Feasibility and acceptability of home delivery of water for dental caries control in Latinx children-"Sediento por una Sonrisa," Thirsty for a Smile: Single-arm feasibility study.

Background: Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage. Methods: A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants' homes and caregivers received patient-centered counseling for setting goals to increase children's water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented. Results: Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child's drinking habits was 9.62 and for the water delivery component, 8.86. Conclusions: This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions.

Anger and substance abuse: a systematic review and meta-analysis

Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

Anger and substance abuse: a systematic review and meta-analysis.

OBJECTIVE: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). METHODS: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. RESULTS: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. CONCLUSION: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

Food processing and its association with dental caries: Data from NHANES 2011-2014.

OBJECTIVE: To assess whether proportional contribution of unprocessed or minimally processed, processed or ultra-processed foods to daily energy intake is associated with dental caries in US adults. METHODS: This secondary cross-sectional analysis included adults aged 20 to 59 years old with complete oral examinations, using data gathered from cycles 2011-2012 and 2013-2014 of the continuous National Health and Nutrition Examination Survey (NHANES). Dietary recall data were categorized according to the NOVA classification into four groups: unprocessed or minimally processed foods (Group 1), processed culinary ingredients (Group 2), processed foods (Group 3) and ultra-processed foods (Group 4). The proportional contribution of each of these groups to mean daily energy intake was calculated and then cut into quartiles (Group 1, Group 3 and Group 4) or tertiles (Group 2). Two separate measures were used to assess dental caries: the decayed, missing, filled teeth (DMFT) index and, after exclusion of edentulous participants, prevalence of untreated caries. Poisson regression was used to model DMFT, while logistic regression was used to model the prevalence of untreated dental caries. Models were calculated for each NOVA group. All models were controlled for age, gender, race/ethnicity, level of education, income, access to oral health services, body mass index, smoking status and total energy intake. Analyses took into account NHANES sampling weights. RESULTS: We analysed data from 5720 individuals, of whom 123 (2.2%) were edentulous. Mean DMFT was 9.7 (± 0.2), while the prevalence of untreated dental caries was 26.0%. Mean daily energy intake was 2170 kcal (± 17). Mean contribution to overall daily energy intake was 28.6% (± 0.5) for G1 foods, 4.3% (± 0.1) for G2 foods, 10.1% (± 0.2) for G3 foods and 56.9% (± 0.5) for G4 foods. A higher intake of G3 was associated with lower DMFT at the fourth quartile (0.89; 95%: CI 0.81-0.96), while a higher intake of G4 was associated with a higher DMFT at the fourth quartile (1.10; 95% CI: 1.04-1.16). In the adjusted models for untreated dental caries, no statistically significant associations were found with any of the NOVA groups. CONCLUSION: Higher proportional intake of NOVA groups is only weakly associated with dental caries. Widespread exposure to a highly ultra-processed diet may explain these weak associations.

Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families

Objective: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Method: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Results: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. Conclusion: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Facility infrastructure of primary health services regarding tuberculosis control: a countrywide cross-sectional study.

BACKGROUND: Tuberculosis (TB) is still a major public health problem in many countries, including Brazil. Primary health care (PHC) services are a set of important services with infrastructure and resources to diagnose, treat, and cure several diseases, including the TB. AIM: The aim of this study is to analyse aspects of the facility infrastructure of Brazilian PHC, regarding the control and treatment of TB from a countrywide perspective. METHODS: This is a cross-sectional study based on PHC services. Data were collected from 38,812 health centres and were assessed by means of the National Program for Improving Access and Quality Primary Care. The outcome was obtained by the presence and availability of the following infrastructure items: air circulation in the consultation room, refrigerator, individual protective equipment, plastic jar for sputum examination, and TB notification form of the primary care information system. Poisson regression was used to calculate the prevalence ratio. FINDINGS: Of the 38,812 evaluated centres, only 1628 (4.2%) presented a positive result regarding the outcome. Primary health centres, among all types of centres, presented the highest quality of facility infrastructure for TB control. Centres with large workloads, as well as those that presented a list of offered services and a welcoming consulting room, also presented the highest quality infrastructure. The present study shows that major improvements should be made to the infrastructure to reach a satisfactory TB control in Brazil.

Decomposing early and adult life social position effects on oral health and chronic diseases in a cross-sectional study of Southern Brazil.

OBJECTIVES: As the socio-economic trajectory can influence on individual health during the life course, the aim of this study was to test a model of socio-economic life course effects on chronic diseases, tooth loss and on oral health-related quality of life using structural equation model (SEM) to decompose direct and indirect effects. METHODS: This cross-sectional study was performed in southern Brazil, within public healthcare users with 18 years old or more (n = 433). Latent variables were the Oral Health Impact Profile (OHIP), Childhood Socio-economic Status (SESC) and Adulthood (SESA), and Chronic Diseases (CD), and observed variables were sex, age, smoking status and tooth loss. The statistical analysis was performed using structural equation modelling (SEM) using WLSMV estimator. For the final model, we kept only plausible significant paths with P < 0.30. RESULTS: Final model presented an adequate fit: RMSA 0.03, Comparative Fit Index (CFI) 0.97, TLI 0.97, and Weighted Root Mean Square Residual (WRMR) 1.19. The direct effect from SESC to tooth loss was ß = -0.08 (P = 0.19) and the indirect was ß = -0.12 (P = 0.02). The indirect effect from SESC to OHIP was ß = -0.14 (P = 0.01) and there is no direct effect. The direct effect from SESA to tooth loss was ß = -0.21 (P < 0.01) and there is no indirect effect. The direct effect from SESA to OHIP was ß = -0.14 (P = 0.05). The association of SESA on SESC was ß = 0.59 (P < 0.01). CONCLUSIONS: SESC had indirect effects on OHIP and number of teeth via SESA, supporting the chain of effects theory, but not for chronic diseases.

Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families.

OBJECTIVE: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. METHOD: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. RESULTS: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. CONCLUSION: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Four-year incidence rate and predictors of root caries among community-dwelling south Brazilian older adults.

OBJECTIVE: This study aimed to assess the incidence density (ID) of new root caries lesions and restorations among community-living south Brazilian older adults and to assess its association with predictor variables. METHODS: We conducted a prospective cohort with a random sample of elders from the municipality of Carlos Barbosa, in south Brazil. Trained dentists performed interviews and oral examinations in 388 individuals at baseline, of which 273 were retained at follow-up 4 years later. Our outcome was root caries ID, with 100 root-years as its unit of measure. Demographic, biological and lifestyle predictors were tested with Poisson regression. RESULTS: The mean number of roots at baseline among participants was 7.0 (SD ± 4.9) and the incidence rate per 100 root-year 4.9 (SD ± 8.9). Incidence of root caries among these older Brazilians was of 47.3%. The associated factors with the incidence of root caries were age, geographic location of residence, frequency of tooth brushing and stimulated saliva flow rate. CONCLUSION: Age, external environment, personal practices and oral status were predictors of the incidence of root caries. Preventive strategies including the use of fluorides and instruction to improve the attitude and behaviour towards oral hygiene are needed.

Impact of Bariatric Surgery on the Saliva of Patients with Morbid Obesity.

BACKGROUND: The oral condition of obese patients may change following bariatric surgery owing to adverse effects that cause alterations in the oral cavity. The aim of this study was to evaluate the impact of bariatric surgery on the saliva of patients with morbid obesity. METHODS: Whole saliva samples were collected from 27 patients with morbid obesity (BMI >40 kg/m(2)), prior to and 6 months after bariatric surgery. Stimulated salivary flow rate, pH, buffering capacity, and microbial levels of mutans streptococci, Lactobacillus spp., and Candida albicans were analyzed from saliva. RESULTS: Values of all salivary variables before and after bariatric surgery were within the normal range, except for the level of C. albicans, which was elevated at both times. An increase in the level of mutans streptococci was observed after bariatric surgery (p < 0.05). CONCLUSIONS: The results suggest that the salivary levels of mutans streptococci increase following bariatric surgery in morbidly obese patients.

Hand function and oral hygiene in older institutionalized Brazilians.

OBJECTIVES: To evaluate whether the oral hygiene of institutionalized older people differs significantly between groups of participants with different degrees of hand function. DESIGN: Cross-sectional study. SETTING: Residents of a long-term institution of Porto Alegre, Brazil. PARTICIPANTS: Forty-nine institutionalized older people. Subjects restricted to bed or with Mini-Mental State Examination (MMSE) scores less than 15 were excluded. MEASUREMENTS: Dental (Silness and Löe Index) and denture plaque (Modified Ambjornsen Plaque Index) scores were assessed as a measure of oral hygiene. Hand functions were assessed using the Jebsen-Taylor and the Purdue pegboard tests. Participants were grouped according to their levels of hand function (regarded as good if test values were at the median or higher in the case of Purdue pegboard test and below the median in the case of Jebsen-Taylor test). Existence of differences between groups was checked using univariate analysis of variance, adjusting for age, sex and cognitive status according to MMSE. RESULTS: Dentate participants with poor hand function according to the Dominant Hand Purdue test harbored significantly more dental plaque after adjustment for age, sex, and cognitive status. Complete denture wearers with poor hand function according to the Dominant Hand and Sum of Three Steps Purdue tests and the total Jebsen-Taylor test also had significantly more denture plaque after adjustment. CONCLUSION: The results support the notion that hand function plays a central role in oral hygiene, mainly removal of dental and denture plaque, in institutionalized older people.

Reproducibility of a hemi mandible positioning device and a method for measuring alveolar bone loss area in mice.

The objective of this study was to determine the reproducibility of a positioning device and a method for measuring the area of alveolar bone loss (ABL) in hemi mandibles of mice. Mucoperiosteal flaps were raised in CF1 Mus domesticus mice (n = 10) on the buccal aspects of the left side of the mandibles. Twenty-one days after surgery, the animals were sacrificed, and the mandibles were resected and stained with 1% toluidine blue. Two positioning devices, one for the buccal and the other for lingual aspect, were fabricated to keep the hemi mandibles in a standard position. The reliabilities of the positioning device and the method for measuring ABL area were analyzed using two series of pictures. The photographs were digitized and ABL measured as the exposed root area. Measurements were performed by two blinded examiners using image analysis software. Intra- and inter-examiner reproducibility of the positioning method ranged from -1.5 to +1.33 mm, while intra- and inter-examiner reproducibility of the measurement technique ranged from -3.37 to 14.70. Our results indicate that, due to the small variation observed in ABL area assessment, the positioning device and method for measuring ABL area represent useful techniques for evaluating ABL in mice.

Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older.

BACKGROUND: The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years. METHODS: In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes. RESULTS: The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%). CONCLUSION: Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.

Impacto da perda dentária na qualidade de vida de idosos independentes / The impact of tooth loss on quality of life in independent elderly people

O objetivo deste estudo foi avaliar o impacto da perda dentária na qualidade de vida em indivíduos idosos. Foram avaliados 28 idosos independentes do grupo de terceira idade do Centro Humanístico Vida, de Porto Alegre, RS. A amostra foi por conveniência e o protocolo foi aprovado pelo CEP-PUCPRS. Os indivíduos foram avaliados quanto ao número de dentes presentese, posteriormente, divididos em 2 grupos de acordo com o seguinte critério: grupo 1 = indivíduos com 0 a 7 dentes e grupo 2 = indivíduos com 8 ou mais dentes. Para determinar a qualidade de vida foi utilizado Inventário de qualidade de vida WHOQoL-breve. Diferenças entre grupos foram verificadas com o teste de Mann-Whiney, e a consistência interna do WHOQoL-breve com o teste Cronbach . O valor para regeição da hipótes nula foi p<0,05. O número médio de dentes dos indivíduos do grupo 1 foi 2,2 e do grupo 2 foi 10,7. O número de dentes naurais foi importante para determinar diferenças relacionadas à qualidade de vida(domínio meio ambiente), pois os idosos que possuiam 8 ou mais dentes apresentaram uma qualidade de vida melhor.