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Few studies of patient harm and harm-prevention methods in dentistry exist. This study aimed to identify and characterize dental patient safety incidents (PSIs) in a national sample of closed dental cases reported to the Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland.The sample included all available fully resolved dental cases (n = 948) during 2000-2012 (initiated by the end of 2011). Cases included both patient and next of kin complaints and notifications from other authorities, employers, pharmacies, etc. The cases analyzed concerned both public and private dentistry and included incident reports lodged against dentists and other dental-care professionals. Data also include the most severe cases since these are reported to Valvira. PSIs were categorized according to common incident types and preventability and severity assessments were based on expert opinions in the decisions from closed cases.Most alleged PSIs were proven valid and evaluated as potentially preventable. PSIs were most often related to different dental treatment procedures or diagnostics. More than half of all PSIs were assessed as severe, posing severe risk or as causing permanent or long-lasting harm to patients. The risk for PSI was highest among male general dental practitioners with recurring complaints and notifications.Despite some limitations, this register-based study identifies new perspectives on improving safety in dental care. Many PSIs could be prevented through the proper and more systematic use of already available error-prevention methods.

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.

To date, studies on the contributions of genetic factors to oral health have been inconclusive. We hypothesized that major dental diseases show a significant genetic component. The study was based on self-reported oral health among young adult twins. The data were derived from the fourth wave of the longitudinal FinnTwin16 study, in which participants completed a questionnaire in 2000-2002 enquiring about the number of filled teeth and the prevalence of gingival bleeding. We used quantitative genetic modeling, based on the genetic similarity of identical and non-identical twins, to calculate the most probable model for both filled teeth and gingival bleeding. The models revealed a strong genetic component behind the number of filled teeth, differing between males (49%) and females (68%), and a weaker genetic component affecting gingival bleeding, being similar for males and females (32%). Genetic factors contribute to inter-individual differences in oral health among young adults.

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.

Obesity, dental caries and periodontal diseases are among major public health concerns which may affect children’s growth and development. This study seeks any clustering between obesity, oral health and life-style factors among school children in Istanbul, Turkey. A cross-sectional study of children, 10- to 12-year-olds, from a public and a private school was undertaken with questionnaires for children and their mothers and child oral health data, in Istanbul (n = 611). DMFS (number of decayed, missing and filled surfaces of permanent teeth), CPI (Community Periodontal Index), body mass index (BMI) and life-style factors (tooth-brushing frequency, milk consumption at breakfast and bedtimes on school nights) of children were examined. Data analysis included factor analysis, Student’s t test and Chi-square tests by cross-tabulation. Public school children were more dentally diseased but less obese than were those in private school (P < 0.001). They more frequently had calculus (62%) and reported non-recommended tooth-brushing (68%) than did those in private school (37%, 56%; P < 0.05). Principal component analysis revealed that DMFS, CPI and BMI shared the same cluster among all children. A need exists for addressing obesity, oral health and nutrition jointly in health promotion strategies to improve children’s well-being and empower good life-style factors.

Objective: The objective of the present study was to investigate smoking habits of Iranian dental students in relation to their background characteristics and oral self-care (OSC). Subjects and Methods: A survey in the form of a questionnaire was conducted of 327 senior dental students in seven randomly selected state dental schools in Iran. In addition to smoking habits and background characteristics, the students were asked about OSC. A recommended level of OSC was defined as a combination of brushing at least twice a day, frequent use of fluoridated toothpaste, and eating sugary snacks less than daily. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 263 students (113 males and 150 females) completely answered the questions and were included in the analyses. Results: Of the 263 students, 59 (23%, 37 males and 22 females) reported current smoking (cigarette, pipe, or water pipe). Current smoking was associated with male gender (OR = 2.9, 95% CI = 1.4–5.6), level of father’s education (OR = 1.4, 95% CI = 1.1–1.8), and OSC (OR = 4.4, 95% CI = 1.3–14.9). Conclusion: Smoking among Iranian dental students is similar to their socioeconomic group, and is associated with the characteristics of their background, such as gender and father’s level of education, as well as the quality of OSC. The results indicate a need to include smoking cessation education and public health activities in the dental curriculum to provide future health care professionals and role models for patients with adequate training in up-to-date patient management to control smoking.

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.

Aim: This was to evaluate the influence of mothers’ oral healthrelated knowledge and attitudes on the tooth-brushing behaviour and dental health of their children and to compare the effect of these maternal aspects on child’s oral health. study design and methods: In 2005, an oral health study conducted among a random sample of 457 mother and child pairs in Tehran, Iran, used self-administered questionnaires to provide data on mothers’ oral health-related knowledge and attitudes and children’s tooth-brushing behaviour. Clinical data allowed assessment of dental status of the primary and permanent dentition. statistics: Chi-square test and binary logistic regression models were employed. Results: Generally, mothers had extensive knowledge of and positive attitudes towards oral health. Mothers’ higher level of oral health knowledge and better attitude scores were associated with children’s sound dentition (p

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.

BACKGROUND: This study aims to assess any clustering between obesity, number of decayed, missing, and filled teeth (DMFT), television (TV) viewing, and lifestyle factors among pre-adolescents living in 2 countries with different developmental status and oral health care systems – Turkey and Finland. PATIENTS AND METHODS: A cross-sectional study of Finnish (n = 338) and Turkish (n = 611) preadolescents, 10–12 years old, was undertaken with preadolescent oral health data and health behavior questionnaires for pre-adolescents and their mothers. The parameters examined were DMFT, body mass index (BMI), leisure time activities (TV viewing), and lifestyle factors (family dinners and dietary habits) of pre-adolescents. Data analysis included factor analysis, Student’s t-test, and Chi-square tests by cross tabulation. RESULTS: Turkish pre-adolescents were more obese and had poorer dental health than their Finnish counterparts (p < 0.05). Turkish and Finnish pre-adolescents drinking fizzy drinks more than 3 times a week were more likely to watch TV for ≥ 2 h/school day (odds ratio (OR) = 1.51, 95% confidence interval (CI) 1.00–2.28) than those consuming them once a week or less (OR = 3.06, 95% CI 1.39–6.75; p < 0.05). Factor analysis revealed that DMFT and obesity shared the same cluster among Turkish and Finnish pre-adolescents. CONCLUSION: Both medical and dental examination of any pediatric patient should include BMI, leisure time activities, and dietary habits as well as socio-economic status.

Objective: To investigate the oral health status of 18-year-old Iranians in relation to their gender, place of residence and level of education. Subjects and Methods: Thirty-three calibrated examiners in 2002 collected data as part of a national survey, according to World Health Organization criteria for sampling and clinical diagnoses, across 28 provinces. The study sample was 4,448; male: 2,021 and female: 2,427 made up of urban: 2,564 and rural: 1,884. Oral health status was assessed in terms of number of teeth, decayed teeth (DT), filled teeth (FT), decayed, missing or filled teeth (DMFT), community periodontal index and plaque index. Results: The mean number of teeth was 27.4, with DMFT: 4.3, DT: 3.0 and FT: 0.7. The mean number of sound teeth was higher (p < 0.01) in men (24.1 vs. 23.3 in women), FT in urban residents (1.0 vs. 0.2 in rural residents) and DT in women (3.3 vs. 2.8 in men). Three of 4 subjects were in need of restorative treatments. All subjects had dental plaque; 387 (8%) healthy gingiva; 1,016 (23%) exhibited bleeding; 2,025 (48%) calculus and 1,020 (21%) deepened pockets. Men’s periodontal status was worse than women’s (p < 0.002). Low level of education was associated with having 27 or fewer teeth (OR = 1.7), calculus (OR = 1.5) or deep periodontal pockets (OR = 2.7). Conclusion: A majority of 18-year-old Iranians seem to enjoy a full dentition. High prevalence of dental plaque, calculus, periodontal pockets and untreated dental cariesespecially among underprivileged groups may put them at risk for tooth loss in adulthood.

AIM To study the oral health behaviour of Iranian dentists. DESIGN A cross-sectional study. SETTING Two annual dental meetings in Tehran, Iran. PARTICIPANTS 1,033 dentists responded, 980 were eligible for this study. METHOD Data were collected using a self-administered questionnaire which covered dentists' oral self-care, dental attendance, and smoking. Recommended oral self-care (ROSC) included tooth brushing > 1/day, eating sugary snacks < daily, and regularly using fluoride toothpaste. Knowledge of preventive dental care was assessed by nine Likert-scale statements. Dentist's gender, age, and professional reading were recorded. Statistical evaluation was by the Chi-square test and logistic regression. RESULTS In total, 59% of respondents reported brushing their teeth at least 2/day, 59% consumed sugary snacks < daily, 74% used fluoride toothpaste regularly, and 76% were non-smokers. Of all, 27% followed ROSC. Women reported desirable behaviours more frequently than did the men (p < 0.01). Female gender (OR 1.4-2.3), being a non-smoker (OR 1.3-1.5), and wider professional reading (OR = 1.2) were the major factors that contributed to dentists' desirable oral health behaviour. CONCLUSIONS That only a small number of Iranian dentists follow the ROSC calls for more attention to behavioural contributions to oral diseases and its consequences with general and oral health, regarding both dental curriculum and continuing education.

To assess factors related to satisfaction with dental care and its role in dental health-related behaviour among Lithuanian university employees.Our cross-sectional survey collected data on respondents' satisfaction with dental care using 24 statements. The self-administered questionnaire also inquired about dental attendance, dental health-related behaviour and attitudes, self-assessed dental status and background details. All 35- to 44-year-old employees (n = 862) of four universities in Lithuania were invited to participate; 64% (n = 553) responded, 78% of them were women. Statements on satisfaction with technical, personal and organisational dimensions of the dental surgery were assessed using a five-point scale, ranging from entirely agree to entirely disagree, with higher scores indicating stronger agreement. Overall satisfaction scores were summed and subjects divided into tertiles to evaluate dental health-related behaviour. For the logistic regression model, subjects were divided into two groups of satisfaction level (below and above the mean of the sum score).Subjects were highly satisfied with dental care, with the mean sum score being 99.5 (SD = 12.62, range 59-120). Stronger satisfaction was reported by those visiting private practices (p0.001) and the same dentist longer (p = 0.006) and by those who entirely agreed with the statements on dental health-related attitudes (p ≤ 0.001). The logistic regression model showed that higher satisfaction with dental care level was more likely for those who indicated check-up-based regular dental attendance (OR = 1.7) and brushing their teeth at least twice daily (OR = 1.6).Satisfaction with dental care is positively related to individuals' dental health-related attitudes and behaviour among highly-educated subjects in particular.

Mechanical load has been proposed as a risk factor for hand osteoarthritis. Dentists produce high manual forces in their work tasks. We studied whether the pattern of dental work tasks was associated with finger osteoarthritis. Radiographs of both hands of 291 middle-aged female dentists were examined for the presence of osteoarthritis. Patterns of dental work tasks during work history were empirically defined by cluster analysis. Three patterns emerged reflecting high, moderate, and mild task variation. Age, specialization, years in clinical work, various activities requiring hand use, family history of Heberden’s nodes, body mass index, and smoking were accounted for in logistic regression analyses. The dentists with a history of low task variation had a greater prevalence of osteoarthritis in the thumb, index, and middle fingers compared with dentists with high variation (OR 2.22; 95%CI 1.04–4.91). The pattern of dental work task history is associated with the localization of osteoarthritis in the fingers.

We assessed changes in periodontal treatment needs among patients with diabetes and the risk factors involved in this phenomenon. The sample consisted of 120 dentate subjects, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. They underwent periodontal examination in 1999 and were re-examined in 2001. The drop-out rate was 4%. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN) index. Diabetes-related factors consisted of information about duration of diabetes, complications, and HbA1c values. Oral health-related factors were collected by questionnaire. The CPITN index proved to be insensitive to change. Pathological pockets (CPITN 3 or 4) were found in 80% of subjects (n = 115) and 48% of sextants (n = 627); in 1999, the corresponding rates were 77% and 49%. The tooth-based individual CPITN index (code 3 or 4) revealed periodontal deterioration in 38 patients. Smoking and infrequent interdental cleaning were significant factors explaining periodontal deterioration in logistic regression. Risk factors should be taken into account when planning prevention, treatment, and supportive periodontal therapy strategies. In diabetes care, the common risk factor approach can be implemented to promote oral health among individuals with diabetes.

Objective We investigated the effects of rheumatic diseases on oral symptoms, health habits, and quality of life in subjects with and without rheumatic diseases. The hypothesis was that patients with rheumatic diseases have more oral symptoms impairing their quality of life than healthy controls. Methods A questionnaire was mailed to a random sample of 1500 members of the Finnish Rheumatism Association, including those with and without rheumatic diseases. We focused on symptoms of the mouth and temporomandibular area, and health habits. Oral Health Impact Profile (OHIP14) was used to evaluate the oral health-related quality of life. We analyzed differences between subjects with and without rheumatic diseases, controlled for age, gender, smoking, and non-rheumatic chronic diseases. Results Completed questionnaires were received from 995 participants (response rate 66%). Of them, 564 reported rheumatic disease, 431 were used as controls. The patients reported significantly more all orofacial symptoms than controls. Severe dry mouth was reported by 19.6% of patients and 2.9% of controls (P

Objectives: To evaluate the quality of root canal treatments performed in every-day practice on young adults. Methods: A quality index related to the treatment process was developed based on the guidelines of the European Society of Endodontology. A random computerised selection of 134 young adults (born 1966–1971) produced 125 (93%) eligible oral health documents, including information on 148 teeth that were root canal treated by 47 dentists. The process of root canal treatment was evaluated according to the original oral health documents. The technical quality of root canal fillings was assessed on postoperative periapical radiographs. Results: The overall Kappa statistics for the inter-examiner reliability of assessments was 0.63; the proportional agreement being 87%. The mean quality index was 6.2, s.d. 2.0, with none of the treatments scoring the maximum 13. On the 56 available postoperative radiographs, 52% of the fillings were optimal, showing a length within 0–3 mm from the radiological apex, no voids in the apical part nor lumen apical to the filling. Of the completed 144 root canal treatments, only 11 included some recorded follow-up information within 15 months from the termination of the treatment. Conclusions: The technical quality of the root fillings was similar to that found in previous studies. However, the quality index, paucity of pre- and post-operative radiographs, and the lack of follow-up all indicated a discrepancy between consensus guidelines and every-day practice.

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.

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.

Information about the oral status and dental health behavior and the working history of 369 Finnish seamen on different types of ships was gathered by means of a questionnaire. A control group of workers on shore was formed for sailors 35-44 years of age. Removable dentures were worn by 16% of the seamen. Oral disorders during the week before the study were reported by one-third. During the previous 2 years 14% of the sailors had had at least one episode of oral troubles, 15% twice and 9% three or even more times. One-third of seamen with oral trouble had needed pain-killing tablets or antibiotics. Sick leave days had been needed by 3% of respondents during the previous 2 years because of oral disorder (mean length of sick leave period was 1.4 days). The control group reported gum bleeding more often than the seafarers. Even though there were no signs of poorer dental condition in sailors than in the controls on shore, the possibility that the seafaring could constitute a risk for the oral health of seamen in other age groups cannot be excluded.

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.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.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.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.

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.

Utilization of dental services by Finnish seamen was surveyed late in 1990. Three hundred and sixty-five respondents on different vessels at sea for more than 5 days returned a pretested questionnaire. A randomly drawn control group of 230 workers at a ventilation-equipment-producing plant was also surveyed. Fifty-five per cent of the seamen studied and 73% of the control group stated they had visited a dentist within the year before the survey. One-third of the seamen stated that an acute dental condition had been the reason for their last dental visit. Almost one-third of the seamen and 5% of the control group reported having last visited a dentist at a health center. When questioned separately, 14% of the seamen stated that they had not received dental treatment fast enough when needed. One-third of the seamen surveyed offered ideas for improving their dental services, half of them suggesting an increase in facilities and personnel at health centers for seamen. Periodic oral examinations for and full use of oral health self-care procedures by seamen are recommended.

Objectives Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland. Methods We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n = 73) and dental hygienists (n = 22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group. Results Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F = 2.31; P = 0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F = 12.13; P = 0.001) and cessation counselling (F = 30.19; P

Background and objectives. Many previous studies showed clear gender differences in the percentages of adults reporting toothbrushing more than once a day. This study evaluated the factors determining gender differences in toothbrushing among Lithuanian middle-aged university employees. Material and Methods. A questionnaire survey was anonymously conducted among 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data covered toothbrushing frequency, habitual dental attendance, dental health attitudes and knowledge, and subject’s background information. Results. Of all respondents, 68% reported brushing their teeth more than once a day (73% of women and 49% of men, P

The purpose of this study was to assess how the eruptive status of third molars relates to gingival and dental health and, in particular, to the status of the adjacent second molar. One hundred and twenty-three young adults were followed up over a 6-year period, from age 20 to age 26. The status of the second and third molars, and DMF, DMFS, DS, MS, and FS indices, periodontal condition, and salivary acidogenic bacterial counts were assessed. The 6-year DFS increase in relation to second molars was greatest in sextants with unerupted third molars. The percentage of erupting third molars that became carious or had been filled during the study period was 30%. Most new caries lesions or filled surfaces were on mesial surfaces of second molars and occlusal surfaces of third molars. The periodontal condition was best in mandibular sextants in which the third molar was missing. It is concluded that the most favourable situation for upper second molars is if the neighbouring third molar is missing by age 20.

Background Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. Methods A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Results Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, α = 0.86), capability (13.3% of variance, α = 0.83), and opportunity (10.0% of variance, α = 0.71). Conclusions This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.

Background Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers. Trial registration Current Controlled Trials ISRCTN15427433

Introduction: Higher levels of smoking, leading to increased levels of nicotine and dopamine release, may be more strongly related to bruxism, although this relationship has remained unclear. Thus, the aim of the present study was to investigate the possible effect of cumulative tobacco use on bruxism in a large sample of young adults.Methods: The material of the present study derives from the FinnTwin16, which consists of five birth cohorts born in 1975-1979. A total of 3,124 subjects (mean age 24 years, range 23-27 years) provided data in 2000-2002 on frequency of bruxism and tobacco use. Multinomial logistic regression was used to explore the relationships of frequency of bruxism with smoking and smokeless tobacco use while controlling covariates (alcohol intoxication, alcohol problems [Rutgers Alcohol Problem Index, RAPI], illicit drug use, psychological distress [General Health Questionnaire], and coffee use).Results: Based on subjective response and multivariate analyses, weekly bruxers were more than two times more likely to report heavy smoking than never bruxers (odds ratio [OR] 2.5, 95 % CI 1.8-3.4). The significant association between heavy smoking and bruxism held when the effects of other tobacco use and multiple covariates were controlled. In addition, the use of smokeless tobacco emerged as an independent risk factor for bruxism.Discussion: Given the observed associations with both heavy smoking and smokeless tobacco and a dose-response relationship, the present results support our hypothesis of a link between nicotine intake and bruxism.

The aim of this study was to investigate the association between cognitive and behavioural factors of preadolescents and those of their mothers, assessed in terms of self-efficacy beliefs and toothbrushing among Turkish and Finnish population in the framework of Social Cognitive Theory. The specific objective was to test if this possible association worked regardless of cultural differences.Self-administered questionnaires for Finnish (n = 338) and Turkish (n = 611) pre-adolescents and their mothers were used to collect the information on cognitive (pre-adolescent and maternal self-efficacy) and behavioural factors (toothbrushing frequencies).Turkish mothers and pre-adolescents reported lower levels of self-efficacy and toothbrushing than did their Finnish counterparts (P0.005). Finnish pre-adolescents reporting high self-efficacy were more likely to have mothers with high levels of self-efficacy (OR = 2.14, 95% CI = 1.16 to 3.93), (P = 0.014). Similar positive associations emerged between Turkish (OR = 2.45, 95% CI = 1.70 to 3.52), (P = 0.001) and Finnish (OR = 6.76, 95% CI = 2.21 to 20.65), (P = 0.001) pre-adolescent self-efficacy and maternal recommended (twice daily) level of toothbrushing behaviour. For pre-adolescents' toothbrushing, their own self-efficacy was the common explanatory variable. Binary logistic regression models revealed that the maternal toothbrushing accounted for the Turkish pre-adolescents' toothbrushing behaviour, whereas maternal self-efficacy did so for the Finnish pre-adolescents' (P0.001) toothbrushing behaviour.This study underlines the need for integration of pre-adolescent self-efficacy and maternal cognition and behaviour into oral health intervention programmes because of their relation to recommended toothbrushing behaviour among pre-adolescents, regardless of cultural differences. These findings seem to fit with the Social Cognitive Theory, which emphasises the significance of cultural factors and cognition as the determinants of behaviour.

The aim of this study was to investigate the diagnostic delay and its determinants among oral cancer patients in Tehran, Iran.This study was conducted between September 2004 and September 2006 in three university hospitals, and included 100 consecutive patients with primary oral squamous cell carcinoma (international classification of disease, ICD-10 sites C01 to C06). Data were obtained through questionnaire interviews and medical records of the patients were reviewed to obtain information on the date of diagnosis, primary tumour site and the stage of the tumour at the time of diagnosis. Statistical analysis was performed by t test, ANOVA and logistic regression.The mean diagnostic delay was 7.2 months (SD 7.5, range 1 to 36 and median 4). The most important determinants of longer diagnostic delay were being single (OR = 4.8; 95% CI = 1.5 to 14.8; P0.05) and being at advanced tumour stages (OR = 5.3; 95% CI = 1.8 to 15.6; P0.01). The mean patient and professional delays were 5.3 months (SD 6.1 and median 2) and 2.1 months (SD 2.1 and median 1), respectively. Patients at advanced tumour stages were more likely to have longer patient and professional delays than those at early stages (OR = 5.6; 95% CI = 1.8 to 17.3 and OR = 3.4; 95% CI = 1.2 to 9.4, respectively; P0.05). Living alone was also a determinant of longer patient and professional delays (OR = 7.1; 95% CI = 2.0 to 24.7, OR = 3.5; 95% CI = 1.2 to 10.3, respectively; P0.05).Developing preventive programmes that focus on the enhancement of public and professional awareness about oral cancer is essential to promote earlier diagnosis in Iran.

Objective. This study aimed to evaluate and describe the dental attendance patterns and to characterize the factors that encourage preventive dental visits among 35- to 44-year-old university employees in Lithuania. Material and methods. A questionnaire survey was conducted anonymously among the 35- to 44-year-old employees (n=862) of four universities in Lithuania in 2005. The response rate was 64% (n=553). Data on their most recent dental visit, habitual dental attendance, and self-reported dental health were collected. Gender, marital status, education, and income levels served as background factors. Of the respondents, 79% were women, and 82% held a university degree. Results. Of all the respondents, 75% reported having their most recent dental visit within the previous 12 months, 19% indicated a preventive check-up as the reason for it (15% – self-decided visit and 4% – dentist’s recall). The most common treatments received were fillings (75%), scaling and cleaning (28%), and endodontic treatment (22%). Analysis of the data about habitual dental attendance showed that preventive check-up as the main reason for attendance was more commonly reported by women (OR=1.7), among those who indicated having lost fewer teeth (OR=1.5), reported higher incomes (OR=1.4), and who indicated a shorter time interval since their most recent dental visit (OR=1.3). Conclusion. Dental problem seems to be a dominant reason for dental attendance in Lithuania where both dentists’ and patients’ behavior weakly reflects preventive orientation.

This study investigated the role of mothers in their preadolescents' oral self-care (OSC) and oral health in Tehran, Iran.In 2005, two self-administered questionnaires provided data on a random sample of 9-year-old children (N = 416) and their mothers. Brushing frequency, use of fluoridated dentifrice and the number of sugary snacks between meals served as OSC assessment criteria for both children and their mothers. Supervision of the child's tooth brushing and control of the child's sugary snacking indicated the mother's role that was defined as either active or inactive. Decayed, missing or filled teeth (DMFT + dmft) values facilitated the assessment of children's dental status in a voluntary clinical examination for children. The child's twice-daily tooth brushing, sound dentition and good oral hygiene were taken as the outcome measures for evaluating the impact of the mother's role. The chi-square test and logistic regression model were used for the analyses.Half of the mothers were assessed as active in the supervision of their children's tooth brushing. Supervision was clearly more frequently reported by the mothers whose own OSC was favourable. In the logistic regression model, the strongest factors contributing to the explanation of twice-daily tooth brushing were the child's female gender (odds ratio, OR = 1.6; 95% confidence interval, 95% CI = 1.1 to 2.4) and the mother's active supervision (OR = 1.5; 95% CI = 1.0 to 2.2). Having sound dentition was most strongly explained by the mothers' active supervision of their children's tooth brushing (OR = 2.4; 95% CI = 1.3 to 4.5).The mothers' supporting role positively reflects on twice-daily tooth brushing and sound dentition in preadolescents. More preventive efforts through mothers should be considered during the planning of promotion programmes for preadolescents.

The objective of the present study was to compare the self-assessed and the clinically determined findings of oral health and their determinants among 15-year-olds in Tehran, Iran.A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out among the 15-year-olds (N = 509). The data were based on a self-administered questionnaire and a clinical dental examination.Altogether 78% of the 15-year-olds assessed their oral health as good or better. Based on self-assessment, 46% reported gingival bleeding, 28% reported the need for a filling and 23% for teeth straightening. Clinical examinations showed that 40% of the students had sound dentition (decayed, missing or filled teeth, DMFT = 0), 40% had current caries (decayed teeth, DT0), 92% had gingival bleeding and 26% had a definite need for orthodontic treatment. Most of those with DMFT = 0 and DT = 0 assessed their oral health as good or better. Compared with clinical findings, sensitivity for self-assessed need for fillings, gingival bleeding and the need for teeth straightening were 42%, 49% and 37%, respectively, whereas the corresponding specificities were 82%, 80% and 81%, respectively. Good or better self-perceived oral health was more likely among those with sound dentition (odds ratio, OR = 2.1, P = 0.01), with no self-assessed need for fillings (OR = 2.1, P = 0.01), with a self-assessed absence of gingival bleeding (OR = 2.9, P0.001) or with highly educated parents (OR = 1.2, P = 0.007).When compared with clinical evaluations, the students most accurately detected healthy conditions. Educating the students on the signs of dental diseases could increase the reliability of self-assessment to provide a useful method for reporting oral conditions, especially in countries with developing oral health care systems.

To investigate the oral health behaviour and the smoking habits among diabetic adults with regard to diabetes-related factors and their background information.In 2005, a questionnaire was conducted among diabetic adults (N = 299) in Tehran, Iran. The subjects were invited to the dental clinic and were asked to complete a self-administered questionnaire. In addition to their background information, the questionnaire requested information on smoking, oral self-care, dental attendance, year of onset of diabetes and organ complications related to diabetes. The data related to the type of diabetes and the latest value of glycosylated haemoglobin level (HbA1c) were obtained from the patient records at the diabetic clinic. Chi-square test and binary logistic regression model were used for statistical analyses.Of all the subjects, 29% reported brushing their teeth on a twice-daily basis. Women (P = 0.05) reported higher frequencies of twice-daily tooth brushing. Subjects with moderate diabetic control (HbA1c = 7.6-8.5%) showed the highest rate for twice-daily tooth brushing (P0.001). Of all the subjects, 47% reported having visited a clinician within the past 12 months; this rate was the highest among those without diabetes-related complications (52% versus 41%; P = 0.05). Subjects who had a physician referral were more likely to report having had a dental visit within the past 12 months (OR = 4.4; CI = 1.9-10.2).The present results call for improvement in the level of oral self-care and the regularity of dental checkups among diabetic adults to compensate for their increased risk for oral diseases.

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.

The development of 412 upper and lower third molars was clinically followed up for 6 years in 120 students, starting at the age of 20 years. Clinical and radiographic examinations carried out at baseline and 6 years later showed that during the follow-up period almost half the third molars originally recorded as partially erupted had erupted. When the lower third molars were initially invisible, only 9% of them had erupted by age 26 years whereas 29% remained invisible. When third molars had been already erupted at baseline, only a few were extracted during the 6-year follow-up period. It was concluded that a certain proportion of third molars erupt relatively late, and therefore the need for surgical interventions may decrease with age during early adulthood.

To assess smoking, tooth brushing and oral cleanliness and their relationships among 15-year-olds in Tehran, Iran.A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out in autumn 2004 among 15-year-olds (n=502) in Tehran. Data were based on a self-administered questionnaire and a clinical dental examination.Smokers comprised 5% of the boys and 2% of the girls (p = 0.02). Smoking was more common among students of less-educated parents (50% vs. 30%, p0.05). Of all students, 26% reported twice-daily tooth brushing; those of higher socio-economic backgrounds and girls did so more frequently. Of the smokers, 11% reported no tooth brushing compared to 6% of the non-smokers. Oral cleanliness was good for 13%, moderate for 32%, and poor for 55%; the rates associated positively with female gender (p = 0.002), having higher-educated parents (p = 0.03), and reporting a higher frequency of tooth brushing (p0.001). Those students reporting twice-daily tooth brushing had less dental plaque and gingival bleeding (por = 0.01) on both anterior and posterior teeth. In multivariable analyses, the best predictors for a good level of oral cleanliness were female gender (OR = 2.0) or twice-daily tooth brushing (OR = 1.7).Oral cleanliness and tooth brushing among 15-year-olds were at poor levels, particularly among boys. Such poor levels call for intensive attempts to enhance rates of twice-daily tooth brushing and to improve its quality. For this age group, anti-smoking purposes should be combined into school-based oral health promotion programmes as well.

Background. Toothbrushing twice daily is a recommended component of oral self-care soon after the eruption of primary dentition. Aim. This study aims to investigate oral hygiene and frequency of oral cleaning in children up to 3 years, in relation to mother-related factors. Design. A cross-sectional study of 504 children aged 12–36 months in Tehran, Iran was implemented. Mothers answered questions about their own oral self-care and their activity in their children's oral hygiene. The child's oral hygiene was assessed on the basis of visible dental plaque on the labial surfaces of the upper central incisors. Data analysis included chi-square test, analysis of variance (anova) and logistic regression. Results. Twice daily oral cleaning was reported for 5% of all children and once daily cleaning for 19% of the 12- to 15-month-old children, 18% of the 16- to 23-month-old children, and 48% of the 24- to 36-month-old children. Of the mothers, 59% stated that they lacked the skill to clean their children's teeth. Dental plaque was observed in 65–76% of the children. Clean teeth were more likely (OR = 1·7, 95% CI 1.3–2.3) in children of mothers who themselves have a higher toothbrushing frequency. Conclusions. To improve oral hygiene in early childhood, more emphasis should be placed on mothers’ own toothbrushing and their skills in their children's oral cleaning.

To investigate knowledge of and attitudes towards prevention of dental caries among Iranian dental educators in relation to their personal and academic background.Of the 15 Iranian state dental schools, 7 were selected by stratified random sampling to serve as clusters. All the present educators (n = 363) were individually asked to voluntarily complete a pre-tested anonymous questionnaire. A total of 291 educators completed the questionnaire (response rate of 80%). The questionnaire requested information on educators' knowledge of caries prevention and attitudes towards preventive dentistry. The educator's age, gender, highest academic degree, department of teaching, and familiarity with the discipline of dental public health (DPH) served as background factors. Chi-square test and a logistic regression model served in statistical analyses.Educators working in paedodontics, operative dentistry or periodontology departments had more extensive knowledge of caries prevention than did the others (p0.05). Women, as well as those familiar with DPH, reported more positive attitudes towards prevention than did the others (p = 0.05). In the regression model, having a more positive attitude towards prevention was associated with female gender (OR = 2.2, 95% CI: 1.2-4.1), more extensive knowledge of caries prevention (OR = 2.4, 95% CI: 1.1-5.6), and greater familiarity with DPH (OR = 2.0, 95% CI: 1.1-4.1).Dental educators seem to have different knowledge of and attitudes towards prevention based on their disciplines. This may reflect negatively in preventive practice among both the educators and students. Continuing education activities and placing emphasis and support on prevention-related research are recommended.

To assess psychological, individual and maternal factors related to dental anxiety among pre-adolescents in the different cultural settings of Turkey and Finland.A cross-sectional study of Finnish (n = 338) and Turkish (n = 611) pre-adolescents aged 10-12 years old by paired matching of questionnaires for the subjects and their mothers. These questionnaires, along with modified dental anxiety scales, were designed to collect data on the pre-adolescents' and their mothers' oral and dietary behaviours in relation to psychosocial factors. Multiple linear regression and factor analyses as well as descriptive and correlation statistics were applied.The Turkish pre-adolescents (TP) reported poorer dental health (50%) and more frequent gingival bleeding (26%) than did the Finnish pre-adolescents (FP) (26%, 0%), (p0.05). A similar trend occurred for reported toothache (70% and 17% for TP and FP respectively [p = 0.00]). Mean dental anxiety (DA) for TP and their mothers, and Finnish counterparts respectively were 9.64 +/- 6.01, 8.70 +/- 4.53 and 7.39 +/- 4.51, 6.02 +/- 5.50 (p0.05). Among TP, those with low DA reported high levels of toothbrushing and dietary self-efficacy (DSES) and self-esteem (p0.05); FP showed similar trends for DSES and self-esteem. Principal component analysis revealed that maternal DA and regular dental visits largely accounted for primary associations with DA among TP.Appreciating the impact of various psychosocial factors may provide a better understanding of DA among preadolescents, and thus may reduce dental avoidance and behavioural management problems for the overall improvement of young patients' oral health.

Objectives: To investigate the study motives and career choices of Iranian senior dental students in relation to their background factors. Subjects and Methods: During the spring term 2005, a questionnaire survey was administered to 327 senior dental students in seven randomly selected state dental schools in Iran. The questionnaire requested information on age, gender, parents’ employment in dentistry, previous education and employment in dental hygiene, study motives, and career choices. Statistical analyses were made using independent sample t test, factor analysis, and binary logistic regression model. Results: Based on the factor analysis, which explained 73% of the total variance, five motive dimensions were identified: altruism and intellectual challenges, characteristics of the profession, social status and security, other person’s recommendation, and failure to be admitted to other study programmes. The mean for the ‘characteristics of the profession’ dimension was lower among the students with at least one parent employed in dentistry (p = 0.03). The ‘altruism and intellectual challenges’ dimension was reported to be more influential by the students with background in dental hygiene (32 students) compared to the others (p < 0.001). Engaging in postgraduate studies was the first career preference of 189 (70%) of the respondents. Those with a background in dental hygiene were less inclined to enter postgraduate courses (p < 0.001), but more eager to be employed in either the public or the private sector (p < 0.001), and to enter the community oral health and research field (p < 0.001) than the others. Conclusion: Personal characteristics and motives of the students play a major role in shaping their career preferences.

Objectives: To investigate self-reported preventive practice of Iranian senior dental students in dental caries management. Subjects and methods: To obtain an estimated sample size of 250 subjects, seven state dental schools were selected based on a stratified random sampling approach. All the senior dental students (n = 327) were asked to voluntarily fill in a self-administered pre-tested questionnaire during the spring term in 2005. In the questionnaire two hypothetical patient cases (a high-risk and a low-risk patient) were presented and the students were asked to express their conceptions on a five-point Likert scale about including each of nine given alternatives in the patients’ treatment plans. The respondents’ self-reported oral self-care (OSC), preventive knowledge, attitude towards prevention and self-perceived competency in giving preventive care were also assessed. Chi-squared test and logistic regression model served for statistical analyses. Results: A total of 270 students filled in the questionnaire (response rate = 82%). Acquiring high scores of preventive practice as assessed by patient cases was found to be more frequent among those reporting recommended OSC (P = 0.007) and those with higher attitude scores (P

Objectives: To study the oral health behaviour (OHB) of Iranian senior dental students in relation to their gender, background characteristics, knowledge of preventive care, and attitudes towards preventive dentistry. Materials and methods: Using a cluster random sampling approach, a questionnaire survey was conducted with 327 senior dental students in seven dental schools. The questionnaire covered age, gender, parents’ employment in dentistry, previous academic education in dental hygiene, oral self-care, most recent dental check-up, knowledge of preventive dentistry and attitudes towards it. Attending a dental check-up by a dentist or a classmate within the last year was defined as preventive care use. Chi-square test and logistic regression models were used for statistical analyses. Results: Women reported significantly higher frequencies of tooth brushing (P

Amis: This was to investigate the association between parents’ educational level and oral health of Iranian primary school children. Methods: Data came from the voluntary clinical examination in 2005 of a random sample of 459 third-year primary school children in the 16 schools in Tehran, together with a self-administered questionnaire regarding information on the educational level of the parents. The study used the dmft/DMFT values for dental status, and the CPI, and PI to assess periodontal condition. Statistics: One-Way ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used. Results: The mean dmft value was 4.2 (SD±2.9) in boys and 3.4 (SD±2.6) in girls for the whole study group. The children of the low education parents had more dental caries than those of high education parents in both primary (p< 0.01) and in permanent teeth (p< 0.05). A strong association was found between high parental education and restorations in primary teeth (p< 0.001), but only a trend for restorations in permanent teeth. Mean number of sextants with a CPI score 0 was significantly associated with parents’ educational level (p< 0.01). Conclusion: The disparities in the oral health of children need to be considered when developing oral health promotion programmes.

To investigate oral health behaviour and smoking habits among academic staff members in Iran's dental schools in relation to their personal and academic background characteristics.Out of 15 state dental schools, seven were selected randomly as clusters. All of the educators who were present (total n = 363) were asked to voluntarily fill in a self-administered pre-tested questionnaire. In addition to background and academic characteristics, the questionnaire requested information on smoking habits, oral self-care, and dental check-ups. Recommended oral self-care was defined as brushing at least twice a day and frequent use of fluoridated toothpaste. Chi-square test and binary logistic regression model served for statistical analyses.A total of 291 educators filled in the questionnaire (response rate = 80%). Women reported higher frequencies of brushing (p = 0.001), use of fluoridated toothpaste (p = 0.002), flossing (p0.01) and eating sugary snacks (p = 0.01) compared with men. Habitual cigarette and pipe smoking was reported by 22% and 3% of male educators respectively. Familiarity with the field of oral public health correlated to higher frequencies of brushing (p = 0.05) and flossing (p = 0.03). Smoker educators reported less favourable oral self-care habits than non-smokers. Female gender (p = 0.002, OR = 2.7) and familiarity with the oral public health field (p0.01, OR = 2.5) were associated with recommended oral self-care criteria.Dental educators should have positive attitudes towards and beliefs in effectiveness of preventive dentistry in order to increase public awareness of its importance.

The dental status of dentate diabetic adults (n = 299) and its associations with diabetes-related factors was explored in Tehran, Iran. Presence of diabetes-related complications made no difference in mean values of DMFT, but was associated with a higher number of decayed and missing teeth, and fewer filled teeth. Higher level of HbA1c was associated with higher DMFT for men, but not for women. In conclusion, the results suggest a possible association between the level of metabolic control of diabetes mellitus and cumulative caries experience.

To study barriers to providing oral health education (OHE) to their patients among Mongolian dentists.A questionnaire survey was carried out in 2000 among practising dentists (n = 250) in the capital city of Mongolia. The response rate was 98%. Barriers to OHE were measured by six statements describing problems that might interfere with dentists' OHE activities and attitudes towards it by a statement about its importance; all answers were rated on a 5-point Likert scale (strongly agree-strongly disagree). Self-perceived competency in providing OHE was measured by means of a 4-point scale of competency (very to not at all competent) and preventive knowledge by 14 statements related to preventive dentistry. Dentists' work-related backgrounds were work experience in years, type of practice (state or private) and field of practice (general practice or speciality field). Statistical evaluation was carried out by chi-square test and logistic regression analysis.Poor appreciation of OHE by patients (85%) followed by insufficient teaching materials (73%) and time constraint due to the huge demand for curative care (59%) were the most commonly agreed-upon barriers. Concerning their attitudes towards and competency in providing OHE, 88% of the dentists agreed that OHE should be statutory, and 85% perceived themselves at least quite competent. Dentists' years of work experience were positively, but preventive knowledge score negatively associated with their agreeing about barriers to OHE activities.Despite appreciation of OHE, Mongolian dentists seem to face practical barriers to providing OHE activities.