Abstracts from the 85th General Session of the IADR: March 21-24, 2007, New Orleans, Louisiana.

These abstracts were among those presented at the 85th General Session of the International Association for Dental Research in New Orleans from March 21-24, 2007. The IADR has given us permission to publish a selection of abstracts in the Canadian Journal of Dental Hygiene.

ORAL CANCER

2143 ORAL PRECANCER: OBJECTIVE AND SUBJECTIVE MEASURES OF NUTRITIONAL STATUS

O. HAMADAH, P. THOMSON, and M. GOODSON, University of Newcastle Upon Tyne, United Kingdom

Background: Evidence supports a role for nutrition in the aetiology and management of oral precancer. Observational epidemiologic studies indicate that poor nutrition is associated with an increased risk of oral precancer. Objective: To assess the value of reported fruit and vegetable intake and nutritional markers [albumin and total lymphocyte count (TLC)] as predictors of severity and outcome in oral dysplasia. Methods: 48 patients undergoing laser resection of dysplastic oral lesions were recruited into the study. Informed consent was obtained and blood samples analysed for full blood count and serum albumin. TLC as an objective marker of nutritional status was subsequently calculated. Patients were grouped using TLC and albumin as well or malnourished using standard criteria. Reported fruit and vegetable intake at presentation was recorded by questionnaire and individuals were assessed for recurrence at two years following laser resection. Statistical comparisons using non-parametric tests were made between fruit/vegetable intake, TLC, albumin and histology at presentation. Comparisons were also made between nutritional status at presentation and clinical outcome at two years. Results: 48 lesions were graded histologically: mild dysplasia (n=4), moderate (n=23), severe (n=21). Using TLC, 49% patients (n=22) were assessed to be well nourished and 51% malnourished (n=26). Albumin levels were normal for 87.5% patients (n=42) and low for 12.5% patients (n=6). 56.3% patients consumed <3 pieces of fruit/vegetable daily and 43.7% [degrees]Y3. Recurrence occurred in 48% patients (n=23). There was no significant relationship (p>0.05) between objective measures of nutritional status (albumin and TLC) or reported fruit/vegetable consumption and histological grade of dysplasia at presentation. Equally, there was no relationship between subjective or objective nutritional markers at presentation and recurrence. Conclusions: Clinical outcome at two years post laser surgery and histological grade of oral dysplasia at diagnosis is unaffected by reported fruit and vegetable intake, serum albumin and TLC at presentation.

1677 DENTAL HYGIENIST VIEWS ON ORAL CANCER CONTROL IN NORTH CAROLINA

C. BIGELOW, L.L. PATTON, R.P. STRAUSS, and R.S. WILDER, University of North Carolina, Chapel Hill, USA

Many oral and pharyngeal cancers (OPC) are preventable. North Carolina (NC) has a continuing high OPC incidence rate at 10.3 per 100,000 population (Elter et al, 2005). Early detection improves survival rates. Hygienists have opportunities to help reduce the oral cancer burden among their patients. Objectives: To qualitatively assess NC dental hygienists' opinions and practices regarding OPC prevention and early detection. Methods: 16 practicing dental hygienists participated in 8 member focus groups. Prompt questions targeted opinions and practices regarding OPC screenings and tobacco use cessation. Focus groups were taped, transcribed, and analyzed qualitatively for content. Results: In most offices, both dentist and hygienist did oral exams. Some limited their exams to high-risk patients while others examined all patients. Not all participants explained to patients that they were doing an OPC exam. 4 major themes arose: 1) The charge of the hygienist was not necessarily to diagnose cancer, but to recognize abnormalities and initiate referral when necessary, 2) The hygienist is only helpful in the tobacco cessation process if the patient has a desire to quit, 3) The hygienist is most effective if the patient believes the provider is genuine and truly cares about the patient's well-being, 4) There is always a need for continued education in oral cancer screenings and tobacco cessation, specifically for hands-on courses. Barriers to performing OPC exams include: financial, time, and insufficient dentist support. Barriers to tobacco cessation include: lack of patient interest, lack of patient education materials and resources, smoking parents of adolescents, personality issues and provider-patient diversity in age, gender, ethnicity, and culture. Conclusions: Dental hygienists felt their most important contribution to oral cancer control was patient education and oral cancer awareness. Professional continuing education is important. Barriers need to be addressed to improve oral cancer control efforts. Supported by: NIH DE14413

ORAL MALODOR

2207 EFFICACY OF AN ESSENTIAL OIL-CONTAINING MOUTHRINSE IN CONTROLLING ORAL MALODOR

C. BENEDUCE (1), S. SANTOS (2), M.-M. WU (2), R. PERFEKT (3), M. LYNCH (2), L. BAILEY (4), J. KRAWCZUK (4), J. QAQISH (5), and C.R. GOYAL (5), (1) Pfizer Consumer Healthcare, Morris Plains, NJ, USA, (2) Pfizer Consumer Healthcare, Pfizer Inc, Morris Plains, NJ, USA, (3) Pfizer Health AB, Pfizer Inc, Helsingborg, Sweden, (4) Hill Top Research, West Palm Beach, FL, USA, (5) Biosci Research Canada, Ltd, Mississauga, Canada

Objectives: The primary objective of these two three-week clinical trials was to determine the degree and duration of effectiveness of Cool Mint Listerine[R] Antiseptic mouthrinse (CMLA) compared to a 5% hydroalcohol mouthrinse (negative control) in reducing and controlling human intrinsic oral malodor using hedonic methodology. Methods: The two observer-blind, randomized, parallel-group, controlled clinical trials were designed in accordance with the ADA Acceptance Program Guidelines for Products Used in Management of Oral Malodor. Following IRB approval and screening examinations, qualified subjects with hedonic scores above the threshold value for unpleasant breath were randomized into one of two groups: CMLA or the negative control rinse. Subjects rinsed for 30 seconds with 20 mL of their assigned mouthrinse and were assessed for six post-rinse ratings at 30, 60, 90, 120, 180 and 240 minutes utilizing a nine point hedonic scale. Subjects rinsed with 20 mL of rinse, twice daily, for 30 seconds for 21 consecutive days. At Days 7 and 21, oral malodor assessments were repeated. Results: In both studies, CMLA rinse was significantly better than the negative control (p<0.05). The first study demonstrated CMLA effectiveness for up to four hours at Days 1, 7 and 21; the second study showed CMLA effectiveness up to 4 hours on Day 1, up to 2 hours on Day 7 and up to 3 hours on Day 21. Over 80% of the subjects had post-rinse mean hedonic scores <6 (below unpleasant range) at 60 minutes on Days 1, 7 and 21 in the first study and at 30 minutes on Days 1, 7 and 21 in the second study. Conclusion: Results of both studies demonstrate that CMLA mouthrinse effectively reduced and controlled intrinsic oral malodor using hedonic methodology in both three-week clinical trials and satisfied the relevant ADA Acceptance Program Guidelines.

UTILIZATION OF DENTAL CARE

0495 ORAL HEALTH AND FOOD INSECURITY IN CANADA

V. MUIRHEAD, J. MAGGIRIAS, and D. LOCKER, University of Toronto, Canada

Food insecurity describes circumstances of compromised food quality or quantity. Like oral health, food insecurity is closely associated with income deprivation. Objectives: This study assessed the relationship between food insecurity and oral health using data from the Canadian Community Health Survey (CCHS), 2003-2004. Methods: The CCHS is a nationwide health survey of persons aged 12 years and older. Secondary data analysis of the CCHS subset included 134,000 individuals who completed both food insecurity and oral health questions. Food insecure household individuals gave "often" or "sometimes" responses to any of the three food insecurity flag questions asking about household experiences in the previous 12 months: (1)"Worried there would not be enough to eat;" (2)"Did not have enough to eat" and (3)"Did not eat desired quality of food." Oral health questions included tooth extractions due to caries or periodontal disease, toothache and oral/facial pain prevalence, self-reported oral health status, frequency of dental visits, toothbrushing frequency and dental insurance coverage. The data subset also included total personal and household income variables. Results: Food insecure household individuals made fewer visits to the dentist and were more likely to report cost as a barrier to dental visits than food secure household individuals (p<0.001). Fewer food insecure household individuals were covered by dental insurance (p=0.001). Food insecure household individuals had lower self-perceived oral health ratings than food secure individuals (p<0.001) but comparable toothbrushing frequency. Multiple logistic regression analysis controlling for income showed that food insecure individuals were more than two times more likely to report "bleeding gums"(OR=2.26, 95% CI:2.02-2.52), toothaches (OR=2.58, 95% CI: 2.31-2.87) and mouth or tooth pain (OR=2.14, 95% CI:1.88-2.44) than food secure individuals. Conclusion: Food insecure household individuals are a dentally vulnerable group.

DENTAL ANXIETY

2745 DENTAL ANXIETY AND PAIN RELATED TO DENTAL HYGIENIST TREATMENT

M. HAKEBERG, Jonkoping university, Sweden

Studies concerning patients' experiences of dental hygienist (DH) treatments with regard to dental anxiety and pain are scarce. Objectives: The aim of this study was to evaluate different groups of patients' self-reported assessments of dental anxiety and pain related to various routine dental hygienist procedures. Methods: A convenience sample of 409 patients from general practices, specialist clinics of periodontology and oral medicine as well as a student hygienist clinic were consecutively asked to participate by answering a battery of questionnaires. The Dental Anxiety Scale and a verbal rating scale (1-5; no pain-extreme pain) were used to assess levels of perceived pain in relation to polishing, probing pocket depth, scaling (manual and ultrasonic) and local anesthesia. Results: Women reported higher fear than men with regard to dental hygienist treatment (7.1% vs 3.9%;p=0.013), however patients were revealing higher dental anxiety levels for treatments performed by dentists as compared to dental hygienists, 11.6% and 5.6% of the sample, respectively. Patients treated at the Periodontology clinics were more dentally anxious for DH-treatment as compared to the other clinics (p=0.002). The most painful (procedures were probing, local anesthesia, manual and ultrasonic scaling with a reported frequency between 7.1%-8.6%, respectively while a polishing procedure only revealed 0.8%. There were proportionally more dentally anxious individuals reporting extreme perceived pain for all DH-treatments except for the polishing procedure. Conclusion: Fear of dental hygienist treatment procedures were frequent in this sample, but fear of dental care performed by a dentist was reported more often as compared to fear of dental hygienist treatment.

ORAL HEALTH

2132 ADEQUACY OF ORAL HEALTH INFORMATION PROVIDED TO DIABETIC PATIENTS

H.K. YUEN, K.M. MAGRUDER, D. BANDYOPADHYAY, C.F. SALINAS, E. SLATE, and S. LONDON, Medical University of South Carolina, Charleston, USA

Objectives: The purpose of this study is to investigate the adequacy of oral health information provided by dental hygienists to people with diabetes. Methods: 228 completed surveys were collected from a random sampling mailing to dental hygienists practicing in South Carolina. The survey queried dental hygienists on the adequacy of oral health information they provided to patients with diabetes, reasons for inadequate coverage of materials, amount of time spent on educating diabetic patients, and frequency of recommending oral hygiene products. Results: Approximately 95% of dental hygienists reported that they adequately covered plaque control and proper oral hygiene; however, only 25%-28% requested their diabetic patients to demonstrate recommended brushing and flossing techniques. About two-thirds of the respondents indicated that they often recommend power toothbrushes and adapted interdental aids to their diabetic patients, and about 60% indicated that they do not cover all essential materials related to oral health when educating patients with diabetes. The proportion of hygienists who feel they covered all essential materials related to oral health was significantly greater among those who report spending more time educating their patients than those who do not spend extra time (P-value = 0.021). The proportion of hygienists who do not have sufficient information on oral care and diabetes was significantly greater among those who feel they have not covered the topic of periodontal disease than those who feel they have adequately covered the topic (P-value < 0.05). Conclusion: In order to improve the adequacy of oral health information for people with diabetes, dental hygienists need to have sufficient information and sufficient time. This study points to the need for continuing education concerning diabetes and oral health for dental hygienists, as well as novel ways (e.g., video demonstrations) to teach patients efficiently.

This project was supported by NIH Grant Number P20 RR-017696.

INFECTION CONTROL

1137 DENTAL HYGIENISTS: INFECTION CONTROL PRACTICES IN ONTARIO

M.R. DARLING, and G.M. MCCARTHY, University of Western Ontario, London, Canada

Objectives: The SARS outbreak and increase in drug-resistant microorganisms have increased scrutiny of recommended infection control practices (RICPs) in Ontario. This study investigated dental hygienists' compliance with RICPs. Method: Questionnaires were mailed to a random sample of hygienists listed by the College of Dental Hygienists of Ontario (n=500), using Dillman's method with three follow-up attempts. SPSS-PC+ was used for data analysis. Response rate was 68%.

Results:

RICP                                               Compliance (%):

Hand Hygiene Practices (HHP-pre & post-treatment)   81%
Barriers:
  Gloves:                                          100%
  Masks:                                            96%
  Protective Eyewear:                               79%
  Protective Uniform:                               82%
HBV Immunization:                                   97%
Additional Precautions For HIV Patients:            56%

Combinations of RICPs                                Compliance (%):

Barriers                                             74%
Barriers, HHP                                        54%
Barriers, HHP, HBV immunization (+serology)          45%
Barriers, HHP, HBV immunization, appropriate heat-   33%
  sterilization
Barriers, HHP, HBV immunization, appropriate heat-   27%
  sterilization, safe handling of sharps
Barriers, HHP, HBV immunization, appropriate heat-   19%
  sterilization, safe handling of sharps, infection
  control manual
Barriers, HHP, HBV immunization, appropriate heat-   14%
  sterilization, safe handling of sharps, infection
  control manual, post-exposure protocol

Conclusion: Although rates of gloves and masks use were >95%, many hygienists appear non-compliant with Standard Precautions. Interventions are required to improve compliance with RICPs and reduce cross infection within the dental office. Funding was received from London Health Sciences Centre Research Institute.

2879 IMMUNIZATION AGAINST INFECTIOUS DISEASES AMONG DENTAL HYGIENISTS IN CANADA

G.M. MCCARTHY, M.R. DARLING, and L. STITT, University of Western Ontario, London, Canada

Objective: There is increasing concern about the ability to control infectious diseases especially newly-evolving strains of influenza. We conducted a national survey of dental hygienists including investigation of immunizations. Methods: The instrument was developed and tested using focus groups, test-retests and a pilot study. Questionnaires were mailed to a random sample of dental hygienists licensed by the Provincial/Territorial Colleges in Canada (n=5,900) and stratified by province. A modification of Dillman's guidelines for administration of mailed surveys was used with two additional mailings to non-respondents. Descriptive statistics were obtained using SPSS/PC+. Results: The response rate was 56%. HBV immunization was reported by 98.5% of respondents (of these, 70% reported post-immunization serology); 59% of respondents reported anti-HBs titers of >10 mIU (3% <10 mIU) and 0.2% reported naturally-acquired immunity. Hygienists reporting immunity (in %) were as follows:

Infectious Disease  Hygienists Reporting Immunity (%)

Hepatitis A virus   22
Measles             91
Mumps               83
Rubella             88
Influenza           38
Varicella           79
Diphtheria          81
Tetanus             91
Polio               87
BCG                 40

Conclusions: It is clear that many hygienists are vulnerable to infectious diseases that can be prevented by immunization, and that dentists can play an important role in improving compliance. Although rates of HBV immunization are very high, only 60% reported knowing that they had adequate anti-HBs titers, raising concerns about a false sense of security for many. The low rates of immunization to influenza are worrying because of the threat of an influenza pandemic and this problem needs to be emphasized. Better awareness and implementation of comprehensive immunization of dental professionals are essential to reduce transmission risks. This study was funded by the Canadian Institutes of Health Research.

MICROBES AND ORAL INFECTIONS

1162 EFFECT OF XYLITOL ON A MODEL OF ORAL BIOFILM 

M.-C. BADET, U.F.R. of Odontology, Bordeaux Cedex, France

Objectives: The aim of the present study was to examine whether xylitol, at different concentrations, inhibits the formation of an experimental model of oral biofilm. Materials and methods: Biofilms of six bacterial species (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus rhamnosus, Actinomyces viscosus, Porphyromonas gingivalis, Fusobacterium nucleatum) were prepared on hydrodyapatite (HA) discs following the Zurich model. Xylitol was tested at a concentration of 1% and 3%. At the end of their designated incubation times, some HA disc were destined for laser scanning microscopy (CLSM) and other were scraped with a sterile surgical instrument. Aliquots of harvested biofilm were diluted and plated onto specific media. After a 48 hrs anaerobic incubation at 37[degrees]C, colony-forming units were counted. Results: CLSM showed that only poor quantity of isolated bacteria was observed on the surface of hydroxyapatite discs. Culture of harvested biofilm showed an inhibition of the growth of the different species included in the biofilm. Conclusions: There is a clear inhibiting effect of xylitol on the formation of the experimental biofilm. This study shows that xylitol is not only efficient on the acid production of cariogenic bacteria, but also on the formation of a multispecies biofilm; it confirms the relevance of the use of this polyol for the prevention of oral diseases caused by dental plaque.

PERIODONTOLOGY

1850 THE EFFECTS OF PERSONALIZED PREVENTION PLANS ON ORAL HEALTH BEHAVIORS

R.M. MIZUMOTO, C.A. DEMKO, and L.T. VERNON, Case Western Reserve University, Cleveland, OH, USA

Objective: Evaluate the clinical and behavioral effects of personalized prevention plans (PPP) in a cohort of HIV+ individuals. Methods: 22 HIV+ people were recalled from an earlier study to qualitatively and quantitatively assess changes occurring after delivery of PPP. At recall, subjects were asked what they remembered and what oral hygiene behavior (OHB) changes they made since baseline. Probing depths (3) 4.0 mm at baseline were assessed on an average of 38 sites per subject. All subjects received a hands-on coaching session focusing on targeted OHB techniques. Subjects self-rated their motivation and confidence to make future OHB changes using a 10-point Likert scale. Results: On average, subjects reported making 3.5 specific OHB changes since written and spoken exposure to a baseline PPP. Elements of knowledge, optimism, interest, and concern about oral health increased in 20 of 22 subjects. Enhancements were reported in frequency of flossing (50%) and tooth-brushing (45%); tooth-brushing technique (50%); and eating habits (27%). 95% attributed OHB changes to PPP. 41% of sites improved; 26% worsened, 33% were unchanged. Compared to smokers, non-smokers were more optimistic about their oral health ([chi square]=.024) and more likely to change their OHB (p=.009). On the Structured Behavior Change Scale, ratings of motivation and confidence were highest for brushing (9.56; 10.0) and flossing (7.7; 8.32) and lowest for use of a proxy brush (5.0; 4.0). All subjects reported increased knowledge with hands-on OHB coaching at recall. 91% of subjects reported that hands-on coaching was more helpful than the baseline visit. Conclusions: In an HIV-1 cohort, PPP effectively enhanced oral health related knowledge and improved OHB's. This study suggests that the use of PPP and OHB coaching can be effective tools to enhance oral home care; providers should encourage incremental change in an ongoing, targeted and personalized manner. Supported by NIDCR, DE15746-01A1.