Stress, anxiety and depression in dental students: Impact of severe acute respiratory syndrome-coronavirus 2 pandemic.

INTRODUCTION: With the emergence of COVID-19, dental medicine students were faced with a new reality, as a modification of the learning methods in Dentistry colleges happened. The aim of this study was to characterise the possible effects of Covid-19 pandemic in terms of anxiety, depression, and stress among students of dentistry. MATHERIALS AND METHODS: This cross-sectional study was conducted between October 2020 and May 2021. A total of 1115 participants from a total of approximately 3000 students from the seven university institutions that teach the master's degree in dentistry in Portugal, agreed to participate. An online self-reported questionnaire was applied through Google Forms® platform. The questionnaire was divided in three sections: the students' sociodemographic characterisation, pedagogical aspects, and questions about anxiety, depression, and stress using the Depression, Anxiety, and Stress-21 Scale. RESULTS: Normal levels of anxiety, depression, and stress, were found in 41%, 36.7%, and 22.7% of the participants, respectively. Being female was the most significant and strong predictor of anxiety and stress, and for depression, not feeling fulfilled in the course they were in was the most significant variable. CONCLUSION: The participants presented high values of anxiety, depression, and stress, during the pandemic state. Gender and not feeling fulfilled in the course were important predictors.

Pregnancy as a Period of Enhanced Risk for Non-Cavitated Caries Lesions.

PURPOSE: To investigate if pregnancy represents a period of increased risk of non-cavitated dental caries related to changes in saliva and oral health behaviours. MATERIALS AND METHODS: A non-randomised longitudinal study was performed with 27 pregnant women and 25 non-pregnant women, who were evaluated twice with the same time gap (24 weeks on average). At the first visit sociodemographic and oral health-related behaviours were assessed through a structured questionnaire. At the second visit changes related to eating sweet snacks and oral hygiene habits were also assessed. In both visits the surface-related caries status was evaluated according to ICDAS II criteria. Calculation of D0 (Sound), D1-2 (visual changes) and D3-4 (precavitated caries lesions) Index was based on data collected from clinical examination. Saliva pH and saliva flow rate were also assessed. RESULTS: Throughout pregnancy, a statistically significant increase of eating sweet snacks between main meals was reported, with no effective adaptation of oral hygiene habits. In comparison to the non-pregnant group, pregnant women presented a lower saliva pH at both the first and second visit, p < 0.0005. During the follow-up period, a decrease in the frequency of caries-free surfaces was observed in the pregnant women (p = 0.004) and an increase in precavitated caries lesions (p = 0.011). CONCLUSION: The main results support the hypothesis that during pregnancy women are prone to enamel demineralisation, namely, to exhibiting additional lesions characterised by precavitated caries lesions.

Physical Violence Against Children and Adolescents in Porto: A 5-Year Study.

The aim of the present study was to analyze the prevalence of physical violence against children and adolescents (PVCA) in a 5-year period in the city of Porto, Portugal. All forensic reports between 2009 and 2013 in the clinical services of the North Branch of the National Institute of Legal Medicine and forensic sciences were analyzed. Victims were classified according to sex, age, relationship with perpetrator, traumatic consequences of the event, and year of occurrence. Statistical analysis was performed using SPSS (Version 22.0). Continuous variables were described when appropriated frequencies were displayed. The association between variables was evaluated using chi-square, Fisher's exact test, or Kruskal-Wallis test, when appropriate and a logistic regression was performed. The margin of error for the statistical tests was 5.0%. A total of 2,148 occurrences were evaluated. Most subjects were male, and mean victim age was 13 years. The single most frequent perpetrator was an unknown individual, but most offenders were known to the victim. The majority site of injury was the face. The larger number of complaints of aggression maintained a similar frequency over the 5 years analyzed. A physical examination to confirm the reasons between the complaint and the type of aggression was performed and shown a high relationship. Adolescents were more susceptible to violence than younger children were. The most affected region was the face.

Sex estimation using the mandibular canine index components.

The mandibular canine index (MCI) has been described as a suitable methodology for sex estimation in forensic scenarios but there are contradictory reports about its accuracy. Moreover, the two mandibular canine teeth must be available, which is not always a viable option. The aim of this study was to strip the MCI by analyzing the MCI itself and its components, in order to optimize its use for sex estimation. The mesiodistal dimensions of the mandibular canine crown and the mandibular canine arch width were measured in a sample of 120 cast models. Five predictor variables were considered in this study: the standard MCI, a variation of the MCI using the left canine, and MCI components (MD43, MD33 and D33-43). Multivariate binary logistic regression was performed using stepwise forward approach to select the most statistical relevant variables on the probability of a cast being from a female. The estimated probability was then analyzed with respect to performance in sex classification (ROC analysis and optimal cut-offs accuracy) and compared with the performance of the univariate variables. MCI43 and MCI33 presented the lowest performance (64.2% and 63.3% respectively), and the highest overall accuracy was attained using the MD43 and MD33 (85.8% in both cases). The multivariate logistic model obtained (using MD43 and MD33) exhibited the same accuracy as the logistic model based solely on MD43 (85.8%). Our results suggest that MD43 should be used instead of MCI for sex estimation.

Orofacial Injuries in Children and Adolescents (2009-2013): A 5-Year Study In Porto, Portugal.

The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer's Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.

Orofacial injuries in children and adolescents (2009-2013): a 5-year study in Porto, Portugal

Abstract The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer's Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.

Resumo O objetivo deste estudo foi verificar a prevalência de atos de agressão à cabeça, face e pescoço em relação às vítimas de Violência Física contra Crianças e Adolescentes (PVCA) que foram examinadas no Instituto Nacional de Medicina Legal e Delegação de Ciências Forenses Norte (INMLCF -DN) no Porto, Portugal. Um estudo foi realizado em 2.148 queixas de agressão física contra crianças e adolescentes [0 a menores de 18 anos] ocorridas entre 2009 e 2013 e que foram recuperadas de informações sobre violência mantidas em arquivos de dados do INMLCF-DN. Variáveis contínuas foram descritas para verificar a suas correlações foram usados os testes do Chi-Quadrado e o Teste Exato de Fisher em um nível de significância de 5%. Nestes 5 anos, foram detectados 1.380 casos que apresentam nexo clínico com agressão física. As vítimas mais acometidas eram adolescentes do sexo masculino, a região do corpo mais atingida foi a face com 747 das lesões (24,7%) registradas. Há significância estatística no teste do qui-quadrado de Pearson na relação de gênero com a cabeça e o rosto. Dentistas rotineiramente examinam o crânio, rosto e pescoço que os torna os profissionais mais adequados para identificar casos de agressão precoce. Os adolescentes são mais suscetíveis à violência do que as crianças menores de 12 anos.

Chronology of mineralization of the permanent mandibular second molar teeth and forensic age estimation.

Forensic age estimation frequently relies upon the chronology of mineralization of the third molar teeth. However, even when present, third molar teeth cannot always be used for estimating age in people who are classified as minors. Seconds molars develop earlier and in a more predictable way, and therefore are often more reliable for age estimation in this age group. This study aims to contribute to forensic age estimation using an age threshold of 14-years, studying the stages of development of permanent mandibular second molar teeth mineralization. 367 orthopantograms of a Portuguese population group, aged between 3 and 19 years, were studied. The stages of mineralization of mandibular permanent second molar teeth were studied following the classification stages proposed by Demirjian et al. Stage descriptive analysis was performed, and associations between age and stage were studied. A logistic regression to determine age over 14 years, using maturation stages and sex as a predictive variables, was made. A second sample was used for testing the model. The significance level was set at 5%. The model correctly classified 92.0% of cases overall. The equation was tested in the second sample, and the results showed that there were no statistical significant differences between the binary real age (i.e. age < 14 and age ≥ 14 years) and the estimated age (p = 0.109). The developed model is useful for age estimation using 14-years as a threshold. However, stage maturation analyses showed that stage F, in males, and stages G and H, in both sexes, lead to an estimated age with significant statistical differences from chronological age.

A new approach to sex estimation using the mandibular canine index.

Rao et al.'s mandibular canine index (MCI) is a simple odontometric method which uses the mandibular canine as the key to sex estimation. This index is defined as the ratio between the right canine mesiodistal dimension and the mandibular canine arch width. The aim of this study was to contribute to sex estimation using dental techniques by analysing the MCI efficiency, and to propose a new approach for its use. Measurements were taken from 120 plaster casts (70 females) in the 16-30 year age group. Although statistically significant sexual dimorphism was observed in both the mesiodistal dimension and the mandibular canine arch width, the MCI showed a low accuracy in sex classification (54.2% correct identifications). This accuracy was improved to 64.2% using receiver operating characteristics curve analysis. Yet, despite the better accuracy, these results reinforce the idea that the MCI may not be particularly useful in sex prediction, since it may not reflect the same degree of sexual dimorphism as its absolute measures.

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal.

We described the distribution of risk factors for cardiovascular disease among homeless people living in the city of Porto, Portugal. Comparisons were made between subsamples of homeless people recruited in different settings and between the overall homeless sample group and a sample of the general population. All "houseless" individuals attending one of two homeless hostels or two institutions providing meal programs on specific days were invited to participate and were matched with subjects from the general population. We estimated sex, age and education-adjusted prevalence ratios or mean differences. The prevalence of previous illicit drug consumption and imprisonment was almost twice as high among the homeless from institutions providing meal programs. This group also showed lower mean systolic and diastolic blood pressure. Prevalence of smoking was almost 50% higher in the overall homeless group. Mean body mass index and waist circumference were also lower in the homeless group and its members were almost five times less likely to report dyslipidemia. Our findings contribute to defining priorities for interventions directed at this segment of society and to reducing inequalities in this extremely underprivileged population.

Risk factors for cardiovascular disease among the homeless and in the general population of the city of Porto, Portugal / Fatores de risco cardiovascular em pessoas sem-abrigo e na população geral da cidade do Porto, Portugal

We described the distribution of risk factors for cardiovascular disease among homeless people living in the city of Porto, Portugal. Comparisons were made between subsamples of homeless people recruited in different settings and between the overall homeless sample group and a sample of the general population. All "houseless" individuals attending one of two homeless hostels or two institutions providing meal programs on specific days were invited to participate and were matched with subjects from the general population. We estimated sex, age and education-adjusted prevalence ratios or mean differences. The prevalence of previous illicit drug consumption and imprisonment was almost twice as high among the homeless from institutions providing meal programs. This group also showed lower mean systolic and diastolic blood pressure. Prevalence of smoking was almost 50% higher in the overall homeless group. Mean body mass index and waist circumference were also lower in the homeless group and its members were almost five times less likely to report dyslipidemia. Our findings contribute to defining priorities for interventions directed at this segment of society and to reducing inequalities in this extremely underprivileged population.

Este estudo descreve a distribuição de fatores de risco cardiovascular em pessoas sem-abrigo que vivem no Porto, Portugal, recrutadas em diferentes contextos, comparando-as entre si e com a população em geral. Todos os indivíduos "sem-casa" presentes em dois albergues de sem-abrigo ou dois refeitórios sociais em dias selecionados para as avaliações foram convidados, e emparelhados com indivíduos da população geral. Foram estimadas as razões de proporções ou diferenças entre médias, ajustadas para sexo, idade e educação. Nos refeitórios sociais, observou-se maior prevalência de consumo de drogas ilícitas e de história prévia de prisão no último ano, e menor pressão arterial sistólica e diastólica do que nos albergues de sem-abrigo. Os sem-abrigo apresentaram uma prevalência quase 50% maior de fumadores, menor índice de massa corporal e perímetro da cintura, e uma probabilidade 5 vezes menor de referir dislipidemia. Este trabalho contribui para a definição de prioridades de intervenção para a redução de desigualdades sociais nessas populações com extremas carências socioeconômicas.

Behaviour of human osteoblastic cells cultured on plasma-sprayed titanium implants in the presence of nicotine.

OBJECTIVES: The aim of this work was to analyse the behaviour of human bone marrow osteoblastic cells cultured on the surface of routinely used plasma-sprayed titanium implants in the presence of plasmatic and salivary nicotine levels reported in smokers. MATERIAL AND METHODS: Human bone marrow cells (first subculture) were seeded on titanium implants and cultured for 35 days in alpha-minimal essential medium supplemented with 10% foetal bovine serum, 50 microg/ml ascorbic acid, 10 mM beta-glycerophosphate and 10 nM dexamethasone. Seeded implants were exposed to nicotine, 10-1 mg/ml, from days 1 to 35, and characterized for cell morphology, viability/proliferation, alkaline phosphatase (ALP) activity and matrix mineralization. RESULTS: Low levels of nicotine, 10 and 50 ng/ml, representative of the plasma concentrations reported in smokers, did not cause significant effects in the cell behaviour, although a small induction in cell growth and functional activity appeared to occur. Higher nicotine levels, 0.01-1 mg/ml, within those attained in saliva through tobacco use, caused evident dose-dependent effects in osteoblastic cell behaviour, i.e., a stimulatory effect in cell growth, ALP activity and matrix mineralization, at concentrations up to 0.2 mg/ml, and a deleterious effect at higher levels. CONCLUSIONS: Considering the high tissue diffusion potential of nicotine, the results suggest the possibility of a direct modulation of the osteoblast activity as a contributing factor to the overall effect of nicotine in the bone microenvironment around dental implants.