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Abstract

For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling. Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03-2.10). However, the increasing trend was stronger among boys (OR(2010 vs. 1994) for boys 1.60; for girls 1.48), and among the younger adolescents (OR(2010 vs. 1994) for 11-year-olds 1.64; for 15-year-olds 1.45). Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004-2010. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
European Journal of Public Health, Vol. 25, Supplement 2, 2015, 20–23
ßThe Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
doi:10.1093/eurpub/ckv013
.........................................................................................................
Trends in toothbrushing in 20 countries/regions from
1994 to 2010
Sisko Honkala
1,2
, Carine Vereecken
3,4
, Birgit Niclasen
5
, Eino Honkala
1,2
1 Department of Developmental & Preventive Sciences, Faculty of Dentistry, Kuwait University, Kuwait City, Kuwait
2 Department of Health Sciences, Faculty of Sport and Health Sciences, University of Jyva
¨skyla
¨, Jyva
¨skyla
¨, Finland
3 Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
4 Research Foundation- Flanders (FWO), Brussels, Belgium
5 National Institute of Public Health, Copenhagen, Denmark
Correspondence: Sisko Honkala, Faculty of Dentistry, Kuwait University, Kuwait. Tel: +965 66499048, Fax: +965 25326049,
e-mail: sisko.l.honkala@gmail.com
Background: For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide.
As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of
brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in
20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. Methods: Eleven-, 13-,
and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N= 474 760).
Trends were analysed by logistic regression and multilevel logistic regression modelling. Results: Prevalence of
recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already
attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia,
Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99%
CI 2.03–2.10). However, the increasing trend was stronger among boys (OR
2010 vs. 1994
for boys 1.60; for girls 1.48),
and among the younger adolescents (OR
2010 vs. 1994
for 11-year-olds 1.64; for 15-year-olds 1.45). Conclusion:
Recommended toothbrushing frequency increased in most of the studied countries/regions and differences
between the countries diminished during 2004–2010.
.........................................................................................................
Introduction
Toothbrushing is the main self-care method to prevent the most
prevalent non-communicable diseases, periodontal disease and
dental caries. Consequently, twice-a-day toothbrushing frequency
is a universally accepted recommendation for maintaining good
dental and periodontal health.
1,2
Poor oral hygiene has been shown to be associated with higher
levels of cardiovascular diseases, diabetes mellitus, hypertension
and metabolic syndrome.
3,4
The effectiveness of regular toothbrush-
ing in preventing oral diseases has become even more important
than before, as a strong association between oral diseases and the
four main non-communicable diseases, i.e. diabetes, cancer, cardio-
vascular diseases and respiratory diseases, has been confirmed.
5
Very few longitudinal studies have monitored toothbrushing
habits over time in the same population.
6–8
They confirm that a
constant toothbrushing habit is adopted quite early in the life and
will not change easily later on. In Finland, health habits have been
monitored in cross-sectional surveys of 12-, 14-, 16- and 18-year-
olds with nationally representative samples every second year since
1977, and among 11-, 13- and 15-year-olds every fourth year since
1985.
9
They confirmed only slow improvement over two decades
among younger age groups and boys, but a decline in prevalence
of toothbrushing among girls in older age groups.
We hypothesize that higher proportions of adolescents have
adopted a twice-a-day toothbrushing habit in 2010 compared with
1994. The aim of this article is to describe the trends in more-than-
once-a-day toothbrushing frequency in different countries/regions
participating in five consecutive Health Behaviour in School-aged
Children (HBSC) Surveys between 1994 and 2010.
Methods
The HBSC mandatory question about toothbrushing ‘How often do
you brush your teeth?’ focuses on the frequency of this habit.
Response options given are from ‘never’ to ‘more than once a
day’. More-than-once-a-day toothbrushing frequency was selected
as the cut-off point for analysis, while twice-a-day toothbrushing
is a universally accepted recommendation.
1,2
Toothbrushing frequency has been determined by this question,
which has remained unchanged, since the first study of the HBSC
survey.
10
This same question has been used since 1977 in the Finnish
nation-wide research program, the Adolescents Health and Life-style
Survey. The reliability and validity of the question have been tested
several times and have been shown to be good.
11
Analyses
Data were analysed using SPSS (version 18.0) and MLwiN (version
2.25). Studied variables included study year, country, gender and
age. All countries/regions included participated in five consecutive
cross-sectional HBSC surveys from 1994 onwards (1994, 1998, 2002,
2006 and 2010). These 20 countries/regions were: Austria, Flemish-
and French-speaking Belgium, Canada, Czech Republic, Denmark,
Estonia, Finland, France, Germany, Greenland, Hungary, Latvia,
Lithuania, Norway, Poland, Russia, Scotland, Sweden and Wales.
Prevalence (%) of more-than-once-a-day toothbrushing among
11-, 13- and 15-year-olds was presented as a total sample for each
country/region for five consecutive HBSC surveys, for the trends
between the individual surveys (4 years) and for the trends
between the 1994 survey and the 2010 survey (16 years). This
sample was weighted by age group and gender in analysis. Trends
in more-than-once-a-day toothbrushing frequency in different
countries/regions were analysed by logistic regression (SPSS), and
for all countries together by multilevel logistic regression modelling
(MLwiN) where children were clustered by country/region
(n= 474 760).
Results
Prevalence of more-than-once-a-day toothbrushing frequency
increased between 1994 and 2010 in most of the countries and
regions from 30–62% to 50–72% (fig. 1). The highest increase (more
than +16%) was observed in Estonia, Russia, Latvia, Finland and in
Flemish Belgium.
A slight decrease in recommended toothbrushing frequency was
seen in countries with the highest prevalence in 1994 (75–86%), i.e.
in Sweden (5.4%), Denmark (4.5%) and in Norway (0.4%).
However, the frequency in these countries still remained at a high
level in the last follow-up year, between 75 and 81% (fig. 1).
Between 1994 and 1998, the improvement was over 10% in Russia,
Latvia, Estonia and Lithuania (fig. 1). Between 1998 and 2002, the
improvement was highest (+5.6%) in Canada and between 2002
and 2006, (over 5%) in French Belgium, Czech Republic, Flemish
Belgium, Finland and Estonia. Between 2006 and 2010, the improve-
ment was over 5% in Greenland, Finland and Flemish Belgium.
In all studied countries and regions between 1994 and 2010, girls
had higher prevalence of more-than-once-a-day toothbrushing
frequency than boys (OR = 2.06, 99% CI 2.03–2.10) (table 1).
Adoption of recommended toothbrushing habits increased with
age for girls (15-year-olds vs. 11-year-olds: OR = 1.50, 99% CI
1.46–1.55), but not for boys (0.95, 0.93–0.98).
The increasing trend from 1994 to 2010 was stronger among boys
than girls (OR
2010 vs. 1994
for boys 1.60; for girls 1.48) and among the
younger adolescents (OR
2010 vs. 1994
for 11-year-olds 1.64; for 15-
year-olds 1.45).
Discussion
From a public health perspective, improvement of toothbrushing
habits is important in preventing the most common dental
diseases, but even more so in reducing common risk factors for
the main non-communicable diseases. Furthermore, twice-a-day
toothbrushing frequency is a good indicator of a healthy lifestyle
in general.
4,12,13
Another positive aspect of good toothbrushing
habits is that it has been shown to predict higher educational
achievements for adolescents in later life.
14
Trends found in our study were mostly positive. Relative and
absolute improvement was greater among the younger age groups
and boys, although these groups had more to improve upon in 1994,
and continue to have lower prevalence in more-than-once-a-day
toothbrushing in 2010. However, inequalities by country, gender
and age group have decreased quite consistently during this time
period, suggesting this to be a period of equalization overall.
A similar positive trend was reported previously in Scotland.
15
The small decline observed in toothbrushing prevalence in the
Scandinavian countries, especially in Denmark and Sweden, might
be attributed to different causes. The major reason is probably that
the public health focus has, in most recent years and to some extent,
drifted away from emphasising dental health. For example in
Denmark, school dental clinics have closed and children have to
25
30
35
40
45
50
55
60
65
70
75
80
85
90
1994 1998 2002 2006 2010
Sweden
Germany
Denmark
Austria
Norway
Scotland
Wales
Canada
Czech Republic
France
Poland
Estonia
Greenland
French Belgium
Flemish Belgiu
m
Hungary
Russia
Finland
Latvia
Lithuania
Figure 1 Prevalences (%) and trend of more-than-once-a-day toothbrushing among 11–15-year-old schoolchildren in 20 different countries/
regions in five consecutive HBSC surveys, from the 1994 survey to the 2010 survey (16 years)
Trends in toothbrushing 21
go to private dental clinics. Although, dental care is still free for all
children, attending services is not as easy as it was when the clinics
were on school premises. This might have especially affected less
privileged groups including the immigrant population. In general,
toothbrushing frequency in the HBSC countries has been shown to
be lower among the less privileged children.
15,16
Immigration has
increased in Scandinavia; in 2010 almost one-fifth of the population
in Sweden and one-tenth in Denmark were immigrants or their
descendants from dozens of different countries.
17,18
Toothbrushing
frequency has been shown to be lower and oral health poorer among
the immigrant children than among the native.
19,20
Oral health and
corresponding habits of immigrants can already be poorer (and es-
tablished) when moving to a new country.
19
This reflects to the
situation of their native country. The difference tends to remain
even after settling into a new living environment.
Conclusions
Adoption of recommended toothbrushing frequency has increased
in most of the studied countries or regions, except in the
Scandinavian countries where the frequency was already high in
1994. This has resulted in an equalization of toothbrushing
frequency cross-nationally.
Acknowledgements
HBSC is an international study carried out in collaboration with
WHO/EURO and involves a wide network of researchers from all
participating countries and regions. The international coordinator
was Prof. Candace Currie, University of St. Andrews, and the
databank manager was Prof. Oddrun Samdal, University of
Bergen. A complete list of participating countries and researchers
is available on the HBSC website (http://www.hbsc.org). The data
collection in each country or region is funded at national level. We
are grateful for the staff at the Norwegian Social Science Data
Services, Bergen, for their work in preparing the international data
file for all the surveys.
Funding
We are grateful for the financial support from the government
ministries, research foundations and other funding bodies in the
participating countries and regions. We particularly thank the
Norwegian Directorate of Health, which contributed funding to
the HBSC Data Management Centre.
Conflicts of interest: None declared.
Key points
The article describes a positive trend in the toothbrushing
frequency in a large number of countries.
Cross-nationally, the article illustrates a declining difference
in toothbrushing frequency.
The article shows greater improvement among the younger
age groups and boys, which have been target groups for oral
health education for decades. However, these groups still
lacks far behind the others and need to be continuously
targeted.
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Trends in toothbrushing 23
... Study results showed that tooth brushing was the oral hygiene practice most frequently employed by the older adults in our sample, although the observed percentage was low compared to the general population and other, younger groups. [10,20] In general, oral health-and particularly oral hygiene practicesamong older adults have been little studied, thus limiting comparisons with other research initiatives. A Hong Kong study of older adults-59 with dementia and 59 apparently healthyindicated that the frequency of tooth brushing was 5% and 31%, respectively. ...
... Consequently, is a universally accepted recommendation for maintaining good dental and periodontal health among all age groups. [20,21] Nonetheless, it has been shown that tooth brushing alone is not sufficient for eliminating interproximal plaque; additional techniques such as the use of dental floss, rubber points and interdental brushes are recommended. [22] Tooth brushing is beneficial for oral health preservation among adults, since it produces pressure, stretching and mechanical vibratory stimulation of the tongue, periodontal ligament (through pressure on the teeth), gums and palate. ...
... Therefore, from a public health perspective, improving tooth brushing habits is conducive not only to preventing the most generalized dental diseases, but also, and more importantly, to reducing common risk factors for the principal non-communicable diseases. [20] It has been reported that the intraoral environment affects intestinal microbiota and may cause systemic inflammation. [24] In recent decades, it has been established that oral health among the general population varies according to social determinants. ...
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The objective of the study was to characterize self-reported oral hygiene practices among Mexican older adults aged ≥60 years, and to measure the association between frequency of tooth brushing and a set of sociodemographic, socioeconomic, and dental variables.We conducted a cross-sectional study of 139 older adults aged ≥60 years in Pachuca, Mexico. A questionnaire and a clinical dental examination were administered to identify specific variables. We determined frequency of tooth brushing (or cleaning of dentures or prostheses) and use of toothpaste, mouthwash, and dental floss among respondents. Non-parametric testing was performed for statistical analysis and a multivariate logistic regression model was generated with Stata 11 software to determine frequency of tooth brushing.In our study sample, 53.2% of participants reported brushing their teeth at least once a day, 50.4% always using toothpaste, 16.5% using mouthwash and 3.6% using floss for their oral hygiene. In general, younger and female respondents used oral hygiene aids more than the others. Our multivariate model yielded an association (P < .05) between tooth brushing at least once daily and the following variables: having functional dentition (OR = 12.60), lacking health insurance (OR = 3.72), being retired/pensioned (OR = 4.50), and suffering from a chronic disease (OR = 0.43).The older adults in our sample exhibited deficient oral hygiene behaviors. The results suggest certain socioeconomic inequalities in oral health. The findings of this study should be considered when designing dental care instructions for older adults.
... 2 Twice-a-day toothbrushing is a good indicator of a healthy lifestyle in general. 14 It is plausible that parents of adolescents from high-income families are better educated than those from low-income families, and hence their knowledge of the importance of toothbrushing thereby exerts an influence on their children's habit of brushing twice-daily from childhood. 36 However, oral health habits also reflect individual factors independent of socioeconomic background. ...
... In our study, a clear gender difference was observed: the girls tended to follow the recommended toothbrushing frequency more often than the boys did, which is in line with previous international studies. 14,29,30 About two-thirds of the girls (67%) brushed their teeth twice daily, while the cor-r r responding percentage for the boys was 40%. The association of gender difference and health behaviour is stronger when adjusting for differences in the families' financial cir-r r cumstances and parental occupational status. ...
... Finnish adolescents have been among the most infrequent toothbrushers in Europe, although the situation has improved in recent years. 14,29 According to the Health Behaviour in School-aged Children (HBSC) study (2001/2002), only 45% of Finnish 15-year-olds brushed their teeth twice a day, while 80% of Danish, 81% of Norwegian, and 83% of Swedish 15-year-olds brushed their teeth as recommended. 29 In a later HBSC study (2005/2006), only half of the Finnish 15-year-olds (50%) brushed their teeth twice daily. ...
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... Tooth brushing twice daily with fluoridated toothpaste is considered the basic oral self-care behaviour for maintenance of good oral health [6], and is recommended for all individuals to prevent caries [2,7]. About 70% of 10-14-year-olds are reported to brush more than once daily [8,9]. Few studies have focussed on the use of dental floss in teenagers and their frequency of daily flossing is reported to be less than 20% [10,11]. ...
... The proportion who reported brushing was slightly higher than previously reported [10]. Several studies have shown that tooth brushing frequency has increased among schoolchildren in many countries [8,33]. The present study showed that one of the five children did not perform the recommended brushing twice daily, and brushing frequency was associated with caries prevalence. ...
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... In addition, because sex-related differences in toothbrushing are common, 15,16 this study aims to investigate the longterm trends of toothbrushing frequency among Finns of working age from 1978 to 2014 and assess the influences of age-, period-, and cohort-specific effects by sex under the age-period-cohort (APC) framework. 17 All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and were approved by the national research ethical committees of National Public Health Institute of Finland and Finnish Institute for Health and Welfare. ...
... Internationally, Finnish boys' low toothbrushing frequency is seen in their adolescence. 15 This may be linked with the wide sex-related differences in health in Finland. Finnish men smoke more, drink more alcohol, eat less healthfully, have higher cholesterol, higher blood pressure levels, more cardiovascular diseases, more diabetes, less social contacts, and trust other people less than Finnish women do. ...
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... Although it is acknowledged how domestic oral health care should be performed, epidemiologic surveys point at a lack of efficient biofilm removal and awareness in the general population. In 16/20 European countries, 25-50% of teenagers brush their teeth less than twice a day [4]. Even children trained at school in group prophylaxis programs have low efficiency to adopt the toothbrushing recommendations given: Only 7.5% of the children brushed both inner and outer surfaces by the intended movements for at least 90% of the respective brushing time [5]. ...
... In the authors' opinion, the development of auto-cleaning devices seems a gratifying approach to increase both the frequency and the efficacy of toothbrushing which have been ascertained to be insufficient in the majority of adults and adolescents/children [3][4][5][6]19]. Therefore, we undertook analyses to spot the reasons for the lack of efficacy of the amabrush® design. ...
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Objectives To compare the cleansing efficacy of a representative “ten seconds” auto-cleaning device with that of uninstructed manual toothbrushing in a pilot study.Materials and methodsTwenty periodontally healthy probands refrained from oral hygiene for 3 days. Baseline full-mouth plaque scores (Rustogi Modified Navy Plaque Index, RMNPI) were assessed. After randomization, probands cleaned their teeth either with the auto-cleaning test device according to the manufacturer’s protocol or with a manual toothbrush. Plaque reduction was assessed by two aligned blinded investigators. After a 2-week recovery, the clinical investigation was repeated in a crossover design. The brushing pattern of the auto-cleaning device was analyzed in probands’ casts.ResultsFull-mouth plaque reduction was 11.37 ± 3.70% for the auto-cleaning device and 31.39 ± 5.27% for manual toothbrushing (p < 0.0001). The investigation of the auto-cleaning device’s brushing pattern in dental casts revealed a positive relationship of bristle rows in contact with tooth surfaces and the cleansing efficacy in the respective areas. A maximum of 2/4 bristle rows were in contact with the tooth surfaces; in some areas, the bristles had no contact to the teeth.Conclusions Uninstructed manual toothbrushing is superior to auto-cleaning. The alignment and density of the auto-cleaning device’s bristle rows need to be improved, and assorted sizes would be necessary to cover different jaw shapes.Clinical relevanceThe auto-cleaning device has been developed to accommodate individuals with poor dexterity or compliance. To date, it is unable to provide sufficient plaque reduction due to an inappropriate bristle alignment and poor fit with diverse dental arches.
... For example, some 50-70% of 11-15-yearold schoolchildren in 20 different countries reported to brush their teeth at least two times per day. 23 This behavior in the present study was reported by as low as 28% of the study participants. This figure is, however, comparable to the findings of some other local population studies; for example, 22% in a group of employees from Birjand University of Medical Sciences, South Khorasan Province 24 , 19% in a group of 13 to 15-year-old students in Isfahan 25 , and 26% of 15-year-old students in Tehran. ...
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Objectives This study aimed to assess the oral health status of a group of Telecommunication Company (TCC) employees in Tehran, Iran. Methods This cross-sectional study included a convenience sample of 426 employees using the WHO suggested protocol for oral health survey. Data regarding employees' oral health knowledge, behaviors, and status were collected by oral examination and using a self-administered questionnaire. Statistical analysis included the Chi-square test, t-test, and ANOVA. Results The participants’ mean age was 45.89±8.17 years, and 63% were males. The majority of the respondents were aware of the effectiveness of tooth brushing and dental flossing for prevention of oral diseases, and the relationship between oral health and general health. Twice a day tooth-brushing was reported by 28% and daily dental flossing by 48%. Also, 93% of the employees were non-smokers. Their mean DMFT was 12.88±5.56 with the following components: D: 1.40±1.80, M: 2.71±3.57, and F: 8.78±4.77). Filled teeth were more prevalent among women, subjects with higher educational degrees, and the office staff than the technicians. Conclusion The TCC employees seem to enjoy a good level of access and utilization of dental care services considering their high share of filled teeth in their DMFT index. Better maintenance and further improvement of their oral health require comprehensive and continuous oral health promotion programs.
... Definitely lower rates of youths who brushed their teeth twice or more times a day were recorded in the Czech Republic (79.5% girls and 61.9% boys), in France (70.9%), in Portugal (65.1%) and in Australia (57%) [56][57][58][59]. In accordance with the results of other authors, we observed a significant difference between the genders referring to the frequency of toothbrushing [59][60][61]. Girls were brushing their teeth at least twice a day (96.6%, p = 0.0001) and before bedtime (97.4%, p = 0.0001) more often than boys. ...
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Caries has a negative influence on health and is still a public health problem among children and adolescents in Poland. The aim of this study was to analyze the association of dietary habits, oral hygiene behaviors and the frequency of usage of dental services with the dental caries index in teenagers in North-West Poland. The study enrolled 264 children (147M/117F) aged 15. Participants filled out a questionnaire regarding age, sex, frequency of visits to the dentist, dietary habits and oral hygiene behaviors, and the Decayed Missing Filled Teeth Index (DMFT) was calculated. Caries was found in 88.6% of subjects. The lower or no caries experience group (DMFT ≤ 5) comprised of 180 subjects, while higher caries experience (DMFT > 5) was found in 84 teenagers and was significantly inversely associated with tooth brushing after the last meal (OR = 0.45; 95% CI:0.21–0.97; p = 0.04) and the daily use of dental floss (OR = 0.12; 95% CI:0.01–0.92; p = 0.04). There is an emerging need for the implementation of effective caries prevention and recovery programs in Poland. Health promotion focusing on oral hygiene behaviors should be disseminated more widely because lower caries experience was demonstrated in teenagers declaring healthy oral habits. Another important need is the development of multi-sectorial actions aiming at the improvement of dietary habits.
... Oral self-care behaviors are necessary for the oral health promotion [6]; oral self-care habits such as tooth brushing, dental flossing, and regular dental visits are recommended for good oral health and prudential health [7][8]. The recent study in Iran showed that 25.0% of children never brushed their teeth, which indicates a poor oral self -care in children [9]. ...
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Statement of the problem: Oral self- care is an important aspect of lifestyle and a serious public health issue. Purpose: This study aimed to evaluate the effect of an educational program based on the theory of planned behavior (TPB) on the mothers and children's oral self-care behaviors. Materials and method: This quasi-experimental study was conducted on 148 mothers and their children (1-6 years) who referred to the health centers of Tabriz, Iran ; divided into two groups of intervention (n=74) and control (n=74). Data were collected through a questionnaire that included demographic characteristics, oral self-care behaviors, and structures of TPB. Both groups completed questionnaires before, immediately, 3 and 6 months after the intervention. The experimental group received three educational sessions, each session held for 120 minutes. The educational methods such as lectures, group discussion, and demonstrations were used. Data were analyzed using SPSS (ver18) software and Chi-square, Independent samples t-test and repeated measure ANOVA at the significant level of < 0.05. Results: Before the intervention, there were no statistically significant differences between both groups in oral self -care behaviors and structures of TPB (p> 0.05). Immediately, 3 and 6 months after the intervention the mean scores of oral self-care behavior presented a significant increase in both mothers and their children in the intervention group (p< 0.001). Six months after the intervention, brushing children's teeth twice a day increased significantly from 8.1% (6/74) to 55.4% (41/74) in the experimental group (p< 0.001). At immediately, 3, and 6 months after the intervention, the mean scores of mothers' attitude, subjective norm, perceived behavioral control and intention towards the children's oral health were significantly increased in the experimental group compared to the control group (p< 0.001). Conclusion: According to the results of this study, intervention based on the theory of planned behavior promotes the oral self-care behavior both in mothers and in their children.
Article
Background: Adverse effects can occur during orthodontic treatment. Objective: To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time. Method: A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included. Results: Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p> 0.05) was observed between enamel demineralization and length of time under orthodontic treatment. Conclusions: A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study.
Article
Objective Whether the understanding of dental caries influences how future dentists manage the disease themselves has not been previously studied. Thus, this study evaluated whether the conceptualization (understanding) of dental caries by dental students is related to their own preventive oral care routine. Methods Dental students at a U.S. dental school (n = 517) were invited to voluntarily respond to an anonymous electronic survey in spring 2018. Demographic characteristics, caries conceptualization (CC), dental care habits, and self‐caries risk determination were asked. Discursive responses to CC were analyzed by content analysis technique, and categories [c] were created. Chi‐square and Fisher's exact tests were used for analysis. Results Overall response rate was 54.5% (n = 282, 48.2% female). Three researchers independently analyzed discursive answers and classified them into 1 of 6 caries concept categories [c]: [c1] only signs of the disease (10.3%), [c2] bacterial disease‐not specifying bacterial metabolism (38.3%), [c3] bacterial byproducts‐not specifying substrate (13.8%), [c4] biological or multifactorial concept (24.8%), [c5] comprehensive multifactorial disease (8.2%), or [c6] other (4.6%). Only 33% completely defined dental caries according to the modern understanding of the disease (c4−c5). Statistical differences were found between: CC and diet modification, CC and rinsing after brushing, year of school (YS) and self‐determined caries‐risk, YS and brushing at school, and YS and rinsing after brushing (P < 0.05). Conclusion Our data suggest that the students’ understanding of the disease can influence how they will manage the disease in terms of diet modification and behavior after brushing. Moreover, self‐caries risk determination influenced students’ brushing behavior.
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To examine if self reported toothbrushing behaviour is associated with cardiovascular disease and markers of inflammation (C reactive protein) and coagulation (fibrinogen). National population based survey. Scottish Health Survey, which draws a nationally representative sample of the general population living in households in Scotland. 11,869 men and women, mean age 50 (SD 11). Oral hygiene assessed from self reported frequency of toothbrushing. Surveys were linked prospectively to clinical hospital records, and Cox proportional hazards models were used to estimate the risk of cardiovascular disease events or death according to oral hygiene. The association between oral hygiene and inflammatory markers and coagulation was examined in a subsample of participants (n=4830) by using general linear models with adjustments. There were a total of 555 cardiovascular disease events over an average of 8.1 (SD 3.4) years of follow-up, of which 170 were fatal. In about 74% (411) of cardiovascular disease events the principal diagnosis was coronary heart disease. Participants who reported poor oral hygiene (never/rarely brushed their teeth) had an increased risk of a cardiovascular disease event (hazard ratio 1.7, 95% confidence interval 1.3 to 2.3; P<0.001) in a fully adjusted model. They also had increased concentrations of both C reactive protein (beta 0.04, 0.01 to 0.08) and fibrinogen (0.08, -0.01 to 0.18). Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.
Article
The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents. Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses. At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4). Daily smoking and infrequent toothbrushing are strongly associated in adolescence.
Article
Inflammation has been strongly related to metabolic syndrome (MetS). Periodontal disease is the most common chronic infection in adults. We investigated a cross-sectional (n = 925) and 3-year longitudinal (n = 685) relationship between the daily frequency of toothbrushing and MetS. In the cross-sectional analysis, the prevalence of MetS was 15.7%. After adjustment for potential confounding factors (including all lifestyle factors), the odds ratios (95% confidence interval [CI]) of having MetS in those who brushed 2 times/day and ≥ 3 times/day were 0.71 (0.48-1.05) and 0.47 (0.24-0.92), respectively, as compared with ratios in those with a toothbrushing frequency of ≤ 1 time/day. Increasing toothbrushing frequency tended to relate inversely to hypertriglyceridemia and high-sensitivity C-reactive protein. In the longitudinal analysis, 99 participants were newly diagnosed with MetS. The adjusted odds ratios (95% CI) of the MetS in participants who brushed 2 times/day and ≥ 3 times/day as compared with participants who brushed ≤ 1 time/day were 0.80 (0.49-1.31) and 0.43 (0.19-0.97), respectively. The frequency of toothbrushing was related inversely only to hypertriglyceridemia, consistent with the cross-sectional analysis. This study found that more frequent toothbrushing is related to a lower prevalence and incidence of MetS. These results suggest that more frequent toothbrushing may contribute to the prevention of MetS due to the inflammation/triglyceride pathway.
Article
To describe the occurrence and severity of dental caries in children and adolescents and to relate these findings to the subject's socio-cultural and socio-economic backgrounds. A cross-sectional study in 12 706 children aged 5, 7, 12 and 15 years was conducted in 2006. Data on children's caries experience were collected from public oral health registers and pooled with socio-cultural and socio-economic data obtained from official statistics. The study population represented 76% of all registered inhabitants. Among 5- and 7-year-old children with non-Danish mothers, the mean caries experience was three to four times higher than among children of Danish mothers, and a doubled rate was seen among the adolescents (p < 0.001). Significant differences in caries experience were found in various ethnic minorities. Multiple regression analysis showed that the level of caries was highest among children in families where mothers were not Danish, with low income, where mothers' educational levels were low, and in with a high number of children (p < 0.001). Although almost all children and adolescents attend the prevention-oriented, free public dental service, a social gradient still exists for dental health. In addition, in all age groups, major inequalities in dental health were found when families with Danish and non-Danish backgrounds were compared. The findings indicate a need for social action by policymakers. Furthermore, a change in the oral health preventive strategy is proposed to meet the needs of children in risk of caries, and appropriate oral health-promotion programmes should be organized in collaboration with leaders from different ethnic minorities.
Article
The aim of this study (part of the Juvenile Health Habit Study) was to analyze changes in how frequently certain oral hygiene measures are used, namely toothbrushing and dental flossing in 1977-81. A representative sample of Finnish adolescents aged 12, 14, 16 and 18 yr old, were sent a postal questionnaire in February 1977 (n = 3209), another in February 1979 (n = 4953), and a third one in February 1981 (n = 4705). The response rates for the three questionnaires were 88%, 86% and 88%, respectively. During the years studied no systematic changes occurred in the toothbrushing frequency. When the background factors that are highly correlated with toothbrushing frequency (school career or school success of adolescents, householder's occupation and education, place of residence) were studied, no consistent changes were observed from 1977 to 1981. The percentage of adolescents who used dental floss daily did not change. However, the proportion of sporadic users of dental floss increased from 13% in 1979 to 24% in 1981. Dental health education had little effect on toothbrushing habits and its background variables, although the amount of time spent in dental health education during the same period had increased significantly. Programs of dental health education should be evaluated so that the situation can be improved in the future.
Article
Families immigrating to Sweden from Finland and Southern Europe (Greece, Yugoslavia, and Turkey), as well as Swedish control families of the same social class, were interviewed twice on their children's oral hygiene and dietary habits and on the parents' knowledge of oral health. The first interview was made on the immigrants' arrival in Sweden and the second one 30 months later. The material comprised 35 Finnish, 23 South-European and 54 Swedish families. During the observation period more immigrant than control children had complained about toothache. The frequency of toothbrushing was lower among the immigrants than among the Swedes at both interviews. The frequency of sweets consumption was significantly higher among the immigrants. Fewer immigrant than Swedish children had been examined or treated by a dentist before the first interview. There was no difference between the immigrants and the controls in channels of information about oral hygiene, the schools and the dentists being the foremost source of information for both groups. The Swedish parents had a more competent knowledge of oral hygiene than the parents of the immigrant children. It was concluded that Finnish and South-European immigrant children definitely have a great need of preventive dentistry.
Article
The purpose of this study was to analyse the establishment of the toothbrushing frequency as a healthy habit by Finnish adolescents between 12 and 18 years of age. The data were collected as part of the nation-wide research programme, the Adolescent Health and Lifestyle Survey. All Finns born in 1968 with birthdays on 20-25 July formed the sample (N=1106). Questionnaires were mailed to the whole sample in February 1981 (12 years of age), -83 (14 years), -85 (16 years) and -87 (18 years). The rate of return for all four questionnaires was 62 percent (six-year follow-up) and for two questionnaires (two-year follow-up studies) 79 percent (12 and 14 years), 72 percent (14 and 16 years) and 68 percent (16 and 18 years). Those adolescents who brushed their teeth more than once a day at age 12, were more stable in their behaviour during the following six years than those who brushed their teeth less often. Over two thirds of the respondents, both boys and girls, indicated one or more changes in their toothbrushing frequency in the four questionnaires during the six-year follow-up. The rate of improvement in toothbrushing frequency was higher among girls than boys, and the rate of deterioration in toothbrushing frequency was higher among boys than girls. One sixth of the adolescents still showed a deterioration in their brushing frequency between the ages of 16 and 18. It may be concluded that although toothbrushing frequency will be gradually adopted as a health habit when the adolescents mature between 12 and 18 years, only half the girls and one fifth of the boys adopt the recommended frequency. Health education should still improve performance in those groups which have not established the recommended toothbrushing frequency.
Article
To analyse trends in development of the toothbrushing frequency of Finnish adolescents and the socio-economic factors associated with these trends between 1977 and 1995. The data were collected as part of a nation-wide research programme, the Adolescent Health and Lifestyle Survey, which started in 1977. Since then a 12-page questionnaire has been sent every other year. Dental health behaviour was studied from the outset. The sample represented 12-, 14-, 16- and 18-year-old children and adolescents in Finland. The sample size varied between 3,205-10,626, making a total of 66,687 participants. The recommended toothbrushing frequency, twice-a-day, was studied. The socio-economic factors included age, gender, self-assessed school performance, level of education, socio-economic status of the householder, and socio-economic category of the residential area. Among boys, daily toothbrushing increased from 1977 to 1995, but among girls it remained stable. Among boys, the prevalence of twice-a-day toothbrushing frequency varied from 13 per cent to 25 per cent between the ages of 12 and 18 years, and among girls from 32 per cent to 60 per cent, respectively. Among 12- to 14-year-old boys, the socio-economic differences almost disappeared. There were no changes among 12- to 14-year-old girls but there was an unexpected declining trend in toothbrushing among 16- to 18-year-old girls. Apparently further improvement in the toothbrushing frequency of girls had stopped. Although there was a clear trend towards improvement of toothbrushing frequency among boys, their toothbrushing frequency still lagged far behind that of girls.