over a 2-year period to counsel mothers of at-risk, pre-school children. The rest were held as a control. MAIN OUTCOME MEASURES: Caries prevalence of the children and dental health knowledge, attitudes and toothbrushing skills of the parents. The full costs of the exercise were kept throughout. The statistical analysis controlled for the clustering of children within practices. RESULTS: After 2 years, 271 (81%) children and 248 (92%) mothers remained in the study. There was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. At the end of the study there was an 18% difference in mean dmft between the groups in favour of the test group children but this was not statistically significant. No difference in plaque levels was found. The mothers in the test group were more knowledgeable, had better attitudes towards the dental health of their offspring and better toothbrushing skills than those in the control. Each 2-hour session to counsel ten parents cost pound 40. CONCLUSION: Primary care trusts should carefully consider the cost value of seconding dental health educators to counsel parents of regularly attending, at-risk, pre-school children when considering such an option.

Attitude to Health↗
PubMed2003

Effects of a mechanical interdental cleaning device on oral hygiene in patients with lingual brackets.

This study was aimed at determining the influence of a battery-operated interdental cleaning device (icd) (WaterPik Flosser) on the oral hygiene of 32 female right-handed patients (mean age 25.9 years) with lingual brackets in the upper (n = 29) and or in the lower arch (n = 25). Approximal plaque index (API) and bleeding on probing (BOP) were recorded at the lingual surfaces by a single blinded examiner before application (t0), on average 38.6 days after (t1), and again on average 46.0 days after (t2) the application of the icd. The patients used the icd once a day in the second and fourth quadrants only (icdq). In all quadrants (icdq and non-icd quadrants [n-icdq]), oral hygiene was performed with a manual toothbrush. Of the patients enrolled in the study, 96.9% found the icd subjectively very helpful to moderately helpful for cleaning their teeth and 65.6% had the subjective impression that their teeth were cleaner with the appliance. Despite those positive subjective assessments, an objective comparison of the icdqs with the n-icdqs revealed no statistically significant differences in the mean changes in API and BOP from t0 to t1, from t0 to t2, or from t1 to t2. Because there were spectacular improvements in API in all quadrants, the improvements could be interpreted as an outcome of the instruction and motivation given to the patients, the increasing awareness of oral hygiene, and the greater skill in using the toothbrush in the course of time.

Adolescent↗
PubMed2000

Dental caries prevalence and dental health behaviour in HIV infected children.

OBJECTIVES: To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour. DESIGN: Standardized epidemiological dental examination and structured interview. SETTING: Paediatric HIV outpatient department in a South London hospital. STUDY POPULATION: HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants). METHODS: Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children's dental health behaviour: toothbrushing, diet, fluoride; oral medication and dental attendance were explored. RESULTS: Sixty-three per cent (n = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4.4. Sixty per cent (n = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child's HIV status on dental attendance. CONCLUSION: Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.

Child↗