Dental Outcomes Research Articles

Stress and Self-Efficacy in Parents/Caregivers and Oral Health of Individuals with Down Syndrome During the COVID-19 Pandemic: A Cross-Sectional Study

The family of individuals living with Down Syndrome (DS) often demonstrate high levels of stress associated with the demand for care and difficulties experienced in everyday life. The aim of this cross-sectional study was to assess perceived stress by parents/caregivers of individuals with DS and its association with general perceived self-efficacy and dental outcomes, considering the COVID-19 pandemic’s impacts on family’s daily activities and finances. A sample of 257 parents/caregivers answered a questionnaire with socioeconomic, dental, and behavioral variables and the short version of the Perceived Stress Scale and the General Perceived Self-Efficacy Scale. The sample was divided into three groups based on perceived stress levels. Associated variables were evaluated using multinomial logistic regression (level of significance 5%), adjusting for socioeconomic factors. The mean perceived stress score was 17.84 ± 5.75 (0–39). Medium stress (second tertile) was associated with finger/nail biting in individuals with DS (OR = 2.05; 95%CI 1.04–4.03; p = 0.038), difficulty in performing oral hygiene (OR = 2.39; 95%CI 1.23–4.65; p = 0.011) and medium and high self-efficacy (OR = 0.12; 95%CI 0.05–0.31; p < 0.001 and OR = 0.38; 95%CI 0.15–0.98; p = 0.046, respectively); high stress (third tertile) was associated with medium and high self-efficacy (OR = 0.25; 95%CI 0.09–0.67; p = 0.006 and OR = 0.05; 95%CI 0.02–0.15; p < 0.001, respectively) and negative impact of COVID-19 in family finances (OR = 3.00; 95%CI 1.39–6.44; p = 0.005). It was concluded that parents/caregivers’ perceived stress was averaged and associated with self-efficacy, finger/nail biting, oral hygiene demands, and the financial impact of COVID-19.

School food policy in secondary schools in England and its impact on adolescents' diets and dental health: the FUEL multiple-methods study.

School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = -2.78 g, 95% confidence interval -4.66 to -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. This trial is registered as ISRCTN68757496. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Correlation of Personality, Temperament, and Behavior of Children in the Dental Environment.

A child's temperament, influenced by inborn traits and emotional regulation, can impact their dental behavior and caries risk. Parenting styles, such as authoritative, authoritarian, permissive, or neglectful, also play a significant role. Authoritative parenting tends to yield more favorable dental outcomes, while permissive parenting can lead to a higher prevalence of caries. Studying these interactions can help tailor dental interventions and address potential risks associated with caries development. Thus, the study aims to correlate parental personality, the child's temperament to dental caries, and child's behavior in a dental setting. A cross-sectional study was conducted on 160 children in the age-group of 6-9 years. The children were selected based on the selection criteria. The children were asked to fill out the parental perception questionnaire (PPQ), and the parents were asked to fill out the emotionality, activity, sociability (EAS) questionnaire to assess the parenting style and child's temperamental status. Later, the child's behavior pattern was assessed using the Frankl behavior rating scale. The children were intraorally examined for the presence of caries using the decayed, extracted, filled teeth (deft) and decayed, missing, filled teeth (DMFT) index. All the data were tabulated and statistically analyzed. In this study, a total of 160 children were assessed, including 84 boys (52.3%) and 76 girls (47.5%), with an average age of 7.8 years. One-way analysis of variance (ANOVA) followed by Scheffe's post hoc test was performed to compare the temperamental status and parenting style with the behavior of the child in the dental office. The results were statistically significant with a p-value of 0.001. Pearson's correlation coefficient revealed a significant positive correlation between Temperament E scores and def scores in children with positive behavior (p-value = 0.004). This study's findings suggest that a child's behavior in a dental office is influenced by the parent's personality, the child's temperament, and the dentist. A child's capacity to handle dental visits and their overall oral health can be notably affected by the child's temperament and parenting style. Thamilvanan S, Srinivasan D, Benedict CH, et al. Correlation of Personality, Temperament, and Behavior of Children in the Dental Environment. Int J Clin Pediatr Dent 2024;17(8):907-912.

Reversing the Effects of Tongue Thrusting Using Tongue Tamers

This case report presents the successful correction of a tongue thrusting habit in a 8-year-old patient using tongue tamers as the primary therapeutic intervention. The patient exhibited anterior open bite and misaligned dentition, both attributed to chronic tongue thrusting during swallowing and speech. A thorough clinical examination and orthodontic assessment confirmed the need for habit correction to prevent further malocclusion and aid in proper dental development. The treatment plan involved the placement of tongue tamers on the lingual surfaces of the maxillary anterior teeth, aimed at retraining the tongue to adopt a correct posture during swallowing. The patient was also provided with oral habit awareness exercises to reinforce the therapy. Follow-up evaluations at 3, 6, and 12 months revealed a significant reduction in tongue thrusting behavior, with a corresponding improvement in the patient’s dental alignment and closure of the anterior open bite. The successful outcome highlights the effectiveness of tongue tamers in correcting tongue thrusting when used in combination with patient cooperation and regular monitoring. This case supports the use of this minimally invasive intervention for habit correction in growing children, improving both functional and aesthetic dental outcomes.

Utilization of Dental Care and Oral Health Outcomes in the United States: Results from the National Health and Nutrition Examination Survey (2017-2020).

This analysis aims to evaluate the association between the time since and reason for a patient's last dental appointment across clinical oral health outcomes. We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately. Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43). Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes.

Autism Severity, Adverse Childhood Experiences, and Oral Health: A Comparative Study of Adolescents in the United States.

Dental health significantly influences overall child physical well-being, academic success, and psychosocial development. This paper explores the intersection of a range of Autism Spectrum Disorder (ASD) functionality, multiple types of Adverse Childhood Experiences (ACEs), and dental health in adolescents. The purpose is to investigate the independent and interactive effects of ASD severity and ACEs on dental outcomes. Data from the 2018 and 2019 National Surveys of Children's Health were analyzed, focusing on 28,263 adolescents (ages 11-17). Logistic regressions assessed associations between ASD severity (mild, moderate, severe), cumulative number of ACEs, and dental outcomes (teeth condition, cavities or bleeding gums, check-ups, cleanings). Covariates included demographic and socioeconomic factors. Controlling for covariates, severe autism independently increased the odds of poor teeth (odds ratio = 6.17), cavities or bleeding gums (OR = 3.76), no previous year check-up(OR = 2.94), and no previous year cleaning (OR = 4.20). Higher ACE scores also independently increased the odds of all dental outcomes. Interactions revealed a cumulative effect of multiple ACEs on poor dental outcomes only for adolescents with severe levels of autism. This study illuminates the heightened vulnerability of adolescents with severe autism and a history of ACEs, emphasizing the need for targeted interventions. Multidisciplinary strategies integrating dental care and mental health support within tailored interventions are crucial for improving dental health and access for older youth with low functioning autism. While these findings provide valuable insights, the cross-sectional design and reliance on parental reports necessitate cautious interpretation.

Improving oral health screening and dental referrals for patients with diabetes in a community health clinic.

Oral health screening and access to dental care in adults with diabetes lead to improved health outcomes and quality of life. Patients with barriers to accessing health services have a greater risk of poor medical and dental outcomes. People with diabetes are more likely to have periodontal disease and less likely to visit a dentist. Oral screening and dental referrals were not being done at a community health clinic in Plano, Texas. The aim of this 6-month quality-improvement project was to increase oral health screenings in adults with diabetes from 0% to 80%; subaim was to increase access to dental services by increasing referrals from 0% to 50%. Adults with diabetes without insurance or dental care in the past 12 months were eligible for the project ( n = 263). Outcome measures were tracked using a longitudinal chart. Eligible patients were screened and referred to a dental office with an income-based financial assistance program using Plan-Do-Study-Act methodology. Staff education, referral order set, and follow-up calls were additional processes implemented. Fifty-two percent of eligible patients were screened, 35.9% were referred to dental services, and 17.7% of those referred established care with dental clinic. Interventions were successful in improving access to dental care, although target goal was not met. Creating systems that facilitate interdisciplinary care improved health equity and standards of health in chronic disease.

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Untreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive. To test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs). The Pediatric Providers Against Cavities in Children's Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3). Clinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory-based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone. Dental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data. Eighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = -0.27; 95% CI, -0.56 to 0.02). In this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs. ClinicalTrials.gov Identifier: NCT03385629.

Revolutionizing dental education: harnessing the power of ChatGPT for personalized learning in dentistry

With the advancements in modern technology, educators in the field of dentistry are exploring innovative and new ways to enhance the learning experience for students. Aim: This journal article integrates ChatGPT, a state-of-the-art language model OpenAI developed into dental education. By leveraging the capabilities of ChatGPT, educators can provide personalized and interactive learning experiences, fostering a deeper understanding of dental concepts and improving the overall educational outcomes in dentistry for both teachers and dental students. By embracing this transformative tool, dental education is poised to adopt a new era of engagement, adaptability, and efficacy in preparing future dental professionals for the challenges ahead. Method: This is an overview of current and future dental education strategies, limitations, and challenges. The data and information reflected and summarized in this article are gathered and extracted from recently published articles, especially a search of online databases. Conclusion: In conclusion, while using ChatGPT in dental education offers substantial benefits in personalized learning, virtual patient interactions, and knowledge reinforcement, ethical considerations and potential disadvantages highlight the need for a balanced and responsible integration.

Association between cognitive rumination and periodontal disease, tooth loss and oral health-related quality of life in a rural Southern Brazil population.

Rumination is a maladaptive emotion regulation strategy. It has been associated with several psychological disorders and physical problems. This cross-sectional study aimed to evaluate whether cognitive rumination is associated with periodontal disease (PD), tooth loss (TL), and oral health-related quality of life (OHRQoL). A population-based sample from a rural area in southern Brazil was evaluated. Calibrated examiners carried out a complete periodontal examination at six sites-per-tooth. Rumination and Reflection (RRQ) and Oral Health Impact Profile (OHIP-14) questionnaires were administered. Regression modeling was used to assess the prevalence ratio (PR) between rumination and PD and to estimate the rate ratio (RR) between rumination and TL and rumination and OHIP. Severe periodontitis prevalence of 33% was observed in the sample. In the Poisson-adjusted model (n = 587), individuals who ruminate more have 27% more periodontal disease (PR: 1.27, 95%CI:1.02 - 1.60). Regarding TL and OHIP, negative binomial regression (n = 672) showed an association with rumination, but it was not significant (RR 1.14, 95%CI 0.99 - 1.31) and (RR 1.20, 95%CI 0.98 - 1.48), respectively. Cognitive rumination was independently associated with periodontal disease in individuals living in a rural area. Borderline non-significant estimates were observed regarding TL and OHRQoL. More research using different populations and focusing on individual's responses to psychological stress may confirm these results. Emotional regulation is crucial to deal with stress, anxiety, and depression. Since psychopathologies are among the most prevalent diseases in the world, it is critical to understand the role of these issues in dental outcomes.

Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure-A Technical Note.

Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets' depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science.

Headgear therapy in children with Class II malocclusion and the role of compliance on treatment outcome: A nine-month randomized controlled trial.

To evaluate three-dimensional movements of maxillary teeth during headgear treatment in Class II growing children, using digital analytical tools, and to determine the effects of compliance on these movements. A 9-month parallel-group randomized controlled trial was carried out on 40 children with Class II malocclusion, aged 8-12 years, half assigned to receive a cervical headgear and half to a no-treatment group, using block randomization. Subjects in the treatment group were instructed to wear the headgear for 12 hours daily and monitored using an electronic module. After 9 months, the following dental outcomes were measured: first maxillary molar distalisation, rotation, tip and torque, arch depth, and interpremolar and intermolar distances. Caregivers and participants were not blinded to group assignments, but those assessing outcomes were. Linear regression models were used to detect differences between groups and correlation coefficients to find correlations between compliance and dental outcomes. All 40 included patients were analysed. A significant difference in molar distalisation was observed between the treatment (1.2 mm) and control groups (-0.2 mm). Arch depth change was also increased to a larger extent in the treatment groups (1.3 mm vs 0.1 mm), as was the interpremolar distance (1.9 mm vs 0.4 mm). In contrast, no significant differences in molar rotation or torque change were observed. With regard to compliance, average compliance was 55%. A significant correlation was found between molar distalisation and compliance in the treatment group. Headgear therapy has significant effects on molar distalisation, arch depth, and arch width. Compliance has a significant positive effect on molar distalisation.

Utilization of dental care and dentate status in diabetic and nondiabetic patients across US states: An analysis using the 2020 Behavioral Risk Factor Surveillance System.

This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM). We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults. Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults. State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM.

Applying artificial intelligence to predict the outcome of orthodontic treatment

Objectives: The study aimed to train an algorithm to predict facial and dental outcomes following orthodontic treatment using artificial intelligence (AI). In addition, the accuracy of the algorithm was evaluated by four distinct groups of evaluators. Material and Methods: The algorithm was trained using pre-treatment and post-treatment frontal smiling and intraoral photographs of 50 bimaxillary patients who underwent all first bicuspid extraction and orthodontic treatment with fixed appliances. A questionnaire was created through Google form and it included 10 actual post-treatment and AI-predicted post-treatment images. The accuracy and acceptability of the AI-predicted outcomes were analyzed by four groups of 140 evaluators (35 orthodontists, 35 oral maxillofacial surgeons, 35 other specialty dentists, and 35 laypersons). Results: The Style-based Generative Adversarial Network-2 algorithm used in this study proved effective in predicting post-treatment outcomes using pre-treatment frontal facial photographs of bimaxillary patients who underwent extraction of all first bicuspids as part of their treatment regimen. The responses from the four different groups of evaluators varied. Laypersons exhibited greater acceptance of the AI-predicted images, whereas oral maxillofacial surgeons showed the least agreement. The base of the nose and the chin demonstrated the most accurate predictions, while gingival visibility and the upper lip-to-teeth relationship exhibited the least prediction accuracy. Conclusion: The outcomes underscore the potential of the method, with a majority of evaluators finding predictions made by the AI algorithm to be generally reliable. Nonetheless, further research is warranted to address constraints such as image tonicity and the proportional accuracy of the predicted images.

Socioenvironmental sugar promotion and geographical inequalities in dental health of 5-year-old children in England.

To investigate the relationship between socioenvironmental sugar promotion and geographical inequalities in the prevalence of dental caries amongst 5-year-olds living across small areas within England. Ecological data from the National Dental Epidemiology Programme (NDEP) 2018-2019, comprising information on the percentage of 5-year-olds with tooth decay (≥1 teeth that are decayed into dentine, missing due to decay, or filled), and untreated tooth decay (≥1 decayed but untreated teeth), in lower-tier local authorities (LAs) of England. These were analysed for association with a newly developed Index of Sugar-Promoting Environments Affecting Child Dental Health (ISPE-ACDH). The index quantifies sugar-promoting determinants within a child's environment and provides standardized scores for the index, and its component domains that is, neighbourhood-, school- and family-environment, with the highest scores representing the highest levels of sugar promotion in lower-tier LAs (N = 317) of England. Linear regressions, including unadjusted models separately using index and each domain, and models adjusted for domains were built for each dental outcome. Participants lived across 272 of 317 lower-tier LAs measured within the index. The average percentage of children with tooth decay and untreated tooth decay was 22.5 (SD: 8.5) and 19.6 (SD: 8.3), respectively. The mean index score was (0.1 [SD: 1.01]). Mean domain scores were: neighbourhood (0.02 [SD: 1.03]), school (0.1 [SD: 1.0]), and family (0.1 [SD: 0.9]). Unadjusted linear regressions indicated that the LA-level percentage of children with tooth decay increased by 5.04, 3.71, 4.78 and 5.24 with increased scores of the index, and neighbourhood, school and family domains, respectively. An additional model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.37, and by family domain it increased to 6.33. Furthermore, unadjusted models indicated that the LA-level percentage of children with untreated tooth decay increased by 4.72, 3.42, 4.45 and 4.97 with increased scores of the index, and neighbourhood, school, and family domains, respectively. The model, adjusted for domains, showed that this increased percentage predicted by neighbourhood domain attenuated to 1.24 and by family domain rose to 6.47. School-domain was not significantly associated with either outcome in adjusted models. This study reveals that socioenvironmental sugar promotion, particularly within neighbourhood- and family-environments, may contribute to geographical inequalities in dental caries in children. Further research involving data on individual-level dental outcomes and confounders is required.

Effectiveness of reframing as behaviour management technique in paediatric dentistry: A scoping review

Background: For children with fear and anxiety, dental appointments are considered as stressful situations. The dental literature has mentioned various behaviour management techniques used to reduce the dental fear and anxiety. Reframing is one such technique which is used for behaviour management with wide applications in health sciences. Hence, exploring this technique in the dental literature is of prime importance.Objectives: This scoping review aims to identify the evidence on the effectiveness of reframing as behaviour management technique in children undergoing dental treatment in the available literature.Method: The Joanna Briggs Institute methodology for scoping reviews is followed in this study and relevant published data from case reports, randomized and nonrandomized controlled clinical trials and literature reviews published without restricting time line till August 2023 from online databases of PubMed, Scopus, ProQuest were assessed by two reviewers for their suitability with our aim of study. The data were synthesized using content analysis.Results: Through literature search, 108 articles were found based on search strategy. After screening the titles, keywords and abstract and removing the duplicates only 10 articles were included for full text review. In the end only 5 articles were included for scoping review for their content analysis.Conclusions: The searched literature has revealed that reframing had changed the behaviour of the child towards dental outcomes but the literature is sparse regarding behaviour management technique for children to alleviate fear and anxiety. Also, there were no clinical trials done to know the efficacy of this technique and means to measure the outcome.

АНАЛИЗ СТОМАТОЛОГИЧЕСКОЙ ЗАБОЛЕВАЕМОСТИ СРЕДИ ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА ИЗ НЕПОЛНЫХ И РАСШИРЕННЫХ СЕМЕЙ

Introduction. This article is devoted to the study of the prevalence of dental diseases in preschool children living in incomplete and extended families. In the course of the study, children from both types of families were examined for dental caries and its complications, for non-caries dental diseases. While studying periodontal diseases, were distinguished inflammatory diseases, such as catarrhal and hypertrophic gingivitis, as well as localized periodontitis, when studying diseases of the oral mucosa, we highlighted diseases of the lips, tongue and oral mucosa. When studying dentoalveolarabnomalies, we identified both abnormalities of bite, dental arches and rows, and individual teeth. 
 The subject of research is dental diseases in preschool children.
 The goal of the study is to analyze dental morbidity in children from extended and incomplete families.
 Methodology. The study was conducted on the basis of the UniDent network of dental clinics, as well as in the Fairy Tale preschool commercial institution in Kazan and municipal preschool institutions of Tatarstan Republic. A total of 222 children from 217 incomplete families and 213 children from 199 extended families of both sexes participated in the voluntary study. Examination of children included examining the child and talking with parents or guardians, filling out medical records, determining the type of family, filling out an individual card in which identified dental diseases were recorded.
 The results of the study indicate a high prevalence of dental diseases among preschool children in TR. The progression of dental diseases is observed with the age of the child. Children from incomplete families are more susceptible to the occurrence and development of dental diseases, compared with children from extended families.
 Conclusions. The findings on the disparate prevalence of dental diseases in children from incomplete and extended families suggest the presence of family type influences, which may be useful in planning prevention methods and predicting dental outcomes in children from different family types.

Poor Glycemic Control Increases Dental Risk in a Sri Lankan Population.

Introduction: The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Materials and Methods: Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and categorized as low risk (≤3 dental outcomes) and high risk (>3 dental outcomes). Results: In this cohort of men and women with type 2 diabetes, there was a high frequency of periodontal related outcomes, including missing teeth (70%), gingival recessions (40%), tooth mobility (41%), and bleeding (20%). Thirty-nine (39%) of participants had high dental risk, while forty-nine (61%) had low risk. Conclusions: After controlling for age, participants with higher capillary blood glucose levels had 3-fold greater odds of a high dental risk score (OR = 2.93, 95%CI = 1.13, 7.61). We found that poor glycemic control indicated by elevated capillary blood glucose was associated with increased dental risk.

Modern methods and materials used to treat root perforation: effectiveness comparison

This study aims to experimentally compare the efficacy of different endodontic materials (iRoot BP Plus, Biodentine, MTA, Rootdent, and Trioxide) in the treatment of pulpitis and perforations on extracted tooth specimens. Additionally, the study aims to investigate the influence of iRoot BP Plus endodontic material on the regenerative processes following pulp amputation in laboratory animals. The secondary goal is to evaluate the effect of iRoot BP Plus on the restoration process in laboratory animals after pulp removal. The study presents a micropermeability analysis of the selected biomaterials performed on a sample of 50 single-rooted apical teeth in 2022. All teeth underwent endodontic treatment. Changes in molar morphology were investigated with eight laboratory animals (rabbits, 3 months old, all males) after simulated pulp removal and subsequent treatment with the iRoot BP Plus biomaterials. iRoot BP Plus appeared to be more effective in retrograde apical root filling than other biomaterials, as evidenced by its higher sealing effect. An experiment involving animal participants revealed the presence of protective adaptive mechanisms, which manifested in the form of an inflammatory process within 6 weeks after the dental pulp was removed. The connective tissue replaced the necrosis, and new capillaries began to form intensively. These dental outcomes suggest that iRoot BP Plus enables hermetical sealing in tooth restoration with good adhesion. Thus, it may have the ability to promote more active tissue regeneration after pulp removal.Graphical

Influence of disabilities on state-level disparity in dental care utilization and tooth loss: Findings from the 2020 Behavioral Risk Factor Surveillance System.

The aim of this study is to describe the prevalence of disparity in access to dental care and tooth loss between US adults with and without disabilities at the state level. This secondary analysis included data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional state-run annual telephone survey of noninstitutionalized US adults aged 18 years or older. The primary predictor, having any disability, was defined as reported difficulty in hearing, vision, cognition, mobility, self-care, or independent living. The two dental outcomes used were reported time since last dental visit and missing teeth status. We conducted descriptive analysis and multinomial regression models on weighted data to report the prevalence and state-level disparity in dental outcomes between individuals with and without disability. Nationally, one in four adults reported a disability, with a disproportionately higher prevalence among females, Native Americans and lower education and income groups. The highest utilization of dental services within a year among individuals with disabilities was found in the Northwestern and Midwestern states. Western states had the highest proportion of individuals with disability to have had a recent dental visit and a complete dentition, while the Southern states had the lowest proportions. After adjusting for sociodemographic factors, 59.1% of individuals with disabilities had dental visits within a year, which is 8.0% points less than those without disabilities. Similarly, only 50.8% of individuals with a disability had complete tooth retention, which is 10.1% points less than individuals without disability. Regardless of the type of disability, adults with a disability were less likely to have visited the dentist in the past year or to have retained all of their teeth. Those with self-care disabilities had the lowest rates of both. There were clear disparities in the utilization of dental care and dentate status among adults with disabilities at the state level. The findings from this study highlighted the necessity of finding local solutions to address the gap in dental care utilization and tooth loss between those with and without disability among the US population.