The influence of motion artefacts on magnetic resonance imaging of the clavicles for age estimation.

PURPOSE: To determine how motion affects stage allocation to the clavicle's sternal end on MRI. MATERIALS AND METHODS: Eighteen volunteers (9 females, 9 males) between 14 and 30 years old were prospectively scanned with 3-T MRI. One resting-state scan was followed by five intentional motion scans. Additionally, a control group of 72 resting-state scans were selected from previous research. Firstly, six observers allocated developmental stages to the clavicles independently. Secondly, they re-assessed the images, allocating developmental statuses (immature, mature). Finally, the resting-state scans of the 18 volunteers were assessed in consensus to decide on the "correct" stage/status. Results were compared between groups (control, prospective resting state, prospective motion), and between staging techniques (stages/statuses). RESULTS: Inter-observer agreement was low (Krippendorff α 0.23-0.67). The proportion of correctly allocated stages (64%) was lower than correctly allocated statuses (83%). Overall, intentional motion resulted in fewer assessable images and less images of sufficient evidential value. The proportion of correctly allocated stages did not differ between resting-state (64%) and motion scans (65%), while correctly allocated statuses were more prevalent in resting-state scans (83% versus 77%). Remarkably, motion scans did not render a systematically higher or lower stage/status, compared to the consensus. CONCLUSION: Intentional motion impedes clavicle MRI for age estimation. Still, in case of obvious disturbances, the forensic expert will consider the MRI unsuitable as evidence. Thus, the development of the clavicle as such and the staging technique seem to play a more important role in allocating a faulty stage for age estimation.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium.

OBJECTIVES: To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders. MATERIALS AND METHODS: Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018. RESULTS: Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively. CONCLUSIONS: Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders. CLINICAL RELEVANCE: The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.

Magnetic resonance imaging of third molars in forensic age estimation: comparison of the Ghent and Graz protocols focusing on apical closure.

PURPOSE: To compare the Ghent and Graz magnetic resonance imaging (MRI) protocols for third molars, focusing on the assessment of apical closure. To study the influence of (1) voxel size and (2) head fixation using a bite bar. To compare both protocols with a ground truth of apical development. MATERIALS AND METHODS: In 11 healthy volunteers, 3T MRI was conducted, including four Ghent sequences and two Graz sequences, with and without bite bar. After removal, 39 third molars were scanned with 7T µMRI and µCT to establish the ground truth of apical development. Three observers in consensus evaluated assessability and allocated developmental stages. RESULTS: The Ghent T2 FSE sequence (0.33 × 0.33 × 2 mm3) was more assessable than the Graz T1 3D FSE sequence (0.59 × 0.59 × 1 mm3). Comparing assessability in both sequences with bite bar rendered P = 0.02, whereas comparing those without bite bar rendered P < 0.001. Within the same sequence, the bite bar increased assessability, with P = 0.03 for the Ghent T2 FSE and P = 0.07 for the Graz T1 3D FSE. Considering µCT as ground truth for staging, allocated stages on MRI were most frequently equal or higher. Among in vivo protocols, the allocated stages did not differ significantly. CONCLUSION: Imaging modality-specific and MRI sequence-specific reference data are needed in age estimation. A higher in-plane resolution and a bite bar increase assessability of apical closure, whereas they do not affect stage allocation of assessable apices.

Perceptions on Oral Care Needs, Barriers, and Practices Among Managers and Staff in Long-Term Care Settings for Older People in Flanders, Belgium: A Cross-sectional Survey.

Background and Objectives: This study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders. Research Design and Methods: This is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others. Results: A total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents' oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15). Discussion and Implications: The results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities.

Multi-factorial age estimation: A Bayesian approach combining dental and skeletal magnetic resonance imaging.

PURPOSE: To study age estimation performance of combined magnetic resonance imaging (MRI) data of all four third molars, the left wrist and both clavicles in a reference population of females and males. To study the value of adding anthropometric and sexual maturation data. MATERIALS AND METHODS: Three Tesla MRI of the three anatomical sites was prospectively conducted from March 2012 to May 2017 in 14- to 26-year-old healthy Caucasian volunteers (160 females, 138 males). Development was assessed by allocating stages, anthropometric measurements were taken, and self-reported sexual maturation data were collected. All data was incorporated in a continuation-ratio model to estimate age, applying Bayes' rule to calculate point and interval predictions. Two performance aspects were studied: (1) accuracy and uncertainty of the point prediction, and (2) diagnostic ability to discern minors from adults (≥18 years). RESULTS: Combining information from different anatomical sites decreased the mean absolute error (MAE) compared to incorporating only one site (P<0.0001). By contrast, adding anthropometric and sexual maturation data did not further improve MAE (P=0.11). In females, combining all three anatomical sites rendered a MAE equal to 1.41 years, a mean width of the 95% prediction intervals of 5.91 years, 93% correctly classified adults and 91% correctly classified minors. In males, the corresponding results were 1.36 years, 5.49 years, 94%, and 90%, respectively. CONCLUSION: All aspects of age estimation improve when multi-factorial MRI data of the three anatomical sites are incorporated. Anthropometric and sexual maturation data do not seem to add relevant information.

Integrating community service learning in undergraduate dental education: A controlled trial in a residential facility for people with intellectual disabilities.

AIMS: The present report describes an oral health promotion project in a residential facility for people with intellectual disabilities as a strategy to implement community service learning in undergraduate dental education. METHODS AND RESULTS: Two undergraduate students developed a project aimed to improve the oral health in residents with intellectual disabilities by educating caregivers. The impact was investigated by a pretest-posttest design, evaluating residents' plaque and gingival indexes and caregivers' knowledge, behavior, attitude, and self-efficacy. Findings demonstrated that within a semester, it was possible for students to obtain a limited but positive impact on the local community. DISCUSSION AND CONCLUSION: Based on the experiences at Ghent University, the following guidelines were suggested to implement service learning in a dental curriculum that renders both a positive impact on student learning and the local community : (1) integrate community service learning in multiple years in the curriculum; (2) use a stepwise approach from theory to exercises to extramural experiences; (3) create a partnership with a local organization; (4) organize long-term projects and annual follow-up to increase the impact; (5) involve supervisors from both the university and the local organization; and (6) establish an evidence based approach to benefit the quality of projects and to facilitate students to develop research competences.