Health technology assessment for oral health in the past decade: a scoping review.

BACKGROUND: Health technology assessment (HTA) is the systematic evaluation of various properties and effects of a health technology. HTA can serve as a bridge between the world of knowledge and that of decision making, offering decision makers the best summary of scientific evidence. Scoping HTA reports in the context of dentistry can help researchers identify grey areas; help practitioners make evidence-based decisions and further initiate better policy making. AIM: To provide an overview on HTAs pertaining to oral health and dentistry in the past decade, map the extension and scope of the methodological practices, key findings, and limitations. METHODOLOGY: A scoping review was conducted using the Joanna Briggs Institute framework. A comprehensive search for HTA reports was done through the International Network of Agencies for Health Technology Assessment Database from January 2010 to December 2020. Consecutively, electronic databases (PubMed and Google Scholar) were searched. Finally, thirty-six reports were included in this review and analyzed. RESULTS: A total of 709 articles were initially identified, of which thirty-six met the inclusion criteria. Reviewed HTAs focused on various specialties of dentistry worldwide. Maximum number of reports (N = 5) were related to "prosthodontics and dental implants" and technologies related to preventive dentistry were most commonly assessed (N = 4). CONCLUSION: Functional, appropriate, and evidence-based information provided through HTA pertaining to oral health on a regular basis will enable decision makers to have enough data to make decisions on the future use of new technology, modify existing policies, accelerate its translation into practice, and ensure provision of robust dental healthcare services.

Infodemiology for oral health and disease: A scoping review.

INTRODUCTION: Increasing affordability, accessibility and penetration of internet services worldwide, have substantially changed the ways of gathering health-related information. This has led to the origin of concept infodemiology that allows the information to be collected and analysed in near real time. Globally, oral diseases affect nearly 3.5 billion people; thus, volume and profile of oral health searches would help in understanding specific community dental needs and formulation of pertinent oral health strategies. AIM: To review the published literature on infodemiological aspects of oral health and disease. METHODOLOGY: This scoping review was conducted in accordance with PRISMA-ScR guidelines. Electronic search engines (Google Scholar) and databases (PubMed, Web of science, Scopus) were searched from 2002 onwards. RESULTS: Thirty-eight articles were included in this review. The infodemiological studies for oral health and disease were mainly used in two domains. Out of 38 articles, 24 accessed the quality of available online information and 15 studied online oral health-related information seeking behaviour. CONCLUSION: The most commonly searched oral diseases were toothache, oral cancer, dental caries, periodontal disease, oral maxillofacial surgical procedures and paediatric oral diseases. Most of the studies belonged to developed countries and Google was the most researched search engine.

Oral health-related quality of life among elderly patients visiting special clinics in public hospitals in Delhi, India: A cross-sectional study.

BACKGROUND: Oral health is recognized as an integral component of general health, and poor oral health is reflected in general health and quality of life (QoL). India has seen a profound shift in the elderly population and is currently home to 103.9 million elders. General Oral Health Assessment Index (GOHAI) is a self-reported oral health assessment index used in elderly population and has been tested in multiple countries. OBJECTIVE: The study aimed to assess the oral health-related QoL (OHRQoL) using GOHAI and various factors affecting it, among elderly patients visiting special Sunday geriatric clinics at Delhi public hospitals. METHODS: A cross-sectional study was conducted among four purposively selected special geriatric public clinics in Delhi, India, and a convenience sample of 145 elderly patients was obtained. OHRQoL was measured using a prevalidated instrument (GOHAI) along with other variables (sociodemographic factors, self-perceived oral health, utilization of medical/dental services, dental problems in the past 12 months, and prosthetic status/need). Statistical analysis was done using Statistical Package for the Social Sciences software version 21, and descriptive results were obtained. RESULTS: The sample consisted of 66 males (45.5%) and 79 females (55.5%), and around 58% (n = 84) of the participants were illiterate. Around 39% (n = 57) of the elderly had never visited a dentist and 48% (n = 69) were financially dependent (no income) on others. The mean GOHAI score for the population was 26.69 + 4.44 (median = 25, interquartile range = 23-27). GOHAI score was compared for age, oral hygiene practices, dental problems in the past 12 months, self-reported oral health, and prosthetic need, and a statistically significant difference was observed. CONCLUSIONS: The current study assessed GOHAI score and highlighted important determinants of OHRQoL in elderly population visiting the special clinics in Delhi. Thus, OHRQoL should be considered as a surrogate measure to clinical oral examination.

Fluoride, Thyroid Hormone Derangements and its Correlation with Tooth Eruption Pattern Among the Pediatric Population from Endemic and Non-endemic Fluorosis Areas.

AIM: To comparatively evaluate the status of fluoride in the body with thyroid activity in the pediatric population of endemic fluorosis areas. The present study also attempted to elucidate whether any correlation exists between fluoride and thyroid hormone derangement with delayed tooth eruption. MATERIALS AND METHODS: A total of 400 pediatric subjects were included in the present study. All the patients were divided into two broad groups; groups A and B. Group A included 200 subjects who belonged to the endemic fluorosis area while Group B included remaining 200 subjects, who belonged to the fluorosis non-endemic area. Group B subjects were taken as control. Group A subjects were further divided into two study groups as follows: Group A1: 100 Pediatric subjects with dental fluorosis, and Group A 2: A total of one hundred pediatric subjects without dental fluorosis. Dean's index of fluorosis was calculated in all the patients. Blood samples were collected and were sent to a laboratory for assessment of thyroid hormone levels. All the results were subjected to statistical analysis by Statistical Package for the Social Sciences (SPSS) software. RESULTS: Mean thyroid stimulating hormone (TSH), water fluoride levels, urine fluoride levels and serum fluoride levels of subjects in group 1 were found to be significantly higher than that of subjects of group 2. Delayed tooth eruption was absent in subjects of group B while it was present in 100 subjects of group A. Thyroid hormone level derangement was seen in 54 percent subjects of group B, while it was seen in 67.5% subjects of group A. CONCLUSION: Positive correlation exists between fluorosis and thyroid functional activity. However; the tooth eruption pattern is independent up on the thyroid hormone derangement. CLINICAL SIGNIFICANCE: Delayed tooth eruption and alteration in thyroid hormone levels can occur in subjects of the endemic fluoride areas. Therefore, adequate measures should be taken for controlling such adverse effects.

Personality Traits Influence on Perception and Hesitancy Towards COVID-19 Vaccination Among Tertiary Care Dental Hospital in Delhi: A Cross-Section Study.

Background  In the COVID-19 pandemic, vaccination is recognized as a global public-health goal for preventing, containing, and stopping transmission. But the reluctance of people to receive safe and recommended available vaccines (i.e., vaccine hesitancy) was a growing concern. One of the key elements that influence how people are perceived and their reluctance to get the COVID-19 vaccine was found to be personality traits. Hence, the aim of the study was to assess the influence of personality traits on perception and hesitancy towards COVID-19 vaccination among patients attending tertiary dental care hospitals in Delhi. Methodology A cross-sectional questionnaire survey was conducted among a sample of 322 participants aged 15-70 years attending the outpatient department of a public sector tertiary care dental hospital in New Delhi. Data was collected over a two-month period using a validated self-administered questionnaire which recorded demographic variables, individual perceptions, hesitancy towards COVID-19 vaccination, and personality traits [using 20-item mini international personality item pool (IPIP)]. Descriptive analysis followed by a Chi-square test and correlation test was applied. Results A total of 322 participants were contacted among which 300 participants (93%) responded which comprised 157 males (52.3%) and 143 females (47.7%). Dominant agreeableness personality shows a statistically significant positive correlation with individual perception (r=0.124, p=0.032) while a negative correlation with vaccine hesitancy (r= -0.146, p= 0.011). Among reasons for vaccine hesitancy, fear of side effects showed a significant association with personality traits (p= 0.018). Conclusion This study concluded that personality trait (dominant agreeableness) was an important factor in shaping individual perception and hesitancy towards COVID-19 vaccination.

Correlates of nicotine dependence among patients visiting a tobacco cessation centre in India: A retrospective analysis.

Background We did a retrospective secondary analysis of 1-year data of a tobacco cessation clinic (TCC) to assess correlates of nicotine dependence among tobacco users visiting the TCC at a tertiary care dental hospital. Methods Secondary data were obtained from the records of patients who had visited the TCC from January to December 2019. Of the 1436 records, 1144 were found to contain all the information needed for the study. Patient records were obtained from a pre-validated standard TCC patient assessment sheet (PAS), which included various sections: Sociodemo-graphic items, tobacco use profile items, nicotine dependence status, strategy used for cessation and follow-up details. Results Of the 1144 proformas, 97.1% (n=1111) were of men and 2.9% (n=33) were of women. Around 48.5% had medium nicotine dependence followed by high nicotine dependence (29.7%) and low nicotine dependence (21.8%). The mean (SD) age of initiation of tobacco use was 26.1 (9.44) years and a significantly lower age of initiation was observed in patients with high nicotine dependence. Greater number of years of tobacco use was significantly associated with high nicotine dependence. About 47% of patients had attempted to quit tobacco in the past and the quitting attempts were found to be significantly higher in patients with high dependence. Conclusion We explored crucial determinants of nicotine dependence among tobacco users reporting to the TCC. These factors may be incorporated in routine assessment of the tobacco use status and may be used in tailored cessation counselling strategies.

Primary Health Care Workforce in Southeast Asia Region, Existing Status and Strategies for Non-Communicable Diseases and Oral Health Alliance: A Scoping Review.

Oral diseases and non-communicable diseases (NCD) share modifiable risk factors and common social determinants, thus creating new opportunities for improving oral health. The existing primary health care workers can play an integral role in NCD and oral health care integration by creating awareness, promoting oral health, controlling risk factors, and referring for timely dental care. This study aimed to identify and understand the roles of the existed human health resources working at primary health care and develop strategies to build on a unified NCD and oral health alliance human resources at this level. A scoping review was conducted to identify the primary health workforce in the Southeast Asia region, their roles and responsibility, and integration in oral health care. Various databases like NCBI (PubMed), Google Scholar, World Health Organisation (WHO)-Southeast Asia region (SEAR), Ministry of Health and Family Welfare websites in SEAR were comprehensively searched from January 1980 to December 2020 for reports, reviews, and original research. The keywords used were "primary health care workers," "community health care workers," "primary oral health care in SEAR," etc. Only full-text articles in English language and reports available in Ministry of Health and Family Welfare (MOHFW) sites of SEAR were included in the study. Information was taken from 39 full-text articles, six WHO reports, and two reports from Ministry of Health sites of SEAR. Primary health workers (PHW) are known by multiple names in different countries of Southeast Asia. They share various common roles and responsibilities. There are many opportunities for the prevention and control of oral diseases in the SEAR. Basic systems and human resources for the control of NCD are in place in many countries. Oral health can be integrated with NCD programs and policies to reduce the burden of diseases.

Feasibility of the novel 'Tobacco-Free Hospital' model and its compliance assessment at a tertiary care hospital of New Delhi, India.

BACKGROUND: Tobacco is one of the biggest threats to the public health. Tobacco harms not only human health but also the environment. The Cigarette and Other Tobacco Products Act (COTPA) was implemented in India in 2003. Compliance of these laws in public places is mandatory. This study presents an innovative model to make hospitals tobacco-free. The aim is to assess the effectiveness of implementation of tobacco-free hospitals among security guards, tobacco users, and key observers visiting a tertiary care dental hospital through a comprehensive strategy. MATERIALS AND METHODS: An exploratory study was conducted in three phases. Structured training was organized for all security guards (n = 25) along with pre- and post-assessment using a validated questionnaire. All the patients and attendants entering the hospital were screened for tobacco products by security guards. Those patients who were carrying tobacco products to the hospital (n = 107) were interviewed using a validated questionnaire. Opinions of key observers (n = 223) who witnessed the event were also recorded. Descriptive statistics (means, frequency distribution) and inferential statistics (Chi-square test) were calculated. RESULTS: At the baseline, only 20% security guards were aware about tobacco legislations, whereas after 1 month, more than 80% security guards were aware about the laws. Around two-third of study participants of both the groups were aware of COTPA Section 4. Approximately 33.6% of tobacco users and 58.4% of key observers were aware of COTPA Section 6b. Forty tobacco users in the study availed tobacco cessation services of the hospital. CONCLUSION: Every staff should be a torch bearer of tobacco control. The study highlights a comprehensive approach of integrating hospital staff and linking vital cessation services by implementing Sections of COTPA.

Self-Perceived Halitosis and Related Factors Among the Mask-Wearing Population During the COVID-19 Pandemic in Delhi, India: A Cross-Sectional Study.

Introduction Halitosis (oral malodor) is a common health condition throughout the world. In India, data on self-reported halitosis and related factors is limited. Mouth mask usage has been made compulsory after the coronavirus disease 2019 (COVID-19) pandemic. This could possibly alter oral microflora and environment and contribute to halitosis. The aim of the study was to determine the prevalence of self-perceived halitosis (SPH) among mask-wearing patients visiting a tertiary care dental hospital in Delhi, India. Methods A cross­sectional study was conducted among a convenience sample of 300 patients visiting a tertiary care dental hospital in the capital of India. SPH status was measured using a self-designed and structured questionnaire containing socio-demographic factors, mask-related habits, and self-perceived oral health status. Statistical analysis was done using Jamovi software (The jamovi project, Sydney, Australia) version 1.8. Descriptive analysis followed by a chi-square test and a multivariate logistic regression test was applied. Results Bad breath was perceived by 86 study subjects. Of the participants, 16.7% felt that they had bad breath before the pandemic, and 38% of the participants had an increased perception or feeling of bad breath since regular mask usage. Of the participants, 42.7% felt that they had an increased feeling of dryness in the mouth post-pandemic. SPH status was associated with mask usage frequency (p<0.001), change (p<0.001) and type of mask (p=0.004), increased feeling of dryness (p<0.001), frequency of toothbrushing (p<0.001), self-reported oral disease (p=0.007), and dental treatment in the past 12 months (p=0.005). Conclusion The SPH status of the study population was associated with mask-related habits and self-reported oral health status. The findings highlight the importance of possible amendments in preventive and curative care for patients with halitosis post-COVID-19 pandemic.

Factors affecting the prevalence of stress, anxiety, and depression in undergraduate Indian dental students.

BACKGROUND: The objective was to assess the prevalence and the associated demographic factors of stress, anxiety, and depression among undergraduate (UG) Indian dental students and determine whether the pattern is different in government-run institutions and those managed by private authorities. MATERIALS AND METHODS: A cross-sectional study was conducted among dental UG students from five dental colleges. Snowball sampling was used to approach 776 potential participants, resulting in a complete response from 507 students. The questionnaire consisted of demographic data; year of study; type of college; accommodation; and Depression, Anxiety, and Stress Scale (DASS)-42. Descriptive data and inferential statistics were obtained. Chi-square test was applied for categorical data to test for significance, and higher analysis was done using multiple linear regression. RESULTS: Females and males comprised 71.8% (n = 364) and 28.2% (n = 143) of the study population, respectively. The prevalence of anxiety was highest (66.86%, n = 339), followed by depression (57.39%, n = 291) and stress (43.99%, n = 223). In terms of severity also, anxiety was the most prevalent condition as more than one-fourth of the students presented with severe and very severe scores in this aspect (25.43%, n = 129) compared to depression (14.39%, n = 73) and stress (10.09%, n = 51). Regression analysis revealed age as a strong positive predictor for all the three conditions, while staying in the hostel was a positive predictor for anxiety and stress. Being female was also an independent predictor for the high prevalence of stress. CONCLUSION: Stress, anxiety, and depression are highly prevalent among Indian dental students. Clinical students and interns have a higher prevalence of stress than preclinical students. Age, being female, and staying in the hostel are positive predictors for the severity of stress. There is no significant difference between government and private colleges, regarding the prevalence of any psychological condition.

Emotional Intelligence and Perceived Stress among Dental Undergraduates in Delhi.

BACKGROUND: Emotional intelligence (EI) is understanding one's own feeling and able to handle those feelings without disturbing themselves. Medical schools are stressful and the ability to manage stress is a major factor of success for these students. The current study contributes further insight to body of research in EI as it relates to students' stress in education, especially among dental undergraduates of Delhi. MATERIALS AND METHODS: A cross-sectional, convenient sampling-based survey was conducted among 323 dental undergraduates from all the 3 dental Institutions across Delhi. The Schutte Emotional Intelligence and Perceived Stress scale instruments were administered to all the students of four professional years. The data analysis was done using SPSS V.17 and various statistical tests were used to determine significant difference. RESULTS: No significant differences were found among gender as well as among professional groups for EI. There was a significant difference (0.008) among gender with respect to perceived stress. Correlation analysis showed an inverse relationship between EI and PS (r = -0.227) which was found to be statistically significant. CONCLUSION: Training in dental education could be quite stressful due to their time-bound work, but regular student performance assessment and associated factors would allow understanding student behavior in handling situations. HOW TO CITE THIS ARTICLE: Yadav V, Mohanty V, Balappanavar AY, et al. Emotional Intelligence and Perceived Stress among Dental Undergraduates in Delhi. Int J Clin Pediatr Dent 2020;13(4):344-347.

Testing of a dental student-administered multidisciplinary health promotion program.

BACKGROUND: A multidisciplinary approach involving healthcare students for health promotion has been recommended. With this view, the primary phase of the integrated health promotion program (IHPP) was designed and pilot tested. METHODS: A pre-post-intervention study was conducted among 55 housewives of two self-help groups in India. The intervention consisted of a motivational interview, interactive session with a nutritionist, group discussion, personal hygiene training, and an illustrative reinforcement leaflet. Interventions were provided by trained dental students. The evaluation was based on outcomes from six tools specifically tailored for the program. These were the health self-regulation self-efficacy scale (HSSS), visual analogue scale (VAS) for self-health perception, oral health knowledge and attitude questionnaire, motivational interview, group discussion, and personal hygiene demonstration test. RESULTS: Statistically significant change in mean pre- and postprogram scores in HSSS (P < 0.001), its two components, metacognitive component, action component, as well as VAS (P = 0.001) indicated a change in health-related perceptions in the participants. Mean oral health knowledge score (6.1), as well as attitude score (3.8), was fair. Most of the participants were able to demonstrate personal hygiene and tooth brushing correctly; take collective decisions about their health, plan changes in their diet, and resolve upon bringing about healthy changes in their lifestyle. CONCLUSION: The program evaluation indicated successful intervention and may be replicated in a larger population. Healthcare student population may be used in developing countries to bring about an attitude change in the underprivileged population through an IHPP.