Identifying dental restorative treatment need in healthy young adults at individual and population level

Abstract Dental caries is one of the most widespread diseases in the world. In the industrialized world the situation improved until the 1990s, after which the good development is claimed to have almost stagnated. One of the aims of this cross-sectional study was to investigate caries prevalence in a young male population. Another aim was to investigate ways to find individuals needing restorative treatment. The hypothesis in this study was that caries prevalence among Finnish young males born in the 1990s was similar or even poorer compared to those born in earlier decades. Polarization of dental caries was still expected to exist. It was also hypothesized that caries prevalence is geographically unevenly distributed in Finland. The Finnish Defence Forces screening protocol was hypothesized to be valid for detecting individuals with restorative treatment need. Finally, it was hypothesized that restorative treatment need at the individual level associates well with a well-chosen set of questions concerning dental symptoms, dental attendance, treatment history and health behaviour. Study material consisted of 255 female and 13,564 male (total n=13,819) conscripts. Anamnestic data, along with information about the socioeconomic status, educational level and place of residence just before military service, were collected with computer-based questionnaire in connection with the oral screening (50 questions and 108 sub-questions). Validity of the screening protocol was evaluated in a sub-population (74 conscripts) examined using both the screening and the ICDAS classification. The screening protocol was validated using the ICDAS criteria and it proved to be well in accord with it considering restorative treatment need at the individual level. The study revealed that on average the conscripts had 1.4 decayed teeth (DT), third molars excluded. The number of decayed, earlier restored or extracted teeth due to caries (DMFT) was 4.1. Ten per cent had about half of the caries lesions and 30% had 90%, suggesting that polarization still exists. It was also found that living in areas with high fluoride content in drinking water, living in urban areas and a Swedish-speaking home municipality were protective factors against dental caries. A positive response to eight questions of a statistically selected set of ten questions reliably predicted restorative treatment need (OR 69.27).Tiivistelmä Karies on yksi maailman laajimmalle levinneistä sairauksista. Menneinä vuosikymmeninä karies väheni merkittävästi aina 1990-luvulle saakka, jonka jälkeen myönteinen kehitys on hidastunut. Tämän tutkimuksen tavoitteena oli tutkia korjaavan hoidon tarpeen määrää nuorten miesten keskuudessa. Tutkimuksen toinen tavoite oli tutkia tapoja erottaa terveistä korjaavan hoidon tarpeessa olevat henkilöt. Tutkimuksen oletuksena oli, että karieksen esiintyvyys 1990-luvun alussa syntyneiden suomalaismiesten joukossa on vastaavalla tai huonommalla tasolla kuin 1970-luvun alussa. Lisäksi oletettiin, että kyseisessä ikäluokassa karies on polarisoitunut. Oletuksena oli myös, että karieksen esiintyvyys on maantieteellisesti epätasaisesti jakaantunut. Tutkimuksessa oletettiin myös, että Suomen Puolustusvoimien käyttämällä suunterveyden seulontamenetelmällä voidaan tunnistaa luotettavasti yksilötasolla korjaavan hoidon tarpeessa olevat yksilöt. Viimeisenä oletuksena oli, että korjaavan hoidon tarve yksilötasolla olisi arvioitavissa seulonnan ja hyvin valitun kysymyspaketin perusteella tutkituissa ikäluokissa. Tämän poikittaistutkimuksen satunnaistettu tutkimusaineisto koostui 13819 varusmiehestä (255 naista ja 13564 miestä) sekä esitietoihin perustuvasta aineistosta joka kerättiin seulonnan yhteydessä tietokonepohjaisella kyselylomakkeella (50 kysymystä ja 108 alakysymystä). Seulonnan tulokset vastasivat hyvin tarkastusta, jossa vauriot diagnosoitiin ICDAS kriteereitä käyttäen. Tutkimus osoitti myös että, keskimäärin yksilöllä oli 1,4 korjaavan hoidon tarpeessa olevaa hammasta viisaudenhampaat pois lukien. Aiemmin korjattujen, karieksen takia poistettujen ja karieksen vaurioittamien hampaiden lukumäärä oli 4,1. Kymmenellä prosentilla tutkimusjoukosta oli puolet kaikista vaurioista ja vastaavasti kolmanneksella tutkituista oli 90 prosenttia kaikista vaurioista. Juomaveden fluoripitoisuus ja asuminen kaupungissa tai ruotsinkielisessä kunnassa olivat suojaavia tekijöitä korjaavan hoidon tarpeen suhteen. Kymmenen esitietokysymystä valittiin tilastollisesti 108 kysymyksen joukosta. Positiivinen, korjaavalle hoidolle altistava, vastaus vähintään kahdeksaan näistä kymmenestä kysymyksestä ennusti luotettavasti (OR 69,27) korjaavan hoidon tarvetta yksilötasolla

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Publisher Copyright: © 2022 Dental Hypotheses.Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.Peer reviewe

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Publisher Copyright: © 2022 Dental Hypotheses.Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.Peer reviewe

General- and oral-health-related predisposing factors for interrupting military service in the Finnish defence forces

Abstract Introduction: Finland’s security policy relies heavily on its own independent national defense, which is based on conscription. In 2011, 26,492 conscripts started their military service in Finland. Of these, 1,706 interrupted their military service and 191 changed to civilian service. Conscripts who interrupt their service seem to have an increased tendency to smoking, alcohol consumption, and taking snuff, which previous studies suggest to have strong associations with the need for restorative dental treatment and with lower socioeconomic status. The aim of this study was to compare the general and oral health habits between Finnish conscripts who interrupt their service and those who completed their military service and to find out what general- and oral-health-related factors could be used in predicting interruption of service. Methods: The study population consisted of 13,819 conscripts taking an oral examination during the service. Of these, 8,449 answered a computer-based anamnestic questionnaire and 264 interrupted their service. Predisposing factors on the anamnestic questionnaire for interrupting military service were evaluated by using a binary logistic regression model. The statistically significant factors were selected to form a sum variable which finally consisted of seven predisposing questions. Odds ratio (OR) values and 95% confidence intervals were calculated for each question and for the sum variable. Predictive accuracy was assessed by area under the receiver-operating curve. Results: The most obvious predisposing factor among those who interrupted their service compared to the reference group was lack of weekly physical exercise (OR = 5.80). The risk for interruption of military service was 68.6 times higher in cases where a subject exhibited six predisposing factors out of seven compared to those who had none. Conclusion: As a conclusion, a set of statistically chosen anamnestic questions could help identify conscripts who have an increased risk of interruption of military service in addition to a risk of dental problems

Association of dental fear with caries status and self-reported dentition-related well-being in Finnish conscripts

Abstract The main aim of this cross-sectional study was to examine the prevalence of dental fear among Finnish conscripts. Other aims were to study the association between dental fear and cariological status as well as their self-reported, dentition-related well-being. The study material consisted of 13,564 men and 255 women conscripts who underwent oral examinations. Of those, 8713 responded to a computer-based questionnaire. The mean number of decayed teeth (DT) was used in analyses for cariological status. Self-reported dental fear, dentition-related well-being and regular check-ups were analysed. Data were analysed with cross tables, Pearson Chi-Square tests, Fisher’s exact test and binary logistic regressive analysis. High dental fear or finding dental visits very scary was associated with DT > 2 both among women (14.6%, when DT = 0; 33.3%, when DT > 2) and men conscripts (2.3% and 10.8%, respectively). In addition, those reporting that dental health had a negative impact on their well-being and had no regular check-ups were more likely to need cariological treatment than the rest. A high education level, both one’s own and parental, was a protective factor for restorative treatment need in male conscripts. The findings of this study support the concept of a vicious cycle of dental fear and dental caries. A preventive, interactive way of work by dental teams would most likely be beneficial for dental health, avoiding the development of dental fear, and dentition-related well-being

Can health kiosks be used to identify oral health care needs?:a pilot study

Abstract Objective: The aim of this study was to investigate the reliability of digital imaging for detecting restorative treatment need among individuals in their 20s by comparing the outcome of digital imaging with clinical caries findings at the patient level. Material and methods: Five intraoral clinical daylight and digital fluorescence images were taken extraorally of 21 patients. A clinical examination was then performed by a trained and calibrated dentist. Additionally, the patients answered a multiple-choice questionnaire about their health habits. The images were analysed and caries findings were recorded. For statistical analysis, sensitivity and specificity were calculated. Results were shown as ROC curves and AUC values. All analyses were done using SPSS (version 24.0, Chicago, IL). Results: Caries lesions were most often detected in molars and least often in canines. When using the clinical status as gold standard, digital imaging gave an AUC value of 0.617, whereas the outcome by questionnaire gave an AUC value of 0.719. When using the combined outcome of digital imaging and the questionnaire, the AUC value was 0.694 with clinical validation. Conclusions: It can be concluded that health kiosks may help to reduce the number of patients waiting for dental treatment; more specifically, the questionnaire with individual feedback may provide a new instrument for providing instructions for homecare online. However, the camera system must be developed further, and dentists and dental hygienists require training to analyse the images

Caries experience and erosive tooth wear in finnish men conscripts 2021:a cross-sectional study

Abstract Background: In Finland, the development of oral health in young, 19- to 21-year-old males regarding restorative treatment need seems to have slowed down according to cross-sectional conscript studies between 1976 and 2011. At the individual level, the mean number of decayed teeth (DT > 0) has also steadily continued to decline. In Finland, military service is mandatory, and around 85% of males complete it. The aim of this cross-sectional study was to investigate the oral health status of young men at the beginning of the 2020s. Methods: The data were collected in July 2021 in the eight biggest Finnish Defence force garrisons by ten calibrated dentists serving in the ranks. The inclusion criteria for this study were a year of birth between 2000 and 2002 and male gender (n = 508). Third molars were included. Restorative treatment need was evaluated using ICDAS scoring. The study was designed according to the STROBE guidelines. Results: Mean DT value was 1.13 when third molars were included and 1.03 when they were excluded. Mean DMFT value was 3.23 and 2.98, respectively. The proportion of conscripts with DT > 0 was 36.4% and 34.8%, respectively. The prevalence of caries was concentrated among a small number of conscripts. Most (76.6%) had BEWE (basic erosive wear examination) of 0–2. Conscripts in the moderate and severe ETW (erosive tooth wear) groups (BEWE 3–13) comprised 23.5% of the cohort. None of the conscripts fell into the most severe group (BEWE 14–18). Conclusions: The oral health of conscripts has improved over the last ten years, and restorative treatment need has decreased significantly. Compared to previous studies, restorative treatment need was concentrated on an even smaller proportion of conscripts

The association between dental caries and physical activity, physical fitness, and background factors among Finnish male conscripts

Abstract Studies on measured physical fitness and oral health are sparse. The aim of this study was to investigate the associations between self-reported physical activity and measured physical fitness and oral health of young men. The study population consisted of 13,564 Finnish male conscripts who had mandatory clinical oral examinations and physical fitness tests at the beginning of military service in 2011. Finally, around 10,800 conscripts had physical fitness test outcomes available and a total of 8552 conscripts answered a computer-based questionnaire on background factors. Decayed Tooth (DT) and Decayed, Missing, or Filled Tooth (DMFT) indices, outcomes of surveys and fitness tests were used in analyses by cross-tabulation and multivariable logistic regression model (odds ratios [OR] with 95% confidence interval [CI]) were calculated. Regularly exercising conscripts had a reduced need for dental restorative treatment than those reporting no physical activity (p < 0.0001). The proportion of participants with sound dentition (DT = 0) increased steadily with increasing physical activity (39.0–59.4%). Good measured physical fitness was a protective factor against increased dental restorative treatment need. A low prevalence of smoking and low use of alcohol and energy drinks were associated with frequent exercise, whereas consumption of sport drinks and snuff use were common among those who exercised frequently. Good measured physical fitness and self-reported physical activity are associated with reduced caries burden. There is a need for information about the harms of tobacco products and the benefits of a healthy diet, even for the increased energy needs of the physically active