Mental Disorders and Oral Diseases: Future Research Directions.

The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.

Effectiveness of school-based behavioural interventions to improve children's oral health by reducing sugar intake and promoting oral hygiene: A rapid review of randomised controlled trials.

OBJECTIVE: To evaluate evidence of the effectiveness of school-based behavioural interventions to improve the oral health of children aged 3-18 years in a rapid review of randomised controlled trials (RCTs). METHODS: Three independent reviewers searched MEDLINE, EMBASE, Web of Science and other sources between January 2000 and December 2020 for eligible published and unpublished studies in English and extracted data. Primary outcomes were caries increment, plaque levels, gingival health, reported frequency and/or amount of free sugars intake and oral hygiene behaviour. Risk of bias was assessed using the Cochrane criteria. RESULTS: Eight cluster RCTs met the inclusion criteria and had substantial heterogeneity. Three trials assessed caries increment and one found significant reductions in the intervention group. Another trial found similar benefits, but these were limited to children from high socioeconomic groups. The third trial found an increase in dental caries in the intervention group. Three studies reported significant reductions in plaque scores and improvements in gingival health with modest effects. Interventions delivered by peers (at adolescence) or with parents' involvement (at pre-adolescence) showed significant reductions in plaque scores compared to those delivered by dentists or teachers only. Most interventions showed significant improvements in self-reported behaviours. CONCLUSIONS: There is limited evidence of clinical benefit to dental health from school-based behavioural interventions. There is a need to conduct well-designed trials of behavioural interventions that are theory-derived and include environmental elements (e.g. supervised toothbrushing). Future trials would benefit from cost-effectiveness analysis and assessment of interventions' effect on oral health inequalities amongst children.

Constructing public health policies in post crisis countries: lessons to learn from the associations between free-sugars consumption and diabetes, obesity and dental caries before, during and after sanctions in Iraq.

BACKGROUND: This article aims to provide evidence for an informed public health policy on free-sugar consumption in post-crisis countries. METHODS: Iraq was selected as a case study. A systematic search for published data on the prevalence/incidence of type-2 diabetes, overweight/obesity, dental caries and free-sugar consumption levels in Iraq was conducted using MEDLINE, the Iraqi Academic Scientific journals and relevant international organisations' websites. Comparable data before (1980-1990), during (1991-2002) and after (2003-2015) the United Nations sanctions (UNS) were included. RESULTS: Ten studies were included. Quality scores ranged between 3 and 7/8. Free-sugar consumption decreased dramatically during the UNS (from 50 to 16.3 kg/person/year) and started increasing afterwards (24.1 kg/person/year). Changes in type-2 diabetes, overweight/obesity and caries levels mirrored those of free-sugar consumption. Caries declined markedly during UNS and started increasing afterwards. Comparable data on diabetes and overweight/obesity were only available for the periods during and after the UNS. Both of these conditions started increasing with increased free-sugar consumption after lifting the UNS. CONCLUSIONS: There is a need to develop a public health policy in post-crisis countries to maintain the reduction in free-sugar consumption, and hence promote both general and dental health, by integrating the common risk factor approach into the social determinant framework.

Adherence of preventive oral care products in the Syrian market to evidence-based international recommendations.

No study has investigated the availability and adherence of preventive oral care products on the Syrian market to evidence-based international recommendations. Data were collected in 2012, and updated in 2016, in terms of availability, characteristics and adherence to evidence-based international recommendations. Few preventive products adhered to the recommendations. Despite the large decrease in the number of oral care products on the Syrian market, due to the Syrian crisis, nonadherence of some of the available products is still present. A multisectorial approach at a policy level is needed to address such important limitations. The Syrian Ministry of Health should reform regulations for fluoride products to become subject to drug monitoring systems; the Syrian Arab Committee for Measurements and Standards needs to update its standards; and the Syrian General Dental Association should distribute a preventive booklet to dental practitioners.

Impact of providing free preventive dental products without health workers' counselling on infants' tooth-brushing and bottle-feeding termination practices: a randomised controlled trial.

OBJECTIVE: To investigate the impact of an integrated oral health promotion intervention, within the Syrian national immunisation programme, which provided free preventive dental health products, without health workers' counselling, on one-year-old infants' tooth-brushing and bottle-feeding termination practices. RESEARCH DESIGN: a randomised controlled parallel-group trial. SETTING: A maternal and child health centre in Sweida city, Syria. PARTICIPANTS: 92 mothers of one-year-old infants, attending an infant vaccination clinic, were allocated into three groups: Test, Control One and Control Two. INTERVENTIONS: The Test group received an oral health promotion package including an infant oral health pamphlet, a baby toothbrush, fluoride toothpaste (1,000 mg/L) and a trainer cup, without health workers' counselling. Control One received only the pamphlet, whilst Control Two received no intervention. MAIN OUTCOME MEASURES: after one month, the presence of old plaque on infants' primary teeth was checked, to assess tooth-brushing behaviour. Also, a mothers' self-completed questionnaire was administered to assess bottle-feeding use. RESULTS: The response rate was 100% and the attrition rate was zero. There were differences in tooth-brushing and bottle-feeding termination practices between the three groups (P⟩0.001). Infants in the Test group were less likely to have old plaque and more likely to stop bottle-feeding than their counterparts in the two control groups. There were no differences in the abovementioned outcomes between the two control groups. CONCLUSIONS: Providing free preventive dental health products, without health worker's counselling, in an integrated oral health promotion intervention, was an effective measure to promote infants' tooth-brushing and bottle-feeding termination practices. These findings should be supported by long-term follow up studies.

Community-based learning in a challenging context: the development and evaluation of an outreach dental public health programme in Damascus University, Syria.

INTRODUCTION: This study aimed to describe the development and evaluation of an outreach dental public health (DPH) programme in Damascus University, in terms of developing undergraduates' required knowledge, skills and attitudes (KSA), improving the quality aspects of training and assessment (T&A), and achieving the satisfaction of served children and their social network. METHODS: The outreach DPH programme offered opportunities to undergraduates to carry out outreach health-promotion activities, conduct and communicate the results of applied DPH research, and build partnership with students in other higher education sectors. A cross-sectional evaluation collected mixed qualitative and quantitative data, by a means of a short-essay and a self-completed questionnaire, from 400 third-year dental undergraduates, on KSA gained from outreach activities and quality aspects of T&A. The latter were compared with corresponding figures of other traditional dental programmes (TDP). Satisfaction with the outreach activities were collected from 215 children with special needs and 130 parents and school staff, by questionnaires. RESULTS: The response rates were 74.8%, 100% and 100% for undergraduates, children and parents/school staff, respectively. The derived categories of students' gained KSA included the following: unique clinical skills, social responsibility, voluntarism, communication, team working, personal growth, reflection on career aspirations and self-satisfaction with the contribution to needy groups. Their satisfaction with quality aspects of T&A was significantly higher than TDP (P < 0.001). Children's and parents/school staff's satisfaction was high. CONCLUSION: The outreach DPH programme in Damascus University is a successful example of developing undergraduates' required KSA, improving the quality aspects of T&A, and achieving the satisfaction of served community.

Diet and the risk of head and neck squamous cell carcinomas in a Syrian population: a case-control study.

Diet has not been investigated as a potential risk factor for head and neck squamous cell carcinomas in the Syrian Arab Republic. In a hospital-based, unmatched case-control study 108 people with cancer and 105 controls were interviewed about dietary intake using a validated food frequency questionnaire in Arabic. Sociodemographic and health risk behavioural information were collected by a self-completed questionnaire. Adjusting for age, sex, education level, working status and tobacco smoking, the multiple regression analysis showed that low intake of vegetables (OR 3.8; 95% CI: 1.57-9.10), cereal/cereal products (OR 2.6; 95% CI: 1.12-5.99) and high-caffeine beverages (OR 3.2; 95% CI: 1.34-7.43) increased the risk of head and neck squamous cell carcinomas, whereas a low level of fats and oils intake decreased the risk (OR 0.6; 95% CI: 0.24-1.30). These findings should be considered in national health promotion programmes in the Syrian Arab Republic.

Capacity Building and Financing Oral Health in the African and Middle East Region.

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.

The role of psychosocial factors in predicting orthodontic treatment outcome at the end of 1 year of active treatment.

The role of psychosocial factors in predicting orthodontic treatment outcome has not been investigated before. Thus, the current study aimed to test whether psychosocial factors, namely 'daily hassles', resiliency, and family environment, can predict orthodontic treatment outcome at the end of 1 year of active treatment. A hospital-based, prospective, longitudinal design was adopted including 145 consecutively selected 12- to 16-year-old male and female adolescents. Baseline psychosocial data were collected by a validated child self-completed questionnaire before the placement of fixed appliances. Thereafter, adolescents were followed up on a monthly basis to collect information relating to their daily hassles and treatment adherence. After 1 year of treatment, orthodontic treatment outcome was measured by the amount of improvement in occlusion achieved. Logistic regression analysis was used. The response rate was 98.6 per cent and the dropout was 5.6 per cent. Maternal support was an important predictor of improvement in occlusion. Adolescents with high levels of maternal support were more likely to achieve a high improvement in occlusion than those with low levels of maternal support (odds ratio = 3, 95 per cent confidence interval = 1.53-6.27, P = 0.002). Paternal support, maternal and paternal control, daily hassles, and resiliency were not significantly associated with improvement in occlusion (P > 0.05). The regression model confirmed the significance of maternal support as a predictor of orthodontic treatment outcome at the end of 1 year of active treatment.

The role of socio-economic position in predicting orthodontic treatment outcome at the end of 1 year of active treatment.

Socio-economic position (SEP) has not been tested as a predictor of orthodontic treatment outcome. This study aimed to determine whether SEP can predict orthodontic treatment outcome at the end of 1 year of active treatment. A hospital-based, prospective longitudinal design was adopted including 145 consecutively selected 12- to 16-year-old males and females. Patients were followed-up on a monthly basis during their orthodontic treatment with fixed appliances. After 1 year of treatment, orthodontic treatment outcome was assessed as the amount of improvement in occlusion achieved. Logistic regression analysis was used. The response rate was 98.6 per cent and the dropout was 5.6 per cent. Adolescents whose mothers were from a low social class were less likely to achieve a high improvement in occlusion than those whose mothers were from a high social class [odds ratio (OR) = 0.1; 95 per cent confidence interval (CI) = 0.01-0.97; P = 0.047). Adolescents from a low household social class were less likely to achieve a high improvement in occlusion compared with their counterparts from a high household social class (OR = 0.2; 95 per cent CI = 0.07-0.79; P = 0.019). The father's social class, parental education, and employment status were not significantly associated with improvement in occlusion (P > 0.05). The regression model confirmed the significance of maternal and household social class as predictors of orthodontic treatment outcome at the end of 1 year of active treatment.