Dental health awareness in patients feeling sad or hopeless- an estimate from youth risk behavior surveillance survey

Introduction

Research has found that low mood including sadness and hopelessness is an important factor for decreased awareness in one’s oral health and lowered frequency of visit to the dental office, this relationship is not well studied in national representative samples. Poor mental wellbeing can lead to poor oral health.

Objectives

Aim is to examine the relationship between feeling sad or hopeless and awareness for dental care.

Methods

Data were obtained from the Youth Risk Behavior Surveillance Survey (YRBS-CDC), USA, for years 2009-2017. All ages from 12 to 18 years, feeling sad or hopeless and dental visits were identified. Univariable relationship between feeling sad or hopeless (>2 weeks in the past year) and dental office visits for all dental care (during the past 12 months, 12-24 months, >24 months, and never) was evaluated using chi-square test.

Results

Out of a total of 53,098 youths, 30.5% of youths were feeling sad or hopeless. Within the youths feeling sad or hopeless, the prevalence of youth who never received dental care was higher at 37.1% in comparison to youths who received dental care >24 months ago 36.4%,12-24 months 33.7%, and visited the dental office in the past 12 months 28.9%. (p<0.0001). In youths who had dental care in the last 12 months, the prevalence of sadness or hopelessness was lower at 65% vs 70%, while it was higher in youths who had never had dental care at 3.3% vs 1.7%.

Conclusions

Further research is warranted to evaluate reduced oral health care awareness among participants feeling sad or hopeless.

Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia

BACKGROUND

Up to 50% of child abuse (CA) victims exhibit evidence of traumatic facial or intraoral injuries. Dental health professionals (DHPs) are therefore well-positioned to detect and report incidences of CA. This study aimed to assess the knowledge and attitudes of Western Australian DHPs towards identifying and reporting CA.

METHODS

General dentists, specialists, hygienists and oral health therapists completed an online questionnaire which assessed their knowledge and experience in identifying and reporting CA.

RESULTS

A total of 228 participants completed the questionnaire (representing 7% of DHPs, 60% of paediatric dentists and 11% of all dental hygienists and therapists in Western Australia). The majority of participants (66.2%, P < 0.05) felt that they were unlikely to recognize a patient with physical abuse, or detect signs of sexual abuse (90.8%, P < 0.001). Uncertainty around diagnosing abuse was a barrier towards reporting cases (86.4%, P < 0.05) and most participants (78.0%, P < 0.05) felt that they did not have adequate safeguarding training to report CA.

CONCLUSIONS

Self-reported confidence in identifying and reporting CA cases was low; with the majority of the dental professionals participating in this study unlikely to recognize signs of CA. Inadequate training and knowledge around correct reporting protocols were identified as barriers, which warrants an appropriate change to improve child safeguarding.

Acidity, fluoride and silver ion concentrations in silver diamine fluoride solutions: a pilot study

BACKGROUND

There has been renewed interest in the use of silver diamine fluoride (SDF) for the management of carious lesions in high-risk groups. Previous studies have found a difference in clinical efficacy among different concentrations of SDF and discrepancies between ionic concentrations of fluoride (F) and silver (Ag) in SDF preparations. The aim of this study was to measure the free F, Ag ion concentrations and pH of a variety of commercially available SDF preparations.

METHODS

Seven SDF products used globally were evaluated for F and Ag ion concentrations using a calibrated ion-selective electrode and optical emission spectrometry respectively. Acidity was determined with a pH electrode.

RESULTS

The 30% SDF solution contained almost half the F concentration and a much higher Ag concentration than expected (16 343 ppmF and 246 000 ppmAg). Comparatively, the mean F concentration of the remaining six 38% solutions was 74 802 ppm (expected mean 44 800 ppm) ranging from 36 457 ppm to 120 760 ppm. The mean Ag concentration was 326 000 ppm (expected mean 253 870 ppm) and ranged from 246 000 ppm to 425 451 ppm. All solutions were found to be neutral or mildly alkaline in nature (pH 7-10.3).

CONCLUSIONS

Wide variations between claimed and measured F and Ag ion concentrations exist among the different brands of commercially available SDF products.

A longitudinal evaluation of cardiovascular risk factors, treatment patterns, and outcomes in patients with documented cardiovascular disease treated with lipid lowering therapy in the United Kingdom

Background

Over time, guidelines for dyslipidemia management in patients at high risk of atherosclerotic cardiovascular disease (CVD) changed with the goal of improving patient outcomes. Guidelines have been released by the European Joint Task Force in 2007, 2012 and 2016, European Society of Cardiology in 2011, 2016 and 2019, Joint British Societies in 2014, and National Institute for Health and Care Excellence in 2014.

Purpose

Evaluate cardiovascular risk factors, treatment patterns, and cardiovascular outcomes over time related to dyslipidemia management.

Methods

Ten prevalent cohorts of patients with documented CVD receiving lipid-lowering therapy (LLT) were created using Clinical Research Practice Datalink (CPRD) records as of January 1, each year from 2008 through 2017. For each cohort, we identified CVD risk factors and LLT, and estimated the 1-year composite rate of fatal and nonfatal myocardial infarction (MI), ischemic stroke (IS), or revascularization. Patient follow-up was censored at the earliest of one year, end of data, or the outcome of interest. Patients in each cohort were required to be ≥18 years old, have ≥1 years of available medical history, and have received ≥2 LLT prescriptions in the prior year. Documented CVD was defined as MI, IS, angina, revascularization, transient ischemic attack, carotid stenosis, abdominal aortic aneurysm, or peripheral arterial disease. Patients could be in multiple cohorts.

Results

Annual patient counts ranged from 170,501 to 179,137 through 2013 and declined to 94,418 by 2017 (due to fewer patients in the overall CPRD data). Comparing 2008, 2011 (when ESC guidelines were revised) and 2017 showed the following for CVD risk factors: mean age was 71.6, 72.3, and 72.5 years; males were 59.9%, 61.1%, and 63.1%; current smoking was 15.1%, 15.2%, and 13.9%; type 2 diabetes was 18.4%, 20.2%, and 22.4%; stage 3–5 chronic kidney disease was 22.4%, 25.1%, and 22.8%; history of MI was 22.5%, 23.9%, and 27.4%; history of IS was 5.5%, 6.6%, and 7.9%; LDL &lt;1.8 mmol/L was 27.8%, 29.2% and 37.2%; and LDL &lt;1.4 mmol/L was 9.9%, 10.1%, and 15.6%. In terms of treatment, high intensity statin use increased from 12.9% to 15.7% to 30.8%; atorvastatin 40–80 mg use increased from 12.9% to 15.5% to 30.5%; while simvastatin 20–40 mg use decreased from 55.4% to 58.8% to 36.7%. The 1-year cardiovascular event rate declined from 2.54 to 2.35 to 1.96 events per 100 person-years (Figure).

Conclusions

After 2011 in the UK, there was an increased use of high intensity statins, a greater proportion of patients with LDL levels &lt;1.8 and &lt;1.4 mmol/L, and lower 1-year cardiovascular event rates. While improved CVD management likely contributed to the event rate decline, less than 40% of very high-risk patients achieved an LDL &lt;1.8 mmol/L, and the proportion with LDL &lt;1.4 mmol/L, as recommended by the 2019 ESC guidelines, was less than 20%. Clinicians should continue their efforts to reduce LDL in these patients.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Amgen

Is toothwear associated with oral health related quality of life in adults in the UK?

OBJECTIVES

Toothwear may impact on an individual's everyday life, yet there is little research investigating the association between toothwear and oral health related quality of life (OHRQoL). The aim of the present study was to investigate the association between toothwear and OHRQoL in adults in the United Kingdom.

BASIC RESEARCH DESIGN

This study involved secondary analysis of data from 5187 participants with toothwear in the Adult Dental Health Survey conducted in 2009. Toothwear was assessed using Smith and Knight criteria and the Basic Erosive Wear Index and classified as mild, moderate and severe.

MAIN OUTCOME MEASURES

Correlation analyses were carried out between OHIP-14 total scores and toothwear type. Regression analyses investigated the association between toothwear and OHRQoL adjusting for demographic variables.

RESULTS

There was a significant association between toothwear and OHRQoL, with more severe toothwear associated with greater oral health impact on daily life. The association between erosive toothwear and OHRQoL was significant for moderate and severe severities only. The adjusted linear regression model identified that toothwear accounted for 0.02% of the variance in total OHIP-14 scores. Females, younger individuals and less deprived individuals showed a greater association between toothwear and OHRQoL.

CONCLUSIONS

In this general population sample, there was a small significant association between toothwear and OHRQoL impacts. However, the association was only significant for more severe categories of toothwear.

AB1030 IgG4-RELATED DISEASE: A RETROSPECTIVE CLINICAL CASE SERIES FROM A TERTIARY CARE CENTRE IN INDIA

Background:

IgG4-related disease (IgG4-RD) is an often unrecognized, rare fibro-inflammatory condition that can involve various organ systems.

Objectives:

The aim of this study was to identify the different clinical patterns of this disease in a single centre in North India.

Methods:

70 patients were diagnosed on the basis of published diagnostic criteria for IgG4-RD. Patients’ presenting complaints, epidemiological profiles, laboratory, radiological and histological findings along with the treatment and outcomes were collated and analyzed from 2011 – 2019.

Results:

In a total of 70 patients who were diagnosed with the disease, the ratio of female to male ratio was 1:1. The mean age of patients was 41.4 years. Involvement of orbits and peri-orbital tissues was highest (52.9%) due to large number of referrals from ophthalmology services. 13% of patients had multiple organ involvement. Patients with involvement of retroperitoneal tissues and lymph nodes were 8.5% and 5.7%, respectively. Increased serum IgG4 levels were found in 74.3% of the patients. Histopathological examinations of the affected organs were performed in 44 (62.85%) patients and a diagnosis of possible (38.57), probable (32.85%) and definite (28.57%) IgG4-RD was made. Majority of the patients (94.3%) required immunosuppressive medications along with corticosteroids. Azathioprine was the most commonly used (72.8%) immunosuppressive medication. Rituximab was used in17.1% of the patients, of whom one had multisystem involvement.

Conclusion:

This study depicts the most common patterns of organ involvement along with the epidemiological, laboratory, histological, radiological data and response to treatment, in IgG4-RD, with a definite ophthalmology referral bias, in a tertiary care centre in North India.

References:

[1]Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med 2012; 366(6):539-51.

[2]Khosroshahi A, CarruthersMN, Deshpande V, Unizony S, Bloch DB, Stone JH. Rituximab for the treatment of IgG4-related disease: lessons from 10 consecutive patients. Medicine 2012; 91(1):57-66.

Table 1.

Clinical and laboratory characteristics

CharacteristicsNumber of patients (N=70)Age (years)41.4Age group in years, n (%) >5024 (34.28) <5046 (65.71)Sex, n (%) Male36 (51.42) Female34 (47.22) ESR (mm/hr)24.37 CRP (mg/dL)12.31 Serum IgG (mg/dL)1214.2 Serum IgE (IU/L)587.2Type of IgG4 related disease, n (%) Definite20 (28.57) Probable23 (32.85) Possible27 (38.57)

Data represented as mean, unless otherwise specified.

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Ig, immunoglobulin.

Table 2.

Distribution of patients according to organ involvement.

Organ involvementNumber (%)Orbital and periorbital37(52.9)Retroperitoneum6 (8.5)Laryngotracheal tissue4 (5.7)Aorta and branches4 (5.7)Lymph nodes3(4.2)Paranasal sinus2 (2.8)Paravertebral tissue2 (2.8)Pancreas2 (2.8)Lung and bronchus2 (2.8)Eye (Scleritis)1 (1.4)Prevesical Mass1 (1.4)Ear polyp1 (1.4)Small Bowel1 (1.4)Primary sclerosing cholangitis1 (1.4)Musculoskeletal1(1.4)Submandibular gland1(1.4)Central nervous system1 (1.4)Multisystem involvement9 (12.86%)Figure 1.

Right eye proptosis

Figure 2.

CT abdomen showing hydronephrosis due to retroperitoneal fibrosis

Disclosure of Interests:

None declared