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To determine the effect of a probiotic combination of Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis BB-12 on the gingival health, dental plaque accumulation, and the oral carriage of four putative periodontal pathogens in healthy adolescents. 108 schoolboys, aged 13-15 years, participated in this study. They were divided into two groups: probiotics (n=54) and placebo (n=54). Both groups received two probiotic-laced or placebo lozenges twice a day during a four-week period. Plaque Index (PI) and Gingival Index (GI) were recorded at baseline and after four weeks. Salivary and plaque carriage of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum were also monitored likewise. 101 subjects completed the study. A statistically significant reduction in GI was seen in the probiotic group as compared to the placebo group (P=0.012). A reduction in PI was found for both groups, with no difference observed between the groups after intervention (P=0.819). Probiotic lozenges significantly reduced levels of A. actinomycetemcomitans and F. nucleatum in saliva and plaque (P

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.

Background: For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. Methods: Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included ( N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling. Results: Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03–2.10). However, the increasing trend was stronger among boys (OR2010 vs. 1994 for boys 1.60; for girls 1.48), and among the younger adolescents (OR2010 vs. 1994 for 11-year-olds 1.64; for 15-year-olds 1.45). Conclusion: Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004–2010.

Objectives: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. Methods: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. Results: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. Conclusions: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

OBJECTIVE: Brushing one's teeth twice a day is the main self-care method to prevent the most prevalent non-communicable diseases. The aim of the study is to describe the trends in brushing teeth in 11-, 13-, and 15-year-old Czech children between 1994 and 2014.METHODS: One question about oral health from the HBSC study protocol was used in the six surveys (1994, 1998, 2002, 2006, 2010, and 2014). Altogether, 21,170 answers from boys and girls were analyzed using statistical description and binominal logistic regression.RESULTS: The findings showed that the prevalence of brushing their teeth more than once a day increased throughout the twenty years, more so in boys, but a preventive programme is still needed to educate the 21-38% of those who brush their teeth less than twice a day.CONCLUSION: Although the recommended frequency of brushing their teeth has increased among Czech school-aged children, it still lags far behind the recommended twice-a-day regularity, especially among boys.

The aim of this study was to determine the effects of short-term xylitol gum chewing on the salivary microbiota of children. The study was a randomised, controlled, double-blind trial. Healthy children used xylitol chewing gum (xylitol group, n = 35) or sorbitol chewing gum (control group, n = 38) for 5 weeks. The daily dose of xylitol/sorbitol was approximately 6 g/day. At baseline and at the end of the test period, unstimulated and paraffin-stimulated saliva were collected. The microbial composition of the saliva was assessed using human oral microbe identification microarray (HOMIM). Mutans streptococci (MS) were plate cultured. As judged by HOMIM results, no xylitol-induced changes in the salivary microbiota took place in the xylitol group. In the control group, Veillonella atypica showed a significant decrease (p = 0.0001). The xylitol gum chewing decreased viable counts of MS in both stimulated (p = 0.006) and unstimulated (p = 0.002) saliva, but similar effects were also seen in the control group. The use of xylitol gum decreased MS, in general, but did not change the salivary microbial composition. Short-term consumption of xylitol had no impact on the composition of the salivary microbiota, but resulted in a decrease in the levels of MS.

Objective: The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions. Methods: The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months. Results: The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups. Conclusions: In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

The objective of the present paper is to report results from oral biologic studies carried out in connection with a caries study.Samples of whole-mouth saliva and dental plaque were collected from initially 7- to 8-year-old subjects who participated in a 3-year school-based programme investigating the effect of the consumption of polyol-containing candies on caries rates. The subjects were randomized in three cohorts, consumed erythritol, xylitol, or sorbitol candies. The daily polyol consumption from the candies was approximately 7.5 g.A significant reduction in dental plaque weight from baseline (p0.05) occurred in the erythritol group during almost all intervention years while no changes were found in xylitol and sorbitol groups. Usage of polyol candies had no significant or consistent effect on the levels of plaque protein, glucose, glycerol, or calcium, determined yearly in connection with caries examinations. After three years, the plaque of erythritol-receiving subjects contained significantly (p0.05) lower levels of acetic acid and propionic acid than that of subjects receiving xylitol or sorbitol. Lactic acid levels partly followed the same pattern. The consumption of erythritol was generally associated with significantly (p0.05) lower counts of salivary and plaque mutans streptococci compared with the other groups. There was no change in salivary Lactobacillus levels.Three-year consumption of erythritol-containing candies by initially 7- to 8-year old children was associated with reduced plaque growth, lower levels of plaque acetic acid and propionic acid, and reduced oral counts of mutans streptococci compared with the consumption of xylitol or sorbitol candies.

The purpose of this study was to examine the associations between daily habits, Streptococcus mutans, and caries using International Caries Detection and Assessment System Caries Index (ICDAS CI); and compare it to the DMF index.Altogether 122 children were examined and interviewed. Saliva and plaque samples were collected and analyzed by Dentocult SM(®) Strip Mutans test. ICDAS CI was calculated by counting all ICDAS caries scores of all surfaces divided by total number of carious teeth.ICDAS CI was significantly (p0.01) and strongly associated with DMFT/dmft (ρ=0.72), DMFS/dmfs (ρ=0.72), total number of carious teeth (DT/dt) (ρ=0.77), enamel caries surfaces (ρ=0.61) and dentine caries surfaces (ρ=0.75). Plaque S. mutans was significantly (p0.05) correlated with ICDAS CI and DT/dt. Children who brushed once a day or more had significantly lower ICDAS CI (p0.01). Children who consumed sweets or drank soft drinks more than once a day had significantly higher ICDAS CI (p0.05). No significant association was found between ICDAS CI and frequency of flossing, use of mouthrinse, or gum chewing.ICDAS CI seems to have similar trends as DMF indices, but includes more information about the stage, severity, and progress of the caries lesions of the patient.

Adolescents make up about one-sixth of the world's population. Most of the healthy and detrimental habits are adopted during childhood and adolescence. In the mid 1980s, a cross-national Health Behaviour in School-Aged Children (HBSC) survey was created to increase information about the well-being, health behaviours and social context of young people by using standard school-based questionnaires adopted by the World Health Organization (WHO) European office. The European Network of Health-Promoting Schools (HPS) was commenced in 1992, followed by the establishment of the WHO Global School Health Initiative in 1995. The initiative aims to improve the health of students, school personnel, families and other members of the community through schools by mobilizing and strengthening health promotion and educational activities at local, national, regional and global levels. The HBSC and HPS programmes have been accepted as activity areas for the WHO Collaborating Centre for Primary Oral Health Care in Kuwait. This article describes the HBSC and the HPS programmes and discusses the importance of establishing these programmes in Kuwait.

Objective: The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait. Subjects and Methods: The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study. Results: The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach's alpha (0.83) indicated a high degree of internal consistency between different GOHAI items. Conclusion: There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.

Manuscript. Published version available at http://dx.doi.org/10.1159/000450762 Objective: Assess the effect of daily consumption of erythritol, xylitol, and sorbitol candies on caries development in mixed dentition during a three-year intervention and three years after the intervention. Methods: 485 Estonian first and second grade primary school children participated. Children were randomly allocated to an erythritol, xylitol, or sorbitol (control) group. Polyol-containing candies were administered on school days with a daily polyol consumption of 3x2.5 g. Yearly, caries development was assessed by calibrated dentists using the ICDAS criteria. Six years after initiation of the study and three years after cessation of daily polyol consumption, 420 participants were re-examined to identify potential long-term effects of polyol consumption. Survival curves were generated at the end of the intervention period and three years post intervention. The model included age of the subjects, schools, tooth surface ages and years of surface exposure to intervention. ICDAS scoring system based events included enamel/dentine caries development, dentine caries development, increase in caries score, and dentist intervention. Results: At the end of the intervention, time to enamel/dentine caries development, dentine caries development, increase in caries score, and dentist intervention was significantly longer in the erythritol group as compared to the sorbitol group. Except for increase in caries score, all effects persisted three years after cessation of daily polyol consumption. Conclusions: A caries preventive effect of three-year erythritol consumption as compared to sorbitol was established in children with mixed dentition. The effect persisted up to three years after the end of the intervention. Trial registration: ClinicalTrials.gov Identifier NCT01062633.

Background: Plaque and saliva pH are the main factors that facilitate the caries process. Consumption of acidic soft drinks is one of the factors responsible for pH changes in the oral cavity. Athletes commonly consume soft drinks. The purpose of this study was to evaluate the effects of two types of varnishes (fluoride and tri-calcium phosphate, TCP) on plaque and saliva pH of professional athletes who consume soft drinks. Methods: In this clinical study, 40 professional athletes aged 18-30 years were first randomly divided into two groups: Fluoride varnish (Sultan®, USA) and TCP varnish (3M®, ESPE, USA). At the first session, the baseline pH of plaque and saliva was measured using a plaque indicator kit (GC, USA) and pH meter (Hana, model AZ 8686, Italy). Then, the varnishes were applied. After 3 weeks, pH value of the participants was examined and varnishes were applied again, following by pH measurements at weeks 6 and 12. The data were analyzed using Repeated Measures ANOVA. Results: Applying fluoride varnish or TCP varnish did not cause any significant difference in saliva and plaque pH during the assessment periods (p>0.05).However, higher buffering capacity was observed among the athlete who had low pH at the baseline (p

AIM The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents. MATERIALS AND METHODS Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses. RESULTS At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4). CONCLUSION Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Objective: The aim of this study was to assess the prevalence of preventive dental visits and to identify self-reported barriers for this practice among Kuwaiti adults. Materials and Methods: A self-administered, anonymous, structured questionnaire was distributed to a random sample of Kuwaiti nationals 18 years of age or older recruited from all six health districts of Kuwait. A total of 2,400 questionnaires were distributed. Multiple logistic regression analysis was performed to identify factors independently associated with not having a preventive dental visit for more than 1 year. Results: Of the 2,400 questionnaires, 1,925 (80.2%) were completed. Of these, 620 (32.2%) had a dental visit within the previous 6 months, 504 (26.2%) between 6 and 12 months and 801 (41.6%) more than 12 months ago. The most common reasons for the last dental visits were pain or a dental emergency, need for restorative treatment, and an examination/prophylaxis. The strongest factors for not having preventive visits were not using a mouthrinse daily, flossing less than once a day, dental fear, belief that there is no need for visits unless pain was present, brushing the teeth less than twice a day, and believing that appointments are too far ahead. Also older respondents (>30 years), female gender, and those having only high school education or less were less likely to visit a dentist for preventive reasons. Conclusion: More than half of the studied population reported not having had a preventive visit for more than 1 year. Unfavorable self-care habits, dental fear and belief that visiting a dentist is necessary only for pain relief were the strongest factors for the nonattendance behavior.

The objective of this study was to assess how frequently schoolchildren report consuming sweets, soft drinks, and cakes, and whether life- and school-satisfaction and self-esteem factors are associated with the consumption of these sugar products.A total of 2,312 schoolchildren between the ages of 11 and 13 years from the government schools in Kuwait completed an anonymous structured questionnaire during 2002 and 2003. A representative sample of children from all six governorates of the country was drawn into the study. The questionnaire of the Health Behaviour in School-Aged Children (HBSC) survey was translated from English to Arabic and was used after modification to suit Kuwaitis. The chi-square test and logistic regression model were used in the analysis.A large proportion of children reported consuming sweets (42%), soft drinks (43%), and cakes (31%) several times a day. Almost every fourth child reported consuming all these sugar products more than once a day. All life-satisfaction and self-esteem variables and almost all school-satisfaction variables seemed to associate with more-than-once-a-day consumption of sugar products. When all the associated variables were analyzed together using the logistic regression model, the life- and school-satisfaction and self-esteem factors seemed to have a stronger association with frequent sugar consumption than did gender, grade, or nationality.Consumption of sugar products was common among schoolchildren in Kuwait, and both positive and negative life-satisfaction and self-esteem factors were associated.

Background: In a 1999 survey high caries levels were found among physically disabled school students in Kuwait. Objectives: A field study was planned to test the efficacy of xylitol candies in preventing caries among individuals in two special schools in Kuwait. Methods: Altogether 176 students were examined in 2002 and 145 (105 in xylitol group and 40 in the control group) after 18 months’ intervention. The WHO criteria were used in recording caries according to surfaces (third molars were excluded) by 2 calibrated examiners (E.H., M.S.). The students were allocated to the xylitol group only if the parent/caregiver returned the informed consent form. School health nurses distributed xylitol candies to the students 3 times during the school day (after breakfast and lunch, and before leaving the school). Results: In the xylitol group, the baseline DS and DMFS scores were 3.4 and 8.2 and in the follow-up 1.9 and 7.1, respectively. In the control group, the baseline scores were DS 3.9 and DMFS 9.8, and the follow-up scores DS 3.9 and DMFS 13.2. Conclusion: Xylitol seemed to have a strong preventive and a clear remineralizing effect on caries.

Objective: The aim of the study was to determine the extent of dental health knowledge among students at the Kuwait University Health Sciences Centre (HSC), as well as their attitudes toward dental health and their oral hygiene habits. Methods: A structured questionnaire was distributed to 450 of the 800 students enrolled in 3 faculties of the HSC from March to April 2000. The questionnaire was completed anonymously by the students. Results: Four hundred and ten students (91.1%) completed the questionnaire. Of these, 64.6% believed that the main cause of tooth decay was ‘not brushing properly’. Only 19.3% of the students believed that sugar could cause dental decay. Half of the students did not know if sugar-free drinks are harmful to their teeth, and 29.5% did not know about any measures to prevent gums from bleeding. Self-assessment questions showed that 84.5% of the students were satisfied with their dental health. A large majority of the students (94.8%) brushed their teeth at least once a day. Female students brushed their teeth more frequently than male students, as did those students who had visited a dentist in the past 6–12 months and those who rated their dental health to be very good. The main reason given for a dental visit was toothache (70.0%). Coffee was consumed daily by 68.9% of students, 76.6% of whom added sugar to their coffee. Conclusions: The findings indicate that although most of the students at the HSC seem to be satisfied with their dental health, they did not have correct knowledge about the causes and prevention of dental diseases. In general, female students were more aware and concerned about dental health issues and more engaged in dental behaviour than male students.

There is an increase in elderly dentate adults who will retain more of their natural teeth, and thus the demand for restorative dental services among them will be high. In Finland, systematic dental care for old people has not been organized. Health centres have mainly targeted the development of dental care for children, adolescents and young adults. With this background, atraumatic restorative treatment (ART) was seen as a complementary procedure in oral health services for the elderly. It was tested in 1997-1999 in Helsinki among 119 old people (mean age 72.5 years) living in their homes and receiving community-based support services. Patients were satisfied with having dental examination and oral health education at home. The ART fillings (n=33) were provided for 21 persons and depuration for 56. After 1 year, 25 fillings (58%) could be evaluated: 68% of the fillings were assessed as being good, 11% as having a slight marginal detect and 16% as having unacceptable marginal defect, and one filling was totally lost. In conclusion, ART is an appropriate approach in dental care for the elderly. However, more testing should be completed to find out how the screening could be organized to make the dental home visits more cost-effective and less time consuming.

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 toothcleaning 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.

Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special-needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3-20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51-3.52), those of increasing age (OR = 1.1; 95% CI = 1.01-1.10), and males (OR = 1.5; 95% CI = 1.05-2.07) had higher risk for the occurrence of severe malocclusion. Less than one-fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17-2.77) and increasing age (OR = 1.2; 95% CI = 1.13-1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.

Objective: The aim of this study was to determine the prevalence of dental fluorosis in disabled subjects attending the special needs schools in Kuwait. Methods: Eight hundred and thirty-two subjects (442 males, and 390 females) aged 3–29 years, who were visually or hearing impaired or who had physical or developmental disorders, were included in the study. The mean age of the subjects was 12.1 years. The subjects were examined for dental fluorosis using WHO criteria. Dental fluorosis was scored according to Dean’s index. Results: None of the subjects had severe fluorosis; less than 1.0% of them showed moderate fluorosis; 0.7% had mild and 2.5% had very mild fluorosis. There were no subjects with fluorosis up to the age of 7 years, but the prevalence varied from 0 to 10% between 8 and 20 years and only 1 subject above 20 years of age had fluorosis. Non-Kuwaiti nationality was a significant risk factor for the occurrence of dental fluorosis (OR = 2.4; p = 0.027). Conclusion: Fluorosis was less prevalent among these disabled subjects than had been reported among the healthy population in Kuwait.

The preventive, and partly the remineralizing, effect of xylitol was shown in Finland in the Turku Sugar Studies in 1971-73. Since then, several clinical trials in many countries have confirmed these results. In Finland, oral health personnel have recommended daily use of xylitol chewing gum in their dental health education. Moreover, commercial companies have advertised xylitol, emphasizing in particular its caries preventive effects. All Nordic dental associations have given their recommendations for xylitol use. The aim of this study was to describe how this health habit has been adopted by Finnish schoolchildren. The study was part of the comprehensive cross-national survey on Health Behavior in School-aged Children (HBSC Study)--a WHO Collaborative Study. The data were collected using standardized questionnaires to which pupils in grades 5 (11 years), 7 (13 years) and 9 (15 years) responded anonymously in school classrooms during the spring term 1998. The response rate varied between 87% (15-year-old boys) and 94% (11- and 13-year-old girls). Among boys, the percentages of daily users of xylitol chewing gum were 47% (11 years), 46% (13 years), and 44% (15 years), and among girls, 57% (11 years), 65% (13 years), and 69% (15 years), respectively. Use of sugar-sweetened chewing gum was very rare (1%), as also was use of chewing gum with other artificial sweeteners (1%). It may be concluded that since 1991 the use of xylitol chewing gum has further increased in Finland and currently more than a half of all schoolchildren benefit from it.

The aim was to (1) assess the proportion of children with dental fear, to (2) compare results obtained by a single fear question to those obtained by using a set of 11 fear questions, to (3) study associations between children's dental fear and their dental health, and to (4) compare children's dental fears to those of their parents.A cross-sectional sample of 344 8-10-year-old schoolchildren from South Estonian primary schools participated. Children's fears were measured with the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). The scale includes 11 fear items amongst which five represent less invasive (noninvasive items), another five invasive aspects of dental treatment (invasive items), and one question represents general dental fear of the child. In addition, two questions were included to assess parental dental fear. The dental health of children was examined using the International Caries Detection and Assessment System (ICDAS) criteria.The proportion of children with general dental fear was 6.1%. The mean score of noninvasive fears was higher among the youngest than among the oldest age group (p0.02). Children whose dmft/DMFT-scores were0 had higher fear scores than those whose dmft/DMFT-scores were =0 (p0.01). A total of 16.8% and 15.7% of mothers and fathers afraid of dentistry in general. There were strong correlations between children's dental fears and maternal (p0.01), and paternal (p0.01) dental fear.Children's fears were strongly associated with untreated caries and experience of dental treatment, and with parental fears.

To determine the levels of daily consumption of soft drinks, sweets and cakes/pastries by schoolchildren in Kuwait and the possible background factors associated with these habits. In addition, the association between daily consumption of these sugar-rich products and other health-related habits was studied.A nationally representative sample of children from public schools was drawn for this study. Altogether, 1292 schoolchildren of an average age of 13 years (SD ± 1.04) participated by anonymously filling out a structured questionnaire in school classrooms. The questionnaire of the WHO Collaborative study (Health Behaviour in School-aged Children) was used after modifications for the Kuwaiti situation.Daily consumption of soft drinks, sweets and cakes was very high, especially among the Kuwaiti schoolchildren. Very strong correlations were found between daily consumption of sweets and cakes/pastries (r = 0.60; P0.01), soft drinks and sweets (r = 0.50; P0.01) and between soft drinks and cakes/pastries (r = 0.42; P0.01). Among other unfavourable habits, late bedtime, watching TV often and smoking were strongly correlated with the daily use of sugary drinks and foods. Sociodemographic or socioeconomic factors were only weakly associated with the consumption of sugar-rich products.Daily consumption of sugar-rich products seems to be alarmingly high in Kuwait, higher than in any other of the 34 countries in the HBSC study. Other unhealthy habits were associated with the daily consumption of these sugar-rich products.

This study aims to assess the caries experience among first- and second-grade children in the elementary schools of southeastern Estonia.A representative sample of 485 children was studied. The mean age of children in the first grade was 7.8 years (SD = 0.35) and in the second grade 8.8 years (0.38). The clinical examinations using ICDAS criteria were completed by four calibrated examiners. The inter- and intra-examiner consistency of the examiners was high (surface and tooth-based kappa0.9).The mean caries experience of dentinal caries lesions was 0.8 (D 4-6 MFT) and 1.6 (D 4-6 MFS) among the first graders and 1.1 (D 4-6 MFT) and 1.6 (D 4-6 MFS) among the second graders. The mean caries enamel lesions among the first graders was 1.6 (D1-3T) and 2.2 (D1-3S) and among the second graders 2.1 and 3.0, respectively. The most affected surfaces were the occlusal surfaces of the lower first molars. The prevalence of sealants was very low-only 2.4% of the first molars were sealed among the first graders and 3.9% among the second graders. There were no statistically significant differences in caries experience or in the provision of restorative treatment between the schools.Caries experience is high in southeastern Estonia. Preventive programs are urgently needed.

The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents.Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses.At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4).Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Caries has traditionally been assessed with WHO criteria including only obvious caries lesions. ICDAS has been developed to detect also the enamel caries lesions. This study aims to study caries and the associations of the number of caries lesions between the permanent and primary molars with ICDAS in the mixed dentition of the first and second grade primary school children. The clinical examinations of 485 children were conducted by four examiners with high reproducibility (inter- and intraexaminer kappas >0.9). The mean number of caries lesions—especially dentine caries—seemed to be higher in the second primary molars than in the first permanent molars. There were significant correlations between the number of lesions on occlusal and lingual surfaces between the primary and permanent molars. Enamel caries lesions, restorations, and caries experience did not increase according to age. Therefore, caries might be increasing in this population. As a conclusion, ICDAS recording seems to give appropriate information from the occurrence of caries lesions and its correlations between the primary and permanent teeth and surfaces.

Background: Females are generally more motivated with regard to oral hygiene practices and thus brush their teeth more frequently than males. Objective: To determine the prevalence of gingival recession, oral hygiene status, oral hygiene practices and associated factors in women attending a maternity ward in Tanzania. Design: Cross-sectional descriptive study. Setting: Maternity ward of Muhimbili National Hospital, Tanzania. Subjects: Four hundred and forty six women were interviewed on oral hygiene practices and maternal factors, and a full-mouth examination was done to determine the presence of plaque, calculus, gingival bleeding and gingival recession at six sites per tooth. Results: The prevalence of gingival recession (GR) > 1mm was 33.6%, calculus 99.3%, plaque 100%, and gingival bleeding 100%. Oral hygiene practices included toothbrushing (98.9%), brushing frequency >2 times/day (61.2%), horizontal brushing method (98%), and using a plastic toothbrush (97.8%). Factors that were significantly associated with gingival recession were age (OR a =2.0, 95% CI=1.3-3.2), presence of calculus (ORa=3.8, 95% CI=2.5-7.1), and gingival bleeding on probing (OR a =4.2, 95% CI=2.5-7.1). Tooth cleaning practices and maternal factors, especially the number of pregnancies or deliveries were not significantly associated with gingival recession. Conclusion: In this study population, oral hygiene was poor and gingival recession was associated with age, calculus and gingival inflammation rather than with tooth cleaning practices.

– Objectives: The aim of this study was to ascertain how frequently toothbrushing and flossing are practiced among schoolchildren in Kuwait and whether life- and school-satisfaction and self-esteem indicators are associated with oral hygiene habits. Methods: A sample of 2312 schoolchildren between 11 and 13 years old filled out a structured questionnaire anonymously in school classrooms during 2002 and 2003. For this study, nationally representative samples of children were drawn from all six governorates of Kuwait. Only government schools were included. The questionnaire of the Health Behaviour in School-Aged Children Study was used in this study after it was modified to suit Kuwait. A chi-squared test and logistic regression model were used for analyzing the data. Results: Over half of the pupils reported brushing their teeth more than once a day; girls reported brushing more frequently than boys did. One-fifth of the pupils did not brush their teeth even on a daily basis. The life- and school-satisfaction and self-esteem indicators were associated with more-than-once-a-day toothbrushing frequency. The strongest predictors for recommended brushing were: feeling very happy (OR 2.0, 95% CI 1.38–2.77), feeling that other pupils always accept him/her (1.5; 1.16–2.02), never/sometimes feeling lonely and feeling that it is very easy to make friends (1.4; 1.06–1.94). The summary variables of life-satisfaction, school-satisfaction and self-esteem seemed to be strongly associated with brushing. Dental floss was never used by 45% of the children, weekly by 18% and daily by 17%; 20% did not even know what dental floss was. Conclusions: Among intermediate schoolchildren in Kuwait, oral hygiene practices were far behind the international recommendations. Special emphasis should be placed on children who have personal problems with their life, school and self-esteem.

Dental caries and periodontal diseases have been declining in most industrialized countries, but this positive trend has not been seen in the Middle East. This study aimed to determine oral health knowledge and behavior of the students at the Health Sciences College in Kuwait as well as possible associated factors. This study was first conducted at the college of the male students (n = 153) during the autumn semester in 2001. A similar questionnaire study was then conducted at the college of the female students (n = 547) during the spring semester in 2002. The samples were merged for this study, for a total sample of 700 students. The response rate was 84% (n = 128) among the male students and 73% (n = 400) among the female students. Most of the students had visited a dentist during the past year, and quite a high proportion was seen for an examination or prevention. Female students reported twice-a-day tooth-brushing frequency much more often than did male students. They also used fluoride toothpaste more often than male students. Oral health knowledge (as a summary variable) was statistically significantly higher among the female students than among the male students. It was also strongly associated with the older age among the female students. The knowledge and oral health behavior of the Health Sciences College students in Kuwait, especially among the male students, seems to be poor and calls for an urgent improvement of health education programs.

To evaluate the effectiveness of xylitol candies on plaque and gingival index scores on physically disabled school pupils in Kuwait.Altogether 145 school pupils (105 in the xylitol group and 40 in the control group), with ages ranging from 10 to 27 years (mean age = 14.7 +/- 3.1 years), participated in this 18-month intervention program. The school health nurses distributed xylitol candies to the pupils three times during the school day. Plaque was scored according to the Silness and Löe Plaque Index, and gingivitis according to the Löe and Silness Gingival Index.The mean Plaque Index score decreased from 1.73 to 1.14 (p0.001), and the mean Gingival Index score from 1.74 to 1.16 (p0.001) in the study group. Significant differences were found between the xylitol and the control groups in the reduction of Plaque (p = 0.037) and Gingival Index scores (p = 0.008). There was high correlation between the individual Plaque and Gingival Index scores at baseline (r = 0.93) and at the final examinations (r = 0.95).Consuming xylitol candies three times during school days seemed to reduce both the Plaque and Gingival Index scores. This school-based delivery system offered a practical way to distribute and use xylitol candies among these disabled pupils. The regular use of xylitol candies may, therefore, support oral hygiene routines in disabled pupils.

Objectives: To compare the reported tooth brushing behaviour among adolescents in relation to age, gender and parental occupation, family affluence, single parent family and at least one parent not working but staying at home. Methods: Representative samples of 11-, 13- and 15 year old pupils in 32 countries completed an anonymous standardised questionnaire during school hours. Results: Large differences in prevalences of reported tooth brushing were found between countries for both genders: from 16–80 % for boys and 26–89% for girls. In some countries the prevalence of more-than-once-a-day tooth brushing increased by increasing age, whereas in others it declined. High occupational status and family affluence were clearly related to a high prevalence of more-than-once-a-day tooth brushing. Children living in two parent families had higher prevalences of recommended tooth brushing in only a few countries. Conclusions: Within the European continent and in North America, gender, family affluence and parental occupation were significantly associated with reported tooth brushing frequency among adolescents. The association between family characteristics, such as absence of one of the parents and the supervisory role of the parents, and brushing behaviour of the children appeared to be rather weak and inconsistent.

This study assessed cariostatic effect of one fluoride varnish Duraphat® among children with a low caries risk and compared this effect to group of a moderate caries risk, belonging to same ethnic group with same socioeconomic background. Results of this study showed that fluoride varnish had cariostatic effect in a group of children with a moderate caries risk but not among those with a low caries risk.

Objectives: The aim of this study was to describe self-reported oral health, oral hygiene habits, and frequency of visits to a dentist among pregnant women in Kuwait. Material and Methods: A cross-sectional study with an anonymous structured questionnaire was distributed among 650 pregnant women during May–June 2003, when they were admitted to the maternity ward at the largest government maternity hospital in Kuwait City. The response rate was 93% (n=603). Results: Every fourth respondent was in her first pregnancy, while 36% already had three or more children. Every fifth woman felt that her oral health was poor, and one-third of the women believed that they had periodontal problems currently. About two-thirds of the women were brushing more than once a day and almost all (94%) at least once a day. Over the previous 6 months, 40% had experienced dental pain. Half of the women had visited a dentist during pregnancy, mostly for dental pain. Most of the women had received no instructions concerning oral health care during their pregnancy. Conclusions: A large proportion of the pregnant women in this study had oral health problems; however, half of the women had not seen a dentist during their pregnancy.

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11-22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.

Background Health auxiliary personnel have an important role in oral health promotion when they graduate and start working in the health care system. This study aims to find out oral health knowledge and oral health behavior of male Health Sciences College students. Methods A questionnaire was distributed to all students at the male Health Sciences College in Kuwait (N = 153) during the academic year 2001/2002. The students filled the anonymous questionnaire in the class after the lecture. The response rate was 84% (n = 128). The questions consisted information on the general background, oral health behavior and oral health knowledge. Results Oral health knowledge seemed to be limited and very few background factors were associated with it. More than half of the students had visited a dentist during the previous 12 months, but only one third of students were brushing twice a day or more often. Conclusions It may be concluded that the male Health Sciences College students seemed to have appropriate knowledge on some oral health topics, but limited knowledge on the others. Their toothbrushing practices are still far behind the international recommendation (twice a day) and also the knowledge, why it should be done so frequently also very limited.

Socio-economic differences in health and health behavior are well-known. Our hypothesis was that toothbrushing frequency in adolescents predicts their education level in adulthood. The aim was also to study the role of toothbrushing in adolescents’ health-related lifestyle. Data from nationally representative samples of 12- to 16-year-olds (N = 11,149) were linked with register data on the highest level of education attained at age 27–33 years. Adolescents with a low toothbrushing frequency reached only the lowest education levels. School achievement or sociodemographic background only partly accounted for the association. Exploratory factor analysis found four dimensions of health behaviors. At age 12, a low toothbrushing frequency was loaded highly with “street-oriented” behaviors, concentrated around smoking and alcohol use. At ages 14 and 16, it was associated with a “traditional” lifestyle of the less-well-educated. Altogether, a low toothbrushing frequency indicated selection into the less-well-educated stratum of society. This is likely to be reflected in socio-economic health differences in adulthood.

Ninety-six patients, fifty-eight healthy patients and thirty-eight special needs patients, ranging in age from 3 to 31yr (average age 6.9yr) had received dental treatments under general anesthesia (GA) at Amiri Hospital. The mean number of dental procedures per child was 13.6 (SD±5.4) with a mean number of 15.6 procedures for healthy patients and 10.5 special needs patients. There was a statistically significantly higher number of dental procedures for healthy patients than for special needs patients (p