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Purpose:
Handedness is the inclination of a person to use one hand more comfortably than
the other. Handedness is an important factor affecting performance in various
tasks, one of which is oral health care. The aim of this research was to find
out the effects of handedness and dental education on tooth brushing and oral
health.
Methods: This
research was conducted on 200 cases (100 males, 100 females), with an average
age 22.5 years (range between 20-25). The dental health status of the
participants was recorded under the proposed term DMRT where “R” stands for a
general term “restored”, instead of “filled”.
Results: The
results showed that; right-handers brushed their left bimaxillary quadrants
better; on the contrary left-handers and ambidextrous cases brushed their right
bimaxillary quadrants better. This result was found related to the location of
DMRT.
Conclusion:
Statistics conducted on the participants’ parents’ education and profession
revealed that the parents’ dental hygiene education was not sufficient to
provide caries free oral health status for their children. Therefore, it is
recommended to receive dental care instructions from a pediatric dentist,
especially on brushing the side of hand dominance. As far as forensic analysis
is concerned, dental caries, which appear to be of common occurrence, can be
helpful at determining the handedness of a victim or a suspect, for precise
deduction.
Keywords: Handedness, Evidence, Dental hygiene,
Dentists pediatric, Oral
health
INTRODUCTION
Handedness is the
inclination of a person to use one hand more comfortably than the other, which
can be technically assessed with the “Edinburgh Handedness Inventory” (EHI)
test [1]. The selection criteria of this test were revised over time and the
number of criteria was decreased and changed [2]. The latest revised version of
the EHI test, allows the assessment of handedness quickly and with precision,
this test encompassed two activities as writing and throwing and usage of two
objects as tooth brush and spoon [3]. The issue of handedness is one of the
personal identity indicators, which are important in diverse fields such as;
forensic sciences, anthropology, sports, arts and dentistry. Concerning the
first two branches the dominant hand side can be deduced from the evidences as;
a forensic pathologist can determine the manner of death from the evidence of
handedness and direction of the incision in a homicide case [4], likewise an
anthropologist can diagnose handedness from structural formations of a skeleton
such as; asymmetric muscle attachments on upper limb bones [5], greater total
length of long bones or greater bicondylar width which correlates with the
dominant side [6]. A research on sports examined the hand grip strength due to
handedness on 268 female and 1,234 male university athletes who were tested
with a digital hand grip dynamometer. The right-hand grip strength test results
were not significant for left and right hander, but left hand grip strength
test showed significant
Since tooth brushing was used as a measure for
determining handedness, from the point of dentistry, therefore, handedness
implies importance for tooth brushing, which is one of the main principles for
protecting oral health. The utilization of the toothbrush object has remained
in the entire above mentioned test lists, which was in the 6th row
of the original list, then it is ranked 4th in the revised list and
3rd at the latest list of revision.
It is stated that for preventing oral diseases,
education of patients on proper oral hygiene and risk increasing factors by
health professionals is required [9]. This training should be initiated,
especially by pediatric dentists, at an early age. The term “Pediatric” used
here is (US) spelling, but pediatricis (UK) [10]. To improve the oral health
status of a community, establishment of extensive collaborative oral health
programs among; families, schools and societies had been suggested [11]. The
aim of this research was to find out the effects of handedness on oral health
regarding tooth brushing and to find out what kind of an education method can
be effectively employed to help patients to overcome the difficulties in tooth
brushing arising from handedness.
MATERIALS
AND METHODS
In this study, oral health status of 200 subject
(100 males, 100 females) with an average age of 22.51 years (male 22.55, female
22.46) were recorded through an interview and clinical examinations by the
second author who is a qualified dental professional in the field of
prosthodontics. During the questionnaire, the handedness of each case for tooth
brushing as: right or left handed and ambidextrous were assigned, plus the
subjects’ mothers and father’s education levels and professions were recorded.
The dental health status of the participants was registered under a
nomenclature abbreviation DMRT for decayed, missing and restored permanent
teeth coined and proposed by the second author - instead of DMFT for decayed, missing
and filled permanent teeth – since the contemporary tooth filling methods vary
excessively as distinct restorations. In this recording third molars were
excluded due to its extreme variability.
In this research, the odds ratio (OR) was used
to measure the association between handedness and DMRT in a young adult group,
to compare the risk factors for oral health. Application of the OR is commonly
preferred for decision making in health studies, which reveals direct
information for clinicians by finding out treatment practices that has the best
OR regarding patient benefit and provides effect-size statistics [12].
RESULTS
The results showed that right handers brushed
their left bimaxillary quadrants better, analogously left handers and
ambidextrous cases brushed their right bimaxillary quadrants better than the
left bimaxillary quadrants. Frequency of DMRT due to handedness and right/left
bimaxillary upper and lower quadrants was shown with OR as; for right handed
cases 2.5% more DMRT was formed on the right bimaxillary quadrant than on the
left side, for left handed cases 16.6% more DMRT was formed on the left side
than on the right side and for ambidextrous cases 6.1% more DMRT was formed on
the left side than on the right side.
When Odds Ratio is 1 it denotes, that there is
no difference between the given parties, however in the case when Odds Ratio is
greater than 1, to find the percentage of the difference, the decimal is
multiplied by 100 (Table 1). The
frequency of DMRT due to sex along with right and left handedness revealed that
DMRT was not significant for sexes, however for the ambidextrous cases DMRT was
1.66 times more for females than males (Table
2). The frequency of DMRT due to sex and handedness according to all teeth
revealed that first and second molar teeth, M1 and M2, respectively were more
prone to decay for both sexes. Additionally, right handed cases tended to have
more DMRT at the right mandibular M1 and M2, conversely left and ambidextrous
handed cases tended to have more DMRT at the left mandibular M1 and M2 (Table 3).
In categorical data analysis; according to the
Gamma, Somers’ d and McNemar-Bowker tests, the number of subjects DMRT
according to their parent’s education level was found statistically
significant, due to non-homogeneous distribution of the data (p-value=0.00<0.05).
When
the average DMRT according to parents' educational level was compared, the
result was not statistically significant, however in case the educational level
of mothers and fathers were equal (interaction), significant differences were
found (p<0.05).The Spearman Correlation coefficient was found as 0.521,
which shows that the effect of educational status of the family on DMRT was
found as 52%.
DISCUSSION
To create a caries free dentition; oral health
education together with regular, effective and frequent tooth brushing practice
is essential. Over the years, there has been numerous research published on the
methods, frequency and duration of tooth brushing activity, concerning the age
range of pre-school children to adults [13-18]. Among them, tooth brushing at
least twice a day, for 2 min, with circling and vertical sweeping type cleaning
movements, not exceeding 300 g of gentle force was accepted appropriate for
tooth brushing, however it is stated that despite of oral health prophylactic
programs, the dental education given still needs to be developed [19,20]. To
reduce the childhood caries, parent focused community-based efforts, dental
check-ups and brushing children’s teeth 2 times a day by their parents were
recommended [21,22].
In this research, the oral health status and
caries prevalence of the participants disclosed the fact that the least number
of caries was seen in the lower anterior region. This shows that dental hygiene
was done naturally with the mechanical contribution of the tongue to tooth
cleaning and function of the salivary ducts to this area. Maximum number of
caries was inspected on the first molar teeth (M1) and subsidiary on second molar
teeth (M2) on all quadrants for both sexes. With respect to M1, M2 erupts 6
years later, which means these teeth should be less affected by caries
promoting factors compared to M1. In this research the high incidence of caries
in M2 suggests that, brushing was not effective in this posterior region. One
of the factors that contributed to the high incidence of caries in M2 was
handedness and the resulting inability to reach to M2 region. Especially, right
hander cannot perform tooth brushing activity precisely on the mandibular right
side, whereas left and ambidextrous handed cases likewise cannot brush the
mandibular left side properly. Here it was found that ambidextrous cases most
act like the left handers (Table 3).
A research performed to evaluate pre and post
brushing plaque on the dentition of 25 adults with 3 types of toothbrushes
revealed that, irrespective of the design of the toothbrush, the right handed
participants could not clean the right side of their dental arch as
sufficiently compared to the left side [23]. In this research it is found that
there was no case present with the left handed or ambidextrous feature among
the illiterate and primary school graduate parents group. The reason behind the
absence of left handed and ambidextrous people in the illiterate group and the
primary school graduates group might be, the parents’ attempts at adapting the
children to right handedness at a young age (Table 6). It is found that the right-handers cannot properly clean
their teeth localized at the right-hand side (DMRT was 2.5% more), similarly
left-handers and ambidextrous cases cannot properly clean their teeth localized
at the left side (DMRT was 16.6% and 6.1% more, respectively) which proves that
the mean DMRT was found higher on the dominant hand side. Therefore, a proper
dental brushing requires special care on the same sides of handedness.
In this research, it has been found that, even
in the case when both the mother and the father were university graduates or
health professionals the mean DMRT values showed that it was not enough alone
to preserve the dental health of the child (Tables
4-6). Therefore, as soon as the child’s teeth erupt in the oral cavity, the
first dental examination of the child and the dental health education of the
parents must be realized by a pediatric dentist. At this stage, brushing the
primary teeth with a finger brush, gauze or tooth wipes by the parents is
necessary. Then from 0 to 3 years of age, a very thin layer of organic swallowable
toothpaste should be spread on the brush for tooth brushing. This amount may be
increased to the size of a lentil at age 3-6 and to a bean size after age 6.
Dental floss can be started after 2.5-3 years of age, by the parents, when the
primary molars are completely erupted; especially to clean the interdental
areas. Tooth brushing should be done by the parents until the child matures
enough to manage his/her own dental care. Even when the children themselves are
capable of brushing their teeth, the control of the families by visual contact
should continue for many years.
This research emphasizes that; the pediatric
dentist should give importance to handedness of the patient. Instructions must
be given on; attentive prolonged tooth brushing for the teeth that are located
at the dominant side, especially on the mandibular quadrant, with tilting the
head towards the non-dominant direction to provide more comfortable brushing
action for the dominant hand.
CONCLUSION
The following results are derived from this
research:
1. As a nomenclature recommendation, it is suggested to use the
abbreviation of DMRT instead of DMFT, due to the fact that the term
“restoration” is more accurate for contemporary fillings.
2. The frequency of DMRT due to sex and handedness according to all teeth
revealed that molar teeth, especially the mandibular molar teeth located at the
same side of hand dominance are more prone to decay for both sexes. The
ambidextrous handed cases mostly behave as the left handers.
3. When tooth brushing, special care to brushing the mandibular molar teeth
located at the same side of hand dominance which is more prone to dental
caries, should be given.
4. This research shows that, dental health information provided to children
by their parents has been found lacking and insufficient. To secure a child’s
dental health, proper education provided by a pediatric dentist is essential. A
Pediatric dentist’s instructions become extremely important in instructing the
child to brush his/her dominant hand side and especially the mandibular molar
teeth of the dominant hand side; longer and with special care, preferably while
tilting his head to the non-dominant side as much as it provides ease for the
dominant hand.
5. Further research is required to assess the difference of performance
regarding various tasks, in people who are naturally right handed and people
who are adapted to right handedness.
6. The specific result of this research is related with forensic cases, for
determining the handedness of a victim or a suspect, dental caries can be
evaluated as evidence.
ACKNOWLEDGEMENT
The authors of this study would like to thank
to their subjects, for their voluntary cooperation throughout the questionnaire
and the dental examinations and to Bahar Aka M.Sc., for her novel suggestions
on tooth brushing and for her support during the implementation of this study.
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