Dental Program Research Articles

Dental Caries Prevention Knowledge, Attitudes, and Practice among Patients at a University Hospital in Guangzhou, China.

Background and Objectives: This study aimed to assess the knowledge, attitudes, and practice (KAP) of patients regarding dental caries prevention in a university hospital in Guangzhou, China. Materials and Methods: A hospital-based KAP survey was conducted in a cross-sectional manner at the First Affiliated Hospital in Guangzhou, China, from 1 September to 30 September 2022. Questionnaires were distributed to eligible patients, resulting in the participation of 251 individuals. The questionnaire consisted of five sections capturing socio-demographic data and exploring participants' knowledge, attitudes, practice, and accurate preventive dental caries knowledge. Descriptive statistics and a generalized linear model with univariate tests were used for analysis. Results: The study results show that the knowledge score 7.97 (±0.91) and attitudes score 7.67 (±0.89) among the participants were good while the practice score was 6.80 (±0.81) moderate. The majority of participants identified tooth infections (81.3%), bacteria (92%), and sugar (89.2%) as the main causes of gum bleeding and tooth decay. Brushing (96%) and fluoride (80.5%) were also recognized as essential for preventing tooth decay. Of oral diseases, 94% were recognized as potentially affecting overall health. The vast majority ranging from 92.8% to 98%, believed that oral health is crucial to overall health and that regular check-ups and proper brushing habits are beneficial. There is a significant association of gender with age (p = 0.018), occupation (p = 0.050), lifestyle habit (p = 0.012), and knowledge score; whole education is significantly associated with practice score (p = 0.050). Conclusions: The majority of patients exhibited accurate knowledge and attitudes with moderate practice towards dental caries prevention, with socio-demographic factors playing a major role. However, effective implementation of dental health education programs across the healthcare system is still required to further enhance outcomes.

Adherence to preprints’ publication in Dentistry by Brazilian researchers

Aim: The objective of this study was to evaluate the adherence to the preprint publication format by a sample of Brazilian researchers. Methods: Searches were carried out, in September 2021, on the MedArxiv, OSF, and SciELO preprints platforms, looking for publications in preprint format by all Brazilian researchers of graduate programs in dentistry (n=211) who were productivity fellows in 2021 (PQ). Searches were performed by typing the authors’ full names and the possible variations, as indicated by each author's curriculum, openly available on the Lattes website platform. The Friedman test, with the Durbin-Conover post-hoc (α=0.05) was applied in order to compare the three platforms. Spearman's correlation test (α=0.05) was performed to assess the possible correlations between the number of preprints and age, career stage, and the researcher’s scholarship level variables. Results: From the 211 researchers searched, 22 (10.4%) published 1 (one) preprint on at least one platform. A total of 39 published preprints were found at MedArxiv (n=19, 48.7%), SciELO preprints (n=18, 46.2%), and OSF platforms (n=2, 5.1%). There was no difference between the adherence to MedArxiv and SciELO preprints (p = 0.731). However, the OSF platform presented the lowest adherence, statistically differing from MedArxiv (p=0.008) and SciELO preprints platforms (p=0.003). In addition, no correlation was found between the publication of preprints and the researcher's age (p=0.128), career stage (p=0.248), or the researcher's scholarship level (p=0.661). Conclusion: It was possible to observe a low adherence to the preprints’ publications by Brazilian researchers’ productivity fellows of graduate programs in dentistry.

ED-DHENTYS (EDUCATION DENTAL HEALTH SYSTEM) MODEL AS AN EFFORT TO CHANGE BEHAVIOR IN THE IMPLEMENTATION OF ORAL HYGIENE THROUGH A FAMILY CENTERED CARE APPROACH IN BIMA REGENCY, NTB

Background : Oral hygiene is still a major problem for the elderly. Riskesdas in 2018 said dental problems in the age group of 55-64 increased 48.5% and ages 65 and above by 38.6%. Various dental health services programs continue to be developed to reduce dental and oral health problems, including by improving the quality of the media used. The relevant media used today is technology-base media. Aim : Producing Ed-Dhentys models as a medium of education in changing the behavior of implementing oral hygiene for the elderly through a family centered care approach. Method : Research and Development (R&D) with Quasy experiment Pretest-Posttest group design. Variables in this study : Knowledge, attitude, brushing skills and debris index. There research project was 2 group : intervention 16 people given Ed-Dhentys Model and Control 16 people given Slide power point. Data tested using Wilcoxon and Mann-Whitney. They hypothesis test meaningfulness criterion uses the p-value 0.002 of the delta value (?). Result : The Ed-Dhentys model is feasible as a dental health education media with expert validation results of 92% and a p-value of and unpaired test results stating that this application is effective in increasing knowledge (?=6.81), attitude (?= 13.75), brushing skills (?6.93), and decreasing the debris index score (?=1.37) compared to the control group. Conclusion : The Ed-Dhentys model proved feasible and its application was effective as an effort to improve behavior in the implementation of oral hygiene and a decrease in debris index in adolescents compared to the contol group.

Periodontal Practice and Referral of Patients by General Dental Practitioners in Province No.1 Nepal

Introduction: General dental practitioners and periodontists working in a close alliance is considered to bestow effective outcome in the context of diagnosis and management of periodontal diseases. Recently, general practitioners are inclined to render the majority of non-surgical procedures by themselves and avoid surgical part. This obscures functional as well as esthetic demand contributing to periodontally challenged conditions. In advanced stages, no matter how efficiently a skilled periodontist handles the case, redemption is not possible.
 Objectives: To assess the periodontal practice and referral of patients by general dental practitioners to periodontists.
 Methodology: An online survey using Google Forms was conducted among the general dental practitioners working in private clinics in province no.1, Nepal from November 2021 to January 2022. A total of 64 general dental practitioners were surveyed using a self-administered questionnaire. Descriptive statistics were calculated.
 Results: The response rate for the present study was 51.2% out of which only 17.2% referred patients to periodontists for non-surgical periodontal therapy and scaling was the most performed procedure by all the practitioners themselves. However, 92.2% referred patients to periodontists for surgical procedures and a majority of the referrals were for mucogingival surgeries. Majority of them expressed satisfaction regarding the number of continuing dental education programs being conducted despite minimum participation.
 Conclusion: Majority of the general dental practitioners seemed to perform non-surgical periodontal therapy by themselves while considering referral for surgical interventions. Also, minimum participation despite remarkable satisfaction in the conduction of continuing education programmes calls for a need to explore the inadequacy.

Training dental hygiene students to care for patients with disabilities.

The purpose of this study was to evaluate the impact of a novel training programme on dental hygiene students' knowledge, attitudes, and beliefs about caring for individuals with disabilities. A mixed methods approach was used. Students from five dental hygiene programmes based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution, gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered, and modifications to treatment. Student comments about their experiences were assessed using thematic analysis. Two hundred and ninety-four students completed didactic training, and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes, and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviours of empathy and compassion towards others. Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities.

Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study.

Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.

The Impact of the Socioeconomic Status(SES) on the Oral Health Status Among 15 Year-Old School Adolescents In Kerbala City/Iraq

Dental caries, plaque, calculus and gingivitis are the most common and widely spread oral health conditions affecting humans at different ages. Socioeconomic status was reported to be one of the factors affecting the severity of oral diseases. The aim of the study included studying the impact of socioeconomic status on oral health variables and investigating the prevalence and severity of dental caries, gingivitis, dental plaque, and dental calculus and an excellent data baseline for planning future preventive programs. The total sample was composed of 500 male students at 15 years old selected randomly from the secondary schools in Karbala city. Assessment of the socioeconomic status using a questionnaire; information about the student's socioeconomic status (SES) was obtained from the student's guardians. Diagnosis and recording of dental caries were according to the criteria described by WHO (2013). gingival index of Loe and Silness (1963) was followed for recording gingival health condition, the Plaque index of Silness and Loe (1964) was used for plaque assessment, and the assessment of calculus was done by applying the Ramfjord index (1959). A high prevalence of dental caries (95.60%) was found, and the caries-free students represented (4.40%); the caries prevalence and severity represented by (DMFT)(DMFS) respectively and the (FS) component of the DMF were significantly affected by the socioeconomic status (SES), Dental plaque and calculus are more in low SES group than other groups, with no significant differences, The mean of gingivitis of the total sample was(1.908), also finding gingivitis is more in low SES group than other groups with a Significant difference(0.011), and regarding the Gingival severity, all subjects have the moderate type of gingivitis (1.1-2). There is a clear and significant increase in the prevalence of dental caries and gingivitis concerning the socioeconomic status of this adolescent group of students. This requires good dental school health programs and improvement in the education level about the importance of oral health and more regular dental visits. Keywords: Dental caries, oral health, gingivitis, socioeconomic

A phenomenological study on East and Southeast Asian dental educators: perceived importance, challenges, and strategies in teaching dental materials science

BackgroundEffective teaching of dental materials science is crucial for dental students to develop a comprehensive understanding of materials used in clinical practice. However, literature on educators’ views on teaching this subject is still scarce. This qualitative study aimed to explore the lived experiences of dental educators in teaching dental materials science subjects, thereby addressing potential gaps and enhancing teaching practices.MethodsThirteen dental educators from East and Southeast Asian countries (Malaysia, China, Indonesia, Thailand, South Korea, and Japan) participated in the present study. The present study adopted a transcendental phenomenological approach. One-to-one semi-structured online interviews were conducted. Interviews were recorded and transcribed verbatim. Thematic analysis was employed to identify patterns in the educators’ experiences.ResultsThree themes emerged from the present study. First, perceptions of the importance of dental materials science, highlighting its relevance in clinical practice, patient care, and lifelong learning. Second, the challenges faced in teaching dental materials science include limited instructional time, complex content, and insufficient resources. Third, specific strategies, such as applying interactive teaching methods, integrating clinical scenarios, and promoting critical thinking skills have been suggested to enhance teaching and learning.ConclusionUnderstanding dental educators’ experiences can improve dental materials science education, curriculum development, teaching methods, and faculty training programmes, ultimately enhancing the knowledge and skills of dental students in this field.

Shared decision-making in scaling and root planing.

Estimate proportion of various approaches used by dental hygienists for engaging patients in decisions commonly arising during scaling and root planing. Distribution of approaches was compared across various task components in this procedure, practice experience of dental hygienists and patient compliance. Survey of graduates from and students in a baccalaureate dental hygiene program. Paternalism (tell then do) and informed consent (give choices and reasons and ask for permission) were more common than shared decision-making (discuss alternatives, solicit patient input and arrive at a mutual decision) and disengagement (patient refusing offered service or avoiding further involvement) by a ratio of 4 to 1 for the first 2 compared with the latter 2. This relationship was held across selecting treatment, procedural adjuncts, homecare instructions and financial arrangements. Dental hygienists exhibited a range of personal preferences for engagement approaches. No-show rate, patient disengagement outside the office, was high (20%). Dental hygienists reported using 'more controlled' approaches to engaging patients in decisions regarding treatment. Patients may prefer to engage in more shared decisions and choose this approach by staying away from the office. This may underestimate patients' decisions to stay away from treatment, for example by not showing for completion of the treatment or disregarding homecare routines.

Pattern of Tooth Extraction and Use of Space Maintainers in Paediatric Dental Patients in Lagos State University Teaching Hospital, Ikeja

The primary dentition is essential in the maintenance of normal occlusion in the permanent dentition. Both dentitions enhance aesthetic, speech and are functional in nature. Early loss of the primary dentition necessitates the placement of space maintainers. This study determined the pattern of tooth extraction of patients attending the paediatric dental clinic in Lagos State University Teaching Hospital, Ikeja and the use of space maintainers. A retrospective study carried out using the dental records of patients who attended the Paediatric dental clinic, Lagos State University Teaching Hospital, Ikeja, Lagos. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 20 (IBM, New York). The prevalence of tooth extraction was 49.8% among a population of 410 subjects with a total of 353 extracted teeth. The male to female ratio was 1:1.37. Majority (58.3%) of the subjects had only one tooth extracted. The commonest reason for extraction was retained primary teeth (35.8%). The commonest arch and segment of extraction was the mandible (56.1%) and the anterior teeth (51.0%). The commonest tooth extracted was upper right primary central incisor (7.6%). The most common space maintainer was band and loop. Retained teeth was the most common reason for tooth extraction followed by sequelae of dental caries, caries and trauma. This highlights the need for implementation of oral health prevention policies with regards to the use of fluoride, fissure sealants, silver diamine fluoride increased awareness of safety protocols to mitigate traumatic injuries and introduction of dental health education programs in schools and community.

Musculoskeletal Disorders and Stress among Moroccan Dentists: A Cross Sectional Study

Background and aim: Dentists' treatment tasks require repetitive actions, uncomfortable postures, and intense effort, all of which can lead to health disorders. The aim of the study was to describe the prevalence of musculoskeletal disorders among Moroccan dentists and the factors associated with these diseases. Material and methods: To conduct a descriptive cross-sectional survey, an anonymous questionnaire on occupational health problems was distributed to a representative sample of 310 Moroccan dentists. Sample size calculation and sampling were performed using Epi info software. Data were analyzed using the SPSS (Statistical Package for the Social Sciences) software. The associations among the frequency of variables were evaluated by the chi-square test (P < 0.05).Results: Out of 310 questionnaires distributed, we received 286 responses, for a response rate of 95.33%. A total of 286 dentists were included in our survey. The mean age of the participants was 41.19 (±7.63) years. The results showed that 62.9% of the surveyed dentists complained of musculoskeletal disorders. Moreover, 79.4% of practitioners had high stress levels. Concerning sports activity, 55.9% of the practitioners practiced a sport activity.Conclusions: For Moroccan dentists, the occurrence of musculoskeletal pain is a critical problem. Considering the scale of the problem, it is necessary to implement education in ergonomics among dentists and dental students, and to promote the holistic health of dental professionals. As musculoskeletal pain is a critical issue for Moroccan dentists, it's judicious to consider ergonomics courses at the beginning of dental education programs, then every year until graduation, and to provide professional dentists with continuous training all along their careers.

Supervisory Practices in Dental Program: Basis for a Proposed Supervisory Model

Introduction Ineffective supervisory practices can be one of the possible causes of poor students’ academic performance. The aim of supervision is basically to promote student’s learning, reflective practice and improving patient safety and the quality of patient care. To date, there have been limited studies on the supervisory practices in the dentistry program. This prompted the researcher to assess their supervisory practices. The respondents’ supervisory practices will practically serve as a basis for a proposed a supervisory model that can be helpful for the dental institutions in the future. Supervisory models aim to improve faculty member’s performances and provide them with the assistance that they need for the improvement of instruction as well as to provide quality education for the students. Methods The study used descriptive research method. Qualitative and quantitative methods of data collection were employed. A researcher-made questionnaire was used in gathering data for the study. Deans, Academic heads, Department heads or Section heads and faculty members from the selected private dental institutions in National Capital Region were selected as the respondents of the study. Results and Discussion The main findings of the study indicated that for instructional supervision in terms of instructional improvement, offering continuing professional development trainings for the faculty members at school level got the highest mean. On the other hand, for curriculum development, highest is on identifying the problems in the implementation of existing. Results for clinical dentistry supervision in terms of instructional improvement indicated that offering continuing professional development trainings for the clinical instructors at school level also obtained the highest mean. Curriculum development contributes in the professional competencies of clinical instructors by providing the latest information on materials as evidenced by the highest mean obtained. With regard to community dentistry supervision in terms of instructional improvement, highest mean is on offering continuing professional development trainings for the fieldwork preceptors at school level. Lastly, in terms of curriculum development, highest is on the indicator on helping in the identification of the problems in the implementation of the existing policies in the community outreach. The study further revealed that continuing professional development for faculty members is of utmost importance to the deans and academic heads. Finally, there is a felt need to help the faculty members in the selection of appropriate resources like teaching aids. The deans and academic heads of the different dental institutions address the problems in the delivery of instructions. There is a need to convene the stakeholders in a meeting for curriculum evaluation and validation. Providing feedback is needed particularly in the fieldwork preceptors on the service rendered. Based on the findings and conclusions, it is therefore recommended to strengthen the offering of professional development as a part of the instructional supervision of the administrators and inclusion of the variables in the continuing professional development of the faculty and explore the possibilities of convening the stakeholders regularly for curriculum evaluation and validation. Further studies should also be done in order to validate and evaluate the proposed supervisory model.

Implication of dental insurance status on patterns of pre-radiation dental extraction and risk of osteoradionecrosis of the jaw in head-and-neck cancer patients

Oral toxicities such as osteoradionecrosis can be minimized by dental screening and prophylactic dental care prior to head and neck (HN) radiation therapy (RT). However, limited information is available about how dental insurance interacts with prophylactic dental care and osteoradionecrosis. To address this gap in knowledge, we conducted a cohort study of 2743 consecutive adult patients treated with curative radiation for HN malignancy who underwent pre-radiation dental assessment and where required, prophylactic dental treatment. Charts were reviewed to determine patient demographics, dental findings, dental treatment and development of osteoradionecrosis following radiation. Three insurance cohorts were identified: private-insured (50.4 %), public-insured (7.3 %), being patients with coverage through government-funded disability and welfare programs, and self-pay (42.4 %).More than half the public-insured patients underwent prophylactic pre-radiation dental extractions, followed by self-pay patients (44 %) and private-insured patients (26.6 %). After a median follow-up time of 4.23 years, 6.5 % of patients developed osteoradionecrosis. The actuarial rate of osteoradionecrosis in the public-insured patients was 14.7 % at 5-years post-RT, compared to 7.5 % in private-insured patients and 6.7 % in self-pay patients. On multivariable analysis, dental insurance status, DMFS160, age at diagnosis, sex, tumor site, nodal involvement, years smoked and gross income were all significant risk factors for tooth removal prior to HN radiation. However, only public-insured status, tumor site and years smoked were significant risk factors for development of osteoradionecrosis. Our findings demonstrate that lack of comprehensive dental coverage (patients who self-pay or who have limited coverage under public-insured programs) associates strongly with having teeth removed prior to HN RT. Nearly 1 in 6 patients covered under public-insurance developed osteoradionecrosis within 5 years of completing their treatment. Well-funded dental insurance programs for HN cancer patients might reduce the number of pre-RT extractions performed in these patients, improving quality of life post-RT.

School-based caries prevention and the impact on acute and chronic student absenteeism

BackgroundPoor oral health is significantly associated with absenteeism, contributing to millions of lost school hours per year. The effect of school-based dental programs that address oral health care inequities on student attendance has not yet been explored. MethodsCariedAway was a longitudinal, cluster-randomized, noninferiority trial of minimally invasive medicines for caries used in a school-based program. We extracted data on school absenteeism and chronically absent students from publicly available data sets for years before, during, and after program onset (2016-2021). Total absences and the proportion of chronically absent students were modeled using multilevel mixed-effects linear and 2-limit tobit regression, respectively. ResultsIn years in which treatment was provided through a school-based caries prevention program, schools recorded approximately 944 fewer absences than in nontreatment years (95% CI, –1,739 to –149). Averaged across all study years, schools receiving either treatment had 1,500 fewer absences than comparator schools, but this was not statistically significant. In contrast, chronic absenteeism was found to significantly decrease in later years of the program (b, –.037; 95% CI, –.062 to –.011). Excluding data for years affected by COVID-19 removed significant associations. ConclusionsAlthough originally designed to obviate access barriers to critical oral health care, early integration of school-based dental programs may positively affect school attendance. However, the observed effects may be due to poor reliability of attendance records resulting from the closing of school facilities in response to COVID-19, and further study is needed. Practical ImplicationsSchool-based caries prevention may also improve educational outcomes, in addition to providing critical oral health care. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT03442309.

The Impact of a Web-Based Restorative Dentistry Course on the Learning Outcomes of Dental Graduates: Pre-Experimental Study.

Restorative dentistry plays a crucial role in dental practice, necessitating professionals to stay abreast with the latest advancements in the field. The advancement of technology has made web-based learning a widely used method of education delivery in dentistry, providing learners with extensive information and flexibility. This study aims to evaluate how effective an online educational course in restorative dentistry is for dental graduates in Syria. This study used a pre-experimental study design, with pretest and posttest assessments to measure changes in participants' knowledge and skills. A total of 21 dental graduates completed the online course in restorative dentistry, which was hosted on Moodle, using the learning management system of the Syrian Virtual University. Participants were provided with a suggested learning sequence and had the flexibility to navigate the course on their own and at their own pace. The course was developed based on the principles of web course design and web-based course development using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) general instructional design model. The pretest and posttest assessments consisted of 50 multiple-choice questions with a single correct answer, aligning with the course content. Furthermore, participants were asked to complete a course acceptance survey upon finishing the course. The results showed a significant improvement in the participants' knowledge of restorative dentistry, supported by a statistically significant P value of less than .05. The effect size of the difference between the pre and posttest indicated that the effect size, as indicated by ω2, demonstrated a significant 62.1% difference between the pre and posttest, indicating a high and statistically significant effect. Furthermore, the value derived from the Haridy obtained work ratio formula indicated that the educational program was effective, with an effectiveness amount of 3.36%. Additionally, 93% (n=19) of respondents expressed confidence in having gained the expected benefits from the educational course upon its completion. The findings indicated a notable enhancement in the participants' understanding of restorative dentistry. The participants' high satisfaction rate and positive feedback from the course acceptance survey further emphasize the favorable reception of the web-based learning approach. This study highlights the potential of web-based learning in dental education, opening the door for future research in this area. The findings of this study carry important implications for the design and implementation of web-based educational programs in dentistry, suggesting that such programs can serve as an effective tool for continuous professional development in the field.

Mediator 1 ablation induces enamel-to-hair lineage conversion in mice through enhancer dynamics

Postnatal cell fate is postulated to be primarily determined by the local tissue microenvironment. Here, we find that Mediator 1 (Med1) dependent epigenetic mechanisms dictate tissue-specific lineage commitment and progression of dental epithelia. Deletion of Med1, a key component of the Mediator complex linking enhancer activities to gene transcription, provokes a tissue extrinsic lineage shift, causing hair generation in incisors. Med1 deficiency gives rise to unusual hair growth via primitive cellular aggregates. Mechanistically, we find that MED1 establishes super-enhancers that control enamel lineage transcription factors in dental stem cells and their progenies. However, Med1 deficiency reshapes the enhancer landscape and causes a switch from the dental transcriptional program towards hair and epidermis on incisors in vivo, and in dental epithelial stem cells in vitro. Med1 loss also provokes an increase in the number and size of enhancers. Interestingly, control dental epithelia already exhibit enhancers for hair and epidermal key transcription factors; these transform into super-enhancers upon Med1 loss suggesting that these epigenetic mechanisms cause the shift towards epidermal and hair lineages. Thus, we propose a role for Med1 in safeguarding lineage specific enhancers, highlight the central role of enhancer accessibility in lineage reprogramming and provide insights into ectodermal regeneration.

Overview of oral and dental healthcare in Dubai health authority: status, gaps, and initiatives, 2016-2021

This article provides an overview of the current status of oral and dental healthcare within the Dubai health authority (DHA) and highlights the gaps and the impact of initiatives implemented between 2016 and 2021. The oral and dental care program, part of the Dubai health strategy 2016-2021, aimed to enhance oral and dental care by ensuring widespread access to high-quality treatments and effective prevention programs. To gain a comprehensive understanding, an initial assessment of the current state of oral and dental care was conducted with the assistance of an external consultant. This assessment encompassed a review of existing clinical guidelines, frameworks, and awareness initiatives, as well as an evaluation of the patient journey and accessibility. While noteworthy innovative measures were already in place, certain gaps were identified, and recommendations were proposed to address them. Subsequently, specific initiatives and programs were implemented in alignment with these recommendations to bridge the identified gaps. A notable achievement was the development of the Dubai dental protocol, which governs a patient-centered model of care and emphasizes a life-course approach to dental health promotion, addressing the diverse stages of life from pre-pregnancy to geriatric care.

Knowledge, Practice and Self-Reported Confidence Level of Croatian Dentists in the Use of Local Anesthesia: A Cross-Sectional Study.

Objectives: To provide safe and effective local anesthesia, dentists must have knowledge of neuroanatomy, anesthesia agents, techniques, equipment, and proper use of local anesthetics. This study aims to explore the knowledge, practices, and confidence regarding local anesthetics and anesthetic techniques in dentistry. Material and Methods: The online cross-sectional questionnaire was conducted via social media, and yielded 441 responses from across the country (69.8% women and 30.2% men; 70.7% general dentists; and 29.3 specialists). The data collected included sociodemographic characteristics, knowledge, and practices pertaining to the usage of local anesthesia. The questionnaire also documents their self-assessed confidence level in applying different local anesthetic techniques and experiences with adverse reactions. The obtained data were processed by description and using a generalized linear model for regression. Results: The respondents had a median knowledge score of 6 out of a possible 14 points regarding local anesthetics in dental medicine, and their median self-confidence level in the successful application of various techniques of local anesthesia was 54 out of a maximum of 85 points. The results showed that a higher knowledge level was associated with the female gender (OR 1.83, CI 1.13-2.98, p = 0.014) and specialization in oral surgery (OR 7.04, CI 1.71-29.07, p = 0.007). In contrast, a lack of confidence in using various local anesthetic techniques was also associated with the female gender (OR 0.63, CI 0.41-0.99, p = 0.047) and specialization in orthodontics (OR 0.16, CI 0.03-0.88, p = 0.035). Of the respondents, 81.4% (n = 371) experienced a local complication, and 42.2% (n = 186) experienced a systemic complication during local anesthesia. The complications experienced cannot be associated with a lack of knowledge or self-confidence (p > 0.05). The majority of respondents (364 of the 441 total-82.5%) expressed interest in receiving further education on the topic of local anesthesia. Conclusions: The research results show that the dentists involved in the study have poor knowledge of local anesthetics and moderate self-reported confidence levels in using various local anesthetic techniques. Moreover, dentists' self-confidence in applying different techniques of local anesthesia is not related to their knowledge. Therefore, it would be necessary for dentists to undergo a continuing dental education program that enables them to enhance their skills and knowledge in local anesthesia.

Towards equitable dental care in Canada: Lessons from the inception of Medicare.

Dental care in Canada is primarily financed through private insurance plans and out-of-pocket payments. While Canada is internationally recognized for Medicare, a publicly-funded health insurance system that covers hospital and physician-provided services at the point of care, it remains one of the least equitable Organization for Economic Co-operation and Development countries in terms of affordable access to dental care. Approximately one third of Canadians do not have access to dental insurance, including half of low-income individuals, and individuals with the greatest dental care needs are often unable to reliably access dental services. Select populations-such as children, Indigenous peoples, seniors, and persons living with disabilities-receive some level of publicly-funded dental services, amounting to approximately 6% of total dental spending nationwide. Despite the evolution of Medicare, dental care has been largely excluded from federal health legislation following World War II. However, in March 2022, the Liberal Party of Canada partnered with the federal New Democratic Party to advance common legislative goals, including a long-term nationwide dental program for low- and middle-income families. As an interim measure, Bill C-31 was signed into law on 17 November 2022, and created the Canada Dental Benefit, which provides a fixed transfer payment to individuals with an annual household income under $90,000. This commentary reviews the origins of Canadian Medicare, discusses the factors that led to the continued exclusion of dental care from federal health legislation, examines the newly-minted Canada Dental Benefit, and explores the potential for expanded public funding in Canadian dental care.

Oral health-related quality of life among women early postpartum: A cross-sectional study.

Periodontal diseases can negatively impact the oral health-related quality of life (OHRQoL) of pregnant women. This study investigates the association between maternal oral inflammatory load (OIL), sociodemographic characteristics, and the OHRQoL in postpartum women. In this cross-sectional study, breastfeeding mothers were recruited from St. Michael's Hospital, Toronto within 2-4 weeks postpartum. Mothers were categorized into "Normal/low" and "High" OIL groups based on the absolute counts of oral polymorphonuclear neutrophils (oPMNs). The Oral Health Impact Profile-14 questionnaire was used to assess the impact of the maternal OIL on the OHRQoL. Multiple linear regression analyses were performed to examine the association between maternal sociodemographic factors including age, marital status, education level, employment status, parity, and their OHRQoL. Forty-seven mothers were included in this study. Mothers with high OIL reported higher impact on their OHRQoL (30%) than mothers with normal/low OIL (21%), but these differences were not statistically different. There was a negative relationship between the mother's education level and the extent of impact of OHRQoL on the "physical pain" dimension (p<0.05), and between the mothers' age and employment status and the "physical disability" dimension (p<0.05). A positive correlation was noted between multi-parity and the extent of impact of OHRQoL on the "physical disability" dimension (p=0.009), and between the marital status and the "psychological disability" dimension (p<0.05). This study highlighted the significant impact of sociodemographic characteristics on the OHRQoL of mothers, showcasing the importance of considering these factors when implementing targeted preventive dental care programs for mothers.