Environmental Cadmium Exposure and Dental Indices in Orthodontic Patients

Oral Health Self-Management Ability and Its Influencing Factors among Adolescents with Fixed Orthodontics in China: A Mixed Methods Study

Objective. To understand the oral health self-management ability status and influencing factors among adolescent patients with fixed orthodontics in Nanjing and to provide a reference for formulating targeted intervention measures. Methods. A mixed research method was used. First, the convenience sampling method was used to select adolescent patients with fixed orthodontics admitted to the orthodontic department of a dental hospital in Nanjing from November 2021 to March 2022. The oral health self-management ability questionnaire was used for the investigation; then, 15 children with poor oral health management ability were selected for in-depth interviews. Results. The total score of oral health self-management ability of 290 adolescent children with fixed orthodontics was 45.6-90.8 points, with an average score of $69.63\pm 7.40$ of which knowledge, belief, and behavior dimension scores were $72.09\pm 10.47,68.50\pm 10.13,\text{and}67.63\pm 8.67$ , respectively, and the environmental score was $69.91\pm 12.50$ . Multiple regression analysis showed that sex, age, bracket wearing time, grade, and place of residence were related to the scores of each dimension of self-management. Qualitative research shows that the main reasons for the poor oral health self-management ability of adolescents with fixed orthodontics are the lack of awareness during fixed orthodontics, lack of knowledge channels, low compliance, inability to solve oral problems during treatment, difficulty in adhering to oral care behaviors, and lack of motivation to treat. Conclusion. The oral health self-management ability of adolescent children with fixed orthodontics needs improvement, and a precise health intervention plan should be formulated.

Association among Helicobacter pylori Infection, Tooth Loss, and Heavy Medal Exposure in a Chinese Rural Population

Previous research suggests that heavy metals may be associated with increased susceptibility to Helicobacter pylori infection. This study investigated the effect of heavy metal exposure (Pb and Cd) on tooth loss and H. pylori infection in a Chinese rural population, who live near a mining and smelting area. Blood samples were collected from the study participants to estimate the lead (Pb) and cadmium (Cd) exposure levels. H. pylori infection was analyzed using the 14C-urea breath test, and the number of missing teeth (MT), filled teeth (FT), and missing or filled teeth (MFT) were counted by conducting a physical examination. Regression analysis was used to assess the difference between H. pylori-positive and -negative individuals in the MT, FT, and MFT groups, adjusting for confounders. The H. pylori infection prevalence was higher in individuals in the high Cd or high Pb groups than that in the low Cd or low Pb groups (p < 0.05). In addition, greater numbers of FT and MFT were observed in individuals in the high Pb group than those in the low Pb group (p < 0.05). We further found 8.7% (95% CI, 2.8−23.8%, p = 0.017) of the effect of the high BPb level on H. pylori infection risk could be statistically explained by FT using amediation analyses in adjusted models, and 6.8% (95% CI, 1.6−24.8%, p = 0.066) by MFT. Furthermore, FT and MFT were significantly associated with increased risk for H. pylori infection (odds ratio (OR) = 4.938, 95% confidence interval (CI): 1.125−21.671; OR = 3.602, 95% CI: 1.218−10.648, respectively). Pb and Cd exposure may be associated with tooth loss and increased susceptibility to H. pylori infection, and tooth loss may be an independent risk factor for H. pylori infection.

Association between Enzyme-Linked Immunosorbent Assay-Measured Kidney Injury Markers and Urinary Cadmium Levels in Chronic Kidney Disease

Cadmium exposure is associated with chronic kidney disease (CKD), but the optimal biomarker for early cadmium-associated nephrotoxicity in low-level exposure has not yet been established. We conducted a cross-sectional investigation involving 167 CKD patients stratified according to tertiles of urinary cadmium levels (UCd), in which enzyme-linked immunosorbent assay (ELISA)-measured novel renal biomarkers were utilized to assess the extent of renal injury associated with cadmium burden. In the analyses, urinary kidney injury molecule-1 (KIM-1) levels and age were the independent factors positively correlated with UCd after adjusting for covariates in non-dialysis-dependent CKD patients (high vs. low UCd, odds ratio (95% confidence interval), 1.0016 (1.0001–1.0032), p = 0.043, and 1.0534 (1.0091–1.0997), p = 0.018). Other conventional and novel renal biomarkers, such as serum creatinine, estimated glomerular filtration rate, CKD staging, urinary protein/creatinine ratio, urinary 8-hydroxy-2-deoxyguanosine (8-OHdG), and urinary epidermal growth factor (EGF) were not independently correlated with UCd in the analyses. In conclusion, our study found that the ELISA-measured urinary KIM-1 level could serve as an early renal injury marker in low-level cadmium exposure for non-dialysis-dependent CKD patients. In addition, age was an independent factor positively associated with UCd in this population.

The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease

Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroups, including non-dialysis CKD, hypertensive patients, non-smokers, and male patients. In conclusion, female sex, smoking, and CKD stage 5D were the major risk factors for elevated BCL; additionally, statins were negatively associated with BCL in CKD.