The letter to Editor regarding ‘Patient-reported outcomes of esthetics, function and oral hygiene with single dental implants 10–15 years after placement: a cross-sectional study’

Little attention has been paid to patients' perception of function and esthetics with single dental implants. The aim of this study was therefore to describe patient-reported function and esthetic outcomes in single dental implants. A second aim was to study the objective esthetics in single dental implants. Patients with one single dental implant in the esthetic zone were selected. Two questionnaires with visual analog scales (VAS) were filled in by the patients, and intraoral photographs were taken. One of the questionnaires related to satisfaction with cleaning and function, and the other involved the esthetics of the single dental implant. One dentist reviewed the photographs using the pink esthetic score/white esthetic score (PES/WES) index. Results: For chewing and for speaking, the scores were 8.8 and 9.9 respectively on a VAS (best 10). The overall esthetic score on a VAS was 8.6 (best 10). The PES/WES in the present study was 14.6 (standard deviation [SD] ± 1.9), and 3/45 (6.7%) of the single dental implants never reached clinical acceptability. Conclusions: Patients reported high satisfaction with both the function and the esthetics of single dental implants. Both subjectively and objectively, the peri-implant mucosa was less favorable compared with the crown.

Cross-sectional studies

Accurate predictions of functional outcome after limb salvage surgery (LSS) in the lower limb are important for several reasons, including informing the patient preoperatively and, in some cases, deciding between amputation and LSS. This study aimed to elucidate the correlation between surgeon-predicted and patient-reported functional outcome of LSS in the Netherlands. Twenty-three patients (between six months and ten years after surgery) and five independent orthopedic oncologists completed the Toronto Extremity Salvage Score (TESS) and the RAND-36 physical functioning subscale (RAND-36 PFS). The orthopedic oncologists made their predictions based on case descriptions (including MRI scans) that reflected the preoperative status. The correlation between patient-reported and surgeon-predicted functional outcome was “very poor” to “poor” on both scores (r2 values ranged from 0.014 to 0.354). Patient-reported functional outcome was generally underestimated, by 8.7% on the TESS and 8.3% on the RAND-36 PFS. The most difficult and least difficult tasks on the RAND-36 PFS were also the most difficult and least difficult to predict, respectively. Most questions had a “poor” intersurgeon agreement. It was difficult to accurately predict the patient-reported functional outcome of LSS. Surgeons' ability to predict functional scores can be improved the most by focusing on accurately predicting more demanding tasks.

This study aimed to assess oral hygiene practices, dental conditions, and access to dental care among children with autism spectrum disorder (ASD) in Tunisia. This descriptive cross-sectional study included 48 children diagnosed with ASD. Data were obtained through a structured questionnaire completed by caregivers and a clinical oral examination. The questionnaire comprised 25 items divided into three domains: (1) Knowledge (awareness of oral hygiene importance, fluoride use, recognition of dental caries, and regular dental checkups); (2) Attitude (motivation for oral care, caregiver perception of dental visits, and beliefs about prevention); (3) Practices (tooth brushing frequency, technique, use of toothpaste, dental attendance, and dietary habits). The clinical examination assessed oral hygiene status, presence of untreated caries, gingival condition, and parafunctional oral habits. Descriptive statistics were used to analyze the data. Of the 48 children included in the study, 23% (n = 11) were classified at the severe end of the autism spectrum, while the remaining 77% (n = 37) presented with mild to moderate forms of ASD. Poor oral hygiene was observed in 46.6% (n = 14) of the children, untreated dental caries were present in 36.6% (n = 11), and 60% (n = 18) had never visited a dentist. Additionally, 33.3% (n = 10) of the children did not brush their teeth regularly. The presence of gingival inflammation and parafunctional habits was also noted but varied across severity levels of ASD. The study reveals considerable challenges regarding oral hygiene behaviors, dental health status, and access to dental care among children with ASD in Tunisia. These findings underscore the necessity for targeted oral health education programs and enhanced caregiver involvement to improve oral health outcomes in this population. A better understanding of the specific oral health needs of children with ASD is essential for tailoring dental care protocols. Focused caregiver training and adapted dental approaches are recommended to promote improved oral hygiene practices and overall oral health in children with ASD. How to cite this article: Ben Hadj Khalfa A, Boukhris H, Ayari G, et al. Oral Health Challenges and Hygiene Practices in Children with Autism Spectrum Disorder: A Cross-sectional Study from Tunisia. J Contemp Dent Pract 2025;26(6):581-586.

BackgroundInadequate sleep and physical activity are common during and after hospitalization, but their impact on patient-reported functional outcomes after discharge is poorly understood. Wearable devices that measure sleep and activity can provide patient-generated data to explore ideal levels of sleep and activity to promote recovery after hospital discharge.ObjectiveThis study aimed to examine the relationship between daily sleep and physical activity with 6 patient-reported functional outcomes (symptom burden, sleep quality, physical health, life space mobility, activities of daily living, and instrumental activities of daily living) at 13 weeks after hospital discharge.MethodsThis secondary analysis sought to examine the relationship between daily sleep, physical activity, and patient-reported outcomes at 13 weeks after hospital discharge. We utilized wearable sleep and activity trackers (Withings Activité wristwatch) to collect data on sleep and activity. We performed descriptive analysis of device-recorded sleep (minutes/night) with patient-reported sleep and device-recorded activity (steps/day) for the entire sample with full data to explore trends. Based on these trends, we performed additional analyses for a subgroup of patients who slept 7-9 hours/night on average. Differences in patient-reported functional outcomes at 13 weeks following hospital discharge were examined using a multivariate linear regression model for this subgroup.ResultsFor the full sample of 120 participants, we observed a “T-shaped” distribution between device-reported physical activity (steps/day) and sleep (patient-reported quality or device-recorded minutes/night) with lowest physical activity among those who slept <7 or >9 hours/night. We also performed a subgroup analysis (n=60) of participants that averaged the recommended 7-9 hours of sleep/night over the 13-week study period. Our key finding was that participants who had both adequate sleep (7-9 hours/night) and activity (>5000 steps/day) had better functional outcomes at 13 weeks after hospital discharge. Participants with adequate sleep but less activity (<5000 steps/day) had significantly worse symptom burden (z-score 0.93, 95% CI 0.3 to 1.5; P=.02), community mobility (z-score –0.77, 95% CI –1.3 to –0.15; P=.02), and perceived physical health (z-score –0.73, 95% CI –1.3 to –0.13; P=.003), compared with those who were more physically active (≥5000 steps/day).ConclusionsParticipants within the “sweet spot” that balances recommended sleep (7-9 hours/night) and physical activity (>5000 steps/day) reported better functional outcomes after 13 weeks compared with participants outside the “sweet spot.” Wearable sleep and activity trackers may provide opportunities to hone postdischarge monitoring and target a “sweet spot” of recommended levels for both sleep and activity needed for optimal recovery.Trial RegistrationClinicalTrials.gov NCT03321279; https://clinicaltrials.gov/ct2/show/NCT03321279

The role of parents is very important because they are the closest figures to children in maintaining oral and dental hygiene, especially for children with special needs such as those who are visually impaired. The role of parents includes being a model, mentor, organizer, and teacher. Oral and dental hygiene is a condition in which a person's mouth is free from impurities such as debris, plaque, and tartar. The issue in this research is that the dental and oral hygiene of visually impaired children is still in the moderate category, and the role of parents in maintaining their children's dental and oral hygiene is still in the fair category. This study aims to determine the relationship between the role of parents in maintaining dental and oral hygiene and the oral hygiene status of visually impaired children at SLB-A YPAB Surabaya. This study uses a quantitative approach with a correlational analytic type of research and a cross-sectional design, involving the use of questionnaires to measure the role of parents and OHI-S examinations. The respondents in this study consisted of 30 visually impaired children and their parents. Data analysis was conducted using the chi-square test. The results showed that the average OHI-S score of visually impaired children was 2.84, which falls into the moderate category, and 67.94% of parents were in the fair category in terms of their role in maintaining their children's oral hygiene, with a correlation value of 0.008. It can be concluded that the role of parents can influence the oral and dental hygiene status of visually impaired children at SLB-A YPAB Surabaya.

Oral care of intensive care unit (ICU) bound individuals is essential for overall health outcomes and to prevent complications. Nurses, who are the primary caregivers, should possess adequate knowledge, attitude, and practice (KAP) in this regard to provide optimal care to these patients. There are no standardized guidelines existing at present in this regard, making the practice of oral care more challenging.There is a diversified representation of nurses who practice in this region of the world and have not been analyzed in the past. This study would like to address this paucity of data. Hence, the aim of the present study was to evaluate the knowledge, attitude, and practice of nurses regarding oral health care in ICU patients along with analyzing any existing hospital-based policies related to oral care. A cross-sectional study was conducted among 230 nurses practicing at ICU of the National Guard Health Affairs (NGHAs) Hospital, King Abdulaziz Medical City, in Riyadh City, Saudi Arabia. Nurses responded to 22 closed-ended questionnaires, which were adopted after content validation and reliability assessment. Descriptive statistics, chi-square analysis, and multinomial logistic regression were carried out using the Statistical Package for the Social Sciences (SPSS, Version 20, 2011; IBM Corp., Armonk, USA). A total of 230 (51.1%) nurses responded. The mean working experience of 12.6 (±7.5) years and ICU experience of 10.6 (±6.7) years were observed. Seventy-four (32.2%) nurses mentioned they received oral care training for ICU patients as part of their degree. A significant variation (p=0.03) in response was observed based on qualification concerning the knowledge of nurses if improper oral care among ICU patients could cause systemic complications. Nurses with less than five years' experience were more likely to provide oral care only once per day compared to nurses with higher experience (>10 years) (OR: 2.97, p=0.00, 95% CI: 2.40-12.2). There were certain knowledge, attitude, and practice-based questions that elicited significant differences in responses based on the qualifications and experience of the nurses. Overall, the nurses did possess fair knowledge and favorable attitudes towards oral care in these patients.

Cross-sectional study of oral health care service, oral health beliefs and oral health care education of caregivers in nursing homes

Treatment-related regret is an integrative, patient-centered measure that accounts for morbidity, oncologic outcomes, and anxiety associated with prostate cancer diagnosis and treatment. To assess the association between treatment approach, functional outcomes, and patient expectations and treatment-related regret among patients with localized prostate cancer. This population-based, prospective cohort study used 5 Surveillance, Epidemiology, and End Results (SEER)-based registries in the Comparative Effectiveness Analysis of Surgery and Radiation cohort. Participants included men with clinically localized prostate cancer from January 1, 2011, to December 31, 2012. Data were analyzed from August 2, 2020, to March 1, 2021. Prostate cancer treatments included surgery, radiotherapy, and active surveillance. Patient-reported treatment-related regret using validated metrics. Regression models were adjusted for demographic and clinicopathologic characteristics, treatment approach, and patient-reported functional outcomes. Among the 2072 men included in the analysis (median age, 64 [IQR, 59-69] years), treatment-related regret at 5 years after diagnosis was reported in 183 patients (16%) undergoing surgery, 76 (11%) undergoing radiotherapy, and 20 (7%) undergoing active surveillance. Compared with active surveillance and adjusting for baseline differences, active treatment was associated with an increased likelihood of regret for those undergoing surgery (adjusted odds ratio [aOR], 2.40 [95% CI, 1.44-4.01]) but not radiotherapy (aOR, 1.53 [95% CI, 0.88-2.66]). When mediation by patient-reported functional outcomes was considered, treatment modality was not independently associated with regret. Sexual dysfunction, but not other patient-reported functional outcomes, was significantly associated with regret (aOR for change in sexual function from baseline, 0.65 [95% CI, 0.52-0.81]). Subjective patient-perceived treatment efficacy (aOR, 5.40 [95% CI, 2.15-13.56]) and adverse effects (aOR, 5.83 [95% CI, 3.97-8.58]), compared with patient expectations before treatment, were associated with treatment-related regret. Other patient characteristics at the time of treatment decision-making, including participatory decision-making tool scores (aOR, 0.80 [95% CI, 0.69-0.92]), social support (aOR, 0.78 [95% CI, 0.67-0.90]), and age (aOR, 0.78 [95% CI, 0.62-0.97]), were significantly associated with regret. Results were comparable when assessing regret at 3 years rather than 5 years. The findings of this cohort study suggest that more than 1 in 10 patients with localized prostate cancer experience treatment-related regret. The rates of regret appear to differ between treatment approaches in a manner that is mediated by functional outcomes and patient expectations. Treatment preparedness that focuses on expectations and treatment toxicity and is delivered in the context of shared decision-making should be the subject of future research to examine whether it can reduce regret.

: Haemophilia is a genetic X linked recessive bleeding disorder characterized by a deficiency or absence of certain clotting factors in the blood, primarily factors VIII (haemophilia A) or factor IX (haemophilia B). Dental caries and periodontal diseases are two main oral diseases affecting majority of population, but their effects are enhanced in hemophiliacs and medically compromised patients. There is a lack of epidemiological studies regarding oral health and oral hygiene of hemophilic patient especially in central India. This study therefore, aimed to evaluate the oral hygiene awareness and hygiene practices of patients with hemophilia in Indore district. This cross-sectional study was conducted on 30 hemophilic patients who were selected via snow ball sampling technique. The patients who were ready to participate voluntarily in the study were included. A study questionnaire in Hindi and English was given to the patients to obtain their knowledge about oral hygiene and dental health awareness.: Thirty hemophilic patients participated in the study with a mean age of 20 ±15 years. All the participants were male. Although hemophilic patients were conscious of oral hygiene, the study found most of them had poor dental practices. The majority of participants (56.67%) reported of using soft-bristled brushes. Only 56.67% of the participants reported cleaning their mouths after meals and having seen gum bleeding. The majority of hemophilia patients (46.15%) reported using Factor VIII, while some also used Tranexamic acid (15.39%).: Oral hygiene is crucial for everyone, but it holds particular importance for individuals with hemophilia. Good oral hygiene reduces the need for invasive dental treatments, minimizing potential complications.

Due to the yearly rise in primary anterior cruciate ligament (ACL) reconstructions, revision ACL reconstruction is becoming more and more common in knee surgery. Choosing the appropriate graft and determining the surgical treatment staging by assessing the likelihood of doing the most anatomical revision canals and placing them with the primary canals before surgery are crucial factors affecting treatment outcomes. The purpose of this study was to evaluate the differences in the patient-reported functional outcomes in revision ACL reconstruction using peroneus longus and bone-patellar tendon-bone (BTB) autografts in a single-stage revision ACL reconstruction. Twenty-three patients who were eligible for follow-up among 25 surgeries performed between 2015 and 2023 were included in this retrospective analysis and met the inclusion criteria. The patient reported functional outcome, Lysholm knee score, Tegner activity level, and Visual Analog Scale (VAS) for pain before the injury and during the most recent follow-up. The peroneus longus (PL) and bone-patellar tendon-bone (BPTB) groups' patient-reported results were assessed. There were no significant differences between the two revision groups with PL and BPTB autograft in terms of age, sex, duration between injury and surgery, concurrent injuries, and isolated or complex surgeries. There was not a significant difference between the groups' pre-injury patient-reported outcomes, including the Lysholm knee score, Tegner activity, and VAS for pain (n.s.). There was not a significant difference in the two groups' functional results at follow-up, although both groups' functional outcomes improved and all patients recovered to their pre-injury activity level. Overall, the findings suggest that graft options (peroneus longus and BTB) and surgical complexities (isolated and complex revision) yield comparable functional outcomes for most measures. However, notable differences in post-operative pain levels warrant further exploration. These results underscore the effectiveness of both graft types and surgical techniques in achieving satisfactory recovery while acknowledging the necessity of customized approaches to pain management based on individual patient circumstances.

In pediatric mild traumatic brain injury (mTBI), high rates of abnormalities are observed in vestibulo-ocular reflex (VOR) and oculomotor (OM) function, but there is a lack of understanding of how these impairments may affect daily functioning. To determine the extent to which clinician-administered measures of VOR and OM function are associated with patient-reported levels of activity limitations and participation restriction in children and adolescents within 31days post-mTBI. Cross-sectional design. Tertiary care pediatric hospital. Participants with mTBI aged 7 to 17.99years. Participants were assessed on a battery of VOR and OM tests within 31days of injury. The Dizziness Handicap Inventory (DHI) and Cardiff Visual Ability Questionnaire (CVAQ) measured patient-reported dizziness and visual disability. The vestibular/ocular motor screening tool (VOMS), Head Thrust Test, computerized Dynamic Visual Acuity (DVA) Test, and video Head Impulse Test were administered to assess VOR and OM function. Linear regression examined the associations between clinician-administered measures of VOR and OM function and patient-reported functional outcomes. The sample consisted of 100 youth (54.4% female; mean age 13.92 [2.63]; mean time since injury: 18.26 [6.16] days). Associations were found between (1) DHI score and age (1.773 [0.473-3.073], P =.01), VOR symptom provocation (18.499 [11.312-25.686], P ≤.001), and DVA (-29.433 [-59.206 to -2.60], P =.03); and (2) CVAQ score and version symptom provocation (0.796 [0.185-1.406], P =.01). High abnormal proportions (up to 56.7%) were found in VOMS performance. The symptom provocation induced by VOR and OM tasks was associated with patient-reported dizziness and visual disability outcomes, highlighting the detrimental impact of symptoms on daily functioning. The findings of this study will assist clinicians when interpreting patient-reported measures of activity limitation and participation restriction.

Aim: The aim of this study was to evaluate the knowledge, attitude, and practice of oral hygiene care among nursing professionals of a tertiary care center of Malda in West Bengal. Background: Oral cavity is the reflector of our general health. The relationship between oral health and systemic health is well established, but a lack of awareness and knowledge regarding dental hygiene restrains people from proper oral care. Most of the people including health workers do only brushing as their daily oral care process, ignoring the other important aspects of oral hygiene including regular tongue cleaning, use of interdental cleaning aids, change of toothbrush in a periodic manner, and regular dental checkups. Materials and Methods: A questionnaire-based descriptive cross-sectional study was carried out. After evaluating for the content validity and reliability, a self-structured questionnaire comprising ten questions about their oral hygiene was distributed among nursing professionals of Malda Medical College in a printed format after obtaining informed consent. Total 261 responses were gathered. Informed consent was obtained from each participant, and data were collected anonymously to maintain participants’ confidentiality. The collected data were analyzed using the statistical software IBM SPSS for Windows, version 27.0. Results: Most of the participants use two times brushing as their regular dental care (77.4%) and use toothbrush and paste for the same (99.2%). Soft toothbrush is the most preferable choice (70.9%). Apart from brushing, other oral care methods are neglected, only 23.8% of participants use interdental cleaning aids, 79.3% use tongue cleaning, and only 8.8% have done regular dental checkups. Conclusion: The result of the present study depicts the limitation of knowledge and practice of oral hygiene care among nursing professionals of Malda Medical College. In spite of their health-care background, they have limited knowledge regarding regular oral hygiene care. Though most of them use two times brushing, but unaware about the importance of interdental cleaning and tongue cleaning habits.

Background: Knowledge of dental and oral health is one of the efforts to prevent and overcome dental health problems through the approach of dental and oral health education. Hearing loss is one of the causes of the lack of knowledge of deaf people to maintain dental and oral hygiene and affect their attitudes and behavior in maintaining dental and oral hygiene. The purpose: from this study is to find out the relationship with dental and oral hygiene in deaf people at SLB Yayasan Bahagia Tasikmalaya City. Method: This type of research is quantitative analytics with cross sectional design. Samples taken by puposive sampling technique, the number of samples as many as 20 samples. Data collection uses questionnaires on dental hygiene knowledge and OHI-S examinations of deaf people. Results: research shows that there is a relationship between knowledge and dental and oral hygiene in deaf people at SLB Yayasan Bahagia Tasikmalaya City with the results of statistical tests of significance of 0.030 (&lt;0.05) with corelation coeffition (0.486%) sufficient, it can be concluded that there is a relationship between knowledge and dental hygiene and mouth on deaf presenters at SLB Yayasan Bahagia Tasikmalaya City. Conclusion: There is a knowledge relationship with dental hygiene in deaf people at SLB Yayasan Bahagia Tasikmalaya City.

During a stroke, the mouth tends to become an unhealthy place and may give rise to various life-threatening conditions. To this end, there have been repeated calls to incorporate oral hygiene guidelines and practices for hospitalized stroke patients to prevent aspiration pneumonia and improve patients' oral health. The objective of the study was to determine health care providers' practices of oral health care among patients hospitalized after an occurrence of stroke and to determine health care providers' background and work environment effect on these practices. A cross-sectional study was conducted among stroke care providers in 13 public hospitals in Malaysia. The questionnaires distributed were self-administered, where nursing staff provided details of their oral health care practices for stroke patients. Information on the background of health care providers and work environment was also collected. Overall, a total of 780 responses from the registered nurses were obtained. Almost half of the respondents (48.1%) reported that they recommended toothbrushing twice or more per day to stroke patients. Two-thirds (64.7%) reported that they performed daily mouthwashing on their patient, while less than half (38.8%) reported daily oral hygiene assistance. Result of the analysis revealed that oral hygiene practices were significantly associated with having working wards ( P < 0.05), level of qualification ( P < 0.05), having oral health care guidelines ( P < 0.001), specific resources ( P < 0.05), and attending previous training in oral care ( P < 0.001). Provision of oral hygiene practices for hospitalized stroke patients is important. A lack of oral health care guidelines, support from dental professionals, specific resources, training, and assistance in daily oral care for patients is evident and detrimental to oral hygiene practices. The current findings have significant implications for new initiatives to support health care providers, particularly the registered nurses performing oral health care for hospitalized stroke patients. Knowledge Transfer Statement: This study may provide a basis of information for improving the delivery of oral health care to stroke patients. Enhancement in the training and improvement in the existing guidelines and resources is pivotal for the provision of better oral health care for the potential benefits to these patients, including their improved quality of life and disease prevention.