Inaug.-Diss.--Bonn. / Vita. "Literaturverzeichnis": p. 57-68.

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Nationally an increased inequality in oral health is seen. Children coming from a lower socioeconomicbackground, as well as children with immigrant background show a higherprevalence of caries. The reason for this can be cultural differences but also parentalunawareness.In this study, the differences in knowledge and oral health habits of children aged 7-8 areinvestigated. The hypothesis is that an increased education and training of oral health inprimary school can help to provide a more equitable oral health in children, regardless oftheir background.Three schools where chosen for this study based on their representation of different socioeconomicareas. A total of 176 pupils participated in the study, where they were asked to fillout a questionnaire about their habits and knowledge of oral health. The same questionnairewas filled out at a later time after they had an educational session and illustrative teachingmaterial was handed out to all of the pupils. The results from the first and second sessionwere compared and analysed.This study shows that there are big differences in children’s oral habits and knowledge inbetween different schools depending on their socioeconomic level. Differences could also beseen depending on the children’s cultural background, as children with foreign-born parentshad a lower knowledge and in some aspects more lacking oral habits. It could also beconcluded that education in school had a positive impact on the children’s knowledge in oral health regardless of their background.

An age stratified random sample of 2280 adults over the age of 60 years, from three different areas of England, were interviewed and examined by a dentist in order to assess their dental status needs and demands. The towns of Salisbury (representing an urban community in the South of England), Darlington (representing an urban community in the North of England) and Richmondshire in North Yorkshire (representing a rural community) were the areas used. This allowed Salisbury and Darlington, the two towns used in one of the original population studies of adult dental health in 1962, to be revisited after 30 years. Response rates were around 55%, and a postal follow up of refusers allowed the influence of sampling bias on key dental factors to be established. The final sample was mostly ambulant and severe disability was rare, except in the oldest subjects (75^). Four dentists conducted the examinations, but one examiner (the author) undertook half of the examinations in each area. Geographical location, age and social class were strongly related to edentulousness. The percentage edentulous ranged from 11% in the younger (age 60-64) Salisbury non-manual workers to 90% in the oldest (age 75^) Darlington unskilled manual workers. A further 10% of the total sample in all three areas was edentulous in one arch. Complete dentures were rarely free of faults, but the relationships between denture faults, as assessed by the dentist, and reported dissatisfaction were weak. In the dentate sample, partial dentures were worn by 40%. Most of these were made of acrylic and were of a simple tissue supported design. Around 20% had had a partial denture made in the past which they were unable or unwilling to wear. Decay, periodontal attachment loss and tooth wear increased with age, but geographical variations were small. The most important influence on the dental health of the dentate was dental attendance pattern. Subjects who only attend the dentist when driven by pain had about six fewer teeth, six fewer filled teeth, and about twice as much decay (taking into account the number of teeth left) as those who attend for check-ups. 40-50% of the sample had some moderate periodontal attachment loss, but signs of more severe disease were found in only 10-25%. CPITN was an inappropriate measure of periodontal disease in an elderly population; loss of attachment and tooth mobility were preferable. Some moderate tooth wear affected about 40% of the sample, but did not seem to be closely related to functional problems. Most of the teeth with root surface decay, advanced periodontal disease and severe wear were concentrated in a minority of the sample. Demands and attitudes in the dentate varied with geography, gender and social class. Dental non-attenders were more common among men (particularly in the North) and people from manual backgrounds. A perceived lack of need for treatment was the major reason given for non-attendance. Fear of edentulousness and a preference to have restorative treatment were more common in the south. Few subjects reported difficulty with access to dental care. The risk factors for dissatisfaction and difficulty with eating were analysed using a model of the factors contributing to oral health and well being. The presence of unfilled anterior spaces and social and demographic variables were the major risk factors for dissatisfaction with aesthetics. Symptoms and the number of missing teeth were the most important factors leading to eating difficulties and dissatisfaction with masticatory function. Partial dentures are much more likely to be worn when there are less than 20 teeth, and where there is an anterior space. Number of posterior contacts and dental attendance pattern were the other major determinants of partial denture wearing. Partial dentures were a major risk factor for having root surface decay and fillings. Oral health goals for the elderly, taking into account the need to retain sufficient teeth to function through life, are presented. The absence of partial dentures, 20-24 teeth and 2-4 posterior contacts are seen as the desirable minimum, although these requirements may reduce with age.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Dentistry (Community Dentistry) Johannesburg, 2015 / This study aims to assess Oral Health-Related Quality of Life among children with special needs, from the caregiver’s perspective. The objectives of the study were: (i) To describe the demographic profile of the caregivers in terms of age, gender and socio-economic status,(ii) To assess the dental caries status of children with special needs,(iii) To establish the caregivers’ perceived Oral Health-Related Quality of Life of the children with special needs using the short-form Parent-Caregiver Perception Questionnaire, (iv) To assess the impact of the dental caries status on the families of children with special needs using the Family Impact Scale questionnaire. Results: The study consisted of 150 caregiver child pairs, the mean age of the caregivers was 39.52 years (SD 9.26) and mean age of children was 8.72 years (SD 6.07). There was a high prevalence of untreated caries regardless of the type of disability. The highest caries prevalence in both the primary and permanent dentition was found in the Epilepsy and the Autism groups (75%-83%) while the lowest was found among Down syndrome and Cerebral palsy groups (30%-47%).All the caregivers expressed impact on the Oral Health-Related Quality of Life.The mean Parent-Caregiver Perception Questionnaire score was 12.88 (SD 12.14) while the mean Family Impact score was 6.05 (SD 6.77). The highest Parent-Caregiver Perception score of 20.5 (SD 11.07) was found in the complex disability group followed by the Down syndrome group 15.87 (SD 13.87). The highest scores were found in the oral symptoms, functional limitation and emotional wellbeing domains which contributed more to the parent perception score. Conclusion: Caregivers of children with special needs in the current study experienced a negative impact on Oral Health-Related Quality of Life. Caries experience of the children with special needs was slightly lower than in the general population irrespective of disabilities and had no impact on the FIS and overall global rating-well-being.

Dental caries prevalence in many developing countries is low but an increased prevalence has recently been reported from some of these countries. This is in contrast to the data from the industrialised countries which show a consistent decrease in caries prevalence, particularly in urban populations. The phenomenon of a low caries experience in areas having an optimal fluoride concentration in water is well documented. On the other hand, many reports show that higher than optimal levels of fluoride in drinking water are associated with varying degrees of fluorosis (Murry et. al, 1991). In developing countries, a high prevalence of periodontal disease has been reported in both teenagers and adults. The present study compared the caries profile, periodontal disease and fluorosis among children and adults residing in low, "optimal" and high fluoride areas in four villages in the Mankwe region, North-West Province of South Africa. The population of the Mankwe region was approximately 63 000 in 1993 and fifty percent of whom were children (Development Bank of South Africa, 1994). The climateis hot and dry, and until recently, people depended on underground and rain water. Access to tap water was costly. Oral health facilities were limited and there were inadequate oral health personnel. The method of sampling, examination techniques, instruments used and the statistical analysis were carried out under supervision of experienced epidemiologist and in consultation with expert statisticians. The indices used included the Decayed, Missing and Filled Teeth (DMFT, drnft), Community Periodontal Index of Treatment Needs (CPITN) (WHO 1987; Ainamo et al, 1982), Dean's Index (Dean et al. 1942) and the Tooth Surface Index of Fluorosis (TSIF) (Horowitz et at,1984). A total of 360 subjects aged 6-7,12-13 and 30-55 years were examined. More than 90 percent of the 6-7 year old children were caries-free in the permanent dentition at all four study villages. Both ttmft and DMFT scores were very low. DMFT values for the 12-13 year old group was also well within the WHO goals in all the villages but increased in the adult group. The D-component was dominant in all groups with the occlusal surfaces most affected. There was a high percentage of periodontal disease but with low severity. Less than 30 percent of the adults aged 30-55 years demonstrated bleeding on probing at all the four villages. In the 30-55 year age groups, calculus was predominantly found at Lerome and less than 32 percent and 20 percent had shallow and deep pockets respectively at all the four villages. All those in the 12-13 and 30-55 year age groups were assessed as needing oral hygiene instructions and less than 20 percent of the adults needed advanced periodontal care. When using Dean's index in the 12-13 year age group, the highest percentage with fluorosis was found at Ruighoek which had an excessive amount of fluoride in drinking water, but fluorosis was also pronounced at Lerome. The central incisors were more affected than the lateral incisors when using the TSIF. Also, mandibular first molars were more affected than maxillary first molars. In the 30-55 year olds, there was a decrease in the severity of fluorosis with age at the high fluoride villages, but all of the adults examined had brown discolouration at Ruighoek. Based on the finding of this study it is suggested that greater efforts be made to introduce proven preventive treatment programmes in these communities. More human resources particularly in the form of auxiliaries should also be employed in order to promote oral health education and provide basic periodontal intervention. The fluorosis problem could be addressed by introducing potable water and the unsightly brown discolouration in adolescents could be eliminated by either bleaching, composite veneers or crowns, However, the latter solution is expensive and Is dependent on sophisticated equipment and highly trained dental personnel.

Background: People with physical and intellectual disabilities have varying health needs and living arrangements. They depend on their carers for their daily oral hygiene care. Objectives: 1. To describe the dental practices and oral health among people aged 18–44 years with physical and intellectual disabilities and 2. To determine if residential setting is associated with care recipients’ oral health status, or if there are other factors, which if modified, could improve the oral health of adults with physical and intellectual disabilities. Methods: Cross-sectional mailed questionnaire survey (February 2005 – June 2006) of carers of adults with physical and intellectual disabilities (18–44 years) living in South Australia in three settings: family home; community housing; and institutions, followed by oral examinations of care recipients by trained examiners at recalls or new appointments. Decayed (D), missing (M) and filled (F) teeth (DMFT), tooth wear, oral hygiene and gingival status were recorded. Results: Carers completed the questionnaire for 485 adults, a yield of 37.9%, of which 267 care recipients were examined (completion rate = 55.1%). Some 47.4% of the care recipients lived in family homes, 31.4% in community housing and 21.2% in institutions. Some 39.3% of care recipients had their teeth brushed once a day or less, with most needing assistance from their carers. Infrequent toothbrushing and inadequate time to clean were more frequently reported by carers at family homes than those at other settings (P<0.001). Care recipients at institutions visited the dentist more frequently than those at other settings (P<0.001). Other care recipients had problems accessing dental care due to their carers’ lack of awareness of dental services available, lack of dentists with adequate skills in managing people with disabilities, cost, location of dental clinic, lack of dentists willing to treat people with disabilities and transportation problems. Some 18.8% of care recipients required a general anaesthetic and 13.1% an oral sedation for oral examination and treatment. Presence of both oral health problems and treatment needs were reported by almost 50% of carers, but only 13.5% of care recipients reportedly experienced one or more negative impacts. Oral examinations showed that the prevalence of untreated decay among the care recipients in South Australia was 16.9% (95% CI= 12.7, 21.7) and 76.3% (95% CI= 71.0, 81.2) had past and present caries experience. None of the examined subjects wore a removable prosthesis, although nearly 50% had one or more missing teeth. After adjusting for carer and care recipient characteristics, multivariate analysis showed that there was no difference (P>0.05) in the prevalence of untreated decay (D>0) missing teeth (M>0), filled teeth (F>0), caries experience (DMFT>0) or mean DMFT among the three residential settings. However, untreated decay was significantly associated with moderate [OR= 3.7 (1.2, 11.4)] and high intake [OR= 3.3 (1.1, 11.1)] of sweet drinks and never visiting the dentist or visiting only because of a problem [OR= 5.2 (1.7, 15.8)]; missing teeth were significantly associated with requirement for a general anaesthetic for dental treatment [OR= 3.2 (1.4, 7.2)] and having low [OR= 3.4 (1.1, 10.3)] and high [OR= 4.2 (1.7, 10.7)] weekly hours of care; filled teeth were significantly associated with 35–44 age-group [OR= 5.4 (2.0, 14.9)], lack of oral hygiene assistance from carers [OR= 5.1 (2.2, 11.8)] and high weekly hours of care [OR= 4.4 (2.0, 9.5)]; and caries prevalence was significantly associated with 35–44 age-group [OR= 7.3 (2.0, 26.3)], lack of oral hygiene assistance from carers [OR= 4.0 (1.3, 12.5)] and high weekly hours of care [OR= 6.3 (2.5, 15.9)]. Mean DMFT was significantly associated with 35–44 age-group [β= 3.0 (0.4, 5.6)], autism [β = 3.4 (1.3, 5.8)], intellectual disability [β = 2.5 (0.3, 4.8)], and high weekly hours of care [β = 3.6 (1.6, 5.6)]. Anterior tooth wear was found in 45.1% (95% CI= 36.1, 53.9) and posterior tooth wear in 23.9% (95% CI= 18.7, 29.0) of care recipients. Care recipients in the community were more likely to have posterior tooth wear compared to those in family homes. Anterior tooth wear was significantly associated with 25–34 age-group [OR= 3.1 (1.5, 6.5)], 35–44 age-group [OR= 2.6 (1.1, 6.2)] and rumination [OR= 3.4 (1.3, 9.2)]. Oral hygiene and gingival status were poor with the prevalence of extensive plaque (dental plaque on all surfaces of the tooth, with a score of 2 or more) of 40.0% (95% CI= 34.1, 45.9), extensive calculus (moderate to abundant amount of supra and subgingival calculus, with a score of 2 or more) of 41.9% (95% CI= 36.0, 47.8), and extensive gingivitis (gingivitis extending all around the tooth, with a score of 2 or more) of 36.0% (95% CI= 30.2, 41.8). Residential setting was not associated with oral hygiene and gingival status. Extensive plaque was significantly associated with 35–44 age-group [OR= 3.9 (1.4, 11.2)], poor to fair general health [OR= 3.3 (1.2, 9.0)], habit of placing food/medicine/other products in mouth for lengthy periods of time [OR= 7.8 (2.7, 22.7)], care recipients cared for by male carers [OR= 3.9 (1.4, 10.8)], and care recipients with high weekly hours of care [OR= 4.0 (1.5, 10.8)]. Extensive calculus was significantly elevated in prevalence in the 25–34 age-group [OR= 4.3 (1.8, 10.7)], 35–44 age-group [OR= 5.3 (1.8, 15.4)]. Extensive gingivitis was significantly associated with always needing help for self-care activities from carers [OR= 3.5 (1.2, 10.2)]. Conclusions: Residential setting was not associated with caries experience, oral hygiene and gingival status among adults with disabilities, after adjustment for age and other relevant characteristics of care recipients. However, care recipients in the community were more likely to have posterior tooth wear compared to those in family homes. Emphasis should be placed on modifiable factors like carer assistance with daily oral hygiene care, diet and regular dental visits, whilst ensuring that carers are not overburdened. / Thesis (Ph.D.)-- University of Adelaide, School of Dentistry, 2008

Objectives: This study aimed to assess the oral health status of the Toronto adult homeless population; to learn how they perceive their own oral health; and how they interact with the dental care system. Methods: This cross-sectional descriptive study collected data from 191 homeless adults who were randomly selected using a stratified cluster sample at 18 shelters. A questionnaire and clinical oral examination were conducted with participants. Results: The mean Decayed/Missing/Filled Teeth (DMFT) score of the subjects was 14.4 (SD=8.1). Only 32% of them had visited a dentist during the last year; 75% believed that they had untreated dental conditions; and 40% had their last dental visit for emergency care. The clinical oral examination observed that 88% needed fillings, 70% periodontal, 60% prosthodontic and 40% emergency treatment. Conclusion: Homeless adults in Toronto have poor oral health, significant oral health treatment needs and a lack of access to dental care.

Objectives: This study aimed to assess the oral health status of the Toronto adult homeless population; to learn how they perceive their own oral health; and how they interact with the dental care system. Methods: This cross-sectional descriptive study collected data from 191 homeless adults who were randomly selected using a stratified cluster sample at 18 shelters. A questionnaire and clinical oral examination were conducted with participants. Results: The mean Decayed/Missing/Filled Teeth (DMFT) score of the subjects was 14.4 (SD=8.1). Only 32% of them had visited a dentist during the last year; 75% believed that they had untreated dental conditions; and 40% had their last dental visit for emergency care. The clinical oral examination observed that 88% needed fillings, 70% periodontal, 60% prosthodontic and 40% emergency treatment. Conclusion: Homeless adults in Toronto have poor oral health, significant oral health treatment needs and a lack of access to dental care.