The relationship between traumatic dental injuries and adolescents' non-suicidal self-injury behaviour: A cross-sectional analysis of an East London cohort.

BACKGROUND/AIM: Recent reviews of case reports have pointed out a potential connection between non-suicidal self-injury (NSSI) and traumatic dental injuries (TDIs). The aim of this study was to investigate the association of a history of NSSI with TDIs in 15- to 16-year-old adolescents. METHODS: This study analysed cross-sectional data from the Research with East London Adolescents Community Health Survey, a prospective population survey of adolescents attending state schools in East London, England. The history of NSSI was obtained using two items from the Lifestyle and Coping questionnaire (whether they have ever engaged with self-harm and the last time they engaged in such behaviours). The presence of TDIs, increased overjet and inadequate lip coverage were determined through clinical assessments by two trained dentists. Survey logistic regression was fitted to test the association of NSSI with TDIs. Odds ratios (ORs) were adjusted for socio-demographic and clinical characteristics as potential confounders. RESULTS: The lifetime and last-year prevalence of NSSI were 11.9% and 6.7%, respectively, whereas the prevalence of TDIs was 16.5%. Neither the lifetime prevalence of NSSI (OR: 1.02, 95% confidence interval: 0.56-1.85) nor the last-year prevalence of NSSI (OR: 0.76, 95% CI: 0.36-1.61) were associated with TDIs in regression models adjusted for confounders. CONCLUSION: This study did not support an association between history of NSSI and TDIs among adolescents aged 15-16 years old in East London.

Troublesome behaviour and traumatic dental injuries during adolescence.

BACKGROUND/AIM: Troublesome behaviour can lead to bodily injuries among young people, although a link with traumatic dental injuries (TDIs) remains unclear. The aim of this study was to evaluate the longitudinal association between troublesome behaviour and TDIs during adolescence. METHODS: This study analysed data from phases 2 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal study of public secondary schools in East London. Troublesome behaviour in the past 12 months was measured with 8 items (told lies to get things from others, started fight, bullied or threatened people, stayed late outside, stole valuable things, ran away from home, played truant from school and intentionally destroyed someone else's property) from the Development and Well-Being Assessment (DAWBA), when participants were 13-14 years old (Phase 2). Adolescents were dentally examined for TDIs when they were 15-16 years old (Phase 3). The association between troublesome behaviour and TDIs was tested in logistic regression models adjusting for socio-demographic characteristics and oral clinical factors. RESULTS: Forty-three per cent of adolescents reported one or more troublesome behaviours at age 13-14 years, and 16% had evidence of TDIs by age 15-16 years. Adolescents who answered 'perhaps' and 'definitely' to any troublesome behaviour item had, respectively, 1.37 (95% CI: 0.62-3.00) and 1.50 (95% CI: 0.69-3.30) greater odds of having TDIs than those who answered 'no' after adjustment for confounders. Of the 8 behaviours assessed, having run away from home, bullied or threatened people, often told lies, and stolen valuable things were associated with having TDIs. CONCLUSION: This study among adolescents shows that reporting troublesome behaviour was associated with TDIs two years later. Given the wide confidence intervals for these associations, the present findings require confirmation from further longitudinal studies.

Cumulative socio-economic disadvantage and traumatic dental injuries during adolescence.

BACKGROUND/AIM: Studies on the association between socio-economic circumstances and traumatic dental injuries (TDIs) are cross-sectional and inconclusive. The aim of this study was to investigate the association between cumulative socio-economic disadvantage and TDIs among adolescents. METHOD: Data from 668 participants in the East London Adolescents Community Health Survey (RELACHS) were analysed. Family socio-economic indicators (parental employment, car ownership and eligibility for free school meals) were collected when participants were in grades 7 (11-12 years), 9 (13-14 years) and 11 (15-16 years). The number of periods (RELACHS waves) adolescents lived in socio-economic disadvantage was counted for each socio-economic measure, ranging from 0 (never in disadvantage) to 3 (always in disadvantage). Adolescents were dentally examined for TDIs at age 15-16 years. The association between each measure of cumulative socio-economic disadvantage and TDIs was tested in logistic regression models adjusting for demographic factors. RESULTS: Significant positive linear trends in the prevalence of TDIs were observed by the number of periods of parental unemployment and being without a family car, but not by eligibility for free school meals. Adolescents whose parents were always unemployed had 2.06 (95% CI: 1.12-3.80) greater odds of having TDIs than those whose parents were never unemployed. Similarly, adolescents from families that never owned a car had 2.17 (95% CI: 1.26-3.74) greater odds of having TDIs than those that always had a family car. CONCLUSION: Cumulative socio-economic disadvantage during adolescence was associated with greater odds of having TDIs.

Depressive symptoms and traumatic dental injuries among adolescents.

BACKGROUND/AIM: A previous cross-sectional study found that young adults with depression were more likely to have traumatic dental injuries (TDIs). The aim of this study was to determine the relationship between depressive symptoms during early and middle adolescence, and TDIs at age 15-16 years. METHOD: This study used longitudinal data from phases 1 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based survey following a representative, multi-ethnic sample of adolescents attending public schools in East London (England). Information on depressive symptoms was collected using the Short Moods and Feelings Questionnaire (SMFQ) during early (age 11-12 years) and middle adolescence (age 15-16 years). TDIs were identified during clinical examinations in phase 3 when pupils were 15-16 years old. Logistic regression was used to test the association between depressive symptoms at different stages of adolescence and TDIs adjusting for confounders (age, gender, ethnicity, parental employment and overjet). RESULTS: Depressive symptoms were reported by 24% and 32% of adolescents in early and middle adolescence, respectively. Evidence of TDIs was found in 18% of adolescents at age 15-16 years. Adolescents with depressive symptoms, either in early or middle adolescence, had greater odds of experiencing TDIs. However, these estimates were not statistically significant. In regression models adjusted for confounders, the odds of having TDIs were 1.23 (95% CI: 0.77-1.96) and 1.23 (95% CI: 0.76-1.95) among pupils with depressive symptoms in early and middle adolescence, respectively. CONCLUSION: There was no association between depressive symptoms and TDIs in early and middle adolescents.

Can socioeconomic and psychosocial factors predict the duration of orthodontic treatment?

INTRODUCTION AND OBJECTIVES: Very little is known about the role of socioeconomic and psychosocial factors in predicting orthodontic treatment duration. Thus, this study aimed to test whether socioeconomic position (SEP) and psychosocial factors, namely, family environment and resiliency can predict orthodontic treatment duration. METHODS: Data were analysed from a hospital-based, prospective, longitudinal study that recruited 145 consecutively selected 12- to 16-year-old male and female adolescents. Baseline SEP and psychosocial data were collected by a validated child self-completed questionnaire before the placement of fixed appliances. Linear regression analysis was used. RESULTS: The response rate was 98.6 per cent and the dropout was 8.2 per cent. Maternal emotional support was an important predictor of orthodontic treatment duration. Adolescents with high levels of maternal emotional support were more likely to have a shorter orthodontic treatment duration (by nearly four months) than those with low levels of maternal emotional support (P = 0.02). Parental SEP, paternal emotional support, maternal and paternal control, as well as resiliency were not significantly associated with orthodontic treatment duration (P > 0.05). The multivariable regression analysis (including age, gender, and malocclusion severity) confirmed the significance of maternal emotional support as a predictor of orthodontic treatment duration. CONCLUSIONS: Maternal emotional support is an important predictor of orthodontic treatment duration. This may be explained by a higher maternal involvement in the orthodontic treatment, which may have facilitated achieving the required orthodontic treatment outcome in a shorter treatment duration.

Illicit drug use and traumatic dental injuries in adolescents.

OBJECTIVE: To explore the association between illicit drug use and traumatic dental injuries (TDI) among adolescents. METHOD: We used data from 618 adolescents who participated in Phases I and III of Research with East Adolescents Community Health Survey (RELACHS), a longitudinal school-based study of adolescents in East London. Illicit drug use was collected when participants were 11-12 and 15-16 years old (Phases I and III, respectively). Clinical examinations for TDI were conducted in Phase III only. The association of lifetime prevalence of illicit drug use at ages 11-12 and 15-16 years with TDI was evaluated in crude and adjusted binary logistic regression models. RESULTS: Overall, 6.3% and 25.4% of adolescents reported having ever used illicit drugs at ages 11-12 (Phase I) and 15-16 years (Phase III), respectively. Also, 8.7% of adolescents were found to have TDI at age 15-16 years. There was no significant association between lifetime prevalence of illicit drug use reported at age 11-12 years (Odds Ratio: 1.07; 95% Confidence Interval: 0.45-2.54) or age 15-16 years (OR: 1.19; 95%CI: 0.74-1.93) and TDI. CONCLUSION: This study found no support for an association between illicit drug use and TDI among adolescents from East London.

Family environment and traumatic dental injuries in adolescents.

BACKGROUND/AIMS: No comprehensive assessment of the influence of the home environment on traumatic dental injuries (TDI) has been conducted to date. The aim of this study was to explore the relationship between family environment and TDI among adolescents from East London. MATERIALS AND METHODS: This cross-sectional study used data from 646 adolescents who participated in phase III of the Research with East London Adolescents Community Health Survey (RELACHS). Family environment was measured with four indicators (non-nuclear family, discordant parental relationship and levels of parental support and parental punishment) measured through a self-administered questionnaire. Clinical examinations were performed for TDI, overjet and lip coverage. Logistic regression was used to test the crude and adjusted (controlling for sociodemographic and clinical factors) association of each family environment characteristic with TDI prevalence. RESULTS: Twenty-nine percent of adolescents were from non-nuclear families, and 52.3% reported a discordant parental relationship. The mean score for parental support was -0.01 (SD: 0.90, range: -0.11 to 0.08), and the mean parental punishment score was 0.03 (SD: 0.86, range: -0.04 to 0.10). Adolescents from non-nuclear families had 1.63 (95% confidence interval: 1.06-2.53) greater odds of having TDI than those from nuclear families. However, this association was fully attenuated after adjusting for sociodemographic and clinical factors. The other three indicators of family environment were not associated with TDI either in crude or adjusted regression models. CONCLUSION: This study found weak evidence of an association between family environment and TDI.

Obesity, physical activity and traumatic dental injuries in adolescents from East London.

BACKGROUND/AIMS: Evidence on the interplay between obesity, physical activity and traumatic dental injuries (TDIs) is still inconclusive and heavily based on cross-sectional studies. The aim of this study was to explore the interrelationship of obesity and physical activity at age 11-12 years with TDI at age 15-16-years among schoolchildren from East London. MATERIALS AND METHOD: Data were analysed regarding 598 adolescents who participated in phases I and III of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal, school-based study of adolescents in East London. Participants reported their level of physical activity and their height and weight were measured to estimate body mass index Z-scores (according to the UK growth reference) when they were 11-12 years old. Oral clinical examinations were conducted to assess TDI, overjet and lip coverage when participants were 15-16 years old. The associations of obesity and physical activity with TDI were evaluated in crude and adjusted models using binary logistic regression. RESULTS: Overall, 22.6% of adolescents were obese and 7.2% exercised for 7 h or more a week at baseline, while 18.1% of adolescents had experienced TDI by age 15-16 years. Physical activity (7+ hours per week) was significantly associated with TDI (odds ratio: 2.19; 95% confidence interval: 1.08-4.43) in the crude model. However, no significant associations were found between obesity and TDI (1.18; 95% CI: 0.72-1.93) or physical activity and TDI (1.96; 95% CI: 0.94-4.07) in adjusted models. CONCLUSION: This study found no evidence of any associations of obesity and physical activity with TDI among adolescents from East London.

Ethnic inequalities in periodontal disease among British adults.

AIM: To explore ethnic inequalities in periodontal disease among British adults, and the role of socioeconomic position (SEP) in those inequalities. METHODS: We analysed data on 1925 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults living in an ethnically diverse and socially deprived area. Participants completed a questionnaire and were clinically examined for the number of teeth with periodontal pocket depth (PPD)≥4 mm and loss of attachment (LOA)≥4 mm. Ethnic inequalities in periodontal measures were assessed in negative binomial regression models before and after adjustment for demographic (gender and age groups) and SEP indicators (education and socioeconomic classification). RESULTS: Compared to White British, Pakistani, Indian, Bangladeshi and Asian Others had more teeth with PPD≥4 mm whereas White East European, Black African and Bangladeshi had more teeth with LOA≥4 mm, after adjustments for demographic and SEP measures. The association of ethnicity with periodontal disease was moderated by education, but not by socioeconomic classification. Stratified analysis showed that ethnic disparities in the two periodontal measures were limited to more educated groups. CONCLUSION: This study showed considerable ethnic disparities in periodontal disease between and within the major ethnic categories.

Ethnic inequalities in dental caries among adults in East London.

BACKGROUND: This study explored ethnic inequalities in dental caries among adults and assessed the role of socioeconomic position (SEP) in explaining those inequalities. METHODS: We analysed data on 2013 adults aged 16-65 years, from the East London Oral Health Inequality (ELOHI) Study, which included a random sample of adults and children living in East London in 2009-10. Participants completed a questionnaire and were clinically examined for dental caries at home. Dental caries was measured using the number of decayed, missing and filled teeth or DMFT index. Ethnic inequalities in dental caries were assessed in negative binomial regression models before and after adjustment for demographic (sex and age groups) and SEP measures (education and socioeconomic classification). RESULTS: White Eastern European and White Other had higher DMFT, whereas all Asian (Pakistani, Indian, Bangladeshi and Other) and all Black (African, Caribbean and Other) ethnic groups had lower DMFT than White British. Similar inequalities were found for the number of filled and missing teeth, but there were no differences in the number of decayed teeth between ethnic groups. CONCLUSIONS: This study showed considerable disparities in dental caries between and within the major ethnic categories, which were independent of demographics and SEP.

Social inequalities in oral cancer literacy in an adult population in a multicultural deprived area of the UK.

BACKGROUND: To report the level and correlates of oral cancer literacy in a deprived area of the UK. METHODS: This study is part of the East London Oral Health Inequality Study, which included a representative sample of adults 16-65 (n = 2343) years old living in Waltham Forest, Redbridge and Barking and Dagenham in 2009-10. This cross-sectional study adopted a multi-stage, stratified, random sampling approach. Data were collected through home visits by trained examiners and interviewers. Hierarchical logistic regression modelling was adopted. RESULTS: Only 26.7% participants were aware that a small lesion in the mouth can develop into oral cancer, and 39.5% were aware that early treatment could prevent a lesion from developing into oral cancer. Adjusted odds ratios confirmed the social gradient in awareness that a small lesion in the mouth can develop into oral cancer, even after adjusting for age, gender and ethnicity. Inequalities in awareness that a small lesion in the mouth can develop into oral cancer were significantly attenuated after forcing education level into the equation. Interestingly, adjusting for education cancelled the difference previously observed between manual/routine and professional/managerial occupations. CONCLUSIONS: Oral cancer literacy is poor among adults in Outer North East London, and we have identified particularly vulnerable sub-populations.

Problem behaviour and traumatic dental injuries in adolescents.

AIM: To explore the relationship between problem behaviour and traumatic dental injuries (TDI) among 15- to 16-year-old schoolchildren from East London. METHODS: This cross-sectional study used data from 794 adolescents who participated in phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents. Participants completed a questionnaire and were clinically examined for TDI, overjet and lip coverage. The Strength and Difficulties Questionnaire (SDQ) was used to assess problem behaviour, which provided a total score and five domain scores (emotional symptoms, conduct problems, hyperactivity, peer problems and pro-social behaviour). The association between problem behaviour and TDI was assessed in unadjusted and adjusted logistic regression models. Adjusted models controlled for demographic (sex, age and ethnicity), socio-economic (parental employment) and clinical factors (overjet and lip coverage). RESULTS: The prevalence of TDI was 17% and the prevalence of problem behaviour, according to the SDQ, was 10%. In the adjusted model, adolescents with problem behaviour were 1.87 (95% confidence interval: 1.03-3.37) times more likely to have TDI than those without problem behaviour. In subsequent analysis by SDQ domains, it was found that only peer problems were associated with TDI (OR = 1.78, 95% CI: 1.01-3.14), even after adjustment for confounders. CONCLUSION: This study found evidence for a relationship between problem behaviour and TDI among adolescents, which was mainly due to peer relationship problems.

Alcohol consumption at age 11-12 years and traumatic dental injuries at age 15-16 years in school children from East London.

AIM: To explore the association between alcohol consumption at age 11-12 years and traumatic dental injuries (TDI) at age 15-16 years. METHODS: Data of 635 adolescents who participated in phases I and III of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal school-based survey of a representative sample of adolescents from East London, were used for this study. Information on socio-demographic characteristics and alcohol consumption was obtained from questionnaires in phase I when adolescents were 11-12 years of age. Data on TDI and clinical characteristics (incisor overjet and lip coverage) were taken from clinical examination in phase III when adolescents were 15-16 years of age. The association between (lifetime and last month) alcohol consumption and TDI was assessed in crude and adjusted logistic regression models. RESULTS: Overall, 14.5% of adolescents had ever consumed alcohol and 3.5% had consumed alcohol the month before the baseline survey, whereas 17% of adolescents had experienced TDI by age 15-16 years. No significant association of alcohol consumption with TDI was seen in these adolescents for either lifetime (adjusted odds ratio [OR]: 0.87; 95% confidence interval [CI]: 0.45-1.67) or last month consumption of alcohol (adjusted OR: 0.86; 95% CI: 0.28-2.69). CONCLUSION: This study did not support the association between alcohol use and TDI in adolescents.

Mother's Perception of General Family Functioning and Sugar Consumption of 3- and 4-Year-Old Children: The East London Family Study.

Frequent consumption of sugary foods is a common risk factor for chronic diseases such as dental caries and obesity. Dietary patterns are acquired at home during early life and form a blueprint for dietary behaviours in later life. A favourable family environment can provide a supportive context that enhances the adoption of healthy dietary habits. The aim of this study was to identify the contribution of general family functioning towards the frequent consumption of sugary foods by 3- and 4-year-old children in Outer North East London. The research question was explored with data from the East London Family study, which collected data through home visits from a representative sample of adults and children living in Outer North East London in 2008-2010. This study analysed data from 3- and 4-year-old children (n = 698) and their mothers and included logistic regression, conceptual hierarchical modelling and mediation analysis. The results showed that 17% of the sample consumed sugary foods more than 4 times per day, and that effective general family functioning may help reducing frequent consumption of sugary foods. There was a 67% reduction in children's frequent consumption of sugary foods with every unit increase in the general family functioning score. Mother's higher education may also help reduce the frequent consumption of sugary foods by children. The negative impact of mother's lower education was buffered by the effect of effective general family functioning. The study findings underscore the prospect of identifying factors that contribute to the acquisition of good dietary behaviours.

UK health performance: findings of the Global Burden of Disease Study 2010.

BACKGROUND: The UK has had universal free health care and public health programmes for more than six decades. Several policy initiatives and structural reforms of the health system have been undertaken. Health expenditure has increased substantially since 1990, albeit from relatively low levels compared with other countries. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to examine the patterns of health loss in the UK, the leading preventable risks that explain some of these patterns, and how UK outcomes compare with a set of comparable countries in the European Union and elsewhere in 1990 and 2010. METHODS: We used results of GBD 2010 for 1990 and 2010 for the UK and 18 other comparator nations (the original 15 members of the European Union, Australia, Canada, Norway, and the USA; henceforth EU15+). We present analyses of trends and relative performance for mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 259 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to the UK. We assessed the UK's rank for age-standardised YLLs and DALYs for their leading causes compared with EU15+ in 1990 and 2010. We estimated 95% uncertainty intervals (UIs) for all measures. FINDINGS: For both mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4·2 years (95% UI 4·2-4·3) from 1990 to 2010. However, the UK performed significantly worse than the EU15+ for age-standardised death rates, age-standardised YLL rates, and life expectancy in 1990, and its relative position had worsened by 2010. Although in most age groups, there have been reductions in age-specific mortality, for men aged 30-34 years, mortality rates have hardly changed (reduction of 3·7%, 95% UI 2·7-4·9). In terms of premature mortality, worsening ranks are most notable for men and women aged 20-54 years. For all age groups, the contributions of Alzheimer's disease (increase of 137%, 16-277), cirrhosis (65%, ?15 to 107), and drug use disorders (577%, 71-942) to premature mortality rose from 1990 to 2010. In 2010, compared with EU15+, the UK had significantly lower rates of age-standardised YLLs for road injury, diabetes, liver cancer, and chronic kidney disease, but significantly greater rates for ischaemic heart disease, chronic obstructive pulmonary disease, lower respiratory infections, breast cancer, other cardiovascular and circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm. Because YLDs per person by age and sex have not changed substantially from 1990 to 2010 but age-specific mortality has been falling, the importance of chronic disability is rising. The major causes of YLDs in 2010 were mental and behavioural disorders (including substance abuse; 21·5% [95 UI 17·2-26·3] of YLDs), and musculoskeletal disorders (30·5% [25·5-35·7]). The leading risk factor in the UK was tobacco (11·8% [10·5-13·3] of DALYs), followed by increased blood pressure (9·0 % [7·5-10·5]), and high body-mass index (8·6% [7·4-9·8]). Diet and physical inactivity accounted for 14·3% (95% UI 12·8-15·9) of UK DALYs in 2010. INTERPRETATION: The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities. The growing burden of disability, particularly from mental disorders, substance use, musculoskeletal disorders, and falls deserves an integrated and strategic response. FUNDING: Bill & Melinda Gates Foundation.

Do health provider-patient relationships matter? Exploring dentist-patient relationships and oral health-related quality of life in older people.

BACKGROUND: patient experience is now a key parameter in health care. Yet, very little is known about the possible impact of dentist-patient relationships on patient-centred outcomes including older peoples' oral health-related quality of life (OHRQoL). OBJECTIVE: this study assessed the relationship between OHRQoL and dentist-patient relationships related to perceived unmet dental needs; shared decision-making; time spent discussing oral health problems; respect and confidence and trust. PARTICIPANTS: older people aged 65 years and over living in East London, U.K. in 2011. METHODS: a cross-sectional study using stratified random sampling recruited a representative sample of older people (n = 772). PARTICIPANTS completed an oral examination and a structured questionnaire including the Oral Health Impact Profile-14 (OHIP-14) measuring OHRQoL and five dentist-patient relationship questions taken from the U.K. 2009 Adult Dental Health Survey. Multivariate Poisson regressions modelled the association between OHRQoL and dentist-patient factors adjusting for socio-demographic factors, clinical oral indicators, and dental attendance. RESULTS: having a perceived unmet need for dental treatment (PRR = 1.84; 95% CI: 1.32, 2.56) and expressing a lack of trust and confidence in one's dentist (PRR = 1.74; 95% CI: 1.01, 2.98) were significant predictors of poor OHRQoL among older people. CONCLUSIONS: these findings suggest that older people with unmet dental needs and those who expressed a lack of trust and confidence in their dentist were more likely to experience poor OHRQoL reinforcing the importance of the dental patient experience in healthy ageing and well-being.

Cost components of school-based oral health-promoting programs: A systematic review protocol.

INTRODUCTION: Oral health-promoting school programs play a crucial role in achieving universal coverage of oral health care, by addressing oral diseases and promoting the well-being and quality of life of children and adolescents. However, a lack of studies has evaluated the costs associated with implementing these programs, which hinders decision-makers in adopting them on a large scale. This review aims to assess the cost components involved in school-based oral health-promoting programs. METHODS: This review will include studies that have conducted either partial or full economic evaluations, focusing on describing the cost components of oral health-promoting programs implemented in primary schools involving students aged 6 to 14. A systematic search was conducted across multiple databases: MEDLINE, The Cochrane Library, the Virtual Health Library, the NHS Economic Evaluation Database, Web of Science, Scopus, and EMBASE. Additionally, gray literature was searched using the Health Technology Assessment Database. Two independent reviewers will screen the titles and abstracts, followed by a full-text review based on predefined inclusion criteria. Data extraction and critical appraisal evaluation will also be carried out independently by two reviewers. In case of disagreements, the reviewer team will resolve them through discussion. DISCUSSION: The systematic review resulting from this protocol aims to provide evidence regarding the cost components and necessary resources for implementing and maintaining oral health-promoting school programs. This information can assist decision-makers in adopting these programs on a larger scale and effectively addressing oral diseases among children and adolescents. PROTOCOL REGISTRATION: CRD42022363743.

IMPACT OF BARIATRIC SURGERY IN ANXIETY AND ORAL CONDITION OF OBESE INDIVIDUALS: A COHORT PROSPECTIVE STUDY.

BACKGROUND: Obesity and bariatric surgery may be related with mental and oral disorders. AIM: To evaluate the impact of bariatric surgery on anxiety, initial dental caries lesion and gingival bleeding in obese patients. METHODS: Eighty-nine patients were divided in two groups: Control Group (CG) - obese patients and Experimental Group (EG) - patients submitted to bariatric surgery. EG was analyzed before and 12 months after bariatric surgery; for the CG, was respected an interval of 12 months between the evaluations. International Caries Detection and Assessment System, Gingival Bleeding Index and Trace-State Anxiety Inventory were used. Medical profile, anthropometrics data, sociodemographic and behavioral variables were considered. RESULTS: There were no statistically significant differences between groups in evaluation times regarding to initial dental caries lesion and anxiety. However, the number of teeth with initial dental caries lesion (p=0.0033) and gingival bleeding (p<0.0001) increased significantly after bariatric surgery in EG. CONCLUSION: These results reinforce the need for multi-professional team follow-up, including dental care, for both obese and bariatric patients.

Socio-economic position, smoking, and plaque: a pathway to severe chronic periodontitis.

AIM: To report periodontal status and elucidate the relationship among socio-economic position (SEP), plaque accumulation, tobacco smoking, and periodontitis in a representative sample of adult Jewish people, aged 35-44 years, living in Jerusalem. METHODS: This cross-sectional study was conducted using a stratified sample of two hundred and fifty-four 35-44-year-old adults in Jerusalem (limited to the Jewish population). A clinical examination (Community Periodontal Index and Plaque Index) and a self-administered questionnaire were applied. RESULTS: Two hundred and fifty-four adults, mean age 38.6 (SD=3.3) years, participated. The response rate was 88%; intra-examiner κ values were above 0.87. The average number of healthy sextants was 1.18, while the average number of sextants with bleeding, calculus, shallow periodontal pockets, and deep periodontal pockets was 1.3, 2.6, 0.7, and 0.1, respectively. Lower level of education was associated with severe chronic periodontitis (SCP, p=0.012) and also with smoking (p=0.030) and higher level of plaque (p<0.001). Smoking was associated with higher level of plaque (p<0.001), which in turn was associated with SCP (p=0.020). CONCLUSION: This study presented a potential explanatory pathway for the relationship between SEP and SCP. Low level of education was proposed as a distal determinant, leading to tobacco smoking and higher levels of plaque, and finally to SCP.

Ethnic differences in treatment preferences among adults in East London.

Aim To explore ethnic differences in treatment preferences among adults.Methods A sample of 1,764 adults from ten ethnic groups were recruited from the adult population in Outer North East London using stratified multistage random sampling. Treatment preferences for a front tooth, a back tooth and an aching back tooth were collected via questionnaires. Ethnic differences in treatment preferences were assessed in regression models adjusting for demographic characteristics, socioeconomic indicators, dental visiting behaviour and clinical dental status.Results Ethnic differences in treatment preferences were observed, albeit only for back not front teeth. Compared to White British, Black African (odds ratio: 0.85; 95% confidence interval [CI]: 0.74-0.97), Caribbean (0.71; 95% CI: 0.51-0.98) and Other (0.73; 95% CI: 0.61-0.87) were less likely to preserve a back tooth. If the back tooth was aching, Black Others were still less likely (0.82; 95% CI: 0.71-0.93) to opt for restorative than surgical treatment. On the contrary, Bangladeshi were more likely (1.14; 95% CI: 1.06-1.22) to preserve a painful back tooth than White British.Conclusion Differences in treatment preferences were found among ethnic groups, suggesting that cultural background might influence the choices made and the value placed on dental extractions versus restorative treatment.