Mercury Concentration in Saliva and the Impact of Chewing: An Inductively Coupled Plasma Mass Spectrometry Study

Mercury, which is found in dental amalgams, is considered to be the most toxic non-radioactive element. However, the health policies of different countries have not reached a consensus on the use and safety of amalgam. This study aims to investigate the effect of amalgam restorations on mercury concentration in saliva, as well as the effect of restoration number, surface number, and chewing on this concentration. A total of 86 participants were included in this study (an equal number for the study and control groups). The number of amalgam restorations and their surfaces were recorded. While both unstimulated and stimulated saliva were collected from the study group, only unstimulated saliva was collected from the control group. The effect of chewing on mercury concentration was examined in the study group with unstimulated and stimulated saliva specimens using inductively coupled plasma mass spectrometry device. Mercury concentration in the unstimulated saliva was found to be higher in the study group compared to the control group (p= 0.000). As the number of amalgam restorations and the number of amalgam restoration surfaces increased, the mercury concentration in the saliva increased (p= 0.015 and p= 0.021, respectively). There was no statistically significant difference between mercury levels in the unstimulated saliva and the stimulated saliva (p=0.316). Chewing presented an insignificant difference in mercury concentration. Given this surprising result, the effect of chewing on mercury concentrations should be explored more extensively in future research.

Association of rotating night shift work with tooth loss and severe periodontitis among permanent employees in Japan: a cross-sectional study

Background

The modern 24/7 society demands night shift work, which is a possible risk factor for chronic diseases. This study aimed to examine the associations of rotating night shift work duration with tooth loss and severe periodontitis.

Methods

This cross-sectional study used data from a self-administered questionnaire survey conducted among 3,044 permanent employees aged 20-64 years through a Japanese web research company in 2023. The duration of rotating night shift work was assessed using a question from the Nurses' Health Study. Tooth loss was assessed based on self-reported remaining natural teeth count. Severe periodontitis was assessed using a validated screening questionnaire comprising four questions related to gum disease, loose tooth, bone loss, and bleeding gums. We employed linear regression models for tooth loss and Poisson regression models for severe periodontitis, adjusting for demographic, health and work-related variables and socioeconomic status.

Results

Among participants included, 10.9% worked in rotating night shifts for 1-5 years, while 11.0% worked in such shifts for ≥6 years. In fully adjusted models, rotating night shift work duration of 1-5 years was associated with tooth loss (beta -0.74, 95% confidence interval (CI) [-1.55 to 0.08]) and severe periodontitis (prevalence ratio 1.80, 95% CI [1.33-2.43]); however, the association with tooth loss was not statistically significant.

Conclusions

This study supports that employees who work short-term rotating night shifts may experience poor oral conditions. Further research is needed to determine whether long-term rotating night shift work is associated with deteriorated oral health.

A cross-sectional study of the association of dental health factors with progression and all-cause mortality in men diagnosed with HPV-associated oropharyngeal cancer

BACKGROUND

Human Papillomavirus-associated oropharyngeal cancer (HPV-OPC) incidence is increasing among men in the United States. Poor dental health has previously been associated with risk of head and neck cancers, oral HPV infection, and persistence but it is not understood whether dental health is associated with outcomes. We sought to determine the association of dental health with progression free survival and overall mortality among men with an HPV-OPC.

METHODS

A cross sectional study of men diagnosed with HPV-OPC between 2014-2020 at Moffitt Cancer Center in Tampa, FL was conducted. Dental records were abstracted for assessment of dental fitness prior to cancer treatment. Five dental factors including number of teeth lost, pocket depth, gingival score, loss of attachment, and bone loss were individually examined. Risk factor and outcome data were collected from a patient risk questionnaire and medical record. Using item response theory, an overall dental fitness score from five dental factors was developed in which missing data were multiply imputed. Cox proportional hazards model was used to assess whether dental factors were associated with progression-free survival or overall mortality.

RESULTS

Among 206 HPV-OPC cases, median follow-up was 3.4 years (IQR: 2.4-4.4) during which 40 cases involved progression or mortality and 25 deaths occurred. Overall dentition was significantly associated with progression free survival (p = 0.04) and with overall survival (p = 0.03) though findings were not significant after adjustment for age at diagnosis, stage, and smoking history (p = 0.146 and p = 0.120, respectively). A pocket depth of 7 mm or more was associated with overall survival (HR: 5.21; 95% CI: 1.43-19.11) and this remained significant after adjustment for confounding (aHR: 4.14; 95% CI: 1.72-16.26).

CONCLUSIONS

Among men diagnosed with an HPV-associated OPC in the US, worse dental health was associated with reduced progression free survival and overall survival, but not after adjustment for confounders. Further studies are needed to examine whether dental health is associated with other prognostic factors and subsequent treatment-related outcomes.

Practical applications of teledentistry during the Covid-19 pandemic in ASEAN member states - a systematic review

OBJECTIVE

The objective of this review is to determine the utilisation and adoption of teledentistry based solutions and technologies during the Covid-19 Pandemic in the Asean region.

BACKGROUND

Teledentistry is a branch of telemedicine that has rapidly advanced in the last few years and has the potential to provide solutions to oral health problems of patients and locations that do not have prompt and immediate access to a dentist or dental services. The Covid-19 has increased the adaption of all digital health technologies and teledentistry is no exception.

METHODOLOGY

The study utilized online databases such as Pubmed (Medline), Scopus (Embase) and CINAHL for the purpose of document search. Newcastle Ottawa (NOS) scale was used to determine the quality of the studies included in our systematic review. PRISMA guidelines were used as the criteria for reporting items in the systematic review.

RESULTS

A total of 1297 documents were found after applying the search criteria and the keywords for the selected study. After applying the Prisma guidelines, removal of duplicates and irrelevant entries, 10 studies that were conducted during the Covid-19 pandemic were selected, fitting the inclusion criteria. All the studies included were evaluated for quality and risk of bias through the Newcastle Ottawa scale. Only high-quality studies were included for the final review.

CONCLUSION

Teledentistry is a cost-effective solution to screen, diagnose and treat dental patients from a distance. Teledentistry also has the potential to continue seamless continuation of dental education to dental students, during disruptive and non-disruptive periods. ASEAN countries should fully utilise the potential of teledentistry, however sound and effective legislation would be the key first step to achieving that potential.

Dental Caries diagnosis from bitewing images using convolutional neural networks

BACKGROUND

Dental caries, also known as tooth decay, is a widespread and long-standing condition that affects people of all ages. This ailment is caused by bacteria that attach themselves to teeth and break down sugars, creating acid that gradually wears away at the tooth structure. Tooth discoloration, pain, and sensitivity to hot or cold foods and drinks are common symptoms of tooth decay. Although this condition is prevalent among all age groups, it is especially prevalent in children with baby teeth. Early diagnosis of dental caries is critical to preventing further decay and avoiding costly tooth repairs. Currently, dentists employ a time-consuming and repetitive process of manually marking tooth lesions after conducting radiographic exams. However, with the rapid development of artificial intelligence in medical imaging research, there is a chance to improve the accuracy and efficiency of dental diagnosis.

METHODS

This study introduces a data-driven model for accurately diagnosing dental decay through the use of Bitewing radiology images using convolutional neural networks. The dataset utilized in this research includes 713 patient images obtained from the Samin Maxillofacial Radiology Center located in Tehran, Iran. The images were captured between June 2020 and January 2022 and underwent processing via four distinct Convolutional Neural Networks. The images were resized to 100 × 100 and then divided into two groups: 70% (4219) for training and 30% (1813) for testing. The four networks employed in this study were AlexNet, ResNet50, VGG16, and VGG19.

RESULTS

Among different well-known CNN architectures compared in this study, the VGG19 model was found to be the most accurate, with a 93.93% accuracy.

CONCLUSION

This promising result indicates the potential for developing an automatic AI-based dental caries diagnostic model from Bitewing images. It has the potential to serve patients or dentists as a mobile app or cloud-based diagnosis service (clinical decision support system).

Detecting high-risk neighborhoods and socioeconomic determinants for common oral diseases in Germany

BACKGROUND

Ideally, health services and interventions to improve dental health should be tailored to local target populations. But this is not the standard. Little is known about risk clusters in dental health care and their evaluation based on small-scale, spatial data, particularly among under-represented groups in health surveys. Our study aims to investigate the incidence rates of major oral diseases among privately insured and self-paying individuals in Germany, explore the spatial clustering of these diseases, and evaluate the influence of social determinants on oral disease risk clusters using advanced data analysis techniques, i.e. machine learning.

METHODS

A retrospective cohort study was performed to calculate the age- and sex-standardized incidence rate of oral diseases in a study population of privately insured and self-pay patients in Germany who received dental treatment between 2016 and 2021. This was based on anonymized claims data from BFS health finance, Bertelsmann, Dortmund, Germany. The disease history of individuals was recorded and aggregated at the ZIP code 5 level (n = 8871).

RESULTS

Statistically significant, spatially compact clusters and relative risks (RR) of incidence rates were identified. By linking disease and socioeconomic databases on the ZIP-5 level, local risk models for each disease were estimated based on spatial-neighborhood variables using different machine learning models. We found that dental diseases were spatially clustered among privately insured and self-payer patients in Germany. Incidence rates within clusters were significantly elevated compared to incidence rates outside clusters. The relative risks (RR) for a new dental disease in primary risk clusters were min = 1.3 (irreversible pulpitis; 95%-CI = 1.3-1.3) and max = 2.7 (periodontitis; 95%-CI = 2.6-2.8), depending on the disease. Despite some similarity in the importance of variables from machine learning models across different clusters, each cluster is unique and must be treated as such when addressing oral public health threats.

CONCLUSIONS

Our study analyzed the incidence of major oral diseases in Germany and employed spatial methods to identify and characterize high-risk clusters for targeted interventions. We found that private claims data, combined with a network-based, data-driven approach, can effectively pinpoint areas and factors relevant to oral healthcare, including socioeconomic determinants like income and occupational status. The methodology presented here enables the identification of disease clusters of greatest demand, which would allow implementing more targeted approaches and improve access to quality care where they can have the most impact.

Fluoride and its Implications on Oral Health: A Review

This article aims to review the literature about the history of fluoride, its toxicity, prevalence, prevention, diagnosis, and management in oral healthcare practice. Fluoride is the cornerstone of oral health, playing a pivotal role in oral health. Fluoride can be administered topically or systemically. Topically, it is found in toothpaste, mouth rinses, and professional treatments such as fluoride varnish. These directly shield teeth from decay and strengthen the existing enamel. Systemically, fluoride is ingested through water, foods, or supplements, benefiting tooth development, especially in children. Nevertheless, responsible fluoride use is essential. Overexposure can lead to dental fluorosis, affecting tooth aesthetics. Consulting a dentist for personalized guidance on fluoride usage can help strike the right balance between oral protection and potential side effects, ensuring a radiant and healthy smile for life.

Effect of light curing on the efficacy of silver diamine fluoride: A systematic review

Objective

This study was aimed at comparing the performance of light-cured (LC) silver diamine fluoride (SDF) to non-LC SDF in dental applications, in terms of various properties.

Methods

Articles published until April 2023 were retrieved from electronic databases (PubMed, Scopus and Science Direct) according to Boolean operators, and the reference lists of the included articles were manually searched. The included articles were all full-text, original studies in English that assessed the effects of LC SDF compared with SDF alone. The risk of bias in the in vitro studies on dental materials was evaluated with the modified Consolidated Standards of Reporting Trials (CONSORT) checklist.

Results

Six studies (five in vitro and one ex vivo) were included in qualitative analysis after a comprehensive manual search and electronic database search. Every study compared LC SDF versus non-LC SDF in terms of properties such as penetration depth, silver ion precipitation, dentine hardness, surface morphology and anti-bacterial characteristics. Four studies were categorised as low quality with a high risk of bias, whereas the remaining two studies were considered high quality with a low risk of bias.

Conclusion

In this investigation, LC SDF, compared with non-LC SDF, was found to be an efficacious approach for enhancing SDF properties. Future high-quality studies, particularly randomised clinical trials, remain necessary to verify these findings.

Clinical significance

The use of light curing with SDF can be a beneficial strategy that enhances SDF's clinical use. This review comparing various properties of LC SDF and non-LC SDF may help clinicians enhance clinical use and patient acceptance of LC SDF.

Immune indices and oral health in patients infected with the human immunodeficiency virus

BACKGROUND

The human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS). During the incubation period of AIDS, oral manifestations may precede systemic symptoms; therefore, it is vitally important to explore the relationship between HIV and oral health and other indicators. This study aimed to further assess the correlation between demographic risk factors, the dental health of HIV-infected patients, and the correlation of oral health indicators with CD4+ T-cell counts (CTCCs) and HIV viral loads (HIV-VLs).

METHODS

Demographic data on 108 HIV-infected patients were first recorded by questionnaire from March 2016 to November 2018. Patients' dental health and oral lesions were assessed by a dental specialist; in addition, they were tested for CTCCs and HIV-VLs by flow cytometry and NucliSENS EasyQ® HIV-1 virometer. Finally, the links between CTCC, HIV-VL, and the dental health (including oral lesions) of the patients were analyzed.

RESULTS

We found that age, marital status, and body mass index (BMI) were relevant to the patient's dental health (P < 0.05) and that their oral hygiene was relevant to their dental health (P < 0.05). However, HIV-VL was not directly related to periodontal/dental clinical indicators (P > 0.05). We discovered that the oral lesions in HIV-infected patients were related to decreased CTCCs and increased HIV-VLs (P < 0.05).

CONCLUSIONS

We concluded that HIV-infected patients with severely impaired immune function tend to have poor dental health. Moreover, the prevalence of oral lesions was negatively correlated with CTCC and positively correlated with HIV-VL.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

BACKGROUND

Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.

METHODS

Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.

RESULTS

The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1).

CONCLUSIONS

One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

The relationship between overprotective parenting, toothbrushing practices and children's behaviour during dental treatments in 4 to 11-year-old Dutch children: a cross sectional study

PURPOSE

Overprotective parenting and its impact on child development has gained increasing public attention. This study explored the association between overprotective parenting and behaviour during dental treatments and toothbrushing behaviour of 4 to 11-year-old-children.

METHODS

In this cross-sectional study, caregivers of 4-to-11-year-old children who visited a referral practice for dental treatment in Leiden, The Netherlands, completed a questionnaire about overprotective parenting, using the Parental Overprotection Measure (POM), and children's toothbrushing behaviour. The dentist and dental assistant used the Venham scale to assess children's behaviour during dental treatments. Associations between the POM and the Venham scale and toothbrushing variables, were analysed using multiple ordered logistic regression.

RESULTS

The sample included 96 children (mean age: 7.3 ± 2.1 years, 59 boys). Overprotective parenting (higher POM scores) was significantly associated with more disruptive behaviour of children during dental treatments (higher Venham categories) (OR: 1.08 (95% CI 1.04; 1.13)) and lower caregiver self-efficacy regarding toothbrushing (OR 0.96 (95% CI 0.93; 0.99)), after adjustment for confounders. No associations between overprotective parenting and toothbrushing frequency or skipping toothbrushing were found.

CONCLUSIONS

Overprotective parenting has been associated with children's negative behaviour during dental treatments and lower caregiver self-efficacy regarding toothbrushing in primary school children who are treated in a referral practice for paediatric dental care.

The aetiology and incidence of infective endocarditis in people living with rheumatic heart disease in tropical Australia

PURPOSE

To define the incidence and microbiological aetiology of infective endocarditis (IE) in patients with rheumatic heart disease (RHD) in tropical Australia.

METHODS

A retrospective study that examined all episodes of IE between January 1998 and June 2021 among individuals on the RHD register in Far North Queensland, Australia.

RESULTS

There were 1135 individuals with a diagnosis of RHD on the register during the study period, representing 10962 patient-years at risk. Overall, there were 18 episodes of definite IE occurring in 16 individuals, although only 7 episodes occurred in native valves (11 occurred in prosthetic valves) equating to 0.7 episodes of native valve IE/1000 patient-years. No patient with mild RHD - and only one child with RHD - developed IE during the study period. Despite the study's tropical location, the causative organism was usually typical skin or oral flora. Among individuals with an indication for benzathine penicillin G (BPG) prophylaxis, only 1/6 episodes of IE due to a penicillin-susceptible organism received BPG in the month before presentation.

CONCLUSION

Although RHD predisposes individuals to IE, the absolute risk of IE in native valve disease in tropical Australia is low and might be reduced further by improved adherence to secondary BPG prophylaxis.

The Dental Health of Looked After Children in the UK and Dental Care Pathways: A Scoping Review

BACKGROUND

There has been a 37% increase in the number of Looked After Children (LAC) in England over the past decade. Although LAC have more health and social problems than their peers, little is known about their dental needs, barriers to dental care, and pathways used to access it.

OBJECTIVES

This scoping review assessed the evidence on the dental health needs of LAC in the UK and their different dental care pathways.

METHODS

Embase, MedLine(R), Scopus, Web of Science, PubMed and CINAHL, grey literature databases and third-sector organisation websites were searched up to February 2022. Included studies were any study type involving UK resident LAC aged 0-18 with no limits placed on time in care/placement. Thematic analysis identified access barriers and dental care pathways.

RESULTS

Twenty-eight articles were included (nine publications, 11 abstracts and 8 grey literature). Oral health surveys, population linkages studies and service evaluations described the poor oral health of LAC and their unmet needs. Barriers included the lack of dental care and irregular attendance; the lack of integrated working between health and social care teams, lack of self-care and oral health promotion, and psychological issues complicating dental treatment. Four dental care pathway models were identified: care navigation, facilitated access, nurse-led triage and referral, and signposting to local dentist with multi-agency information sharing.

CONCLUSION

LAC are a vulnerable group with barriers to care suggesting the need for integrated working between health and social care teams, specialist services and an evaluation of pathways to identify best practice.

Oral and craniofacial research in the Generation R study: an executive summary

OBJECTIVES

Oral conditions are of high prevalence and chronic character within the general population. Identifying the risk factors and determinants of oral disease is important, not only to reduce the burden of oral diseases, but also to improve (equal access to) oral health care systems, and to develop effective oral health promotion programs. Longitudinal population-based (birth-)cohort studies are very suitable to study risk factors on common oral diseases and have the potential to emphasize the importance of a healthy start for oral health. In this paper, we provide an overview of the comprehensive oral and craniofacial dataset that has been collected in the Generation R study: a population-based prospective birth cohort in the Netherlands that was designed to identify causes of health from fetal life until adulthood.

METHODS

Within the multidisciplinary context of the Generation R study, oral and craniofacial data has been collected from the age of 3 years onwards, and continued at the age of six, nine, and thirteen. Data collection is continuing in 17-year-old participants.

RESEARCH OUTCOMES

In total, the cohort population comprised 9749 children at birth, and 7405 eligible participants at the age of seventeen. Based on questionnaires, the dataset contains information on oral hygiene, dental visits, oral habits, oral health-related quality of life, orthodontic treatment, and obstructive sleep apnea. Based on direct measurements, the dataset contains information on dental caries, developmental defects of enamel, objective orthodontic treatment need, dental development, craniofacial characteristics, mandibular cortical thickness, and 3D facial measurements.

CONCLUSIONS

Several research lines have been set up using the oral and craniofacial data linked with the extensive data collection that exists within the Generation R study.

CLINICAL RELEVANCE

Being embedded in a multidisciplinary and longitudinal birth cohort study allows researchers to study several determinants of oral and craniofacial health, and to provide answers and insight into unknown etiologies and oral health problems in the general population.

Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada

OBJECTIVE

This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined.

METHODS

We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models.

RESULTS

The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants.

CONCLUSION

Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.

The effects of a sugar-sweetened beverage tax: moving beyond dental health outcomes and service utilisation

Despite considerable academic and policy interest in the taxation of sugar-sweetened beverages (SSBs), its extra-health implications remain largely unexplored. We investigated the impact of an SSB tax on school absenteeism due to improved dental health, in a framework that accounted for the distribution of the benefit. We designed a quantitative, decision-analytic model that synthesised existing evidence in the areas of dental epidemiology, public health and economics, and simulated causal mechanisms that lead to changes in school attendance in Australian children and adolescents aged 6-17, in a tax vs no tax scenarios. Introducing a 20% sales tax on SSBs would result in a 0.73% (95% confidence interval: 0.38; 1.10), or 4684 (2412; 7071) days per year nationwide, reduction in school absences attributable to dental health reasons. While positive impacts would be seen across the board, the distribution of benefit was favourable towards boys, older teens and those from lower socio-economic status. Our study highlights the need for, and the viability of, quantifying distributions of direct and indirect consequences of public health policy. Despite modest effect size, the equity profile of SSB tax, the long-lasting benefits of educational gains, and potential synergies with other interventions, make it an attractive option for policymakers to consider.

Childhood dental caries experience in northern Spain: a cross-sectional study

PURPOSE

This study aimed to describe the caries experience in primary and permanent dentition of schoolchildren from a sample taken in public schools in Bilbao, to identify the most vulnerable child population, and compare them with the findings obtained by the Children's Dental Care Programme in the region of the Basque Country (Spain).

METHODS

A cross-sectional study was conducted using a representative sample (n = 1682) of children from 5-year-old early childhood education classes and the first- and second-year elementary classes in public schools in Bilbao. The dependent variable was the caries experience determined through oral examinations carried out by a single dentist. On the other hand, independent variables were measured through questionnaires completed by families, with help from teachers as appropriate. In the statistical analysis, Mann-Whitney and Kruskal-Wallis nonparametric tests, as well as two logistic regressions, were performed, and the significance level was set at α = 0.05 for decision making.

RESULTS

The mean (SD) values of dft, DMFT, DMFS and DMFT of first permanent molars scores were 1.25 ± 2.20, 0.16 ± 0.61, 0.20 ± 0.90 and 0.15 ± 0.57, respectively. Compared to the findings in the most recent PADI report, the schoolchildren in our sample had slightly greater experience of dental caries in primary dentition and much greater experience in permanent dentition.

CONCLUSION

The dft index of the primary dentition for the current sample is 1.25, while the DMFT index for the permanent dentition is 0.16. Among pupils in early childhood and elementary education in public schools in Bilbao, children from families with low socioeconomic status and educational attainment are most vulnerable to developing caries.

Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children

Aims and objectives

To determine the differences between type 1 diabetic children and healthy children regarding oral hygiene, gingival and periodontal health, and permanent teeth eruption.Materials and methods: A case-control study was conducted on 80 children (40 type 1 diabetic children and 40 healthy children) aged 6-12-year-old. The groups were further divided into subgroups (early and late mixed dentition). All study aspects were examined clinically using the simplified oral hygiene index, Löe and Silness gingival index, clinical attachment loss (CAL), and Logan and Kronfeld stages for tooth eruption. The data were analyzed using Fisher's exact test, chi-squared test, and logistic regression models. A p-value of ≤0.05 was the threshold for statistical significance.

Results

No significant difference was found between diabetic and healthy children regarding oral hygiene and gingival health. Most children had poor oral hygiene (52.5% in the case group and 60% in the control group), with fair gingival health (70% in the case group and 55% in the control group). Diabetic children had significantly (p = 0.05) more periodontitis than healthy children. Teeth in the advanced stage of the eruption were significantly higher in diabetic than control subjects (p = 0.048 in stage V and p = 0.003 in stage VI). Older diabetic children in late mixed dentition exhibited accelerated eruption.

Conclusion

Periodontitis was significantly more common in diabetic than in healthy children. The advanced stage of the eruption was significantly higher in diabetic than in control subjects.

Clinical significance

Type 1 diabetic children had more periodontal disease and advanced stage of permanent teeth eruption compared to healthy children. Therefore, periodic dental evaluation and a strong preventive plan for diabetic children is crucial.

How to cite this article

Mandura RA, El Meligy OA, Attar MH, et al. Assessment of Oral Hygiene, Gingival, and Periodontal Health, and Teeth Eruption among Type 1 Diabetic Saudi Children. Int J Clin Pediatr Dent 2022;15(6):711-716.

Age-specific associations with dental caries in HIV-infected, exposed but uninfected and HIV-unexposed uninfected children in Nigeria

Background

HIV infection and its management confer a substantial health burden to affected individuals and have been associated with increased risk of oral and dental diseases. In this study, we sought to quantify HIV-associated differences in the prevalence and severity of dental caries in the primary and permanent dentition of 4–11-year-old Nigerian Children.

Methods

We used clinical, laboratory, demographic, and behavioral data obtained from an ongoing cohort study of age-matched HIV-infected (HI, n = 181), HIV-exposed-but-uninfected (HEU, n = 177), and HIV-unexposed-and-uninfected (HUU, n = 186) children. Measures of dental caries experience (i.e., prevalence and severity) were based on dmft/DMFT indices recorded by trained and calibrated clinical examiners. Differences in primary and permanent dentition caries experience between HI, HEU, and HUU were estimated using multivariable logistic and negative binomial regression modeling.

Results

HI children had significantly higher caries experience (33%) compared to HEU (15%) and HUU (22%) children. This difference persisted in fully adjusted analyses [odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.0–2.6], was most pronounced in the permanent dentition (OR = 3.4; 95% CI = 1.2–9.5), and mirrored differences in caries severity. While molars were predominantly affected in both primary and permanent dentitions, caries lesion patterns differed between dentitions. Caries severity was significantly associated with hypoplastic primary teeth, gingival inflammation, and lower CD4 counts.

Conclusions

We found that the higher prevalence and severity of dental caries among HI children was driven by increased burden of permanent dentition caries compared to their uninfected counterparts. The dentition-specific associations identified in this study highlight the need to design and implement age-specific caries prevention strategies. These may include intensified oral hygiene regimens aimed at mitigating the cariogenic impact of hyposalivation among HI children. Similarly, the long-lasting impacts of developmental defects of the enamel in the primary and permanent dentitions must not be ignored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02421-w.

The impact of COVID-19 on individual oral health: a scoping review

BACKGROUND

Poor oral health due to dental caries is one of the most prevalent non-communicable diseases worldwide. It has a significant impact on individuals across the lifespan and is a leading cause of preventable hospitalizations. The impacts of COVID-19 on oral health at the practice level are well documented, but gaps in understanding the impact on individual oral health remain. This review addresses this gap.

METHODS

Using a JBI scoping review process we mapped and summarized the evidence to identify the impact of COVID-19 on individual oral health. Key search terms were developed, and searches were undertaken by an experienced research librarian.

RESULTS

The 85 included studies were conducted in 23 countries from 5 regions across the world classified using the United Nations Geoscheme system. The majority (82/85) were quantitative, 2 were reviews and there was one qualitative interview study. Cross-sectional surveys were the most common data collection approach followed by an analysis of clinical data, analysis of internet trends and other online methods. Five key areas were identified including changes to the provision of emergency dental services, provision of routine oral health services, oral hygiene maintenance at home, changes in dietary preferences, alternative models of dental provision and help-seeking and attitudes towards dental care in the future.

CONCLUSIONS

This scoping review has demonstrated that the pandemic has impacted on oral health at the individual level. It is important that we are aware of these impacts and ensure that support systems are in place to overcome future periods where access to dental care might be compromised. The provision of preventive care remains a vital first step in ensuring good overall oral health as is paramount during periods where access to dental treatment might be limited.

Anterior Dental Injuries in 8-12-year-old Schoolchildren of Yamunanagar, Northern India: A Districtwide Oral Health Survey

Background/aim

Due to its frequency, early occurrence, and severe adverse effects, if untreated, traumatic dental injury (TDI) is a public dental health issue. The purpose of this study was to investigate the prevalence of dental injuries caused by trauma in the anterior teeth among schoolchildren of Yamunanagar (Haryana), Northern India.

Materials and methods

A sample of 11,897 schoolchildren in the age-group of 8-12 years from 36 urban/rural schools was examined for TDI using Ellis and Davey classification. Children with TDI were interviewed using a structured questionnaire and presented with validated motivational videos to educate them about dental trauma, the sequelae of unmet treatment, and to motivate them to undergo treatment. The subjects with trauma were reevaluated after 6 months to assess the percentage of subjects who have undergone treatment after motivation.

Result and conclusion

The overall prevalence of children afflicted with TDI was 6.33%. Statistically, a significant difference of p ≤ 0.001 was noted between the percentage of boys (7.29%) and girls (4.8%) experiencing TDI. Maxillary incisors (94.3%) were the most commonly injured teeth. Falls in the playground (37.70%) were the major cause; on reevaluation, only 9.26% of the study population got their traumatized tooth treated. TDI is an existing dental problem. Motivating children at schools was found to be ineffective. There is a need to educate the parents and teachers to take appropriate preventive measures.

How to cite this article

Singh B, Pandit IK, Gugnani N, et al. Anterior Dental Injuries in 8-12-year-old Schoolchildren of Yamunanagar, Northern India: A Districtwide Oral Health Survey. Int J Clin Pediatr Dent 2022;15(5):584-590.

Dental health and dentistry in ancient Egypt: Possible evidence for dental filling and extraction at Deir el-Medina

OBJECTIVE

This study combines caries and antemortem tooth loss rates with possible dental interventions and medical texts to evaluate whether dentistry was practiced in Pharaonic Egypt.

MATERIALS

The study includes 32 mandibles and 44 maxillae consisting of 485 teeth and 1052 tooth sockets. It includes 14 Egyptian texts on dental treatments.

METHODS

Human remains were observed macroscopically for carious lesions and antemortem tooth loss. Egyptian texts were translated from photographs.

RESULTS

11 % of teeth were lost antemortem and 42 % of maxillae and mandibles had one or more teeth lost antemortem. One possible dental extraction is presented. Carious lesions were present in 10 % of teeth and 39 % of mandibles and maxillae. One example of a possible dental filling is presented. Two treatments from Papyrus Ebers discuss treatments to fill a tooth.

CONCLUSION

AMTL and carious lesions were common in this sample, especially in older adults. The possible presence of a dental extraction and a dental filling in combination with textual references to dental fillings indicate dental interventions were sometimes used to manage dental health in Egypt.

SIGNIFICANCE

This study is the earliest evidence in Egypt for a dental filling in human remains. It also offers an interdisciplinary analysis of dental treatments that indicates, contrary to earlier publications, that dental interventions were practiced in Egypt during the New Kingdom.

LIMITATIONS

The poor dental health of many Egyptian populations makes it impossible to assess how frequently Egyptians used dental interventions.

FURTHER RESEARCH

Future analysis of the dental filling could help determine its composition.

Oral health status of hospitalised patients with mental disorders: Systematic review of the literature

According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care. The aim was to carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD). A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017. According to the different filters that were applied, 14 articles describing the oral health status were obtained-through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)-of hospitalised patients with MD. The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Diabetes Mellitus and Dental Health in Children: A Review of Literature

Aim and objective

To illustrate the most important general findings significant for dentists dealing with pediatric diabetic patients, as well as the effect of type 1 diabetes mellitus (T1DM) on children's oral health.

Background

Type 1 DM is considered to be the most popular type of diabetes in children and adolescents which has a strong impact on their lifestyle. Diabetes mellitus (DM) mainly affect organs and tissues that are affluent with blood vessels including kidneys, eyes, and nerves. Adding to that oral cavity is covered with epithelial tissues that are rich with small blood vessels.

Materials and methods

An electronic search of English scientific papers was accomplished using PubMed, Google Scholar, and King Abdulaziz University digital library. Search terms used were children, DM, dental health, gingival health, oral hygiene, periodontal health, and teeth eruption.

Review results

Thirty-six articles were obtained from the electronic search and references of selected studies. In addition, other references were included from selected studies about DM and its relationship to oral health. Multiple studies confirmed that T1DM has a negative impact on oral hygiene, gingival and periodontal health, and teeth eruption. While other studies contradict these results.

Conclusion

There are contradictory studies regarding the effect of T1DM on oral health in children and adolescents. Well-established high-quality research with clear and concise materials and methods are required to have representative results.

Clinical significance

Studying the effect of T1DM on oral health in children and adolescents is indicated to set well-established guidelines to reach a high standard of care for those children.

How to cite this article

Mandura RA, El Meligy OA, Attar MH, et al. Diabetes Mellitus and Dental Health in Children: A Review of Literature. Int J Clin Pediatr Dent 2021;14(5):719–725.

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs

Background

The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group.

Methods

A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis.

Results

From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers’ perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers’ perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN.

Conclusions

An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community’s health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07293-4.

The association between periodontitis and cardiovascular risks in asymptomatic healthy patients

Background

Periodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. Pathophysiological evidence suggests a possible common inflammatory background between periodontitis and cardiovascular diseases (CVD). Pathological and epidemiological associations between these two diseases have been presented, but are still debated. This study aimed to investigate the association between the inflammatory burden of periodontitis and the presence and extent of coronary calcification. Secondary aims were to study other cardiovascular parameters and cardiovascular risk predictors in relation to periodontitis and dental health.

Methods

Healthy periodontitis or non-periodontitis patients 45-70 years of age were included in a prospective cross-sectional study. Full-mouth examinations were performed by a periodontist to determine their Periodontal Inflamed Surface Area (PISA) score and other dental parameters. To assess the cardiovascular conditions, Coronary Artery Calcium (CAC) scores, endothelial function assessments by the EndoPAT ™, and several physical and biochemical examinations were performed.

Results

Seventy-one patients were included. Elevated CAC scores and endothelial dysfunction were not significantly related to PISA or dental health. PISA was significantly related to the Framingham and Reynolds CVD risk predictors, but were no longer significant after correction for confounders. The same applied to the significant relations between tooth loss, dental plaque and bleeding scores and the CVD risk predictors.

Conclusions

Periodontitis is associated with increased CVD risk, but is not an independent risk factor. This link is still important to make to bridge the gap between dentistry and general medicine and to identify patients at risk for CVD in an earlier stage.

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

Background

We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan.

Methods

A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data.

Results

Compared with the CG, the IG had a greater reduction in plaque index among second graders (β =  − 0.36) and plaque control record scores among second, fourth, and sixth graders (β =  − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG.

Conclusions

The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01927-z.

Gender and age group modified association of dental health indicators with total occlusal force among Korean elders

BACKGROUND

This study aimed to investigate the distribution of objective total occlusal force (TOF) and its association with dental health indicators: dental status, number of natural teeth (NT), natural and rehabilitated teeth, natural posterior teeth (NT-Post), and natural and rehabilitated posterior teeth among Korean elders after controlling for various confounders encompassing socio-demographic factors, behavioral factors and health/oral health factors.

METHODS

This cross-sectional study recruited 551 elders from the Sungbook-Gu health education cohort. TOF was measured using Prescale II as an outcome variable. Dental health indicators assessed by dentists were the main explanatory variables. Analysis of covariance and multivariable linear regression models were applied to evaluate the adjusted association of dental health indicators with TOF. Gender and age group stratified analyses were also applied.

RESULT

TOF was higher in dentate elders than denture wearers in males and younger elders. The adjusted mean of TOF and standard error was 464.24 ± 17.15 N for dentate elders, 297.15 ± 28.85 N for partial denture wearers, 280.42 ± 47.71 N for complete denture wearers. Among all dental health indicators, NT-Post showed the highest association with TOF (partial r = 0.330, p < 0.001, R² = 0.15), followed by NT (partial r = 0.329, p < 0.001, R² = 0.16). Older elders highlighted the association of NT (partial r = 0.37, p < 0.001, R² = 0.18). Males decreased the association of NT (partial r = 0.30, p < 0.001, R² = 0.20) and NT-Post (partial r = 0.29, p < 0.001, R² = 0.20).

CONCLUSION

TOF was significantly associated with dental health indicators, and its association was modified by sex and age group.

Effect of National Oral Health Screening Program on the Risk of Head and Neck Cancer: A Korean National Population-Based

Purpose

Poor oral health is associated with head and neck cancer (HNC). We evaluated whether a national oral health screening program (OHSP) could reduce the risk of HNC.

Materials and Methods

Data from 408,247 healthy individuals aged ≥ 40 years from the National Health Insurance System-National Health Screening program during 2003 and 2004 in Korea were analyzed. The risk of HNC was compared between subjects who underwent OHSP (HEALS-Dental+, n=165,292) and routine health check-ups only (HEALS-Dental‒, n=242,955). The impact of individual oral health-related factors on HNC risk was evaluated in HEALS-Dental+.

Results

A total of 1,650 HNC cases were diagnosed. The 10-year HNC-free rate was 99.684% with a median follow-up of 11 years. The risk of all HNC (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.03 to 1.29; p=0.011) and oropharyngeal cancer (HR, 1.48; 95% CI, 1.13 to 1.94; p=0.005) was significantly higher in HEALS-Dental‒ than in HEALS-Dental+. In HEALS-Dental+, oral cavity cancer was marginally reduced (p=0.085), and missing teeth was a significant factor for HNC (HR, 1.24; 95% CI, 1.02 to 1.50; p=0.032). Toothbrushing was a significant factor in univariate analysis (p=0.028), but not in multivariate analysis (p=0.877).

Conclusion

The National OHSP significantly reduced the long-term HNC risk, particularly the incidence of oropharyngeal cancer. Routine OHSP should be considered at the population level.

From early to late modern societies (late 16th - early 20th century): Shifts in dental health status in two populations from southeastern France

In France, bioarcheological research has long overlooked the early and late modern periods, which witnessed major transformations impacting population structure and leading to the dawn of modern industrialized societies. Two recently excavated large cemeteries in Provence present a unique opportunity to investigate on a large scale the impact on health and living conditions brought about by the Industrial Revolution and consequently track health status changes from the 16th to the early 20th century. The sample includes 642 individuals from the early modern cemetery of Saint-Jacques, La Ciotat (1581-1831) and the late modern cemetery of Les Crottes, Marseille (1784-1905). This study aims to document dental health markers and compare the results between both assemblages, considering ante-mortem tooth loss, wear, caries, abscesses, calculus, periodontitis and linear enamel hypoplasia. The available archaeological and historical sources for these recent periods provide a full documentation in which to interpret and discuss the biological analysis, thus enabling an inclusive bioarcheological approach. RESULTS: revealed similarities between both samples. Differences are more subtle than expected and are seen through the increase in carious lesions and in linear enamel hypoplasia. The former seem to indicate changes in diet with the introduction of new foodstuffs and manufacturing processes during the Industrial Revolution. The latter could reflect the increase in early childhood stress, perhaps due to new feeding practices around weaning and breastfeeding or a poorly diversified diet. Finally, the increasing number of stress events could suggest a noxious sanitary and infectious environment. During the 19th century, Marseille experienced strong demographic and urban growth, resulting in overcrowded areas where sanitation facilities were insufficient or absent. Moreover, the activity of this important trading seaport might have promoted the transmission and appearance of epidemic diseases despite scientific and medical advances, which would have a real impact only from the 20th century onwards.

Dental health problems and treatment-seeking behavior among special need school students in Amhara region, Ethiopia

Background

Oral diseases are a public health concern with a significant impact on the quality of life of individuals. Children with special needs face significant challenges in carrying out oral hygiene due to their disability, and they are more prone to poor oral health and illnesses. This study assessed dental health problems and treatment-seeking behaviors of special needs school students in Amhara region, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from November 2020 to April 2021, in eight special needs schools located in the Amhara Regional State, Ethiopia. A total of 443 randomly selected special needs students were included. Data were collected using a structured interview-administered questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with oral health problems and treatment-seeking behavior. A p-value of less than 0.05 was used to declare statistical significance.

Results

The prevalence of self-reported dental health problems and treatment-seeking behaviors among special needs school students was 46.1% (95% CI: 41.4%, 50.7%) and 60.3% (95% CI: 53.4%, 66.8%), respectively. Place of residence, grade level, religious affiliation, years lived with disability, and knowledge of dental health-related risk behaviors were associated with dental health problems. Whereas, place of residence, being hearing impaired, and having prior information about dental health problems were associated with dental treatment-seeking behavior.

Conclusions

A significant number of special needs students reported dental problems and about 40% of them did not seek dental treatment. Oral hygiene practice and access to dental care services are important in the prevention of dental problems. Hence, oral hygiene promotion programs focusing on oral hygiene practice and dental treatment services are needed in special needs schools. It is also strongly suggested to incorporate oral health related information in health-related academic lessons to enhance optimum oral health among special needs students.

Prophylaxis of caries with fluoride for children under five years

We looked at existing recommendations and supporting evidence on the effectiveness and potential harms of the different fluoride interventions in preventing dental caries in children under 5 years of age.

We conducted a literature search up to the 12th of September 2019 by using key terms and manual search in selected sources. We summarized the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported.

Water fluoridation has been widely implemented worldwide for several decades and evidence shows it reduces the prevalence of dental caries. Salt or milk fluoridation are other collective fluoride interventions that are also effective to prevent dental caries in children. The evidence of effects of oral fluoride supplements for caries prevention is limited and inconsistent. The use of fluoride toothpastes has consistently been proven to be effective in the prevention of dental caries. The evidence for the effects of the different levels of fluoride concentration in toothpastes is more limited. Topical fluorides (gels and varnishes) are effective in preventing dental caries and are mainly recommended to children with high risk of dental caries. Early childhood intake of fluoride supplements and fluoride level of 0.7 ppm (ppm) in drinking water are associated with the risk of dental fluorosis, ranging from minor forms to severe forms that are of aesthetic concerns.

Improvements in Dental Health and Dentists' Workload in Norway, 1992 to 2015

OBJECTIVES

There has been a marked improvement in dental health in Norway during the last few decades. What effect has this had on provision of dental services, and how has private dental practitioners' assessment of their workload changed?

METHODS

The data were from 2 large surveys of private dental practitioners carried out in 1992 (n = 1056) and 2015 (n = 1237). An analysis of nonresponders showed that they were evenly distributed according to their age, gender, and the region in which their practice was located. Thus, the samples were representative of private dental practitioners. For 1 representative week in practice, the practitioners were asked to report the number of visits and the number of patients who received 1 or more of the following items of treatment: filling, crown, bridge, denture, root filling, extraction, and periodontal treatment. As a measure of patient supply, the responses from the following questions were used: "Based on an overall assessment of economy, workload, and other personal factors, is the number of regular patients adequate? If not, do you wish to have more patients or fewer patients?"

RESULTS

From 1992 to 2015, the annual number of visits per practitioner decreased by 23%. The number of patients per practitioner who received fillings, crowns, bridges, dentures, root fillings, or extractions decreased by 50% or more. The decrease was largest for practitioners younger than 35 years and for men. The proportion of practitioners who reported a deficit of patients increased from 20% to 37%.

CONCLUSIONS

Many dentists will have too few patients and a fall in income in the years to come is expected.

What makes inequality in the area of dental and oral health in developing countries? A scoping review

Background

Equity in health is an important consideration for policy makers particularly in low and middle income developing country. The area of oral and dental health is not an exception. This study is conducted to explore the main determinants that make inequality in oral and dental health area in developing countries.

Methods

This was a scoping review applying the framework enhanced by Levac et al. Four databases of Scopus, PubMed, WOS and ProQuest were systematically searched applying to related keywords up to 27.11.2020. There restriction was placed in the English language but not on the study design. All the related studies conducted in the low or middle income developing countries were included. A qualitative thematic analysis was applied for data analysis and a thematic map was presented.

Results

Among 436 articles after excluding duplications, 73 articles were included that the number of publications from Brazil was greater than other developing countries (33.33%). Thematic analysis of the evidence has led to 11 determinants that may result in inequality in oral and dental health services in developing countries including personal characteristics, health status, health needs and health behaviours, social, economic, cultural and environmental factors, as well as insurance, policies and practices and provided related factors.

Conclusion

The policymakers in the low and middle income developing countries should be both aware of the role of inequality determinants and also try to shift the resources to the policies and practises that can improve the condition of population access to oral and dental services the same as comprehensive insurance packages, national surveillance system and fair distribution of dentistry facilities. It is also important to improve the population’s health literacy and health behaviour through social media and other suitable mechanisms according to the countries’ local contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12962-021-00309-0.

Common Dental Issues in Pediatrics

This article reviews common issues in pediatric dental health, including normal development, developmental issues, infections, trauma, and preventative care.

Global concerns of dental and oral health workers during COVID-19 outbreak: a scope study on the concerns and the coping strategies

BACKGROUND

Dental and oral health workers have direct contact with respiratory aerosols of patients during procedures. This study aimed to determine the main concerns of dental and oral health workers globally during COVID-19 outbreaks and the coping strategies that help the resilience of dental and oral healthcare system.

METHODS

This scoping study was conducted in August 2020. After adjusting the search strategy, a systematic search of five databases (PubMed, ISI Web of Science, Scopus, ProQuest and EMBASE) was conducted. Data was extracted using Microsoft Excel and the contents of retrieved articles were analysed through a qualitative thematic analysis applying MAX QDA₁₀.

RESULTS

Most articles were either editorial/letters to the editor/commentary formats (34%), or literature reviews (26%). About half of the articles belonged to three countries of Italy, China and the USA (each 16% and totally 48%). Thematic analysis of included papers led to the identification of four main global concerns and 19 sub-concerns. Economic, ethical, social and professional concerns are among dental and oral health concerns. Other results indicate on three main themes and 13 sub-themes as the coping strategies including patient management, infection control and virtual strategies.

CONCLUSION

Dental and oral health care workers have many concerns relating to COVID-19 including economic, ethical, social and professional factors. Resolution of concerns may involve enhancing coping strategies relating to patient management and infection control strategies as well as using new technologies for virtual contact with the patient without any risk of infection.

The relationship between COVID-19 and the dental damage stage determined by radiological examination

OBJECTIVE

COVID-19 causes severe complications particularly in respiratory system especially in the elderly and those with poor general health. General and oral health are closely related to the course of such viral diseases. This study aims to reveal the relationship between the Dental Damage Stage (DD Stg) and the severity of COVID-19 disease.

MATERIALS AND METHODS

The study included 137 patients (20-65 years) based on oral examination records and panoramic X-rays of 1516 COVID-19 patients diagnosed through real time PCR tests. DD Stg were determined according to data of Apical Periodontitis Grading Scale, Radiologic Alveolar Bone Loss and Pathophysiological Process of Dental Caries obtained from dental radiological images. DD Stg were determined according to the severity of dental pathology and compared in terms of age, gender, numbers of dental caries (NDC), dental implants (NDI), root canal treatment (NRCT), tooth fillings (NTF), missing teeth (NMT) and hospitalization due to COVID-19 (NHC), presence of chronic disease (CD), and symptom associated with COVID-19 (SAC) RESULTS: Patients in DD Stg 3 had significantly higher age and mortality. CD, NDC and NHC values were higher in DD Stg 2 and 3 than in DD Stg 0 and 1. NHCs were higher in DD Stg 3 than in DD Stg 2. NMTs were higher in DD Stg 3 than other stages. SACs were significantly lower in DD Stg 0 than in DD Stg 1, 2 and 3. NDC, NHC, SAC and CD were effective on DD staging; they were moderately positively related.

CONCLUSIONS

The relationship detected between DD stage and the severity and prognosis of viral disease such as COVID-19 was found to be remerkable for extensive studies.

Parental Awareness and Knowledge toward their Children's Oral Health in the City of Dammam, Saudi Arabia

Introduction

Two main factors have a great influence on the youth's oral well-being. These are their dental health and age. These two factors are significantly directed by parents through establishing a system of proper oral hygiene and a preventative routine for those young adults.

Aim and objective

The following study was run in the Dammam region, Saudi Arabia, to assess guardian awareness of youngster's dental health.

Materials and methods

This community-based study was designed in a cross-sectional pattern, where a sample size of 248 parents who fulfilled inclusion criteria was selected and a well-designed validated questionnaire was used for the collected database using SPSS (VER. 24).

Results

The main found included that, about 51% of participants were fathers and 49% were mothers, 90% of them above the age of 26 years old and most of the participants had a secondary certificate or university degree, 38% and 45%, respectively, only 64% of parents have checked their children teeth, the average of overall knowledge of parents toward dental health was medium 7.97 points out of 16.0 points and there was a statistically significant relationship between parents type, educational level, and overall knowledge related to oral health.

Conclusion

From our study, it was acknowledged that the perception of children's oral health status by their parents in the Dammam region is relatively medium, so general awareness of parents' knowledge should be raised by conducting effective oral health programs and interventions.

How to cite this article

Alshammari FS, Alshammari RA, Alshammari MH, et al. Parental Awareness and Knowledge toward their Children's Oral Health in the City of Dammam, Saudi Arabia. Int J Clin Pediatr Dent 2021;14(1):100-103.

The Many Facets of Vitamin D in the Pediatric Population

Vitamin D is important for skeletal growth, bone mineralization and dental health. Vitamin D deficiency is reported in many countries, may have several causes and can cause rickets in children. A guideline with recommendations of vitamin D supplementation to prevent nutritional rickets was published recently. The vitamin D receptor is present in many cells of the body including cells of the immune system. Many studies have been published on associations between vitamin D deficiency and extra skeletal effects, mainly without proof of causality in intervention studies. This review aims to summarize available evidence of the skeletal and extra-skeletal effects of vitamin D. For the extra-skeletal effects there is proof that vitamin D supplementation can prevent acute respiratory infections in children with vitamin D deficiency and can reduce the rate of asthma exacerbations requiring corticosteroids in children with vitamin D deficiency. The evidence of benefit of vitamin D supplementation is too limited for pediatric patients with other infectious, inflammatory, and autoimmune diseases.

Associations between vision, hearing and tooth loss and social interactions: the JAGES cross-sectional study

BACKGROUND

Difficulties in communication due to vision, hearing and tooth loss have a serious impact on health. We compared the association between and attribution of each of these factors on social interaction.

METHODS

This cross-sectional study examined data from the 2016 Japan Gerontological Evaluation Study (n=22 295) on community-dwelling people aged ≥65 years in Japan. The dependent variable was the frequency of meeting friends as a measure of social interaction, and less-than-monthly was defined as fewer social interactions. The independent variables were self-reported degrees of vision, hearing (5-point Likert scale) and tooth loss (five categories), with 'poor' or '0 teeth' defined as the worst category. Sex, age, educational attainment, comorbidity and residential area were used as covariates. Poisson regression analysis with multiple imputations was used to estimate the prevalence ratios (PRs) of fewer social interactions by each status. Subsequently, the population attributable fraction (PAF) was calculated to assess the public health impact.

RESULTS

The number of participants with fewer social interactions was 5622 (26.9%). Proportions of fewer social interactions among those with the worst vision, hearing and number of teeth categories were 48.7%, 40.1% and 32.0%, respectively. Their corresponding PRs of fewer social interactions were 1.72 (95% CI 0.97 to 3.05), 1.35 (95% CI 0.99 to 1.85) and 1.23 (95% CI 1.10 to 1.37), respectively. The total PAF for vision, hearing and number of teeth was 8.3%, 5.0% and 6.4%, respectively.

CONCLUSION

Self-reported vision, hearing and tooth loss were associated with fewer social interactions. The magnitude of these impairments was largest in vision, followed by tooth and hearing loss.

Structuring, reuse and analysis of electronic dental data using the Oral Health and Disease Ontology

Background

A key challenge for improving the quality of health care is to be able to use a common framework to work with patient information acquired in any of the health and life science disciplines. Patient information collected during dental care exposes many of the challenges that confront a wider scale approach. For example, to improve the quality of dental care, we must be able to collect and analyze data about dental procedures from multiple practices. However, a number of challenges make doing so difficult. First, dental electronic health record (EHR) information is often stored in complex relational databases that are poorly documented. Second, there is not a commonly accepted and implemented database schema for dental EHR systems. Third, integrative work that attempts to bridge dentistry and other settings in healthcare is made difficult by the disconnect between representations of medical information within dental and other disciplines’ EHR systems. As dentistry increasingly concerns itself with the general health of a patient, for example in increased efforts to monitor heart health and systemic disease, the impact of this disconnect becomes more and more severe.

To demonstrate how to address these problems, we have developed the open-source Oral Health and Disease Ontology (OHD) and our instance-based representation as a framework for dental and medical health care information. We envision a time when medical record systems use a common data back end that would make interoperating trivial and obviate the need for a dedicated messaging framework to move data between systems.

The OHD is not yet complete. It includes enough to be useful and to demonstrate how it is constructed. We demonstrate its utility in an analysis of longevity of dental restorations. Our first narrow use case provides a prototype, and is intended demonstrate a prospective design for a principled data backend that can be used consistently and encompass both dental and medical information in a single framework.

Results

The OHD contains over 1900 classes and 59 relationships. Most of the classes and relationships were imported from existing OBO Foundry ontologies. Using the LSW2 (LISP Semantic Web) software library, we translated data from a dental practice’s EHR system into a corresponding Web Ontology Language (OWL) representation based on the OHD framework. The OWL representation was then loaded into a triple store, and as a proof of concept, we addressed a question of clinical relevance – a survival analysis of the longevity of resin filling restorations. We provide queries using SPARQL and statistical analysis code in R to demonstrate how to perform clinical research using a framework such as the OHD, and we compare our results with previous studies.

Conclusions

This proof-of-concept project translated data from a single practice. By using dental practice data, we demonstrate that the OHD and the instance-based approach are sufficient to represent data generated in real-world, routine clinical settings. While the OHD is applicable to integration of data from multiple practices with different dental EHR systems, we intend our work to be understood as a prospective design for EHR data storage that would simplify medical informatics. The system has well-understood semantics because of our use of BFO-based realist ontology and its representation in OWL. The data model is a well-defined web standard.

Early childhood caries prevention: non-dental health professionals' viewpoint

BACKGROUND

Dental caries can develop early in life and have harmful consequences. Objective: To examine non-dental practitioners' knowledge of early childhood caries (ECC).

METHODS

A questionnaire on oral health and caries knowledge was emailed to five types of health professional who work with young children: paediatricians, GPs, midwives, paediatric nurses and paediatric healthcare assistants. Questions concerned: when a child should first visit a dentist; at what age toothbrushing should start; aetiopathogenic factors; early diagnosis; and the effect of breastfeeding.

RESULTS

494 health professionals (79 paediatricians, 59 physicians, 217 midwives, 92 paediatric nurses and 47 paediatric healthcare assistants) participated. Although most (89.86%) discussed oral health with parents, responses on when a child should first see a dentist and when toothbrushing should start varied. Almost half of respondents said they could diagnose caries but not all were confident in this. Aetiological factors in ECC mentioned included oral hygiene, bottle feeding, sugar intake, genetics and a lack of fluoride.

CONCLUSION

Non-dental practitioners lack knowledge about ECC, so cannot help prevent it. Initiatives including interprofessional training would improve their knowledge of oral health in early childhood.

Factors associated with disparities in out-of-pocket expenditure on dental care: results from two cross-sectional national surveys

Background

Socioeconomic differences in oral health and dental care utilization are a persistent problem in many high-income countries. We evaluated demographic, geographic and socioeconomic factors associated with disparities in households’ out-of-pocket expenditure (OOPE) on dental care, and the effect of ongoing dental health reform on these disparities.

Methods

This cross-sectional analysis used data collected in two Israeli Household Expenditure Surveys conducted in 2014 and 2018. OOPE for dental care was estimated using a two-part multivariable model. A logistic regression was used to examine the likelihood of reporting any OOPE, and a log-transformed linear regression model examined the level of expenditure among those who reported any OOPE.

Results

In 2018, OOPE on dental care accounted for 22% of total health expenditure for all households, whereas among those who reported dental OOPE it reached 43%. Households with children up to age 14 years reported lower OOPE, regardless of ownership of supplementary health insurance. Owning supplementary health insurance had a heterogeneous effect on the level of OOPE, with a significant increase among those with 0–8 years of education, compared to households without such insurance, but not among those of higher educational level. In 2014, Arab ethnic minority and residence in the country periphery were associated with a greater likelihood for any OOPE and higher amounts of OOPE on dental care. While the gaps between Jewish and Arab households persisted into 2018, those between peripheral and non-peripheral localities seem to have narrowed.

Conclusions

The burden of dental OOPE on Israeli households remains heavy and some disparities still exist, even after the implementation of the dental health reform. Expanding the dental health reform and addressing barriers to preventive dental care, especially among Arabs and those of lower educational level, may help in reducing households’ private expenses on dental care.

An assessment of the readability of online material related to fluoride

Community water fluoridation has been deemed one of the greatest public health achievements, yet it remains a controversial topic. As those who are concerned about the benefits and safety of community water fluoridation are likely to turn to the Internet to find information, it is important to know the ease with which a person can read popular materials online. The aim of this study was to assess the readability levels of pro- and anti-fluoride articles on the Internet. Using a highly-recommended readability site, the first 100 articles garnered from websites in a Google were analyzed for a multitude of scores on popular readability tests. Of the 100 articles analyzed, 71 were deemed to be pro-fluoride, and 29 were anti-fluoride. Anti-fluoride materials were more readable across all scores when compared to the pro-fluoride materials. It is critical for consumers to be aware of the credibility of the health information they are reading and to be educated on how to determine if a website or source is reliable, especially when information is conflicting. It is also critical that health associations and other websites devoted to public health promotion develop and provide more accessible health information in terms of readability.

Oral Health Status of Hospitalised Patients with Mental Disorders: Systematic Review of the Literature

BACKGROUND

According to the literature, hospitalised patients with mental disorders have a higher risk of developing cavities and periodontal disease than the general population, associated with the motor difficulty to perform adequate oral hygiene, to the adverse effects caused by drugs for the control of psychiatric symptoms, as well as the lack of oral care and clinical care.

AIM

To carry out a systematic review of the literature on the oral health status of hospitalised patients with mental disorders (MD).

MATERIALS AND METHODS

A systematic search of the literature was carried out in PubMed, according to the PRISMA statement methodology, through the MeSh health descriptors "Dental Caries" and "Mental Disorders" in February 2017 RESULTS: According to the different filters that were applied, 14 articles describing the oral health status were obtained - through the DMF-T index (teeth with cavities, teeth with restorations, missing teeth and teeth with necessary extraction)- of hospitalised patients with MD.

CONCLUSIONS

The recognition of the importance of oral health by health professionals, carers and family members should be promoted; the oral cavity should be explored to determine the state of health in addition to instructing patients and support personnel in oral hygiene; mental health institutions should establish an intervention programme to eliminate oral infectious sites and then implement a multidisciplinary preventive programme to maintain oral health according to the MD diagnosis.

Aspects of oral health and dementia among Swiss nursing home residents

BACKGROUND

Little empirical evidence of high levels of oral diseases of people in need of care and the impact of dementia is available. The resident assessment instrument minimum data set (RAI-MDS) is an evaluation tool for caregivers.

OBJECTIVE

The aim of this study was to show oral health of nursing home residents through RAI-MDS 2.0 data as a function of the cognitive impairment.

METHODS

A retrospective analysis of RAI-MDS (general, cognitive, oral health variables) of 357 long-term care facilities in Switzerland (data of 105,835 residents) was carried out. The final sample size was 7922 residents after applying the inclusion/exclusion criteria in four evaluation groups (no dementia, moderate, severe and incident dementia).

RESULTS

As dementia developed and severity increased over time, subjects often had fewer or no teeth and did not wear removable dentures. Chewing problems increased over time regardless of the dementia severity. Oral complaints increased over time in subjects with severe dementia, which in turn led to low body mass index (BMI) values (<23 kg/m²) and was associated with an higher risk of mortality.

CONCLUSION

This dataset provides an overview on dental aspects in patients with dementia in nursing homes. The accuracy of the assessment of a given dental situation by nursing staff is to be questioned. The results indicated an underdetection of oral illnesses by nurses.

A rare case of brain abscess caused by Actinomyces meyeri

Background

Brain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess.

Case presentation

A 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam.

Conclusions

In conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.

Using Evidence-Based Dentistry in the Clinical Management of Methadone Maintenance Therapy Patients

AIMS AND OBJECTIVES

There is an increased interest to incorporate interprofessional educational models in the academic dental institutions to serve both student education and patient care. The aim of this report is to integrate evidence-based dentistry (EBD) with an interprofessional approach to treat methadone maintenance therapy (MMT) patients. Current example illustrates the case of a 26-year-old man receiving MMT who presented at Tufts University School of Dental Medicine with the chief complaint of "I want to fix my teeth." He presented with a collapsed vertical dimension of occlusion, extensive partial edentulism on both arches with bone loss, and a past history of drug abuse since the age of 16 years.

MATERIALS AND METHODS

The 5-step (ask, acquire, appraise, apply, assess) framework for the EBD process was used. First, the PICO (population, intervention, comparison, and outcome) question was asked, and then the literature was acquired and appraised. An expert librarian assisted in finding articles on the effects of methadone on the oral cavity and consequences that will affect dental treatment. The search was conducted on PubMed, using the following keywords: oral health, dentistry, dental health, and methadone. The search was performed from 1/1/2005 to 1/1/2018. After appraisal, the studies were applied in the clinical setting and treatment outcomes were assessed both subjectively and objectively.

RESULTS

The initial search identified there is sparse evidence on the topic. Only 34 articles were acquired. Based on the scientific evidence published, the interprofessional expertise of the clinical care team, and patient's perspective, 4 treatment plan options were proposed. The selected treatment plan was considered the best option considering an EBD person-centered approach. Progress of treatment, outcomes, and lessons learned were assessed.

CONCLUSIONS

This study demonstrates that incorporating EBD concepts and an interprofessional approach, MMT patients can be successfully treated. Future studies on this topic are recommended, specially considering the growth of the opioid epidemic in the past years and the need to treat the MMT patients and educate students.

The level of two trace elements in carious, non-carious, primary, and permanent teeth

Purpose

The boron and fluoride mainly accumulate in the bones and teeth of the human body. The purpose of this study is to determine boron or fluoride levels in the whole tooth, to evaluate the correlation between their levels and to compare these levels in primary/permanent, carious, and non-carious groups.

Materials and methods

The boron and fluoride levels of thirty-six teeth, separated such as primary carious (n=9) and non-carious (n=9), permanent carious (n=9) and non-carious (n=9), were determined by ICP-MS and ion-selective electrode, respectively.

Results

While boron levels were between 0.001 and 5.88 ppm, the fluoride levels were between 21.24 and 449.22 ppm. The boron level of non-carious teeth was higher than those of carious teeth in primary and permanent tooth groups. However, this difference was not statistically significant (p>0.05). The fluoride level of non-carious teeth was higher than those of carious teeth in primary (p=0.062) and permanent teeth groups (p=0.046). Negative correlation, found between boron and fluoride in all groups, was significant only in non-carious teeth group (r=-0.488, p=0.040).

Conclusion

The results of our study proved the importance of fluoride as a protective factor for dental caries once more. The boron levels in non-carious teeth were also higher than carious teeth. However, it was not significant. Moreover, there was negative correlation between teeth boron and fluoride levels. Therefore, it is necessary to conduct more detailed studies on the tooth boron level and its relation with caries formation and with fluoride levels.