WHO's global oral health status report 2022: Actions, discussion and implementation

Oral hygiene predicts lower life satisfaction and subjective health: experience of post-Soviet countries

Oral diseases are among the most common non-communicable diseases around the globe and become a public health challenge that considerably impact general health and well-being in all ages across the lifespan. Oral health is an integral part of general health, where poor oral health and other lifestyle-related chronic diseases have a common risk factor background. The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors. For more than a decade, data from the Health Behavior in School-aged Children (HBSC) survey showed that tooth brushing rates are very low in post-Soviet countries. The general aim of our study was to focus on a more detailed profile of schoolchildren from post-Soviet countries, who have poor habits of teeth brushing, in terms of their family, social support, physical activity, nutrition, and other health-related behaviors. Data for this study was extrapolated from the Health Behavior in School-aged Children study, a World Health Organization collaborative cross-national study, conducted every 4 years since 1983/1984. For this study, the post-Soviet countries from Eastern Europe and Central Asia were selected: Armenia, Azerbaijan, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Moldova, Tajikistan, Ukraine, and Uzbekistan. Data from all countries (some exceptions for Kyrgyzstan, Tajikistan, and Uzbekistan) were collected within 2017-2018 HBSC study, following international research protocol. The sample consisted of 44,760 schoolchildren, aged 11, 13, and 15 years from 12 countries. Irregular tooth brushing is more common among boys, elder adolescents, and schoolchildren from less affluent families. Low own health measures, low life satisfaction, low physical activity, and low FAS relate to poorer adolescent dental hygiene in post-Soviet countries. Adolescents characterized by irregular tooth brushing were more likely to assess their health as fair or poor rather than excellent or good (OR = 1.22), and also had greater odds of reporting low life satisfaction (OR = 1.36). Individual mental health complaints-feeling low, being irritable, being nervous, and having sleep difficulties-were assessed as a possible outcome of irregular tooth brushing. However, irregular tooth brushing was not associated with poorer mental health outcomes (p > 0.05).    Conclusions: Oral hygiene in post-Soviet countries is still a major public health challenge and have to be addressed properly. What is Known: • Oral health strongly affects the overall health of children and adolescents in the future. • Oral diseases often share common determinants and risk factors with other chronic diseases. • The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors. What is New: • Irregular tooth brushing was more common among adolescents with low life satisfaction and poor or fair health as well as in less affluent families. • Irregular tooth brushing was not found to be associated with poorer mental health among post-Soviet countries adolescents.

LMCD-OR: a large-scale, multilevel categorized diagnostic dataset for oral radiography

In recent years, digital dentistry has increasingly utilized advanced image analysis techniques, such as image classification and disease diagnosis, to improve clinical outcomes. Despite these advances, the lack of comprehensive benchmark datasets is a significant barrier. To address this gap, our research team develop LMCD-OR, a substantial collection of oral radiograph images designed to support extensive artificial intelligence (AI)-driven diagnostics. LMCD-OR comprises 3,818 digital imaging and communications in medicine (DICOM) oral X-ray images from local medical institutions that are meticulously annotated to provide broad category information for both primary dental outpatient services and detailed secondary disease diagnoses. This dataset is engineered to train and validate multiclassification models to improve the precision and scope of oral disease diagnostics. To ensure robust dataset validation, we employ four cutting-edge visual neural network classification models as benchmarks. These models are tested against rigorous performance metrics, demonstrating the ability of the dataset to support advanced image classification and disease diagnosis tasks. LMCD-OR is publicly available at http://dentaldataset.zeroacademy.net .

Periodontitis adversely affects lipoprotein subfractions - results from the cohort study SHIP-TREND: Periodontitis adversely affects lipoprotein subfractions

AIM

We aimed to investigate the medium-term associations of periodontitis and the number of missing teeth with serum lipoproteins and their plasma subfractions using follow-up data from the population-based Study of Health in Pomerania (SHIP-TREND).

METHODS

A total of 2,058 participants with 7-year follow-up data underwent periodontal examinations, serum lipid panel tests, and proton nuclear magnetic resonance (1H-NMR) spectroscopy of plasma lipoproteins and their subfractions. Generalized models with gamma distribution and loglink were used to analyze associations between periodontal variables and lipoproteins and their subfractions, adjusting for confounders using propensity score weighting.

RESULTS

Periodontal variables were consistently associated with elevated follow-up serum levels of triglycerides, total cholesterol, and low-density lipoprotein cholesterol levels. When plasma lipoprotein subfractions were evaluated, periodontal variables were associated with elevated levels of triglycerides and cholesterol-enriched apolipoprotein B-containing lipoprotein particles, particularly small dense low-density lipoprotein, very-low-density lipoprotein and intermediate density lipoprotein. In addition, altered high-density lipoprotein particle composition was observed, suggesting potential functional changes.

CONCLUSION

This study provides evidence for causal effects of periodontitis on conventional serum lipids and plasma lipoprotein subfractions. As the underlying biological mechanisms are not fully understood, further research is needed.

Clinical insights into tooth extraction via torsion method: a biomechanical analysis of the tooth-periodontal ligament complex

Traditionally, extracting single, flat- or curved-rooted teeth through twisting is unfeasible. However, our clinical practice suggests that such teeth can be extracted efficiently through moderate twisting in a minimally invasive manner. Given the lack of studies on biomechanics of the tooth-periodontal ligament (PDL) complex during torsion, which has further constrained its application, we assessed the feasibility of the torsion method for extracting single-rooted teeth and evaluated its minimally invasive potential. Using three-dimensional finite element analysis, we examined the stress distribution of the tooth and PDL during torsion. Then, we examined changes in the optimal torsion angle (OTA) and stress distribution across various anatomical scenarios. During torsion loading, stress concentration was primarily observed on the sing-rooted tooth surface near the alveolar crest, whereas molars at the root furcation. The OTA was found to increase under conditions such as narrowing of root width, decrease in the root apical curvature, change from type I to IV bone, alveolar bone loss, and shortening of root length. Moreover, the clinically validated model demonstrated that 74% of outcomes fell within the standard OTA range. In conclusion, the decrease in PDL area necessitated a larger angle for complete PDL tearing. Single-rooted teeth with root width-to-thickness ratios of ≥0.42 and apical curvatures of ≤30°are suitable for extraction using the torsion method. This study confirms the feasibility of the torsion method for minimally invasive tooth extraction and expands its indications, laying the theoretical foundation and essential insights for its clinical application.

Oral health status and factors associated with oral health of primary school children in Gulu district, northern Uganda

BACKGROUND

Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda.

METHODS

A comparative cross-sectional study was conducted among 356 school children aged 11-13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding.

RESULTS

Of the 356 children (11-13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0-7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1-6), 5.40 ± 1.81 (range, 0-9), 25.66 ± 4.29 (range 9-54) and 2.1 ± 1.65 (range, 0-6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02-1.39).

CONCLUSION

The prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education.

Exploration of oral hygiene practices, oral health status, and related quality of life of individuals residing in the Rorya district of Tanzania, East Africa

Introduction

Oral health substantially impacts individuals' quality of life, making it an important target for global health interventions. This research describes oral health status, practices, and beliefs within the Rorya district of Tanzania to understand barriers to care.

Methods

To quantify physical oral health status, intraoral examinations were conducted on adults, noting the Decayed Missing and Filled Teeth (DMFT) and Comprehensive Periodontal Inflammatory Burden Index (CPBI). Oral Health-Related Quality of Life (OHRQoL) and semi-structured interviews were conducted to understand oral hygiene behaviors and beliefs. Data was analyzed via two-sample t-tests, Pearson's statistics, and NVIVO.

Results

A purposive sample (n = 139) of participants self-reported to reside in either Burere (n = 32), Nyambogo (n = 52), or Roche (n = 55) were assessed. A two-sample t-test revealed females (n = 67; x¯ = 7.1; SD = 5.4; p < 0.05) have a significantly higher DMFT score than males (n = 72; x¯ = 3.7; SD = 3.9). Moreover, the OHRQoL score of females (n = 67; x¯ = 12.10; SD = 14; p < 0.05) were significantly higher than males (n = 72; x¯ = 10.16; SD = 3). In contrast, males have significantly higher CPBI scores (x¯ = 3.8; SD = 1.5; p=<0.05) than females (x¯ = 3.0; SD = 1.3). Additionally, older age groups presented higher GI and PISA scores, while the younger group (20-30 years) displayed the highest mean DMFT score. The themes that emerged from semi-structured interviews were "pearls of laughter guarded by wisdom teeth," "whispered tales of oral tides and communal echoes," and "tales of the tooth fairy."

Discussion

In this community, proper oral health maintenance techniques are vital yet frequently disregarded, mainly due to disparities in access to resources, reflected in oral health scores. Addressing this is a crucial intervention, presenting an opportunity to uplift overall well-being. Moreover, gender and age disparities in oral health highlight the urgent need for tailored interventions.

Periodontitis: etiology, conventional treatments, and emerging bacteriophage and predatory bacteria therapies

Inflammatory periodontal diseases associated with the accumulation of dental biofilm, such as gingivitis and periodontitis, are very common and pose clinical problems for clinicians and patients. Gingivitis is a mild form of gum disease and when treated quickly and properly is completely reversible. Periodontitis is an advanced and irreversible disease of the periodontium with periods of exacerbations, progressions and remission. Periodontitis is a chronic inflammatory condition that damages the tissues supporting the tooth in its socket, i.e., the gums, periodontal ligaments, root cementum and bone. Periodontal inflammation is most commonly triggered by bacteria present in excessive accumulations of dental plaque (biofilm) on tooth surfaces. This disease is driven by disproportionate host inflammatory immune responses induced by imbalance in the composition of oral bacteria and changes in their metabolic activities. This microbial dysbiosis favors the establishment of inflammatory conditions and ultimately results in the destruction of tooth-supporting tissues. Apart microbial shift and host inflammatory response, environmental factors and genetics are also important in etiology In addition to oral tissues destruction, periodontal diseases can also result in significant systemic complications. Conventional methods of periodontal disease treatment (improving oral hygiene, dental biofilm control, mechanical plaque removal, using local or systemic antimicrobial agents) are not fully effective. All this prompts the search for new methods of therapy. Advanced periodontitis with multiple abscesses is often treated with antibiotics, such as amoxicillin, tetracycline, doxycycline, minocycline, clindamycin, or combined therapy of amoxicillin with metronidazole. However, due to the growing problem of antibiotic resistance, treatment does not always achieve the desired therapeutic effect. This review summarizes pathogenesis, current approaches in treatment, limitations of therapy and the current state of research on the possibility of application of bacteriophages and predatory bacteria to combat bacteria responsible for periodontitis. We present the current landscape of potential applications for alternative therapies for periodontitis based on phages and bacteria, and highlight the gaps in existing knowledge that need to be addressed before clinical trials utilizing these therapeutic strategies can be seriously considered.

Content quality and reliablity of YouTube™ videos as a source of information about good oral hygiene practices in adults

Background

Good oral hygiene is crucial for preventing dental caries and periodontal diseases. However, proper and regular application of oral hygiene practices requires adequate knowledge. In recent years, the internet has become one of the most popular places to find health-related information, necessitating studies that analyze the quality of the content available online. The purpose of the present study was to analyze the content quality and reliability of YouTube™ videos on the topic of adult oral hygiene practices and to guide oral health care professionals who use this platform for patient education.

Methods

A YouTube™ search was performed of the most frequent search term, 'dental hygiene'. A total of 150 videos were screened, and 51 were included in the final study. The characteristics, sources, and content of the videos were analyzed using the Global Quality Score (GQS) and DISCERN reliability indices. The IBM SPSS 25 program was used for statistical analyses.

Results

Most of the included videos were uploaded by oral health care professionals (63%). GQS revealed only 17.6% of the videos were excellent quality whereas 23.5% of them were poor quality. In the content analysis, 62.7% of the videos were deemed moderately useful. Video duration, total content score, and interaction indices were all significantly higher in the useful and very useful groups compared to the slightly useful group (p = 0.020, p < 0.001, p = 0.040). GQS had a positive, low-medium statistically significant correlation with both video duration and total content scores (r = 0.235, r = 0.517; p < 0.05). DISCERN score also had a positive, low-medium statistically significant correlation with total content score (r = 0.500; p < 0.05).

Conclusion

The study concluded that most YouTube™ videos on oral hygiene practices for adults are moderately useful. When using YouTube™ for patient education, oral health care professionals and organizations should be aware of low-quality videos and seek out accurate, useful videos. There is also a need for quality videos with expanded oral health content.

Extracellular Release of a Disintegrin and Metalloproteinase Correlates With Periodontal Disease Severity

AIM

Periodontal disease is driven by oral pathogens, including Porphyromonas gingivalis, and the release of inflammatory cytokines. These cytokines (e.g., TNF) or their receptors (e.g., IL-1R) are substrates of a disintegrin and metalloproteinases (ADAMs). In this study, we aimed to determine the effects of ADAMs on periodontal disease phenotypes.

MATERIALS AND METHODS

Western blot and FRET-based activity measurements of the gingival crevicular fluid (GCF) of patients were compared with those of infected (P. gingivalis) or cytokine-stimulated oral keratinocytes and primary human neutrophils, respectively. This was accompanied by an analysis of the released extracellular vesicles and MMP9 activity.

RESULTS

In the GCF of patients, ADAM8 protein expression and activity were correlated with disease stage, whereas ADAM10 protein expression was inversely correlated with disease stage. Infection and the resulting cytokine release orchestrated the release of soluble ADAM8 by oral keratinocytes and primary neutrophils as soluble ectodomain and on exosomes, respectively. Furthermore, ADAM8 regulated the release of ADAM10 and MMP9.

CONCLUSION

Dysregulation of cell-associated and extracellular ADAM proteolytic activity may be an essential regulatory element in the progression of periodontal disease driven by ADAM8. The influence of ADAM8 on disease onset and the evaluation of targeting ADAM8 as a potential and novel local treatment option should be addressed in future translational in vivo studies.

Association between LTF/MMP20/CA6/TAS1R2 polymorphisms and susceptibility to dental caries

OBJECTIVES

The aim was to assess the associations between the LTF, MMP20, CA6, and TAS1R2 polymorphisms and caries in the Zhuang population and explore the underlying mechanism of the impact of lactoferrin on caries susceptibility.

METHODS

A case-control study of 315 adolescents was conducted in Guangxi, China, from May-November 2022. Data were collected through oral examinations and questionnaires. Buccal mucosa cells and DNA samples were collected using the SNPscan technique. Saliva and supragingival plaque samples were taken from 69 subjects with various LTF rs10865941 genotypes. The relationships among the LTF rs10865941 polymorphism, lactoferrin, Streptococcus mutans, and caries were investigated by using the ELISA and qRT-PCR, along with logistic regression analysis.

RESULTS

The genotype distribution of the LTF gene were significantly different between the case and control groups (p = 0.018). The case group had lower C allele and greater T allele frequencies than the control group (p = 0.006). The LTF rs10865941 polymorphism was associated with caries in the codominant, dominant, and additive models (p < 0.05). MMP20 rs1784418, CA6 rs2274328, and TAS1R2 rs35874116 were not significantly different between the two groups (p > 0.05). A greater quantity of S. mutans. in the supragingival plaque was found in the case group (p = 0.03). There were significant differences between the two groups in both the codominant model and the dominant model (p < 0.05).

CONCLUSIONS

The LTF rs10865941 polymorphism may be associated with caries susceptibility in the Zhuang population of China. The LTF rs10865941 T allele may be a potential risk factor for dental caries.

Centrifugal Microfluidic Cell Culture Platform for Physiologically Relevant Virus Infection Studies: A Case Study with HSV-1 Infection of Periodontal Cells

Static well plates remain the gold standard to study viral infections in vitro, but they cannot accurately mimic dynamic viral infections as they occur in the human body. Therefore, we established a dynamic cell culture platform, based on centrifugal microfluidics, to study viral infections in perfusion. To do so, we used human primary periodontal dental ligament (PDL) cells and herpes simplex virus-1 (HSV-1) as a case study. By microscopy, we confirmed that the PDL cells efficiently attached and grew in the chip. Successful dynamic viral infection of perfused PDL cells was monitored using fluorescent imaging and RT-qPCR-based experiments. Remarkably, viral infection in flow resulted in a gradient of HSV-1-infected cells gradually decreasing from the cell culture chamber entrance towards its end. The perfusion of acyclovir in the chip prevented HSV-1 spreading, demonstrating the usefulness of such a platform for monitoring the effects of antiviral drugs. In addition, the innate antiviral response of PDL cells, measured by interferon gene expression, increased significantly over time in conventional static conditions compared to the perfusion model. These results provide evidence suggesting that dynamic viral infections differ from conventional static infections, which highlights the need for more physiologically relevant in vitro models to study viral infections.

Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study

Background

In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people's lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population.

Objective

This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces.

Methods

A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed.

Results

A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores.

Conclusions

Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases.

Oral Health and "Modern" Digestive Diseases: Pathophysiologic and Etiologic Factors

In the contemporary era of medicine, exploring the complexity of the human body and its intricate interactions has become a central concern for health researchers. The main purpose of this article is to summarize the current understanding of relevant pathophysiological factors such as chronic inflammation, dysbiosis (microbial imbalance), and metabolic disorders, as well as etiological factors including dietary habits, lifestyle choices, obesity, metabolic syndrome, and genetic predispositions, as well as to emphasize potential avenues for upcoming studies and their medical significance. Additionally, this article aims to assess the potential impact of integrated treatment approaches on patient outcomes, emphasizing the need for interdisciplinary collaboration between gastroenterologists, dentists, and other healthcare professionals to develop comprehensive care plans that address both oral and digestive health issues simultaneously. Among the branches with a significant impact on general well-being are oral cavity health and digestive diseases, which have been the subject of intensive research in recent decades. In this context, analysis of the current state of knowledge on oral cavity disorders in relation to "modern" digestive diseases such as non-alcoholic fatty liver disease (NAFLD), small intestinal bacterial overgrowth (SIBO), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS) becomes essential for a deeper understanding of the interconnections between oral and digestive health. The temporal overlap or succession, whether preceding or following, of oral manifestations and digestive disorders should be taken seriously by both gastroenterologists and dentists to facilitate early diagnosis and explain to patients the correlation between these two body systems. In summary, this article underscores the importance of understanding the intricate relationship between oral and digestive health, advocating for interdisciplinary approaches to improve patient outcomes and guide future research.

Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief

Background

Preterm birth, which is child delivery before 37 weeks of pregnancy, is the primary cause of perinatal mortality worldwide. Preterm birth remains a major public health challenge in Rwanda, affecting approximately 13.8% of birth. The World Health Organization estimates that 15 million babies are born prematurely each year. While the association between periodontitis and preterm deliveries is increasingly recognized, little is known about this link in Rwanda. This policy brief aims to bridge this knowledge gap by presenting the findings of a recent study investigating the prevalence of periodontitis among pregnant women in Rwanda and its association with preterm deliveries. This policy brief also aims to inform and guide decision making towards incorporating periodontal screening into the antenatal care package in Rwanda. This has the potential to improve pregnancy outcomes and contribute to improved oral health in the future.

Policy outcome and Implications

Contemporary evidence has shown a six-fold increased risk of preterm delivery for women with periodontitis in Rwanda, with a concerningly high prevalence (60%) among pregnant women. Additionally, nurses working in antenatal clinics displayed insufficient knowledge about gum disease.

Actionable recommendations

The adoption of basic periodontal screening within existing antenatal care packages is recommended. This, coupled with nurse training and public awareness campaigns, can empower women and healthcare professionals to prioritize oral health for better pregnancy outcomes.

Conclusions

Integrating periodontal screening into antenatal care has the potential to significantly reduce preterm deliveries and contribute to a healthier future generation in Rwanda.

Artificial Intelligence in Dental Caries Diagnosis and Detection: An Umbrella Review

BACKGROUND AND AIM

Dental caries is largely preventable, yet an important global health issue. Numerous systematic reviews have summarized the efficacy of artificial intelligence (AI) models for the diagnosis and detection of dental caries. Therefore, this umbrella review aimed to synthesize the results of systematic reviews on the application and effectiveness of AI models in diagnosing and detecting dental caries.

METHODS

MEDLINE/PubMed, IEEE Explore, Embase, and Cochrane Database of Systematic Reviews were searched to retrieve studies. Two authors independently screened the articles based on eligibility criteria and then, appraised the included articles. The findings are summarized in tabulation form and discussed using the narrative method.

RESULT

A total of 1249 entries were identified out of which 7 were finally included. The most often employed AI algorithms were the multilayer perceptron, support vector machine (SVM), and neural networks. The algorithms were built to perform the segmentation, classification, caries detection, diagnosis, and caries prediction from several sources, including periapical radiographs, panoramic radiographs, smartphone images, bitewing radiographs, near-infrared light transillumination images, and so forth. Convoluted neural networks (CNN) demonstrated high sensitivity, specificity, and area under the curve in the caries detection, segmentation, and classification tests. Notably, AI in conjunction with periapical and panoramic radiography images yielded better accuracy in detecting and diagnosing dental caries.

CONCLUSION

AI models, especially convolutional neural network (CNN)-based models, have an enormous amount of potential for accurate, objective dental caries diagnosis and detection. However, ethical considerations and cautious adoption remain critical to its successful integration into routine practice.

Postbiotic mediators derived from Lactobacillus species enhance riboflavin-mediated antimicrobial photodynamic therapy for eradication of Streptococcus mutans planktonic and biofilm growth

BACKGROUND

Streptococcus mutans has been implicated as a primary causative agent of dental caries and one of its important virulence properties is an ability to form biofilm on tooth surfaces. Thus, strategies to prevent and control S. mutans biofilms are requested. The present study aimed to examine the eradication of S. mutans planktonic and biofilm cells using riboflavin (Rib)-mediated antimicrobial photodynamic therapy (aPDT) enhanced by postbiotic mediators derived from Lactobacillus species.

MATERIALS AND METHODS

Minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of Rib and postbiotic mediators were determined. The antimicrobial and anti-biofilm effects of Rib-mediated aPDT (Rib plus blue light), Rib-mediated aPDT in combination with postbiotic mediators derived from Lactobacillus casei (LC) (aPDT+ LC), and Rib-mediated aPDT in combination with postbiotic mediators derived from Lactobacillus plantarum (LP) (aPDT+ LP) were evaluated. The anti-virulence potential of Rib-mediated aPDT, aPDT+ LC, and aPDT+ LP were assessed by measuring the expression of the gtfB gene using quantitative real-time polymerase chain reaction (qRT-PCR) at the highest concentrations of Rib, LC, and LP, at which the S. mutans had proliferation as the same as in the control (non-treated) group.

RESULTS

According to the results, the MIC doses of LC, LP, and Rib were 64 µg/mL, 128 µg/mL, and 128 µg/mL, respectively, while the MBC values of LC, LP, and Rib were 128 µg/mL, 256 µg/mL, and 256 µg/mL, respectively. Rib-mediated aPDT, aPDT+ LP, and aPDT+ LC showed a significant reduction in Log10 CFU/mL of S. mutans compared to the control group (4.2, 4.9, and 5.2 Log10 CFU/mL, respectively; all P < 0.05). The most destruction of S. mutans biofilms was observed after treatment with aPDT+ LC followed by aPDT+ LP and Rib-mediated aPDT (77.5%, 73.3%, and 67.6%, respectively; all P < 0.05). The concentrations of 31.2 µg/mL, 62.5 µg/mL, and 62.5 µg/mL were considered as the highest concentrations of LC, LP, and Rib, respectively, at which S. mutans replicates as same as the control group and were used for gtfB gene expression assay using qRT-PCR during Rib-mediated aPDT, aPDT+ LP, and aPDT+ LC treatments. Gene expression results revealed that aPDT+ LP and aPDT+ LC could decrease the gene expression level of gtfB by 6.3- and 5.7-fold, respectively (P < 0.05), while only 5.1-fold reduction was observed after Rib-mediated aPDT (P < 0.05).

CONCLUSION

Our findings indicate that aPDT+ LP and aPDT+ LC hold promise for use as a treatment to combat S. mutans planktonic and biofilms growth as well as anti-virulence as a preventive strategy to inhibit biofilms development via reduction of gtfB gene expression.

Athletes' medical preventive behaviors: the case of oral health and ultraendurance trail runners

Ultra-endurance runners are particularly exposed to caries risk factors due to the continuous intake of sugars in liquid or sticky forms during long-distance exercise. The risk of caries increases due to a failure to perform oral hygiene during races. Ultra-endurance runners had good oral health status despite these particularities. Our hypothesis is that high compliance with preventive oral health recommendations (toothbrushing and preventive or regular dental visits) counterbalance the risks associated with their exposure to caries. We aimed to gain a better understanding of preventive dental behaviors in ultra-endurance runners. We then studied the determinants of two major recommendations: (1) visiting a dentist for preventive check-ups and (2) visiting a dentist during the year. 37% of the total sample reported patterns of both preventive dental visits and recent visits. Early visits (ORa = 4.8***), good oral health (ORa = 8.8**) and tooth brushing (ORa = 2.2**) were associated with preventive dental visits, but there was no significant influence of snacking or weekly work hours. The ultra-endurance race frequency was associated with early dental visits despite equal needs. Most risk-control behaviors were associated with each other, indicating that they are all-or-nothing behaviors. Individual prevention strategies implemented at the dental office may not be as effective as they predominantly target individuals who are already aware of and interested in preventive care. Instead, developing targeted primary prevention strategies that are accessible at race venues, such as stands, villages, or food supply points, could be more effective.

Prevalence of Malocclusion and Orthodontic Treatment Need in 9- to 12-Year-Old Schoolchildren in Ulaanbaatar, Mongolia

Background The prevalence of malocclusion in Mongolia is increasing every year. Estimating the need for orthodontic treatment in the population is crucial for planning orthodontic care services and monitoring oral health programs. Therefore, the present study aimed to assess the need for orthodontic treatment among schoolchildren in Ulaanbaatar, Mongolia, using the Index of Orthodontic Treatment Need (IOTN). Methods A total of 656 schoolchildren aged 9-12 years were enrolled from 8 schools located in urban and suburban areas of 6 districts of Ulaanbaatar city. All the children were assessed according to the two components of the IOTN, the Dental Health Component (DHC) and the aesthetic component (AC). Statistical analyses were carried out using IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States). Results The prevalence of malocclusion was 561 (84.5%), consisting of 452 (68%) Angle Class I, 178 (26.8%) Angle Class II, and 34 (5.2%) Angle Class III malocclusion. For the DHC, the moderate need for treatment was 194 (29.3%) and the definite need was 53 (8.1%). For the AC, the moderate need was 148 (22.3%) and the definite need was 45 (6.9%). The association between the DHC and the AC was found to be statistically significant (p<0.001). The most common malocclusions were an increased overjet (maxillary protrusion), a contact point displacement (crowding), and an increased overbite (deep bite). The AC, Angle's molar relationship, an increased overjet, a contact point displacement, and an increased overbite were factors associated with the need for orthodontic treatment. Conclusion Approximately one-third of schoolchildren in Ulaanbaatar, Mongolia, require orthodontic treatment. This finding helps dental practitioners to better understand oral health problems, leading to an improvement in the overall quality of life of children.

Reducing maternal and child oral health disparities in Sub-Saharan Africa through a community-based strategy

Oral conditions disproportionately affect mothers and children in Sub-Saharan Africa, due to biological vulnerabilities, a scarcity of oral health workers, deficient preventive strategies, and gender-based barriers to care. The World Health Organization (WHO) recommends integrating oral health into broader health delivery models, to reduce these disparities. We propose integrating preventive oral healthcare into community-based programs to bridge these gaps. We examine integrating preventive oral healthcare into Western Kenya's Chamas for Change (Chamas) community-based program which aims to reduce maternal and child health disparities. Chamas incorporates women's health and microfinance programs best practices to produce a low-cost, community-driven, sustainable, and culturally acceptable health delivery platform. Our strategy is based on the Maternal and Child Oral Health Framework and uses the WHO Basic Package of Oral Care principles. This framework prioritizes community involvement, cultural sensitivity, regular screenings, and seamless integration into general health sessions. We discuss the strengths, weaknesses, opportunities, and threats to enriching Chamas with oral health promotion activities. It is crucial to assess the effectiveness, sustainability, and acceptability of the proposed strategy through implementation and evaluation. Future studies should investigate the long-term impact of integrated oral health models on community health and oral health disparity reduction in Africa.

Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria

Introduction

The primary health care system provides an ideal setting for the integration of oral health into general health care as well as equitable access to oral health care. However, the limited oral health knowledge of primary health care workers necessitates appropriate training before they can participate in health promotion efforts. This pilot training was designed to examine the impact of the Oral Health Education module for Nurses and Community Health Care Workers on their oral health awareness and referral practices.

Methods

This study will utilize a quasi-experimental design (pre-and post with a non-equivalent control group) to assess the impact of a five-day pilot oral health education program on the knowledge and referral practices of Nurses and Community Health Workers in primary health care centers in three states in Nigeria-(Lagos, Oyo, and Kano). The training modules were developed based on the six iterative steps described in the intervention mapping framework - needs assessment, highlighting program objectives and outcomes, selection of theory and mode of intervention, designing program based on theory, designing implementation plans, and developing an evaluation plan. Only the intervention group will participate in the full educational training sessions but both groups will complete the pre-and post-intervention questionnaires.

Discussion

This pilot training combined the standardized training modules from the recently launched "Oral Health Training Course for Community Health Workers in Africa" and a newly developed maternal and child oral health module by our group using an evidence-based approach. To the best of our knowledge, this is the first program to examine the impact of the standardized OpenWHO modules. The success of this training will lay the foundation for developing a sustained channel for providing oral health education at the primary health care level in Nigeria, West Africa, and Africa.

Bioinformatics for Dentistry: A secondary database for the genetics of tooth development

Genes strictly regulate the development of teeth and their surrounding oral structures. Alteration of gene regulation leads to tooth disorders and developmental anomalies in tooth, oral, and facial regions. With the advancement of gene sequencing technology, genomic data is rapidly increasing. However, the large sets of genomic and proteomic data related to tooth development and dental disorders are currently dispersed in many primary databases and literature, making it difficult for users to navigate, extract, study, or analyze. We have curated the scattered genetic data on tooth development and created a knowledgebase called 'Bioinformatics for Dentistry' (https://dentalbioinformatics.com/). This database compiles genomic and proteomic data on human tooth development and developmental anomalies and organizes them according to their roles in different stages of tooth development. The database is built by systemically curating relevant data from the National Library of Medicine (NCBI) GenBank, OMIM: Online Mendelian Inheritance in Man, AlphaFold Protein Structure Database, Reactome pathway knowledgebase, Wiki Pathways, and PubMed. The accuracy of the included data was verified from supporting primary literature. Upon data curation and validation, a simple, easy-to-navigate browser interface was created on WordPress version 6.3.2, with PHP version 8.0. The website is hosted in a cloud hosting service to provide fast and reliable data transfer rate. Plugins are used to ensure the browser's compatibility across different devices. Bioinformatics for Dentistry contains four embedded filters for complex and specific searches and free-text search options for quick and simple searching through the datasets. Bioinformatics for Dentistry is made freely available worldwide, with the hope that this knowledgebase will improve our understanding of the complex genetic regulation of tooth development and will open doors to research initiatives and discoveries. This database will be expanded in the future by incorporating resources and built-in sequence analysis tools, and it will be maintained and updated annually.

Comparative Study of Callistemon citrinus (Bottlebrush) and Punica granatum (Pomegranate) Extracts for Sustainable Synthesis of Silver Nanoparticles and Their Oral Antimicrobial Efficacy

A comparative study was applied to investigate the potential of Callistemon citrinus (bottlebrush) flower extract (BBE) and Punica granatum (pomegranate) peel extracts (PPE) for the sustainable synthesis of the silver nanoparticles, Ag-BBE and Ag-PPE, respectively. The synthesis process of Ag NPs using the selected extracts was applied under optimized conditions. Hence, the effect of the selected plant's type on the different characteristics of the synthesized green Ag NPs was investigated. The UV-Vis spectroscopy revealed the presence of the characteristic silver peaks at 419 and 433 nm of the Ag-BBE and Ag-PPE, respectively. The XRD spectra reported the fcc phase formation of Ag NPs. The TEM results highlighted the morphological features of the synthesized Ag NPs. with a size range of 20-70 nm, and with 10-30 nm for Ag-BBE and Ag-PPE, correspondingly. The Raman spectra revealed characteristic silver bands in the Ag-PPE and reflected some bands related to the natural extract in the Ag-BBE sample. The antimicrobial activity and statistical analysis investigation were conducted against four selected oral pathogens (Staphylococcus aureus (SA), Candida albicans (CA), Staphylococcus epidermidis (S. epi), and Enterococcus faecalis (EF)). Both tested extracts, BBE, and PPE, revealed potential effectivity as reducing and capping agents for Ag NP green synthesis. However, the synthesized NPs demonstrated different features, depending on the used extract, reflecting the influence of the plant's biomolecules on the nanoparticles' properties.

Quantifying variations associated with dental caries reveals disparity in effect allele frequencies across diverse populations

BACKGROUND

Dental caries (DC) is a multifaceted oral condition influenced by genetic and environmental factors. Recent advancements in genotyping and sequencing technologies, such as Genome-Wide Association Studies (GWAS) have helped researchers to identify numerous genetic variants associated with DC, but their prevalence and significance across diverse global populations remain poorly understood as most of the studies were conducted in European populations, and very few were conducted in Asians specifically in Indians.

AIM

This study aimed to evaluate the genetic affinity of effect alleles associated with DC to understand the genetic relationship between global populations with respect to the Indian context.

METHODOLOGY

This present study used an empirical approach in which variants associated with DC susceptibility were selected. These variants were identified and annotated using the GWAS summary. The genetic affinity was evaluated using Fst.

RESULTS

The effect of allele frequencies among different populations was examined, revealing variations in allele distribution. African populations exhibited higher frequencies of specific risk alleles, whereas East Asian and European populations displayed distinct profiles. South Asian populations showed a unique genetic cluster.

CONCLUSION

Our study emphasises the complex genetic landscape of DC and highlights the need for population-specific research as well as validation of GWAS-identified markers in Indians before defining them as established candidate genes.

Dentin Mechanobiology: Bridging the Gap between Architecture and Function

It is remarkable how teeth maintain their healthy condition under exceptionally high levels of mechanical loading. This suggests the presence of inherent mechanical adaptation mechanisms within their structure to counter constant stress. Dentin, situated between enamel and pulp, plays a crucial role in mechanically supporting tooth function. Its intermediate stiffness and viscoelastic properties, attributed to its mineralized, nanofibrous extracellular matrix, provide flexibility, strength, and rigidity, enabling it to withstand mechanical loading without fracturing. Moreover, dentin's unique architectural features, such as odontoblast processes within dentinal tubules and spatial compartmentalization between odontoblasts in dentin and sensory neurons in pulp, contribute to a distinctive sensory perception of external stimuli while acting as a defensive barrier for the dentin-pulp complex. Since dentin's architecture governs its functions in nociception and repair in response to mechanical stimuli, understanding dentin mechanobiology is crucial for developing treatments for pain management in dentin-associated diseases and dentin-pulp regeneration. This review discusses how dentin's physical features regulate mechano-sensing, focusing on mechano-sensitive ion channels. Additionally, we explore advanced in vitro platforms that mimic dentin's physical features, providing deeper insights into fundamental mechanobiological phenomena and laying the groundwork for effective mechano-therapeutic strategies for dentinal diseases.

Painless cost control as a central strategy for universal oral health coverage: A critical review with policy guide

AIM

This study aimed to critically review the methods used to control the significantly increasing costs of dental care.

METHODS

Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance.

RESULTS

From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry.

CONCLUSION

Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.

Effect of Dentifrice Ingredients on Volume and Vitality of a Simulated Periodontal Multispecies Biofilm

The aim of this in vitro study was to investigate the effect of different toothpaste ingredients on biofilm volume and vitality in an established non-contact biofilm removal model. A multi-species biofilm comprising Porphyromonas gingivalis, Streptococcus sanguinis, and Fusobacterium nucleatum was grown on protein-coated titanium disks. Six disks per group were exposed to 4 seconds non-contact brushing using a sonic toothbrush. Four groups assessed slurries containing different ingredients, i.e., dexpanthenol (DP), peppermint oil (PO), cocamidopropyl betaine (CB), and sodium hydroxide (NaOH), one positive control group with the slurry of a toothpaste (POS), and a negative control group with physiological saline (NEG). Biofilm volume and vitality were measured using live-dead staining and confocal laser scanning microscopy. Statistical analysis comprised descriptive statistics and inter-group differences. In the test groups, lowest vitality and volume were found for CB (50.2 ± 11.9%) and PO (3.6 × 105 ± 1.8 × 105 µm3), respectively. Significant differences regarding biofilm vitality were found comparing CB and PO (p = 0.033), CB and NEG (p = 0.014), NaOH and NEG (p = 0.033), and POS and NEG (p = 0.037). However, no significant inter-group differences for biofilm volume were observed. These findings suggest that CB as a toothpaste ingredient had a considerable impact on biofilm vitality even in a non-contact brushing setting, while no considerable impact on biofilm volume was found.

Association between periodontitis and dental caries: a systematic review and meta-analysis

OBJECTIVES

Recent evidence suggested a link between periodontitis (PD) and dental caries, but the trends and nature of this association remained unclear. The overall aim of this study was to critically assess the correlation of two disorders.

METHODS

A comprehensive search was conducted within the PUBMED and EMBASE databases including grey literatures up to July 5th, 2023. The Newcastle-Ottawa scale was used to qualitatively evaluate the risk of bias.

RESULTS

Overall, 18 studies were included. In terms of caries risk in PD patients, the prevalence of caries was increased by PD (OR = 1.57, 95%CI:1.20-2.07), both in crown (OR = 1.03, 95%CI:1.01-1.05) and root caries (OR = 2.10, 95%CI:1.03-4.29). Odds of caries were also raised by PD severity (OR moderate = 1.38, 95%CI:1.15-1.66; OR severe = 2.14, 95%CI:1.74-2.64). Besides, patients with PD exhibited a higher mean number of decayed, missing and filled teeth (DMFT) and decayed and filled root teeth (DFR) [weighted mean difference (WMD)DMFT = 0.87, 95%CI: -0.03-1.76; WMDDFR = 1.13, 95%CI: 0.48-1.78]. Likewise, patients with caries had an elevated risk of PD (OR = 1.79, 95%CI:1.36-2.35). However, Streptococcus mutans, one of the main pathogens of caries, was negatively correlated with several main pathogens of periodontitis.

CONCLUSIONS

This study indicated a positive correlation between dental caries and periodontitis clinically, while the two disease-associated pathogens were antagonistic.

CLINICAL RELEVANCE

Further research, including clinical cohort studies and mechanisms of pathogens interaction is needed on this link for better prevention and treatment of PD and caries. In addition, innovative prevention strategies need to be developed and incorporated in dental practices to prevent these two highly prevalent oral diseases.

3D intraoral scanning techniques support the effects of crown morphology on dental caries

BACKGROUND

With the development and utilization of three-dimensional (3D) intraoral scanning (IOS) technology, the morphological characteristics of teeth were quantitatively assessed. In this research, we aimed to explore the prevalence of dental caries in relation to each measurable morphological indicator of the tooth body via 3D intraoral scanning techniques.

METHODS

A hospital-based single-centre study was conducted at our hospital from Dec. 2021 to Apr. 2023. A total of 53 patients were involved in the study, providing complete morphological data for 79 teeth. Each patient completed an oral hygiene routine questionnaire and underwent examination by an experienced dentist to evaluate caries conditions before undergoing 3D intraoral scanning to obtain a digital dental model. Geomagic Studio 2014 was used to extract oral morphological data from the models. The acquired data were entered, cleaned and edited using Excel 2016 and subsequently exported to SPSS version 25.0 for analysis. Chi-square analysis and logistic regression analyses were employed to test the associations.

RESULTS

Among the participants, 33 (61.1%) were female, with a mean age of 26.52 ± 10.83 years. Significant associations were found between dental caries and the vertical distance between the distal tip and the gum (OR 14.02; 95% CI 1.80-109.07; P = 0.012), the distal lateral horizontal distance of occlusion (OR 0.40; 95% CI 0.18-0.90; P = 0.026), and the mesial horizontal distance of occlusion (OR 2.20; 95% CI 1.12-4.31; P = 0.021). The Hosmer-Lemeshow test indicated a P value of 0.33.

CONCLUSIONS

The vertical distance between the distal tip and the gum, the distal lateral horizontal distance of the occlusion and the mesial horizontal distance of the occlusion were the influencing factors for dental caries (identified as independent risk factors). We hypothesize that these factors may be associated with the physiological curvature of teeth and the role of chewing grooves in plaque formation over time. However, further studies involving larger population samples and more detailed age stratification are still needed.

Assessment of the general health status of children in Turkey: A community-based cross-sectional study

AIM

This study aims to assess the general health status and factors affecting the general health status in the 0-14 age group in Turkey.

METHODS

This cross-sectional study was conducted using the Turkish Statistical Institute Turkey Health Survey 2022 micro data set.

RESULTS

This study included 7019 participants. Household heads described the general health status of 91.3% of children and the dental and gum status of 82.4% of children as very good or good, and 9.2% of children had any chronic disease. Although the median breastfeeding duration was 15 months, there is statistical significant association between sex and general health status (p = 0.014) and sex and duration of breastfeeding (p = 0.006). A statistical difference was found between duration of breastfeeding and general health status (p = 0.009) and dental and gum status (p = 0.001).

CONCLUSION

In 2022, the majority of children in Turkey had very good or good general health and dental and gum status. More than a third of children were breastfed for less than 12 months. Considering the possibility of neglecting oral and dental health problems, it is recommended to prioritize oral and dental health literacy trainings and to continue breastfeeding promotion programmes.

Oral Health Status of Healthcare Workers in Ilembula/Tanzania during the COVID-19 Condition

The challenge of reduced dental treatment and education infrastructure in the Tanzanian highlands affects the oral health situation of both the general population and local healthcare workers. The aim of this study was to investigate the oral health status of healthcare workers at Ilembula Lutheran Hospital (ILH), Tanzania, during the COVID-19 pandemic. In total, 134 healthcare workers (62 women, 72 men; mean age 36.48 ± 9.56 years, range 19-59 years; median age 35.00 years) participated in this cross-sectional study, conducted from 12 February to 27 February. A dental examiner trained in oral health screening performed the oral health data collection. Data collection was performed by probability sampling using the Ilembula Data Collection Form-Oral Health (IDCF-Oral Health) questionnaire distributed in paper form. Ethical approval was obtained from the National Institute for Medical Research/Tanzania. The decayed, missing, and filled teeth (DMF/T) index proposed by the World Health Organization (WHO) was used with the associated caries measurement method and the simplified oral hygiene index (OHI-S). Details regarding edentulism, nutritional habits, and socio-economic factors were collected. Statistical analysis was performed using linear regression (α = 0.05). The average DMF-T index was 3.33 ± 0.82, with age, gender, meal frequency, and soft drink consumption significantly influencing the index. No evidence of dental plaque was detected in 43.3% of the participants. Of the participants, 32.8% required prosthetic treatment (Kennedy Class III), while 16.4% needed it for acute malocclusions. Oral hygiene products were used in 97% of cases. A total of 35.8% of the participants had an OHI-S score of up to 1.0, with (p < 0.001) age and (p < 0.001) sex having a significant influence on the index. The current oral health situation of healthcare workers at ILH shows a moderate need for restorative and prosthetic treatment in rural Tanzania. Despite the COVID-19 pandemic, there was no change in the need for dental treatment, which may be explained by the generally restricted access to dental healthcare in the investigated region. The development of an interdisciplinary oral health prophylaxis system could help to reduce the need for future treatments.

A Holistic Approach for Ethics and Sustainability in the Food Chain: The Gateway to Oral and Systemic Health

Food production is a complex matter, affecting people's lives, organizations' profits, and the well-being of the whole planet, and has multifaceted ethical considerations surrounding its production, distribution, and consumption. This paper addresses the pressing need to confront ethical challenges within the food system, encompassing issues such as environmental sustainability, food security, and individual food choices for better oral and systemic health of all individuals around the globe. From agricultural practices to global trade and food waste, ethical implications are addressed across various domains, highlighting the interconnectedness of ethical decision-making in the food industry. Central themes explored include the ethical dimensions of food production methods, the impact of global trade on food ethics, and the role of individuals in making ethically informed food choices. Additionally, this paper considers the spiritual and physical significance of food, particularly through the lens of oral health as a gateway to holistic well-being. Recognizing the complexity of the food and mouth ecosystem, this paper calls for serious interventions in legislation and economics to promote ethical protocols and techniques for sustainability reasons. It emphasizes the importance of ethical considerations in food safety management systems, regulatory frameworks, and quality standards. Moreover, this paper underlines the need for a comprehensive approach to address ethical dilemmas and moral values inherent in the food industry and oral health policies, adopting the precautionary principle and ethical decision-making frameworks. This article finally aims to serve as a call to action for stakeholders across the food industry and the healthcare sector, to prioritize ethical practices, promote transparency, rearrange economic parameters, and work towards a more sustainable and equitable food system for inner and outer oral and systemic health and human sustainability for all.

Impact of tobacco habits on poor oral health status among bone-factory workers in a low literacy city in India: A cross-sectional study

Oral health is a vital indicator of well-being that is influenced by various habits and lifestyles of individuals. Oral diseases are the bottleneck in the effective control of non-communicable diseases (NCDs) due to chronic in nature and reciprocal relationship as sharing the common risk factors and habits such as sugar, tobacco, and alcohol consumption that increase the risk of developing various inevitable diseases. However, there is a lack of literature highlighting the relationship between risk factors for oral diseases and general health among individuals. This cross-sectional study was carried out among 500 study participants aged 20 to 64 years who gave written informed consent and were recruited by Multistage Stratified Cluster Sampling technique among workers in five bone factories, working for at least one year since January 2001 to March 2022 in Sambhal city, Uttar Pradesh. WHO-Basic Oral Health Survey-1997 was used to record the data regarding sociodemographic and oral health status variables. We used the modified WHO-STEPWISE pre-structured questionnaire to record tobacco consumption habits and oral health-seeking behavior. We scheduled a clinical intra-oral examination to record the Decayed Missing Filled Teeth (DMFT) index and the interview on the premises of five bone factories. Among the 500 bone-factory workers, the total number of males was 342 (68.40%) and 158 (31.60%) were females. The mean age (Standard Deviation) was 33.18 (10), and the mean DMFT score of factory workers was 2.84 (3.12). Production workers had the highest mean DMFT score of 4.60 (3.25). More than half of the factory workers (53.2%) were tobacco users. Tobacco users were 3.52 times more likely to have a severe DMFT index. Most common pre-cancerous lesions were oral submucous fibrosis and leukoplakia. Compared to non-tobacco users, mild tobacco users have 6.80 folds higher odds of oral lesions. Tobacco consumption is not only harmful for oral health but also leads to several non-communicable and systemic diseases. NCDs and dental caries are chronic and preventable conditions with a bidirectional relationship implicated by modifiable major risk factors such as tobacco consumption. Decreasing the consumption of tobacco use may improve oral health and reduce the risk of the development of NCDs. Also, regular dental visits should be scheduled to monitor the oral health status of factory workers. Additionally, tailored intervention for tobacco cessation should be implicated to maintain the general and oral health of industrial workers.

Hypromellose-, Gelatin- and Gellan Gum-Based Gel Films with Chlorhexidine for Potential Application in Oral Inflammatory Diseases

The oral cavity is constantly exposed to contact with an external environment. Pathogens can easily access and colonize it, causing a number of medical conditions that are usually accompanied by inflammation, which in turn require medical intervention and cause the deterioration of wellbeing. The aim of this study was to obtain polymer films that could be a carrier for chlorhexidine, an active substance used in the treatment of inflammation in the oral cavity, and at the same time act as a dressing for the application on the mucous membrane. Combinations of three biocompatible and biodegradable polymers were used to prepare the films. The obtained samples were characterized by assessing their water loss after drying, swelling ability, hygroscopicity and tensile strength. It was shown that the mixture of HPMC and gellan gum or gelatin could be used to prepare transparent, flexible polymer films with chlorhexidine. All tested films showed high hygroscopicity and swelling ability. However, it was observed that the composition containing gellan gum was more suitable for obtaining films with prolonged stay at the site of administration, which predisposes it to the role of a local dressing.

Potential role of Citrus bergamia flower essential oil against oral pathogens

BACKGROUND

Oral bacterial infections are difficult to treat due to emergence of resistance against antibiotic therapy. Essential oils are considered emerging alternate therapy against bacterial infections and biofilms. We investigated Citrus bergemia flower essential oil against oral pathogens.

METHODS

The essential oil was analsyed using Gas Chromatography(GC-MS), in silico investigations, antioxidant, antimicrobial, antibiofilm and antiquorum sensing assays.

RESULTS

Gas Chromatography analysis confirmed presence of 17 compounds including 1,6-Octadien-3-ol,3,7-dimethyl, 48.17%), l-limonene (22.03%) and p-menth-1-ol, 8-ol (7.31%) as major components. In silico analysis showed compliance of all tested major components with Lipinski's rule, Bioavailability and antimicrobial activity using PASS (prediction of activity spectrum of substances). Molecular docking with transcriptional regulators 3QP5, 5OE3, 4B2O and 3Q3D revealed strong interaction of all tested compounds except 1,6-Octadien-3-ol,3,7-dimethyl. All tested compounds presented significant inhibition of DPPH (2,2-diphenyl-1-picrylhydrazyl) (IC50 0.65 mg/mL), H2O2 (hydrogen peroxide) (63.5%) and high FRAP (ferrous reducing antioxidant power) value (239.01 µg). In antimicrobial screening a significant activity (MIC 0.125 mg/mL) against Bacillus paramycoides and Bacillus chungangensis was observed. Likewise a strong antibiofilm (52.1 - 69.5%) and anti-QS (quorum sensing) (4-16 mm) activity was recorded in a dose dependent manner.

CONCLUSION

It was therefore concluded that C. bergemia essential oil posess strong antioxidant, antimicrobial and antibiofilm activities against tested oral pathogens.

Influence of internal angle and shape of the lining on residual stress of Class II molar restorations

Polymerization shrinkage is a major side effect of resin composite materials that affects the success and longevity of caries restorations. This study was to analyze the effect of the internal angle and shape of the lining on the shrinkage residual stress of dental restorations in Class II mesio-occlusal-distal (MOD) cavities through finite element analysis (FEA). A 3D reconstructed model of a human mandibular first molar was created from micro-CT images, and then the tooth was prepared as a Class II MOD cavity. 3D models of four regular internal corner shapes of Class II MOD cavities with different internal angles of lining and one 90° filleted corner model were created. The thermal expansion technique was applied to approximate the shrinkage impact of composite resin polymerization in the FE software ABAQUS. Von Mises stress was taken as a metric. The results showed that the level of residual stresses in the Class II MOD cavities was greatly dependent on the internal angle of the lining. The maximum von Mises stress in tooth tissue decreased as the internal angle of the lining increased. The internal shapes of the lining had no obvious effect on the stress, and the filleted corner model had less stress. This lining strategy is appropriate for Class II MOD cavities with serious loss of tooth tissue.

Emergent Patterns, Collaborative Networks and Thematic Evolution on Black Stain and Dental Caries: A Scientometric Study

AIM

To conduct a scientometric analysis on black stains, and dental caries, with a focus on identifying emergent patterns, collaborative networks, and thematic evolution.

MATERIALS AND METHODS

A retrospective, descriptive, observational study was conducted using a scientometric approach. The Scopus database was utilized for literature search, selecting articles published between 1976 and 2023. The literature search was carried out on February 8, 2024, using AND and OR Boolean operators which were adapted to the search strategy. Finally, SciVal used different scientometric indicators such as "Scholarly Output", "Views Count", "Field-Weighted Citation Impact" and the "Citation Count".

RESULTS

A total of 13 documents from 10 different sources were analyzed, covering a period from 1976 to 2023. Despite an annual growth rate of 0%, each document has an average of 21.08 citations, indicating their relevance in the field. The documents have an average age of 12.9 years and contain 336 references. A total of 143 additional keywords and 26 author keywords were identified. The documents were written by 62 different authors, with an average of 5 coauthors per document and 30.77% international coauthorships.

CONCLUSION

The results indicate a significant relevance of the documents in the field, a notable collaboration among authors, and a significant thematic evolution in the research topics. The mentioned institutions and sources produced documents with notable results, indicating a significant interest and impact in the field.

CLINICAL SIGNIFICANCE

This study provides a detailed view of the trends and patterns in the research of dental caries and black stains. The findings can assist dental health professionals in better understanding the prevalence and impact of these conditions. Furthermore, it can guide future research and treatment strategies in this field. How to cite this article: Mayta-Tovalino F, Espinoza-Carhuancho F, Reyes-Carmona J, et al. Emergent Patterns, Collaborative Networks and Thematic Evolution on Black Stain and Dental Caries: A Scientometric Study. J Contemp Dent Pract 2024;25(4):326-330.

Behaviors, hygiene habits, and sources of care among removable complete and partial dentures wearers: A multicenter cross-sectional study

OBJECTIVES

There is a lack of data regarding the hygiene practices and sources of care among individuals in Yemen who wear removable complete and partial dentures. The purpose of this study was to explore the behaviors, hygiene habits, and sources of care information among patients who utilize complete and partial dentures in Yemen.

MATERIALS AND METHODS

A descriptive cross-sectional research design was utilized, and a sample of 217 consecutive participants who wore removable complete and/or partial dentures were enlisted. A questionnaire was employed to collect data on demographic information, educational attainment, denture habits, denture cleaning practices, and encountered difficulties. Statistical analysis was conducted using SPSS software, and significance was determined using chi-square tests, with a significance level of .05.

RESULTS

The data analysis revealed that a majority of the participants were male (72.4%) and had an average age of 65.14 years. Fifty-three percent of the participants wore partial dentures, while 34.6% wore complete dentures. Only 6.5% of the participants wore both complete and partial dentures, and 6% wore overdentures. The majority of participants (88.47%) had dentures made of acrylic material. Additionally, 43% of participants wore dentures while sleeping, and 61.3% stored their dentures in dry places without a water-filled container when not in use. The most commonly reported cleaning methods were water only (24.4%), followed by water and soap (19.4%). Furthermore, a large portion of the participants (59.4%) received denture care information from dentists. However, the majority (59%) did not visit a dentist for regular denture maintenance or any denture-related issues. The data analysis did not reveal any significant association between age or education level and denture cleaning methods.

CONCLUSION

This cross-sectional survey provides insight into the hygiene knowledge and practices of removable denture wearers in Yemen. The findings underscore the necessity for enhanced oral hygiene education and awareness within this population. The study offers valuable insights for oral health professionals to design targeted interventions and educational initiatives aimed at promoting proper denture care and maintenance. These efforts have the potential to enhance the oral health and overall well-being of removable denture wearers.

Serum lipoprotein subfractions are associated with the periodontal status: Results from the population-based cohort SHIP-TREND

AIM

To investigate the medium-term associations of serum protein subfractions derived from proton nuclear magnetic resonance (1 H-NMR) spectroscopy with periodontitis and tooth loss.

MATERIALS AND METHODS

A total of 3031 participants of the cohort Study of Health in Pomerania (SHIP-TREND) were included. In addition to conventional serum testing, serum lipoprotein contents and subfractions were analysed by 1 H-NMR spectroscopy. Confounder-adjusted associations of lipoprotein variables with periodontitis and the number of missing teeth variables were analysed using mixed-effects models with random intercepts for time across individuals, accounting for multiple testing.

RESULTS

While only spurious associations between lipoprotein levels from conventional blood tests were found-that is, triglycerides were associated with mean clinical attachment level (CAL) and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio with the number of missing teeth - several associations emerged from serum lipoprotein subfractions derived from 1 H-NMR analysis. Specifically, elevated LDL triglycerides were associated with higher levels of mean probing depth (PD), mean CALs, and increased odds of having <20 teeth. HDL-4 cholesterol levels were inversely associated with mean PD. Systemic inflammation (C-reactive protein) might mediate the effects of LDL and HDL triglyceride contents on periodontitis severity.

CONCLUSIONS

Several associations between serum lipoprotein subfractions and periodontitis were observed. As the underlying biochemical mechanisms remain unclear, further research is needed.

Beyond the Needle: A Comparative Evaluation of Silk Sutures and Cyanoacrylate for Periodontal Flap Closure

Introduction As the incidence of periodontal diseases continues to surge, there is a concurrent elevation in the demand for periodontal treatment. Periodontal surgical therapy is done to control and eliminate disease activity. Conventionally, silk sutures have been considered the gold standard for post-operative flap closure that leads to biofilm accumulation and tissue trauma. Cyanoacrylates are alternate options to avoid the limitations. Objective The objective of the study was to assess clinical outcomes by comparing the healing after periodontal flap surgery when secured with 3-0 braided silk suture versus cyanoacrylate. Methodology Twenty surgical sites from 10 patients with moderate to severe periodontitis were selected and randomly divided into two groups after phase-1 therapy: the test group (isoamyl 2-cyanoacrylate) and the control group (3-0 silk braided suture). Post-operative wound healing, pain assessment using a verbal rating scale (VRS), and analgesic tablets taken were evaluated on the third, fifth, seventh, and 14th days. Statistical analysis was done using the ANOVA test with the post-hoc Bonferroni test. Results There was no statistically significant difference between the VRS and wound healing index at different levels of intervals during intergroup comparison, but the number of analgesics consumed post-operatively was less in the test group as compared to the control group. Conclusion The present study concluded that isoamyl 2-cyanoacrylate can be used as an alternative to conventional silk sutures as it decreases post-operative pain and discomfort.

Interplay between dental caries pathogens, periodontal pathogens, and sugar molecules: approaches for prevention and treatment

Globally, oral diseases affect nearly 3.5 billion people, accounting for 4.6% of the healthcare expenditure. Common oral diseases include dental caries and periodontal disease, associated with biofilms formed by cariogenic pathogens. Epidemiological studies associate carbohydrates with these diseases due to  the sugars metabolized by cariogenic pathogens. This review focuses on dental caries and periodontal pathogens, quorum sensing, lectin-carbohydrate interactions, and various sugar molecules. Cariogenic sugars significantly influence biofilms by enhancing pathogen adhesion, viability, and gene expressions associated with biofilm formation. Moreover, lectin-carbohydrate interactions contribute to biofilm stability. Disrupting these interactions is a potential strategy for oral disease prevention. The use of nanoparticles, such as quantum dots, provides novel insights into lectin-sugar interactions and the development of inhibitors. Additionally, nanomaterials like calcium phosphate nanoparticles neutralize acids and inhibit microbial growth. This overview emphasizes understanding the relationships between oral diseases, microbial communities, and sugars to devise preventive and therapeutic strategies against oral diseases.

Caries Experience before and after COVID-19 Restrictions: An Observational Study

Background: The declaration of COVID-19 as a pandemic by the World Health Organization in 2020 led to the suspension of several clinical practices globally, including dentistry. This study investigates the impact of these restrictions on dental caries experience. Methods: A retrospective cross-sectional study was conducted at Egas Moniz University's dental hospital in the Lisbon Metropolitan Area from June 2019 to June 2021. The study involved 3380 participants who were divided into two cohorts: after and before COVID-19 restrictions. Data collection included a questionnaire, full-mouth clinical examinations, and radiographs (panoramic X-rays, bitewings). Results: Before the COVID-19 restrictions, the prevalence of dental caries was 91.8%, with an average DMFT (decayed, missing, and filled teeth) index of 12.13. Post-restrictions, the prevalence decreased to 84.5%, with a DMFT index of 10.99. There was an increase in missing teeth and a decrease in decayed and filled teeth. Additionally, the frequency of toothbrushing declined among participants. Conclusions: The COVID-19 pandemic restrictions have significantly impacted dental caries experiences and oral health, highlighting a decrease in dental caries, but also a concerning reduction in oral hygiene practices. These results emphasize the importance of customized dental healthcare during public health emergencies to reduce impacts and maintain oral health.

Effectiveness of an oral health promotion training program among school nurses in India

BACKGROUND

Schools are a valuable platform for oral health promotion and the role of school nurse is critical in promoting oral health of children. A training program was carried out to assess its effectiveness in promoting oral health among school nurses of Navodaya Vidyalaya Samiti (NVS), one of the largest groups of central schools in India.

METHODOLOGY

A total of 557 school nurses of Navodaya Vidyalaya schools participated in the training program. The training was delivered virtually using didactic teaching methods based on a conceptual framework. Pre and post knowledge scores were assessed for all the participants.

RESULTS

A total of 451 pre-post complete responses were received during training program, with a response rate of 81 %. There was significant improvement in the overall knowledge scores (p < 0.001) of school nurses. After the training program was completed, oral health screening and education for students was conducted by these trained nurses in coordination with teachers in their respective schools.

CONCLUSION

The present training program was effective in addressing the gaps in oral health knowledge of the school nurses and significantly improving their oral health knowledge.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French

Background

Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate.

Objective

The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge.

Method

This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F.

Results

A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996).

Conclusion

The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.

Is Burning Mouth Syndrome Associated with Extraoral Dryness? A Systematic Review

Burning mouth syndrome (BMS) is characterized by a persistent intraoral burning sensation, often experienced by postmenopausal women. The etiology of BMS remains partially understood, and consequently, treatments remain suboptimal. Extraoral manifestations of BMS, such as extraoral dryness, are less studied. However, it has been suggested that the identification of the frequency and patterns of extraoral dryness and potential underlying mechanisms are essential to optimize treatment strategies and reduce the burden of disease. Therefore, we conducted this systematic review to provide existing evidence about extraoral dryness in BMS. The guidelines for the conduction and reporting of systematic reviews were followed. An electronic search was conducted in four major databases-PubMed, Web of Science, COCHRANE Library, and EBSCOhost-and the grey literature was assessed through Google Scholar. From each included article, information on extraoral dryness in BMS was extracted, and odds ratios were calculated for extraoral dryness among BMS patients compared with non-BMS controls. The findings demonstrated higher odds of the prevalence of extraoral dryness in BMS, which was found to a high degree in the lips, eyes, skin, and genitalia. The pattern of spread and locations of extraoral dryness propose a potential central mechanism. Based on our findings, we encourage the standardization of the assessment, recording, and reporting of the extraoral characteristics of BMS, including extraoral dryness, which can lead to better management strategies and enhance the quality of life of the affected patients.

Antibacterial Activity of a Lysin LysP53 against Streptococcus mutans

Dental caries is a common disease affecting quality of life globally. In the present study, we found that a bacteriophage lysin LysP53 against Acinetobacter baumannii possesses selective activity on Streptococcus mutans, the main etiological agent of dental caries, even in low pH caries microenvironments, whereas only minor LysP53 activity was detected against Streptococcus sanguinis, Streptococcus oralis, and Streptococcus mitis. Testing activity against S. mutans planktonic cells showed that 4 μM LysP53 could kill more than 84% of S. mutans within 1 min in buffer with optimal pHs ranging from 4.0 to 6.5. Daily application of LysP53 on biofilms formed in BHI medium supplemented or not with sucrose could reduce exopolysaccharides, expression of genes related to acid resistance and adhesion, and the number of live bacteria in the biofilms. LysP53 treatment also showed similar effects as 0.12% chlorhexidine in preventing enamel demineralization due to S. mutans biofilms, as well as effective removal of S. mutans colonization of tooth surfaces in mice without observed toxic effects. Because of its selective activity against main cariogenic bacteria and good activity in low pH caries microenvironments, it is advantageous to use LysP53 as an active agent for preventing caries.

Dentin Degradation: From Tissue Breakdown to Possibilities for Therapeutic Intervention

Purpose of the Review

Presently, dental materials science is driven by the search for new and improved materials that can trigger specific reactions from the affected tissue to stimulate repair or regeneration while interacting with the oral environment to promote or maintain oral health. In parallel, evidence from the past decades has challenged the exclusive role of bacteria in dentin tissue degradation in caries, questioning our understanding of caries etiopathogenesis. The goal of this review is to recapitulate the current evidence on the host and bacterial contributions to degradation, inflammation, and repair of the dentin-pulp complex in caries.

Recent Findings

Contrasting findings attribute dentin breakdown to the activity of endogenous enzymes, such as matrix metalloproteinases (MMPs) and cathepsins, while the role of bacteria and their by-products in the destruction of dentin organic matrix and pulp inflammation has been for decades supported as an incontestable paradigm. Aiming to better understand the mechanisms involved in collagen degradation by host enzymes in caries, studies have showed that these proteinases are expressed in the mature dentin (i.e., after dentin formation) and become activated by the low pH in the acidic environment resulted by bacterial metabolism in caries. However, different host sources other than dentin-bound proteinases seem to also contribute to caries progression, such as saliva and pulp. Interestingly, studies evaluating pulp responses to bacteria invasion and inflammation in caries report higher levels of MMPs and cathepsins in inflamed tissue, but also showed MMP potential to resolve inflammation and stimulate wound healing. Notably, as reported for other tissues, MMPs exert dual roles in the dentin-pulp complex in caries, participating or regulating both degradative and reparative mechanisms.

Summary

The specific roles of host and bacteria and their by-products in caries progression have yet to be clarified. The complex interactions between inflammation and repair in caries pose challenges to a clear understanding of the dentin-pulp complex responses and changes to bacteria invasion. However, it opens new venues for the development of novel therapies and dental biomaterials based on the modulation of specific mechanisms to favor tissue repair and healing.

Dental Caries Experience in Children in Public Kindergartens of Sarajevo, Bosnia and Herzegovina

OBJECTIVES

Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day's busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well.

AIMS

To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers.

METHODS

The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits.

RESULTS

ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children's parents (CI=10.55%, RI=10.80%, TI=12.98%).

CONCLUSION

Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.