title: Factors associated with oral hygiene practices among adults with systemic sclerosis.
abstract: OBJECTIVE
  To identify factors associated with oral hygiene practices in adults with systemic sclerosis (SSc).
  
  
  METHODS
  In this cross-sectional study, 178 dentate adults with SSc received an oral examination which included measurement of oral aperture, assessment of manual dexterity to perform oral hygiene, as well as completion of the Center of Epidemiological Studies Depression (CES-D) Scale and an oral health-related questionnaire.
  
  
  RESULTS
  Multivariable logistic regression modelling showed male, minority and high CES-D scores (i.e. clinically significant symptoms of depression) were associated with less likelihood of participants brushing teeth at least twice daily, but the presence of self-reported dry mouth symptoms increased the likelihood of toothbrushing. Having a dental visit in the past 12 months and use of an adapted flossing or interdental cleaning device were significantly associated with daily dental flossing; however, having difficulty flossing teeth reduced the likelihood of daily flossing.
  
  
  CONCLUSIONS
  Overall, demographic variables were strongly associated with toothbrushing frequency, whereas flossing self-efficacy and barriers were strongly associated with dental flossing frequency in adults with SSc. The results suggest that dental health professionals should take mental health into consideration when educating patients with SSc to improve their oral hygiene and consider making referrals for patients exhibiting suspected clinically significant depressive symptoms to mental health professionals for further evaluation and treatment. In addition, an appropriate adapted flossing or interdental cleaning device should be recommended to increase dental flossing practices in this patient population.
authors.affiliation: Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: H K
authors.initials: HK
authors.lastname: Yuen
authors.forename: F N
authors.initials: FN
authors.lastname: Hant
authors.forename: C
authors.initials: C
authors.lastname: Hatfield
authors.forename: L M
authors.initials: LM
authors.lastname: Summerlin
authors.forename: E A
authors.initials: EA
authors.lastname: Smith
authors.forename: R M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D003742:Dental Devices, Home Care / Q000706:statistics & numerical data; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009055:Mouth / Q000473:pathology; D009067:Mouthwashes / Q000627:therapeutic use; D009909:Oral Health; D009910:Oral Hygiene / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D012595:Scleroderma, Systemic / Q000503:physiopathology* / Q000523:psychology; D014099:Toothbrushing / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D014987:Xerostomia / Q000503:physiopathology; D055815:Young Adult
chemical_list: D009067:Mouthwashes
keywords: adapted devices; epidemiologic methods; mental health; oral hygiene; scleroderma