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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