The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed gingival health and to investigate possible factors associated with the amount of self-assessed gingival bleeding. A study group comprising students enrolled in grade 7 or 8 in Helsinki, Finland (n = 172), performed a self-assessment based on two tests: the amount of bleeding after toothbrushing and after interproximal tooth cleaning with toothpicks. Clinical examinations based on bleeding on probing (BOP%) were carried out by four local community dentists. The highest observed kappa value was 0.43 for the agreement between BOP% and self-assessment when tested with different cut-off points of diagnosis. Multivariate analysis showed that clinical status and toothbrushing frequency were statistically significantly associated with self-assessed gingival bleeding in both tests. Socioeconomic status and locus of control orientation were also statistically significant factors in the toothpick test. In conclusion, the validity of self-assessment of bleeding was sufficient for monitoring adolescents' gingival health in groups. Self-assessed bleeding was explained by the same factors that were associated with clinical gingival health status.
The aim of this longitudinal study was to compare the effectiveness, in terms of cognitive and clinical changes, of two oral self-care promoting interventions based on a self-assessment of bleeding from gums or of presence of plaque. Adolescent students (age 14.0 + 0.7 years) from two health districts in Helsinki, Finland, participated in this one-year study. The self-assessment of bleeding group (n = 172) recorded bleeding during tooth brushing and inter-proximal cleaning with toothpicks on a single session. The self-assessment of plaque group (n = 156) recorded the presence of plaque with disclosing dye. Both programmes resulted in comparable clinical improvement in bleeding on probing over 9 months. Increased awareness of gingivitis was associated with clinical improvement. The subjects' socio-economic background, baseline gingival health status and age were statistically significantly associated with gingival health improvement during the follow-up. The results support earlier reports on self-assessment and suggest that both self-assessment approaches are beneficial for promoting gingival health in adolescents.
The benefit obtained from the use of a manual for self-assessment of gingival bleeding was evaluated among a group of Finnish army conscripts. After the baseline examination, performed by a dentist, three test groups self-assessed bleeding from their gums during toothbrushing and when cleaning between their teeth with a toothpick. The dentist re-examined the first test group 1 month, the second group 3 months and the third group 6 months after the self-assessment. Gingival bleeding among the test group subjects was compared with that of control group subjects who had been matched for number of bleeding sites at baseline. The self-assessed gingival bleeding was found to correlate with the clinical findings of bleeding. One and 3 months after the self-assessment the test groups had better gingival health than their respective control groups. Six months after the self-assessment, no difference in gingival health was found between the test and control groups. Observed gingival bleeding during the original self-assessment was found to be a positive predictive factor for the subsequent improvement in gingival health.
A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking.
A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed.
Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit.
Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.