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An Evaluation of Oral and Dental Health Services in Turkey and in the Member States of the EU in Terms of Economy
Abstract
Dental health expenditures are a big part of general health expenditures. In Turkey, oral health services are provided by both private practitioners and government sections. In 2012, approximately 7 million fillings were made by government clinics. According to Turkish Dental Association data, in the same year, the number of fillings that Turkish citizens needed was 247 million. Even if the entire budget of the Health Ministry of Turkey were spent for these fillings, it is impossible to handle this demand. In 2012, in the European Union with 24 member countries, dental health spending was close to 74 billion Euro. Because of this financial burden, Turkey and the other countries are trying to find cost-effective methods to minimize dental health spending. This chapter emphasizes dental health conditions of both Turkey and European Union, firstly, and then successful and cost-effective strategies are discussed.
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We investigated the association between diet and head and neck cancer (HNC) risk using data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. The INHANCE pooled data included 22 case–control studies with 14,520 cases and 22,737 controls. Center-specific quartiles among the controls were used for food groups, and frequencies per week were used for single food items. A dietary pattern score combining high fruit and vegetable intake and low red meat intake was created. Odds ratios (OR) and 95% confidence intervals (CI) for the dietary items on the risk of HNC were estimated with a two-stage random-effects logistic regression model. An inverse association was observed for higher-frequency intake of fruit (4th vs. 1st quartile OR = 0.52, 95% CI = 0.43–0.62, p
trend < 0.01) and vegetables (OR = 0.66, 95% CI = 0.49–0.90, p
trend = 0.01). Intake of red meat (OR = 1.40, 95% CI = 1.13–1.74, p
trend = 0.13) and processed meat (OR = 1.37, 95% CI = 1.14–1.65, p
trend < 0.01) was positively associated with HNC risk. Higher dietary pattern scores, reflecting high fruit/vegetable and low red meat intake, were associated with reduced HNC risk (per score increment OR = 0.90, 95% CI = 0.84–0.97).
Biomed Central, Cochrane Oral Health Group Trials Register, CENTRAL, Directory of Open Access Journals, Expanded Academic ASAP Plus, Metaregister of Controlled Trials, PubMed, ScienceDirect, Research Findings Electronic Register, BBO and LILACS.
Studies reporting in English, Spanish or Portuguese were included if they reported on the caries preventive effect of salt fluoridation and provided mean DMFT scores with standard deviations or 95% confidence intervals. Randomised or quasi-randomised studies together with cross-sectional studies where historical control data were available for relevant cohorts were included. Studies were assessed for quality.
Data were extracted independently by two reviewers, with disagreements being resolved by discussion. Nine studies were included in a meta-analysis.
Two studies included 6-8 year-old children and showed a pooled reduction in DMFT scores of -0.98 (95%CI -1.68 to -0.29). The eight studies involving 9-12 year-old children showed a significant pooled DMFT reduction of -2.13 (95%CI -2.55 to -1.70, p<0.0001), while the four studies with cohorts of 13-15 year-old children exhibited a great reduction in DMFT scores of -4.22 (95%CI -6.84 to -1.59, p<0.001). In one study that compared salt fluoridation with water fluoridation there was no statistical difference between the two groups.
The pooled estimates for each of the age cohort favoured salt fluoridation versus no exposure. However, due to the poor quality of the studies the contribution of fluoridated salt to the declines in DMFT could not be quantified. Thus, while this meta-analysis favours salt fluoridation, further high quality studies are needed to confirm its efficacy.
head and neck cancers are a heterogeneous group of malignancies, affecting various sites and subsites, with differing prognoses. The aim of this study was to analyse survival for European head and neck cancer patients in populations covered by population-based cancer registries (CRs), in relation to tumour subsite as prognostic factor.
we analysed 51 912 adult head and neck cancer cases (36 322 mouth-pharynx and 15 590 larynx) diagnosed from 1995 to 1999 and archived by 45 CRs in 20 countries participating in EUROCARE-4. Five-year age-standardised relative survival was estimated for mouth-pharynx and larynx sites by sex and country. Relative survival was modelled to provide estimates of relative excess risks (RERs) of death by country, adjusted for confounding factors.
a large but site-variable proportion of tumours were incompletely specified. Five-year age-standardised relative survival was low in Slovakia and high in The Netherlands. Adjustment for subsite reduced RERs of death for most countries; 5-year relative survival increased from 1990-1994 to 1995-1999 for all subsites, while between-country differences in survival narrowed.
differences in subsite distribution explain a considerable part of the survival differences for head and neck cancers, however, incomplete/inaccurate subsite reporting complicate interpretation.
Caries prevalence in underprivileged children is particularly high and, even though many efforts have been made, adherence to dental preventive programs is low. The purpose of this study was to evaluate whether a tutoring program can improve oral health behavior in underprivileged and/or immigrant children.
Thirty fourth-grade children (mean age = 9.6), over 50 percent of immigrant background, participated in this longitudinal pilot study. The fourth graders were invited to develop on oral health program for their first-grade peers. For this purpose, the fourth graders learned oral health practices and developed the peer tutoring program. Prior to the intervention and after having instructed their first-grade peers, all fourth graders were interviewed about their oral health habits and their tooth-brushing was recorded on video. Toothbrushing time, performance of circular tooth-brushing movements, and systematic cleaning of all dental surfaces were analyzed before and after the intervention.
After peer teaching, there was a significant increase concerning tooth-brushing time (P = .004), performance of circular tooth-brushing movements (P < .001), and systematic cleaning of all dental surfaces (P < .001).
The tutoring program yielded a significant improvement in relevant oral care behavior. This approach provided an environment which, in contrast to traditional approaches, facilitates empowerment.
The magnitude of risk conferred by the interaction between tobacco and alcohol use on the risk of head and neck cancers is not clear because studies have used various methods to quantify the excess head and neck cancer burden.
We analyzed individual-level pooled data from 17 European and American case-control studies (11,221 cases and 16,168 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We estimated the multiplicative interaction parameter (psi) and population attributable risks (PAR).
A greater than multiplicative joint effect between ever tobacco and alcohol use was observed for head and neck cancer risk (psi = 2.15; 95% confidence interval, 1.53-3.04). The PAR for tobacco or alcohol was 72% (95% confidence interval, 61-79%) for head and neck cancer, of which 4% was due to alcohol alone, 33% was due to tobacco alone, and 35% was due to tobacco and alcohol combined. The total PAR differed by subsite (64% for oral cavity cancer, 72% for pharyngeal cancer, 89% for laryngeal cancer), by sex (74% for men, 57% for women), by age (33% for cases <45 years, 73% for cases >60 years), and by region (84% in Europe, 51% in North America, 83% in Latin America).
Our results confirm that the joint effect between tobacco and alcohol use is greater than multiplicative on head and neck cancer risk. However, a substantial proportion of head and neck cancers cannot be attributed to tobacco or alcohol use, particularly for oral cavity cancer and for head and neck cancer among women and among young-onset cases.
A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.
Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents' health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27-33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with "street-oriented" behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a "traditional" lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.
The use of fluoride toothpastes, mouthrinses, gels or varnishes reduces tooth decay in children and adolescents. Tooth decay (dental caries) is painful, expensive to treat and can seriously damage teeth. Fluoride is a mineral that prevents tooth decay. The review of trials found that children aged 5 to 16 years who applied fluoride in the form of toothpastes, mouthrinses, gels or varnishes had fewer decayed, missing and filled teeth regardless of whether their drinking water was fluoridated. Supervised use of self applied fluoride increases the benefit. Fluoride varnishes may have a greater effect but more high quality research is needed to be sure of how big a difference these treatments make, and whether they have adverse effects.
The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries.
Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status.
In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable.
The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.
Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain.Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness.Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.
The common risk factor approach (CRFA) has been highly influential in integrating oral health into general health improvement strategies. However, dental policy makers and oral health promoters have interpreted the CRFA too narrowly. They have focussed too heavily on the common behavioural risks, rather than on the broader shared social determinants of chronic diseases. A behavioural preventive approach alone will have minimal impact in tackling oral health inequalities and indeed may widen inequalities across the population. Based on recent WHO policy recommendations, this study presents the case for updating the CRFA in accordance with the social determinants agenda. The theoretical basis for a social determinants framework for oral health inequalities is presented, and implications for oral health improvement strategies are highlighted. Future action to address oral health inequalities in middle- and high-income countries requires a radical policy reorientation towards tackling the structural and environmental determinants of chronic diseases. In more equal and fairer societies, all sections of the social hierarchy experience better health and social well-being.
This review gives an update on recent epidemiologic data on periodontal diseases and a description of current periodontal services in Europe. A Medline search of articles published within the last decade with the keywords epidemiology, prevalence, periodontitis, tooth loss, and Europe was performed. Data on provision of dental services originated from international databases. Epidemiologic data on the prevalence of edentulism, the number of missing teeth, the prevalence of probing depth (Community Periodontal Index - CPI >or= 3 or Pocket Depth - PD >or= 4 mm), and clinical attachment loss (CAL >or= 4 mm) displayed a fragmentary picture within Europe. With respect to the limited data on periodontal health, Spain, Sweden, and Switzerland ranked as the healthiest among European countries in contrast to Germany where increased tooth loss and the highest prevalence of CAL >or= 4 mm were reported. The role of dental auxiliaries especially of dental hygienists and/or the medico-legal framework in which they work, appears to be an important factor in provision of effective periodontal care. Actual epidemiologic data on periodontal diseases are non-homogeneous and absent from several European countries. This emphasises the need for more national representative epidemiological studies with a uniform design to permit comparability between different nations. Merging actual epidemiologic data with former data on provision of periodontal care may help to explain differences in periodontal parameters on a population basis and to define future provision of dental care.
There are adverse effects of income inequality on morbidity and mortality. This relationship has not been adequately examined in relation to oral health.
To examine the relationship between income inequality and periodontal disease in rich countries.
Adults aged 35-44 years in 17 rich countries with populations of more than 2 million.
National level data on periodontal disease, income inequality and absolute national income were collected from 17 rich countries with populations of more than 2m. Pearson and partial correlations were used to examine the relationship between income inequality and percentage of 35-44-year-old adults with periodontal pockets > or = 4 mm and > or = 6 mm deep, adjusting for absolute national income.
Higher levels of income inequality were significantly associated with higher levels of periodontal disease, independently of absolute national income. Absolute income was not associated with levels of periodontal disease in these 17 rich countries.
Income inequality appears to be an important contextual determinant of periodontal disease. The results emphasise the importance of relative income rather than absoluteincome in relation to periodontal disease in rich countries.
Epidemiologic studies provide broad-based evidence that men are at greater risk for developing destructive periodontal disease than women, even after adjusting for behavioral and environmental factors, such as oral hygiene practice and smoking. What requires clarification, however, is whether sex-specific differences in immune function provide a plausible biologic basis for a sexual dimorphism in susceptibility to destructive periodontal disease. This review examines evidence that might provide an underlying biologic basis for a sexual dimorphism in the prevalence and severity of destructive periodontal disease.
A narrative review of the literature related to sexual dimorphism in pathogen-mediated inflammatory diseases and immune response was retrieved from searches of computerized databases (MEDLINE, PubMed, and SCOPUS).
Sex steroids exert profound effects on multiple immunologic parameters regulating both the amplification and resolution of inflammation. Strong evidence exists for sexual dimorphisms in immune function, involving both innate and acquired immunity. Injury and infection have been associated with higher levels of inflammatory cytokines, including interleukin-1β and tumor necrosis factor-α, in men than women, paralleling observed sex-specific differences in periodontitis.
Differential gene regulation, particularly in sex steroid-responsive genes, may contribute to a sexual dimorphism in susceptibility to destructive periodontal disease.
Up-to-date statistics on cancer occurrence and outcome are essential for the planning and evaluation of programmes for cancer control. Since the relevant information for 2008 is not generally available as yet, we used statistical models to estimate incidence and mortality data for 25 cancers in 40 European countries (grouped and individually) in 2008. The calculations are based on published data. If not collected, national rates were estimated from national mortality data and incidence and mortality data provided by local cancer registries of the same or neighbouring country. The estimated 2008 rates were applied to the corresponding country population estimates for 2008 to obtain an estimate of the numbers of cancer cases and deaths in Europe in 2008. There were an estimated 3.2 million new cases of cancer and 1.7 million deaths from cancer in 2008. The most common cancers were colorectal cancers (436,000 cases, 13.6% of the total), breast cancer (421,000, 13.1%), lung cancer (391,000, 12.2%) and prostate cancer (382,000, 11.9%). The most common causes of death from cancer were lung cancer (342,000 deaths, 19.9% of the total), colorectal cancer (212,000 deaths, 12.3%), breast cancer (129,000, 7.5%) and stomach cancer (117,000, 6.8%).
The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in two rural county areas, i.e. Fyrbodal and Skaraborg, Västra Götaland, Sweden, with special reference to gender and socioeconomic grouping. A randomized sample of 506 individuals (Fyrbodal 250 and Skaraborg 256 individuals, respectively) was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets and gingival recession. Bitewing radiographs were used for assessment of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. A majority of the subjects (76%) claimed to brush their teeth at least twice a day, while interdental hygiene means were used daily by 4%. The subjects showed a mean plaque score of 47% and a gingivitis score of 56%. Forty-six % of the adolescents had a plaque score of > or = 50%, whereas the corresponding figure for gingivitis was 62%. The subjects had on average 5.5 teeth with facial gingival recession. The mean prevalence of sites with probing depth (PPD) of > or = 4 mm was 8, out of which 99% were located at proximal sites. A radiographic bone level of > 2 mm was observed at on average 0.4 teeth per subject. Logistic regression analyses revealed that gender (males) and county area (Fyrbodal) were significant factors for a high plaque and gingivitis score. There was no significant difference in periodontal conditions in relation to socio-economic grouping. In conclusion, the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents, but no differences between socioeconomic groups.
School-based sealant programs (SBSPs) increase sealant use and reduce caries. Programs target schools that serve children from low-income families and focus on sealing newly erupted permanent molars. In 2004 and 2005, the Centers for Disease Control and Prevention (CDC), Atlanta, sponsored meetings of an expert work group to update recommendations for sealant use in SBSPs on the basis of available evidence regarding the effectiveness of sealants on sound and carious pit and fissure surfaces, caries assessment and selected sealant placement techniques, and the risk of caries' developing in sealed teeth among children who might be lost to follow-up. The work group also identified topics for which additional evidence review was needed.
The work group used systematic reviews when available. Since 2005, staff members at CDC and subject-matter experts conducted several independent analyses of topics for which no reviews existed. These reviews include a systematic review of the effectiveness of sealants in managing caries.
The evidence supports recommendations to seal sound surfaces and noncavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece prophylaxis to clean tooth surfaces, and to provide sealants to children even if follow-up cannot be ensured.
These recommendations are consistent with the current state of the science and provide appropriate guidance for sealant use in SBSPs. This report also may increase practitioners' awareness of the SBSP as an important and effective public health approach that complements clinical care.
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.
Previous studies have shown that sociodemographic factors are associated with adolescent toothbrushing. While there has been some investigation of parental modelling of oral health behaviour and the association between parental support and oral health, there has been no investigation of the home environment and its effect on oral health behaviour. The current study examines variables related to the family, including mealtime routines and family relationships to determine the best predictors of adolescent toothbrushing.
Data from the 2006 Health Behaviour in School-Aged Children Survey were modelled using logistic univariate and multivariable modelling with outcome variable twice-a-day toothbrushing.
Higher family socioeconomic and affluence were significantly associated with greater odds of toothbrushing twice a day or more. Family structure was also significantly associated with girls' toothbrushing. However, under the multivariable model, eating breakfast was found to be the best predictor of twice-a-day toothbrushing among boys and girls. The next best predictor of boys' toothbrushing was eating family meals and of girls' toothbrushing, never going to bed hungry, followed by family affluence for both boys and girls. Under the multivariable model, family structure was no longer significantly associated with girls' toothbrushing.
The study shows that the family and home environment should play a central role in the promotion of oral health, through mealtime routines, incorporating a fair parenting style and developing open and positive family relationships. Not only are these strongly associated with twice a day toothbrushing but, unlike sociodemographic factors, they may be relatively easy to adopt.
The authors conducted a systematic review of original studies that was designed to assess the impact of polyol-containing chewing gum on dental caries compared with the effect with no chewing gum.
The authors searched MEDLINE, The Cochrane Library and Google Scholar up to May 2008 to identify peer-reviewed articles that compared polyol-containing chewing gum with no chewing gum. The authors extracted study characteristics, data on incremental dental caries and quality by consensus. Data on prevented fraction (PF) were pooled across studies.
The results of 19 articles with data from 14 study populations showed that the use of xylitol, xylitol-sorbitol blend and sorbitol were associated with mean PF (95 percent confidence interval) of 58.66 percent (35.42-81.90), 52.82 percent (39.64-66.00) and 20.01 percent (12.74-27.27), respectively. For the sorbitol-mannitol blend, it was 10.71 percent (-20.50-41.93), which was not statistically significant. Sensitivity analyses confirmed the robustness of the findings.
Although research gaps exist, particularly on optimal dosing and relative polyol efficacy, research evidence supports using polyol-containing chewing gum as part of normal oral hygiene to prevent dental caries.
The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in immigrants and refugees in Catanzaro and Crotone, Italy. The mean DMFT and DMFS scores of adults, 18 or more years, were 8.1 and 33.1 for Yugoslavs, 7.4 and 28.8 for Moroccans, and 1.4 and 4.5 for Senegalese. The analysis of variance carried out on the three groups showed a significant inequality in their DMFT and DMFS scores. The stepwise linear regression showed that in the Moroccans and Yugoslavs the DMFT increased with age. The needs for dental extractions and for conservative dental care were respectively 15.8% and 39.5% in the Senegalese, 28.6% and 73.8% in the Yugoslavs, 32.7% and 77% in the Moroccans. Good oral hygiene status was scored for 26.3% Senegalese, 7.1% Yugoslavs, and 5.5% Moroccans. Good periodontal health was scored for 7.9%, 2.4%, and 1.2% of these groups. The analysis of variance carried out on the three groups showed a significant inequality in their OHI-S and PI, and the Bonferroni test showed a significant differences in both indices comparing the Senegalese with the Moroccans and in the OHI-S between Senegalese and Yugoslavs. The stepwise linear regression showed that in the Yugoslavs the OHI-S and in the Moroccans and Yugoslavs the PI increased with age. The results of this investigation demonstrated high caries prevalence, poor oral hygiene and periodontal health, and unmet needs for dental treatment in particular Moroccans and Yugoslavs, and a systematic and comprehensive implementation of oral health promotion program for these groups is a priority need.
To explore Gypsy Travellers' perceptions of dental health and dental service use within the context of culture, environment and the use of other services.
The author was a community dental officer and the study formed part of a MSc dissertation in dental public health.
Information was obtained from semi-structured interviews with 43 Gypsy Travellers supplemented by a questionnaire and clinical screening of 72 Travellers.
Place of residence, registration with GMP and GDP, school attendance, caries, normative and perceived barriers to care.
The Travellers in the study had a high level of unmet need, low dental registration and very little use of preventive services. Travellers have no cultural barriers to dental care. Control of their travelling was the major factor determining access to education and health services.
There is inequity of dental health and dental service use with more disadvantage being experienced by Travellers on unauthorized and transit sites.
This study was designed to examine associations between the number of posterior occlusal pairs of teeth and the nutritional status of older adults participating in the third National Health and Nutrition Examination Survey (NHANES III) survey.
Impaired dentition was assessed by number of posterior occluding pairs of teeth (grinding teeth, n=8 pairs) and complete denture status. Nutritional status was measured by nutrient intake, Healthy Eating Index (HEI) score, serum values, and body mass index (BMI). Subjects/setting Data from 5,958 participants in NHANES III ages 50 years and over with dental examination were included in the analysis. Statistical analyses performed Analysis of covariance and multivariate linear regression analyses were performed to examine associations between number of tooth pairs and nutritional status indicators controlled for potential confounders.
Compared with individuals with five to eight posterior occluding pairs (HEI=68.2), those with impaired dentition (no posterior pairs, one to four pairs remaining, or full dentures) had consistently lower HEI scores (HEI=64.3, 66.5, and 66.5, respectively), consumed fewer servings of fruits, and had lower serum values of beta carotene and ascorbic acid. Participants with one to four posterior pairs also had a higher mean BMI (28.0) than those with five or more pairs (27.2). Participants in one or more groups with impaired dentition had lower dietary intake levels of vitamin A, carotene, folic acid, and vitamin C, and scored less well on diet variety, cholesterol, and sodium components of the HEI.
Results show that dental health is closely associated with nutritional status and suggest that status of dentition should be considered in nutritional counseling and assessment of older adults.
People with disabilities have more dental disease, more missing teeth, and more difficulty receiving dental care than other members of the general population. Because of the deinstitutionalization movement during the later 20th century, many formerly institutionalized people now reside in community settings, which lack oral health services. Even individuals who were not institutionalized have barriers to oral health services. These realities underscore the importance of preventing dental disease in people with special needs by establishing preventive dental disease protocols.
Individuals undergoing treatment for alcohol use disorders exhibit increased risk for impaired oral health. We conducted a study to assess oral health and demographic characteristics of inpatients under treatment for alcohol use disorders.
Thirty-four inpatients, 24 male and 10 female, with diverse ethnicity, were recruited in a rehabilitation center for alcohol use disorders in Buffalo, NY. Before undergoing oral examination, subjects completed a questionnaire on dental hygiene, associated behaviors, and demographic characteristics. Information regarding patients' oral health was collected using plaque, gingival, and decayed, missing or filled teeth (DMF) indices, and by examining soft tissue and evaluating signs of abrasion, erosion, and attrition. Statistical analysis determined prevalence and descriptive characteristics.
Alcohol intake for the population was, on average, 45.7 drinks/week, and 61.8% had smoked cigarettes within the past month. Patients were missing 15.1% of their teeth. Of teeth examined, 13.5% had dental caries. Prevalence of soft tissue abnormalities was 35.3%, prevalence of tooth erosion was 47.1%, and prevalence of moderate/severe gingival inflammation was 82.3%. Although study participants reported brushing at least once a day, 70.6% of subjects presented with heavy dental plaque accumulation. Most participants (85.3%) described the condition of their mouth and teeth as fair or poor. Finally, we observed a satisfactory participation rate among those who qualified for the study.
Oral examination showed significant levels of dental caries, gingival inflammation, soft tissue abnormalities, and tooth erosion. In addition, this study indicates that patients undergoing treatment for alcohol use disorders evidence poor oral health, and are at heightened risk for the development of periodontal disease.
The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.
The departmental service of maternal and infantile protection (PMI) of Moselle (Lorraine region), together with the Paediatric Dentistry Department from Nancy University, organized a study of the dental health of 4-year-old children.
To assess the children dental health; to evaluate parental knowledge of dental health; to identify the factors associated with caries amongst children.
The study was a cross sectional observation. A random sample of 4-year-old children was selected among 11 586 children in nursery schools. The study was based on a clinical examination performed by a dentist and a structured questionnaire completed by parents.
The overall proportion of children affected by caries was 37.5%. The mean dmft score was 1.51 (sd = 2.82) and 11.6% of the children had caries which affected their upper incisors, a sign of early childhood caries. Only 6.2% had received dental treatment on at least 1 occasion. There was a clear disparity in dental health: 1 child out of 3 suffered from caries but 1 out of 2 children in priority education districts was affected, compared with only 1 out of 4 children coming from a rural area. The questionnaires completed by parents showed a lack of knowledge of dental health and inadequate use of current prevention facilities. The multivariate logistic regression analysis showed that the variables that were significantly associated with caries in 4 year-old children were the mother's education, the low social background, the level of consumption of drinks containing sugar by both children and parents, the consumption of fluoride, and the level of knowledge about fluoride.
Preventive measures must be developed in close relationship between pediatricians and dentists. Initial training of health care professionals has to be reinforced. Health care professionals in paediatrics are far more likely to meet mothers and young children than are dentists.
The effect of a relatively common chronic disease, severe dental caries, affects young childrens' growth and well-being. Treating dental caries in pre-school children would increase growth rates and the quality of life of millions of children. Severe untreated dental caries is common in pre-school children in many countries. Children with severe caries weighed less than controls, and after treatment of decayed teeth there was more rapid weight gain and improvements in their quality of life. This may be due to dietary intake improving because pain affected the quantity and variety of food eaten, and second, chronic inflammation from caries related pulpitis and abscesses is known to suppress growth through a metabolic pathway and to reduce haemoglobin as a result of depressed erythrocyte production.
The authors provide an overview of chewing gum as a delivery vehicle for dental-protective agents, highlighting xylitol and its potential application in caries-prevention programs for children.
The authors reviewed selected clinical investigations and previous reviews associated with chewing gum containing substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol and their effects on reducing caries. They searched the MEDLINE database by using the key words "dental caries," "oral health," "calcium," "bicarbonate," "carbamide," "chlorhexidine," "fluoride" and "xylitol."
Chewing gum is being used as a delivery vehicle for substances such as calcium, bicarbonate, carbamide, chlorhexidine, fluoride and xylitol to improve oral health and reduce caries. These substances exhibit properties that are protective of the oral environment and mediate common oral diseases. The debate for advocating xylitol use in caries prevention is advancing; however, chewing gum use by young schoolchildren in the United States is hindered by choking hazard concerns and lack of specific xylitol dosing recommendations.
The use of chewing gum containing dental-protective substances, particularly xylitol, in caries-prevention programs can reduce the tooth decay epidemic. Chewing gum use by children in the school setting should be reconsidered.
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