A systematic review and meta-analysis of the role of sugar-free chewing gum on Streptococcus mutans.

BACKGROUND: Preventive strategies targeting Streptococcus mutans may be effective in reducing the global burden of caries. The aim of the current systematic review of published literature was to determine the difference in level of Streptococcus mutans in adults and children who chew sugar-free gum (SFG), compared with those who did not chew gum, who chewed a control gum or received alternatives such as probiotics or fluoride varnish. METHODS: Systematic review (PROSPERO registration No. CRD42018094676) of controlled trials with adult and child participants where chewing of SFG was the main intervention. Databases searched (1 Jan 1946 to 31 August 2020): MEDLINE, EMBASE, PsycINFO, Scopus, Web of Science, Allied and Complimentary Medicine Database, Cochrane Central Register of Controlled Trials (CENTRAL), Open Grey, PROSPERO and the Cochrane library of systematic reviews. 'Search terms included Medical Subject Headings, and free text to cover the following range of constructs: chewing gum, sugar free, oral health, caries, xerostomia, periodontal disease. Data extraction and Risk of Bias assessment was undertaken by three researchers using a modified version of the Cochrane RoB tool (version 1). Data synthesis was conducted using meta-analysis in STATA. RESULTS: Thirteen studies of SFG with micro-organisms as outcomes were identified. The use of SFG significantly reduced the load of Streptococcus mutans (effect size - 0.42; 95% CI - 0.60 to - 0.25) compared to all controls. In seven of the 13 studies the confidence intervals of the effect size estimate included zero, suggesting no effect of the intervention. Twelve trials used xylitol gum only as the basis of the intervention; xylitol gum significantly reduced the load of Streptococcus mutans (effect size - 0.46; 95% CI - 0.64 to - 0.28) in comparison to all controls. There was a moderate level of heterogeneity across the included studies. No adverse effects were recorded. CONCLUSION: Chewing SFG reduces the load of Streptococcus mutans in the oral cavity in comparison to non-chewing controls. Considering the degree of variability in the effect and the moderate quality of the trials included, there is a need for future research exploring the use SFG as a preventive measure for reducing the cariogenic oral bacterial load.

Cariology consensus for undergraduates at dental schools in the Caribbean region.

AIM: To obtain a consensus on the domains of cariology for undergraduates in dental schools in the Caribbean. MATERIALS AND METHODS: Dental school deans from the Dominican Republic (DR) and Puerto Rico (PR) were invited to participate. Afterwards, 24 cariology faculty members from the dental schools in the DR received a 40-h workshop on the current understanding of dental caries. Then, representatives from participating dental schools in the DR and PR were divided into six groups and tasked with exploring the cariology domains described in the European and Colombian consensus. For each domain, the competencies in what the dental student, upon graduation, would have to (1) be proficient in, (2) have knowledge of, (3) and be familiar with were described. Two cariology consensus meetings to work on the domains and suggest changes for the Caribbean region were done, and representatives from the DR and PR agreed on a cariology consensus. For the second stage, Caribbean English-speaking countries were invited to participate in the consensus. Meetings were held with representatives from dental schools in Trinidad and Tobago (TT) and Jamaica (J) to include their suggestions on each consensus domain. RESULTS: A total of 15 dental schools (DR = 12; PR = 1; TT = 1; and J = 1) participated; they agreed on a new consensus considering the realities of the Caribbean participating countries. CONCLUSION: A cariology consensus for undergraduates was achieved for 15 dental schools in the Caribbean region. This accomplishment will promote a shift for the Caribbean dental schools' graduates towards a current understanding of dental caries.

Motivation and compliance with intraoral elastics.

INTRODUCTION: Intraoral elastics are commonly used in orthodontics and require regular changing to be effective. Unfortunately, poor compliance with elastics is often encountered, especially in adolescents. Intention for an action and its implementation can be improved using "if-then" plans that spell out when, where, and how a set goal, such as elastic wear, can be put into action. Our aim was to determine the effect of if-then plans on compliance with elastics. METHODS: To identify common barriers to compliance with recommendations concerning elastic wear, semistructured interviews were carried out with 14 adolescent orthodontic patients wearing intraoral elastics full time. Emerging themes were used to develop if-then plans to improve compliance with elastic wear. A prospective pilot study assessed the effectiveness of if-then planning aimed at overcoming the identified barriers on compliance with elastic wear. Twelve participants were randomized equally into study and control groups; the study group received information about if-then planning. The participants were asked to collect used elastics, and counts of these were used to assess compliance. RESULTS: A wide range of motivational and volitional factors were described by the interviewed participants, including the perceived benefits of elastics, cues to remember, pain, eating, social situations, sports, loss of elastics, and breakages. Compliance with elastic wear was highly variable among patients. The study group returned more used elastics, suggesting increased compliance, but the difference was not significant. CONCLUSIONS: The use of if-then plans might improve compliance with elastic wear when compared with routine clinical instructions.

The Longitudinal Relationship between Edentulism and the Progress of Multimorbidity.

OBJECTIVES: To examine the longitudinal relationship between edentulism, nutritional intake, and the progress of multimorbidity among older Americans. METHODS: We used data from the Health and Retirement Study (2006-2018), a longitudinal survey of older Americans that has collected data biennially since 1992. Edentulism was assessed in 2006 while nutritional intake was assessed in 2013. Multimorbidity was indicated by five self-reported chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Individuals with two or more conditions at baseline were excluded from the analysis. Nutritional intake was calculated by summing 10 nutrients (protein, vitamins C, D, B12 and E, calcium, zinc, polyunsaturated fatty acids, folate, and ß-carotene). Structural equation modelling (SEM) was used to examine the nutritional pathway between edentulism (2006) and the increase in multimorbidity from 2006 to 2018. RESULTS: The number of individuals included in the analysis was 3463. The incidence of multimorbidity between 2006 and 2018 was 24.07%, while the percentage of edentate participants in 2006 was 16.42%. The mean total nutrition in 2013 was 4.50 (4.43, 4.55). The SEM analysis showed that edentulism was negatively associated with nutritional intake {estimate -0.15 (95%CI: -0.30, -0.01)}. A negative association was found between total nutrition and multimorbidity {estimate -0.008 (95%CI: -0.01, -0.002)}. Age, wealth, and smoking were included in the analysis and had statistically significant associations with multimorbidity. CONCLUSION: The analysis demonstrated a longitudinal association between edentulism, nutritional intake, and the progress of multimorbidity.

A Systematic Review and Meta-Analysis of the Role of Sugar-Free Chewing Gum on Plaque Quantity in the Oral Cavity.

Background: The aim of this systematic review of published literature was to answer the research question, "What is the difference in the level of plaque quantity, in adults and children who chew sugar-free gum (SFG), compared with those who do not chew SFG, who do not chew gum, or who use alternatives such as probiotics or fluoride varnish?". Methods: The systematic review [registered on PROSPERO 2018 (CRD42018094676)] included studies on adults and children with chewing of SFG as the main intervention, where "sugar" referred to monosaccharides and disaccharides. Included studies were in English and corresponded to primary research published between 1946 and 2020. The search conducted spanned all relevant databases using both Medical Subject Headings (MESH) and free text with combinations of "chewing gum," "sugar-free," "caries," "xerostomia," "periodontal disease." Results: Eight articles included plaque quantity as part of their outcomes. Meta-analysis showed that SFG significantly reduced plaque quantity (effect size-0.778; 95% CI-1.167 to-0.39). The correlation between the baseline and the end of study data was assumed to be 0.95 for the control and 0.65 for the SFG group. A sensitivity analysis was conducted with the pre- to post-test correlation, set at 0.95 for the SFG group. This gave an effect size of-1.098 (95% CI-1.539 to-0.656) with I 2 = 89.73%. When looking more specifically at xylitol gum, the results of the meta-analysis showed that it significantly reduced plaque quantity (effect size-0.743; 95% CI-1.148 to-0.338). There was a high degree of heterogeneity between studies with I 2 = 86.0%. Conclusion: There is some evidence that chewing sugar-free gum, in particular xylitol SFG, reduces the quantity of plaque in the oral cavity in comparison to non SFG chewing or no chewing controls. Further research with improved design, lengthier timeframes and higher number of participants should be considered. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=94676.

Adopting the COM-B model and TDF framework in oral and dental research: A narrative review.

BACKGROUND: Recent advances in the psychological understanding of health-related behaviour have focused on producing a comprehensive framework to model such behaviour. The Capability-Opportunity-Motivation-Behaviour (COM-B) and its associated Theoretical Domains Framework (TDF) allow researchers to classify psychological and behavioural constructs in a consistent and transferable manner across studies. AIM: To identify oral and dental health-related studies that have used the TDF and/or COM-B as frameworks to guide research and examine the ways in which these concepts have been practically used in such research. METHOD: Narrative review of published literature. To be included, the paper had to (1) state that the TDF or COM-B had been used and to have targeted at least one construct identified in either framework, (2) include primary empirical data, (3) focus on a behaviour directly related to oral or dental-related health (eg brushing, applying fluoride varnish, flossing) and/or attitudes, intentions and beliefs related to the behaviour. Studies could include any research design, and participants of any age or gender and include patients, parents or dental health professionals. FINDINGS: Nine studies were identified that had drawn on the COM-B and/or TDF as the framework for their research. Seven of the studies were based on the TDF only, with one employing both the COM-B and Health Belief Model, and one using the TDF with COM-B. The nine studies covered a broad range of oral health-related behaviours including child tooth brushing, fluoride varnish application and non- or micro-invasive management of proximal caries lesions. The populations in the studies included dentists, dental teams and parents of children. All studies adopted only a subset of the constructs within the TDF, often without justification. CONCLUSIONS: It is encouraging that oral health researchers are adopting standardized psychological frameworks to develop their research and oral health interventions. Future work should build on the small number of studies identified in this review and consider using standardized tools to do so.

Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial.

BACKGROUND: Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual's capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual's capability, opportunity, and motivation. OBJECTIVE: This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial. METHODS: This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app. RESULTS: This study was approved by the London - Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020. CONCLUSIONS: Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/18021.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review.

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.

Implementation of clinical practice guidelines in dental settings.

OBJECTIVE: This study aimed to determine the knowledge and application of current expert recommendations on antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) both in the United Kingdom and Iran. METHODS: The study used a 3-part postal questionnaire survey of dentists in the United Kingdom (n=467) and Iran (n=200) covering demographic data, antimicrobial prophylaxis prescribing habits for adults treated under local analgesia, and sources of information about recommended schedules and changes in dentists' prophylaxis regimens. RESULTS: Most UK dentists (87%) reported following the British National Formulary guidelines (BNF) on AP. Seventy-five percent of Iranian dentists follow the guidelines of the American Heart Association (AHA). A significant proportion of practitioners prescribed the correct antibiotic regimens for patients who are nonallergic or allergic to penicillin in the United Kingdom, but in Iran the knowledge of and compliance with the available guidelines regarding antibiotic regimens was poor. Although dentists were familiar with the dental procedures that could place their patients at risk, and more than 80% prescribed prophylaxis for patients with "prosthetic heart valves" and "previous bacterial endocarditis," they also considered AP for patients with medical conditions not known to be at risk. For the UK dentists, the most common source of information on AP is medical and dental journals, whereas for Iranian dentists, academic meetings, colleagues, and textbooks were cited as sources of information on AP. Furthermore, 80% of participants in both countries would like to attend further courses about this topic. CONCLUSION: Generally, dentists in the United Kingdom were more familiar with the current expert recommendations on AP than dentists in Iran; however, dentists in both countries tended to overprescribe. This could contribute to the problem of antimicrobial resistance. Educational initiatives aimed at implementing updated recommendations and continuous assessment of dental practice might reverse this trend.

Achieving consensus on clinical examination and record keeping in NHS dentistry: a Delphi approach.

Introduction Members of the dental profession in the UK are legally required to create and maintain patient records. In 2016, the Faculty of General Dental Practice (UK) published the third edition of its good practice guidelines on clinical examination and record keeping.Aim To identify a core set of items which should be recorded in three clinical situations (new patient appointment; recall appointment; emergency appointment) in primary dental care.Design Four-stage Delphi methodology.Methods Stage one: a comprehensive list of items taken from the FGDP guidance were reviewed by an expert group for relevance and clarity in relation to three scenarios (new patient appointment, recall appointment; emergency appointment). The panel was also asked to identify their perceptions of any omissions or redundancies. Stage two: following feedback of the results, the expert group again reviewed the full item list, with the addition of any items identified in stage one. Consensus was defined as 75% or more of the panel agreeing on the score for an item. Stage three: online survey of dental practitioners (N = 2,840) asking them to rate the relevance of the item pool for the same clinical scenarios. Stage four: a second expert group was formed and asked to rate the feasibility of implementing each item as 'essential' to record in primary dental care. The final list of items rated as 'essential' and feasible comprises: 21 items for new patient appointments; 17 items for recall appointments; ten items for emergency appointments.Results A high degree of consensus was found between the expert group and dental practitioners regarding those items viewed as 'essential' to be recorded across the three appointment types.Conclusions A core set of items are identified as 'essential' and feasible to be recorded for three different types of dental consultation in primary care: new patient appointment, recall and emergency appointment.

The impact of idealised facial images on satisfaction with facial appearance: comparing 'ideal' and 'average' faces.

OBJECTIVES: Recent work has demonstrated that female orthognathic patients display more dissatisfaction with their facial appearance after viewing idealised images of facial photographs, than do controls. Patients may request orthognathic surgery because they hope to improve their appearance to conform with ideals portrayed in the mass media, and these hopes may not be realistic. Patients who demonstrate certain personality traits are more likely to hold such hopes. The current study sought to identify the role of dental status (orthognathic patient versus control), personality traits and media images in dissatisfaction with facial appearance. METHODS: Female patients and controls completed a bank of personality measures and then gave repeated measures of satisfaction with their facial appearance after viewing images of 'ideal' and 'average' women. RESULTS: Neither group showed any change in satisfaction with appearance after viewing either set of images. Patients showed lower satisfaction with facial appearance than controls, but did not differ on other personality measures. CONCLUSIONS: Viewing 'ideal' images of other women has no significant impact on satisfaction with appearance compared to viewing images of 'average' women. These results may help inform the development of a psycho-educational intervention to protect women against the negative effects of viewing idealised images in the media.

Factors related to reducing free sugar intake among white ethnic adults in the UK: a qualitative study.

OBJECTIVE/AIMS: To determine the barriers and enablers to behavioural change to reduce free sugar intake related to dental caries in a sample of UK adults who identify their ethnicity as White. MATERIALS AND METHODS: Qualitative study comprising semi-structured interviews of 27 participants. Interviews were recorded, transcribed and analysed using thematic analysis methods. The Capability-Opportunity-Motivation-Behaviour model (COM-B) and the Theoretical Domains Framework (TDF) were used to guide the derivation of themes. RESULTS: Data saturation occurred at 27 interviews. The COM-B Model and TDF domains captured various factors that may influence the consumption of free sugar. TDF elements which are reflected in the study are: Knowledge; Psychological skills; Memory, attention, and decision processes; Behavioural regulation; Physical skills; Social influence; Environmental context and resources; Social and professional role and identity; Beliefs about capabilities; Beliefs about consequence; Intentions and goals reinforcement; and Emotions. COM-B Model elements which are reflected in the study are: psychological capabilities, physical capabilities, social opportunities, physical opportunities, reflective motivation, and automatic motivation. DISCUSSION AND CONCLUSION: The COM-B model and TDF framework provided a comprehensive account of the barriers and facilitators of reducing sugar intake among white ethnic groups.

Theory based interventions for caries related sugar intake in adults: systematic review.

BACKGROUND: Theories of behavior change are essential in the design of effective behaviour change strategies. No studies have assessed the effectiveness of interventions based on psychological theories to reduce sugar intake related to dental caries. The study assessed the effect of interventions based on Social Congition Models (SCMs) on sugar intake in adults, when compared with educational interventions or no intervention. METHODS: A range of papers were considered: Systematic review Systematic Reviews with or without Meta Analyses; Randomised Controlled Trials; Controlled Clinical Trials and Before and after studies, of interventions based on Social Cognition Models aimed at dietary intake of sugar in adults. The Cochrane database including: Oral Health Group's Trials Register (2015), MEDLINE (from 1966 to September 2015), EMBASE (from 1980 to September 2015), PsycINFO (from 1966 to September 2015) were searched. RESULTS: No article met the full eligibility criteria for the current systematic review so no articles were included. CONCLUSION: There is a need for more clinical trials to assess the effectiveness of interventions based on psychological theory in reducing dietary sugar intake among adults. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: PROSPERO: CRD42015026357 .

What reward does a child prefer for behaving well at the dentist?

BACKGROUND: Paediatric dentists often report using positive reinforcement to encourage their young patients to show co-operative behaviour. For effective reinforcement to take place the reward should be salient to the individual. To date, there is little research into what reward a young patient will choose when attending the dentist. AIM: To identify what reward children between the age of 4-8 years will choose when attending the dentist, and to determine the extent of agreement between children and caregivers in reward choice. METHOD: Observational study. Fifty-two children from different age groups (4-5 years, 6-7 years and 8 years) attending a primary-care dental clinic were asked to choose between a range of different rewards. The caregiver attending with them was also asked to anticipate the child's preferred choice. RESULTS: There was no clear favourite reward for children from both genders and different age group. However, no child chose the 'sticker' reward that is traditionally given out at the dentist. Overall carers agreed with the child's choice of toy on 18 occasions (34.6%), but there were significant differences across the age groups with carers of older children showing less agreement. CONCLUSION: To ensure that rewards are salient, children should be given a choice of rewards when attending the dental clinic. Parents ability to predict their child's preferred rewards decreases as the child ages. CLINICAL RELEVANCE: A child's motivation to co-operate during dental treatment can be increased by offering a range of rewards. Asking children to choose their reward from a limited range will increase the saliency of the reward for the child.

A systematic review of randomized controlled trials of interventions to improve adherence among orthodontic patients aged 12 to 18.

OBJECTIVE: To investigate the effectiveness of interventions to enhance adherence among orthodontic patients aged 12 to 18 years. Specific adherence outcomes included were recall of information given by the orthodontic team, attendance at orthodontic appointments, self-reported oral hygiene behavior, and clinical indexes of oral hygiene. MATERIALS AND METHODS: Electronic searches of Medline via OVID (January 1, 1966 through March 1, 2012), EMBASE, and the Cochrane central register of control trials from its inception through March 2012, as well as a hand search, were undertaken to identify relevant studies. RESULTS: Through the electronic searches, 381 article were identified. Initial screening of the abstracts and titles by all review authors identified 21 articles that met the inclusion criteria for this review. The full articles were then retrieved. Four randomized controlled trials were found, all of which used different methods of intervention: a system of rewards or awards, the Hawthorne effect, written information, and demonstration of the microbiology of plaque. All the interventions, except the use of award/reward, were associated with improvements in adherence. CONCLUSION: The literature advocates the use of several methods to improve compliance/adherence among orthodontic patients. Although there is insufficient evidence to allow clinicians to choose a single method, the results demonstrate the value of spending time with patients to illustrate the importance of adherence. Future studies should develop multiple methods of assessing patient adherence, including self-report, behavioral observation and recording, and change in clinical indexes. Such studies should test different types of interventions for effectiveness.

Interdisciplinary health promotion: a call for theory-based interventions drawing on the skills of multiple disciplines.

Promoting the health of populations demands the adoption of a perspective exploring the societal, political, community, family and individual determinants of health. I will argue that to develop interventions to modify health-related behaviours and health risks requires collaboration with a range of disciplines, in order to draw upon their theoretical, empirical and oftentimes political knowledge. To illustrate this thesis, I will draw upon research in three areas: improving oral health-related behaviours in individuals with periodontal disease and childhood caries; encouraging early recognition in head and neck cancer; and managing dental anxiety. Reviews of oral health education in the early 1990 s suggested that approaches based on education were largely ineffective in the absence of the provision of fluoride supplementation. More recently, high-quality research has identified simple, theory-based interventions that can improve adherence to specific oral hygiene-related behaviours. Similarly, a range of studies have demonstrated the effectiveness of motivational interviewing for targeting caries-related behaviours in targeted groups. Dental anxiety remains a significant barrier to the uptake of dental services, and again, by working in multi-disciplinary teams, a proportionate and comprehensive range of interventions can be adopted to alleviate the burden of dental fear. Finally, head and neck cancer has potentially serious effects for sufferers, but often presents late for a variety of reasons. Through developing a theoretical model of help-seeking behaviour, psychologists have been able to identify targets for interventions and work together with the healthcare team to develop these.

The PAS-ADD Checklist: independent replication of its psychometric properties in a community sample.

BACKGROUND: The development of reliable, valid measures of psychopathology in people with intellectual disabilities is an important task. However, independent replication studies are rarely reported. AIMS: To report data on the psychometric properties of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-ADD) Checklist. METHOD: The PAS-ADD Checklist was completed for 226 adults as part of the assessment process for a specialist mental health service for people with intellectual disabilities. RESULTS: Internal consistency was acceptable. Factor analysis revealed one main factor that was characterised by items related to mood. The Checklist was sensitive to differences between diagnostic groups and had an overall sensitivity of 66%; its specificity was 70%. CONCLUSIONS: The PAS-ADD Checklist is a quick and easy to use screening tool. Although at present it is the best measure available, it should not be the only method used to identify psychiatric disorders in people with intellectual disabilities.

The impact of dental appearance on the appraisal of personal characteristics.

PURPOSE: The purpose of this study was to ascertain the influence of dental appearance upon subjective ratings of personal characteristics, specifically social competence, intellectual ability, and psychologic adjustment. MATERIALS AND METHODS: A cross-sectional analytic interview study was conducted with 201 undergraduates. Each participant was asked to make judgments about the personal characteristics of the subject of a single color photograph. Eight photographs of four different men were used, each with one of two degrees of dental status (visible disease, no visible disease). Outcome measures were participants' judgments of the social competence, intellectual ability, and psychologic adjustment of the subjects of the photographs. RESULTS: Participants judged subjects with less dental disease to be more socially competent, to show greater intellectual achievement, and to have better psychologic adjustment. CONCLUSION: In the absence of other information, the judgments an individual makes concerning the personal characteristics of others are influenced by dental appearance.

Descriptive psychopathology in people with mental retardation.

This article considers variables associated with the presence of a psychiatric diagnosis in those referred to a specialist mental health service for people with mental retardation (MR). Data were collected on 752 newly referred clients. The presence of a psychiatric diagnosis was assessed by two psychiatrists based on International Classification of Diseases, 10th Revision, criteria. A series of binary logistic regression analyses were conducted. Older age, mild MR, admission to an inpatient unit, referral from generic mental health services, and detention under current mental health legislation were associated with an increased presence of any psychopathology. Severe MR, the presence of epilepsy, and residence with the family were associated with a lower incidence of any psychopathology. Findings relating to specific psychiatric diagnoses on the whole supported previous research. Clear service arrangements are necessary for people with mild MR who have a high incidence of psychiatric disorders.