Prevalence of dental myths,oral hygiene methods and tobacco habits in an ageing North Indian rural population

doi: 10.1111/j.1741‐2358.2010.00395.x
Prevalence of dental myths, oral hygiene methods and tobacco habits in an ageing North Indian rural population Background and objectives: Though increased emphasis is being given to expanding dental care facilities and awareness in Indian villages, the target population is unfortunately less literate and financially‐equipped compared to their urban counterparts. This study attempted to evaluate dental myths, oral hygiene methods and beliefs, and tobacco habits present in a rural ageing population. Material and methods: The study area consisted of a group of 10 villages, situated in the district of Lucknow, Uttar Pradesh, India. The sample comprised 681 people aged 50 years or above. The subjects were questioned about dental myths, tobacco habits and oral hygiene methods and then divided into groups on the basis of age, gender, and educational status. Mean values, standard deviation, chi‐square test, t‐test and p values were used to obtain inter‐group comparisons. Results: Forty percent of the subjects considered oral hygiene unnecessary, with 61% relying on simple mouth rinsing for maintaining oral hygiene, 48% either smoked and chewed tobacco or both and 81% had one or more dental myth. Conclusion: The results showed that the rural ageing population is deprived and a targeted programme to spread scientific dental practices to them is necessary.     

An Introduction to a Symposium in Geriatric Dentistry: Issues in Gerontology

The papers in this collection address geriatric dentistry at a time when society is rapidly becoming older. More than ever before, all dental care providers must understand the special needs of elderly patients and the unique biological features of the aged person that affect the diagnosis and prognosis of oral pathology. Attitudes about aging in the elderly must be discussed within the context of the health care setting so we can address the needs for social change, particularly in the dental and medical professions. This symposium brings together a series of papers on topics that are being researched in geriatric dentistry. The topics are diverse, including methods to finance dental care, psychiatric considerations, temporomandibular joint dysfunction, prosthodontics, artificial saliva and nutritional factors, immunology and the new frontiers in dental science, periodontal disease and oral cancer. And as an epilogue to our theme, a dentist with a primarily geriatric practice reflects on the difficulties and the rewards of the elderly patient. Improving the quality of life is the goal of aging research and to investigate aging legitimately we must ask in a systematic manner, what is aging? In this introduction, we discuss briefly the several theories of aging that are guiding research efforts.     

Factors affecting the motivation for dental check‐ups and anxiety in the elderly in Tokyo

Objectives: The purpose of this study was to identify factors influencing the motivation for regular dental check‐ups and anxiety about future dental problems in the elderly. Background: Regular dental check‐ups are important to maintain oral health. Anxiety affects the quality of life of the elderly. However, few studies have investigated the factors influencing the motivation for regular dental check‐ups and anxiety in the elderly. Materials and methods: Among 452 elderly persons, 215 participants provided useful answers to our questionnaire. The questionnaire consisted of items concerning oral and living conditions of the subjects. Logistic regression analysis was conducted. Results: The mean age of the study sample was 75.7 ± 5.8 years. The percentage of edentulous subjects was 12.1%. The motivation for regular dental check‐ups was significantly positively correlated with the number of teeth present (p < 0.01), using inter‐dental brushes (p < 0.01), being on regular prescribed medication (p < 0.05), and having experience of providing oral care for the bedridden (p < 0.05). Anxiety about future oral problems was significantly associated with self‐rated health status (p < 0.01) and the presence of dentists who could be counted on to provide domiciliary visits (p < 0.05). Conclusion: The participants of this study had a high motivation for regular dental check‐ups, but were concerned about the future, particularly if they became bedridden.     

Oral health in nursing home residents with different cognitive statuses

Objective: To compare oral health in nursing home (NH) residents with different cognitive statuses. Background: Oral health is a significant issue for NH residents because of its relationships to quality of life, systemic health and well‐being. It is known that oral health is poor in NH residents. However, how oral health differs in NH residents with different cognitive statuses remains unclear. Materials and methods: Nine hundred and two NH residents were retrospectively recruited from a community‐based geriatric dental clinic in Minnesota, USA. Comprehensive medical, dental, cognitive and functional assessments were completed for the participants. On the basis of medical history and cognitive status, participants were categorized into three groups: without cognitive impairment (non‐impaired group), with cognitive impairment but no dementia (impaired group) and with dementia (demented group). ANOVA, Chi‐square and Fisher’s exact tests were used to compare medical, dental and functional statuses between groups. Results: Oral hygiene was poor in NH residents. Forty per cent of participants in the impaired group were edentulous, significantly higher than the edentulism rate in the demented group (29%, p = 0.01). More than 60% of the participants lost 16 or more teeth prior to examination. Depending on their cognitive status, 82–92% of the participants arrived with one or more caries or retained root. Dentate participants in the impaired and demented groups averaged about six caries or retained roots, significantly more than 4.7 caries or retained roots in the non‐impaired group (p = 0.01). Conclusion: Oral health was poor but slightly different in NH residents with different cognitive and functional statuses.     

Geriatric dentistry in the next millennium: opportunities for leadership in oral health

"The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective." Arnold Toynbee, British historian. Individuals throughout the world often view the passage of a new year as a time for re-evaluation of personal and/or professionals goals. The new millennium offers the dental profession a chance to view the future and observe the challenges and opportunities facing it. Professor Toynbee's observation is particularly poignant when one considers the improvements in oral health made in the last 100 years. Caries, once considered a ubiquitous oral disease, has been prevented in some children in developed countries. Research on periodontal disease continues to identify risk factors and the pathobiological mechanisms underlying the disease. Concurrently the population of the world is aging presenting new opportunities for improving oral health. In this paper the data on aging, chronic diseases and oral health is largely from the US but reflects to varying degrees other industrial countries. By integrating these demographic, epidemiologic and biologic data, one can paint a portrait of the future dental patient and their oral health needs. From this portrait, dental professionals can identify leadership opportunities to improve the oral health of an aging world population.     

Oral health-related well-being of the long-term hospitalised elderly

Objective: To investigate oral health‐related well‐being of the long‐term hospitalised elderly as reported by their primary nurses in relation to subject's oral health assessed either by primary nurses or by a clinical dental examination. Background data: Little is known about oral health‐related well‐being of the medically compromised, long‐term hospitalised elderly, most of whom are unable to express their feelings and opinions. Materials and methods: A cross‐sectional study using a questionnaire for primary nurses about oral health and oral health‐related well‐being regarding functional, pain/discomfort‐related, and psychosocial limitations of the subjects (n = 255) and assessment of oral health by clinical examination. The total number of limitations and the number of limitations in each category was calculated. Results: Most (77%) of our subjects were unable to eat normal food. Functional limitations dominated followed by psychosocial and pain/discomfort‐related limitations. Overall assessment by each subject's primary nurse ranked oral health of as good for 9% of subjects, as moderate for 44%, and as poor for 47%. Clinical examination‐based assessment ranked oral health as good for 19%, as moderate for 33%, and as poor for 48% of our subjects, with good oral health being ranked as good for more men than women (26% vs. 16%; p = 0.045). Fewer limitations were recorded for those with better oral health assessed both by primary nurse and by clinical examination. Conclusion: More efforts are called for to maintain the oral health of the long‐term hospitalised elderly so as to improve their well‐being.     

Plate-like permanent dental laminae of upper jaw dentition in adult gobiid fish, Sicyopterus japonicus

Sicyopterus japonicus (Teleostei, Gobiidae) possesses a unique upper jaw dentition different from that known for any other teleosts. In the adults, many (up to 30) replacement teeth, from initiation to attachment, are arranged orderly in a semicircular-like strand within a capsule of connective tissue on the labial side of each premaxillary bone. We have applied histological, ultrastructural, and three-dimensional imaging from serial sections to obtain insights into the distribution and morphological features of the dental lamina in the upper jaw dentition of adult S. japonicus. The adult fish has numerous permanent dental laminae, each of which is an infolding of the oral epithelium at the labial side of the functional tooth and forms a thin plate-like structure with a wavy contour. All replacement teeth of a semicircular-like strand are connected to the plate-like dental lamina by the outer dental epithelium and form a tooth family; neighboring tooth families are completely separated from each other. The new tooth germ directly buds off from the ventro-labial margin of the dental lamina, whereas no distinct free end of the dental lamina is present, even adjacent to this region. Cell proliferation concentrated at the ventro-labial margin of the dental lamina suggests that this region is the site for repeated tooth initiation. During tooth development, the replacement tooth migrates along a semicircular-like strand and eventually erupts through the dental lamina into the oral epithelium at the labial side of the functional tooth. This unique thin plate-like permanent dental lamina and the semicircular-like strand of replacement teeth in the upper jaw dentition of adult S. japonicus probably evolved as a dental adaptation related to the rapid replacement of teeth dictated by the specialized feeding habit of this algae-scraping fish.     

An Epidemiologic Study on the Correlation Between Oral <Emphasis Type="Italic">Helicobacter pylori</Emphasis> and Gastric <Emphasis Type="Italic">H. pylori</Emphasis>

The current study was conducted to determine the prevalence of Helicobacter pylori in the oral cavity of a Chinese population. Nested polymerase chain reaction (PCR) was used to investigate whether individuals with oral H. pylori show more possibility of gastric infection and to examine the relationship between gastric H. pylori infection and the presence of the bacteria in the oral cavity. A total of 443 dyspeptic patients participated in the study. Gastric H. pylori infection was detected by the rapid urease test and histology with Giemsa staining, PCR, or smear examination, whereas the presence of the bacteria in the oral cavity was observed by nested PCR from dental plaque. Relevant periodontal and dental parameters were recorded in the process of oral examination. Of the 443 study patients, oral H. pylori was found in the dental plaque of 263 (59.4%) and the stomach of 273 (61.6%). Additionally, in all four age groups, the prevalence of gastric infection was significantly higher among the patients with positive tests for H. pylori in their dental plaque than in the patients with no H. pylori in their dental plaque (P < 0.05). The oral cavity may be a potential reservoir for H. pylori, and the prevalence of oral H. pylori approximated that of gastric H. pylori in the studied population. Furthermore, a close relationship may exist between H. pylori in the oral cavity and bacteria in the stomach or gastric infection, and dyspeptic patients with gastric infection are more likely to harbor H. pylori in their oral cavity. Y. Liu and H. Yue contributed equally to the accomplishment of this study.     

Drug repurposing for aging research using model organisms

Many increasingly prevalent diseases share a common risk factor: age. However, little is known about pharmaceutical interventions against aging, despite many genes and pathways shown to be important in the aging process and numerous studies demonstrating that genetic interventions can lead to a healthier aging phenotype. An important challenge is to assess the potential to repurpose existing drugs for initial testing on model organisms, where such experiments are possible. To this end, we present a new approach to rank drug‐like compounds with known mammalian targets according to their likelihood to modulate aging in the invertebrates Caenorhabditis elegans and Drosophila. Our approach combines information on genetic effects on aging, orthology relationships and sequence conservation, 3D protein structures, drug binding and bioavailability. Overall, we rank 743 different drug‐like compounds for their likelihood to modulate aging. We provide various lines of evidence for the successful enrichment of our ranking for compounds modulating aging, despite sparse public data suitable for validation. The top ranked compounds are thus prime candidates for in vivo testing of their effects on lifespan in C. elegans or Drosophila. As such, these compounds are promising as research tools and ultimately a step towards identifying drugs for a healthier human aging.     

Attitudes to and knowledge about oral health care among nursing home personnel--an area in need of improvement

doi: 10.1111/j.1741‐2358.2011.00562.x
Attitudes to and knowledge about oral health care among nursing home personnel – an area in need of improvement Background: In 1999, a dental reform became law in Sweden that regulated both dental care to dependent individuals and training in oral health care for nursing home personnel. Substantial resources have been channelled into these efforts, but the outcome of these efforts has not been evaluated. The aim of this study was to explore attitudes to and knowledge about oral health care among nursing home personnel more than 5 years after the law was adopted, that being 2005. Methods: A total of 454 individuals employed at nursing homes answered a questionnaire of 16 multiple‐choice items concerning attitudes to and knowledge about oral health care. Results: Eighty‐nine per cent considered oral health care to be an important part of good nursing. The answers indicated problems, however, when it came to its implementation and knowledge, and 35% stated that they had had no formal education in oral health care. Conclusions: Despite generally positive oral health care attitudes, it is important that oral health care education is available to and made of interest for all nursing home personnel, especially in light of the increase in number of natural teeth and frequency of crowns and bridges among dependent elderly.     

Anti-biofilm activity of a novel pit and fissure self-adhesive sealant modified with metallic monomers

Abstract

Dental plaque is a biofilm composed of a complex oral microbial community. The accumulation of plaque in the pit and fissures of dental elements often leads to the development of tooth decay (dental caries). Here, potent anti-biofilm materials were developed by incorporating zinc methacrylates or di-n-butyl-dimethacrylate-tin into the light-curable sealant and their physical, mechanical, and biological properties were evaluated. The data revealed that 5% di-n-butyl-dimethacrylate-tin (SnM 5%) incorporated sealant showed strong anti-biofilm efficacy against various single-species (Streptococcus mutans or Streptococcus oralis or Candida albicans) and S. mutans-C. albicans cross-kingdom dual-species biofilms without either impairing the mechanical properties of the sealant or causing cytotoxicities against mouse fibroblasts. The findings indicate that the incorporation of SnM 5% in the experimental pit and fissure self-adhesive sealant may have the potential to be part of current chemotherapeutic strategies to prevent the formation of cariogenic oral biofilms that cause dental caries.     

The Epidemiology of Dental Diseases in the Elderly1

This paper summarizes and evaluates epidemiologic evidence on adult dental conditions with a focus on older adults. Information is presented on coronal caries; root caries; loss of teeth, attrition, abrasion, and erosion; periodontal diseases; and oral cancer. The author concludes that the oral health status of the elderly in the United States is essentially unknown. There are no recent, representative population base studies of oral conditions in the elderly. Studies of prevalence or incidence of oral diseases typically include few elderly persons or describe a select group of elderly who are at high risk. Furthermore, it is not really known whether the incidence and prevalence of coronal caries or root caries is actually increasing or is part of a cohort effect. While oral cancers have been shown to increase with age, there is no information as to whether their incidence rates are increasing. While, clinically, there are indications that attrition, abrasion and erosion are characteristics that are more likely to be seen in older adults, there is no information about their distribution in the population. There is evidence that loss of teeth is decreasing but nothing is known about the patterning of that loss. As for periodontal diseases, much work is needed to identify various syndromes that may be distinguished by their distribution in the population as well as determining whether periodontitis is a condition responsible for a majority of tooth loss or just the majority of tooth loss in a small high risk group. In addition, some suggestions are presented for future directions of research in this area.     

Evolutionary origins of teeth in jawed vertebrates: conflicting data from acanthothoracid dental plates (‘Placodermi’)

Placoderms (Devonian fossil fishes) are resolved phylogenetically to the base of jawed vertebrates and provide important evidence for evolutionary origins of teeth, particularly with respect to the Arthrodira. The arthrodires represent a derived group of placoderms; the dentition of other more primitive placoderms such as the acanthothoracids is less well known. Articulated acanthothoracid dental plates are rare; x‐ray computed tomography of a single, unique specimen, along with 3D segmentation of bone, oral denticles and vascular spaces, provides intrinsic developmental and topological information relevant to tooth origins. Recently, a disarticulated element was identified as a dental plate of the acanthothoracid Romundina stellina, with synchrotron microtomography providing characters to comment on ongoing debates regarding the evolution of teeth. We used segmental quantitative methods to re‐analyse this data, for comparison to the articulated and unquestionable acanthothoracid dental plates above. We demonstrate substantial differences between these, disputing the identity of the isolated plate of R. stellina as a dental plate, and thus its relevance to questions of tooth evolution.     

Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care

doi: 10.1111/j.1741‐2358.2009.00274.x
Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care Background: Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utilise primary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. Objectives: To explore perceptions of oral health and oral healthcare services amongst older people living in a socially deprived inner city area and how these are related to service utilisation. Methods: A qualitative approach was utilised to explore the range of issues related to older people’s perceptions of oral health and their views on health care. This involved a combination of focus groups and semi‐structured individual interviews with older people and their carers. Data analysis was conducted using the Framework approach. Results:

• ? Response: Thirty‐nine older people and/or their carers participated in focus groups.
• ? Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist.
• ? Oral health life‐course: Older people have a long and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel.
• ? Citizenship and right to health care: There was a strong perception that, as ‘British citizens’, older people should have a right to free health care and that the National Health Service (NHS) should support them in this phase of their life.

Conclusions: The oral health life‐course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for older people.     

Oral health and morbidity--implications of oral infections on the elderly

Detrimental effects of oral infections on general health have been known for almost 3000 years. Modern studies, however, have cast new light on the pathogenic mechanisms by which oral infections appear to link with morbidity and mortality. In particular, among the elderly, poor dental health seems to associate with all-cause mortality. This review aims to provide an overview of present knowledge of these issues, starting from dental bacteraemia, oral mucosal infections and problems of drug resistance and, briefly, discussing what is known about the link between oral health and some systemic diseases such as atherosclerosis and type-2 diabetes. The main conclusions are that scientific evidence is still weak on these interactions and that the elderly should be better taken into account when planning future studies. Functions of the body differ in the frail and diseased from those of the young. Consequently, novel prevention and treatment strategies should be developed and properly tested for combating oral infections in elderly populations. Specific suggestions for further research are outlined.     

Analysis of Oral Microbiota in Children with Dental Caries by PCR-DGGE and Barcoded Pyrosequencing

Oral microbiota plays a vital role in maintaining the homeostasis of oral cavity. Dental caries are among the most common oral diseases in children and pathogenic bacteria contribute to the development of the disease. However, the overall structure of bacterial communities in the oral cavity from children with dental caries has not been explored deeply heretofore. We used high-throughput barcoded pyrosequencing and PCR-denaturing gradient gel electrophoresis (DGGE) to examine bacterial diversity of oral microbiota in saliva and supragingival plaques from 60 children aged 3 to 6 years old with and without dental caries from China. The multiplex barcoded pyrosequencing was performed in a single run, with multiple samples tagged uniquely by multiplex identifiers. As PCR-DGGE analysis is a conventional molecular ecological approach, this analysis was also performed on the same samples and the results of both approaches were compared. A total of 186,787 high-quality sequences were obtained for evaluating bacterial diversity and 41,905 unique sequences represented all phylotypes. We found that the oral microbiota in children was far more diverse than previous studies reported, and more than 200 genera belonging to ten phyla were found in the oral cavity. The phylotypes in saliva and supragingival plaques were significantly different and could be divided into two distinct clusters (p < 0.05). The bacterial diversity in oral microbiome analyzed by PCR-DGGE and barcoded pyrosequencing was employed to cross validate the data sets. The genera of Streptococcus, Veillonella, Actinomyces, Granulicatella, Leptotrichia, and Thiomonas in plaques were significantly associated with dental caries (p < 0.05). The results showed that there was no one specific pathogen but rather pathogenic populations in plaque that significantly correlated with dental caries. The enormous diversity of oral microbiota allowed for a better understanding of oral microecosystem, and these pathogenic populations in plaque provide new insights into the etiology of dental caries and suggest new targets for interventions of the disease.     

Dental Status of New Caledonian Children: Is There a Need for a New Oral Health Promotion Programme?

Background

Before implementing a new oral health promotion program in the French overseas territory of Nouvelle Calédonie, the health authorities needed recent data about dental status of the New Caledonian child population.

Objectives

This study aimed to describe the dental status of 6, 9 and 12-yr-old New Caledonian children and to investigate the environmental and behavioural risk factors related to oral health.

Methods

A randomly selected sample of 2734 children (744 6-yr-olds, 789 9-yr-olds, and 1201 12-yr-olds) was examined clinically by seven calibrated investigators and participants responded to a questionnaire. The main variables were objective criteria about dental status and subjective criteria about experience of dental care, dental fear, self-perception of oral health, cultural or ethnic identity and environmental and behavioural risk factors.

Results

Overall, most of the children had infectious oral diseases: more than 50% had gingivitis, and 60% of 6- and 9 yr-olds had at least one deciduous or permanent tooth with untreated caries. The mean 12-yr-old number of decayed missing and filled teeth (DMFT) was 2.09±2.82. The number of carious lesions was related to the unfavourable lifestyle, deprived social status and no preventive dental care. Kanak, Polynesians and Caledonians (respectively 27%, 18% and 45% of the study sample) were more affected by caries than metropolitan French and Asian children. Children with many untreated carious lesions had negative perceptions of their oral health; they complained of chewing difficulty and had higher scores for dental anxiety.

Conclusion

This study highlights the need for new strategies aimed at improving oral health and at reducing inequalities in New Caledonia. An oral health promotion program would need to be developed in connection with other health programmes using the common risk factor approach within the context of the local environment.     

Assessing oral health promotion determinants in active Greek elderly

doi: 10.1111/j.1741‐2358.2011.00491.x
Assessing oral health promotion determinants in active Greek elderly Objective: To explore older adults’ patterns and risk behaviours to be invoked in the allocation of strategies to promote oral health. Background: Access to dental services is determined by factors that serve as barriers to or enablers of older adults’ behaviour and attitudes towards oral health. Appropriate oral health promotion activities are of particular importance among the elderly in altering oral health behaviour through education, prevention and health protection. Methods: A cross‐sectional study was conducted among 108 dentate elderly subjects. They were attending a University Prosthetic Dentistry Clinic in Greece as patients seeking treatment. Participants underwent a clinical examination and an interview. Results: Data extracted revealed that cost and no disease awareness were the most frequently mentioned barriers to regular dental visits. Most of the participants presented low level of income and education and reduced presence of adverse dental health symptoms compared with the actual oral health status. Besides some predisposing factors, enabling and need variables significantly affected access to dental care services, participants’ number of remaining teeth and as a consequence oral health status. Conclusion: Profiling older adults’ demographics, economic, social and cultural status and their attitudes and beliefs could further contribute in developing universal activities and strategies for oral health promotion so as ageing challenges are favoured.