The Effect of a Personalized Oral Health Education Program on Periodontal Health in an At-Risk Population: A Randomized Controlled Trial

Can oral health care be a gateway to improve cardiovascular disease? A scoping review

Background

Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, resulting in a high socioeconomic burden. Growing evidence has shown a link between oral diseases and several chronic conditions including CVDs. The focus of this review is to investigate and summaries the evidence surrounding oral health interventions and their potential impact on reducing both the risk and/or severity of CVDs.

Methods

A scoping review was conducted to examine oral health interventions for managing CVD outcomes and risks. The review adhered to the Joanna Briggs Institute (JBI) framework for evidence synthesis and followed the reporting standards outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis- extension to Scoping Review (PRISMA-ScR). A systematic search across EBSCOhost, PubMed, and Scopus databases from 2012 to 2024 was utilized to identify relevant studies. Inclusion criteria focused on English language articles with a sample size of at least 50, evaluating the impact of oral health interventions on CVD outcomes.

Results

Out of the initial 2,154 studies identified in the search, 12 studies met the inclusion and exclusion criteria and were included in the final analysis. Overall, the studies revealed that along with surgical and non-surgical periodontal therapy, regular oral hygiene care practices, including toothbrushing, tongue brushing, and flossing, significantly reduced the risk of cardiovascular events and mortality. These interventions in patients with or without CVD baseline have shown a decrease in CVD risk markers as well as a reduction in bacterial colonization. Similarly, consistent oral hygiene routines, combined with regular dental visits, were associated with a lower risk of heart failure and CVD risk mortality.

Conclusion

The evidence extracted from this review suggests that periodontal therapy, regular dental cleaning, and re-enforcing of oral health regimes can stabilize oral health conditions and subsequently improve CVD progression/risks. However, limited to no evidence exists regarding the therapeutic effects of oral health promotion in managing CVD markers and its direct impact on disease outcomes, warranting further investigation.

Unemployment and expenditure on health and education as mediators of the association between toothbrushing and global income inequalities

Objective

The study assessed the association of country-level income inequalities with the percentage of schoolchildren toothbrushing-at-least-twice-daily; and the mediating effect of country-level unemployment rate and governmental expenditure on health and education (EH&E).

Methods

This was an ecological study. The dependent variable was country-level toothbrushing-at-least-twice-daily among 11-15-year-old schoolchildren. Data for the period 2009 to 2019 were extracted from two global surveys about schoolchildren’s health and from manuscripts identified through a systematic search of three databases. The independent variable was country-level income inequalities measured by the Gini coefficient (GC) extracted from the Sustainable Development Report 2021. The mediators were the unemployment rate and EH&E. We stratified the sample by the level of GC and assessed the correlation between the dependent and independent variables in each stratum. Linear regression was used to assess the relations between the dependent and independent variables, and mediation path analysis was used to quantify the direct, indirect, and total effects.

Results

Data were available for 127 countries. The mean (SD) percentage of children who brushed-at-least-twice-daily was 67.3 (16.1), the mean (SD) GC = 41.4 (8.2), unemployment rate = 7.5 (4.7) and EH&E = 8.4 (3.3). The percentage of children brushing at-least-twice-daily had weak and non-significant correlation with GC that was positive in countries with the least inequality and negative for countries with higher levels of inequality. A greater percentage of schoolchildren brushing-at-least-twice-daily was significantly associated with higher GC (B = 0.76, 95%CI: 0.33, 1.18), greater EH&E (B = 1.67, 95%CI: 0.69, 2.64) and lower unemployment rate (B=-1.03, 95%CI: -1.71, -0.35). GC had a significant direct positive effect (B = 0.76, 95%CI: 0.33, 1.18), a significant indirect negative effect through unemployment and EH&E (B=-0.47, 95%CI: -0.79, -0.24) and a non-significant total positive effect (B = 0.29, 95%CI: -0.09, 0.67) on the percentage of schoolchildren brushing-at-least-twice-daily.

Conclusion

Unemployment and EH&E mediated the association between income inequality and toothbrushing. Country-level factors may indirectly impact toothbrushing.

Self-determination theory guided oral self-care training for adolescents-A cluster randomised controlled trial

Quality oral self-care is a key element in maintaining oral health, which is important for students' general health, their overall well-being and learning. The cluster randomised controlled trial tested the following hypotheses: (1) self-determination theory (SDT)-guided dental education is superior to conventional dental instruction in modifying oral self-care in adolescents; (2) after the discontinued dental education, improved oral self-care is only maintained for short rather than long term and (3) multiple predictors explain variations in adolescents' oral self-care at different observation periods. The intervention group (N = 97) received three face-to-face educational sessions to facilitate adolescents' intrinsic motivation, while the control group (N = 99) had one conventional dental instruction session. Dental plaque scores (% of tooth area covered by dental plaque) indicated a lack of oral self-care. Linear multivariable models tested the following predictors of oral self-care at different observation periods: socio-demographics (sex, socio-economic status, school) and self-determination attributes (autonomy, relatedness, competence). Results indicated that from baseline to the 6-month follow-up, dental plaque scores decreased (oral self-care improved) in the intervention group but not in the control group. At the 12-month follow-up point, there were no significant differences in mean plaque scores between the study groups. Baseline plaque levels (β = 0.807), the type of dental instruction (theory guided vs. conventional) (β = 0.208), relatedness (β = 0.106) and competence (β = 0.102) were significant predictors that explained 67.6% of the variance in dental plaque scores at the 12-month follow-up point. The theory-guided education was superior to conventional verbal instruction in improving adolescent oral self-care; however, this improvement was only maintained short term. Variations in adolescent oral self-care at short- and long-term observation points were explained by baseline oral self-care levels and two SDT components: relatedness and competence.

Effects of Artificial Intelligence (AI)-Assisted Dental Monitoring Intervention in Patients with Periodontitis: A Randomized Controlled Trial

AIM

To evaluate the effects of an at-home AI-assisted dental monitoring application on treatment outcomes in patients with periodontitis.

MATERIALS AND METHODS

Participants with periodontitis were recruited and randomly assigned into an AI (AI; n = 16), AI and human counseling (AIHC; n = 17), or control (CG; n = 20) group. All participants received nonsurgical periodontal treatment. We employed an AI-assisted tool called DENTAL MONITORING® (DM) intervention, a new technological AI monitoring product that utilizes smartphone cameras for intraoral scanning and assessment. Patients in the AI and AIHC groups respectively received additional (a) DM or (b) DM with real-person counseling over three months. Periodontal parameters were collected at baseline and follow-ups. A mixed-design model analyzed the follow-up effects over time.

RESULTS

The AI and AIHC groups respectively exhibited greater improvement in probing pocket depth [Mean diff = -0.9±0.4 and -1.4±0.3, effect size (ES) = 0.76 and 1.98], clinical attachment level (Mean diff = -0.8±0.3 and -1.4±0.3, ES = 0.84 and 1.77) and plaque index (Mean diff = -0.5±0.2 and -0.7±0.2, ES = 0.93 and 1.81) at 3-month follow-up than the CG did. The AIHC group had a greater reduction in probing pocket depth (ES = 0.46) and clinical attachment level (ES = 0.64) at the 3-month follow-up compared with the AI group.

CONCLUSION

Using AI monitoring at home had a positive effect on treatment outcomes for patients with periodontitis. Patients with AI-assisted health counseling exhibited better treatment outcomes than did patients who used AI monitoring alone. This article is protected by copyright. All rights reserved.

Residual Self-Calibration and Self-Attention Aggregation Network for Crop Disease Recognition

The correct diagnosis and recognition of crop diseases play an important role in ensuring crop yields and preventing food safety. The existing methods for crop disease recognition mainly focus on accuracy while ignoring the algorithm’s robustness. In practice, the acquired images are often accompanied by various noises. These noises lead to a huge challenge for improving the robustness and accuracy of the recognition algorithm. In order to solve this problem, this paper proposes a residual self-calibration and self-attention aggregation network (RCAA-Net) for crop disease recognition in actual scenarios. The proposed RCAA-Net is composed of three main modules: (1) multi-scale residual module, (2) feedback self-calibration module, and (3) self-attention aggregation module. Specifically, the multi-scale residual module is designed to learn multi-scale features and provide both global and local information for the appearance of the disease to improve the performance of the model. The feedback self-calibration is proposed to improve the robustness of the model by suppressing the background noise in the original deep features. The self-attention aggregation module is introduced to further improve the robustness and accuracy of the model by capturing multi-scale information in different semantic spaces. The experimental results on the challenging 2018ai_challenger crop disease recognition dataset show that the proposed RCAA-Net achieves state-of-the-art performance on robustness and accuracy for crop disease recognition in actual scenarios.

Reduction of hsCRP levels following an Oral Health Education Program combined with routine dental treatment

OBJECTIVES

The present study aimed to determine the effect of a personalised oral health education program, in combination with routine dental treatment, on serum biomarkers of systemic disease compared to dental treatment alone in a population from a low-socioeconomic community with poor oral health.

METHODS

This secondary analysis of a randomised clinical trial involved 295 participants (mean age, 45.4 ± 11 years) assigned to two groups. One group received dental treatment combined with the Oral Health Education Program (OHEPDT), while the second group (DT) received dental care without the Education Program. Serum levels of high-sensitivity C-reactive protein (hsCRP), lipid profile (total cholesterol, triglycerides, and high- and low-density lipoprotein cholesterol), and HbA1c levels were analysed at baseline and after 12 months. Changes in diet, smoking and alcohol consumption were also determined.

RESULTS

No intergroup differences were observed for the lipid profile and HbA1c levels. A reduction in the hsCRP levels at the 12-month follow-up was observed in the OHEPDT group, which was significantly different from the DT group (p = 0.01). Multivariate modelling indicated that baseline hsCRP levels (p = 0.000), baseline body mass index (p = 0.000), and higher consumption of vegetables (p = 0.021) predicted a reduction in hsCRP levels.

CONCLUSIONS

This study demonstrated that personalised oral health education combined with routine dental treatment was associated with a significant reduction in hsCRP levels subsequent to dietary behavioural changes. These findings suggest that personalised oral health education in combined with routine dental treatment may have beneficial effects on general health.

CLINICAL SIGNIFICANCE

The strategy for developing an oral health program that involves education of the modifiable common risk factors for general health has beneficial effects and should be one of the priority components of these programs to improve oral and general health, particularly for at-risk communities.