Oral Health Researchers Research Articles

How Research Training Will Shape the Future of Dental, Oral, and Craniofacial Research.

This is a critical time in the history of the dental profession for it to fully embrace the responsibility to safeguard its reputation as a learned profession. In this golden era of scientific and technological advances, opportunities abound to create new diagnostics, preventions, treatments, and cures to improve oral health. Dental schools are the largest national resource entrusted with the responsibility to educate, train, and retain oral health researchers who can leverage such technologies and research opportunities that will benefit the profession at large as well as patients. This article reemphasizes the theme that research training and scholarship must be inextricably woven into the environment and culture in dental schools to ensure the future standing of the profession. An overview of the history of support provided by the National Institutes of Health and National Institute of Dental and Craniofacial Research for the training and career development of dentist-scientists is presented. In addition, new data on the outcomes of such investments are presented along with a comparison with other health professions. This overview underscores the need to expand the capacity of a well-trained cadre of oral health researchers through the reengineering of training programs. Such strategies will best prepare future graduates for team science, clinical trials, and translational research as well as other emerging opportunities. The urgent need for national organizations like the American Dental Association, American Dental Education Association, and American Association for Dental Research to create new alliances and novel initiatives to assist dental schools and universities in fulfilling their research mission is emphasized. To ignore such calls for action is to disavow a valuable legacy inherited by the dental profession. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Current Status of Post-Graduate Dental Hygiene Education in the United States

Objectives: The aim of this study was to explore post-graduate dental hygiene education in the United States in order to acquire data and information that could be utilized for advancing dental hygiene education and stimulating the field of dental hygiene research in Korea. Methods/Statistical Analysis: Extensive literature review was conducted and official websites of all 22 schools that offer post-graduate dental hygiene programs and ADHA were utilized to obtain statistical data and significant information. Retrieved data were analyzed via Frequency analysis and descriptive analysis and then, visualized utilizing SPSS 20.0 for windows and Microsoft excel program. Findings: According to the official website of ADHA, based on survey data utilized in 2014, there are 332 dental hygiene programs (53 Baccalaureate level programs and 287 associate level programs) in America. Data revealed that 17 schools (77%) are offering Master of Science in Dental Hygiene (MSDH) while other five schools have related programs such as Master of Science (M.Sc.) or Master of Health Science (MHS). As these postgraduate dental hygiene programs’ most significant objective is to train and educate dental hygienists or dental hygiene students to succeed as educators, oral health professionals and researchers, they put a great emphasis on diversity, social and cultural sensitivity, health care policy, interpersonal collaboration advocacy, health informatics and technology, health promotion and disease prevention, leadership, professionalism, program development and administration, scholarly inquiry and research methodology. Improvements/Applications: Most post-graduate programs that conduct dental hygiene education in the states seem to focus on preparing their students to become educators, administrators and researchers in the field of dental hygiene.

Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women: A Qualitative Study.

Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women's understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists' purported incorrect beliefs about providing dental treatment to pregnant women and the women's lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women. Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.

Current Status of Post-Graduate Dental Hygiene Education in the United States

Objectives: The aim of this study was to explore post-graduate dental hygiene education in the United States in order to acquire data and information that could be utilized for advancing dental hygiene education and stimulating the field of dental hygiene research in Korea. Methods/Statistical Analysis: Extensive literature review was conducted and official websites of all 22 schools that offer post-graduate dental hygiene programs and ADHA were utilized to obtain statistical data and significant information. Retrieved data were analyzed via Frequency analysis and descriptive analysis and then, visualized utilizing SPSS 20.0 for windows and Microsoft excel program. Findings: According to the official website of ADHA, based on survey data utilized in 2014, there are 332 dental hygiene programs (53 Baccalaureate level programs and 287 associate level programs) in America. Data revealed that 17 schools (77%) are offering Master of Science in Dental Hygiene (MSDH) while other five schools have related programs such as Master of Science (M.Sc.) or Master of Health Science (MHS). As these postgraduate dental hygiene programs’ most significant objective is to train and educate dental hygienists or dental hygiene students to succeed as educators, oral health professionals and researchers, they put a great emphasis on diversity, social and cultural sensitivity, health care policy, interpersonal collaboration advocacy, health informatics and technology, health promotion and disease prevention, leadership, professionalism, program development and administration, scholarly inquiry and research methodology. Improvements/Applications: Most post-graduate programs that conduct dental hygiene education in the states seem to focus on preparing their students to become educators, administrators and researchers in the field of dental hygiene. Keywords: Dental Hygiene Education, Dental Hygiene Student, Distance Education, Master of Science in Dental Hygiene (MSDH), Postgraduate Curricula

Advancing Health Promotion in Dentistry: Articulating an Integrative Approach to Coaching Oral Health Behavior Change in the Dental Setting.

Oral health is managed based on objective measures such as the presence and severity of dental caries and periodontal disease. In recent years, oral health researchers and practitioners have shown increasing interest in a widened array of physical, psychological, and social factors found to influence patients' oral health. In this article, we introduce a behavior change coaching approach that can be used to enhance psychosocial diagnosis and client-centered delivery of health-promoting interventions. Briefly, this health coaching approach is based on an interactive assessment (both physical and psychological), a non-judgmental exploration of patients' knowledge, attitudes, and beliefs, a mapping of patient behaviors that may contribute to disease progression, gauging patient motivation, and tailoring health communication to encourage health-promoting behavior change. Developed in a clinical setting, this coaching model is supported by interdisciplinary theory, research, and practice on health behavior change. We suggest that, with supervision, this coaching process may be learned.

Measuring oral health literacy: a scoping review of existing tools.

BackgroundThis article presents findings from a scoping review of tools used to measure oral health literacy. Internationally, interest in oral health literacy is driven by oral health disparities, particularly for disadvantaged groups, with conditions such as dental caries and periodontal disease contributing substantially to the global burden of disease. The increasing focus on measuring oral health literacy aligns with reasons for measuring broader health literacy, that is, by assessing oral health literacy, decisions can be made about instigating interventions at policy and practice level to improve individual and population level oral health. There are numerous tools available that measure oral health literacy using a range of indicators.MethodsA scoping review was designed to map the existing tools designed to measure oral health literacy (OHL). Key search terms were developed and mapped. Selected databases were used that identified 32 relevant studies reporting a range of OHL tools.ResultsWe identified 32 articles that reported a range of oral health literacy tools. Many of the studies used the Rapid Estimate of Adult Literacy in Dentistry (REALD) and/or the Test of Functional Health Literacy in Dentistry (ToFHLiD) that were developed from earlier tools designed to measure broader health literacy. These tools have been widely criticised for providing only an approximate measure of OHL based mainly on word recognition. A number of newer tools have included new measures of oral health literacy including numeracy and oral health conceptual knowledge however tools that measure important indicators of oral health literacy such as service navigation are rare.ConclusionsFindings from this scoping exercise confirm our findings from preliminary scans that the majority of tools are heavily biased towards word recognition, numeracy and reading skills, rather than what this means in terms of health behaviours and service utilisation. More recent developments have attempted to incorporate other aspects considered important, including decision making and service navigation. The incorporation of these aspects into newer tools will provide oral health researchers and policy makers with further evidence of the importance of oral health literacy when designing interventions to improve oral health.

Oral Biology in Middle Age

In 1960, the first Department of Oral Biology in the United States dedicated to the conduct of research, graduate biomedical research education, and the provision of basic oral science education for the DDS curriculum was established at the University at Buffalo. In 1963, the Department organized the first PhD Program in Oral Biology in the United States. This PhD program has produced a large cadre of oral health researchers, many of whom have gone on to make major contributions to dental research and education. This article provides a brief history of the program, the context within which the program was organized and developed, and a description of some of the many faculty, students, and fellows associated with the program. Additionally, to celebrate the 50th anniversary of this program, a symposium, entitled “The Oral Microbiome, Immunity and Chronic Disease”, was held on June 12-14, 2013, in Buffalo, New York. The proceedings are published online in Advances in Dental Research (2014, Vol. 26).

Differential Effects of 1,25-dihydroxyvitamin D3 on Oral Squamous Cell Carcinomas In Vitro

ABSTRACTObjective: The inverse association between vitamin D and cancer risk is well-established, but the relationship with oral cancer is less well-understood. To further the understanding of these relationships, this study sought to evaluate any growth-inhibiting effects of vitamin D on well-characterized oral cancers. Methods: This study utilized 1,25-dihydroxy Vitamin D3 to evaluate any changes in growth using CAL27, SCC15, and SCC25 oral cancer cell lines at physiological and supraphysiological concentrations. Results: These assays revealed that the growth of all three cancer cell lines was significantly reduced by vitamin D administration, with maximal inhibition in SCC15 of –6.8% at 50 nmol, –19.7% in CAL27, and –43.6% in SCC25 at 100 nmol (p < .05). In addition, the observed decreases in growth were associated with significant decreases in viability (ranging from –18% in SCC15, –23% in CAL27, and –47% in SCC25 cells), as well as activation of two key apoptotic pathways (caspase and bcl:bax). Conclusion: The results of this study demonstrate the growth-inhibitory effects of vitamin D administration in specific oral cancer cell lines, which will enhance the understanding of oral oncologists and oral health researchers in developing standards for generalizing the health-protective effects of diet and dietary supplements as treatment options for patients with oral cancer.

Methodological characteristics and treatment effect sizes in oral health randomised controlled trials: Is there a relationship? Protocol for a meta-epidemiological study

IntroductionIt is fundamental that randomised controlled trials (RCTs) are properly conducted in order to reach well-supported conclusions. However, there is emerging evidence that RCTs are subject to biases which can...

Expanding the Foundation for Personalized Medicine

Personalized medicine aims to individualize care based on a person’s unique genetic, environmental, and clinical profile. Dentists and physicians have long recognized variations between and among patients, and have customized care based on each individual’s health history, environment, and behavior. However, the sequencing of the human genome in 2003 and breakthroughs in regenerative medicine, imaging, and computer science redefined “personalized medicine” as clinical care that takes advantage of new molecular tools to facilitate highly precise health care based on an individual’s unique genomic and molecular characteristics. Major investments in science bring a new urgency toward realizing the promise of personalized medicine; yet, many challenges stand in the way. In this article, we present an overview of the opportunities and challenges that influence the oral health community’s full participation in personalized medicine. We highlight selected research advances that are solidifying the foundation of personalized oral health care, elaborate on their impact on dentistry, and explore obstacles toward their adoption into practice. It is our view that now is the time for oral health professionals, educators, students, researchers, and patients to engage fully in preparations for the arrival of personalized medicine as a means to provide quality, customized, and effective oral health care for all.

Oral health researchers form Canadian network

The newly formed National Network for Canadian Oral Health Research (NCOHR) aims to take on the next wave of challenges for oral health in Canada by connecting 10 faculties of dentistry in universities nationwide. The network recently distributed its first round of peer-reviewed funding for

Strauss et al. Respond

We appreciate the response to our article regarding the proportion and characteristics of patients who saw a dentist but not a primary care health provider in 2008. Like Greenberg and Glick, we also performed an earlier analysis using National Health and Nutrition Examination Survey (NHANES) data. We determined the proportion of individuals at increased risk of having diabetes, but who were unaware of that increased risk.1 We found that 93% of US persons over 20 years of age, undiagnosed with diabetes but with moderate or severe periodontal disease, have risk factors indicating the importance of diabetes screening. We determined that 50% of those persons had seen a dentist in the past year and could have been screened for diabetes in the dental office. We appreciate Greenberg and Glick’s analysis regarding the potential use of the dental visit to identify males at increased risk for developing a severe cardiovascular event.2 Like their subsequent analyses demonstrating dental provider and patient willingness to participate in patient screening for medical conditions in the dental office,3,4 our research has shown the willingness of dentists and patients to be screened for diabetes.5 This is especially the case if screening involves the use of oral blood from at-risk patients with periodontal disease. In our article, we report results of a preliminary assessment of the extent to which a dental practice could serve as a site of opportunity to identify a variety of systemic health disorders for patients of all ages. Medical Expenditure Panel Survey (MEPS) data were very useful because they enabled explicit inclusion in our analysis of specific types of primary care health providers (physicians, nurses, nurse practitioners, physician assistants, physical therapists, optometrists, and chiropractors) who saw patients on an outpatient basis in an office, hospital outpatient department, or hospital emergency room.6 Using interactive MEPSnet query tools,7 the analyses were straightforward, enabling researchers who have limited familiarity with complex survey analysis software to conduct other salient analyses. Our finding that 19.5 million people with diverse sociodemographic characteristics only visited a dental practice in 2008 suggests that the potential value of disease screening by dentists cuts across all strata of the US population. Like Greenberg and Glick, we welcome the potential collaboration between oral and systemic health practitioners and researchers that may be stimulated by discussion of our findings. Such a collaboration can serve to improve patients’ health, even as it reduces long-term health care costs resulting from unnecessary delay in disease identification.

Progress in Children's Oral Health Since the Surgeon General's Report on Oral Health

I n 2008 the American Academy of Pediatrics (AAP) convened a National Summit on Children’s Oral Health (see Acknowledgments and http://www.aap. org/oralhealth/summit.cfm) to assess progress made in meeting the recommendations of Oral Health in America: A Report of the Surgeon General and the National Call to Action to Promote Oral Health, relative to children’s oral health. As background information for the Summit, white papers were commissioned from nationally prominent oral health educators, researchers, and policy makers. This special issue on children’s oral health contains the updated papers from this effort with special commentaries by former US Surgeon General David Satcher, and Rebecca L. Slayton (guest editor of this issue) and Harold Slavkin, formerly director of the National Institute of Dental and Craniofacial Research (NIDCR). This issue also contains results of the AAP’s 2008 Periodic Survey of Fellows practices in oral heath.

Post-consent assessment of dental subjects' understanding of informed consent in oral health research in Nigeria

BackgroundResearch participants may not adequately understand the research in which they agree to enroll. This could be due to a myriad of factors. Such a missing link in the informed consent process contravenes the requirement for an "informed" consent prior to the commencement of research. This study assessed the post consent understanding of Nigerian study participants of the oral health research they were invited to join.MethodsA descriptive cross sectional study with research participants who had just consented to one of three ongoing research studies on oral health. Study sites included two centers, one in the northern and one in the southern part of Nigeria. Data were collected using a combination of quantitative and qualitative methods.ResultsA total of 113 research participants were interviewed. The southern part of the country had 58 respondents with the north having 55. The age range was 21 – 80 years. Mean age was 46.1 (SD16.3). The sample was predominantly male (69.9%) and married (64.6%). There was poor understanding of some key elements of the informed consent process such as involvement in research, benefits, contacts, confidentiality and voluntariness. Some identified factors potentially compromising understanding were poverty, illiteracy, therapeutic misconception and confusion about the dual roles of the Dentist and the researcher.ConclusionThe participants recruited into the oral health research in Nigeria did not adequately understand the studies they were invited to join nor do they understand their rights as research participants. Measures should be taken to include research bioethics into the curricula of Dental schools and to train oral health researchers in the country on research ethics.

Awareness, Attitude and Oral Hygiene Practices of 5 and 12 year old Navy School Children in Southern Nigeria in the year 2000

Background: The WHO goals of oral health for all by the year 2000 was the target for many oral health researchers. The awareness, attitudes and oral hygiene practices of 1357 five (5) and 23 year old Naval School children in the southern part of Nigeria was assessed in the year 2000 as part of a general survey. Objective: - To assess the awareness, attitude, oral hygiene practices and determine oral hygiene status of the 5 and 12 year old Nigeria Naval School children. Method: A questionnaire asking about oral health care, their oral hygiene practices, reasons for tooth cleaning, causes of tooth decay, sources of their information and frequency of dental visit was administered to them followed by intra-oral examination to assess the level of oral cleanliness using the Plaque Index (which is one of the oral hygiene indices. Results: Over 50% knew that sweet foods (mainly dietary sugars-refined carbohydrates e.g. milk and milk containing product, non-milk sugars, soft drinks, fruit juices and confectionary) could cause tooth decay. Parents and guardians were sources of information to 63.7% of the children as regard oral health care, causes of tooth decay and other oral diseases. The toothbrush and paste is used for tooth cleaning by 81.7% but only 52.5% had good oral hygiene. A higher proportion of the 12 year-olds (55.1%) than the 5year-olds (48.8%) had good oral hygiene. This is statistically significant with p>0.05. This may be explained by the inability to effectively clean due to lack of manual dexterity at this age (5yr) to carry out oral hygiene. Children from Calabar (65.9%) performed the best in the overall assessment while Children from Lagos (44.0%) performed the poorest. Fewer children (3.1%) use the traditional oral hygiene methods compared to the previous years (80-90% in 1978, 10.8% in 1985, 21.6% in sub-urban area and 49.8% in rural areas in 1994, 37.8% in 1998 and 0.5% urban and 31.6% rural area 2000). Conclusion: Oral health awareness 66.3% and frequency of dental visit by children 33.3%, in our study and those from previous studies in the Southern part of Nigeria has not changed dramatically between 1985 and year 2000. This is based on findings from other researchers of 11.2% in Lagos in 1985, 20% in Lagos in 1987 and 3.2% in Lagos in 2000). Keywords: Awareness, oral hygiene practices of 5, & 12 year old.NQJHM Vol. 15 (4) 2005: pp. 172-178

Theoretical explanations for social inequalities in oral health

Social inequalities in health and oral health continue to present a major challenge to public health. Progress towards the development of interventions to reduce health inequalities is currently being hampered by an incomplete understanding of the causes of inequalities in health. This paper aims to provide oral health researchers with an overview of four current explanations for inequalities in oral health and to suggest further areas of research needed to advance our understanding of the causes of social inequalities in oral health.

The problem of analysing the relationship between change and initial value in oral health research

The relationship between initial disease status and subsequent change following treatment has attracted great interest in dental research. However, medical statisticians have repeatedly warned against correlating/regressing change with baseline because of two methodological concerns known as mathematical coupling and regression to the mean. In general, mathematical coupling occurs when one variable directly or indirectly contains the whole or part of another, and the two variables are then analyzed by using correlation or regression. Consequently, the statistical procedure of testing the null hypothesis - that the coefficient of correlation or the slope of regression is zero - may become inappropriate. Regression to the mean occurs with any variable that fluctuates within an individual or a population, either owing to measurement error and/or to physiological variation. The aim of this article was to clarify the conceptual confusion around mathematical coupling and regression to the mean within the statistical literature, and to correct a popular misconception about the correct analysis of the relationship between change and initial value. As examples that use inappropriate methods to analyze the relationship between change and baseline are still found in leading dental journals, this article seeks to help oral health researchers understand these problems and explain how to overcome them.

The relationship between baseline value and its change: problems in categorization and the proposal of a new method

Oral health researchers have shown great interest in the relationship between the initial status of diseases and subsequent changes following treatment. Two main approaches have been adopted to provide evidence of a positive association between baseline values and their changes following treatment. One approach is to use correlation or regression to test the relationship between baseline measurements and subsequent change (correlation/regression approach). The second approach is to categorize the lesions into subgroups, according to threshold values, and subsequently compare the treatment effects across the two (or more) subgroups (categorization approach). However, the correlation/regression approach suffers a methodological weakness known as mathematical coupling. Consequently, the statistical procedure of testing the null hypothesis becomes inappropriate. Categorization seems to avoid the problem of mathematical coupling, although it still suffers regression to the mean. We show, first, how the appropriate null hypothesis may be established to analyze the relationship between baseline values and change in the correlation approach and, second, we use computer simulations to investigate the impact of regression to the mean on the significance testing of the differences in the average treatment effects (or average baseline values) in the categorization approach. Data available from previous literature are reanalyzed by testing the appropriate null hypotheses and the results are compared to those from testing the usual (incorrect) null hypothesis. The results indicate that both the correlation and categorization approaches can give rise to misleading conclusions and that more appropriate methods, such as Oldham's method and our new approach of deriving the correct null hypothesis, should be adopted.