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Stress and the progression of periodontal disease.

This study examined the association between occupational stress and the progression of periodontitis in employed adults. 23 regular dental attenders, enrolled in a longitudinal study of periodontal disease, were examined on 2 occasions at an interval of 5.5 (SD 0.6) years. The mean age at the 2nd examination was 41.1 (SD 7.3) years. Clinical measurements of periodontal status including clinical attachment level were made at four proximal sites on all teeth. A questionnaire, the occupational stress indicator, was used at the second examination to assess stress retrospectively. The mean change in clinical attachment level was 0.63 (SD 0.42) mm and 9.6 (SD 8.6)% of sites measured at both examination lost > or = 3 mm of periodontal attachment. Multiple regression analysis was used to explore the relationship between mean loss of periodontal attachment and measures of occupational stress and sociodemographic data. In the final regression model, an increase in loss of periodontal attachment was significantly predicted by increasing age, lower socio-economic status, lower job satisfaction and type A personality. In addition, locus of control was included in the regression model which explained 65% of the variance in the loss of periodontal attachment. The results suggest that occupational stress may have a relationship to the progression of periodontitis.

Adult↗

A case-control study to investigate an association between adverse pregnancy outcome and periodontal disease.

OBJECTIVES: The aim of this case-control study was to ascertain if women who experienced a preterm (or premature) birth had any differences in periodontal disease severity compared with women who delivered at term. MATERIAL AND METHODS: Subjects were recruited postpartum. Case subjects delivered a baby before 37 weeks of gestation whereas control subjects gave birth at or around term. A questionnaire was administered by a Research Midwife, designed to collect demographic information, pregnancy outcome variables and information on other factors which may influence health in pregnancy. A periodontal examination was then performed at the bedside. RESULTS: Demographic variables were similar between case and control subjects. There was a higher proportion of case subjects who reported smoking. There were no differences in oral hygiene, bleeding on probing or loss of attachment; however, control subjects had a higher proportion of periodontal pockets probing 5 mm or greater. CONCLUSIONS: There was no association between the severity of periodontal disease and pregnancy outcome in this population.

Adult↗

Measuring inequalities in the distribution of dental caries.

OBJECTIVES: To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services. METHODS: The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT > or = 4) and rampant- (DMFT > or = 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of São Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates. RESULTS: The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease. CONCLUSION: An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.

Brazil↗

Total fluoride intake in children aged 22-35 months in four Colombian cities.

OBJECTIVE: To obtain information on the level of total fluoride intake from food, beverages and toothpaste by children at the age of 22-25 months of low and high socioeconomic status (SES) in major Colombian cities. METHODS: Daily fluoride intake was assessed by the duplicate plate method and by recovered toothpaste solution during a 3-day period and afterwards analysed by the microdiffusion method. RESULTS: Mean daily fluoride intake was 0.11 (+/-0.10), 0.14 (+/-0.12), 0.10 (+/-0.07) and 0.07 (+/-0.06) mg/kg body weight (bw)/day in Bogota, Medellin, Manizales and Cartagena, respectively. The total fluoride intake was higher in low-SES subjects in the cities of Medellin and Bogota. In the high-SES children of the four cities, the average intakes ranged from 0.06 to 0.09 mg F/kg bw, whereas, the low-SES children in three cities had intakes between 0.11 and 0.21 mg F/kg bw (Cartagena, 0.07). Toothpaste (containing 1000-1500 ppm F, with 1500 ppm F being more common) accounted for approximately 70% of total fluoride intake, followed by food (24%) and beverages (<6%). More than half the children had their teeth brushed by an adult, on average twice a day, using 0.22-0.65 g of toothpaste. CONCLUSION: Children from three Colombian cities have a mean total daily fluoride intake above the 'optimal range'. Health authorities should promote an appropriate use of fluoridated dentifrices discouraging the use of dentifrices containing 1500 ppm F in children younger than 6 years of age and promoting a campaign of education of parents and oral health professionals on adequate toothbrushing practices.

Analysis of Variance↗

The importance of oral health to older people's quality of life.

OBJECTIVES: This study was designed to determine whether older people perceive oral health as being important to Quality of Life (QoL) and if so, to identify the most important ways in which their lives are affected. In addition, to identify if subgroups of older people perceive its importance differently. DESIGN: Nationwide qualitative face to face interviews with older people were carried out utilising the Office for National Statistics Omnibus survey in Great Britain. SUBJECTS AND METHODS: 454 adults aged 65 or older took part in this study, part of a random probability sample of adults in the UK. SETTING: Respondents were interviewed in their homes. RESULTS: 72% (313) perceived their oral health status as important to their QoL through a variety of physical, social and psychological ways. Most frequently its impact on function: eating (29%, 126) and symptoms: comfort (14%, 59) were considered most important. Gender and social class variations were apparent (P < 0.05). CONCLUSION: Older people perceive oral health as being important to life quality in a variety of different ways. There are significant social class and gender variations which must be taken into consideration when assessing oral health needs of older people.

Age Factors↗

Worries of school-age children.

PURPOSE: To determine how worrisome some situations are for school-age children and if parents can identify how worrisome the situation would be for their child. DESIGN: Descriptive. SETTING: Families' homes. PARTICIPANTS: 48 school age-children (7-11 years old), 40 mothers, 8 fathers. MAIN OUTCOME MEASURES: The 27-item "What Worries You (Your Child) the Most" questionnaire. RESULTS: For the most part, parents were able to ascertain what would worry their child the most. However, they did underestimate the importance of pets to children as well as adequate family income. There were significant differences in child and parent perceptions of three items ranked among the most worrisome: "being asked to take drugs," being in a war," and "hearing parents quarrel." Age and gender of children were not significant factors in the distribution of scores. CONCLUSIONS: Findings indicate that considerable discrepancies can exist between what the parent and the child perceive as worrisome.

Age Factors↗

Comparing different methods to detect and correct nonresponse bias in postal questionnaire studies.

OBJECTIVES: This study compares methods for detecting and correcting the bias associated with nonresponse to postal questionnaires. METHODS: Questionnaires were sent out in three sequential stages to parents of all 5-year-old children examined in a clinical survey. Each stage progressively targeted nonresponders. Data on dmft and area measures of socioeconomic status were available for all children. Estimates for whole population dmft were produced by different methodologies comparing the relationship between dmft and stage of response and three area measures of socioeconomic status. RESULTS: A total of 1,776 children were examined and 1,437 questionnaires were obtained, a response rate of 80.9 percent. The mean dmft of the total population (1.49) was 17.3 percent more than responders (1.27). The dmft of the nonresponders was 2.41, 89.7 percent more than responders. There were significant linear trends in dmft and socioeconomic status across the mailing stages. The methodology using mailing stage regressed against dmft produced the most accurate adjusted dmft value (1.42). The methods using area measures of socioeconomic status produced nearly identical adjusted dmft values ranging from 1.31 to 1.32. CONCLUSIONS: Even with an "acceptable" response rate, nonresponse bias can still be present. Researchers should report the outcomes of analyses to detect nonresponse bias when publishing questionnaire studies.

Bias↗

Facial attractiveness and the aged.

This study examined the relationship between dentofacial appearance and judgments of facial attractiveness in a sample of 60 subjects between ages 65 and 75. Subjects completed questionnaires regarding their current dental appearance and level of satisfaction with their facial attractiveness. Subjects then viewed and ranked four sets of five photographs that had been digitally manipulated to simulate common dental defects. Regardless of background facial attractiveness or gender of stimulus photographs, a specific ranking order for dental defects emerged with rank-order correlations in the 90% range. Findings suggest that dental appearance affects judgments of facial attractiveness regardless of gender or background facial attractiveness.

Aged↗

Risk factors for dental caries in children with cerebral palsy.

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non-handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non-parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.

Adolescent↗

Arthritis and use of dental services: a population based study.

BACKGROUND: Rheumatoid arthritis (RA) and osteoarthritis (OA) are chronic systemic conditions that can have a profound effect on oral health as the result of physical disability, immunosuppressant and other medications and autoimmune disease. However, there is insufficient information available on the use of dental services by the people suffering from RA or OA. The purpose of this study was to investigate dental visits and factors associated with dental attendance in those with RA and OA in order to improve access to dental care in these groups. METHODS: The study used population based data from the 1995 National Health Survey (total n=53828). The main variables of interest were reported RA (n=1193) and OA (n=3091) and the main outcome variable was having visited a dental professional in the previous 12 months. Chi-square analysis was performed using SAS software. RESULTS: The proportion of people visiting a dental professional in previous 12 months was significantly less in both RA and OA respondents compared to non-arthritic respondents. Both males and females with RA and OA were found to be less likely to have visited a dental professional when compared to general population (p=0.001 in each case). Furthermore, the findings have revealed that RA and OA patients living in metropolitan centres were more likely to have a dental visit than those living in rural or remote areas (p=0.001 in each case). CONCLUSIONS: When compared to non-arthritic subjects, all patients with RA and OA were less likely to receive dental care, in particular preventive care. This is especially important in patients with Sjogren's Syndrome and those who are immunosuppressed.

Adolescent↗

Reasons for tooth extraction in a Brazilian population.

AIM: To identify the reasons for tooth extraction in Recife, Brazil and to test whether they differ by socio-economic groups and levels of caries experience. DESIGN: Cross-sectional survey. SETTING: Ten health centres of the public health system and ten health centres of insurance companies. PARTICIPANTS: Patients attending health centres. METHODS: Ten dentists from each selected centre and two patients from each selected dentist were randomly selected from; the list of all health centres in Recife, all dentists carrying out dental extractions at each selected centre and all patients who had an appointment with the selected dentists respectively. Participants were examined by both the researcher (AC) and dentists. OUTCOME MEASURE: Reasons for tooth extraction. RESULTS: Of the 404 teeth extracted, 70.3 per cent were because of caries and its sequelae; 15.1 per cent because of periodontal disease; 6.4 per cent for pre-prosthetic reasons; 3.7 per cent wisdom teeth, 2.5 per cent for orthodontic reasons and 1 per cent for trauma and patient's request. A trend was observed for patients with less than secondary school education and lower salaries to have more tooth extraction due to caries, but the differences were not of statistical significance.

Adolescent↗

Multistage scoring system for identifying infants at risk of unexpected death.

Obstetric and perinatal records have been assembled on 250 infant deaths and an equal number of live controls including 55 deaths associated with congenital anomalies. The information was used to construct a scoring system to identify high-risk infants at birth. Parents of 115 of the cases and their controls were also interviewed and all hospital, general practitioner, and health service records abstracted. Cases and controls were compared item by item in respect of all information available up to the age of one month and a scoring system constructed for use at one month. The 'at birth' and combined scoring systems are presented. The chance of death by age attained is presented for various risk groups. In a small prospective test, the multistage scoring system was nearly 50% more effective than the birth score alone.

ABO Blood-Group System↗

Parental compliance with home cardiorespiratory monitoring.

AIMS: To evaluate parental compliance with home cardiorespiratory monitoring of premature infants with apnoea, siblings of infants who died of sudden infant death syndrome (SIDS), and infants with an apparent life threatening event (ALTE), during the first month of use. METHODS: A retrospective review of the first month's recordings was conducted on 39 premature infants with apnoea, 13 siblings of SIDS, and 16 infants with ALTE. All infants were singletons. Recommendations during the study period (1992-1994) were for daily use for 23 hours per day. Measurements were average daily hours of use and consistency of use (daily or variable). Gestational age, maternal age, and socioeconomic status as measured by receipt of public assistance were also recorded. RESULTS: Siblings of SIDS were monitored for fewer hours than were premature or ALTE infants. Only 54% of sibings of SIDS were monitored daily, compared to 87% of premature infants and 93% of ALTEs. Within each diagnostic category socioeconomic status did not affect average hours of monitoring. Consistency of use was more evident in those with private insurance, although the trend did not reach significance. CONCLUSIONS: Parents of infants with apnoea of prematurity or ALTE are highly compliant with cardiorespiratory monitoring recommendations in the first month of monitor usage. Siblings of SIDS are monitored for fewer hours and are less likely to be monitored on a daily basis.

Analysis of Variance↗

Neurodevelopmental outcome in meningococcal disease: a case-control study.

AIMS: To determine long term neurodevelopmental outcome following the spectrum of meningococcal infection. METHODS: Between 1988 and 1990, 152 cases of meningococcal disease were recruited; 139 survived. Between 1998 and 1999, 115 survivors (83%) were evaluated, together with 115 sex and age matched controls. Standard measures of neurological function, coordination, cognition, behaviour, and hearing were used to assess neurodevelopmental status. RESULTS: One case has spastic quadriplegia. Gross neurological examination was normal in all other cases and all controls. Five cases and no controls have significant hearing loss. Cases performed at a lower level than controls on measures of coordination, cognition, and behaviour. Four cases and no controls had major impairments. The adjusted odds ratios for moderate and minor impairments were 3.6 (95% CI 1.3 to 10.3) and 1.6 (95% CI 0.8 to 3.4) respectively. CONCLUSION: The majority of survivors from this cohort do not have gross neurological deficits. However, when objective measures of motor function, cognitive ability, and behaviour were applied significant detriments were found in meningococcal survivors.

Adolescent↗

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932.

AIMS: To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class. METHODS: Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932. Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921. Moray House Test scores from the Scottish Mental Survey 1932 were traced on 449 of these children. RESULTS: Mean score on Moray House Test increased from 30.6 at a birth weight of <2500 g to 44.7 at 4001-4500 g, after correcting for gestational age, maternal age, parity, social class, and legitimacy of birth. Multiple regression showed that 15.6% of the variance in Moray House Test score is contributed by a combination of social class (6.6%), birth weight (3.8%), child's exact age (2.4%), maternal parity (2.0%), and illegitimacy (1.5%). Structural equation modelling confirmed the independent contribution from each of these variables in predicting cognitive ability. A model in which birth weight acted as a mediator of social class had poor fit statistics. CONCLUSION: In this 1921 birth cohort, social class and birth weight have independent effects on cognitive function at age 11. Future research will relate these childhood data to health and cognition in old age.

Age Factors↗