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Dentists by their professional knowledge of prevention have a key role in providing a positive role model for oral health-promoting behaviours. We aimed to investigate the health behaviour of Iranian senior dental students in terms of oral self-care and tobacco use during a 10-year period to assess their preparedness to act as role models for health-promoting behaviours.The study was performed in six dental schools selected through stratified cluster random sampling to have a representative sample of all dental schools in Iran. Data were collected in four occasions in 2005, 2008, 2011 and 2015. Senior dental students (N = 1188) were invited to voluntarily complete a self-administered anonymous questionnaire about their oral self-care and tobacco use. Recommended tooth-brushing habit (RTH) was defined as at least twice a day brushing with fluoridated toothpaste. Three separate questions about cigarette, pipe and waterpipe use were applied to assess the students' reported use of tobacco.The response rate was 81%. Female students reported more frequently RTH than males (p .001). The reported RTH was more prevalent among nonsmokers. In 2005, 2008, 2011 and 2015, 22.5%, 26%, 28.5% and 24.6% of the students reported smoking, respectively. The trend of reported smoking had the least variation among female students. This was true also for male students regarding RTH.The status and trend of oral self-care and tobacco use among Iranian dental students call for more emphasis on adopting health-promoting behaviours during dental education.

Objectives Clinical guidelines for tobacco use cessation (TUC) counseling recommend that healthcare professionals should provide brief tobacco counseling for all tobacco users. Widespread implementation of these guidelines seems to be insufficient. To enhance adherence to TUC counseling guidelines, it is essential to identify provider behaviors related to a successful implementation. This study aims to assess adherence to TUC counseling guidelines and factors that are associated with counseling behaviors. Methods A 41-item questionnaire relevant to the implementation of TUC counseling guidelines among healthcare professionals was administered. This questionnaire included items used to evaluate TUC counseling behaviors as well Theoretical Domains Framework (TDF)-based behavior change items. Of the 95 oral health professionals invited from 34 community dental clinics in Finland, 73 professionals (76.8 percent) participated. The TDF factors and their associations to TUC counseling behaviors were analyzed using correlations and logistic regression analyses. Results Adherence to TUC counseling guidelines, especially for providing advice to quit, assisting in quitting and arranging follow-up services, were low. In addition, only 15.1 percent of the providers reported asking about tobacco use and 8.2 percent assessed interest in quitting among the majority (>75 percent) of their patients. Of the behavior change domains, “Memory, Attention and Decision Processes” and “Professional Role and Identity” were found to be significantly associated with TUC counseling behavior among oral health professionals. Conclusions Regarding the adherence to TUC counseling guidelines, there is room for improvement. The identified TDF factors related to TUC behaviors provide an avenue for targeted interventions to improve guideline implementation.

Aim: The aim of the present study was to develop a functional oral health literacy (OHL) instrument for adults, including new measures of literacy skills (OHL Adults Questionnaire: OHL-AQ). Methods: An item pool was provided, and an expert panel evaluated the items by assessing the content validity index and content validity ratio. The reliability analysis, including internal consistency and reproducibility, were examined using Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC). In addition a known-groups comparison was performed to assess how well the questionnaire discriminates between individuals who differ in education and brushing behavior. Results: A total of 97 participants were studied. The mean age of the participants was 36.3 (standard deviation [SD] = 12.8) years; 34% had more than 12 years’ formal education. Overall, 39.2% of interviewees had inadequate, 16.5% had marginal, and 44.3% had adequate OHL. The internal consistency, as measured by Cronbach’s alpha, was found to be 0.72, and the ICC was 0.84. Participants who brushed more frequently had significantly higher OHL scores (P = 0.03). The association between OHL scores and years of education was also significant (P < 0.001). Conclusion: The OHL-AQ is a valid and reliable measure of functional OHL, with additional sections for evaluating listening and decision-making skills.

Bayat F, Vehkalahti MM, Murtomaa H, Tala H. Why do adults entitled to free or highly subsidized dental services select fully out-of-pocket-paid care? Community Dent Oral Epidemiol 2010; 38: 88–95. © 2009 John Wiley & Sons A/S Abstract – Objective: To investigate patients’ reasons for selecting a dental clinic given their choice of free or highly-subsidized dental services. Methods: The study was based on cross-sectional data obtained through phone interviews with adults in Tehran, Iran. The present study included those entitled to free or highly-subsidized dental services (n = 726). The data covered the patients’ awareness of subsidized dental services and type of dental clinic for their most recent visit and their reasons for selecting that clinic. Awareness of subsidized dental services was dichotomized as being either aware or unaware of such subsidy. The type of clinic was dichotomized as providing either free or highly-subsidized (FHS) or fully out-of-pocket paid (FOP) services. Free format answers about the subjects’ reasons for selecting a particular clinic were later sub-grouped as: convenient access, good technical aspects, good interpersonal aspects, low or reasonable fees, recommendation by a friend, and no reason. Socio-demographic status was based on background. Data analysis included the chi-square test and logistic regression model. Results: Of the subjects (n = 726), 60% were women and 58% were under 35 years of age. The subjects’ mean age was 33.5 years with no difference by gender (P = 0.24) and the majority had public insurance (91%). Of all the subjects, 60% selected FOP. Good interpersonal aspects were the strongest reason for selecting FOP (OR = 4.6), follow by good technical aspects (OR = 2.3). Those subjects who were unaware of their benefit had 4.6 times the odds of selecting FOP. Conclusions: Despite the opportunity to use highly-subsidized dental services, good interpersonal and good technical aspects lead patients to select private dentists and to pay fully out of pocket.

The Medical Faculty of the University of Helsinki decided to employ a web-based evaluation system as an integral and essential part of all courses beginning in the autumn term of 2006. Objectives: To analyse the effects of the intervention on dental students’ web-based responses at the University of Helsinki, Finland. Subjects and Methods: A previously developed web-based tool was used for all preclinical and clinical courses from the beginning of the 2006—2007 academic year. We analysed data sets of student feedback for all courses before (2005—2006) and after (2006—2007) the intervention. We then compared the quantity and quality of the students’ feedback for the six standardised questions used in the evaluation, and calculated the means and standard deviations of values obtained with a Likert scale. The students’ assessments in the open questions were categorised according to key issues. Results: Implementation of the system resulted in a considerable increase in student feedback: the mean response rate for the preclinical phase rose from 59% (SD 15.0; range 25—80) before the intervention to 90% (SD 9.6; range 72—100) after it. In the clinical phase, the response rates more than doubled from 34% (SD 15.9; range 9—69) to 73% (SD 12.9; range 45—100). The students’ assessments showed no significant change despite the marked rise in response rates. The educators’ positive attitude towards the students was appreciated (4.2—4.3) whereas the general goals for the courses in the clinical phase seemed unclear to the students (3.4) (P

Objectives: Evaluation of the effectiveness of a school-based oral health promotion intervention on preadolescents' gingival health. Methods: A community trial designed for a 3-month intervention study in a representative sample of 9-year-olds (n = 457) in 16 schools in Tehran, Iran. The schools were randomly assigned to three intervention groups and one control group, each group comprising two boys' and two girls' schools. The first group of children (n = 115) received intervention via class work, solving a set of puzzles containing oral health messages, under supervision of their health counsellor. The second group (n = 114), intervention via parents, included an oral health education leaflet and a brushing diary for supervising the child's tooth-brushing; the third group (n = 111) received a combination of both these interventions. The control group (n = 117) had no intervention. Effects of the intervention were assessed as changes in dental plaque and gingival bleeding. Improvements in gingival health were recorded when half of the index teeth with plaque at baseline became clean (acceptable oral hygiene) or when all index teeth with bleeding at baseline became healthy (healthy gingiva). Statistical analysis included chi square, anova, t-test, Number Needed to Treat (NNT) and generalized estimating equations (GEE). Results: At baseline, none of the children were free of plaque and all except for three boys had bleeding. After the trial, acceptable oral hygiene was more frequent in the parental-aid (P < 0.001) and the combined groups (P < 0.05), and healthy gingiva in both groups (P < 0.001) in comparison with the control group. Outcomes in the class- work group did not differ from those in the control group. The GEE models confirmed a strong intervention effect on healthy gingiva in both groups where parents were involved: parental-aid group (OR = 7.7, 95% CI: 2.2-27.7) and combined group (OR = 6.6, 95% CI: 2.0-22.1). In all intervention groups more girls than boys achieved healthy gingiva (OR = 2.5-2.6). Parents' education showed no impact on the outcome. Conclusions: When a school-based oral health intervention involves parents it may result in a significant improvement in the gingival health of preadolescents with poor gingival health at baseline.

Background. Schools can be an important setting for health education programmes, controlling the growing burden of oral diseases and promoting oral health. Aim. The aim of this study was to evaluate the short-term effect of school-based educational intervention on oral cleanliness and gingival health of 15-year-olds in Tehran, Iran. Design. The present cluster randomized trial was based on exposing students (n = 287; control, n = 130) at public schools to oral health knowledge through a leaflet or a videotape. The outcome was evaluated after 12 weeks. A positive outcome was defined as at minimum a 50% reduction in numbers of teeth with dental plaque or gingival bleeding compared to baseline. Evaluation included percentage changes, number needed to treat (NNT), and students’ self-assessment. Results. At baseline, all students had dental plaque, and 93% had gingival bleeding on at least one index tooth. Positive outcome for oral cleanliness was 58% (P

The reliability and validity of the Dental Fear Survey Schedule for Children (DFSS-C) was examined in a sample of 828 school children in Finland. The DFSS-C mean was 22.1. Choking, injections and drilling were the most common fears. Internal consistency indicated a high level of reliability. Factor analysis (principal components, varimax rotation) found three factors accounting for 54% of the scale variance. Factors were defined as (1) fear of highly invasive procedures, such as injections and drilling; (2) fear of potential victimization, including fear of strangers, choking and hospitals; and (3) fear of less invasive procedures, such as opening the mouth and being examined by the dentist. The factor pattern was similar to results obtained with a sample of children in the United States. There were significant differences in fear score for children whose parents reported them fearful and/or reported them to have had a previous bad experience at the dentist. Boys (but not girls) who had a DMFT score of at least 1 had a significantly higher mean DFSS-C score (21.1) than those who were caries free (20.0). These data suggest the DFSS-C operates in Finland as it does in the United States, but that culture-specific minimal scores for determining high dental fear are needed.

This study aimed to investigate the frequency of tooth loss and the magnitude of prosthodontic rehabilitation based on socio-demographic information among 35- to 44-year-old Iranians. Data (n = 8240) were collected by 33 examiners as part of a national survey using WHO criteria for sampling and clinical diagnosis. Gender, age, place of residence and level of education served as socio-demographic information. The number of teeth, functional dentition (subjects with 20 or more teeth) and prosthodontic rehabilitation were used as clinical variables. The chi-square test and logistic regression analysis were the methods of statistical evaluation. Of all subjects, 3% were edentulous. Of dentate subjects, 3% had 1-9 teeth, 21% had 10-19 teeth, 37% had 20-24 teeth and 39% had 25-28 teeth. In total, 76% of dentate subjects enjoyed a functional dentition. Among dentate subjects, 11% of the men and 16% of the women had prosthodontic rehabilitation with higher figures (P < 0.001) among women, older subjects and urban residents. Having a functional dentition was more likely among those with higher levels of education [odds ratios (OR) = 1.8, 95% confidence intervals (CI) = 1.6-2.1]. Women (OR = 2.4, 95% CI = 1.8-3.0) and urban residents (OR = 2.4, 95% CI = 1.8-3.3) were the most likely groups to have prosthodontic rehabilitation. Having prosthodontic rehabilitation was more likely among those lacking a functional dentition (OR = 6.0, 95% CI = 4.8-7.6). The greatest unmet treatment needs were found among those without a functional dentition. Functional dentition should be set as a primary oral health goal among working-age adults.

Item does not contain fulltext This paper presents a brief context of dental undergraduate curricular structure and content and lays out the Association for Dental Education in Europe's views on requirements and recommendations for learning, teaching and assessment procedures/performance.

This paper presents a proposed curriculum structure and system of European Credit Transfer (ECTS) for undergraduate dental schools throughout Europe. It is the result of the work of a Taskforce ('Taskforce II'), appointed by DentEd, a thematic network of European dental schools and the Association for Dental Education in Europe (ADEE). There has been pan-European discussion of the document in draft stages (it was distributed to 200 dental schools) and following amendment, it was agreed formally at the National Assembly of ADEE in Athens, Greece, in September 2005. The main elements of the paper relate to: (i) a description of the framework proposed with relevance to the Bologna recommendations and common directive on recognition for professional qualifications as they apply to Dentistry; (ii) the structure of an undergraduate dental curriculum; (iii) student exchange and ECTS. In addition, the paper presents a series of requirements, guidelines and recommendations for action. ADEE expects that the 'requirements' proposed will be followed by dental schools in Europe, whilst the 'guidelines' and 'recommendations' also provided are open to local interpretation. The paper is also published on the ADEE website.

In May 2000, a questionnaire-based survey was targeted at all Mongolian dentists practising in the capital city of Mongolia in May 2000 with the aim of evaluating attendance at and the self-perceived need for continuing education (CE) in relation to their background characteristics and to their attitude towards CE. The response rate was 98% (n = 245), with 38% of the dentists reporting a CE learning opportunity in at least one of the clinical disciplines of dentistry during the 2 years prior to the survey. A need for CE in at least one of the disciplines was perceived by 58%. A dentist's field of practice and attitude towards CE were the significant factors for attendance, whereas length of working experience, field of practice, holding a postgraduate degree, and having attended CE courses were significant factors for perceiving a need for CE, when controlling for all other variables in the logistic regression analyses (P < 0.05). There seems to be a need for an increased attendance at CE courses among the dentists and a need for preparing them to have a positive attitude towards CE. On the other hand, creating an organized CE system which produces courses for dental practitioners, based on their need, will be at present a challenge for the Mongolian dental profession.

Summary. Objectives. To describe the dental health of dentists’ children, to evaluate its association with their dentist-parents’ background and work-related characteristics and to compare it with that of children in the general population in Mongolia. Design. Cross-sectional survey, questionnaire-based data. Subjects. Dentists’ children, aged 3–13 years. Sample. All dentists (n = 250) actively practising in the capital city of Mongolia. Results. The dentists’ children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries-free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = −0·22; P = 0·001). Dentist-parents’ background and work-related factors were not associated with their children's caries status (P > 0·05). When dentists’ children were compared with their counterparts at the population level, mean dmft for 6-year-olds was 2·6 for (urban) dentists’ children, 6·5 for children in the urban population and 0·9 for those in rural population of equivalent age. Mean DMFT for 12-year-olds were 1·0, 1·8 and 1·2, respectively, in the same three groups. In general, (urban) dentists’ children in all age groups had better dental health than did their urban counterparts at the population level. Among 5–7-year-olds, dentists’ children had worse dental health than did their counterparts in the rural population. Conclusions. Despite the dentists’ knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.

Objectives: To evaluate the treatment practices of Finnish general practitioners (GPs) and dental teachers (DTs) regarding periodontal treatment modalities, and their knowledge of possible contraindications for periodontal surgery. Material and methods: A questionnaire on two periodontal cases was mailed to 400 GPs, selected by stratified randomization from the public and private sector, and to 47 DTs. The response rate was 77%. Respondents were asked to choose the optimal treatment for a patient with a bleeding, 8-mm-deep periodontal pocket and to consider the influence on their treatment decision of the six possible contraindications for periodontal surgery presented, two of which were absolute (inadequate oral hygiene and poorly controlled diabetes) and four of which were relative contraindications. The respondents' treatment decisions were compared with recommendations from textbooks and the Consensus Report from the 1996 World Workshop of Periodontology. Results: The majority of public (65%) and private (70%) dentists and almost all of the DTs chose treatment in agreement with recommendations. Correct answers from dentists were associated with a greater number of days in continuing education (OR = 1.5; p= 0.005). The two absolute contraindications were known by 38% of public and 31% of private sector dentists, and by 29% of DTs. The respective figures for relative contraindications were 40, 58 and 53%. Conclusion: The majority of Finnish dentists followed the recommendations, but elaboration of international guidelines for good clinical practice is still needed to help clinicians to make optimal treatment decisions.

This Section considered the immense challenges presented by the changing demography of populations (in particular, cross-boundary flow), changing oral and dental disease trends. It also considered the difficulties of gathering data on such information. It then considered how these challenges may affect the education of the dental team in the future. The Section considered the concept of the ‘global village’ as a representation of the changing world demography. We were at pains to recognize that our role was in considering both emerging and established market economies. In fact, a major part of the Section's activities concentrated on the development of the professional ethic of social responsibility – represented at the local, regional, national and international levels. We considered a finite group of oral and dental diseases, namely dental caries, periodontal diseases, oral cancer and cranio-facial disorders. In addition, we chose to comment on systemic diseases influenced by oral diseases, oral diseases influenced by systemic diseases and iatrogenic diseases (including prion disorders and cross-infection control issues). The Section recognized the profound difference between needs and demands in the provision of oral and dental health care. We considered the concept of best practices within our working remit and named these as: • the gathering of valid data on health trends; • uniformity in the measurement of disease and diagnostic parameters; • the identification of a core curriculum which best addresses an increased awareness of changing demography; and • a multidisciplinary approach to education and research in the context of global collaboration. The Section recognized the enormous potential for global networking with the explosion of information and communication technology. We investigated the requirements in converging towards higher global standards, while accepting and appreciating important regional and continental differences. To this end, the Section has put forward a number of important recommendations and realistic goals.

Objectives: The importance of maintenance and promotion of periodontal health is emphasized among people with diabetes because of their high risk for periodontal diseases. Our aim was to evaluate oral health behavior and its determinants among adults with diabetes in Finland. Methods: The population of the questionnaire study consisted of 420 systematically selected adults with diabetes, who were members of a national diabetes register. The response rate was 80%. Questions focused on self-treatment, -prevention, and -diagnosis of oral diseases, utilization of dental services, and knowledge and attitudes toward oral health among adult people with diabetes. Oral self-care was evaluated in the framework of the New Century model of oral health promotion. Results: The proportion of edentulous subjects was 23%, and these were excluded from further analysis. Self-reported twice-a-day brushing among dentate participants was significantly more common among women and the highly educated, but was less common compared with earlier studies among Finnish adults. A quarter of those surveyed reported never cleaning interdental surfaces, with the number of daily cleaners being nearly equal (27%). Age 40 years or over and recent treatment by a private dentist were significant predictors for daily interdental cleaning. The proportion of those who had attended a dental appointment within the last year was 63%, and the main reason for the last dental visit was an emergency among almost one-fifth of those surveyed. Conclusions: A need exists for further promotion of oral self-care among adults with diabetes. Support by dental and other health care professionals involved in diabetes care should be encouraged.

To investigate the preventive practice of Mongolian dental students, in relation to their knowledge of preventive care, self-perceived competency, oral self-care, and dental health status, a questionnaire was distributed to all (n = 79) clinical-year students of The Dental School of the Mongolian National Medical University. Dental students' reported preventive practice was explained by their knowledge of preventive care (P = 0.002) and self-perceived competency (P = 0.002), whereas their study-year, oral self-care, and dental health status, expressed as the Tissue Health Index (THI), remained statistically non-significant in the linear regression model. This explained 28% of the variation in the parameters examined. In logistic regression analysis, a student's study year (OR = 2.5), knowledge of preventive care (OR = 1.1), and THI (OR = 1.8) were related to their highest scores on preventive practice. Preventive practice among Mongolian dental students could be improved by increasing their knowledge, particularly in modern methods for caries-prevention such as fluoride, sealants, and xylitol. Preventive methods should be integrated into all topics of the dental curriculum and the learning environment should support such training for future oral health professionals.

Objectives: To determine the degree of psychological distress, the experience of emotional exhaustion, and the extent of stress associated with course work in dental students and to compare these measurements among seven European dental schools. Design: Multi-centred survey. Setting: Dental Schools at Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool and Manchester. Participants: 333 undergraduate first-year dental students. Measures: General Health Questionnaire (GHQ12), Maslach Burnout Inventory (MBI), Dental Environment Stress Questionnaire (DES), demographic variables. Procedure: Questionnaire administered to all students attending first year course. Completed questionnaires sent to central office for processing. Results: Seventy-nine percent of the sampled students responded. Over a third of the students (36%) reported significant psychological distress (morbidity) at the recommended cut-off point (>3 on GHQ). These scores were similar to those reported for medical undergraduates. Twenty-two percent recorded comparatively high scores on emotional exhaustion. A wide variation in these 2 measurements was found across schools (p's 0.5). Some evidence showed that contact with patients and the level of support afforded by living at home may be protective. Conclusion: Higher than expected levels of emotional exhaustion were found in a large sample of first-year undergraduate dental students in Europe.

A review of the dental curriculum was undertaken in Helsinki in the mid 90s. The objectives of the new curriculum were to reinforce the links between basic biomedical and dental sciences in order to give more emphasis to oral medicine and comprehensive dental care. Furthermore, the curriculum needed to promote an interdisciplinary approach and encourage students to understand dental diseases in relation to the community at large. A two-year, topic-based, preclinical curriculum, fully integrated with medical students, was started. For didactic teaching in the clinical phase, new learning entities were established to promote an inter-disciplinary approach. For the first time in Finland, objectives were formulated for attitudes and interpersonal skills. Clinical training was conducted in a comprehensive clinic, based on the team concept, where emphasis was given to proven competency instead of to the number of procedures performed. The time spent in the clinic was kept the same as previously (1440 h). Students' learning process was assessed with a portfolio. The majority of students welcomed the comprehensive care clinic, especially its team concept and treatment planning seminars. However, feedback seminars after treatment of the patient were not in favour. As part of the evaluation process, a DENTED visitation took place in Helsinki in March 1999. The results obtained in the student questionnaire were consistent with the aims of the undergraduate training and with the present patient treatment range. In conclusion, the curriculum change enabled the school to broaden the biomedical aspects by increasing the period of preclinical studies. Although the extent of these studies was greater than in the past, and meant postponement of clinical skills courses by one semester, it did not jeopardise the competency in clinical dentistry, owing to the effective integration of the clinical phase teaching.

The association between an employer-provided dental benefit scheme and dental status was studied in male industrial workers in southern Finland in 1994. A total of 325 workers (age 38-65 yrs) with access to subsidized dental care and 174 controls completed a multiple-choice questionnaire followed by clinical examinations. One or more carious teeth was registered in 19% of the subsidized group and 50% of the controls (P < 0.001). For subjects with retained roots the proportions were 2% and 15%, respectively (P < 0.001). Among those with caries the mean number of carious teeth was 2.1 (SD 2.0) in the subsidized group, and 3.2 (SD 3.8) in the control group (P < 0.05). The groups did not differ significantly in numbers of teeth or filled teeth. The probability of having one or more carious teeth was negatively associated with access to subsidized dental care, with a recall or check-up as the reason for the last dental visit, and with having had the last dental visit within the past two years. The results showed that the dental benefit scheme resulted in less untreated caries.

Objectives: A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking. Methods: A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed. Results: Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit. Conclusions: Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.

Objectives Environmental hazards contribute to the poor oral health in many occupations. Among the earliest occupations mentioned are those of the baker and confectionery worker. To determine appropriate ways of promoting oral health in places of work, factors affecting caries susceptibility were studied. Methods Dental caries status, dietary and dental health behaviors, and salivary microbiologic findings in 338 confectionery and 101 shipyard workers were compared. A caries risk index based on salivary findings was used in log-linear models where the effects of sex, diet, use of dental services, and work environment were studied. Results Caries experience was found to be high in both populations. Dietary habits were the most important factor affecting caries occurrence and susceptibility. Similar dietary behaviors were found in both groups. Conclusions The confectionery industry did not seem to be an exceptionally hazardous environment for dental health in general. However, the screening of high-risk workers should be organized. Reimbursement of costs had no major effect on use of dental services or caries risk. Oral health promotion should be integrated with existing occupational health services to improve oral health in industrial populations.

All 277 pregnant women (mean age 28.4 yr, SD 4.6) living at the Lohja municipal health center area in Southern Finland participated in a survey during the first 6 months in 1990. The women's own opinions of the effect of pregnancy on their oral health were questioned during their first trimester of gestation. A special emphasis was put on the attitudes of dental restorative materials. The results showed that 57% of the subjects would have accepted the use of any restorative material during pregnancy while 43% were against one or more materials. 77 (65%) were opposing dental amalgam. 129 women (47%) were of the opinion that pregnancy as such is detrimental to their dental health. This opinion was significantly more frequent among women who were pregnant for third or more times than those having their first gestation. 70 (26%) thought dental treatment to have an effect on their gestation. Also 70 subjects (26%) thought that dental treatment may affect normal development of the fetus. The results showed that in spite of the long tradition in maternity counseling in Finland, the conceptions among pregnant women are often erroneous from the dental point of view.

A dental degree programme is a complex combination not only just to acquire knowledge and skills but also to develop interpersonal skills. It is a challenge for both students and staff to conceptualise studies in larger entities and to emphasise learning as a process. This project's general aim is to support student's development to become a self-guided critical expert. This goal may be achieved by developing creative and inspiring learning and assessment atmosphere for basic, specialist and continuous education. The specific aim is to create a personal e-portfolio program to facilitate utilisation of ICT based interaction and information, e.g. to document text, pictures, film and sound. The program is part of the assessment plan using e-portfolio both summatively and formatively. Intra- and Internet are utilised to build a common data bank also to secure teaching continuity. The project plan was awarded the first prize in the ICT-for-teaching competition at the University of Helsinki. The work is done in co-operation by university and a private company. Project's pilot phase started on spring 2002 involving the first and third year students and their teachers. It continues for the fall term 2002 with two additional student groups. Participants have completed a questionnaire on their pre-project ICT skills and attitudes. Training has been planned and carried out accordingly. The students are given the opportunity to produce a variety of personal versions and their copies for later use. We conclude that it is very important to widen learning assessment methods to support students' continuous development beyond undergraduate programme and to learn to benefit from ICT. E-portfolio used in this project is a digital platform for all these purposes. We are looking forward to collecting more data from our own institute and to working in close international co-operation.

To test the hypothesis that localized and generalized juvenile periodontitis is one disease entity, the localization of bone loss was measured from orthopantomograms of 88 patients with untreated juvenile periodontitis. Linear regression analysis showed a significant correlation between the age of the patient and the number of teeth with bone loss. Similarly, a correlation was found between the Gingival Bleeding Index scores, the age of the patient, and the number of affected teeth. It is concluded that juvenile periodontitis, known to be genetically controlled, is a disease entity which starts as a localized form with affected first molars and/or incisors and develops, if not treated, gradually to the generalized form of the same disease, which resembles the adult periodontitis.

In order to elucidate dental care behavior related to interdental cleaning, a group of first-year students were invited to a free dental examination. 186 of the students invited (76%) were examined clinically and roentgenologically. The mean DMFS-index of the students was 22.6 (+/- 12.6). They were also asked about their use of dental floss. 35% of the students reported using dental floss, but only 2% reported daily usage. 45% of the students had been taught how to use dental floss, and 83% of these had been taught by dental personnel. Teaching had no effect on the reported frequency of use. There were no statistically significant differences in the occurrence of dental plaque and gingivitis between those who used dental floss and those who did not. The subjects were unable to use dental floss on 1 out of every 3 filled proximal surfaces of the first molars. No correlation could be found between dental caries experience and the reported use of dental floss.

The conceptions of Finns regarding their own periodontal status were surveyed in 1972. The interviewed sample, drawn to cover the total Finnish population aged 15 years and over, comprised 965 persons. After exclusion of 233 edentulous subjects, a total of 732 dentulous persons were accepted for the present interview study. 10 percent of the interviewees were aware of their having gingivitis at that time. 57 percent were of the opinion that they had never had gingivitis. On the other hand, 20 percent of the interviewed persons had recently observed gum bleeding while 54 percent stated that they had never observed it. 21 percent of the interviewees were aware of their having dental calculus and 46 percent had the impression that they had never had calculus. 24 oercent of those interviewees who presently had calculus or had had calculus stated that they had never had it removed. Generally Finns failed to realize that gingival bleeding is a symptom of gingival inflammation. This point should be made clear in the dental health education of the future. The knowledge could help individuals to evaluate the state of their own periodontal tissues in order to obtain the best possible benefit from efficient home care.

Conceptions among the general public in Finland regarding the etiology and prevention of dental caries and periodontal disorders were surveyed in two interviews in 1971 and 1972. Both population samples interviewed comprised about 1,000 persons aged 15 years and over. Inadequate oral hygiene was the most common (65%) possible cause chosen by I he subjects among the causes of dental caries. Only 44% of the interviewees considered sugar to be a cause of caries. Thorough cleaning of the teeth (83%) and dentist's check-ups twice a year (67%) were the factors most frequently chosen in caries prevention. Avoidance of sugar (56%) ranked as the third in frequency. As regards symptoms of periodontal disorders, tender gingiva, gingival bleeding, and loosening of the teeth were correctly suggested as symptoms by 62, 61 and 45%, respectively. Poor oral hygiene (77%) was the cause of gingivitis most commonly chosen by the interviewees, while simultaneous systemic disease (37%) was considered more important than, for example, dental calculus (31%). As regards treatment of periodontal disorders, careful toothcleaning (73%) received most support. However, this factor was closely followed by misconceptions regarding the supposed advantageous value of drugs and rinses (50%), chewing of fibrous foods (45%), and vitamin therapy (38%).

The frequency of removable dentures and their suppliers were surveyed in March 1983 by interviewing a sample comprising 957 persons drawn to cover the total Finnish population aged 15 yr and over. The interviews revealed that there were 328 denture wearers in this sample (34.3%). The age-standardized rates were 39.7% for denture wearers and 20.4% for those wearing full dentures in both jaws. The rates for complete edentulousness, removable partial dentures of some kind and only partial denture wearing were 21.3%, 10.3% and 6.9%, respectively. Almost all of the removable denture wearers had a denture in the maxilla (97%); 62% had one in the mandible. Dental technicians with a special degree have the right to supply full dentures direct to clients in Finland. Dentists supplied 45% and dental technicians 53% of the full dentures surveyed. The study revealed a contradiction between the legal rights of dental technicians to supply dentures direct to clients and the current practice. The choice of the supplier of a removable denture showed no significant correlation with the education and income of denture wearers. The high frequency of dentures and the misconceptions regarding the supplying of them call for improvement in oral health education.

The public image of dentists and dental visits were surveyed in 1980 by interviewing a national sample of 648 Finns 15–50 years. 67 persons who reported having last visited a dentist more than 5 years ago were excluded from this report. 55 % of the interviewees had visited the same dentists earlier, 69% of these had been seeing the same dentist for more than 3 years. The last dentist visited was characterized on three dimensions: technical competence, personality and organization of the surgery. This characterization demonstrated the importance of personal and professional characteristics of the dentists. The interviewees expressed a high degree of satisfaction with the last dentist visited. 28% of the variance in satisfaction experienced was explained in multiple regression analysis. The dental visit was considered important but unpleasant by the interviewees. The principle of free choice of dentist was important to the vast majority of interviewees. It seems that the process of forming the dentist's image is so complex that the dental profession should be comprehensively taught interpersonal skills.

In March 1983 dental satisfaction was studied by interviews with a sample comprising 957 persons drawn to cover the total Finnish population aged 15 yr or over. 34% of the interviewees wore removable dentures of some kind. 78% of persons with only natural teeth and 56% of denture wearers were satisfied with their dentition (subjective estimation of dentition excellent or good). Among persons with only natural teeth the level of satisfaction differed significantly with respect to sex, age, toothbrushing frequency and the latest dental visit. Such a difference was not found among denture wearers. The time elapsed since the latest dental visit was the most important single variable in the discriminant analyses of the level of satisfaction both in the whole series and among persons with only natural teeth. Sex was the only variable in the discriminant analysis which related to satisfaction with dentition among denture wearers. The classification of dissatisfied persons, with and without removable dentures, was far from adequate. It was rarely possible to predict satisfaction with removable dentures using discriminant analysis. The results depict the complexity of the problem. More understanding is needed of the contributions of psychologic factors to patient behavior.

The present study was undertaken in response to a growing concern among clinicians about an increase in gingival recession among children and adolescents. Groups of 50 boys and 50 girls aged respectively 7, 12, and 17 yr were examined at Espoo Health Centre in 1983. Gingival recession was measured on the facial and lingual aspects of all permanent teeth. Whenever the gingival margin was located on root cementum, the distance from the gingival margin to the enamel border was measured to the nearest 0.5 mm. Recession was categorized as “slight” (0.5 or 1 mm) or “extensive” (1.5–3.5 mm). The prevalence of gingival recession was 5% at 7 yr, 39% at 12 yr, and 74% at 17 yr of age. More girls than boys had recession in the two youngest age groups. At 17 yr recession was equally common in both sexes and both “slight” and “extensive” recession was most often recorded on facial surfaces of first molars, premolars and canines. The alarmingly high prevalence of gingival recession at young age warrants further study of both the reasons and the consequences of early cementum exposure.

The periodontal status of 217 5th-year students (aged 25-26 years and born in Helsinki) at the University of Helsinki was assessed. The students had been eligible for community-based dental care free of charge until the age of 18 years, after which they could obtain low-cost dental care from the Helsinki Student Health Service. Their periodontal status was determined according the community periodontal index of treatment needs; gingival retraction was recorded when 1 mm or more of the cementum was exposed. Code 0 sextant was found for 67% of the women and 57% of the men. 20% of the students examined had sextant scoring of code 3; no-one had code 4 sextants. 69% of the women and 49% of the men had gingival retraction, in average 1.5 ± 0.5 mm. No correlation was found between the frequency of tooth brushing or the hand used for brushing and the number of retractions, nor did the number of healthy sextants correlate with the frequency of retractions. The findings emphasize the importance of better guidance regarding qualitative aspects of oral hygiene at home.

Oral hygiene behavior was surveyed in June 1971 by interviews with a sample comprising 1063 persons drawn to cover the total Finnish population aged 15 years and over. The interview revealed that the frequency of brushing as reported by dentulous interviewees was distributed as follows: less than once a day (32 %), once a day (25 %) and more than once a clay (43 %). Six percent of the interviewees stated that they did not brush their teeth. Most commonly the brushing was performed either as the last thing before retiring for the night (67 %) or immediately after waking up in the morning (47 %). There was a strong positive correlation between high socioeconomic status and high frequency of toothbrushing. Freshening of the breath and mouth was the most common (55%) reason for brushing the teeth and forgetfulness was the most frequent reason for neglecting it (56%). The investigation showed that the dental health behavior of the Finnish people with respect to brushing of the teeth has much room for improvement.

The validity of self-examination information regarding the number and distribution of remaining teeth, the presence of dentures and the validity of molar support construed professionally from the self-examination data was assessed from 93 persons. This was done by comparing self-examination information with data from clinical and radiographical examinations. Agreement between self-examination and clinical examination was found to be fairly good regarding the number of remaining teeth and the presence of removable dentures. Regarding the distribution of remaining teeth there was an average of 2.1 misdiagnosed teeth per person. In conclusion, self-examination method makes possible the collection of accurate data for screening and planning purposes in assessing oral health status regarding the number of remaining teeth and presence of removable dentures.