Non-invasive assessment of periodontal inflammation by continuum-removal hemodynamic spectral indices.

BACKGROUND: Hyperspectral techniques have aroused great interest in non-invasively measuring periodontal tissue hemodynamics. However, current studies mainly focused on three typical inflammation stages (healthy, gingivitis and periodontitis) and practical approaches for using optical spectroscopy for early and precisely detection of periodontal inflammation at finer disease stages have not been well studied. METHODS: This study provided novel spectroscopic insights into periodontitis at different stages of disease, and developed six simple but physically meaning hemodynamic spectral indices (HSIs) including four spectral absorption depths of oxyhemoglobin ( D HbO 2 ), deoxyhemoglobin ( D Hb ), total hemoglobin ( t Hb ) and tissue water ( D water ), and two normalized difference indices of oxyhemoglobin( N D HbO 2 I ) and deoxyhemoglobin ( N D Hb I ) from continuum-removal spectra (400-1700 nm) of periodontal tissue collected from 47 systemically healthy subjects over different severities from healthy, gingivitis, slight, moderate to severe periodontitis for early and precision diagnostics of periodontitis. Typical statistical analyses were conducted to explore the effectiveness of the proposed HSIs. RESULTS: D Hb and t Hb exerted significant increasing trends as inflammation progressed, whereas D HbO 2 exhibited significant difference (P < 0.05) from the healthy sites only at moderate and severe periodontitis and D water presented unstable sensitives to disease severity. By contrast, N D HbO 2 I and N D Hb I showed more steadily downward trends as severity increased, and demonstrated the highest correlations with clinical gold standard parameters. Particularly, the proposed normalized HSIs ( N D HbO 2 I and N D Hb I ) yielded high correlations of - 0.49 and - 0.44 with probing depth, respectively, far outperforming results achieved by previous studies. The performances of the HSIs were also confirmed using the periodontal therapy group. CONCLUSIONS: These results indicated great potentials of combination optical spectroscopy and smart devices to non-invasively probe periodontitis at earlier stages using the simple and practical HSIs. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry on October 24, 2021, and the clinical registration number is ChiCTR2100052306.

Oral and periodontal assessment at the first trimester of pregnancy: The PERISCOPE longitudinal study.

INTRODUCTION: Periodontal diseases (gingivitis and periodontitis) are chronic non-communicable inflammatory diseases. The risk of developing gingivitis and periodontitis increases during pregnancy. Also, periodontitis increases the risk of developing adverse pregnancy outcomes such as preterm birth and preeclampsia. Early diagnosis of adverse pregnancy outcomes is essential and periodontitis could be an early sign to take into consideration. MATERIAL AND METHODS: We conducted a longitudinal observational study (PERISCOPE study: CNIL, no. 1 967 084 v 0; CER, no. 01-0416) on 121 pregnant women in the first trimester to determine their oral and periodontal health status. We explored the relations between oral and periodontal health status and sociodemographic and behavior characteristics, as well as their course and outcome of pregnancy. RESULTS: A total of 47.1% of the women had periodontitis, of which only 66.7% presented clinical manifestations associated with the disease such as gingival bleeding. These women had a poorer oral and periodontal health, and a higher body mass index, and more of them developed gestational diabetes during the course of pregnancy. The remaining 33.3% showed only discreet and isolated inflammatory signs and, unless thoroughly examined, would have gone undiagnosed for periodontitis. Interestingly these women were more often primiparous, still active professionally and had had a recent oral examination. CONCLUSIONS: The PERISCOPE study is one of the few studies that reports the oral and periodontal health status of pregnant women in the first trimester. Furthermore, the results highlight the need for early oral and periodontal assessment and treatment, even in the absence of exterior clinical signs, in order to prevent periodontal disease aggravation and also, by reducing low grade systemic inflammation, possibly adverse pregnancy outcomes.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report.

Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

Periodontal disease and its impact on general health in Latin America: LAOHA Consensus Meeting Report

Abstract: Periodontal diseases are considered a worldwide public health problem, owing to their high prevalence in developed and developing countries. Periodontitis may lead to tooth loss, which can impact oral health-related quality of life. Gingivitis and periodontitis have been extensively studied regarding their etiopathogenesis, epidemiology, prevention and treatment outcomes. However, most of these aspects are studied and discussed globally, which may hamper a clear interpretation of the findings and the design of effective plans of action for specific regions or populations. For example, in Latin America, epidemiological data about the distribution of periodontal diseases is still scarce, mainly when it comes to nationwide representative samples. This Consensus aimed to address the following topics related to periodontal diseases in Latin America: a) The impact of the global burden of periodontal diseases on health: a global reality; b) Periodontal diseases in Latin America; c) Strategies for the prevention of periodontal diseases in Latin America; d) Problems associated with diagnosis of periodontal conditions and possible solutions for Latin America; e) Treatment of Periodontitis. This consensus will help to increase awareness about diagnosis, prevention and treatment of periodontal diseases, in the context of Latin American countries.

[Use of integral indices in the assessment of bucсal cytology in health and in the oral cavity pathology.]

Cytological analysis of buccal epithelium (BE) - the buccal cytogram allows to select about 20 parameters reflecting cytogenetic, inflammatory, proliferative and other disorders in epithelial cells used for biomonitoring and laboratory diagnostics. In order to simplify and increase the information content of this study, we conducted a comparative analysis of various integral indices when interpreting the buccal cytogram. 40 practically healthy volunteers, 35 patients with chronic periodontitis, 22 patients with chronic gingivitis and 20 patients with partial loss of teeth were examined. The obtained data revealed an increase in the degree of disorders of proliferation and apoptosis, their ratio as the inflammation increased from gingival tissue lesions to inflammation periodontal tissue. In assessing the condition of the mucous membranes in chronic gingivitis, the apoptosis index turned out to be more informative.In chronic periodontitis the index of cytogenetic disorders is indicative. In this category of patients, the accumulation index of cytogenetic disorders did not have any advantages over the others, and the reparative index was less informative.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability.

OBJECTIVE: This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. MATERIAL AND METHODS: Ten predetermined self-report questions evaluating early signs and symptoms of gingivitis were preliminary assessed by a panel of clinical experts. Eight questions were selected and cognitively tested in 20 adolescents aged 12 to 18 years from Santiago de Chile. The questionnaire was then conducted and answered by 178 Chilean adolescents. Internal consistency was measured using the Cronbach's alpha and temporal stability was calculated using the Kappa-index. RESULTS: A reliable final self-report questionnaire consisting of 5 questions was obtained, with a total Cronbach's alpha of 0.73 and a Kappa-index ranging from 0.41 to 0.77 between the different questions. CONCLUSIONS: The proposed questionnaire is reliable, with an acceptable internal consistency and a temporal stability from moderate to substantial, and it is promising for estimating the prevalence of gingivitis in adolescents.

Development of a self-report questionnaire designed for population-based surveillance of gingivitis in adolescents: assessment of content validity and reliability

Abstract The major infectious diseases in Chile encompass the periodontal diseases, with a combined prevalence that rises up to 90% of the population. Thus, the population-based surveillance of periodontal diseases plays a central role for assessing their prevalence and for planning, implementing, and evaluating preventive and control programs. Self-report questionnaires have been proposed for the surveillance of periodontal diseases in adult populations world-wide. Objective This study aimed to develop and assess the content validity and reliability of a cognitively adapted self-report questionnaire designed for surveillance of gingivitis in adolescents. Material and Methods Ten predetermined self-report questions evaluating early signs and symptoms of gingivitis were preliminary assessed by a panel of clinical experts. Eight questions were selected and cognitively tested in 20 adolescents aged 12 to 18 years from Santiago de Chile. The questionnaire was then conducted and answered by 178 Chilean adolescents. Internal consistency was measured using the Cronbach's alpha and temporal stability was calculated using the Kappa-index. Results A reliable final self-report questionnaire consisting of 5 questions was obtained, with a total Cronbach's alpha of 0.73 and a Kappa-index ranging from 0.41 to 0.77 between the different questions. Conclusions The proposed questionnaire is reliable, with an acceptable internal consistency and a temporal stability from moderate to substantial, and it is promising for estimating the prevalence of gingivitis in adolescents.

Assessment of pain among a group of Nigerian dental patients.

BACKGROUND: Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. METHODS: A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. RESULTS: Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. CONCLUSION: It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Chemical salivary composition and its relationship with periodontal disease and dental calculus

Aim: To determine the relationship between the chemical composition of saliva, periodontal disease and dental calculus. Methods: An observational analytical cross-sectional study was conducted with patients over 55 years of age. Ethical principles of autonomy and risk protection were applied according to the international standards. Sociodemographic and diagnosis variables (presence of dental calculus and periodontal status) were considered to measure salivary concentrations of glucose (by the glucose oxidase/peroxidase method, amylase (by the colorimetric test), urea (by the amount of indophenol), total protein (by the Bradford method) and albumin (by the nephelometric method). Patients chewed a sterile rubber band and 3 mL of stimulated saliva were collected. The samples were stored at -5 °C, centrifuged at 2,800 rpm for 10 min, and the supernatant was removed and stored at -20 °C. Data were presented as frequencies and proportions for qualitative variables and measures of central tendency and dispersion for quantitative variables. Data were analyzed by either analysis of variance or Kruskal Wallis test . A p value <0.05 was considered statistically significant. Results: Significant relationships were observed between the concentration of salivary urea and periodontal status (p = 0.03) and the presence of dental calculus and urea (p = 0.04) was demonstrated. Conclusions: A relationship between the salivary urea concentration and the presence of periodontal disease and dental calculus is suggested.

The utility of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation evolution following professional teeth cleaning.

UNLABELLED: The AIM of this study was to evaluate the usefulness of 40 MHz periodontal ultrasonography in the assessment of gingival inflammation, following professional teeth cleaning. MATERIAL AND METHODS: The study was performed on 18 teeth without restorations having subgingival calculus (upper and lower premolars and frontal teeth). After the clinical exam the Gingival Index and the Sulcus Bleeding Index were calculated. Then a 40MHz transducer (ULTRASONIX SonoTouch device) was used to obtain longitudinal sections in the frontal plane. Three measurements were performed: alveolar crest - cementum-enamel junction distance (ACJ), gingival height (GH), and gingival width (GW). Professional cleaning was performed by ultrasound scaling (SatelecP5 booster, France) and airflow (NSK, Japan). Two and seven days after the first evaluation, ultrasonographic and clinical examinations were repeated. RESULTS: Two days after the treatment the median value of the ACJ, was 2.70 (2.38; 2.95) mm, whereas 7 days after treatment it was 2.55 (2.45; 3.01) mm. The intraclass correlation coefficient for ACJ measurement was 98.8 (p<0.001).The values obtained measuring GH [3.84(3.44; 4.27) mm vs. 3.52 (3.00; 3.76) mm] and GW [(1.81 (1.65; 1.95) mm vs.1.62 (1.40; 1.95) mm) had statistically significant differences between the 2nd and 7th day. CONCLUSIONS: Periodontal ultrasonography is a highly precise and reproducible imagistic method, with which bone resorption, gingival inflammation as well as the presence or absence of subgingival calculus can be assessed.

Primary and secondary prevention of periodontal and peri-implant diseases: Introduction to, and objectives of the 11th European Workshop on Periodontology consensus conference.

BACKGROUND: Periodontitis prevalence remains high. Peri-implantitis is an emerging public health issue. Such a high burden of disease and its social, oral and systemic consequences are compelling reasons for increased attention towards prevention for individuals, professionals and public health officials. METHODS: Sixteen systematic reviews and meta-reviews formed the basis for workshop discussions. Deliberations resulted in four consensus reports. RESULTS: This workshop calls for renewed emphasis on the prevention of periodontitis and peri-implantitis. A critical element is the recognition that prevention needs to be tailored to the individual's needs through diagnosis and risk profiling. Discussions identified critical aspects that may help in the large-scale implementation of preventive programs: (i) a need to communicate to the public the critical importance of gingival bleeding as an early sign of disease, (ii) the need for universal implementation of periodontal screening by the oral health care team, (iii) the role of the oral health team in health promotion and primary and secondary prevention, (iv) understanding the limitations of self-medication with oral health care products without a diagnosis of the underlying condition, and (v) access to appropriate and effective professional preventive care. CONCLUSIONS: The workshop provided specific recommendations for individuals, the oral health team and public health officials. Their implementation in different countries requires adaptation to respective specific national oral health care models.

Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools.

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.

Assessment of relationship between oral health behavior, oral hygiene and gingival status of dental students.

BACKGROUND: The behavior of oral health providers toward their own oral health reflects their understanding of the importance of preventive dental procedures and of improving the oral health of their target population. AIM: This study was done with an aim to assess the relationship between oral health behavior, oral hygiene and gingival status of third and final year dental students from a Dental College in Indore City, India. METHODS: A total of 137 dental students participated in the study. The students were invited to complete the Hiroshima University-Dental Behavioral Inventory (HU-DBI) questionnaire. The HU-DBI questionnaire consisted of twenty polar responses (agree/disagree) regarding oral health-related behavior. In addition, two further questions about the frequency of brushing and flossing were included. Subsequently, oral health examination was conducted to assess plaque and gingival status. Data were analyzed using Chi-square test, Independent sample t-test, and Pearson's correlation. The significance level was set at P ≤ 0.05. RESULT: The results showed that about 66.6% of the students checked their teeth in the mirror after brushing. Only 20.1% of the students reported bleeding from gums. The mean oral heath behavior score (HU-DBI) was 6.47 ± 2.0. A negative correlation of HU-DBI scores with plaque (r = -0.501) and gingival scores (r = -0.580) was observed. CONCLUSION: Thus, it is concluded that there is a significant relationship between the oral health behavior, oral hygiene, and gingival status of dental students. Dental students with better self-reported oral health behavior had lower plaque and gingival scores indicating a better attitude toward oral health.

Assessment of the hemodynamic profile in periodontal tissues of diabetic subjects with periodontitis by optical spectroscopy.

BACKGROUND AND OBJECTIVE: The influence of diabetes mellitus (DM) on the hemodynamics of periodontal tissues has not been assessed previously. The primary objective of this study was to validate optical spectroscopy as a periodontal diagnostic tool for subjects with type 2 DM and chronic periodontitis. MATERIAL AND METHODS: Using a portable optical near-infrared spectrometer, optical spectra were obtained from healthy (n = 127), gingivitis (n = 115), and periodontitis (n = 109) sites of 65 subjects with type 2 DM and chronic periodontitis. Healthy (n = 65) sites of 15 nondiabetic subjects without periodontitis were used as controls. A modified Beer-Lambert unmixing model that incorporates a nonparametric scattering-loss function was used to determine the relative contribution of deoxygenated hemoglobin and oxygenated hemoglobin (HbO2 ) to the overall spectrum. The balance between tissue oxygen delivery and oxygen utilization in periodontal tissues was assessed. RESULTS: In diabetic subjects, tissue oxygen saturation and HbO2 concentration were significantly decreased in the periodontitis sites (p < 0.01) compared with the healthy and gingivitis sites. Furthermore, tissue oxygenation in healthy sites of control subjects was significantly higher than that in sites of diabetic subjects (p < 0.01). CONCLUSION: In summary, the results of this study suggest that optical spectroscopy can monitor the hemodynamic profile in diabetic subjects with chronic periodontitis. Furthermore, healthy sites of diabetic subjects presented lower tissue oxygenation than did those of nondiabetic subjects.

An epidemiological study to determine the prevalence and risk assessment of gingivitis in 5-, 12- and 15-year-old children of rural and urban area of Panchkula (Haryana).

OBJECTIVE: The aim and objective of the present study was to determine the prevalence and severity of gingivitis and evaluate the factors associated with gingivitis in children residing in rural and urban areas of Panchkula. MATERIALS AND METHODS: The present study was carried out on a sample of 1269 school children, aged 5, 12 and 15 years, randomly selected from the rural and the urban schools of Panchkula and gingival index was recorded as devised by Loe and Silness (1963) to assess the severity of gingivitis. A standardized questionnaire was self prepared, which was filled by the examiner prior to the clinical examination. The data were subjected to SPSS, version 13, and statistically analyzed using Chi test, F test, ANOVA test. RESULTS: In the age group of 5 years, the children affected with gingivitis in the rural and the urban areas were 67 and 33%, respectively, which was statistically highly significant (P = 0.0001). In the age group of 12 years, the children affected with gingivitis in the rural and the urban areas were 94 and 92%, respectively (P = 0.537), whereas in 15-year olds, the children affected with gingivitis in the rural and the urban areas were 98 and 64%, respectively (P = 0.0001). The children who brushed once a day had higher prevalence of gingivitis as compared to children who brushed more than once per day in all the age groups. CONCLUSION: The results showed that the percentage of children affected with gingivitis was significantly higher in the rural areas in 5- and 15-year-old children, but this trend was not seen in 12-year age group, reflecting the lack of awareness in rural areas.

Assessment of pre-analytical and analytical variables affecting peptidome profiling of gingival crevicular fluid by MALDI-TOF mass spectrometry.

BACKGROUND: Gingival crevicular fluid (GCF) may be a source of new biomarkers of periodontitis/gingivitis. However, the minute volumes of GCF harvested in healthy sites are a serious drawback. We evaluated how pre-analytical and analytical variables concerning GCF collection and processing, could significantly influence quality and reproducibility of MALDI-TOF profiles. METHODS: GCF was collected from healthy sites. The use of paper strips vs paper points was compared. Peptides and proteins were extracted by centrifugal elution in different solutions, at different accelerations, with and without protease inhibitor cocktail (PIC). Finally, we evaluated how matrix composition and matrix/sample volume ratio affect the reproducibility of MALDI-TOF profiles. RESULTS: Trifluoroacetic acid elution generated richer gingival fingerprints compared to acetic acid, independently of the collection device. Centrifugation speed and PIC supplementation did not change GCF profiles. A fine modulation of matrix composition and matrix/sample volume ratio resulted in a satisfactory reproducibility (CV less than 10% for peak area and signal-to-noise ratio). CONCLUSION: An optimized procedure, enabling generation of reproducible MALDI-TOF profiles from limited volume of GCF, is proposed. These fingerprints may serve as reference for future studies oriented to the maintenance and preservation of good gingival status and to discovery biomarkers of periodontitis/gingivitis.

Flow cytometry-based analysis by Sysmex-UF1000i® is an alternative method in the assessment of periodontal inflammation.

BACKGROUND: Gingivitis is a common inflammatory condition. We explored the value of flow cytometry of saliva in patients with periodontal inflammation. METHODS: A cohort of 249 healthy adults (age range: 18-81 y; 2.5th to 97.5th percentile: 19-66 y) was investigated for caries, dental plaque and gingivitis. Saliva was analyzed using flow cytometry on a Sysmex UF-1000i®. RESULTS: Sysmex UF-1000i® is capable to reproduce reliable measurements of cellular components in saliva. A statistically significant lower number of salivary bacteria was found in patients with gingivitis in comparison with healthy adults (p<0.0001). A significant difference in salivary leukocyte count was found between patients with different gingival index scores (p<0.0005). The gingivitis score was strongly dependent on the number of salivary leukocytes, the age of the patient and the degree of caries and dental plaque (r(2)=0.60, p<0.001). At a cut-off level of 10(3) leukocytes/µl saliva, an area under the curve of 0.82 was obtained with a sensitivity of 76% and a specificity of 78% in patients (>35 y) with a gingivitis score of 3. CONCLUSION: Flow cytometry is an alternative method to evaluate local inflammatory processes in the mouth with a sensitivity of 76% and a specificity of 78%.

Validity and reproducibility of the revised oral assessment guide applied by community health workers.

OBJECTIVE: To determine the validity and reproducibility of the Revised Oral Assessment Guide (ROAG) as pre-diagnostic tool used in elderly citizens by community health workers (CHWs) of the Family Health Strategy (FHS). MATERIAL AND METHODS: Initially, we adjusted the English version to Portuguese and then developed a training program for use of ROAG, with the participation of CHWs, in selected districts that had the highest enrolled number of elderly people in the city. The elderly persons were distributed among 10 previously trained CHWs. To assess the validity of the ROAG, a CHW and a dentist (considered as the gold standard) independently evaluated the same individual. The reproducibility of the ROAG was evaluated by each of the CHWs examining 5-6 elderly individuals twice with a 7-day interval. RESULTS: The sensitivity ranged from 0.17 for evaluation of saliva to 0.80 for voice. The specific ranged from 0.69 for teeth/dentures to 0.98 for saliva using mirror and the accuracy ranged from 0.92 for swallow to 0.64 for mucosa. The intra-rater reproducibility of the ROAG was perfect for evaluation of voice, lips and swallow (κ=1.000). CONCLUSION: When used by trained CHWs, the ROAG is a tool with high sensitivity and specificity to assess voice, swallowing, tongue and teeth/dentures. Moreover, it can efficiently detect patients showing no alteration in lips, saliva, mucosa and gums. High reproducibility was observed in almost all the categories. Trained CHWs can use this tool to improve the access of elderly patients to dental services.

Early childhood caries screening tools: a comparison of four approaches.

BACKGROUND: Early childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness. METHODS: The authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness. RESULTS: The results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved. CONCLUSIONS: Salivary culture of MS alone in a population of young, low-income Hispanic children outperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values). CLINICAL IMPLICATIONS: Screening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.

Assessment and maintenance of dental implants: clinical and knowledge-seeking practices of dental hygienists.

PURPOSE: This study surveyed dental hygienists in order to assess their routine approach for dental implant maintenance and to determine if a relationship exists between the formal education of dental hygienists and their previous attendance and interest in future implant related continuing education courses. METHODS: A survey was distributed to dental hygienists attending an annual national continuing education course. Participants voluntarily completed and submitted their survey before the end of the first day of the 3 day course. RESULTS: The results indicate that there is a statistically significant relationship between the level of formal education and implant related continuing education course attendance. Dental hygienists whose formal education did not include dental implant care were more likely to attend implant related continuing education courses than those whose formal education included this content. The majority of the dental hygienists expressed interest in continuing education courses on dental implants. Results of chi-square analysis show a statistically significant relationship between the type of education and interest in attending implant related continuing education courses. There was no statistically significant difference in continuing education interest between dental hygienists whose formal education did or did not include dental implants. CONCLUSION: Additional continuing education courses have been completed by most dental hygienists whose curricula did not include formal training on dental implant care. Most dental hygienists are interested in gaining additional knowledge whether or not their dental hygiene curriculum contained content on dental implants.