Download Post-meal Oral Care Habit and Dental Health of Hong Kong People

Post-meal Oral Care Habit and Dental
Health of Hong Kong People Behavioural
Survey and Recommendation
Speakers:
Dr. Robert Chung, Programme Director,
The University of Hong Kong Public Opinion Programme
Dr. Cecilia Young, Registered Dental Surgeon
Date:
May 20, 2004
Post-meal Oral Care Habit and
Dental Health of Hong Kong
People Behavioural Survey
Speaker:Dr. Robert Chung
Programme Director,
The University of Hong Kong Public Opinion Programme
Research overview
Objective
To understand Hong Kong people’s tooth decay problem,
eating and post-meal oral care habit and dental health
situation.
Targets
10-44 year old, Cantonese-speaking Hong Kong resident
Date
February 24 – 26, 2004
Organization
The University of Hong Kong Public Opinion Programme
Method
Telephone interview through random sampling
Successful
response
506 people
Success rate
72.5% (based on qualified targets)
Sampling error
Less than 2.2%
Demographic Information
Gender
52%
Female
48%
Male
Successful samples: 506
Age
10-19 years old
23%
20-29 years old
26%
30-39 years old
33%
40-44 years old
18%
0%
10%
20%
30%
40%
Weighted samples: 506
Marital status
Separated/divorced/widowed
2%
54%
45%
Single
Married
Weighted samples: 506
Occupation
Full-time job
48%
Student
30%
Housewife
13%
Part-time job
5%
Unemployed
4%
0%
10%
20%
30%
40%
50%
Weighted samples: 506
Job nature
Clerical
33%
Service industry/sales
26%
Blue Collar
19%
Professional
15%
Executive
4%
Self-employed
4%
0%
10%
20%
30%
40%
Weighted samples: 270 (full-time or part-time workers)
Personal income
Below HK$8,000
21%
HK$8,000-HK$14,999
50%
HK$15,000-HK$29,999
21%
HK$30,000 or above
8%
0%
10%
20%
30%
40%
50%
Weighted samples: 247 (full-time or part-time workers)
Education
Primary or below
7%
Below secondary
28%
Secondary
31%
Matriculation
7%
Tertiary/university
26%
0%
10%
20%
30%
40%
Weighted samples: 506
Tooth Decay Situation of Hong
Kong People
59% Hong Kong people have caries
Do you have any carie? (Include milk teeth, permanent teeth, filled and
extracted teeth)
Don’t know/hard to tell
2%
39%
No
59%
Yes
Successful samples: 506
62% of those who had tooth decay have
1-3 bad teeth
How many caries do you have? (Include milk teeth, permanent teeth, filled and
extracted teeth)
Don’t know/hard to tell
11-15
7-10
1% 9%
5%
62%
24%
4-6
Successful samples: 301 (with caries)
1-3
Caries increases with age
Percentage with caries in different age groups (Include milk teeth, permanent
teeth, filled and extracted teeth)
10-19 years old
48%
20-29 years old
55%
30-39 years old
63%
40-44 years old
75%
0%
20%
40%
60%
80%
Eating Habit
Meal habits of respondents
Do you eat...
Breakfast
69%
Lunch
56%
48%
Dinner
88%
8% 99%
91%
Afternoon tea 8%
97%
Supper 3%
Snacks
19%
37%
13%
Post-meal fruits
Post-meal dessert/ice-cream 1%
0%
3% 100%
40
%
82%
69%
39%
46%
20%
50%
89%
47%
40%
60%
80%
100%
Always
Sometimes
Successful samples: 506
Over half respondents have 4-6 meals a
day
On average, how many meals do you have per day? (Include
breakfast, lunch, dinner, afternoon tea, supper, snacks, fruits,
dessert)
1-3 times
46%
4-6 times
51%
7 times or above
2%
Don't know/hard to
tell
2%
0%
20%
40%
Successful samples: 506
60%
Sweet is the most popular taste
Among sweet, sour, bitter, hot and salty, which is your favourite taste for food?
Don’t know/hard to tell
9%
8%
Sour
43%
Sweet
19%
Hot
21%
Salty
Successful samples: 506
Most respondents eat meals or snacks
with sugar content
Do you eat meals containing sweet foods or drinks, drink milk or
add sugar in your drinks?
Snacks
93%
Afternoon tea
75%
Breakfast
71%
Lunch
55%
Supper
49%
Dinner
30%
0%
20%
40%
60%
80%
100%
Successful samples: 203 - 506 (who eat particular meal)
Over half of the respondents who eat
snacks choose sweets
The taste of the snacks you eat is
mostly...
Sweet
53%
Salty
32%
Hot
4%
Sour
4%
Bitter
<1%
Don't know/hard to tell
0%
6%
20%
40%
60%
Successful samples: 410 (who eat snacks)
Post-meal Oral Care Habit
99% have the habit of brushing teeth
No habit of brushing teeth
1%
99%
Habit of
brushing
teeth
Successful samples: 506
The majority of respondents brush
their teeth in the morning and before
sleep
When do you usually brush your teeth?
After getting up in the morning
97%
Before sleep
87%
After lunch
3%
After dinner
After breakfast
After eating sweet foods
After eating foods with strong taste
After eating snacks
After eating fruits
Others
3%
2%
1%
1%
1%
<1%
1%
0%
20%
40%
60%
80%
100%
Successful samples: 502 (have the habit of brushing
teeth; multiple responses)
87% Hong Kong People Do Not Brush
Their Teeth After Every Meal Or Snack
Do you brush your teeth every time after you eat? (Include breakfast,
lunch, dinner, snacks and fruits etc.)
Often
Sometimes
4%
9%
87%
Never
Successful samples: 502 (have the habit
of brushing teeth)
74% of respondents do not brush their
teeth after eating because of
“inconvenience” and “no such habit”
Why don’t you brush your teeth after eating?
Troublesome/inconvenience
49%
No such habit
30%
No need
15%
No time
Feel strange
11%
1%
Don't know/hard to tell
0%
3%
10%
20%
30%
40%
50%
60%
Successful samples: 438 (do not brush their teeth
after meal or snack; multiple responses)
64% of respondents have oral care
habits other than teeth brushing
Besides brushing teeth, do you perform any other oral care?
36%
30%
Often
Never
34%
Sometimes
Successful samples: 506
Flossing and mouth wash are the
most common oral care used
What types of oral care do you usually use?
Use dental floss
44%
Rinse with mouth wash
35%
Use tooth pick
15%
Rinse with water
15%
Chew chewing gum
12%
Go to dentist/scaling
Drink water
Others
Don't know/hard to tell
0%
6%
3%
2%
2%
10%
20%
30%
40%
50%
Successful samples: 325 (perform oral care habits other
than teeth brushing; multiple responses)
“No such habit” is the key reason for
respondents who brush their teeth but not
using any other oral care methods
Why don’t you use other oral care methods to clean your teeth?
Troublesome/inconvenience
33%
No such habit
27%
No need
24%
No time
Don't know such methods
Feel strange
Don't know/hard to tell
0%
12%
2%
1%
11%
10%
20%
30%
40%
Successful samples: 181 (besides brushing teeth, do
not use any other oral care methods; multiple response)
Attitude and Knowledge
Towards Post-meal Oral Care
Methods
68% respondents feel there is a need to
brush their teeth after meals or snacks
Do you think there is a need to brush your teeth after meals and snacks?
Don’t know/hard to tell
7%
26%
No need
68%
Should brush
the teeth after
meals and
snacks
Successful samples: 506
Over half of the respondents know they will
have tooth decay if they do not brush their
teeth after meals or snacks
If you do not brush your teeth after meals or snacks, what consequence do you
think there will be?
Tooth decay
69%
Periodontal disease
18%
Bad breath
16%
Dirty teeth
Others
Don't know/hard to tell
0%
9%
3%
16%
20%
40%
60%
80%
Successful samples: 506 (multiple
Knowledge on oral care methods other
than brushing teeth
Besides brushing teeth, do you know any other oral care methods?
Use dental floss
42%
Rinse with mouth wash
29%
Chew chewing gum
24%
Rinse with water
15%
Drink water
8%
Go to dentist/scaling
Use tooth pick
Others
3%
3%
2%
Don't know/hard to tell
0%
16%
10%
20%
30%
40%
50%
Successful samples: 506 (multiple
responses)
Conclusion: Hong Kong People like sweets and
have multiple meals, but don not brush their teeth
after meals, thus increasing the chance of tooth
decay
59% have tooth decay, among which 62% have 1-3 bad
teeth.
Respondents have multiple meals in a day.
Sweet is the most popular taste.
Inconvenience is the key reason for not brushing their
teeth after meals and snacks for most respondents.
This increases the chance of tooth decay.
24% respondents know gum chewing can help oral
care.
Dental flossing and mouth wash are the most common
oral care methods, with chewing gum as the third one.
Hong Kong people are snacking and taking multiple
meals due to long working hours and high pressure
One of the reasons people taking multiple meals a day
is the long working hours and high pressure. This
echoes with an earlier survey which shows many Hong
Kong workers reduce stress by eating, among which
snacking is the first choice of women.
The findings reveal that many people have basic
knowledge of after meal oral care, however, most are
unable to do so because of individual or environmental
constraints.
Hong Kong is lucky not to have any case of SARS, but
we must continue our effort to promote public health
education.
Dental Health and Post-meal
Oral Care Recommendations
Speaker:
Date:
Dr. Cecilia Young, Registered Dental Surgeon
May 20, 2004
About the survey
Gender, age, marital status, occupation, job nature,
personal income and education in the survey reflect the
lifestyle of common Hong Kong people, which is not
biased towards any population group.
80% of respondents eat snacks, among which 93% eat
snacks that are sweet. This shows the eating habit of
Hong Kong people.
Most respondents feel there is a need to brush their
teeth after meals and snacks but are unable to do so.
Multiple meals is the most import issue that needs to be
addressed.
What is dental plaque?
What is Dental Plaque?
It is the mixture of bacteria and its products
Above and below gum
Can be disclosed by stain
Mainly on the lines of the teeth, any sunken area of
teeth and adjacent sides between two teeth
Composed of various bacteria
What is Dental Plaque?
Bacteria harboured the oral cavity since birth.
Glycoprotein in saliva helps the bacteria to attach onto
the surface of teeth. Through the generation of
mucopolysaccharide matrix, plaque becomes
strengthened and more plaque attaches.
In diets with high sugar content, there are more
streptococcus mutans and lactobacilli
30% of the volume of plaque is organic matter
Effects of plaque
Reduce diffusion – acidity by bacteria stays at a high level
Reduce the entrance of buffer – stops the neutralization of
acids
Plaque disclosing agent
Use of plaque disclosing agent
Microorganisms commonly present
in dental plaque
Gram-positive
cocci
rods and
filaments
Gram-negative
cocci
rods and filaments
Streptococcus
Actinomyces
Neisseria
Bacteroids
Peptococcus
Lactobacillus
Branhamella
Fusobacterium
Peptostreptoccu
s
Bacterionema
Veillonella
Haemophilus
Staphyloccus
Rothia
Vibrio
(Campylobacter)
Micrococcus
Arachnia
Leptotrichia
Bifidobacterium
Capnocytophaga
Eubacterium
Selenomonas
Propionibacterium
Spirochaetes
Catabolism
organic starting material
catabolites
substrate
end product
Example:
glucose
↘ Energy
2 lactic acid
starch amylaseglucose+maltose bacteria in plaque Acid
glycogen amylaseglucose+maltose+dextrin bacteria in plaque Acid
Bacteria in plaque can use all fermentable
carbohydrates to form acid, thus, almost all sorts of
food lead to increase of acidity in plaque.
Both enamel on the surface of teeth and dentine
inside teeth are composed of minerals. Loss of
minerals due to the increase of acidity is known as
demineralization. The whole picture becomes caries.
Dental caries
Change in plaque pH after
eating
Increase the risk after eating
The more times you eat, the higher the risk
Healthy tooth vs decayed tooth
Health tooth
Unhealthy tooth
Cariogenic potentials of foods
Caries Potential Index
Foods
Buccal
Sulcal
Raisins
1.3
0.95
Bananas
1.2
1.17
French fries (chips)
1.2
0.98
Granola (a breakfast cereal)
1.1
0.64
Sucrose
1.0
1.0
Bread
0.82
0.90
Grahams (digestive biscuits)
0.66
0.79
Cup cakes
0.62
1.73
Chocolate
0.59
0.81
Cornstarch
0.47
0.76
Sponge cake
0.44
0.95
Rye crackers
0.36
0.86
Saltines (savoury crackers)
0.36
0.69
Peanuts
0.30
0.43
Pretzels
0.21
0.77
Jello (fruit jelly)
0.11
0.43
Yogurt
0.11
0.65
Corn chips
0.10
0.54
Functions of saliva
1.Washing effect
Mechanically washes the plaque on the surface of teeth
2.Buffering effect
Neutralizes the acids generated by bacteria, hence reduces
demineralization
3.Remineralization
Repairs the enamel which has lost minerals; contains calcium,
phosphate and fluoride
4.Combat bacteria
Contains immunoglubolin A and lysosome
Remineralization
Demineralization
Remineralization
Prevention of tooth decay
Parents to help children to build up the habit of proper oral care,
including the correct way of brushing teeth and use of floss.
Use fluoride-containing tooth-paste. Fluoride helps to strengthen
teeth. Most tooth-pastes contain fluoride.
Add fluoride into drinking water. Hong Kong drinking water
contains fluoride. Hong Kong people do not need to take fluoride
pills.
Reduce the number of times and duration of eating. Brush your
teeth after every meal or snack.
Fill the deep tooth lines with anti-caries agent, to prevent plaque
from building up in areas where tooth brush cannot reach.
Use high concentration fluoride-containing gel.
For high-risk people and patients with a track record of tooth decay,
follow the instructions of dental professionals and use fluoridecontaining mouth wash.
Regular dental check-ups.
Chew sugarfree gum.
Effect of brushing on plaque pH
Therefore, we should brush our
teeth after meals and snacks
Travel tooth brush
China brushing program – supervision of
primary students to brush their teeth together
after lunch
Severe tooth decay
of children who do
not brush their teeth
Chewing gum
If you find it inconvenient to brush your teeth, you can
chew chewing gum. The mechanical action and the
gustatory stimulus of gum-chewing increase the
secretion of saliva – from 37.1ml to 167.3ml per hour.
This promotes the protection and repairing function of
washing effect, buffering effect, remineralization and
combat bacteria effect of saliva.
Recommend chewing sugarfree chewing gums for no
less than 20 mins to reduce tooth decay after eating.
Effect of chewing sugarfree gum on
plaque pH
Xylitol
Belongs to polyols, sugar alcohol.
Is the top-of-the-mind sugar-free component among dental
professionals.
The sweet taste is comparable with sucrose. Yet it does not have
bitter aftertaste and only accounts for 1/3 calories of that of
sucrose. Xylitol contains 2.4 calories/gram.
Natural Xylitol can be found in banana, mushroom and strawberry.
Can be derived from xylose
2H↘
xylose ------------- ＞
d- xylitol
Xylitol
Is a kind of metabolic intermediate.
Can transfer to energy and CO2, and can be stored in the
format of glycogen at the liver.
Cannot be catabolized by bacteria, thus would not cause
caries.
Recommend to brush the teeth after intake of food. However,
if brushing is not feasible, may consider chewing sugarfree
gum.
According to statistics, brushing teeth can reduce the
possibility of developing caries by 30%, while chewing Xylitolcontaining chewing gum for 20 mins can reduce caries by
12.3%.
Yet is 10 times more expensive than sucrose.
Can absorb 90% in 5 gram dosage, and 60% in 30 gram
dosage.
Conclusion
Bacteria of the dental plague catabolize carbohydrates to form acid.
Acid dissolves enamel and dentine, causes caries.
Intake of food increase the risk of developing caries. The more frequent
you eat, the higher the chance of developing caries.
Saliva helps to clean the plaque on the surface of the teeth, neutralize
the acids created by bacteria, and hence reduce demineralization.
Saliva contains minerals which helps to repair the lost enamel through
remineralization. It also helps to combat bacteria.
Gum-chewing can increase the secretion of saliva.
Sugarfree chewing gum contains Xylitol, which cannot be catabolized
by bacteria. Chewing Xylitol-containing gum for 20 mins can reduce
tooth decay by 12.3%.
Recommend chewing sugarfree chewing gums for no less than 20 mins
to reduce tooth decay.
End