Publications by authors named "Tubert-Jeannin Stephanie"

32 Publications

O-HEALTH-EDU: A scoping review on the reporting of oral health professional education in Europe.

Eur J Dent Educ 2021 Feb 7;25(1):56-77. Epub 2020 Sep 7.

Cardiff University, Cardiff, UK.

Introduction: The variability in oral health professional education is likely to impact on the management of oral health needs across Europe. This scoping review forms the initial part of a larger EU-funded collaborative Erasmus + project, 'O-Health-Edu'. The aim of this scoping review is to investigate how oral health professional education in Europe is reported.

Methods: The PRISMA and Arksey & O'Malley methodological frameworks for scoping reviews were used to guide reviewers in answering the research question "How is oral health professional education reported in Europe?". The search strategy encompassed published literature searches, internet searches and further searching of relevant documents from educational organisations, regulators and professional bodies. Once the search strategy was developed, it was sent to key stakeholders for consultation. Sources were reviewed by two authors (JD, JF) and included in the review if they reported on oral health professional education in Europe.

Results: A total of 508 sources were retrieved from all of the searches. A total of 405 sources were excluded as they did not report on the topic of interest, leaving 103 sources that reported on oral health professional education in Europe. Handsearching the references of published sources lead to a further 41 sources being screened, of which, 15 were included. In total, 33 duplications were removed and the final number of included sources was 85. The average year of publication for the included sources was 2007, with sources most commonly published in journals dedicated to dental education. Surveys represented the most common form of reporting. From the data obtained, four broad themes of reporting were evident: dental education at a programme level, dental education at a discipline level, other oral health professional education, and postgraduate education and continuous professional development.

Conclusion: The reporting of dental and oral health professional education in Europe is limited. Whilst there are many useful documents that provide guidelines on dental education, there is limited knowledge on how education is implemented and delivered. There is a greater need for comprehensive educationally driven programme-level data on oral health professional education across Europe.
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http://dx.doi.org/10.1111/eje.12577DOI Listing
February 2021

Consommation de soins dentaires préventifs en région Centre-Val de Loire : une étude rétrospective.

Sante Publique 2020 Jun;Vol. 32(1):87-95

Context: The demography of dentist-surgeons in the Centre-Val de Loire region is far inferior to the national average and characterized by many territorial inequalities of health. The aim of this study is to provide details concerning the dental hygienic care-seeking consumption habits in this region based on one dental care treatment, dental scaling, which allows for the mechanical elimination of dental plaque in order to prevent periodontal diseases.

Method: This retrospective study is based on data from several databases of the National Health Insurance Cross-Schemes Information System (Sniiram) for the year 2016, analyzed by the Statistical Institute of Liberal Health Professionals.

Results: It can be observed that less scaling treatments have been sought out in this region in comparison with metropolitan France and certain territories which also face difficulties in terms of care treatment offers and scaling treatment inferior to the regional average. Although the care offer is unequally distributed, it seems to have little influence on the number of treatment acts consumed per patient and notably scaling treatments. Inversely, indicators of wealth or poverty do have an impact on treatment consumption HBJD001.

Conclusion: This study suggests that the consumption of scaling treatment is independent from the dental care offers, but linked to the social gradient of the population. It points to the deficit in the consumption of this treatment in comparison to metropolitan France. The potential role of the HBJD001 treatment as a marker of the trajectory of preventive health care as well as the necessity of the adjustment of the zones determined by the ARS are put forward.
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http://dx.doi.org/10.3917/spub.201.0087DOI Listing
June 2020

COVID-19: The immediate response of european academic dental institutions and future implications for dental education.

Eur J Dent Educ 2020 Nov 13;24(4):811-814. Epub 2020 Jul 13.

University Clermont Auvergne, Clermont-Ferrand, France.

The COVID-19 pandemic has had an immediate and dramatic impact on dental education. The Association of Dental Education in Europe decided to carry out an investigation to assess the immediate response of European Academic Dental Institutions. An online survey was sent to both member and non-member dental schools to investigate the impact on non-clinical and clinical education, assessment and the well-being/pastoral care measures implemented. The preliminary findings and discussion are presented in this paper, for the responses collected between the 25 March and 5 April 2020. The survey at this time of publication is ongoing, and detailed results can be accessed https://adee.org/covid-19-european-dental-education%E2%80%99s-immediate-response.
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http://dx.doi.org/10.1111/eje.12542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272881PMC
November 2020

Implementation and impact of a dental preventive intervention conducted within a health promotion program on health inequalities: A retrospective study.

PLoS One 2020 24;15(3):e0230639. Epub 2020 Mar 24.

CROC, Université Clermont Auvergne, Clermont-Ferrand, France.

Background: The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program. A greater or at least equivalent quality and impact of the intervention was expected for children living in socially deprived regions with the greatest health needs.

Methods: The study population was the schoolchildren, aged 6 years in 2016, who benefited from the dental sealant program (n = 2532). The study sample was randomly selected in 2017 from that population (n = 550). The children's dental status was evaluated at school in 2017 and compared with that recorded in 2016 during the sealant intervention allowing the calculation of the retention rates and one-year carious increment on first permanent molars. Socio-demographic variables (gender, public/private school) and conditions of sealant placement (school/dental office, presence of a dental assistant) were recorded. The carious increment was explained using a mixed multiple random-effects regression. A mediation analysis was conducted to assess the respective contributions of the retention rates and the region of origin on caries increment.

Results: The participation rate was very high (89%) and on average, children had 83% of their dental sealants present after one year, 31% fully and 52% partially present. Caries increment varied depending on the sealant retention rate as well as on the region (North, South, Islands). The mediation analysis showed that living in a deprived area (The Islands) was a strong determinant for high caries increment particularly when the retention rates were low.

Conclusions: This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program. Nevertheless, the intervention was not effective enough to totally balance the influence of health determinants, especially in socially deprived sectors characterized by greater dental needs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230639PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093001PMC
June 2020

The Schizophrenia Oral Health Profile: Development and Feasibility.

Transl Neurosci 2018 22;9:123-131. Epub 2018 Sep 22.

EA 481 Integrative and Clinical Neurosciences, University Hospital of Besançon, F-25000 Besançon, France.

Background: The aim of this study was to present the different stages of development of the Schizophrenia Oral Health Profile (SOHP) questionnaire, aimed at assessing oral disorders and their impacts on functioning and psychosocial wellbeing for patients with schizophrenia (PWS) and to give the results of a feasibility study conducted in France.

Materials And Methods: The first step of this qualitative study was semi-structured interviews were conducted with 20 PWS and 6 health professionals (HP). A focus group integrating 4 PWS and 4 HP was also organised to identify the items of the SOHP. The data were analysed using a thematic analysis. Second, a feasibility study was conducted in a sample of 30 PWS who answered the SOHP questionnaire. The acceptability and understanding of the SOHP were evaluated, using a specific questionnaire.

Results: The semi-structured interviews and focus groups included 34 individuals in total. Items' selection was done with several stages and led to a SOHP scale with 53 final items related to oral disorders and their impacts on functioning and psychosocial well-being. These items were classified in 13 preselected dimensions including one additional module related to the side effects of medications (11 items). The feasibility study showed good acceptability and understanding of the items of the SOHP scale.

Conclusions: The psychometric validation of the SOHP scale, involving a large sample of PWS, is currently in progress. The SOHP is important to evaluate PWS oral health needs and to offer appropriate strategies to improve oral health of this persons.

Trial Registration: Clinical Trials Gov NCT02730832. Date registered: 21 March, 2016.
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http://dx.doi.org/10.1515/tnsci-2018-0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153450PMC
September 2018

[Oral health inequalities: Determinants of access to prevention and care in France].

Sante Publique 2018 March April;30(2):243-251

Introduction: Oral diseases are unequally distributed according to a social gradient, which now constitutes a major public health problem. Acting against oral health inequalities requires a better understanding of the underlying mechanisms in order to identify the appropriate solutions to improve access to oral health promotion and dental care for deprived populations.

Methods: A patient-centered model of health care access, describing the ideal interactions between individuals and the health care system was applied to the field of oral health in the French context. This model defines access to health care as the result of interactions between individuals and the health care system, in which health needs are perceived, health care is sought, health care structures are accessed and effectively used. Analysis is based on quantitative and qualitative bibliographic data acquired through an explanatory sociological approach.

Results: Socially deprived populations face many barriers preventing their access to dental care: the need for dental care is not necessarily perceived, and, when perceived, dental care is not immediately sought, accessibility to dental care structures is difficult and dental attendance is erratic.

Conclusion: This review provides information to decision-makers in order to support regional health policies and to help implement public health strategies according to the principle of proportionate universalism. Two axes for action were identified, namely to integrate oral health promotion interventions within health promotion programmes and to gradually reorganize the dental care system to make it more accessible to everyone.
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http://dx.doi.org/10.3917/spub.182.0243DOI Listing
November 2018

Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies.

Clin Oral Investig 2019 Jan 2;23(1):235-243. Epub 2018 Apr 2.

University Clermont Auvergne, CROC EA 4847, Dental Faculty, 2 rue de Braga, F-63000, Clermont-Ferrand, France.

Objectives: This study explores whether the chemotherapy regimen has a role in inducing oral health problems and malnutrition in elderly patients with other cancers than head and neck malignancies.

Material And Methods: An observational cross-sectional study was designed to compare the relationships between oral health and nutritional status between four groups of elderly differing in cancer or chemotherapy regimen. Data were collected using a questionnaire including the Mini-Nutritional Assessment (MNA), the Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia. The oral examinations recorded the number of functional dental units (PFU) and the presence of oral lesions.

Results: The sample comprised 46 patients receiving chemotherapy, 48 patients on a non-chemotherapy regimen, 45 persons in complete remission not under treatment and 53 non-cancer patients. Oral health perception was significantly worse in chemotherapy patients. They reported limiting the kinds of food they consumed, the discomfort felt when eating and took medications for oral pain. Oral lesions were frequent in chemotherapy participants. Nutritional status was related to the cancer treatment regimen (OR = 4.17; p value = 0.017), the presence of oral lesions (OR = 4.51; p value = 0.003), perception of xerostomia (OR = 3.54; p value = 0.012), the number of PFU (OR = 2.51; p value = 0.046) and GOHAI score (OR = 1.617; p value = 0.019).

Conclusion: The presence of oral lesions and the chemotherapeutic regimen were highly associated with nutritional status in older patients with cancer.

Clinical Relevance: Dental professionals should be asked to intervene preventively and per-therapy to optimise oral health status in elderly patients with other cancers than head and neck malignancies.
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http://dx.doi.org/10.1007/s00784-018-2430-1DOI Listing
January 2019

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey.

Aging Clin Exp Res 2018 Dec 8;30(12):1513-1521. Epub 2018 Mar 8.

Department of Prosthetic Dentistry, School of Dentistry, Saint-Joseph University, Beirut, Lebanon.

Background And Objective: The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level.

Results: 264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES.

Conclusion: There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.
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http://dx.doi.org/10.1007/s40520-018-0927-8DOI Listing
December 2018

Common risk indicators for oral diseases and obesity in 12-year-olds: a South Pacific cross sectional study.

BMC Public Health 2018 01 8;18(1):112. Epub 2018 Jan 8.

University Clermont Auvergne, EA 4847, Centre de Recherche en Odontologie Clinique, BP 10448, 63000, Clermont-Ferrand, France.

Background: Despite the increasing need to prevent obesity and oral diseases in adolescents worldwide, few studies have investigated the link existing between these conditions and their common risk factors. This study aims to evaluate the oral health and weight status of New Caledonian Children (aged 6,9,12 years) and to identify, amongst 12-year-olds, risk indicators that may characterize the groups of children affected by oral diseases, obesity or both diseases.

Methods: This survey evaluated in 2011-2012 the oral health and stature-weight status and related risk indicators in a national representative sample of 6, 9 and 12 years-old children in New Caledonia. Dental status, chewing efficiency, height, weight and waist circumference were clinically recorded at school. The body mass index (BMI) and the waist to height ratio (WtHR) were calculated. For BMI the WHO Cut-offs were used. Twelve years-old participants responded to a questionnaire concerning socio-demographic and behavioural variables. For statistical analysis, the Clinical Oral and Global Health Index (COGHI) was developed and used. Twelve years-old children were categorised into four groups; Oral Diseases (ODG), Obesity (OG), Obesity and Oral Diseases (ODOG) and a Healthy Group (HG). A multivariate analysis was conducted using mixed-effects multinomial logistic regression models.

Results: Prevalence of overweight and obesity was greatly increasing from 6 years (respectively 10.8% [8.8;13.3] and 7.8% [6.0;9.9]) to 12 years (respectively 22.2% [19.9;24.7] and 20.5% [18.2;22.9]) and one third of the 12-yr-olds had an excess of abdominal adiposity. At age 12, 36.6% of the children were healthy (HG), 27.3% had oral diseases (ODG), 19.7% were obese (OG) and 16.5% had both conditions (ODOG). Geographical location, ethnicity, tooth-brushing frequency and masticatory disability were significant risk factors for the OG, ODOG and ODG groups. Ethnicity and masticatory impairment were common risk indicators for the association of oral diseases and obesity.

Conclusions: In NC health promotion programs should be specifically addressed towards Native populations who are particularly exposed to oral diseases and obesity, integrating a multiple risk factors approach, in order to prevent the onset of chronic diseases in adulthood. The impact of masticatory ability on children's weight status is a major issue for future research.
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http://dx.doi.org/10.1186/s12889-017-4996-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759176PMC
January 2018

A Rasch Analysis between Schizophrenic Patients and the General Population.

Transl Neurosci 2017 28;8:139-146. Epub 2017 Oct 28.

UMR 1246 INSERM - SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Nantes, France.

Background: The aim of this study was to test the General Oral Health Assessment Index Questionnaire (GOHAI) items for differential item functioning (DIF) according to demographic characteristics (gender, age) and mental health status (schizophrenic disorders versus general population) using Rasch analysis.

Methods: This is a cross-sectional study using aggregated baseline data from a validation study of the GOHAI in the French general population (GP) and similar validation study in persons with schizophrenia (PWS). DIF was tested using the Partial Credit Model. DIF were estimated in different groups of patients.

Results: The cohort comprised 363 persons: 65% were female, 83% were 25-45 years old and 30% were PWS.Five of the 12 items exhibited DIF. DIF effects were observed with schizophrenia for 3 items, with age for 3 items and with gender for 1 item. The variable "age" gave a significant explanation of the latent variable: the latent variable decreased with age (-0.40±0.08-p<0.001 for each increase of the age of 10 years). This decrease represented an effect size of 0.27 which can be qualified of a small to medium effect. The status of the individuals (GP versus PWS) and the gender did not significantly explain differences in the values of the latent variable.

Conclusion: The GOHAI scores may not be comparable across sub-groups defined by health status, age and gender without accounting for DIF. In the future, other studies should explore this way with other Oral Health related Quality of Life assessment tools and populations with mental illness.
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http://dx.doi.org/10.1515/tnsci-2017-0020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662753PMC
October 2017

[Salt fluoridation and dental caries: state of the question].

Sante Publique 2017 Apr;29(2):185-190

Objective: Dental caries remains a public health problem, particularly among socially deprived populations. In some developing countries, salt fluoridation programmes have been recently developed, but the use of fluoridated salt is limited worldwide and the level of evidence for its efficacy remains debated. Method: A literature review was conducted to identify epidemiological or clinical studies that have evaluated the effect of salt fluoridation on dental caries experiences in children. Results: After a literature search, 22 references were selected reporting data on the preventive effect of salt fluoridation programmes in Europe (Hungary, Switzerland, France, Germany) and South and Central America (Colombia, Mexico, Jamaica...). Data were mainly obtained from descriptive or retrospective epidemiological studies. The results indicate that, in the absence of topical fluoride support, salt fluoridation leads to a significant reduction in caries indexes among treated children compared to a control group. In a context of widespread use of fluoridated toothpastes, the additional effect achieved by salt fluoridation is limited. The prevalence of fluorosis is not markedly increased with fluoridated salt, but side effects were not always evaluated. Conclusion: Today, a salt fluoridation programme could be useful in areas in which fluoridated toothpastes are not widely used. The communication policy promoting the consumption of fluoridated salt is crucial to ensure the effectiveness of such a programme.
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April 2017

Psychometric characteristics of the "General Oral Health Assessment Index (GOHAI) » in a French representative sample of patients with schizophrenia.

BMC Oral Health 2017 Apr 11;17(1):75. Epub 2017 Apr 11.

EA 481 Integrative Neurosciences and Clinical, University Hospital of Besançon, F-25000, Besançon, France.

Background: The "General Oral Health Assessment Index" (GOHAI) was widely used in clinical or epidemiological studies worldwide, as it was available for use in different languages. Therefore, the aim of this study was to evaluate the psychometric characteristics of the GOHAI in a representative sample of patients with schizophrenia.

Methods: A total of 90 schizophrenic patients (in-patients and out-patients) were recruited from the participants of the "buccodor study" (NCT02167724) between March and September 2015. They were selected using a random stratified sampling method according to their age, sex, or residential area (urban/rural area). GOHAI validity (construct, predictive, concurrent and known group validity) and internal consistency (reliability) were tested. Test-retest reliability was evaluated in 32 subjects.

Results: The mean age was 47.34 (SD = 12.17). Internal consistency indicated excellent agreement, with a Cronbach's α value of 0.82 and average inter-item correlation of 0.65. Intraclass correlation coefficients for test-retest reliability with 95% confidence intervals were not significantly different (p > 0.05). Construct validity was supported by three factor that accounted for 60.94% of the variance observed. Predictive validity was corroborated as statistically significant differences were observed between a high GOHAI score, which was associated with self-perceived satisfaction with oral health, lower age and high frequency of toothbrushing. Concurrent validity was corroborated as statistically significant relationships were observed between the GOHAI scores and most objective measures of dental status. For known group validity, they was no significant difference of the mean GOHAI score between out or in-patients (p > 0.05).

Conclusion: Acceptable psychometric characteristics of the GOHAI could help caregivers to develop ways to improve the Oral Health related Quality Of Life of schizophrenic patients.

Trial Registration: Clinical Trials Gov NCT02167724 . Date registered 17 June, 2014.
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http://dx.doi.org/10.1186/s12903-017-0368-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387256PMC
April 2017

Validation of the child oral health impact profile (COHIP) french questionnaire among 12 years-old children in New Caledonia.

Health Qual Life Outcomes 2015 Oct 30;13:176. Epub 2015 Oct 30.

Clermont University, University of Auvergne, EA 4847, Centre de Recherche en Odontologie Clinique, BP10448, F-63000, Clermont-Ferrand, France.

Background: The Child Oral Health Impact Profile (COHIP) is an Oral Health Related Quality of Life (OHRQOL) tool that assesses the impact of oral diseases on quality of life in children. This study aimed to assess the validity of the COHIP French questionnaire (45 items) and to evaluate the OHRQOL of 12-years children in New Caledonia.

Methods: After cultural adaptation of the COHIP questionnaire, data were collected from clinical oral examinations and self-administered questionnaires in a representative sample of children aged 12 years in New Caledonia. Questions related to socio-demographic status or children's perception of their oral and general health were added to the COHIP questionnaire. Studying the association between COHIP scores and health subjective perceptions or dental status indicators assessed concurrent and discriminant validity. The items of the COHIP were subjected to principal components analysis. Finally, reproducibility and reliability were evaluated using Intraclass Correlation Coefficients (ICC) and Cronbach's alpha coefficient.

Results: Two hundred and thirty-six children participated in the main study; mean age was 12.6 ± 0.31 years, 55.1 % were girls and diverse ethnic groups were represented. A preliminary reliability analysis has led to calculate COHIP scores with 34 items as in the English version, scores ranged from 35 to 131 (mean ± SD, 101.9 ± 16.84). Lower COHIP scores were significantly associated with the self-perception of poor general or oral health. COHIP was able to discriminate between participants according to gender, ethnic group, oral hygiene, dental attendance, dental fear and the presence of oral diseases. Test-retest reliability and scale reliability were excellent (ICC = 0.904; Cronbach's alpha coefficient = 0.880). Four components were identified from the factor analysis.

Conclusion: The French 34-items COHIP showed excellent psychometric properties. Further testing will examine the structure and utility of the instrument in both clinical and epidemiological samples.
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http://dx.doi.org/10.1186/s12955-015-0371-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628352PMC
October 2015

[Development and evaluation of a triage tool for patients in a dental emergency unit].

Sante Publique 2015 Jan-Feb;27(1):79-88

Objective: This study was designed to develop and evaluate a guidance tool to refer patients with dental emergencies to a hospital dental emergency unit.

Methods: The referring tool was first developed. It was designed to define a waiting timeforpatient management by assessing the clinical signs described by these patients on presentation at the dental care unit. The validity of the tool was then assessed by comparing the waiting time defined by the referring tool to that defined by a practitionerfor 300 patients attending the Emergency Dental Unit in Clermont-Ferrand. Indicators for specificity, sensitivity and the kappa coefficient were used.

Results: The referring tool was able to define a waiting timefor 92% of patients. It was able to correctly identify patients needing care "within 24h" (s = 0.84, k = 0.72). Patients who reportedfew symptomswere referred within a "3-7 days" waiting time (s= 0.88, k = 0.62). The tool was less effective for patients needing care within "1-2 days"(s = 0.42, k= 0.41), whose clinical signs were less acute. Specificity exceeded 0.8 in every case. Accordingly, regardless of the waiting time, the use of this tool avoided scheduling appointments for patients who did not need care. The toolfacilitated emergency unit activity, as 50% ofthe appointments could be scheduled beyond 24 hours.

Conclusion: The metrological characteristics of the referring tool were well adapted to the setting studied.
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August 2015

Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice.

Caries Res 2015 24;49(4):408-16. Epub 2015 Jun 24.

Service d'Odontologie, Hôtel-Dieu, CHU Clermont-Ferrand, Clermont-Ferrand, France.

A survey conducted in 2002 among French general dental practitioners (GPs) showed variations between treatment decisions and a tendency towards early restorative intervention for caries. The aims of the present questionnaire survey were to investigate, among a random sample of 2,000 French GPs, the management decisions for occlusal lesions in 2012 and to compare the results to those obtained in 2002. The response rate was 41.9%. The majority of the respondents (60.7%) would postpone their restorative decisions until the lesion was in the dentin, based on clinical and radiographic examinations. Almost 68% of the respondents suggested that the cavity preparation should be limited to the lesion (vs. a preparation extending to the occlusal fissure), and 81.6% chose composite as restorative material for the earliest lesion requiring restoration in a 20-year-old patient with his/her caries risk factors under control. Statistical analysis (χ(2) and logistic regression) showed that the management decisions were influenced by certain demographic characteristics (gender, clinical experience and participation in cariology courses). When comparing the 2002 and 2012 responses, it appears that even if French GPs still tend to intervene surgically for occlusal lesions, which could benefit from noninvasive care such as therapeutic sealants, the restorative threshold has been delayed to later stages of carious progression (p < 0.0001). Moreover, the 2012 respondents were less likely to open the fissure system than the 2002 respondents (p = 0.032), and less amalgam restorations would have been placed in 2012 (p < 0.0001). Furthermore, the results showed that the variability observed in 2002 toward caries management decisions was persisting in 2012.
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http://dx.doi.org/10.1159/000381355DOI Listing
December 2016

Dental status of new caledonian children: is there a need for a new oral health promotion programme?

PLoS One 2014 7;9(11):e112452. Epub 2014 Nov 7.

Clermont University, University of Auvergne, EA 4847, Centre de Recherche en Odontologie Clinique, BP 10448, Clermont-Ferrand, France; CHU Clermont-Ferrand, Clermont-Ferrand, France.

Background: Before implementing a new oral health promotion program in the French overseas territory of Nouvelle Calédonie, the health authorities needed recent data about dental status of the New Caledonian child population.

Objectives: This study aimed to describe the dental status of 6, 9 and 12-yr-old New Caledonian children and to investigate the environmental and behavioural risk factors related to oral health.

Methods: A randomly selected sample of 2734 children (744 6-yr-olds, 789 9-yr-olds, and 1201 12-yr-olds) was examined clinically by seven calibrated investigators and participants responded to a questionnaire. The main variables were objective criteria about dental status and subjective criteria about experience of dental care, dental fear, self-perception of oral health, cultural or ethnic identity and environmental and behavioural risk factors.

Results: Overall, most of the children had infectious oral diseases: more than 50% had gingivitis, and 60% of 6- and 9 yr-olds had at least one deciduous or permanent tooth with untreated caries. The mean 12-yr-old number of decayed missing and filled teeth (DMFT) was 2.09±2.82. The number of carious lesions was related to the unfavourable lifestyle, deprived social status and no preventive dental care. Kanak, Polynesians and Caledonians (respectively 27%, 18% and 45% of the study sample) were more affected by caries than metropolitan French and Asian children. Children with many untreated carious lesions had negative perceptions of their oral health; they complained of chewing difficulty and had higher scores for dental anxiety.

Conclusion: This study highlights the need for new strategies aimed at improving oral health and at reducing inequalities in New Caledonia. An oral health promotion program would need to be developed in connection with other health programmes using the common risk factor approach within the context of the local environment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0112452PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224488PMC
January 2016

The pertinence of oral health indicators in nutritional studies in the elderly.

Clin Nutr 2014 Apr 28;33(2):316-21. Epub 2013 May 28.

Department of Public Health, School of Medicine, Saint-Joseph University, Beirut, Lebanon. Electronic address:

Background And Aim: Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly.

Methods: A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU).

Results: The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ≥ 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]).

Conclusion: Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score.
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http://dx.doi.org/10.1016/j.clnu.2013.05.012DOI Listing
April 2014

[Effects of hypnosis in dental care].

Presse Med 2013 Apr 18;42(4 Pt 1):e114-24. Epub 2013 Feb 18.

Université d'Auvergne, faculté de chirurgie dentaire, laboratoire EA3847, 63000 Clermont-Ferrand, France.

Objective: Hypnosis is widely used in medicine and dentistry, but many practitioners still consider it as a mysterious technique. Thus, a systematic review was conducted to assess the effects of hypnosis during dental treatment.

Methods: A literature search was conducted on PubMed (1981-2012) to retrieve references, written in French or English, reporting controlled clinical studies that have evaluated any type of hypnosis. The quality of included studies was assessed by evaluating randomisation, blindness and drop-outs. The effects of hypnosis on anxiety, physiological parameters, patients' behaviour or pain were analysed descriptively.

Results: The electronic search retrieved 556 references. Nine studies, generally characterized by low methodological quality, were selected. Results indicated that hypnosis has significant positive effects on anxiety, pain, behaviour and physiological parameters when it is compared with no treatment. When hypnosis is compared with other psychological treatment such as cognitive behavioral therapy (CBT), the effects on anxiety and behaviour are almost identical with an advantage for CBT. Individualized hypnosis brings more benefits than standardized hypnosis with audio recordings.

Conclusion: This review demonstrated the effectiveness of hypnosis but the poor quality of the clinical studies and the multiplicity of evaluation outcomes limit the level of evidence. It is therefore necessary to conduct further clinical studies to confirm the effects of hypnosis during dental treatments.
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http://dx.doi.org/10.1016/j.lpm.2012.08.006DOI Listing
April 2013

Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon.

Health Qual Life Outcomes 2012 Oct 30;10:131. Epub 2012 Oct 30.

Department of Prosthetic Dentistry, School of Dentistry, Saint-Joseph University, Beirut, Lebanon.

Background: The respective abilities of the GOHAI and OHIP-14 to discriminate between aged patients with different levels of oral diseases have rarely been studied in developing countries. The aim of this study was to compare the discriminative abilities of the OHIP-14 and the GOHAI in an elderly Lebanese population, and particularly to identify persons with different masticatory function.

Methods: A sample of elderly, aged 65 years or more, living independently was recruited in two primary care offices in Beirut, Lebanon. Data were collected by means of personal interview and clinical examination. The Arabic OHIP-14 and GOHAI questionnaires were used after cultural adaptation for use in Lebanon. The internal consistency, reproducibility and concurrent validity were verified. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile respectively and logistic regressions were conducted using socio-demographic, clinical and subjective explanatory variables.

Results: Two hundred and six participants were included; mean age was 72 years and 60% were women. Good psychometric properties were observed for both questionnaires for internal consistency (Cronbach's alpha>0.88), reproducibility (ICC>0.86) and concurrent validity. Strong correlations were found between GOHAI and OHIP-14 scores but a high prevalence of subjects with no impact was observed using the OHIP-14. Both questionnaires were able to discriminate between participants according to age, perception of temporomandibular joint (TMJ) pain or functional status as represented by the number of dental Functional Units (FU). GOHAI was more discriminant since it identified participants with high dental care needs: high numbers of decayed teeth, low numbers of teeth and socially deprived status.

Conclusions: Lebanese elderly with high dental care needs and impaired oral health were identified more easily with the GOHAI. These results may guide the choice of dental indicators to use in a national geriatric survey.
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http://dx.doi.org/10.1186/1477-7525-10-131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495839PMC
October 2012

Topical preventive measures to avoid or reverse white spot lesions in orthodontic patients.

Evid Based Dent 2012 Mar;13(1):21-2

Department of Dental Public Health, Faculty of Dental Surgery, Universite d'Auvergne, CHU de Clermont-Ferrand, France.

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http://dx.doi.org/10.1038/sj.ebd.6400844DOI Listing
March 2012

Addressing children's oral health inequalities: caries experience before and after the implementation of an oral health promotion program.

Acta Odontol Scand 2012 May 3;70(3):255-64. Epub 2012 Feb 3.

CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, France.

Objective: (1) To evaluate the dental status of 5-year-old children in Clermont-Ferrand (France) in 2009; (2) To measure changes in children's dental status between 2003 and 2009; and (3) To estimate the impact of an Oral Health Promotion (OHP) program implemented in nine schools since 2005.

Materials And Methods: All 5-year-olds attending public schools in deprived areas (n = 15) and six randomly selected other schools in Clermont-Ferrand were invited to participate. Dental status was recorded using d(3)mft, as in 2003. Parents responded to questions about their child's oral hygiene and provided socio-demographic information.

Results: Of children invited, 478 (77%) were examined. Mean dmft was 1.18 (SD 2.61); 27.6% had at least one tooth affected. Caries experience varied significantly with deprivation status, oral hygiene and household SES indicators. The only difference observed between 2003 and 2009 was an increase in the 'f' component (p < 0.001). Dental status had slightly deteriorated in areas characterized in 2003 by low caries levels (p=0.07). In deprived areas, mean dmft increased in schools without the OHP program (p = 0.04). Changes between 2003 and 2009 were studied at school level using Multiple Factorial Analysis; it tended to improve in four schools, which had the OHP program. Household indicators of SES changed little. Oral hygiene levels varied differently from one school to another.

Conclusions: Caries experience was high, with large inequalities between children. No major differences were observed between 2003 and 2009. The OHP program has done little to reduce disparities in oral health, even if dental status improved in four schools.
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http://dx.doi.org/10.3109/00016357.2011.645059DOI Listing
May 2012

Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children.

Cochrane Database Syst Rev 2011 Dec 7(12):CD007592. Epub 2011 Dec 7.

Dental Public Health, Faculty of Dentistry, CHU of Clermont-Ferrand, University of Auvergne, 11 Boulevard Charles de Gaulle, Clermont-Ferrand, France, 63000.

Background: Dietary fluoride supplements were first introduced to provide systemic fluoride in areas where water fluoridation is not available. Since 1990, the use of fluoride supplements in caries prevention has been re-evaluated in several countries.

Objectives: To evaluate the efficacy of fluoride supplements for preventing dental caries in children.

Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 12 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE via OVID (1950 to 12 October 2011), EMBASE via OVID (1980 to 12 October 2011), WHOLIS/PAHO/MEDCARIB/LILACS/BBO via BIREME (1982 to 12 October 2011), and Current Controlled Trials (to 12 October 2011). We handsearched reference lists of articles and contacted selected authors.

Selection Criteria: We included randomised or quasi-randomised controlled trials comparing, with minimum follow-up of 2 years, fluoride supplements (tablets, drops, lozenges) with no fluoride supplement or with other preventive measures such as topical fluorides in children less than 16 years of age at the start. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (DMFS).

Data Collection And Analysis: Two review authors, independently and in duplicate, assessed the eligibility of studies for inclusion, and carried out risk of bias assessment and data extraction. In the event of disagreement, we sought consensus and consulted a third review author. We contacted trial authors for missing information. We used the prevented fraction (PF) as a metric for evaluating the efficacy of the intervention. The PF is defined as the mean caries increment in controls minus mean caries increment in the treated group divided by mean caries increment in controls. We conducted random-effects meta-analyses when data could be pooled. We assessed heterogeneity in the results of the studies by examining forest plots and by using formal tests for homogeneity. We recorded adverse effects (fluorosis) when the studies provided relevant data.

Main Results: We included 11 studies in the review involving 7196 children.In permanent teeth, when fluoride supplements were compared with no fluoride supplement (three studies), the use of fluoride supplements was associated with a 24% (95% confidence interval (CI) 16 to 33%) reduction in decayed, missing and filled surfaces (D(M)FS). The effect of fluoride supplements was unclear on deciduous or primary teeth. In one study, no caries-inhibiting effect was observed on deciduous teeth while in another study, the use of fluoride supplements was associated with a substantial reduction in caries increment.When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth.The review found limited information on the adverse effects associated with the use of fluoride supplements.

Authors' Conclusions: This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.
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http://dx.doi.org/10.1002/14651858.CD007592.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876544PMC
December 2011

[Evaluation of an oral health promotion program after one year of implementation in a nursery school].

Sante Publique 2008 Jan-Feb;20(1):7-17

Université d'Auvergne, Département de santé publique, Equipe d'Accueil 3847, UFR d'Odontologie, 63000 Clermont-Ferrand, France.

An oral health promotion programme and study are currently being carried out in 9 nursery schools with children at high risk for cavities located in the deprived neighbourhoods of the city of Clermont-Ferrand (France). The programme's objective is to promote the improvement of tooth brushing habits (2 times/day) and general oral hygiene associated with the use of fluoridated toothpastes. Dental care and dental hygiene visits are also encouraged. In 2005-2006 the programme was implemented in 4 schools; another group of 5 schools constituted a control group. After one year, an evaluation of the process, the programme's effectiveness and short-term outcomes was conducted. The majority of the parents, teachers and children participated in the program but their involvement was limited, with active participation being difficult to achieve. The programme was positive in terms of its prevention component and objective. A significant improvement in children's oral hygiene habits was obtained in the programme group as compared to the control group. However, the care and treatment needs of the children in both groups were not covered, given that one child out of four remained with untreated lesions at the end of the year. These results suggest that here are many barriers that prevent children's access to care which need to be addressed.
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http://dx.doi.org/10.3917/spub.081.0007DOI Listing
July 2008

Dental status and measures of deprivation in Clermont-Ferrand, France.

Community Dent Oral Epidemiol 2006 Oct;34(5):363-71

Department of Dental Public Health, Faculty of Dental Surgery, Universite d'Auvergne, Clermont-Ferrand, France.

Background: Many background variables, such as socioeconomic status (SES), may be measured at the level of the individual or using some ecological indicators.

Objectives: This study aimed to examine, in 5- and 10-year-olds in Clermont-Ferrand, the relationship between household SES indicators, SES measured as an area-based ecological variable and dental status.

Methods: All 5- and 10-year-olds attending public schools in deprived and semi-deprived zones (n = 15) and six other randomly selected schools in Clermont-Ferrand were invited to participate. All children were examined clinically. On a questionnaire, parents provided sociodemographic information.

Results: Of the children invited, 84% (880 children) were examined. Mean dft of 5-year-olds was 0.93 (SD 2.27); 26.5% had at least one tooth affected. The caries experience (DMFT) of 10-year-olds was 0.85 (SD 1.14) and 37.2% had permanent tooth caries experience. Caries experience varied significantly with school deprivation status: the greater the deprivation score, the more likely was poor dental health. Country of birth, parents' employment status, family size and health insurance type were significantly related to dental status. Logistic analyses estimated the importance of SES and ecological variables; deprivation influenced dental status in 5-year-olds even when household SES indicators were considered. In 10-year-olds, caries experience was influenced by household SES, immigrant background, father's employment and family size.

Conclusion: The use of school deprivation as an ecological measure status was useful for identifying population subgroups with different levels of oral health, particularly in young children. This indicator of social deprivation could be used for targeting preventive programmes to high caries risk communities defined geographically.
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http://dx.doi.org/10.1111/j.1600-0528.2006.00284.xDOI Listing
October 2006

Validation of a French version of the Child-OIDP index.

Eur J Oral Sci 2005 Oct;113(5):355-62

Department of Dental Public Health, Faculty of Dental Surgery, Université d'Auvergne, Clermont-Ferrand, France.

The Child-OIDP index is an indicator of oral health-related quality of life, which has been validated among 12-yr-old children in Thailand. The aim of this study was to assess the reliability, validity, and applicability of this questionnaire among French children. After translation and cultural adaptation, the Child-OIDP was tested on 414 10-yr-old children in France. The children completed the Child-OIDP in face-to-face interviews, were clinically examined, and answered questions evaluating their global self-rated oral health. Parents filled in a questionnaire concerning their socio-demographic background. An oral impact on daily life was reported by 73% of the children. The mean Child-OIDP score was 6.32 [standard deviation (SD) 8.22] and the median was 3.33. The internal reliability was confirmed with a Cronbach's alpha of 0.57. The retest procedure (n = 62) showed a satisfactory reproducibility (r = 0.81, kappa = 0.75). The index was shown to be a valid instrument. Construct validity was satisfactory as the Child-OIDP score increased when the children's perceived oral health decreased. The Child-OIDP score was able to discriminate between different socio-demographic groupings and varied according to dental status. This study showed that the Child-OIDP is applicable for use among children in France. It has promising psychometric properties but further research is required to evaluate its sensitivity to change.
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http://dx.doi.org/10.1111/j.1600-0722.2005.00230.xDOI Listing
October 2005

Towards a new taxonomy of idiopathic orofacial pain.

Pain 2005 Aug;116(3):396-406

EA 3847, Faculté de Chirurgie Dentaire, CHU Clermont-Ferrand 63000, France INSERM E 0216, Neurobiologie de la Douleur Trigéminale, Clermont-Ferrand, France INSERM E-332, Hôpital Ambroise-Paré, APHP, Boulogne-Billancourt and Université Versailles Saint-Quentin, Versailles, France Faculté de Chirurgie Dentaire, Université Paris 5, Montrouge, France Faculté de Médecine Dentaire, Université Laval, Sainte-Foy, Que., Canada CHU, Saint-Etienne, France CHU, Clermont-Ferrand, France INSERM U525, Faculté de médecine, CHU, Nancy, France.

There is no current consensus on the taxonomy of the different forms of idiopathic orofacial pain (stomatodynia, atypical odontalgia, atypical facial pain, facial arthromyalgia), which are sometimes considered as separate entities and sometimes grouped together. In the present prospective multicentric study, we used a systematic approach to help to place these different painful syndromes in the general classification of chronic facial pain. This multicenter study was carried out on 245 consecutive patients presenting with chronic facial pain (>4 months duration). Each patient was seen by two experts who proposed a diagnosis, administered a 111-item questionnaire and filled out a standardized 68-item examination form. Statistical processing included univariate analysis and several forms of multidimensional analysis. Migraines (n=37), tension-type headache (n=26), post-traumatic neuralgia (n=20) and trigeminal neuralgia (n=13) tended to cluster independently. When signs and symptoms describing topographic features were not included in the list of variables, the idiopathic orofacial pain patients tended to cluster in a single group. Inside this large cluster, only stomatodynia (n=42) emerged as a distinct homogenous subgroup. In contrast, facial arthromyalgia (n=46) and an entity formed with atypical facial pain (n=25) and atypical odontalgia (n=13) could only be individualised by variables reflecting topographical characteristics. These data provide grounds for an evidence-based classification of idiopathic facial pain entities and indicate that the current sub-classification of these syndromes relies primarily on the topography of the symptoms.
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http://dx.doi.org/10.1016/j.pain.2005.05.009DOI Listing
August 2005

French dentists' restorative treatment decisions.

Oral Health Prev Dent 2004 ;2(2):125-31

Department of Operative Dentistry, Faculty of Dentistry, University of Auvergne, Clermont-Ferrand, France.

Purpose: Variations in decision-making about restorative treatments have been demonstrated among dentists in several countries. This study sought to assess the restorative treatment philosophies based on a representative sample of French dentists.

Materials And Methods: A sample (n = 2000) was randomly extracted from a national list (n = 42,000). Each dentist received a questionnaire, illustrations of carious conditions, and a reply-paid envelope. The questionnaire assessed the stage of lesion progression at which the respondents considered restorative treatment appropriate, their choice of restorative technique and dental material. For all questions, an imaginary 20-year-old patient with low caries activity was described.

Results: After one reminder, the response rate was 40%. Almost half of the respondents would restore an occlusal lesion confined to enamel and 88% would have prepared a cavity for a proximal lesion at the amelo-dentinal junction. The majority of the respondents would not use the Black concepts for cavity preparation. Their preferred restorative material was composite.

Conclusions: Answers indicated a tendency towards early restorative intervention and showed large variations between the treatment decisions of French dentists.
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February 2005

Dental status and oral health quality of life in economically disadvantaged French adults.

Spec Care Dentist 2004 Sep-Oct;24(5):264-9

Department of Public Health, School of Dentistry, University of Clermont-Ferrand, France.

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.
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http://dx.doi.org/10.1111/j.1754-4505.2004.tb01704.xDOI Listing
December 2004