Does the Trimester of Smoking Matter in the Association between Prenatal Smoking and the Risk of Early Childhood Caries?

INTRODUCTION: Development of the primary tooth bud commences at the end of the 5th week of gestation, with mineralization starting at about the 13th week and continuing throughout pregnancy to the end of the first year of life. During this critical period, exposure to maternal lifestyle factors, specifically, prenatal smoking can negatively affect the quality (i.e., tooth calcification and mineralization) and timing of tooth eruption. METHODS: This study evaluated the association between the trimester of smoking and offspring caries experience at 3 time points (31, 43, and 61 months) by analyzing data from 1,429 mother-offspring participants in the 1991/92 Avon Longitudinal Study of Parents and Children, conducted in Bristol, England. Prenatal smoking in the first, second, and third trimesters were self-reported during pregnancy while offspring caries experience was determined by clinical oral examinations. Adjusted for confounders, log-binomial regression estimated the risk ratio (RR) and 95% confidence interval (CI) of the association between trimester of smoking and the risk of offspring caries. RESULTS: Twenty percent smoked in the first trimester of their pregnancy, 15% in the second, and 17% in the third. Forty-six percent of children whose mothers smoked during pregnancy had caries experience (i.e., dmft ≥1) with a mean dmft count of 1.58, versus children whose mothers did not smoke during pregnancy (33% of whom had dmft ≥1 with a mean dmft count of 0.33). Smoking in the first, second, and third trimesters were independently associated with a higher adjusted RR (95% CI) of caries experience at 61 months, i.e., 1.16 (0.93-1.43), 1.11 (0.75-1.65), and 1.60 (1.09-2.32), respectively. CONCLUSIONS: Within the limitations of covariates adjusted for, with the caveat that residual confounding and bias from unmeasured covariates are likely present, our findings suggest that smoking during pregnancy may be harmful to the oral health of the offspring irrespective of the trimester during which the smoking occurred. Nevertheless, these results should be interpreted cautiously because the findings might not generalize broadly.

Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study.

BACKGROUND: Oral cancers account for 3% of annual U.S. cancer diagnosis, 2 in 5 of which are diagnosed late when prognosis is poor. The purpose of this study was to report the population-level prevalence of oral cancer examination among adult smokers and alcohol drinkers and assess if these modifiable lifestyle factors are associated with receiving an oral cancer examination. METHODS: Adult participants ≥30 years (n = 9374) of the 2013-2016 cycles of the National Health and Nutrition Examination Survey were included. Oral cancer examination (yes/no), smoking (never, former, current) and alcohol use (abstainers, former, current) were self-reported. Survey-logistic regression estimated odds ratios (OR) and 95% confidence intervals (CIs) of ever and past year oral cancer examination adjusted for age, gender, race/ethnicity, education, income, and time since last dental visit. RESULTS: One third (33%) reported ever been examined for oral cancer, 66% of whom reported an examination in the past year. Adjusted OR (95% CI) of past year examination comparing current and former smokers to non-smokers were 0.51 (0.29, 0.88) and 0.74 (0.53, 1.04) respectively. Similarly, current and former alcohol drinkers relative to abstainers were less likely to report a past year oral cancer examination, OR (95% CI) = 0.84 (0.53, 1.30) and 0.50 (0.30, 0.83) respectively. CONCLUSION: This study showed that smokers and alcohol users were less likely than abstainers to self-report a past year oral cancer examination. Access to affordable and targeted oral cancer examination within the dental care setting might ensure that these high-risk individuals get timely examinations and earlier diagnosis that might improve prognosis and survival.

A new way to estimate disease prevalence from random partial-mouth samples.

AIM: Standard partial-mouth estimators of chronic periodontitis (CP) that define an individual's disease status solely in terms of selected sites underestimate prevalence. This study proposes an improved prevalence estimator based on randomly sampled sites and evaluates its accuracy in a well-characterized population cohort. METHODS: Importantly, this method does not require determination of disease status at the individual level. Instead, it uses a statistical distributional approach to derive a prevalence formula from randomly selected periodontal sites. The approach applies the conditional linear family of distributions for correlated binary data (i.e. the presence or absence of disease at sites within a mouth) with two simple working assumptions: (i) the probability of having disease is the same across all sites; and (ii) the correlation of disease status is the same for all pairs of sites within the mouth. RESULTS: Using oral examination data from 6793 participants in the Arteriolosclerosis Risk in Communities study, the new formula yields CP prevalence estimates that are much closer than standard partial mouth estimates to full mouth estimates. CONCLUSIONS: Resampling of the cohort shows that the proposed estimators give good precision and accuracy for as few as six tooth sites sampled per individual.

Periodontitis and Non-alcoholic Fatty Liver Disease, a population-based cohort investigation in the Study of Health in Pomerania.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) affects 20%-30% of adults with risk factors like obesity and insulin resistance putatively acting through chronic low-grade inflammation. Because periodontitis elicits low-grade inflammation, we hypothesized that it could contribute to NAFLD occurrence. OBJECTIVE: To investigate epidemiologic associations between periodontitis and the incidence of NAFLD among 2,623 participants of the Study of Health in Pomerania. METHODS: Periodontitis at baseline was defined as the percentage of sites (0%, <30%, ≥30%) with (i) clinical attachment level (CAL) ≥3 mm; (ii) probing pocket depth (PD) ≥4 mm. Incident NAFLD was defined as a significant increase in liver echogenicity on ultrasound relative to the kidneys, with the diaphragm indistinct or the echogenic walls of the portal veins invisible. RESULTS: After a median 7.7 years of follow-up, 605 incident NAFLD cases occurred at a rate of 32.5 cases per 1,000 person-years. Relative to participants without CAL ≥3 mm, NAFLD incidence was elevated slightly in participants with <30% of sites affected and moderately in participants with ≥30% of sites affected (multivariable-adjusted incidence rate ratio = 1.28, 95% CI, 0.84, 1.95 and 1.60, 95% CI, 1.05-2.43), respectively. A similar dose-response relationship was not observed for PD. CONCLUSION: History of periodontitis may be a risk factor for NAFLD.

Systematic Review and Meta-analysis of the Association Between Exposure to Environmental Tobacco Smoke and Periodontitis Endpoints Among Nonsmokers.

OBJECTIVE: A systematic review was conducted to summarize the epidemiological evidence on environmental tobacco smoke (ETS) exposure and prevalent periodontitis endpoints among nonsmokers. METHODS: We searched PubMed, EMBASE, Web of Science, Pro-Quest dissertations, and conference proceedings of a dental research association. We included studies from which prevalence odds ratios (POR) could be extracted for periodontitis determined by examiner measurements of clinical attachment level (CAL) and/or probing pocket depth (PD) or self-report of missing teeth. Studies determined ETS exposure by self-report or biomarker (cotinine) levels. RESULTS: For studies reporting CAL and/or PD (n = 6), associations were stronger with cotinine-measured exposure (n = 3; random effects POR [95% prediction interval] = 1.63 (0.90, 2.96)) than self-reported exposure (n = 3; random effects POR = 1.15 (0.68, 1.96)). There was no meaningful difference in summary estimate for studies reporting CAL and/or PD endpoint (n = 6; random effects POR = 1.34 (0.93, 1.94)) as opposed to tooth loss (n = 2; random effects POR = 1.33 (0.52, 3.40)). CONCLUSIONS: There appears to be a positive association between exposure to ETS and prevalent periodontitis endpoints among nonsmokers, the magnitude of which depended mostly on the method of ETS assessment. IMPLICATIONS: The notoriety of ETS is often discussed in terms of its associations with cancer, chronic conditions like cardiovascular diseases, and respiratory illnesses in children. However, very little attention is paid to its association with oral diseases, especially periodontitis. Periodontitis affects a large proportion of the population and is a major cause of tooth loss. This study summarized the epidemiologic association between exposure to ETS and periodontitis among nonsmokers. Although the findings are consistent with a positive association, methodological weaknesses relating to study design, assessment of ETS, periodontitis, and adjustment covariates were highlighted and recommendations for improvement in future studies provided.

Tooth loss and obstructive sleep apnea signs and symptoms in the US population.

PURPOSE: The aim of this study is to investigate the relationship between tooth loss and signs and symptoms of obstructive sleep apnea (OSA) in a representative sample of the general US population. METHODS: Data were from 7305 men and women aged ≥25 years participating in the 2005-2008 National Health and Nutrition Examination Survey. Tooth loss, occlusal contacts, and denture use were determined by dental examination. Four cardinal OSA signs and symptoms were evaluated by questions based on American Academy of Sleep Medicine criteria. Adults with ≥2 signs/symptoms of OSA were classified at high-risk of OSA. Prevalence ratios (PR) and 95 % confidence limits (CL) from log binomial regression models estimated the strength of association between tooth loss and high-risk for OSA, adjusting for demographic characteristics, body mass index, dentures, and sleep duration. RESULTS: Prevalence of high-risk for OSA increased 2 % for each additional lost tooth (PR = 1.02, 95 % CL, 1.01, 1.03) among adults aged 25 to 65 years. When tooth loss was modeled as an ordinal variable with 0-4 lost teeth as the referent category, adjusted prevalence of high-risk for OSA was as follows: 25 % greater in those missing 5-8 teeth (PR = 1.25, 95 % CL, 1.07, 1.46); 36 % greater in those missing 9-31 teeth (PR = 1.36, 95 % CL, 1.06, 1.73); and 61 % greater in the edentulous (PR = 1.61, 95 % CL, 1.11, 2.33). CONCLUSION: Tooth loss may be an independent risk factor for OSA.

Bias in estimating the cross-sectional smoking, alcohol, obesity and diabetes associations with moderate-severe periodontitis in the Atherosclerosis Risk in Communities study: comparison of full versus partial-mouth estimates.

OBJECTIVE: To assess whether partial-mouth protocols (PRPs) result in biased estimates of the associations between smoking, alcohol, obesity and diabetes with periodontitis. METHODS: Using a sample (n = 6129) of the 1996-1998 Atherosclerosis Risk in Communities study, we used measures of probing pocket depth and clinical attachment level to identify moderate-severe periodontitis. Adjusting for confounders, unconditional binary logistic regression estimated prevalence odds ratios (POR) and 95% confidence limits. Specifically, we compared POR for smoking, alcohol, obesity and diabetes with periodontitis derived from full-mouth to those derived from 4-PRPs (Ramfjörd, National Health and Nutrition Examination survey-III, modified-NHANES-IV and 42-site-Random-site selection-method). Finally, we conducted a simple sensitivity analysis of periodontitis misclassification by changing the case definition threshold for each PRP. RESULTS: In comparison to full-mouth PORs, PRP PORs were biased in terms of magnitude and direction. Holding the full-mouth case definition at moderate-severe periodontitis and setting it at mild-moderate-severe for the PRPs did not consistently produce POR estimates that were either biased towards or away from the null in comparison to full-mouth estimates. CONCLUSIONS: Partial-mouth protocols result in misclassification of periodontitis and may bias epidemiologic measures of association. The magnitude and direction of this bias depends on choice of PRP and case definition threshold used.

Prenatal Iodine Intake and Maternal Pregnancy and Postpartum Depressive and Anhedonia Symptoms: Findings from a Multiethnic US Cohort.

Objective: Emerging evidence suggests that essential trace elements, including iodine, play a vital role in depressive disorders. This study investigated whether prenatal dietary iodine intake alone and in combination with supplemental iodine intake during pregnancy were associated with antepartum and postpartum depressive and anhedonia symptoms. Methods: The study population included 837 mothers in the PRogramming of Intergenerational Stress Mechanisms (PRISM) study. The modified BLOCK food frequency questionnaire was used to estimate prenatal dietary and supplemental iodine intake, while the 10-item Edinburg Postpartum Depression Scale (EPDS) ascertained depressive symptoms. Analyses considered the global EPDS score and the anhedonia and depressive symptom subscale scores using dichotomized cutoffs. Logistic regression estimating odds ratios and 95% confidence intervals (CIs) assessed associations of iodine intake in the second trimester of pregnancy and 6-month postpartum depressive and anhedonia symptoms considering dietary intake alone and combined dietary and supplementary intake in separate models. Results: Most women were Black/Hispanic Black (43%) and non-Black Hispanics (35%), with 39% reporting a high school education or less. The median (interquartile range, IQR) dietary and supplemental iodine intake among Black/Hispanic Black (198 (115, 337) µg/day) and non-Black Hispanic women (195 (126, 323) µg/day) was higher than the overall median intake level of 187 (116, 315) µg/day. Relative to the Institute of Medicine recommended iodine intake level of 160-220 µg/day, women with intake levels < 100 µg/day, 100-<160 µg/day, >220-<400 µg/day and ≥400 µg/day had increased adjusted odds of 6-month postpartum anhedonia symptoms (aOR = 1.74 (95% CI: 1.08, 2.79), 1.25 (95% CI: 0.80, 1.99), 1.31 (95% CI: 0.82, 2.10), and 1.47 (95% CI: 0.86, 2.51), respectively). The corresponding estimates for postpartum global depressive symptoms were similar but of smaller magnitude. Conclusions: Prenatal iodine intake, whether below or above the recommended levels for pregnant women, was most strongly associated with greater anhedonia symptoms, particularly in the 6-month postpartum period. Further studies are warranted to corroborate these findings, as dietary and supplemental iodine intake are amenable to intervention.

Heightened vigilance and perceived discrimination in dental trainees' readiness for clinical practice.

PURPOSE/OBJECTIVE: The aims of this study were to examine associations between heightened vigilance and perceived discrimination on readiness for clinical practice and to examine the mediating effects of social support and resilience. METHODS: A survey was distributed to dental trainees (dental and dental hygiene students) enrolled at a US dental school located in the mid-Atlantic region. The survey assessed readiness for clinical practice and included measures of perceived discrimination, heightened vigilance, and the following wellness measures: perceived stress, resilience, anxiety, social support, and coping. Adjusted for gender, and race/ethnicity, we regressed heightened vigilance and perceived discrimination independently on students' readiness for clinical practice. To assess mediation, we computed the direct effects of heightened vigilance and perceived discrimination and potential indirect effects mediated through social support and resilience. RESULTS: A total of 250 students who completed the survey had complete data on all variables. Five percent identified as Black or African Americans, 34% as Asians, and 8% as Hispanic/Latino. Sixty-two percent were female and 91% were dental students. The overall mean (SD) heightened vigilance and perceived discrimination scores were 18.9 (4.9) and 10.5 (7.6), respectively. Only the mean score for heightened vigilance differed significantly by race/ethnicity (p = 0.02). Higher heightened vigilance (odds ratio [OR] = 0.75 95% confidence interval [CI]: 0.25, 2.23), and perceived discrimination (OR = 0.52, 95% CI: 0.33, 0.88) scores were independently associated with lower adjusted odds of reporting high confidence in readiness for clinical practice even after adjusting for the mediating effects of social support and resilience, although the association for heightened vigilance was not statistically significant. CONCLUSIONS: Heightened vigilance and perceived discrimination appear to negatively impact dental trainees' career readiness. Intentional efforts to prioritize an anti-racism approach within dental education programs and patient care across the nation are warranted.

Teledentistry Acceptability Among Latina/o/x Adults in Rural Southwest Virginia.

Inequitable access to dental care remains a barrier to optimal health for rural populations. With the COVID-19 pandemic, teledentistry to improve the delivery of oral health care has been emphasized. Few previous investigations of teledentistry acceptability have included Latina/o/x populations in rural areas of the United States. We recruited Latina/o/x adults (N=91) in rural southwest Virginia to participate in a survey to assess correlates related to teledentistry acceptability. More than half of participants (57%) reported no interest in using teledentistry if it were available. Having a yearly household income above $24,000 and not having dental insurance were positively associated with telehealth acceptability (p=.04 and p=.01, respectively). Inequitable access to dental care may persist even with broad availability of teledentistry services unless there is explicit integration of health equity.

Prepregnancy BMI, gestational weight gain and offspring caries experience: Avon longitudinal study of parents and children.

Pre-existing maternal overweight/obesity and pregnancy weight gain are associated with adverse birth outcomes such as low birth weight and prematurity, which may increase the risk of developmental tooth defects and early childhood caries. We sought to investigate the association between prepregnancy BMI, gestational weight gain (GWG) and the risk of early childhood caries. Data from 1,429 mother-offspring participants of the 1991/1992 Avon Longitudinal Study of Parents and Children were analyzed. The exposures were prepregnancy BMI (under/normal weight vs. overweight/obese), and gestational weight gain (GWG) based on the Institute of Medicine's recommended levels. The main outcome measured was offspring caries experience determined by clinical oral examinations at three time points. Log binomial regression estimated risk ratios and 95% confidence intervals. Seventy six percent (76%) of the mothers were under/normal weight prepregnancy, 39% and 26% respectively gained less and more than the recommended weight for their prepregnancy BMI during pregnancy. Being overweight/obese prepregnancy was associated with unadjusted RR (95% CI) of offspring caries of 1.16 (0.90, 1.51) at 31-months, 1.20 (0.96, 1.49) at 43-months and 1.09 (0.91, 1.30) at 61-months. GWG less than recommended was associated with higher unadjusted offspring caries experience of 1.13 (0.86, 1.48), 1.17 (0.92, 1.48) and 1.04 (0.87, 1.25) at 31-months, 43-months and 61-months respectively. There was insufficient evidence to indicate an association between prepregnancy BMI and gestational weight gain on offspring caries experience risk.

Religiosity and COVID-19: Impact on Use of Remote Worship and Changes in Self-Reported Social Support.

Objective: This study examines associations between changes in the use of remote worship services and changes in the types of social support among religious adults during the COVID-19 pandemic. Materials and Methods: Cross-sectional, web survey data (n = 461; 15 May to 6 July 2020) were collected during the COVID-19 pandemic. Multinomial logistic regression models calculated unadjusted odds of increases and decreases of three types of perceived social support from before to during COVID-19 based on remote worship use. Results: Adults who initiated use of remote worship had lower odds of gaining social support for personal problems (OR: 0.38; 95% CI: 0.19, 0.79) and greater odds of reporting less ease of getting practical help from neighbors (OR: 1.77; 95% CI: 1.04, 3.02) compared to adults who never used or stopped using remote worship. Adults who continued using remote worship services were more likely to report less ease of getting practical help from their neighbors (OR: 2.23; 95% CI: 1.17, 4.25) and decreased interest and concern felt from other people (OR: 2.62; 95% CI: 1.24, 5.51) than adults who never used or stopped using remote worship. Conclusions: Adults who initiated and continued using remote worship during the COVID-19 pandemic had poorer perceived social support outcomes relative to adults who never used or stopped using remote services. Despite continued engagement with their religious communities, adults participating in worship remotely may have had residual personal, emotional, and instrumental social support needs that remote worship did not mitigate.

Adverse Childhood Experiences and Oral Health Outcomes in U.S. Children and Adolescents: A Cross-Sectional Study of the 2016 National Survey of Children's Health.

This study investigated the cross-sectional associations between exposure to nine Adverse Childhood Experiences (ACEs) and U.S. children's and adolescent's oral health outcomes. Data from 41,294 participants of the 2016 National Survey of Children's Health (NSCH) were analyzed. Past year exposure to ACE, oral health outcomes (decayed teeth, bleeding gums, and condition of the teeth), and child and caregiver sociodemographic factors were self-reported. Using SAS v. 9.4, propensity score weighted, multilevel survey-logistic regression estimated adjusted odds ratios (AORs) and 95% Confidence Intervals (CIs) of the proposed associations. The overall mean (SE) age was 8.9 (0.1) years with 51% being male. Fifty-four percent (54%) identified as non-Hispanic white, and 12% as non-Hispanic black. The prevalence of the nine ACE measures ranged from 3% for caregiver death to 25% for financial hardship and parental divorce. Children who experienced caregiver mental illness, when compared to those who did not, were more likely to report decayed teeth (AOR: 1.73 (95% CI: 1.24, 2.42)) and the condition of their teeth as fair/poor (AOR: 1.60, 95% CI: 0.61, 4.19). Children in households with financial hardship were about twice as likely to report dental caries (AOR: 1.85, 95% CI: 1.50, 2.29) and have fair/poor teeth (AOR: 1.87, 95% CI: 1.40, 2.51) and bleeding gums (AOR: 2.39, 95% CI: 1.48, 3.86). ACEs appear to be associated with worse oral health outcomes among children and adolescents. Nevertheless, the cross-sectional nature of this study precludes a causal interpretation of these findings and necessitates more research to elucidate the oral health impacts of exposure to ACEs in longitudinal follow-up studies.

The "sufficient cause" model framework applied to the periodontitis-systemic diseases link.

The premise for the oral-systemic diseases relationship dates to the early 20th century with the introduction of the focal infection theory that posited that oral disease affects overall health and wellbeing. While the biological plausibility for the link has been supported by experimental animal models and observational studies in humans, findings from interventional studies in which periodontal therapy failed to alleviate systemic health outcomes have often been interpreted as evidence against periodontitis contribution to the etiology of systemic health conditions. One concept of causation assumes a one-to-one correspondence between cause and effect. Nevertheless, common chronic diseases to which periodontitis is associated have multifactorial etiologies. This commentary provides an overview of Rothman's "sufficient cause" model as a framework for consideration of the oral-systemic diseases link.

A scoping review of Table 2 fallacy in the oral health literature.

BACKGROUND: Coined by Westreich and Greenland in 2013, Table 2 fallacy refers to the practice of reporting estimates of the primary exposure and adjustment covariates derived from a single model on the same table. This study seeks to describe the extent to which Table 2 fallacy is present in the oral health literature and provide recommendations on presenting findings from multivariable-adjusted models and/or interpretation of adjustment covariate estimates that are not the primary exposure. METHODS: We conducted a scoping review in PubMed and Scopus of human observational studies published in 4 oral health journals (JDR-CTR, CDOE, JPHD, BMC Oral Health) starting in 2013 until the end of 2018. The resulting articles were exported into Excel and were either included or excluded for full-text review based on six criteria. After categorizing the articles, we exported and summarized the results in SAS. RESULTS: A total of 1358 articles were initially screened of which 937 articles were excluded based on title or abstract for being animal studies, systematic reviews or meta-analysis, prediction models or descriptive studies. The remaining 421 articles were eligible for full text reviewed of which, 189 (45%) committed Table 2 fallacy. The prevalence of table 2 fallacy appears high in the oral health literature. CONCLUSIONS: The problem of presenting multiple effect estimates derived from a single model in the same table is that it inadvertently encourages the reader to interpret all estimates the same way, often as total effects. Implications and recommendations are discussed.

SARS-CoV-2 Vaccine Hesitancy in a Sample of US Adults: Role of Perceived Satisfaction With Health, Access to Healthcare, and Attention to COVID-19 News.

Understanding which communities are most likely to be vaccine hesitant is necessary to increase vaccination rates to control the spread of SARS-CoV-2. This cross-sectional survey of adults (n = 501) from three cities in the United States (Miami, FL, New York City, NY, San Francisco, CA) assessed the role of satisfaction with health and healthcare access and consumption of COVID-19 news, previously un-studied variables related to vaccine hesitancy. Multilevel logistic regression tested the relationship between vaccine hesitancy and study variables. Thirteen percent indicated they would not get vaccinated. Black race (OR 2.6; 95% CI: 1.38-5.3), income (OR = 0.64; 95% CI: 0.50-0.83), inattention to COVID-19 news (OR = 1.6; 95% CI: 1.1-2.5), satisfaction with health (OR 0.72; 95% CI: 0.52-0.99), and healthcare access (OR = 1.7; 95% CI: 1.2-2.7) were associated with vaccine hesitancy. Public health officials should consider these variables when designing public health communication about the vaccine to ensure better uptake.

A descriptive pilot study of the immediate impacts of COVID-19 on dental and dental hygiene students' readiness and wellness.

BACKGROUND: The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has impacted dental students training across the U.S. academic dental institutions by moving classroom instruction to an online modality, limiting patient care, canceling external rotations, and rescheduling of licensure examinations. OBJECTIVE: The aim of this study was to assess the immediate impacts of COVID-19 on students' readiness to enter clinical practice or residency and its association with well-being (anxiety, perceived stress, coping and social support, and resilience). METHODS: An online REDCap survey was distributed to 407 D1-D4 year dental students and 29 DH3-DH4 year dental hygiene students enrolled at a U.S. dental school. The survey consisted of readiness and wellness measures as well as socio-demographic variables. RESULTS: Overall response rate was 58% (N = 252) ranging from 40% among D4 students to 72% among D1 students. About half (55%) of the respondents were White, a third (34%) Asians and 5% were African Americans. Ninety-two percent were non-Hispanics while 62% were female. Overall mean (SD) anxiety score was 6.5 (5.3) and 26% of respondents reported moderate or severe levels of anxiety. Anxiety score differed significantly by gender with females reporting higher anxiety levels, mean (SD) = 7.3 (5.5) versus 5.2 (4.7) for males; P = 0.002). Furthermore, mean anxiety score differed significantly among the dental school classes, ranging from 5.5 (5.3) among D2 students to 11.8 (6.2) in DH4 students (P = 0.02). CONCLUSION: Academic dental institutions need to be responsive to the heightened anxiety and uncertainly levels of students and provide responsive training and support to mitigate its effects.

Prenatal smoking and the risk of early childhood caries: A prospective cohort study.

INTRODUCTION: Dental caries is a chronic complex disease of multifactorial etiology that affects a quarter of U.S. children. This study evaluated the association between prenatal smoking and offspring caries experience and used a negative control exposure analysis to assess if the association is causal. METHODS: Data from 1429 mother-offspring participants of the 1991/92 Avon Longitudinal Study of Parents and Children conducted in Bristol, England were analyzed. Prenatal smoking (yes v. no) and quantity smoked (none,

Accuracy of Maternal Reports of Young Children's Dental Disease Status: Avon Longitudinal Study of Parents and Children.

Background: Parental reports of their children's health status is integral to pediatric medical and dental care. Therefore, understanding the accuracy of such reports is vital. Our objectives were to (1) assess the correlation between maternal reports of their children's indicators of caries experience (subjective assessment) and actual caries status determined by oral examination (objective assessment), and (2) identify potential modifiers of this correlation. Methods: Longitudinal data from the Avon longitudinal study of parents and children (n = 1429) was used to assess the correlation between maternal reports of the number of missing and filled teeth of children aged 38 months, 54 months, and 5.5 years and clinical oral examinations of decayed, missing and filled teeth conducted when the same children were 31, 43 months, and five years of age. Homogeneity chi-square tests assessed differences in correlations according to sociodemographic factors. Results: Overall, we found a statistically significant correlation that was weak to moderate in magnitude. Maternal reports of missing teeth at 38 months was significantly correlated with decayed teeth, 0.27 (p < 0.001); missing teeth, 0.23 (p < 0.001), and the decayed, missing and filled (dmft) index, 0.35 (p < 0.001) based on oral examination at 31 months. A maternal report of filled teeth at 54 months was significantly correlated with decayed teeth, 0.30 (p < 0.001); filled teeth 0.30 (p < 0.001), and dmft 0.40 (p < 0.001) at 43 months. Mothers tended to underestimate the extent of missing and filled teeth in their children irrespective of the child's age, but the extent of underestimation was greater among younger children. Maternal age, education level, and whether the child had ever visited a dentist were significant modifiers of subjective and objective caries assessments. Conclusions: From a clinical and dental public health perspective, our findings of a weak to moderate correlation of maternal assessments of their children's caries experience may be concerning when reporting the burden of dental diseases in large population studies or for surveillance purposes that rely on self-reported measures and must therefore be utilized with caution because of the potential to result in underestimated disease burden.

Perceived dental care need and actual oral health status in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVES: To evaluate the performance of subjective self-assessment of dental care need with objective oral disease status in a sample of Hispanics/Latinos. METHODS: Data from 13,561 participants of the 2008-2011 Hispanic Community Health Study/Study of Latinos were analyzed using complex survey procedure in SAS 9.4. Subjective self-reports of types of dental care needed (check-up or cleaning, teeth filled, teeth pulled, gum treatment, denture repair) were validated against objectively determined oral disease status [dental decay, periodontitis, bleeding on probing (BOP) and count of missing teeth]. RESULTS: Individuals who reported needing a cleaning/checkup were twice as likely to present with BOP upon oral examination (POR = 2.01, 95% CI: 1.54, 2.63). Similarly, individuals who reported needing gum treatment were more likely to present with periodontitis (POR = 1.96, 95% CI: 1.71, 2.24) and BOP (POR = 2.70, 95% CI: 2.37, 3.07) upon oral examination. In multivariable prediction modeling, demographic factors and subjective dental care measures were associated with the respective oral disease states. Moreover, the sensitivity, specificity, and area under the ROC curve for the count of missing teeth were, respectively, 77 percent, 57 percent, and 0.84, while the positive predictive value (PPV) was 26 percent. CONCLUSIONS: In bivariate analysis, self-reported type of dental care needed appear indicative of actual oral disease state and may be of value for the surveillance of oral diseases when clinical measures are unattainable. In multivariable prediction modeling, these subjective measures had low PPVs thus limiting the generalizability of our findings. Nonetheless, validation and refinement of these constructs in other populations is warranted.