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

Background: Dentists according to professional knowledge of the prevention, have a key role in providing a positive model for oral health-promoting behaviours. We aimed to investigate health behaviour of Iranian senior dental students in terms of oral self-care and tobacco use during a ten-year period to assess their preparedness to act as role models for health-promoting behaviours.Method: The study was performed in six dental schools selected through stratified cluster random sampling to have a representative sample of established (old) and new dental schools in Iran. Data were collected in four occasions in 2005, 2008, 2011, and 2015. Senior dental students (n=1185) were invited to voluntarily complete a self-administered anonymous questionnaire about their oral self-care and tobacco use. Recommended tooth-brushing habit (RTH) was defined as at least twice a day brushing with fluoridated toothpaste. Three separate questions about cigarette, pipe, and water-pipe use were applied to indicate the students’ tobacco use. Results: In 2005, 2008, 2011, and 2015, 22.5% (n=60), 26% (n=52), 28.5% (n=81), and 24.6% (n=51) of the students reported smoking, respectively. Women reported a better status in both tooth brushing twice daily and frequent use of fluoridate toothpaste than men did (p

Objective: To assess the association of oral health behavior (OHB) and the use of dental services with oral health literacy (OHL) among Iranian adults.Methods: This was a cross-sectional population study of a random sample of 1031 adults aged 18–65 in Tehran, Iran. We collected data on tooth brushing frequency, the consumption of sugary snacks and beverages, and time since last dental visit. To measure OHL, we used a validated OHL adults' questionnaire (OHL-AQ). In addition to descriptive analysis, we used multiple logistic regression models to assess the association of OHB and the most recent dental visit with OHL while controlling for socioeconomic and demographic factors.Results: The participants' mean age was 36.3 (standard deviation 12.9), and 51% were women. Of the participants, 81.3% reported brushing their teeth daily (≥1/day), 37.6% consumed sugary snacks or beverages between meals less than once daily (

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.

Purpose – The purpose of this paper is to: determine the prevalence and distribution of patient/family-generated, dentistry-related complaints to Regional State Administrative Agencies (AVIs) and the National Supervisory Authority for Welfare and Health (Valvira) in Finland from 2000 to 2011, study patient/family safety incident experiences and other reasons for complaints, assess complaint validity and evaluate factors associated with disciplinary processes against dentists. Design/methodology/approach – Data included closed cases handled by AVIs and Valvira (2000-2011) against dental practitioners or dental practice units (n=782). The authors analysed the complaints distribution and examined the antecedent factors and circumstances. Findings – This study demonstrated that patients/families can detect many dental treatment hazards, substandard processes and even serious safety risks rather well. The investigation processes revealed some physical harm or potential patient safety (PS) risks in more than half the alleged cases. Many complaints accumulated against certain individuals and statistically significant positive correlations were found between some patient/family complaints, dentist-specific variables and disciplinary actions. Practical implications – Patient/family-generated complaints must be taken seriously and seen as relatively good safety risk indicators. However, more knowledge on how patients might cooperate with dental care providers to prevent errors is needed. Originality/value – This work provides a unique opportunity to learn from several dentistry-related patient complaints. Despite some limitations, patient complaints appear to be useful as a complementary source together with other PS study methods.

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

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

Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 participants (mean age 36.3 (SD 12.9); 51% female), women reported brushing their teeth more frequently (P<0.001) and scored higher for oral health literacy (mean 10.9 versus 10.2, P<0.001). In the adjusted model, high age (OR = 1.01, 95% CI 1.003–1.034), low education (OR = 1.88, 95% CI 1.23–2.87), small living area in square meters per person (OR = 1.85, 95% CI 1.003–3.423), poor tooth brushing behavior (OR = 3.35, 95% CI 2.02–5.57), and low oral health literacy scores (OR = 1.58, 95% CI 1.02–2.45) were significant risk indicators for poor self-reported oral health. Conclusions. Low oral health literacy level, independent of education and other socioeconomic determinants, was a predictor for poor self-reported oral health and should be considered a vital determinant of oral health in countries with developing health care systems.

Objectives: To assess the relationship between insurance status and type of service received among dentate adults in a developing oral health care system. Methods: A cross-sectional survey based on phone interviews in Tehran, Iran. Four trained interviewers collected data using a structured questionnaire. Of 1,531 subjects answering the phone call, 224 were

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.

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

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

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

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

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.

Objectives: Interest is growing on conceptualizing dental disease aetiology under the life-course approach. The aim of this study was to assess the association of dental caries experience with the major components of life-course approach, health- and behavioral capital, among Turkish and Finnish pre-adolescents, with different family-related characteristics, as this association has not been explored yet.Methods: A cross-sectional study of Finnish (n=338) and Turkish (n=611) pre-adolescents was undertaken with questionnaires and oral health data.Results: Turkish pre-adolescents, more dentally diseased (84%) than the Finnish (33%) (P.05). Health capital, in terms of body height, and family-related characteristics in differing patterns, contributed to DMFT, in common, among Turkish and Finnish pre-adolescents. Self-esteem, behavioural capital was explanatory variable for DMFT only for the Turks.Conclusions: Dental health of pre-adolescents was associated with health- and behavioural capital in different pathways under the influence of family-related characteristics. The cooperation of paediatricians and dentists is vital in assessment of general and dental health in a holistic context throughout the life-course, to enhance the well-being of pre-adolescents. (Eur J Dent 2008;2:153-160)

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.

Objectives: To assess Iranian dentists’ knowledge of and attitudes towards preventive dental careMethods: A questionnaire survey was conducted at two nationwide annual dental congresses in 2004 and 2005 in Tehran, Iran. Dentists’ level of knowledge was assessed based on their responses on a Likert scale (0-4) to nine statements on preventive dental care. Higher scores indicated more accurate knowledge. Dentists’ attitudes towards preventive dental care were rated based on responses on a Likert scale (1-7) to nine pairs of bipolar adjectives. The respondents were to choose the response which best described their opinion. Higher scores indicated more positive attitudes. Of 1033 responding dentists, 980 (64% men) were deemed eligible for this study. Statistical evaluation was by t-test and the Chi-square testResults: Highest ratings were obtained for knowledge of the role of sugar consumption (Mean±SD: 3.73±0.60), sealants (3.58±0.68), and water fluoridation (3.35±0.81) in caries prevention; the lowest for their knowledge of the superiority of the use of fluoride toothpaste over technique of brushing (1.11±1.09). Dentists’ attitudes towards preventive dental care appeared most positive regarding its usefulness (Useful — Useless; 6.67±0.94), value (Valuable — Worthless; 6.59±0.98) to the community and for its status as a scientific (Scientific — Unscientific; 6.47±1.06) subject. Overall, female dentists had more favourable attitudes towards preventive dental care than male colleaguesConclusions: Preventive dentistry should be emphasised in dental education in order to update dentists’ knowledge and attitudes regarding preventive dental care. (Eur J Dent 2007;1:222-229)

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

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.

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

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.

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

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

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.

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

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

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

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

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

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

To determine the role of pre-adolescents' conceptions in improving their oral health in a school-based health education programme.A school-based programme was designed as a 3-month intervention study for a representative sample of 9-year-olds (n = 338) in 12 schools in Tehran, Iran. The schools were randomly assigned to the intervention groups and controls, separately for boys' and girls' schools. Children (n = 222) underwent two kinds of oral health education programmes. The control group (n = 116) had no intervention. Positive changes in the child's oral health conceptions were evaluated after the programme as determinants of each child's oral health. Final effects of the intervention were assessed as improvements in gingival health when all index teeth with bleeding at baseline became healthy (healthy gingiva). Statistical analysis included chi-square, independent samples t-test and logistic regression models. Factor analyses were applied to the child's oral health conceptions.Three factors regarding the children's oral health conceptions emerged. After the programme, boys and girls in the intervention group experienced fewer barriers to dental care than did the controls. Healthy gingiva was apparent among the boys (OR = 2.0) and the girls (OR = 4.1) in the intervention group. Girls experienced fewer barriers to dental care after the programme (OR = 1.5) and achieved more healthy gingiva, but boys' oral health conceptions showed no effect on the health of their gingiva.In designing health education programmes, in addition to other determinants, pre-adolescents' oral health conceptions deserve consideration. Intervention planning necessitates awareness of gender differences.

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

Objective: To evaluate the quality of young adults' radiographs exposed and processed under everyday clinical conditions. Setting: One administrative unit of the Finnish public oral health service. Design: Two reviewers independently evaluated the radiographs by the same written criteria that were designed as a checklist for on-site evaluations, without any further calibration. Sample: In total, 312 radiographs (178 bitewing, 88 periapical and 46 panoramic) from 1990 to 1996, collected from patient documents of a randomly selected sample of young adults born in 1966–1971. Outcome measures: Radiographs were assessed by quality indicators pertinent to the clinical utility as acceptable or unacceptable. If erroneous by some indicator(s) but still contributing to the diagnostic information, a radiograph was rated as diagnostically acceptable. A score of quality points was calculated for each radiograph. Results: The overall kappa statistics for intra-examiner reliability was 0.63, the proportional agreement 83%. For inter-examiner reliability, 0.42 and 71%, respectively. Although the evaluation criteria took the clinical utility of the radiographs into consideration, only 15% of bite-wings, 13% of periapicals, and 2% of panoramics received the maximum quality points. Erroneous film positioning was the most common fault on intraoral radiographs. On panoramics, the most frequent faults were in density and contrast and in patient positioning. The radiological evaluation had only been recorded for less than one fifth of the films. Conclusions: A proportion of radiographs fell short of the ideal. There is room for improvement in the quality of radiography in order to obtain the greatest possible diagnostic yield from the exposed radiographs.