The adoption of xylitol chewing gum in Finland was studied using data from two comparable postal surveys for national samples of 12- to 18-year-olds in 1977 (response rate 79%, n = 2,528) and 1991 (77%, n = 7,672). In 1977 only 12% of this age group used xylitol chewing gum but, by 1991 it had become common (64% of boys, 81% of girls). Daily use increased from 1 to 15% among boys and from 1 to 32% among girls. Use of sucrose chewing gum decreased; in 1991 only 2% used it daily. Daily use of xylitol chewing gum did not vary according to socioeconomic status or level of urbanization. The increase in use of xylitol chewing gum is an example of the positive effect of health education given by a comprehensive, preventively oriented system of dental health care in association with commercial interests.
Equal distribution of health care services has long been a major goal of health policy in the Nordic countries. According to these guidelines, every child is expected to have an examination and treatment at least every second year. The aim of this study was to analyze the trends and, in particular, the socioeconomic differences in dental visits between 1977 and 1995. The data were collected as part of a nationwide research program, the Adolescent Health and Lifestyle Survey, which began in 1977. Every second year a self-administered questionnaire was mailed to a representative sample of 14-, 16- and 18-year-old Finns. The sample sizes in the surveys varied from 2422 to 9556, making a total of 56,605 subjects in the whole study. The response rates in different years varied from 77% to 88%. The percentage of adolescents visiting a dentist increased between 1977 and 1981 and thereafter remained stable. Dental visits seemed to correlate with the occupational and educational status of the parents up to 1983, but not after that. The Finnish primary oral health care policy seems to have gained a major objective by eliminating social inequality in dental service utilization among adolescents.
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.
The purpose of this study was to analyse the establishment of the toothbrushing frequency as a healthy habit by Finnish adolescents between 12 and 18 years of age. The data were collected as part of the nation-wide research programme, the Adolescent Health and Lifestyle Survey. All Finns born in 1968 with birthdays on 20-25 July formed the sample (N=1106). Questionnaires were mailed to the whole sample in February 1981 (12 years of age), -83 (14 years), -85 (16 years) and -87 (18 years). The rate of return for all four questionnaires was 62 percent (six-year follow-up) and for two questionnaires (two-year follow-up studies) 79 percent (12 and 14 years), 72 percent (14 and 16 years) and 68 percent (16 and 18 years). Those adolescents who brushed their teeth more than once a day at age 12, were more stable in their behaviour during the following six years than those who brushed their teeth less often. Over two thirds of the respondents, both boys and girls, indicated one or more changes in their toothbrushing frequency in the four questionnaires during the six-year follow-up. The rate of improvement in toothbrushing frequency was higher among girls than boys, and the rate of deterioration in toothbrushing frequency was higher among boys than girls. One sixth of the adolescents still showed a deterioration in their brushing frequency between the ages of 16 and 18. It may be concluded that although toothbrushing frequency will be gradually adopted as a health habit when the adolescents mature between 12 and 18 years, only half the girls and one fifth of the boys adopt the recommended frequency. Health education should still improve performance in those groups which have not established the recommended toothbrushing frequency.
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.
To analyse trends in development of the toothbrushing frequency of Finnish adolescents and the socio-economic factors associated with these trends between 1977 and 1995.
The data were collected as part of a nation-wide research programme, the Adolescent Health and Lifestyle Survey, which started in 1977. Since then a 12-page questionnaire has been sent every other year. Dental health behaviour was studied from the outset.
The sample represented 12-, 14-, 16- and 18-year-old children and adolescents in Finland. The sample size varied between 3,205-10,626, making a total of 66,687 participants.
The recommended toothbrushing frequency, twice-a-day, was studied. The socio-economic factors included age, gender, self-assessed school performance, level of education, socio-economic status of the householder, and socio-economic category of the residential area.
Among boys, daily toothbrushing increased from 1977 to 1995, but among girls it remained stable. Among boys, the prevalence of twice-a-day toothbrushing frequency varied from 13 per cent to 25 per cent between the ages of 12 and 18 years, and among girls from 32 per cent to 60 per cent, respectively. Among 12- to 14-year-old boys, the socio-economic differences almost disappeared. There were no changes among 12- to 14-year-old girls but there was an unexpected declining trend in toothbrushing among 16- to 18-year-old girls. Apparently further improvement in the toothbrushing frequency of girls had stopped.
Although there was a clear trend towards improvement of toothbrushing frequency among boys, their toothbrushing frequency still lagged far behind that of girls.