Early childhood caries, climate change and the sustainable development goal 13: a scoping review

BACKGROUND

Sustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC).

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported.

RESULTS

The initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation.

CONCLUSION

The evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Scoping review on the association between early childhood caries and responsible resource consumption and production: exploring Sustainable Development Goal 12

BACKGROUND

The Sustainable Development Goal 12 (SDG12) promotes patterns that minimize waste and maximize resource utilization. It is therefore plausible that preventing Early Childhood Caries (ECC) and promoting oral health can contribute to sustainable consumption. In addition, sustainable consumption and production can contribute to the control of ECC. This scoping review aimed to explore the possible evidence on the link between ECC and the SDG12 targets.

METHODS

This scoping review identified articles on the link between resource consumption and production and caries according to the PRISMA-ScR guidelines. Three electronic databases (PubMed, Web of Science, and Scopus) were systematically searched in August 2023, using specific search terms. Studies written in English, with full text available, addressing dental caries and linked with waste minimization and resource utilization maximisation, with results that could be extrapolated to ECC in children less than 6 years of age) were included. Descriptive statistics were planned to summarize the categories of retrieved papers.

RESULTS

The initial search yielded 904 articles, with 863 screened for eligibility after the removal of duplicates. No studies were identified that reported data on an association between responsible consumption and production of resources factors and ECC.

CONCLUSION

This scoping review did not identify any articles published in English on evidence of the direct associations between ECC and SDG12 targets. However, there is a plausibility of such a link using minimum intervention dentistry for ECC management as a waste prevention and resource utilisation maximization strategy.

Scoping review on the link between economic growth, decent work, and early childhood caries

BACKGROUND

Early Childhood Caries (ECC) is a prevalent chronic non-communicable disease that affects millions of young children globally, with profound implications for their well-being and oral health. This paper explores the associations between ECC and the targets of the Sustainable Development Goal 8 (SDG 8).

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In July 2023, a search was conducted in PubMed, Web of Science, and Scopus using tailored search terms related to economic growth, decent work sustained economic growth, higher levels of productivity and technological innovation, entrepreneurship, job creation, and efforts to eradicate forced labor, slavery, and human trafficking and ECC all of which are the targets of the SDG8. Only English language publications, and publications that were analytical in design were included. Studies that solely examined ECC prevalence without reference to SDG8 goals were excluded.

RESULTS

The initial search yielded 761 articles. After removing duplicates and ineligible manuscripts, 84 were screened. However, none of the identified studies provided data on the association between decent work, economic growth-related factors, and ECC.

CONCLUSIONS

This scoping review found no English publication on the associations between SDG8 and ECC despite the plausibility for this link. This data gap can hinder policymaking and resource allocation for oral health programs. Further research should explore the complex relationship between economic growth, decent work and ECC to provide additional evidence for better policy formulation and ECC control globally.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status

BACKGROUND

The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation's Sustainable Development Goal 16 (SDG 16).

METHODS

Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed.

RESULTS

Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16.

CONCLUSION

There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

Impact of Protracted War Crisis on Dental Students: A Comparative Multicountry Cross-sectional Study

BACKGROUND

The impact of conflict and war crisis on dental students is poorly understood. Given the prolonged conflicts and political instability in the Arabic-speaking countries, it is crucial to investigate the effect of these conditions on dental students. This study aimed to assess the impact of protracted war on dental students by comparing the personal, university, and wider context challenges they face across war-affected and unaffected countries.

METHODS

A cross-sectional study was conducted including a convenience sample of dental students from 13 universities in 12 Arabic-speaking countries. Respondents were those at entry and exit points of their undergraduate dental training. A self-administered paper questionnaire collected anonymized data on sociodemographics, and personal, university, and wider context challenges that students were facing. Multivariable Poisson regression analyses were carried out.

RESULTS

The overall response rate was 64.8%. The mean age was 21.2 (standard deviation = 2.1) years, with 68% of participants being female. After adjusting for age and sex, dental students in Arabic-speaking countries affected by protracted war crisis were significantly more likely to report wider context challenges compared to their counterparts in unaffected countries (n = 2448; beta = 1.12; 95% confidence interval: 1.10-1.13; P < 0.001).

DISCUSSION

Dental students in Arabic-speaking countries affected by protracted war crisis were more likely to suffer from wider context challenges such as difficulties in attendance due to the deterioration of security and lack of flexibility of teaching time to accommodate the different circumstances induced by the war crisis. Supporting dental students in areas affected by protracted war crises is needed and may include developing online dental education programs.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study

BACKGROUND

The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19.

METHODS

The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion.

RESULTS

The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC.

CONCLUSIONS

This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Individual, familial and country-level factors associated with oral hygiene practices in children: an international survey

BACKGROUND

Maintaining good oral hygiene is key to preventing dental caries and periodontal disease. Children and adolescents with good oral hygiene behaviours are likely to grow into adults with the same behaviours. This study assessed the frequency of using various oral hygiene methods among children and adolescents from different countries and individual, familial and country-level factors associated with the use of these methods.

METHODS

A multi-country online survey collected data from caregivers of children in 2020-21 about children's use of oral hygiene methods including toothbrush, fluoridated toothpaste, mouthwash, dental floss and miswak using self-administered, close-ended questions. Adjusted multilevel logistic regression models were used to assess the relationship between each of the five oral hygiene methods (dependent variables) and the independent factors: sex, age, and history of dental visits (individual factors), mother's education and area of residence (familial factors) as well as country income and region (country-level factors).

RESULTS

A total of 4766 parents/caregivers were included from 20 countries (77.4% Eastern Mediterranean-region and 41.6% lower middle income countries). The most frequent oral hygiene methods were using toothbrush and toothpaste (90% and 60.3%). The use of oral hygiene methods differed by age, sex and history of dental visits as well as mother's education and area of residence (P < 0.05). In addition, children from low income countries had significantly lower odds of using mouthwashes and dental floss than those from high income countries (AOR = 0.55, 95% CI 0.31, 0.98 and AOR = 0.34, 95% CI 0.12, 0.97) whereas children from the European region had higher odds of using mouthwash (AOR = 2.82, 95% CI 1.27, 6.26) and those from the region of the Americas had higher odds of using dental floss (AOR = 3.84, 95% CI 1.28, 11.52) than those from the Eastern Mediterranean region.

CONCLUSIONS

The use of various oral hygiene methods is associated with individual, familial and country-level factors. Oral health promotion programs should be developed taking into account these influences.

Antibiotic use and resistance: Information sources and application by dentists in Jordan

Introduction: The availability of evidence-based information sources for dentists is essential to influence antibiotic prescribing practices and we need to understand how dentists interact with such sources and how this influences their practice. The present study aimed to evaluate dentists’ preferred sources of information and their awareness of available information and initiatives on prudent antibiotic prescribing practices in Jordan. Methodology: An online cross-sectional questionnaire was administered to dentists between July to September 2021. It was an adapted version of the European Centre for Disease Prevention and Control (ECDC) survey for antibiotic use and resistance. Results: A total of 204 dentists responded to the survey. The main sources of information regarding avoiding unnecessary antibiotic prescribing were published guidelines (35.5%), the dental professional body (20.0%), colleagues or peers (18.6%), and scientific organizations (17.2%), with the influence of these sources on changing prescribers’ views being 40.7%, 9.8%, 10.3%, and 14.2%, respectively. Of the surveyed dentists, 9.3%, 33.8%, and 56.9% were aware, unaware, and unsure of the presence of national action plans on antimicrobial resistance, respectively. Dentists reported their desire to receive more information about resistance to antibiotics (57.8%), medical conditions for which antibiotics are used (52.9%), how to use antibiotics (41.2%), prescribing of antibiotics (39.7%), and links between the health of humans, animals, and the environment (26.0%). Conclusions: The study provided insights into the information available to and used by dentists, which can inform effective antimicrobial stewardship strategies for improving antibiotic prescribing.

Outcome of vital pulp therapy in deeply carious molars affected with molar incisor hypomineralisation (MIH) defects: a randomized clinical trial

PURPOSE

To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months.

METHODS

In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant.

RESULTS

A total of  n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period.

CONCLUSIONS

VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp ²), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp ²=0.01), followed by physical violence (ηp ²=0.005), and sexual violence (ηp ²=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the associations between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country's gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp 2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp 2=0.01), followed by physical violence (ηp 2=0.005), and sexual violence (ηp 2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: Emotional and sexual violence where the two types of IPV associated with the prevalence of ECC. The associations were minor and the directions of their effects were difference. These findings need to be studied further.

Oral health practices and self-reported adverse effects of E-cigarette use among dental students in 11 countries: an online survey

OBJECTIVES

E-cigarette use has become popular, particularly among the youth. Its use is associated with harmful general and oral health consequences. This survey aimed to assess self-reported oral hygiene practices, oral and general health events, and changes in physiological functions (including physical status, smell, taste, breathing, appetite, etc.) due to E-cigarette use among dental students.

METHODS

This online, multicounty survey involved undergraduate dental students from 20 dental schools across 11 different countries. The questionnaire included demographic characteristics, E-cigarette practices, self-reported complaints, and associated physiological changes due to E-cigarette smoking. Data were descriptively presented as frequencies and percentages. A Chi-square test was used to assess the potential associations between the study group and sub-groups with the different factors. Statistical analysis was performed using SPSS at P < 0.05.

RESULTS

Most respondents reported regular brushing of their teeth, whereas only 70% used additional oral hygiene aids. Reported frequencies of complaints ranged from as low as 3.3% for tongue inflammation to as high as 53.3% for headache, with significant differences between E-cigarette users and non-users. Compared to non-smokers, E-cigarette users reported significantly higher prevalence of dry mouth (33.1% vs. 23.4%; P < 0.001), black tongue (5.9% vs. 2.8%; P = 0.002), and heart palpitation (26.3%% vs. 22.8%; P = 0.001). Although two-thirds of the sample reported no change in their physiological functions, E-cigarette users reported significant improvement in their physiological functions compared to never smokers or tobacco users.

CONCLUSION

Dental students showed good oral hygiene practices, but E-cigarette users showed a higher prevalence of health complications.

Self-reported knowledge, attitudes, and practice of final-year dental students in relation to child abuse: A multi-centre study

BACKGROUND

The number of child abuse cases is increasing worldwide; therefore, it is important to educate individuals having contact with children about it. This includes dentists who play a pivotal role in detecting and reporting child abuse.

AIM

To identify and compare the final- year dental student's knowledge, attitudes, and practice in relation to child abuse.

DESIGN

A 38- item and four- part online questionnaire was distributed to students of 11 dental schools in 10 countries. SPSS and GraphPad Prism were used for data analysis. The levels of statistical significance were determined using a chi- square test. P ≤ .05 was considered to be statistically significant.

RESULTS

A total of 660 students completed the survey. Fifty- six percent of the students received formal training on child abuse, and 86% wanted additional training. The knowledge of child abuse was significantly higher in Australia, the United States, and Jordan compared with other countries. Internet (60.3%) was commonly used as an information source for child abuse.

CONCLUSIONS

The study showed that dental students lack knowledge and experience in recognizing and reporting child abuse. Most respondents indicated a desire for additional training; therefore, dental schools should review what they are currently teaching and make changes as appropriate.

An ecological study on the association between early childhood caries and intimate partner violence in 20 low- and middle-income countries: 2007-2017

Background: Women are the worst affected by intimate partner violence (IPV), and this impacts negatively on the health of the children they care for. This study aimed to determine the relationship between IPV and the prevalence of early childhood caries (ECC) in 3-5-year-olds. Methods: This was an ecological study using IPV (physical, sexual, emotional) data extracted from the Demographic Health Survey of 20 low- and middle-income countries and ECC data for 3-5-year-olds of the same countries for the period 2007-2017. Linear regression analysis was used to assess the relationship between the percentage of 3-5-year-olds with ECC (outcome variable) and IPV indicators (physical, sexual, emotional). The model was adjusted for the country’s gross national income and the percentage of women with secondary or higher education. Partial eta squared (ηp2), regression coefficients, confidence intervals and p-values were calculated. Results: Data on ECC in 3-5-year-olds and IPV were available for six low-income-countries, 10 lower-middle-income-countries and four upper-middle-income-countries. The most prevalent form of IPV was physical violence (10.09%). The Democratic Republic of Congo had the highest prevalence of physical violence (45.8%), sexual violence (25.4%), and ECC (80.0%). The strongest association was between the prevalence of ECC and emotional violence (ηp2=0.01), followed by physical violence (ηp2=0.005), and sexual violence (ηp2=0.003). For every 1% higher prevalence of emotional violence, there was 0.28% higher prevalence of ECC, and for every 1% higher percentage of physical violence, there was 0.21% higher prevalence of ECC. On the contrary, for every 1% higher prevalence of sexual violence, there was 0.35% lower prevalence of ECC prevalence. Conclusions: The association between IPV and the prevalence of ECC in 3-5-year-olds is minor, with the strongest direct association effect being with emotional violence; and there was an inverse association between sexual violence and the prevalence of ECC. These findings need to be studied further.

Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

Correction to: An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

An amendment to this paper has been published and can be accessed via the original article.

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Background

Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC.

Methods

Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ²) as measure of effect size were calculated.

Results

Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ² = 0.18 vs. 0.05).

Conclusions

Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01500-8.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics’ and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics’ and institutions’ attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = −1.31, p = 0.006) and upper-middle income (UMICs) (B = −0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = −0.55, p < 0.0001) and in research only (B = −1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = −0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey

BACKGROUND

COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries.

METHODS

We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries.

RESULTS

Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007).

CONCLUSIONS

Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

An ecological study of the association between environmental indicators and early childhood caries

Objectives

A prior study described the association between ecosystem vitality, environmental health, and early childhood caries (ECC). The objective of this study was to determine the association between 24 global environmental indicators and ECC in 3–5-year-old children.

Results

In 61 countries, 55.5% of 3–5-year-old children had ECC. Eight factors had a small effect-size association with ECC: percentage of area that is marine-protected (partial eta squared; ƞ² = 0.03); species habitat index (ƞ² = 0.06); percentage of tree-cover loss (ƞ² = 0.03); regional marine trophic index (ƞ² = 0.03); total carbon dioxide emission intensity (ƞ² = 0.03); methane emission intensity (ƞ² = 0.04); nitrous oxide emission intensity (ƞ² = 0.06); and sulfur dioxide emission intensity (ƞ² = 0.03). Regression analysis revealed that two of these factors were significantly associated with the prevalence of ECC: methane emission intensity was inversely associated with ECC prevalence (B = − 0.34, 95% CI = − 0.66, − 0.03; p = 0.03), and nitrous oxide had a direct association with ECC prevalence (B = 0.35, 95% CI = 0.04, 0.67; p = 0.03).

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity

OBJECTIVE

COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors.

METHODS

We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms).

RESULTS

1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11).

CONCLUSIONS

COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

Knowledge, Attitude, and Practices of dentists in offering dental treatment to pregnant women in Jordan: A Cross-Sectional survey.. [DOI: 10.21203/rs.3.rs-38323/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Although international guidelines emphasized that pregnant patients should receive proper dental treatment, many dentists are still hesitant to do so. This study aimed to determine the knowledge, attitude, and practices of dentists towards offering dental treatment to pregnant women in Jordan.Methods: An online survey was distributed to 1000 dentists using social-media applications between August and October, 2019. The survey consisted of three sections; dentists’ knowledge about the association between oral diseases and pregnancy, their participation in training courses, and their practices regarding various dental treatments during pregnancy. Descriptive statistics were obtained and Chi-square tests were used to measure the association between demographic variables and knowledge, attitude, and practices variables. Significance was considered at P-value < 0.05.Results: A total of 547 (54.7%) responded to the questionnaire. Only (37.5%) agreed that periodontal diseases might increase risk of adverse pregnancy outcomes. Almost (75.9%) did not attend any training program. The 2nd trimester was the most preferable time to do all dental procedures. There was a tendency to perform scaling and fillings especially in the 2nd trimester (82.4%), (86.1%) respectively. The majority of dentists would feel comfortable to do RCT (72.0%) or extraction (60.0%) in the 2nd trimester, whereas greater caution was apparent on 1st and 3rd trimester. A proportion of (32.5%) thought that taking x-rays during pregnancy was contraindicated. About (53.7%) didn’t know about the safety to administer nitrous oxide sedation during pregnancy. Around (75.9%) refused to prescribe non-steroidal anti-inflammatory drugs to pregnant women. By far, paracetamol was the drug of choice (96.9%) to prescribe as an analgesic and amoxicillin as an antibiotic (89.2%).Conclusion: lack of knowledge, poor attitude and incorrect practices were observed among surveyed dentists with regards to management of pregnant women. Thus, further education courses about international guidelines are needed to correct the common misconceptions and negative attitudes and practices of dentists in treating pregnant women.

Knowledge, Attitude, and Practices of dentists in offering dental treatment to pregnant women in Jordan: A Cross-Sectional survey.. [DOI: 10.21203/rs.3.rs-38323/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BackgroundAlthough international guidelines emphasized that pregnant patients should receive proper dental treatment, many dentists are still hesitant to do so. This study aimed to determine the knowledge, attitude, and practices of dentists towards offering dental treatment to pregnant women in Jordan.MethodsAn online survey was distributed to 1000 dentists using social-media applications between August and October, 2019. The survey consisted of three sections; dentists’ knowledge about the association between oral diseases and pregnancy, their participation in training courses, and their practices regarding various dental treatments during pregnancy. Descriptive statistics were obtained and Chi-square tests were used to measure the association between demographic variables and knowledge, attitude, and practices variables. Significance was considered at P-value < 0.05.ResultsA total of 547 (54.7%) responded to the questionnaire. Only (37.5%) agreed that periodontal diseases might increase risk of adverse pregnancy outcomes. Almost (75.9%) did not attend any training program. The 2nd trimester was the most preferable time to do all dental procedures. There was a tendency to perform scaling and fillings especially in the 2nd trimester (82.4%), (86.1%) respectively. The majority of dentists would feel comfortable to do RCT (72.0%) or extraction (60.0%) in the 2nd trimester, whereas greater caution was apparent on 1st and 3rd trimester. A proportion of (32.5%) thought that taking x-rays during pregnancy was contraindicated. About (53.7%) didn’t know about the safety to administer nitrous oxide sedation during pregnancy. Around (75.9%) refused to prescribe non-steroidal anti-inflammatory drugs to pregnant women. By far, paracetamol was the drug of choice (96.9%) to prescribe as an analgesic and amoxicillin as an antibiotic (89.2%).ConclusionLack of knowledge, poor attitude and incorrect practices were observed among surveyed dentists with regards to management of pregnant women. Thus, further education courses about international guidelines are needed to correct the common misconceptions and negative attitudes and practices of dentists in treating pregnant women.

Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital

Aim

This 3-year retrospective case series evaluated the clinical and radiographic outcome of ferric sulfate and formocresol pulpotomy in primary molar teeth in a dental teaching hospital in Malaysia.

Materials and methods

Clinical and radiographic records of all pediatric patients who had pulpotomy of primary molar teeth between July 2005 and October 2008 were evaluated. A total of 55 pulpotomized primary molars were observed. Clinical assessments were carried out during the second visit to assess the presence of sinus tract, gingival swelling, excessive tooth mobility, tenderness to percussion, and abnormal exfoliation of the treated teeth. Periapical radiographs were reviewed for evidence of pathologic root resorption, radicular and/or periapical radiolucency, and abnormal pulp canal calcification. Treatments were regarded as failure in the presence of one or more of the above clinical and/or radiographic signs and symptoms.

Results

Of 55 pulpotomized teeth, 26 (47.3%) remained free from any clinical signs and symptoms and 48 (87.3%) showed no pathological radiographic findings. The clinical success rates of ferric sulfate and formocresol pulpotomy were 44.4% and 60.0%, respectively, whereas the radiographic success rates of ferric sulfate and formocresol pulpotomy were 86.7% and 90.0%, respectively. Although teeth treated with formocresol had higher both clinical and radiographic success rates compared with those treated with ferric sulfate, it was not statistically significant.

Conclusion

The clinical success rates of pulpotomy were lower compared with radiographic success rates. Ferric sulfate is an alternative to formocresol; however, the use of both agents in the dental undergraduate teaching at Universiti Sains Malaysia can still be recommended.

Clinical significance

Formocresol and ferric sulfate are advocated as pulpotomy agents in primary molar teeth since both agents showed comparable clinical and radiographic success rates.

How to cite this article

Sanusi SY, Jamaludin SA, Al-Batayneh OB, et al. Fate of Pulpotomized Teeth in Pediatric Patients: A 3-year Case Series in a Malaysian Dental Teaching Hospital. Int J Clin Pediatr Dent 2020;13(1):79-84.

Governance, maternal well-being and early childhood caries in 3-5-year-old children

Background

This study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children.

Methods

Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women’s opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis.

Results

Voice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence.

Conclusion

Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.

Women's economic empowerment, participation in decision-making and exposure to violence as risk indicators for early childhood caries

Objectives

In view of the association between early childhood caries (ECC])and maternal social risk factors, this study tried to determine if there were associations between indicators of processes, outputs and outcomes of women’s empowerment, and the prevalence of ECC.

Methods

In this ecological study, indicators measuring the explanatory variables - economic empowerment, decision-making and violence against women - were selected from the Integrated Results and Resources Framework of the UN-Women Strategic Plan 2018–2021 and WHO database. Indicators measuring the outcome variables - the prevalence of ECC for children aged 0 to 2 years, and 3 to 5 years - were extracted from a published literature. The general linear models used to determine the association between the outcome and explanatory variables were adjusted for economic level of countries. Regression estimates (B), 95% confidence intervals and partial eta squared (η²) were calculated.

Results

Countries with more females living under 50% of median income had higher prevalence of ECC for 3 to 5-year olds (B = 1.82, 95% CI = 0.12, 3.52). Countries with higher percentage of women participating in their own health care decisions had higher prevalence of ECC for 0 to 2-year-olds (B = 0.85, 95% CI = 0.03, 1.67). Countries with higher percentage of women participating in decisions related to visiting family, relatives and friends had higher prevalence of ECC for 3 to 5-year-olds (B = 0.67, 95% CI = 0.03, 1.32). None of the indicators for violence against women was significantly associated with the prevalence of ECC.

Conclusion

Empowerment of women is a welcome social development that may have some negative impact on children’s oral health. Changes in policies and norms are needed to protect children’s oral health while empowering women.

Effect of different acid etchants on the remineralization process of white-spot lesions: An in vitro study

PURPOSE

To investigate the effect of acid etchants with different low concentrations on remineralization of white spot lesion (WSL).

METHODS

WSL were prepared on buccal surfaces of 100 intact premolars using the methyl cellulose gel/lactic acid method. The samples were then placed in a remineralizing solution in addition to fluoride application twice daily for 5 minutes. The changes were quantified weekly using the Quantitative Light-induced Fluorescence (QLF) system. When changes in fluorescence radiance approached zero, each sample was etched with one of the following acids; 5% phosphoric acid, 10% phosphoric acid, 5% polyacrylic acid or 10% polyacrylic acid for 15 seconds, washed, dried, and placed again in the remineralizing solution. Two samples were randomly selected from each group for transverse microradiography (TMR) and scanning electron microscopy (SEM) analysis.

RESULTS

The 10% polyacrylic acid group showed the most significant improvement in fluorescence gain over the second phase of remineralization. It also showed partial loss of surface minerals without affecting enamel thickness as the phosphoric acid did. Additionally, 10% polyacrylic acid created the largest number of pores and smallest in size when compared to phosphoric acid, thus enhancing remineralization more efficiently than phosphoric acid without compromising the enamel outermost layer.

CLINICAL SIGNIFICANCE

The findings of this study may improve the remineralization of WSL from the bottom of the lesion instead of precipitation on the outermost layer of the lesion leaving a better quality of enamel. 10% polyacrylic acid enhanced remineralization more efficiently than phosphoric acid without compromising the enamel outermost layer.

Association between early childhood caries and poverty in low and middle income countries

Background

The aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods

This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R² measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.

Results

Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion

The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic

Objective

This study aims to assess the knowledge and confidence of dentists related to behavior management with extra personal protective equipment (PPE), non-aerosol-generating dental procedures in the course of the coronavirus disease-2019 (COVID-19) pandemic.

Materials and methods

A cross-sectional online survey was conducted among a sample of dentists who worked in Jordan and India in June 2020 during the COVID-19 pandemic.

Results

This study included a total of 177 dentists in Jordan and India that were practicing during the early months of the pandemic. Most dentists were seeing <6 patients per day. The most common emergency treatments during the pandemic by Jordanian dentists were abscesses (51.8%) and cellulitis (44.6%) vs (44.6%) abscesses and (35.5%) pulpitis in India. There was a high adoption of all elements of the PPE protocol. Most participants never or rarely used N₂O sedation to manage their patients in Jordan and India (80.4 and 71.1%), respectively. Participants in Jordan and India that considered treatment non-aerosol-generating procedures (non-AGP) were (82.1 vs 97.5%, p = 0.000), respectively.

Conclusion

Most of the surveyed dentists believe the extra PPE acts as a barrier to patient communication and child behavior management and would consider modifying the PPE to be more child-friendly. Most dentists consider non-AGP procedures and silver diamine fluoride (SDF) to be practical ways to practice safer dentistry, yet more training and information is needed for dentists treating children to provide a more confident safe environment for both dentists and their patients.

How to cite this article

Alsaleh MM, Sabbarini JM, Al-Batayneh OB, et al. Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic. Int J Clin Pediatr Dent 2020;13(S-1):S125–S131.

Parental Knowledge and Acceptance of Different Treatment Options for Primary Teeth Provided by Dental Practitioners

Background: Parents have an influence on dental treatment options for young children regarding type of care provided. The aim of this study was to assess parents' knowledge and acceptance of different treatment options for primary teeth provided by dental practitioners for their children.

Materials and Methods: In this descriptive, cross-sectional study, caregiver/child dyads (n = 476) were recruited from patients at Pediatric Dental Clinics, Jordan University of Science and Technology. The data collection questionnaire to parents included: 1-demographic data 2-parental knowledge and practices regarding child's oral hygiene, caries and caries prevention 3-parental knowledge and acceptance of different treatment options for primary teeth including two given clinical scenarios (ICDAS-5 molar requiring intra-coronal restoration, ICDAS-6 molar requiring pulp therapy and stainless steel crown) with pictures before and after treatment. Afterwards, the child underwent a dental examination to record dmft/DMFT, gingival and plaque indices. Data was analyzed using SPSS, significance was set at P ≤ 0.05.

Results: Children's ages were 2–12 years (mean/SD 6.97 ± 2.5); with 255/53.6% males, 221/46.4% females. There were (166) children 2–5 years in primary dentition; (108/166) 65% had ECC, and (n = 62/166) 37.4% had S-ECC, and (310) 6–12 years in mixed dentition; (278/310) 89.7% had caries. Scaling and extraction were the highest known and accepted treatments for primary teeth by parents (35.5 and 30.1%, respectively), while nitrous oxide/oxygen sedation was the least (3.6%). Parental educational level was significant for composite restorations, fluoride gel application and pulp therapy (P = 0.03, 0.02, and 0.03, respectively) and age above 40 for amalgam restorations (P = 0.04). In both scenarios, most parents preferred to leave any care decision in hands of the dentists with no effect of educational level (P > 0.05). There were 81.5% parents who reported that their children's dental status was good, however, 78.4%/42.8% children had an average dmft/DMFT score 5.34/2.32 and mean PI/GI scores 0.88 ± 0.20/0.17 ± 0.23.

Conclusion: Parental knowledge and acceptance about dental treatment options for primary dentition was generally low. Parental education and age had an impact on parental knowledge and practices regarding child's oral hygiene, caries and caries prevention, and some treatment options. There was an overrated parental opinion of their child's teeth status despite the high dmft/DMFT and PI.

Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders

PURPOSE

The Picture Exchange Communication System (PECS) is a communication system for children with autism spectrum disorders (ASD). The aim of this study was to assess the effect of a PECS-based tooth-brushing programme on gingival health in children with ASD and assess parents' perception of PECS.

METHODS

This was a prospective interventional study. Using PECS as a pictures/cards series showing a structured tooth-brushing method, 37 children with ASD (31 males, 6 females) (average age 9.49 ± 4.10, 4-16 years) and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3, 6-months) included gingival and plaque indices (GI, PI) and two questionnaires (baseline, 6-months) for demographic data and parents' perception of PECS including difficulty rating (easy, hard, very hard) and PECS usefulness.

RESULTS

Most children with ASD had language abilities (64.9%) and prior PECS use (67.6%). Both GI and PI significantly dropped between baseline and both re-evaluations, (P < 0.001). Age, among studied factors, significantly affected PI only at all stages (P < 0.001). Most parents/caregivers (75.7%) rated PECS as hard, but useful (100%). Age and PECS prior use significantly affected PECS difficulty rating (P  = 0.000 and 0.031, respectively), while sex did not (P  > 0.05).

CONCLUSION

PECS though rated as hard was useful in improving gingival health in children with ASD.

Prevalence and Data Availability of Early Childhood Caries in 193 United Nations Countries, 2007-2017

OBJECTIVES

To assess the relationship between health care system and economic factors and early childhood caries (ECC) data availability and prevalence.

METHODS

We estimated ECC data for 193 United Nations countries from studies published between 2007 and 2017. We obtained other variables from the World Health Organization and the World Bank databases. We assessed association with ECC data availability by using logistic regression and with ECC prevalence by using linear regression.

RESULTS

We included 190 publications from 88 (45.6%) countries. The mean ECC prevalence was 23.8% and 57.3% in children younger than 36 months and children aged 36 to 71 months, respectively. The odds of ECC data availability were significantly higher for countries with more physicians and more dentists. In children younger than 36 months, ECC prevalence was associated with universal health coverage (B = -6.56). In children aged 36 to 71 months, it was associated with growth of gross national income (B = 0.27).

CONCLUSIONS

Countries with more physicians and more dentists were more likely to have ECC data. Among those with data, countries with higher economic growth had higher ECC prevalence.

Dentists' intention to report suspected violence: a cross-sectional study in eight Arab countries

OBJECTIVES

This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour.

METHODS

A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders.

RESULTS

The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report.

CONCLUSION

Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries.

Association of weight and height with timing of deciduous tooth emergence

OBJECTIVES

The aim of this study was to associate weight and height with the timing of deciduous tooth emergence.

METHODS

1756 children, aged from 1 to 33 months (755 females and 1001 males) had been previously examined for the timing of deciduous tooth emergence and their weights and heights measured. Children were categorized into weight and height groups (underweight, normal, overweight, short stature, normal and tall stature). Probit regression analysis was used to calculate the ages at emergence of each deciduous tooth. Tooth emergence ages were compared pairwise across the weight and height groups.

RESULTS

The deciduous dentition emerged between 7.9-31.5, 7.8-29.6 and 6.3-26.5 months in the underweight, normal and overweight children, respectively. In the height groups, the ranges were 9.0-31.3, 7.4-27.0 and 6.7-24.3 in the short, normal and tall children, respectively. The extremes of weight and height were related to the times at deciduous tooth emergence where a substantial increase in weight or height was associated with earlier emergence, and vice versa. However, only canines, lateral incisors and upper central incisor showed statistically significant association with weight and none of the teeth exhibited statistically significant association with height. Moreover, no emergence sequence change was associated with weight and height.

CONCLUSIONS

The present study provides the first weight and height- specific data on the timing of deciduous tooth emergence. Although both weight and height are generally associated with the timing of deciduous tooth emergence, weight shows a stronger association for canines, lateral incisors and upper central incisor. The findings will aid assessing normal emergence timing in children with variant weights and heights.

Traumatic dental injuries in children with special health care needs

BACKGROUND/AIM

Children with special healthcare needs (CSHCN) are at an increased risk for traumatic dental injuries (TDI) due to unique predisposing factors; moreover, their access to dental care is compromised. In Jordan, there is a need to study TDI among CSHCN to highlight their dental care needs. The aim of this study was to identify the prevalence, types, possible risk factors associated with TDI, and treatment-seeking behavior in CSHCN in Jordan.

MATERIAL AND METHODS

Children (n=959) were examined in schools/centers for CSHCN, and compared to a healthy age- and gender-matched control group. Data concerning demographics, types of trauma, risk factors associated with TDI, and treatment-seeking behavior were collected. Data were analyzed using SPSS for descriptive and bivariate analyzes. Significance level was set at P≤.05.

RESULTS

Prevalence of TDI in the study group (age, 11.76±4.2 years) and control group (age 11.70±4.2 years) was (83 of 959, 8.7%) and (42 of 1010, 4.1%), respectively. TDI prevalence was highest in children with multiple disabilities (14.0%), followed by intellectual disabilities (13.1%), and cerebral palsy (12.2%). The most common type of TDI was an uncomplicated crown fracture (91.0%). Increased overjet and incompetent lips were significant risk factors associated with TDI. Reasons for not seeking treatment in the study vs control group included parental attitude and lack of dental awareness (68.1% vs 60%), difficulties getting an appointment and availability of dental clinics willing to see CSHCN (36.2% vs 0%), P≤.01, and financial reasons (31.9% vs 40%).

CONCLUSIONS

Prevalence of TDI was higher in CSHCN, and associated with increased overjet and incompetent lips. Uncomplicated crown fracture was the most common injury. In both groups, the main reason for not seeking treatment was lack of dental awareness among parents/caregivers; however, difficulties in getting an appointment and availability of dental clinics willing to see children were more prominent in the CSHCN group.

Assessment of Er:YAG laser for cavity preparation in primary and permanent teeth: a scanning electron microscopy and thermographic study

PURPOSE

Most studies of cavity preparation using Er:YAG lasers have employed permanent teeth. This study's purpose was to compare the cutting efficiency of an Er:YAG laser versus diamond burs in primary and permanent teeth in order to measure thermal effects on the pulp and evaluate lased surfaces using scanning electron microscopy (SEM).

METHODS

A total of 80 primary and permanent teeth were used. Crater depths and mass loss were measured after delivering laser pulses at varying energies onto sound or carious enamel or dentin using the Key-3 laser. Control samples were cut using diamond burs in an air turbine handpiece. Thermal changes were measured using miniature thermocouples placed into the pulp chamber. Lased surfaces were evaluated using SEM.

RESULTS

Laser ablation crater-like defects were deeper in dentin than enamel at the same pulse energy. Greater ablation rates for dentin and enamel and significantly more efficient removal of carious tooth structure by laser was present in primary teeth. Temperature rises in the pulp did not exceed the 5.5 degrees Celsius threshold in any teeth during laser ablation.

CONCLUSIONS

The Er:YAG laser is an efficient device for cavity preparations in primary teeth, with no unacceptable increases in temperature detected in this model.

Pre-eruptive intracoronal dentine radiolucencies in the permanent dentition of Jordanian children

PURPOSE

To determine the prevalence of pre-eruptive intracoronal dentine radiolucencies (PEIR) and subject factors or dental conditions associated with PEIR from orthopantograms (OPGs) in unerupted permanent teeth of children.

METHODS

OPGs were evaluated for 1,571 subjects (807 males, 764 females) with mean age (8.72 ± 2.5) years. Unerupted permanent teeth prior to emergence into the oral cavity were assessed. The Chi square test was used to determine statistical differences between the group showing and the group not showing the defect with regards to sex, stage of dental development, presence of developmental anomalies, and condition of primary predecessor teeth.

RESULTS

Prevalence was (8.1%) by subject and (0.62%) by teeth. All subjects showed only one affected tooth per subject with no significant gender differences. The highest prevalence was in mandibular first premolars (3.02%). Most defects were noted in the mixed dentition stage (89.06%), mainly in the mandible (79.7%) as single lesions at a mesial location intracoronally, and a size of less than one-third of dentine thickness in (50%). Among all variables examined, PEIR defects were significantly associated with mixed dentition stage (p = 0.000) and decayed/filled primary predecessor teeth (p = 0.028).

CONCLUSIONS

PEIR defects occur at a significant prevalence rate in unerupted teeth. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PEIR defects in children.

The alveolar bone height of the primary and first permanent molars in healthy 6- to 9-year-old Jordanian children

AIM

To establish a threshold cemantoenamel junction (CEJ)-alveolar bone crest (ABC) distance in healthy 6- to 9-year-old Jordanian children and determine the effect of pathological changes, physiological changes, gender, and age on the CEJ-ABC distance.

DESIGN

Bitewing radiographs were made for 539 6- to 9-year-old children. Plaque index (PI), gingival index (GI), calculus index (CI), DMFS score, and pocket depth were all assessed through clinical examination. CEJ-ABC distance was measured from radiographs at the mesial surface of permanent first molars (PFM), and the mesial and distal surfaces of primary molars.

RESULTS

The CEJ-ABC distance ranged from 0.00 to 4.49 mm, the mean for all surfaces was 0.84 ± 0.44 mm, no gender or age group differences were found. The mesial surface of the PFMs had the smallest mean CEJ-ABC distance. The CEJ-ABC distances were greater in the maxilla than in the mandible. No significant effect of PI, GI or CI on CEJ-ABC distance was found. Caries, faulty restorations, exfoliation, and partial eruption adjacent to measured surfaces had significant effect on the CEJ-ABC distance.

CONCLUSION

The mean CEJ-ABC distance was <1 mm. Threshold CEJ-ABC distances of 1.0 and 1.5 mm for PFMs and primary molars, respectively, are suggested to be used in 6- to 9-year-old children.

Missense mutation of the EDA gene in a Jordanian family with X-linked hypohidrotic ectodermal dysplasia: phenotypic appearance and speech problems

Mutations in the EDA gene are responsible for X-linked hypohidrotic ectodermal dysplasia, the most common form of ectodermal dysplasia. Males show a severe form of this disease, while females often manifest mild to moderate symptoms. We identified a missense mutation (c.463C>T) in the EDA gene in a Jordanian family, using direct DNA sequencing. This mutation leads to an amino acid change of arginine to cysteine in the extracellular domain of ectodysplasin-A, a protein encoded by the EDA gene. The phenotype of a severely affected 11-year-old boy with this mutation included heat intolerance, sparse hair (hypotrichosis), absence of 17 teeth (oligodontia), speech problems, and damaged eccrine glands, resulting in reduced sweating (anhidrosis). Both the mother (40 years old) and the sister (10 years old) were carriers with mild to moderate symptoms of this disease, while the father was healthy. This detailed description of the phenotype caused by this missense mutation could be useful for prenatal diagnosis.