Medical and dental student knowledge about COVID-19 and influenza vaccines impact opinions about vaccine advocacy and future practice.

Introduction: The World Health Organization has identified vaccine hesitancy as a global public health challenge. Healthcare providers are among the most influential and trusted figures for vaccine counseling. This article focuses on COVID-19 and influenza personal immunization behaviors, vaccine knowledge and opinions, and vaccine counseling confidence among future healthcare providers - dental and medical students. Methods: A cross-sectional anonymous online survey was conducted at four dental schools and one allopathic medical school in the United States. Items included personal vaccination status for the COVID-19 and influenza vaccines and vaccine-specific items developed based on past research to assess knowledge, opinions, and behaviors. Results: Two hundred and thirty-two medical and 221 dental students completed the survey. 68 and 55% scored average/above-average knowledge on COVID-19 and influenza vaccine items, respectively. There were significant differences between those with average/above-average and below-average knowledge scores regarding learning about, recommending, and advocating for vaccines and counseling vaccine-hesitant patients for both vaccines (p < 0.0001). Although higher-knowledge students had higher vaccination rates (p < 0.0001), many had insufficient knowledge about vaccines. Discussion: Healthcare providers play a crucial role in vaccine advocacy. The identified knowledge gaps are significant as they impact quality of patient care. And opinions about future vaccination practice such as recommending, providing, and counseling about vaccines. Equipping students with knowledge and communication skills will enable them to be strong vaccine advocates to improve overall public health.

Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations.

BACKGROUND: The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory guidance regarding dental radiography and cone-beam computed tomography. An expert panel presents recommendations on radiation safety, appropriate imaging practices, and reducing radiation exposure. TYPES OF STUDIES REVIEWED: A systematic search run in Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews identified relevant topical systematic reviews, organizational guidelines, and regulatory reviews published in the peer-reviewed literature since 2010. A supplemental search of the gray literature (eg, technical reports, standards, and regulations) identified topical nonindexed publications. Inclusion criteria required relevance to primary oral health care (ie, general or pediatric dentistry). RESULTS: A total of 95 articles, guidance documents, and regulations met the inclusion criteria. Resources were characterized as applicable to all modalities, operator and occupational protection, dose reduction and optimization, and quality assurance and control. PRACTICAL IMPLICATIONS: Understanding factors affecting imaging safety and applying fundamental principles of radiation protection consistent with federal, state, and local requirements are essential for limiting patient ionizing radiation exposure, in conjunction with implementing optimal imaging procedures to support prudent use of dental radiographs and cone-beam computed tomographic imaging. The regulatory guidance and best practice recommendations summarized in this article should be followed by dentists and other oral health care providers.

Dementia exacerbates periodontal bone loss in females.

BACKGROUND: Periodontitis is a chronic inflammatory disease defined by the pathologic loss of the periodontal ligament and alveolar bone in relation to aging. Although clinical cohort studies reported that periodontitis is significantly elevated in males compared to females, emerging evidence indicates that females with dementia are at a greater risk for periodontitis and decreased alveolar bone. OBJECTIVE: This study aimed to evaluate whether dementia is a potential sex-dependent risk factor for periodontal bone loss using an experimental model of periodontitis induced in the triple transgenic (3x-Tg) dementia-like mice and clinical samples collected from senior 65 plus age patients with diagnosed dementia. MATERIALS AND METHODS: We induced periodontitis in dementia-like triple-transgenic (3x-Tg) male and female mice and age-matched wild-type (WT) control mice by ligature placement. Then, alveolar bone loss and osteoclast activity were evaluated using micro-CT and in situ imaging assays. In addition, we performed dental examinations on patients with diagnosed dementia. Finally, dementia-associated Aß42 and p-Tau (T181) and osteoclastogenic receptor activator of nuclear factor kappa-Β ligand (RANKL) in gingival crevicular fluid (GCF) collected from mice and clinical samples were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Alveolar bone loss and in situ osteoclast activity were significantly elevated in periodontal lesions of 3x-Tg females but not males, compared to wild-type control mice. In addition, we also observed that the probing pocket depth (PPD) was also significantly elevated in female patients with dementia. Using ELISA assay, we observed that females had elevated levels of osteoclastogenic RANKL and dementia-associated Aß42 and p-Tau (T181) in the GCF collected from experimental periodontitis lesions and clinical samples. CONCLUSION: Altogether, we demonstrate that females with dementia have an increased risk for periodontal bone loss compared to males.

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association.

BACKGROUND: An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED: The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS: The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS: The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.

Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth. TYPE OF STUDIES REVIEWED: The authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs. RESULTS: Thirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass isomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Owing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.

COVID-19 vaccine acceptance and hesitancy among dental and medical students.

BACKGROUND: Dental students (DS) and medical students (MS) are exposed to COVID-19. It is important to achieve high COVID-19 vaccination coverage rates in both of these groups. The authors developed a survey to assess COVID-19 vaccine hesitancy among MS and DS. METHODS: The authors conducted the study at 3 US dental schools and 1 US medical school using an online survey that assessed previous immunization behavior, attitudes about and perceptions of COVID-19 vaccines, and personal experience with COVID-19. RESULTS: A total of 248 DS and 167 MS completed the survey. Forty-five percent of DS and 23% of MS were hesitant about receiving the COVID-19 vaccine. Results of bivariate analyses found that MS were 2.7 times more likely than DS to receive the vaccine (odds ratio, 2.74; 95% CI, 1.76 to 4.31; P = .0001). Although DS were more likely than MS (P < .05) to have had COVID-19 and to personally know someone who had COVID-19, MS were more likely to agree with mandates and trust information about the vaccines. In multivariable analyses, after controlling for demographic variables, experience with COVID-19, and personal vaccination behaviors, being a MS or DS was no longer predictive of willingness to get the vaccine. CONCLUSIONS: These results highlight the need for profession-specific curricula designed to enhance student knowledge about the vaccines and vaccine counseling skills. PRACTICAL IMPLICATIONS: The American Dental Association supports dentists administering vaccines, including the COVID-19 vaccines. Dentists and DS should be willing to receive the vaccines themselves. Education about the vaccines is needed to improve uptake.

Dental students' attitudes and hesitancy toward COVID-19 vaccine.

BACKGROUND: Dentists are a group of providers who have been identified by CDC at high risk of exposure to COVID-19 through their contact with patients. This would apply to dental students as well. Thus, it is important to achieve high COVID-19 vaccination rates in this group. Further, as healthcare providers, they are entrusted with providing health recommendations and advocating for their patients, community, and profession, including vaccinations. METHODS: Using ualtricsXM an online platform, in 2020, a survey was administered anonymously to dental students at three dental schools to assess the attitudes of dental students to the novel COVID-19 vaccine. Factors and reasons associated with vaccine hesitancy and acceptance toward the COVID-19 vaccine and likelihood of recommending and giving the vaccination to patients were assessed. RESULTS: Nearly, all participants had positive attitudes toward vaccines in general, agreed they would likely be exposed to COVID-19, and personally knew someone who had COVID-19; however, only 56% are willing to take a COVID-19 vaccine as soon as an FDA-approved vaccine was available. Of those unwilling to take the vaccine, 63% reported they would take it if mandated by the health systems/dental school; however, 16.3% of the overall respondents would not take the COVID-19 vaccine even if mandated. Several factors are associated with vaccine acceptance and the likelihood of recommending the vaccination, such as trusting public health experts, concerns about side effects, and agreeing with vaccine mandates. CONCLUSION: Our results highlight the need for an educational curriculum about the safety and effectiveness to promote the uptake of COVID-19 vaccine.

Does the general public have concerns with dental anesthetics?

BACKGROUND: Consumers and patients in the last two decades have increasingly turned to various internet search engines including Google for information. Google Trends records searches done using the Google search engine. Google Trends is free and provides data on search terms and related queries. One recent study found a large public interest in "dental anesthesia". In this paper, we further explore this interest in "dental anesthesia" and assess if any patterns emerge. METHODS: In this study, Google Trends and the search term "dental pain" was used to record the consumer's interest over a five-year period. Additionally, using the search term "Dental anesthesia," a top ten related query list was generated. Queries are grouped into two sections, a "top" category and a "rising" category. We then added additional search term such as: wisdom tooth anesthesia, wisdom tooth general anesthesia, dental anesthetics, local anesthetic, dental numbing, anesthesia dentist, and dental pain. From the related queries generated from each search term, repeated themes were grouped together and ranked according to the total sum of their relative search frequency (RSF) values. RESULTS: Over the five-year time period, Google Trends data show that there was a 1.5% increase in the search term "dental pain". Results of the related queries for dental anesthesia show that there seems to be a large public interest in how long local anesthetics last (Total RSF = 231) - even more so than potential side effects or toxicities (Total RSF = 83). CONCLUSION: Based on these results it is recommended that clinicians clearly advice their patients on how long local anesthetics last to better manage patient expectations.

Is fluoride varnish safe?: Validating the safety of fluoride varnish.

BACKGROUND: Fluoride varnish is widely used in dentistry as a caries preventive measure with recommendations for its use even in infants. In addition, nondental providers are also applying varnish on children's teeth in various settings. However, there are questions from these nondental providers as to the safety of fluoride varnish. METHODS: To evaluate and describe the adverse events (AEs) related to fluoride varnish, the US Food and Drug Administration's Manufacturer and User Facility Device Experience database was used. AEs reported for the dental product code for "varnish, cavity," "varnish," and "fluoride" were evaluated. The identified AEs were then reviewed and categorized using appropriate key words for the various signs and symptoms, outcomes, and treatment. RESULTS: Over the 10-year period, only 65 AEs were reported for fluoride varnish products. Swelling (33.8%); burning, itching, or soreness (23.1%); and rash (16.9%) were the most common signs and symptoms reported. The most common site reported was the lips (27.7%). The most common outcome was that the patient was taken to the hospital (18.5%) or emergency department (15.4%). No deaths were reported. The patients were treated primarily using diphenhydramine (Benadryl, Johnson & Johnson Consumer) (26.1%), followed by an epinephrine autoinjector (EpiPen, Mylan) and other forms of epinephrine (15.4%), and prednisolone (9.2%). In 16.9% of the cases with AEs there was a history of allergies. The rate of AEs is estimated to be between 0.099 and 0.105 per million for fluoride varnish. A concern is the likelihood of underreporting AEs in the Manufacturer and User Facility Device Experience database. CONCLUSIONS: Given the widespread use of fluoride varnish in the United States, the number of AEs reported to the US Food and Drug Administration were few. Thus fluoride varnish can be considered a safe dental product. PRACTICAL IMPLICATIONS: Provides data on the safety of fluoride varnish that can be used by the dental profession to allay concerns by nondental providers and patients on this important caries preventive measure.

Age-dependent effect between MARCO and TLR4 on PMMA particle phagocytosis by macrophages.

Progressive generation of total joint implant-derived wear particles is one of the major risk factors in development of peri-prosthetic osteolysis especially in the aging society. It is commonly accepted that macrophages predominantly drive the inflammatory response to wear debris particles. Among various surface receptors that activate the macrophages to phagocytize particles, it is believed that the Toll-like receptor 4 (TLR4) and the scavenger macrophage receptor with collagenous structure (MARCO) play key roles in recognition of wear debris particles. However, a strong body of evidence indicates an age-dependent diminished function of human TLRs. Thus, we hypothesized that the MARCO receptor may be more engaged than TLRs in the phagocytosis of wear debris particles which in turn up-regulate production of pro-inflammatory cytokines from aged macrophages. We demonstrated that peritoneal macrophages isolated from aged mice show elevated expression of MARCO receptor compared to that from young mice. In contrast the expression of TLR4 was significantly decreased on the surface of aged macrophages. Furthermore, using anti-MARCO and anti-TLR4 neutralizing mAbs, we demonstrated the age-dependent pathogenic role of MARCO, but not TLR4, receptor in promoting poly-methyl methacrylate (PMMA) bone cement particles phagocytosis by macrophages leading to the release of pro-inflammatory cytokines migration inhibitory factor and tumour necrosis factor in vitro. These data also suggest that the approach to neutralize MARCO may lead to the development of therapeutic regimen for the prevention of particle-induced osteolysis in aged patients.

Improving Diversity of Dental Students Through the Boston University Master's of Oral Health Sciences Postbaccalaureate Program.

Boston University Goldman School of Dental Medicine (GSDM), in collaboration with Boston University School of Medicine, introduced the Oral Health Sciences (OHS) pipeline program in 2005 to enhance the academic preparedness of students from underrepresented minority (URM) groups for dental school admission. The aim of this study was to evaluate the OHS program's success in preparing URM students for dental school, as measured by acceptance to dental school and performance in the first and second years. Data on 2005-15 program enrollees were collected from admissions records, the registrar, and the Office of Institutional Research on students' race/ethnicity, undergraduate and OHS grade point average (GPA), and Dental Admission Test (DAT) scores. Acceptance to dental school and performance at GSDM for non-URM OHS graduates, URM OHS graduates, and non-OHS dental students were compared. A total of 55 URM students completed the OHS program during this period, with 49 successfully matriculating to a dental school in the U.S. and 33 attending GSDM. Average OHS GPA was higher for those URM students accepted to dental school than for those who did not gain admission (3.36±0.30 vs. 2.94±0.19). Evaluation of the academic performance of URM OHS students in the first year (p=0.13) and second year (p=0.88) at GSDM showed that these students performed as well as the non-OHS and non-URM OHS students. These results demonstrate that the OHS master's program serves as a successful credential-enhancing program for dental school applicants, while also serving as a pipeline to increase the number of qualified applicants from URM groups.

A survey of dental public health specialists on current dental public health competencies.

In preparation to update the Dental Public Health specialty competencies, the Expert Panel determined that a needs assessment be conducted. A nine item open and close ended survey developed by the Expert Panel was used to collect data on the Diplomates current work environment, the utility of the current set of Dental Public Health competencies, and to identify any gaps in the current competencies. In 2015, the survey was administered to all active Diplomates of the American Board of Dental Public Health. One hundred and nine Diplomates responded. Diplomates overwhelmingly reported that each of the ten current competencies were still relevant for Dental Public Health specialists in the 21st Century, but needed to be updated to be more contemporary. Domains suggested to achieve this were interprofessional care, cultural competency, health literacy, and evidence-based dentistry.

New competencies for the 21st century dental public health specialist.

The American Board of Dental Public Health (ABDPH) currently recognizes 10 core competencies, which identify the skills, knowledge and understanding expected of all dental public health specialists. The last update to the competencies was 1998. The American Board of Dental Public Health, along with the American Association of Public Health Dentistry and its many partners, initiated a process to revise the competencies. This report presents the process and the new competencies for the dental public health specialist of the 21st century. Each of the developed competencies is supported by a "statement of intent". These competencies take effect immediately. The new competencies will be used in testing candidates for specialty status beginning with the 2018 ABDPH examination.

Who Needs More than 1,000 ppm? The Epidemiology of High-Risk Populations.

Good oral health is necessary to overall health and well-being. Most oral diseases, and in particular dental caries, are entirely preventable. However, in 2010, 3.9 billion people were globally affected by oral conditions, and the global prevalence of untreated caries in permanent teeth was 35.3%. The contemporary thinking is that dental caries starts as an infectious disease which then becomes a chronic disease. Public health measures and other caries-preventive approaches have resulted in dramatic reductions in dental caries across populations. However, in a given population, not all individuals have experienced these successes uniformly. High-risk populations, defined as those with a 'higher-than-expected risk', exist for most diseases and conditions including caries. The global scientific literature suggests that these are the following: (1) minorities, (2) individuals with low-socioeconomic status and (3) other vulnerable populations such as the very young and elderly who continue to battle with oral health disparities by experiencing higher oral disease levels including dental caries. As the science and resources exist to prevent caries, it is essential to identify and target these high-risk individuals and populations.

Five-year Sealant Retention and Efficacy in a Multi-operated School-based Oral Health Programme in Kuwait.

PURPOSE: To evaluate sealant retention in a multi-operator school-based oral health programme and sealant efficacy in preventing caries in a high caries-risk population. MATERIALS AND METHODS: Sealant retention and caries status in previously placed sealants on permanent first molars were evaluated in 503 children ages 6 to 8 years at 20 primary schools. A total of 2538 sealants were applied on 876 first permanent molars and evaluated for retention and efficacy in preventing caries from 2002 to 2007. These sealants were placed on occlusal and buccal or palatal surfaces using a standard protocol after isolation with rubber-dam or cotton roll. Caries was scored in teeth in which the sealants were partially or completely lost. RESULT: 1752 sealants (69%) were examined at the end of the fifth year, with 58.3% of the sealants completely retained, 7.4% partially lost, 19% completely lost, 6.2% resealed and 9.1% restored. Only 3.1% of the previously sealed teeth were carious and 87.8% of previously sealed teeth were caries free. In multivariate analysis, occlusal surfaces were 2.0 times more likely to retain a sealant than were the buccal and palatal pits (p < 0.0001). No differences in sealant retention vs caries by arch, or teeth isolated using rubber-dam vs cotton roll were seen. CONCLUSION: The present study shows the effectiveness of sealants in caries prevention in a multi-operator school sealant programme, and provides evidence supporting their use in such programmes for high-caries populations.

Developing a flexible core Dental Public Health curriculum for predoctoral dental and dental hygiene schools.

OBJECTIVE: The curriculum for graduating dental and dental hygiene students must prepare them to contribute to the improvement or maintenance of health for individual patient's and the public's health. The objective is to describe the background for and the process used to develop a core Dental Public Health Curriculum for such students. METHODS: The process used was to solicit and review existing dental public health curriculum in dental and dental hygiene schools; review curriculum for other health professionals; identify the themes needed to frame the curriculum; select usable materials and identify gaps in existing curricular materials; and develop appropriate curriculum materials that would embody the competencies developed for undergraduate dental and dental hygiene education. RESULTS: Twenty-three topics were identified as embodying the eight competencies. Based on these topics, six courses, Principles of Dental Public Health, Evidence-Based Dentistry, Ethics and Dental Public Health, Dental Public Health Policy and Advocacy, Oral Health Promotion and Disease Prevention, and Oral Health Literacy and Dental Public Health, were prepared. Each course includes syllabus, PowerPoint presentations, student assignments and activities, instructor guide, and classroom discussion points. Depending on the hours available in the existing curriculum at the dental or hygiene school, lecture presentations and take home assignments/discussions may be used independently or in combination with presentations from other courses. In addition, individual discussions and activities may be used to integrate dental public health materials into other courses. CONCLUSION: A flexible curriculum is available at the AAPHD website to enable the incorporation of DPH topics into the curriculum.

Developing core dental public health competencies for predoctoral dental and dental hygiene students.

Dental professionals are an "underutilized" workforce, when it comes to advocating for prevention and wellness in populations. The goal of this HRSA-funded project is to develop dental public health (DPH) competencies and curriculum for US predoctoral dental and dental hygiene programs. These competencies and accompanying curriculum are designed to better prepare the oral health workforce to meet the needs of the entire population, including the chronically underserved, those challenged by poor health literacy, or communities encountering barriers to accessing oral health care. By increasing the DPH competency of all graduating dental providers, in population-based approaches to preventing oral diseases rather than the existing exclusive focus on treatment, the number of providers who can respond to a population or the public's unmet needs and challenges, both in private practices and publicly supported clinics, will increase. This paper describes the competency development process and the eight competencies that were identified.

Caries prevalence, oral hygiene, and oral health habits of Kuwaiti infants and toddlers.

OBJECTIVE: The purpose of this study was to describe the oral health, oral hygiene, and oral health habits of Kuwaiti infants and toddlers. SUBJECTS AND METHODS: This cross-sectional study of a convenience sample included 336 infants and toddlers (156 females and 180 males). The teeth of the infants and toddlers were examined using a mirror and a light source. Oral hygiene was recorded, and then all teeth were cleaned with gauze and examined for caries. Parents were interviewed regarding their children's feeding habits, brushing or tooth cleaning, and night feeding. The evaluation criteria for caries were sound teeth, noncavitated lesions, cavitated lesions, filled teeth, and missing teeth. RESULTS: The mean age was 11.1 ± 2.4 months (range 2-23). Of the 336 subjects, 247 (73%) had good oral hygiene, 64 (19%) had parents who brushed or cleaned their infants' and toddlers' teeth; 288 (86%) were bottle-fed, and 290 (86%) were also night fed. The mean number of teeth upon examination was 4.6 ± 2.7 (range 2-8). Three percent of the infants and toddlers had caries. Cavitated lesions were present in 6 patients (1.8%), while 4 (1.2%) had noncavitated lesions. The mean d1d2t (caries teeth: noncavitated lesions and cavitated lesions) was 0.03 ± 0.3, and the mean d1d2s (carious surfaces) was 0.07 ± 0.5. CONCLUSION: The caries prevalence and severity was low in infants and toddlers. However, poor oral health practices and habits as well as unhealthy feeding practices that could affect the future caries prevalence were noted.

Children's utilization of the U.S. military dental insurance.

OBJECTIVES: The objectives of this study were to determine the dental utilization of children enrolled in a military dental insurance program and to assess if utilization differs by socioeconomic status. METHODS: Claims data for children enrolled in the Department of Defense TRICARE Dental Program for the period of February 1, 2010 through January 31, 2011 were used to identify children who had a dental visit during that benefit year. RESULTS: Of the 376,681 continuously enrolled children, 266,862 (71%) had at least one dental visit during the benefit year. 82.7% of children of officers had a dental visit, as compared to 66.4% of children from enlisted families. There was a difference in dental utilization based on the military rank of the sponsors (χ(2) = 8,939.39, df = 1, p < 0.0001). Children of officers were 2.5 times (95% confidence intervals = 2.44-2.61), and children of warrant officers were 1.6 times (95% confidence intervals = 1.51-1.74) more likely to have a dental visit than children from enlisted families. The results also show utilization trends within the enlisted and officer categories with higher utilization among more senior personnel. CONCLUSIONS: Socioeconomic status does play a role in dental care-seeking behavior of military families. Even when families voluntarily enroll in a program and there are no cost shares for services such as preventive services, there may be other barriers to accessing care that need to be addressed so that all groups can maximize their oral health.

Effectiveness of fissure sealant retention and caries prevention with and without primer and bond.

OBJECTIVE: This study evaluated the effectiveness of sealant retention and caries prevention with and without primer and bond below the fissure sealant among Kuwaiti schoolchildren. SUBJECTS AND METHODS: This clinical trial used fissure sealant that was applied to four sound first permanent molars on 78 children. All the teeth were cleaned with pumice and rubber cups, isolated with rubber dams, and etched for 20 s. In a split-mouth study design, for the test teeth (n = 156), primer and bond (3M Scotchbond Multi-Purpose Plus System primer and bond) were applied below the sealant, and for the control teeth (n = 156), only sealant (Delton Plus) was applied. The number of tooth surfaces included was 480. Due to loss to follow-up, only 60 children were evaluated at 5 years for sealant retention and caries. The evaluation criteria were: completely retained sealant, complete or partial sealant retention, and caries. RESULTS: In teeth sealed with primer and bond, 47 (19.6%) tooth surfaces had completely retained sealant, 60 (9.2%) teeth had partially retained sealant, while in 51 (21.3%) caries was prevented and 120 (50%) tooth surfaces were carious or filled. In teeth sealed without primer and bond, 25% (60 tooth surfaces) had completely retained sealant, 6% (14 teeth surfaces) had partially retained sealant, 26% (54 teeth surfaces) showed caries prevention, and 49.6% (119 tooth surfaces) were carious or filled. There was no difference between teeth sealed with primer and bond (120 teeth) and teeth sealed without primer and bond (120 teeth) in completely retained sealant (p = 0.15), complete or partial sealant retention (p = 0.6), caries prevented (p = 0.37), and caries (p = 0.93). CONCLUSION: Caries prevention was not enhanced in teeth sealed with primer and bond sealant compared with those sealed with sealant alone.