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Background: The aim of this study was to determine if paediatric oral health education leaflets with a food and nutritional focus provide messages that are clear and consistent with the current Australian Dietary Guidelines and the Infant Feeding Guidelines., Methods: Forty-three leaflets aimed at parents were sourced from Australian state and territory Health Departments, oral health industry partners and commercial organisations, and a content analysis was performed. Recommendations on food and drink type, consumption frequency and general diet and nutrition advice were considered and cross-referenced with the Australian Dietary Guidelines and the Infant Feeding Guidelines to identify areas of consistency and discrepancy., Results: Twenty leaflets recommended reducing the consumption of sugary and/or acidic food, while 23 leaflets recommended reducing the consumption of sugary and/or acidic drinks. The majority of the leaflets advised water (n = 35) and milk (n = 23) to drink. Although 33 leaflets encouraged a healthy diet, seven of these did not specify what a healthy diet was. Twenty-eight leaflets provided early childhood-related (0-2 years) feeding advice. Confusing messages were found in nine leaflets, with ambiguous recommendations that were open to individual interpretation., Conclusions: There were some inconsistencies between the leaflets and the dietary and infant feeding guidelines in Australia; and across the leaflets, as not all important messages were included in any one leaflet. Government Health Departments and other relevant agencies should ensure that advisory messages regarding diet, particularly those with dental implications, are clear, complete and consistent across all dental educational leaflets.

Background and Objective: Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years., Methods: Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle., Results: In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits., Conclusions: With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC., (Copyright © 2016 by the American Academy of Pediatrics.)

Our study investigated the effect of a selective intensive prevention (SIP) programme on dental health of pupils in comparison to a control group. While no differences were observed in respect to dental health of first graders, the DMF-T values of fourth and 6 graders participating in SIP were significantly lower. Concerning the psychometric variables only few differences were found. The fourth and 6 graders in the test group reported less dental fear than the pupils in the control group., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Fidelity assessments are integral to intervention research but few published trials report these processes in detail. We included plans for fidelity monitoring in the design of a community-based intervention trial., Methods: The study design was a randomized clinical trial of an intervention provided to low-income women to increase utilization of dental care during pregnancy (mother) or the postpartum (child) period. Group assignment followed a 2 × 2 factorial design in which participants were randomly assigned to receive either brief Motivational Interviewing (MI) or Health Education (HE) during pregnancy (prenatal) and then randomly reassigned to one of these groups for the postpartum intervention. The study setting was four county health departments in rural Oregon State, USA. Counseling was standardized using a step-by-step manual. Counselors were trained to criteria prior to delivering the intervention and fidelity monitoring continued throughout the implementation period based on audio recordings of counselor-participant sessions. The Yale Adherence and Competence Scale (YACS), modified for this study, was used to code the audio recordings of the counselors' delivery of both the MI and HE interventions. Using Interclass Correlation Coefficients totaling the occurrences of specific MI counseling behaviors, ICC for prenatal was .93, for postpartum the ICC was .75. Participants provided a second source of fidelity data. As a second source of fidelity data, the participants completed the Feedback Questionnaire that included ratings of their satisfaction with the counselors at the completion of the prenatal and post-partum interventions., Results: Coding indicated counselor adherence to MI protocol and variation among counselors in the use of MI skills in the MI condition. Almost no MI behaviors were found in the HE condition. Differences in the length of time to deliver intervention were found; as expected, the HE intervention took less time. There were no differences between the overall participants' satisfaction ratings of the HE and MI sessions by individual counselor or overall (p > .05)., Conclusions: Trial design, protocol specification, training, and continuous supervision led to a high degree of treatment fidelity for the counseling interventions in this randomized clinical trial and will increase confidence in the interpretation of the trial findings.

This paper reviews the range of school-based approaches to oral health and describes what is meant by a Health Promoting School. The paper then reports the results of a World Health Organization global survey of school-based health promotion. Purposive sampling across 100 countries produced 108 evaluations of school oral health projects spread across 61 countries around the globe. The Ottawa Charter for Health Promotion noted that schools can provide a supportive environment for promoting children's health. However, while a number of well-known strategies are being applied, the full range of health promoting actions is not being used globally. A greater emphasis on integrated health promotion is advised in place of narrower, disease- or project-specific approaches. Recommendations are made for improving this situation, for further research and for specifying an operational framework for sharing experiences and research.

Aim: Pregnancy is related with changes in oral health. While the medical care of pregnant women in Germany is well-regulated, there are no structured recommendations for dental examinations. During an "Oral Health Awareness Week" the periodontal conditions of pregnant women in the Federal State of Thuringia (Germany) were examined., Methods: 85 pregnant women participated in this study. Oral health indices (PSI, BoP and DMFT) were recorded. 61 of the 85 women followed the invitation to repeat the investigations after parturition. Additionally, birth weight and height of the newborn were recorded., Results: There were no correlations between periodontal condition and birth weight. However, pregnant women demonstrated in high levels periodontal inflammation (only 1.2% showed periodontal health). Pregnant woman with periodontitis (PSI 3 and 4) demonstrated clear deficiencies in health education regarding oral health and adverse pregnancy outcomes., Conclusions: These findings implicate the importance of periodontal care in pregnant women. An association between periodontitis and reduced birth weight was not observed in the studied Thuringian cohort., (© Georg Thieme Verlag KG Stuttgart · New York.)

The purpose of this study was to investigate the degree to which patients have perceived that they got questions or advice about eating habits and smoking habits at their last visit at the dental clinic and if this information was differently distributed between different age groups. A further aim was to study whether there were differences in the proportions of questions and advice given to individuals who perceived problems regarding caries and gum bleeding compared to those that did not feel they had problems. The results are based on a postal questionnaire survey,"Life and Health 2008". The study was conducted in a population of women and men aged 18-84 years in 5 counties in Sweden. A total of 68,710 questionnaires were sent out and the response rate was 59.2%. Substantial differences in proportions existed between age groups regarding who received questions and advice related to dental caries and periodontal disease. The differences between age groups regarding information were statistically significant since it was less common that older people got questions and advice than younger.These differences also exist, but less pronounced, between those with disease related problems and those without.Three factors were statistically significantly associated with information. Age, education level and problems with caries or bleeding gums had statistical effect on the prevalence of questions and advice related to eating habits or smoking habits respectively. In conclusion, it is an urgent need of education in methods for dental staff if they want to contribute to changes in life style behaviors for their patients since most patients today don't perceive that they got important disease relevant information at the last dental visit.

Background: (i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses., Methods: This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway., Results: The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent., Conclusion: Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.

Background: Early childhood caries (ECC) is the presence of caries in primary teeth in children 71 months of age or younger. Despite a decreasing prevalence of caries in China, ECC and related risk factors in China have not been well studied., Aims: This study aimed to investigate the status of ECC in children living in Xiamen city in China and to analyse the associated social and behaviour determinants., Design: A stratified random sample consisted of 1523 children with normal birth records. Clinical examination was performed to record caries at the surface level. Parents filled in questionnaires regarding eating habits, family status, childcare provider, and oral intervention., Results: Prevalence of ECC in studied child population was 56.8-78.31%, with an increasing tendency with age. The following factors were found to be significantly associated with ECC: age, candy, carbonated drink, bedtime eating, late start of brushing, low education of parents, private childcare, increased number of siblings, rural residence, and lack of oral health knowledge. Using a stepwise forward logistic regression analysis, a prediction model was established., Conclusion: Early childhood caries in children living in Xiamen city was strongly associated with eating habits, family- and childcare-related factors and tooth-brushing. The ECC-high-risk group is children in rural private childcare facilities., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

Objective: To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil., Material and Methods: Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted., Results: The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables., Conclusions: Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.

Objective: To report on the dental health of three-year-old children in Greater Glasgow, and to examine the amount of dental caries associated with deprivation in this young age group., Design: Dental inspections in nursery schools., Subjects and Methods: The national inspection programme using BASCD criteria was extended to include an additional group of nursery attending three-year-olds in Greater Glasgow in 2006/7 and 2007/8. Caries experience was analysed by logistic regression models and ROC plots., Results: Fourteen percent of this population was sampled in 2006/7 and 19% in 2007/8 (usable data n = 1,711 in 2006/7, 2,428 in 2007/8). Mean d(3)mft was 1.1 in 2006/7 and 1.0 in 2007/8. The prevalence of caries experience was 26% in 2006/7 and 25% in 2007/8 (33% and 32%, respectively, for children in deprived areas). The adjusted odds-ratio for caries experience for children living in the most deprived areas was 2.90 (2.31, 3.64), p <0.001. There was a high rate of caries in the upper anterior teeth., Conclusion: It was feasible to conduct large scale caries surveys of three-year-olds in a nursery setting. Poor dental health and inequality commence early in life. Caries prevention should be targeted toward deprived families from birth.

Unlabelled: Inequalities in oral health in areas of socio-economic disadvantage are well recognised. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. However, to what extent schools are able to do this is unclear. The aim of this study was therefore to investigate opportunities and challenges to promoting oral health in primary schools., Methods: A purposive sample of 20 primary schools from socially and economically disadvantaged areas of Cardiff, UK were selected to participate in this qualitative study. Data were collected through semi-structured interviews conducted with head teachers or their nominated deputies., Results: General awareness of health and oral health was good, with all schools promoting the consumption of fruit, water and milk and discouraging products such as carbonated drinks and confectionaries. Health promotion schemes wereimplemented primarily to improve the health of the children, although schools felt they also offered the potential to improve classroom behaviour and attendance. However, oral health was viewed as a separate entity to general health and perceived to be inadequately promoted. Successful health promotion schemes were also influenced by the attitudes of headteachers. Most schools had no or limited links with local dental services and, or oral health educators, although such input, when it occurred, was welcomed and highly valued. Knowledge of how to handle dental emergencies was limited and only two schools operated toothbrushing schemes, although all expressed an interest in such programmes., Conclusion: This study identified a positive predisposition to promoting health in primary schools. The challenge for the dental team, however, is to promote and integrate oral health into mainstream health promotion activities in schools. The paper also makes recommendations for further research.

Introduction: Tooth avulsion is the complete displacement of a tooth from its socket due to intentional or non-intentional injuries. Treatment in these cases comprises tooth replantation. This accident is very critical as the success of tooth replantation is directly dependent on several factors, such as extra-alveolar period, storage of the tooth until replantation, type of retention employed, time of endodontic intervention, type of drug prescribed, oral hygiene status as well as general health. This trauma commonly occurs during sports practice, school, and leisure activities. The first measures are critical for the prognosis of the avulsed tooth. Several studies report lack of knowledge of the population, educators, sports professionals, and health professionals in the management of tooth avulsion. This study evaluated the influence of education on different groups of professionals, addressing the knowledge and prevention and emergency management of the avulsed tooth., Method: The study was conducted on five different groups of professionals (elementary school teachers, physical education professionals, bank employees, dental doctors, and pediatricians) from the city of Brasília, DF, Brazil. The professionals attended a lecture and were evaluated by a questionnaire applied twice, before and after the lecture., Results: The results of the 479 returned questionnaires were analyzed. The difference between questionnaires before and after the lecture was statistically analyzed by the Wilcoxon test. There was statistically significant change in the performance of professional groups after information was provided (P < 0.0001)., Conclusion: Education is extremely important to favor the knowledge on prevention and emergency management of an avulsed tooth, and may enhance the prognosis of tooth avulsion.

In avulsion, teeth are bodily displaced out of the bony socket. Boys, aged 7-9 years, are most prone to avulsion of maxillary central incisors. Tooth avulsion should ideally be treated with immediate replantation. Because of the urgency in treatment, personnel dealing with this injury should have knowledge about the first-aid treatment. This study was conducted to assess the first-aid knowledge about tooth avulsion among dentists, doctors, students, school teachers and the general public in Lahore, Pakistan. Data were collected using a form with one open-ended question about the first-aid treatment of traumatic avulsion. Immediate replantation of the avulsed tooth was suggested by 10.1% of 377 respondents. Among dentists, 45.8% suggested immediate replantation, with the rest suggesting transport of the tooth to a dentist for replantation. Among all other groups (non-dentists) immediate replantation was suggested by 4.6% and transport to a dentist by 3.3%. Non-dentists in Pakistan, including doctors, have insufficient knowledge about the immediate treatment of tooth avulsion. Dentists, in comparison, have significantly more knowledge, but may need training in selection of the appropriate treatment option and handling and care of the avulsed tooth.

The multidisciplinary nature of the follow-up evaluations of traumatic dental injuries (TDI) requires that both the lay public and practitioners possess knowledge of the treatment strategies involved. The aim of this paper was to assess the level of knowledge of elementary public schoolteachers, parents and dentists of the city of Joaçaba, Southern Brazil, about the emergency management of TDI. Three independent cross sectional studies were carried out involving samples of elementary public schoolteachers (n = 245), parents (n = 107) and dentists (n = 85) in the city in 2001. Data were collected through structured interviews for schoolteachers and dentists, and questionnaires for parents, containing questions about socio-demographic characteristics and about incidents resulting in TDI. The responses in the three studies showed a wide variability of indicated procedures for the situations of TDI proposed. The results of association studies showed that older schoolteachers (P = 0.003), older dentists (P = 0.013) and dentists who had graduated more recently (P = 0.032) chose significantly more correct answers in some TDI incidents. The answers of schoolteachers, parents and dentists showed a wide variability of indicated procedures for the situations proposed. The great majority of them would not follow the approaches most recommended in the literature. A greater importance should be placed on TDI through educational campaigns aiming schoolteachers and parents and also through undergraduation and postgraduation dental curricula in order of improving its management.

Aim: The aim was to compare the working profiles of Finnish and Norwegian dental hygienists in public and private practice. To this end, we compared the procedures performed, the type of patients and the time devoted to different tasks., Subjects and Methods: A questionnaire survey was originally conducted among a representative sample of dental hygienists in Finland (n = 595) and all authorized dental hygienists in Norway (n = 1,138) in 2004. The questionnaires collected data on the dental hygienists' age, gender, year of graduation, working experience, work sector (private or public), working time spent on different activities and patient groups. The questionnaire also assessed how frequently the dental hygienists performed 25 different treatment measures., Results: The Norwegian dental hygienists spent 45.4% of their clinical time on check-ups, whereas the Finns spent 49.9% of their time scaling. Dental hygienists in Finland and Norway working in the public sector spent 42.9% and 74.6% of their working time dealing with children and youth respectively., Conclusions: The working profiles of dental hygienists in Finland and Norway were quite similar, although differences in distribution by activities, type of patients and treatment measures do exist. The main activity of the dental hygienists was clinical work. The most commonly practised clinical activity among Finnish dental hygienists was scaling, and among Norwegians, check-ups. Public dental hygienists in both countries dealt mainly with children and youths. Oral hygiene instruction was the most commonly reported treatment measure among both Finns and Norwegians.

Unlabelled: It has been demonstrated that nutrition/healthy lifestyle counseling can help alleviate the childhood obesity crisis. Because pediatric dentists see children with regular frequency, they are uniquely positioned to help provide such counseling., Purpose: To document current nutrition/healthy lifestyle counseling practices of pediatric dentists in NC and examine factors associated with those practices., Methods: A 65-item survey instrument was developed by an expert committee, pilot-tested and revised. The instrument contained questions in 6 domains: Academic Preparation, Knowledge, Confidence, Opinions, Practice Patterns and Barriers. It was sent to all clinically active pediatric dentists in NC., Results: The response rate was 69% (70/102). Less than 25% provided nutrition counseling services. Academic preparation in residency training was statistically significant (P<.05) in determining those who practiced nutritional counseling. Logistic regression revealed that respondents with higher overall knowledge (OR=18.2), those comfortable discussing weight-related issues (OR=47.7), those in practice >10 years (OR=20.6), and females (OR=173) were more likely to provide nutrition/healthy lifestyle counseling., Conclusions: All respondents believed that childhood obesity is a major health concern and expressed a willingness to assist other health professionals in addressing this problem. These findings offer a rich source of data that can be used for educational initiatives and strategic planning.

Professional practices reflect the structuring of health services and are related to the underlying principles of the prevailing health care model. This study focused on preventive and educational practices by dentists in the Family Health Program in Natal, Rio Grande do Norte State, Brazil. A structured interview was held with 80 dentists, in addition to analysis of documents from the Outpatient Database of the Unified National Health System (SIA-SUS) and the Primary Care Database. Individual activities involving orientation for oral hygiene and topical application of fluoride were reported by 87.5% and 95% of dentists, respectively. At the collective level, all the dentists that worked in schools (91.2%) performed topical fluoride application, while 86.2% conducted educational activities. According to SIA-SUS records, preventive activities accounted for 41% of all procedures. Among these, topical application of fluoride gel per sitting and supervised brushing accounted for 24.4% and 31%, respectively. As for educational activities, 57.4% were held in the health care unit and 42.6% in the community. The findings indicate that the preventive practices focus on dental caries, particularly in schoolchildren, and that they need to be expanded to include other oral health problems.

The aim of this ecological study was to determine the association of the frequency of dental health activities conducted as public health service and sociodemographic characteristics with caries prevalence in Japanese 3-year-old children using data for each municipality as one unit. Data on caries prevalence in 3-year-old children in 2000 were obtained from 3,251 municipalities (almost all municipalities in Japan). Caries prevalence for each municipality was recalculated using the empirical Bayes estimation model to make adjustments for variations in municipalities with small numbers of children. Explanatory factors included annual frequency of dental health activities such as dental health education and topical fluoride application programs and various sociodemographic characteristics. Multiple linear regression analysis was applied to examine the associations between caries prevalence and annual frequency of dental health activities with adjustment of other sociodemographic variables. Variations in caries prevalence in municipalities with small populations became smaller after being adjusted by the empirical Bayes estimation model. Multiple linear regression analysis showed significant associations of caries prevalence with sociodemographic characteristics such as the proportion of residents with university degrees, total fertility rate, and the proportion of workers in the manufacturing industry (p < 0.001). Annual frequency of topical fluoride application showed a significant but relatively weak association with caries prevalence (p < 0.001), explaining only 0.8% of the total variation in caries prevalence, whereas no correlation was found between caries prevalence and annual frequency of dental health education. It was concluded that the effect of the fluoride application service on caries prevalence in 3-year-old children, although statistically significant, was of far lower clinical significance than sociodemographic characteristics.

The study of the whole range of measures of primary dentofacial anomalies prevention has determined the most often used methods of their prophylaxis. It is also shown that consultations with specialists in the allied medical areas and use of technical preventive devices are underestimated. Information modalities for patients, hygiene (sanitary) education are not at due level. Small attention was paid to preventive examinations of children in the so-called organized collectives and to regular medical check-up of children population.

Objectives: To determine dentists' and dental hygienists' intervention activity towards patients who smoke or use snus (oral moist snuff), and to establish which factors impede interventions and cause variations in approach., Methods: A questionnaire was mailed to a sample of 1500 dentists (response rate: 68%) and all dental hygienists in the country (522 in all; response rate: 61%)., Results: Dental hygienists conversed with patients on smoking habits on average 18 min/week, while the dentists spent 13 min doing the same. The issue of snus-use was discussed, on average, for 3 min. In eight of 10 consultations with patients suffering from tobacco-induced disorders in the oral cavity, the dentists/dental hygienists raised the subject of smoking habits with the patient. In cases without visible tobacco-induced symptoms, inquiries were made concerning smoking habits in three of 10 dentist consultations and four of 10 consultations with dental hygienists. For first-time consultations, six of 10 were queried concerning their smoking habits by their dentist, while dental hygienists enquired in seven of 10 cases. Self-reported skills, perceived barriers and attitudes explained far more of the variance in intervention impact than background variables. There were moderate differences between dentists and dental hygienists., Conclusions: There is room for improvement in smoking and snus-use prevention efforts in the dental sector. If staff is to be rid of their misconceptions regarding the efficacy of intervention, it is important to inform them about the encouraging results at the population level., (Copyright Blackwell Munksgaard, 2004)

The purpose of this study was to know the prevalence and pattern of dental health problems in rural school children of Kerala and to identify the priority area for dental health education programmes. The children were examined and findings recorded. the findings show that more than 50% of the children in the 12 to 15 years of age group in rural Kerala suffers from some form of dental diseases. Males and females are equally affected and dental caries is the most common problem encountered.

Objectives: To assess the present level of oral hygiene practices in the Danish adult population aged 16 or above, in particular to analyse how self-care practices in terms of oral hygiene habits and cleaning of dentures are affected by socio-economic factors, dental status, actual dental visiting habits, and the experience of oral health care during school years., Basic Research Design and Participants: A cross-sectional study of 5802 persons, randomly sampled amongst the Danish population aged 16 years or above. Data were collected by means of personal interviews and self-administered questionnaires. The response rate was 66%., Results: Toothbrushing twice-a-day was reported by 68% of the dentates while 32% brushed their teeth once-a-day or less frequent. Daily use of toothpicks was reported by 28% while daily use of dental floss was reported by 11%. Oral hygiene habits were more frequent amongst women. Toothbrushing twice-a-day was related to regular dental visits, dental care during school years, and a high level of education. Daily use of toothpicks was more common among females and older persons. Regular dental visits, having 20 or more teeth in situ, and regular dental service through school years were predictors for daily use of toothpicks. Amongst denture wearers, one-third cleaned their dentures twice-a-day. Frequency of denture cleaning was significantly associated with gender, age, number of teeth left, and educational level., Conclusion: Intensive population-directed strategies for oral health education should be considered in order to further improve the oral hygiene practices of the entire population.

The purpose of this study was to evaluate the knowledge and attitudes toward oral health of education and health professionals working in a children care program for handicapped children from 0 to 6 years of age, run by a public municipal institution in Rio de Janeiro. Using a printed questionnaire, 67 professionals (teachers, attendants and health professionals) were interviewed. The results were compared to the children's oral hygiene habits, by directly observing their daily nursery routine. Although 97.0% said that oral health could play a part in general health, only 37.3% of the professionals answered correctly on this matter. As for methods for preventing caries, although 92.5% said that they were aware of them, only 17.9% went to the dentist for preventive treatment. Although the majority (81.3%) indicated oral hygiene as a way of preventing caries, observation showed that this practice is not always put into effect in the program's day nursery. Regarding when to start toothbrushing in children, 75.0% of the teachers and 94.4% of the health professionals said that they were aware of the need to begin brushing before one year of age, although this reply was given by only 52.5% of the attendants (chi-square, p = 0.006). In view of these results, it was concluded that attitudes toward oral health were not always coherent with the knowledge that these professionals express.

Objective: To describe the prevalence of dental caries among Jordanian preschool children and risk factors for caries., Design: Preschool children aged 1 to 5 years from randomly selected nurseries and kindergartens in Amman were surveyed in September 2001. A questionnaire to investigate factors that might have affected dental caries level was completed by parents. Dental caries was diagnosed as recommended by the World Health Organization., Results: The mean dmft scores at 1, 2, 3, 4, and 5 years were 0.19, 1.15, 1.7, 2.13, and 3.22 respectively. Overall, 52% of children were caries-free. Caries level was significantly related to feeding practices, snacking habits, oral health practices and pattern of dental visiting as well as to socio-economic background, parents, education level and awareness., Conclusion: The dental caries level was slightly higher than that of children in industrialised countries but lower than that of children in the neighbouring Arab countries. However, the early caries development seen in children from the lower socio-economic classes, because they are at high risk for caries in Jordan, reinforces the need for preventive programmes before eruption of the teeth. Access to dental care must be improved to enable any preventive strategies to be implemented.

Objectives: To assess the occurrence of dental caries over time in Polish schoolchildren, to analyse the oral health behaviour of children and mothers, and to compare the levels of dental knowledge and attitudes of mothers and schoolteachers., Design: Cross-sectional oral health surveys of children aged 6 and 12 years were carried out in 1995, 1997, 1999 and 2000; questionnaire surveys of a sample of mothers and schoolteachers were conducted in 1999., Setting: The surveys in schools intended to aid planning and evaluation of the revitalised school oral health programme in Poland., Subjects: Children of age six years comprised: 1995 (n = 1860); 1997 (n = 922); 1999 (n = 2290); 2000 (n = 3391). The surveys of 12-year-old subjects covered: 1995 (n = 1859); 1997 (n = 2743); 1999 (n = 3060): 2000 (n = 3391). Mothers (n = 1040) of a randomised subsample of children (response rate 83%) and 471 schoolteachers (response rate 95%) were identified for the questionnaire surveys in 1999., Outcome Measure: Dental caries in children was recorded by WHO methods and criteria, self-administered questionnaires were used to gather information on dental knowledge, attitudes and practices of children and mothers while self-administered questionnaires for teachers covered dental knowledge, attitudes and involvement in health education., Results and Discussion: The proportions of 6-year-old children being caries-free were 13% in 1995, 17% in 1997, 18% in 1999 and 12% in 2000. The mean DMFT of children aged 12 years was 4.2 in 1995, 4.0 in 1997, 4.0 in 1999 and 3.8 in 2000; the D-component was particularly high for rural children. In 1999, toothbrushing at least twice a day was reported for 64% of children and this practice was relatively frequent in urban areas. Dental visits were made by 71% of children and 56% of mothers. Knowledge and attitudes were low, particularly in rural areas. Dental care habits of children were highly influenced by dental attendance and level of education of mothers. Knowledge and attitudes were higher for teachers than mothers. The teachers knew about the poor dental conditions in children and wanted to become involved in oral health education. In conclusion, the need for oral health education of children and mothers was shown and the continuous implementation of school oral health programmes is most relevant.

Aim: The aim of the study was to ascertain periodontal treatment needs and their socio-demographic determinants among adults in the United States by transforming nationally representative periodontal data into an index routinely used internationally., Design: Data were abstracted from a complex, highly stratified, multistage probability cross-sectional study to create a modified Community Periodontal Index of Treatment Needs (CPITN)., Participants: 11,339 persons aged 20-79 who participated in the third US National Health and Nutrition Examination Survey (NHANES III), 1988-94., Results: At least 3% of the adult US population required complex periodontal treatment, 90% needed scaling and prophylaxis, and nearly 5% did not need periodontal treatment or oral hygiene instruction. A multivariate cumulative logistic model indicated that being older, male, non-Hispanic black, having lower education, smoking, or not having had a dental visit in the past year increased the likelihood of needing more complex periodontal treatment. The risk factors that indicated the greatest potential for increasing complexity of periodontal treatment, after controlling for all covariates, were being either non-Hispanic black (OR=2.51; 95% CI=1.98, 3.18), or not completing high school (OR=2.10: 95% CI=1.60, 2.77), or a current cigarette smoker (OR=2.02; 95% CI=1.76, 2.33)., Conclusions: The need for increasingly complex periodontal treatment differs by sociodemographic factors. Most American adults need some type of periodontal treatment; however, the majority of periodontal treatment needs in the US are within the clinical skill range of dental hygienists. There is significant disparity in the distribution of need for periodontal treatment; persons from socially disadvantaged groups are more likely to present with increasing complexity of periodontal treatment needs.

Background: The purposes of this study were to compare patient expectation before periodontal surgical treatment with their level of satisfaction afterward on the basis of a self-reported questionnaire, and to analyze the relationship between various satisfaction factors and periodontal surgical treatment., Methods: Information was obtained from 33 patients initially diagnosed with chronic periodontitis. The survey was completed twice by each patient, once before and once after modified Widman flap surgery., Results: The satisfaction scores of items related to patient expectation of treatment outcome decreased significantly following surgery. The patients also expressed great dissatisfaction with items regarding disease prevention such as "desire for knowledge of periodontal disease prevention" and "desire for knowledge of recurrence control methods." However, some items such as "dental pain during treatment," "dental fear of treatment," and "cost of treatment" increased significantly after treatment. The total mean score of general satisfaction before treatment was 2.65, decreasing to 2.60 after treatment., Conclusions: Among the 5 subscales, any increase in patient satisfaction related to the treatment factors is difficult to achieve, but we should be able to raise the satisfaction level of our patients through improvement of the preventive measure factors.

Objectives: The aim of this study was to find out how commonly adolescents receive oral hygiene instructions and dietary sugar advice in the Finnish public oral health care system and whether there have been any changes between 1989 and 1997., Methods: The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey. Since 1977, a questionnaire has been sent every second year to a representative sample of 12-, 14-, 16- and 18-year-old Finns eligible for free comprehensive oral health care. The sample size was 3105 in 1989 and 8390 in 1997., Results: Almost all adolescents (95-96%) had visited a dentist during the last 2 years. In all age groups, boys reported having received tooth cleaning instructions during their dental visit more often than girls did (40%/35%). There was only a minor decrease in instructions received between 1989 and 1997. Boys and those who brushed their teeth once a day or less often were the most likely to receive instructions in 1997. Only one-fifth of adolescents reported having received dietary sugar advice, and there was a slight decrease between 1989 and 1997. In 1997, the groups of adolescents most likely to be advised were 12-16-year-old-boys, those using sweets daily and those living in Central Finland., Conclusions: Oral health instructions were only given to a minority of adolescents. The targeting of adolescents with health-damaged behavior is therefore important.

Background: Tanzanian primary school teachers have long been utilised as oral health educators but little is known about their level of participation., Objectives: To asses the participation of primary school teachers as general and oral health educators., Design: Cross-sectional, using structured self-administered questionnaires., Setting: Rural and urban Primary Schools in Rungwe District, Mbeya Tanzania., Participants: Primary school teachers from 15 rural and 4 urban schools., Main Outcome Variables: Provision of oral health education., Results: Teachers with primary education, who are teaching in lower grades were significantly more active in providing general and oral health education (OHE) than those with secondary education and who teach pupils in higher grades., Conclusion: Oral health education seems to be given mainly to primary school pupils in lower grades; teachers involved in oral health education provision were mainly female juniors in the profession and relatively young by age (below 40 years old)., Recommendation: There is a need for influencing teachers of pupils in higher grades and males to be involved in oral health education programmes throughout their teaching profession.

Oral diseases are widespread in South Africa and affect large numbers of people in terms of pain, tooth loss, disfigurement, loss of function and even death. The majority of South Africans have no access to private services and are dependent on the government for oral health care services, but less than 10% of the population utilises public oral health services. This underutilisation is due to limited resources and inaccessibility. This article reports on the data collected on adults, 15 years and older, from the South African Demographic and Health Survey carried out in 1998, relating to perceptions of oral health. The questions dealt with oral health problems, utilisation of oral health services, loss of natural teeth, oral health practices and knowledge of water fluoridation. The results are discussed in terms of age, gender, education, place of residence, province and classification according to the previous population registration act. A high proportion (36%) of people had experienced oral health problems. Teeth problems were most commonly reported in the higher age groups, non-urban areas, Eastern Cape, Northern Cape and Free State, people with little education and those classified as non-urban Africans. Significant differences were found in regard to periodontal disease, tooth loss, knowledge of fluoride between groups according to age, geographic location, race and level of education. 62% of the respondents reported that they had lost some of their natural teeth and in some communities almost a third of the respondents were edentulous. In comparing the goals of the current draft national oral health policy with the findings of this survey the following implications for policy development should be noted: A higher priority needs to be given to oral health issues; Improve access by increasing primary health care facilities through the delivery of oral health care services; The high prevalence of hepatitis and HIV/AIDS infection poses a higher risk to oral health personnel and the public and The successful implementation of water fluoridation depends upon public knowledge, understanding and support.

Background: Practice beliefs have been related to service rate variation. The aims of this study were to replicate practice belief scales in Australia and investigate associations with dentist and practice characteristics and services., Methods: A random sample of Australian dentists completed mailed questionnaires (response rate 60.3 per cent)., Results: Private general practitioners (n = 345) provided service data from a typical day. Eight practice belief items were recorded on a five-point Likert scale, yielding four factor-based scales. Approximately 85 per cent of responses were on the agreement side of the midpoint for the scales of Information giving and Patient influence, 45 per cent for Preventive orientation and approximately 10 per cent for Controlling active disease rather than developing better preventive advice. Capital city dentists had higher agreement with the Preventive orientation scale, while males and older dentists showed less disagreement with the Controlling active disease item (Mann-Whitney, Kruskal-Wallis P < 0.05). Those agreeing with the scales (that is scores < or = the median) showed (Poisson regression P < 0.05): a higher rate of crown and bridge, a rate ratio (RR) of 1.31, but lower rates of extraction (RR = 0.76) and prosthodontic services (RR = 0.64) for the Information giving scale; a higher rate of restorative (RR = 1.22) and total services per visit (RR = 1.06) for the Preventive orientation scale; a higher rate of preventive services (RR = 1.14), but a lower rate of crown and bridge services (0.78) for the Patient influence scale; and higher rates of crown and bridge (RR = 1.40) and prosthodontic (RR = 1.59) but lower rates of periodontic (RR = 0.60) and extraction services (RR = 0.62) for the Controlling active disease item., Conclusions: These findings confirm the factor structure of practice beliefs and demonstrate small to moderate associations with variation in service rates.

This study determined the oral health status of a group of 3-8-year-old South African black children, comprising a total of 214 children from the townships of Garankuwa, Shosanguwe, Mabopane, Hebron and Erasmus who attended a school in Akasia, Greater Pretoria Metropolitan Substructure. The decayed, missing and filled teeth (dmft), oral hygiene status, dental IQ and malocclusion status were determined. The study found that the children's oral health status and occlusal status were unacceptable. The level of their dental IQ scores was low, their oral hygiene poor, and they were in urgent need of primary and secondary dental care. In addition they were in need of both preventive and interceptive orthodontic care. A national strategy to address primary dental health care is recommended.

Objective: The aim of the pathfinder survey was to assess the periodontal status and treatment needs in The Gambia., Methods: A multistage stratified random sampling technique was used to obtain a sample of 1,235 (or 0.1% of the national population). The study was conducted according to the World Health Organisation's criteria (WHO, 1987). The WHO J2 software programme was used to analyse the data., Results: Not more than 12% of subjects in any age group had healthy periodontal tissues. Two to three sextants were healthy among those under the age of 35 years. Shallow (4-5 mm) pockets were present in all ages. However, less than one sextant was involved among subjects younger than 25 years. Despite the high prevalence of pockets, few sextants were edentulous. The majority of subjects needed oral hygiene instructions and oral prophylaxis. Of the subjects between the ages of 8 and 29 years, 5-28% needed complex treatment in only half of a sextant. Similarly, 38% and 80% of older subjects needed complex treatment in 0.8-1.9 sextants., Conclusion: A national oral health plan in The Gambia should focus on health education and provision of oral prophylaxis by trained auxiliary health care workers. In conclusion, there is a need to develop a functional district oral health services system in The Gambia.

The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians.

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.

In 1995, a study was undertaken in France to assess the periodontal health status of 603 noninstitutionalized elderly subjects aged 65-74 years. Thirty areas were identified in the Rhône-Alpes region, with a sampling method based on stratified quotas according to sex, place of residence and socio-economic group (S-EG). The CPITN index was used. The total prevalence of healthy dentate adults (n = 483) was 16.5 per cent, whilst 16.3 per cent of the adults were edentulous. The prevalence of CPITN code 1 + 2 (low) was 50.7. The higher S-EG having fewer codes 1 and 2 (45.8 per cent) than the lower S-EG (49.7 per cent) and the medium S-EG (55.7 per cent). The total prevalence of periodontal disease (code 3 + 4) was 31.5. The prevalence of periodontal disease was lower in adults of medium socio-economic status and was also lower in adults living in urban residences. Overall, 66.9 per cent of the entire population needed oral hygiene instruction, 56.6 per cent scaling and 2.3 per cent complex periodontal treatment.

Objectives: To assess whether it was possible to implement an oral health programme in Kuwait which followed guidelines underlying the public Danish Child Oral Health Service, and thereby improve the oral health of Kuwaiti children., Design: Successive cross-sectional surveys were carried out in one governorate in Kuwait (Al-Ahmadi) during the period 1986-97 interrupted by the Gulf War. Data were collected by clinical examinations., Setting: The programme was initiated by the Ministry of Health in Kuwait in order to improve the community services through a school-based oral health care programme., Participants: The study population comprised incrementally all children in the four primary school classes in the governorate., Interventions: The children received bi-weekly tooth brushing instructions with fluoridated toothpaste and fluoride rinsing, fissure sealing, oral health education, and restorative treatment of dental caries., Outcome Measures: The children were clinically examined each year before the start of the treatment. Dental caries was scored at surface level in accordance with the Danish registration system, using the WHO criteria for dental caries., Results: The average participation rate was 94%. The percentage of caries-free children, exemplified by second class, increased from 64% in 1987 to 78% in 1990, dropped to 71% in 1992 and increased again to 79% in 1997., Conclusion: It is concluded that it has been possible to adapt the principles from the Danish Child Oral Health Service programme to Kuwait, that parents and teachers accepted the principle of treating the children during school hours, and that the oral health of the children improved. Whether the improvement in the oral health is due to the programme or to changes in the society is discussed.

Aims: To examine the attitudes of pharmacists to sugar in medicine and sugar-free preparations and their levels of knowledge concerning sugar-free preparations and the implications for dental health., Design: A questionnaire was designed with a mixture of closed and open-ended questions., Setting: Pharmacists practising in the Greater Belfast area of Northern Ireland., Method: Seventy pharmacists were randomly chosen from the list of pharmacists practising in the area and were asked to participate in the study., Results: Responses were obtained from 52 of the 70 selected pharmacists, representing a response rate of 74%. Seventy-five per cent of the pharmacists stated that they had not received formal education concerning sugar in medication and it's effect on dental health. Their main source of information on the subject was dental health literature. Eighty-seven per cent felt that all medication should be available in sugar-free form. Forty-six per cent stated that sugar in medication was definitely an important cause of dental caries in children and 44% felt that it was a possible factor. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising. Thirty-nine per cent of the pharmacists always offered a sugar-free preparation for over-the-counter medication (provided that a sugar-free alternative was available), and 56% sometimes did so. Fifty per cent always offered a sugar-free form for prescribed items wherever possible, the remainder depended on it being specified by the prescriber., Conclusion: There is a high level of interest in this issue among pharmacists, but there is a need for an increased educational input on a continuous basis.

Aims: To examine the reported receipt of oral health education among mothers of children who required the extraction of teeth under general anaesthesia., Design: Cross-sectional study using questionnaires completed at interview., Sample: 150 mothers of children aged 5 or younger who had been referred for extraction of teeth under general anaesthesia., Setting: Dental School, University of Wales College of Medicine., Results: 27% of mothers recalled receiving advice from their dentist about dental care during their pregnancy. With regard to their child's oral health, 48% had received dietary advice and 31% oral hygiene advice from the same source. All children lived in areas with suboptimal water fluoride levels; 27% of mothers had been advised by their dentist to give their child fluoride supplements. Few of the mothers recalled receiving advice about oral health from their health visitor.

A panel of public health practitioners sponsored by the Health Resources and Services Administration met December 6-8, 1994, to examine current roles and responsibilities for dental public health workers and to recommend changes in education and training to meet challenges posed by an evolving health care system. Overall, at least the same number, if not more, dental public health personnel will be needed in the future. While some new roles were identified, the panel felt that only small numbers of personnel will be needed to fill these new roles. Not all of these roles necessarily require a dental degree. The panel felt that a need exists for more academicians for dental schools, schools of public health, dental public health residencies, and dental hygiene programs; oral epidemiologists and health services researchers; health educators; and specialists in utilization review/outcomes assessment, dental informatics, nutrition, program evaluation, and prevention. To meet these personnel needs: (1) dental public health residency programs should be structured to meet the educational needs of working public health dentists with MPH degrees through on-the-job residency programs; (2) the standards for advanced specialty education programs in dental public health should be made sufficiently flexible to include dentists who have advanced education and the requisite core public health courses; (3) flexible MPH degree programs must be available because of the rising debt of dental students and the decreased numbers of graduating dentists; (4) loan repayment should be available for dentists who have pursued public health training and are working in state or local health departments; and (5) standards for advanced education in dental public health should be developed for dental hygienists.

The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society." An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.

Public knowledge of water fluoridation (WF), sources of information, purpose of WF and the level of support for the implementation of WF was assessed in South Africa. Of the 2229 respondents interviewed, 23 per cent had heard or read about WF. Almost a third said they obtained their information from schools or community networks while 60 per cent mentioned either radio, newspapers/magazines, or television. About 25 per cent correctly recognized the protection of teeth as the purpose of fluoridation, while two-fifths believed the purpose of WF is to purify water. More than sixty per cent of respondents were in favour of WF, with almost a quarter of the sample feeling uncertain. This study demonstrates that a considerable amount of educational and political action is required for water fluoridation to be implemented in South Africa.

Purpose: This study assessed the performance of dental hygiene services and the perception of preventive oral health care in the Commonwealth of Independent States (CIS), formerly known as the USSR., Methods: In April 1996, questionnaires were distributed to a convenience sample of 200 dentists in four cities of the CIS: Moscow, St. Petersburg, Kiev, and Odessa. All questions were designed for practicing dentists since the dental hygiene profession in the CIS is not presently recognized., Results: The overall response rate was 93% (N = 186). The results indicated that oral hygiene care is provided by dentists on a selective, non-routine basis. The number of missing teeth in persons age 35 is 5 to 7. An oral prophylaxis in the CIS accounts for 3.1 percent of all dental visits and is performed to either remove deposits that create an obstacle to oral health care treatment or, less often, to improve the esthetic appearance of teeth. Approximately 75 percent of the dentists responding indicated they perform periodontal probing on patients with obvious periodontal problems. Fluoride supplements are provided by 82 percent of respondents, although three-fourths do not perform routine bitewing radiographs and occlusal sealants. The majority indicated a need for dental hygienists to be employed within the CIS oral health care system., Conclusion: The study indicates a critical need for developing dental hygiene in the CIS. It is recommended that preventive oral health care be provided by dental hygienists who have been formally educated in such a curriculum.

Objective: To compare the patterns of treatment of general dental practitioners working under fee-for-service in 1987/88 with those working under capitation in 1992/93., Design: 73 randomly selected general dental practitioners working under capitation in three contrasting areas in England retrospectively recorded the treatment provided during 1992/93 to a random selection of their regularly attending 6-12- and 14-15-year-old patients., Results: Mean numbers of examinations per year reduced in the three areas from 1.7-1.8 in 1987/88 to 1.2-1.4 in 1992/93. Mean numbers of visits per patient dropped from 2.5-2.9 to 1.8-2.2. Mean numbers of fillings in permanent teeth reduced from 0.15-1.04 to 0.09-0.52 and in deciduous teeth from 0.28-0.53 to 0.24-0.31. Mean percentages of children per dentist having extractions fell from 9.3-28.1% to 4.7-16.2% while the radiographs reduced from 14.0-9.0% to 6.0-10.6%. Mean percentages of children per dentist receiving oral hygiene instruction rose from 18-31% in 1987/88 to 26-33% in 1992/93. Dietary advice increased from 3-18% to 11-20% and fissure sealants from 3-6% to 3-12%., Conclusions: In 1992/93, dentists working under capitation were carrying out fewer examinations, fillings and extractions and were taking fewer radiographs for their regularly attending child and adolescent patients than dentists working under fee-for-service in 1987/88. These patients also attended less frequently for treatment but received marginally more preventive care and advice.

The purpose of the present study was to analyze self-reported oral hygiene habits, sources of oral health information, and oral health knowledge in a group of Japanese junior high school students and to determine whether there is a need for improvement in the school's present oral health instruction. A sample of 110 students aged 12-14 in Chiba City were surveyed by means of a questionnaire composed of 24 multiple choice questions. The questions focused on: (1) experience of school-based oral health education, (2) sources of oral health information, (3) knowledge about dental caries, periodontal disease, and the preventive action of fluoride, (4) oral hygiene habits, and (5) dietary behavior. Results showed that more than two-thirds of the students had participated in some kind of school-based oral health education program. Most students (76%) claimed that toothbrushing was the main event attended and 63% claimed that toothbrushing was the main subject they had been taught. The school nurse was identified by 48% of the students as their main source of oral health information in school-based oral health education. When asked to identify their main source of oral health information, most of the students identified "school". Half of the students (48%) identified dental plaque as the main cause of dental caries but only 31%, as the main cause of periodontal disease. Few students (11%) were able to identify the preventive action of fluoride; 58% answered "I don't know"). These results suggest that a meaningful target for the oral health education of children should be the improvement of the school's oral health instruction.

A total of 886 pupils aged 15-16 years selected from 20 public and 10 private schools in northern Jordan were investigated for frequency of toothbrushing and sweet consumption, dental caries and periodontal treatment needs. A questionnaire and clinical examination were used utilising decayed-missing-filled teeth (DMFT) code and the Community Periodontal Index of Treatment Needs (CPITN), respectively. Results revealed that 35.5 per cent of public and 57.1 per cent of private school pupils reported to brush their teeth regularly while the majority of them frequently consumed sweets. There were slight differences in caries experience amongst public and private school pupils, as measured by DMFT (4.74: 4.95). While bleeding and calculus scores were prevalent in pupils of both types of schools, they were slightly higher in pupils of public schools than those in private schools. Both shallow and deep pathological pockets were found in fewer numbers (6.09 per cent) in pupils in public schools only. Oral hygiene instruction and scaling were the predominant periodontal treatment needs in both types of schools. However, the treatment needed by pupils in public schools was higher than those in private schools. Complex treatment was rarely needed by public school pupils only.

The study reported here assessed the periodontal status in Ukonga using the CPITN index in the oral health survey data collected in 1988, and subsequently estimated the treatment needs in relation to Tanzanian circumstances. The resultant calculations showed that the estimated need was far greater than the dental services could supply. The authors therefore question whether or not all persons with a positive CPITN score do need treatment and speculate that there may be a more realistic approach using other models.

A CPITN survey involving Chilean high school students aged 15-19 years was conducted. A random stratified sample by age, sex and socio-economic status was obtained, and comprised 2400 subjects. The total prevalence of periodontal disease (Code 3+4) was 10.49 per cent. There was a significant difference in the prevalence of periodontal disease in males (9 per cent) compared to females (12.16 per cent). The prevalence of periodontal disease was higher in students of low socio-economic status (15.87 per cent) than in students of middle (9.22 per cent) and high socio-economic status (8.93 per cent). The periodontal treatment needs were also higher for students of low socio-economic status than for students of the highest family income. The prevalence of periodontal disease and treatment needs found in Chilean students showed that virtually this entire population needs oral hygiene instruction, that 70 per cent need scaling, and that 10.49 per cent need complex periodontal treatment.

The oral health status of minority ethnic groups is a critical issue for practitioners in today's multicultural society. The National Dental Health survey, conducted by the OPCS, provides baseline information on the oral health and oral health related behaviour of the population in the United Kingdom but not specifically relating to the minority ethnic communities. To date, little is known concerning oral health status and self-reported oral health related behaviours among minority ethnic communities in this country. Following a review of the published literature, this paper will address two questions: how has ethnicity been used as a variable by dental researchers and, what is known of the oral health status of minority ethnic groups? Other background variables are considered which might explain the differences in oral health status between these communities and the indigenous population, and recommendations are made concerning further research in this area.