Risk Factors Associated with Children's Behavior in Dental Clinics: A Cross-Sectional Study.

One of the most crucial tasks of pediatric dentists is to control children's negative behaviors. This study aimed to assess dental behavior and the associated risk factors among children aged 4-12. This cross-sectional study recruited healthy, unaffected children aged 4 to 12 years. Parents were interviewed regarding the sociodemographic details and characteristics of their children's dental visits. Two collaborative dentists examined the children for dental caries (DMFT/DMFT) and behavioral status (Frankl's behavior rating scale). This study included 439 children: 27.3% exhibited uncooperative behavior, and the mean DMFT/dmft was 8.46 ± 3.530. Uncooperative behavior significantly increased when the dental visit was scheduled as an emergency treatment (p = 0.134; Adjusted Odds Ratio (AOR): 1.530) and when there was an elevated DMFT/DMFT ratio (p < 0.001; AOR: 1.308). This study revealed a significant association between children's uncooperative behavior and their first dental visit, emphasizing the need for tailored strategies to address behavioral challenges when scheduling pediatric dental care. The proactive measures included controlling caries and avoiding emergencies.

COVID-19 vaccine and non-syndromic orofacial clefts in five arab countries. A case-control study.

OBJECTIVES: Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries. MATERIALS AND METHODS: This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting. RESULTS: The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006). CONCLUSION: This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly. CLINICAL RELEVANCE: The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study's results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.

Assessment of knowledge, attitude, and practice of faculty and postgraduates toward Bisphenol A (BPA) exposure in dental care.

Bisphenol A (BPA) is commonly used in resin-based dental materials and is categorised as an endocrine-disrupting compound. This study aimed to evaluate the knowledge, attitudes, and practice toward the use of BPA among faculty members and postgraduate students. In this descriptive study, a validated self-administered questionnaire was used, and 204 dentists were included, with a response rate of 56.2%. The findings revealed that faculty members had significantly better knowledge (p=0.024) and practice (p=0.036) and more positive attitudes (p=0.024) toward BPA exposure. Regression analysis showed a significantly positive effect of attending a workshop/lecture or reading an article about BPA on the participants' total mean knowledge (p<0.001) and practice scores (p<0.001). Furthermore, faculty members showed a significantly more positive attitude (p<0.001) toward BPA exposure. These results emphasise the importance of increased awareness and education concerning BPA exposure to ensure optimal dental care.

Oral Health-Related Quality of Life Following Root Canal Treatment of First Permanent Molars Among Children. A Cross-Sectional Study.

Aim: This study aimed to assess the Oral Health-Related Quality of Life (OHRQoL) of pediatric patients (9-18 years old) who underwent root canal treatment (RCT) on first permanent molars (FPMs). Methods: A cross-sectional study was conducted at three healthcare centers in Jeddah, Saudi Arabia. Participants (n = 482) completed the validated OHIP5-Ar questionnaire to assess OHRQoL. Responses were classified as "optimal" (no problems) or "less than optimal" (any reported problems). Logistic regression analyzed the relationship between OHRQoL and sociodemographic factors. Results: There were 66.8% children reported optimal OHRQoL after RCT. Logistic regression showed no significant association between optimal OHRQoL and gender, family income, or location of treated tooth. However, although not statistically significant. Treating only one FPM with RCT (compared to multiple teeth) and lower family income (compared to higher income) were more likely to have decreased or increased odds of optimal OHRQoL (AOR = 0.684 or 1.424; respectively). Conclusion: RCT on FPMs can be a successful treatment option for pediatric patients, offering optimal oral health-related quality of life.

Maternal Exposure to Stress During Covid-19 and Non-Syndromic Orofacial Clefts: A Cohort Retrospective Study.

OBJECTIVE: The coronavirus (COVID-19) pandemic presents an opportunity to study stress's effect on the development of non-syndromic orofacial clefts (NSOFCs). This study was aimed at assessing maternal stress exposure during the pregestational to first trimester pregnancy periods and the development of NSOFCs during a year of the COVID-19 pandemic. DESIGN: Cohort study of infants with NSOFCs and controls matched based on recruitment site and age. SETTING: Government hospitals in Saudi Arabia between November 2020 and November 2021. MAIN OUTCOME MEASURES: Data collection included NSOFC clinical examination and maternal stress exposure assessment using the Modified Life Events Questionnaire, the Fear of COVID-19 Scale, and a focus on the lack of pregnancy planning and a threatened miscarriage. RESULTS: Of the 557 infants recruited, 191 had NSOFCs. Logistic regression analysis with adjusted odds ratios (AORs) that removed the effects of confounders showed that any of the seven stressful life events (AOR:3.78, P < .001) and the family histories of relatives with NSOFCs (AOR:9.73, P < .001) increased the AOR for NSOFC development. In contrast, maternal folic acid (AOR:0.56, P.010), threatened miscarriage (AOR:0.17, P = .001), fear of COVID-19 (AOR:0.83, P = .038), and suspected COVID-19 infection (AOR:0.43, P = .008) decreased the AOR for NSOFC development. CONCLUSION: Along with an established risk associated with family history of birth defects, stressful life events may be a risk factor for NSOFC development. Beyond folic acid's known benefit, it may be that higher maternal health concerns contribute to increased protective health behaviors during pregnancy. Ongoing research is needed to specify the maternal risk factors for NSOFC.

Incidence of non-syndromic orofacial cleft during the COVID-19 pandemic in Saudi Arabia.

OBJECTIVES: This is the first national study to investigate the incidence of non-syndromic oro-facial clefts (NSOFC) and Pierre-Robin-Sequence in Saudi Arabia over the Covid-19 pandemic period. METHODS: All maternity hospitals (30-hospitals) in the major regions and cities of Saudi from November 2020-to-2021 were included in the study. Patients were evaluated for cleft phenotype using the LASHAL-classification system. The incidence of NSOFC in Saudi Arabia was calculated by comparing the number of NSOFCs cases born out of all live births during the study period at the included hospitals. Clinical examination was performed and information was gathered using a validated data collection form. RESULTS: In one year, 140,380 live-infants were born at the selected hospitals. Of these, 177 were diagnosed with NSOFC giving an incidence of 1.26/1,000 live-births in Saudi Arabia and the highest incidence in Medina city (2.46/1000 live-births). The incidence of cleft lip-and-palate (0.67/1000 live-births) was higher than that of cleft-palate (0.37/1000 live-births) and cleft-lip (0.22/1000 live-births). Pierre-Robin Sequence incidence was (0.04/1000 live-births). There were 21(12.1) or 23(13.2%) of NSOFC's mothers exposed or vaccinated with Covid-19, respectively. CONCLUSION: The national incidence of NSOFC in Saudi Arabia was 1.26/1000 live births with variation between phenotypes and regions in the country. In addition, to reporting Covid-19 infection prevalence and vaccine exposure among NSOFC's mothers, this study represents the first of its type to evaluate NSOFC prevalence in Saudi Arabia on a national level.

Preference for Comprehensive Dental Treatment under General Anesthesia among Parents with Previous Experience: A Cross-Sectional Study.

This study aims to assess whether parents of children who previously received comprehensive dental treatment under general anesthesia (GA) would prefer comprehensive dental treatment under GA over regular dental care if any of their other children required comprehensive dental treatment. In this cross-sectional study, parents of children who met the inclusion criteria were interviewed by a trained pediatric resident about parental-related factors as well as their satisfaction with their previous GA experience. Also, the factors related to the previously treated child were obtained from dental records. Statistical analysis was carried out, and the p value was set to 0.05. A total number of 306 parents were included. Although most parents, 293 (95.8%), showed satisfaction with the previous GA, 170 (58%) of the satisfied parents preferred regular care. Parents of children who were previously treated under GA for medical-related reasons (p = 0.018), fathers working in a governmental sector (p = 0.021), and families with low-average monthly income (p = 0.017) significantly preferred regular care. In conclusion, most parents were satisfied with the previous GA experience. Family income, fathers' occupation, and medical-related factors can influence parental preference for comprehensive dental treatment under general anesthesia if any of their other children require comprehensive dental treatment.

A literature review of clinical efficiency, patient satisfaction, and future preference of Isolite and DryShield dental isolation systems among pediatric patients.

This review aims to summarize and analyze previous studies that evaluated the clinical efficiency, patient satisfaction, and future preference of Isolite System Isolation (ISI) and DryShield System Isolation (DSI) and compare them to other forms of isolation during dental treatment in children. Both authors independently searched engines using the keywords "Isolite", "Vacuum", "DryShield" and their combinations in March 2022. The inclusion criteria included peer-reviewed articles written in English and clinical trials that assessed the clinical efficiency, patient satisfaction, and future preference of ISI or DSI during dental treatment on healthy unaffected children and compared it to other isolation systems such as rubber dam and cotton roll. A total of five articles were included, and data were extracted by both authors independently and compiled into one single table.Five clinical trials were identified. The use of both ISI and DSI systems is associated with more noise, requires less chair time, is more comfortable, and is preferred by more children than rubber dam or cotton ball isolation.The review reports promising results in clinical efficiency, patient satisfaction, and future preference for both Isolite and DryShield isolation systems. Both systems require less chair time and were preferred by pediatric patients for future dental treatment when compared to both rubber dam and cotton roll isolation systems. Less fluid leaking and gagging reflex were reported when compared to cotton roll isolation. When compared to rubber dam isolation, they were associated with less discomfort.

Effect of ergonomics awareness in controlling work-related musculoskeletal-pain among dental students: A cross-sectional study.

BACKGROUND: Dentistry is a profession that demands a high level of physical work and excessive repetitive movements in strained positions, both of which are risk factors for developing musculoskeletal pain (MS-P). OBJECTIVE: This study aims to assess the awareness of ergonomics and physical activities in controlling MS-P among dental students. METHODS: A cross-sectional study conducted at a university dental hospital in Saudi Arabia, through a validated self-administered questionnaire, distributed to undergraduates and postgraduate's dental students. RESULTS: Out of 402 students responded to the questionnaire, 337(83.8%) reported suffering from MS-P with 67.7% of participants did not take any measures to alleviate their symptoms and the majority reported limited physical activity. Females reported significantly higher MS-P than males. Lower back (56.5%), neck (56.2%) and shoulder (50%) were the most frequently reported MS-P. Unexpectedly, undergraduate reporting significantly more pain than interns and postgraduate students (P = 0.009). The dental students' awareness of ergonomics and MSDs were insufficient. CONCLUSION: Physical activity, student's awareness of MSD and ergonomics were the major factors for controlling MS-Ps. Therefore, this study highlights the importance of enhancing students' knowledge of the importance of controlling work-related MS-P, especially during their university educational hours.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Prenatal maternal stress and the severity of autism spectrum disorder: A cross-sectional study.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder linked to several genetic and environmental factors including antenatal stress. Hence, we aimed to examine whether a mother's stress during pregnancy is associated with the severity of autism spectrum disorder in children. The study was conducted with 459 mothers of children with autism (aged 2-14 years) who were attending rehabilitation and educational centers in the two major cities of Makkah and Jeddah in Saudi Arabia. Environmental factors, consanguinity, and ASD family history were assessed using a validated questionnaire. The Prenatal Life Events Scale questionnaire was used to assess whether the mothers were exposed to stress during pregnancy. Two models of ordinal regression analysis were conducted including gender, child age maternal age, parental age, maternal education, parental education, income nicotine exposure, mother taking medication during pregnancy, family history of ASD, gestation, consanguinity, exposure of prenatal life events (in model 1), and severity of prenatal life events (in model 2). Family history of ASD showed a statistically significant association with the severity of ASD in both regression models (p = .015, odds ratio [OR]: 4.261 in Model 1, and p = .014, OR: 4.901 in model 2). In model 2, the moderate severity prenatal life events showed higher statistically significant adjusted odds ratio for ASD severity compared to no stress (p = .031; OR: 3.82). Within the limitations of this study, prenatal stressors showed some potential contribution to ASD severity. Family history of ASD was the only factor that showed a persistent association with ASD severity. A study that assesses the effect of COVID-19 stress on ASD prevalence and severity is recommended.

Individual, familial and country-level factors associated with oral hygiene practices in children: an international survey.

BACKGROUND: Maintaining good oral hygiene is key to preventing dental caries and periodontal disease. Children and adolescents with good oral hygiene behaviours are likely to grow into adults with the same behaviours. This study assessed the frequency of using various oral hygiene methods among children and adolescents from different countries and individual, familial and country-level factors associated with the use of these methods. METHODS: A multi-country online survey collected data from caregivers of children in 2020-21 about children's use of oral hygiene methods including toothbrush, fluoridated toothpaste, mouthwash, dental floss and miswak using self-administered, close-ended questions. Adjusted multilevel logistic regression models were used to assess the relationship between each of the five oral hygiene methods (dependent variables) and the independent factors: sex, age, and history of dental visits (individual factors), mother's education and area of residence (familial factors) as well as country income and region (country-level factors). RESULTS: A total of 4766 parents/caregivers were included from 20 countries (77.4% Eastern Mediterranean-region and 41.6% lower middle income countries). The most frequent oral hygiene methods were using toothbrush and toothpaste (90% and 60.3%). The use of oral hygiene methods differed by age, sex and history of dental visits as well as mother's education and area of residence (P < 0.05). In addition, children from low income countries had significantly lower odds of using mouthwashes and dental floss than those from high income countries (AOR = 0.55, 95% CI 0.31, 0.98 and AOR = 0.34, 95% CI 0.12, 0.97) whereas children from the European region had higher odds of using mouthwash (AOR = 2.82, 95% CI 1.27, 6.26) and those from the region of the Americas had higher odds of using dental floss (AOR = 3.84, 95% CI 1.28, 11.52) than those from the Eastern Mediterranean region. CONCLUSIONS: The use of various oral hygiene methods is associated with individual, familial and country-level factors. Oral health promotion programs should be developed taking into account these influences.

Risk Factors Associated with Children Receiving Treatment at Emergency Dental Clinics: A Case-Control Study.

(1) Background: The process of managing children at the emergency dental clinic (ER-C) is a difficult challenge. This matched case-control study assessed risk factors associated with children visiting the ER-C compared to visits at the regular dental clinic (RD-C). (2) Methods: The participants included 421 children aged three to 12 years who were recruited at the ER-C (cases) and RD-C (controls) at King Abdulaziz University Dental Hospital, with each group matched for gender and age. A data-collection form was developed and validated in both Arabic and English, containing the following four sections: DMFT/dmft index, Frankl's behaviour rating scale, Dental Neglect Scale, and Dental Care Barriers questionnaire. (3) Results: The ER-C (vs RD-C) group showed significantly more uncooperative behaviour (p = 0.002), a higher total mean dental neglect score (p = 0.003), and a higher dental barrier score (p < 0.001). Binary regression analysis showed that those making their first visit (AOR: 2.65, p < 0.001) and with higher dental barriers (AOR: 1.121, p < 0.001) were statistically significantly more associated with ER-C visitation. (4) Conclusion: These findings suggest that children who visit the ER-C are more prone to dental care barriers, uncooperative behaviour, and dental neglect, thus highlighting the importance of encouraging and planning their attendance to ensure optimal dental care.

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults.

BACKGROUND: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions' association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. METHODOLOGY: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents' educational level). Multilevel binary logistic regression was used for analysis. RESULTS: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). CONCLUSION: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA.

Oral Health Needs and Barriers among Children in Saudi Arabia.

(1) Background: Understanding oral health needs and barriers is important to overcome the oral disease burden, especially after the COVID-19 pandemic. The aim of this study was to assess oral health needs and barriers among Saudi children after the COVID-19 pandemic wave started. (2) Methods: Parents of healthy children aged 3-11 years from five regions of Saudi Arabia were surveyed using an electronically administered validated questionnaire from Febuary-2021 to July-2021. Oral lesions/manifestations during the last 12 months reported by parents included tooth discoloration, ulcers, abscess, swelling of the gingiva, halitosis, gingival bleeding, dry mouth, pain while eating, difficulty in speaking or eating, burning sensation, and white spots. Barriers were assessed according to the WHO Oral Health Questionnaire. (3) Results: Children experiencing toothaches were reported by 1098 (72.4%) respondents. When reported, oral manifestations and lesions were associated with a higher inability to visit a dentist (p < 0.001). Barriers to dental care were more frequent among parents with lower education (p < 0.001; adjusted-odds ratio (AOR), 1.815) and a greater number of children (p < 0.001; AOR, 1.197). (4) Conclusion: Parents reported a high frequency of unmet oral health needs. Education could play an important role in improving oral health care in children and as a predictor of public health concerns.

Outcomes of root canal treatment of first permanent molars among children in Jeddah, Saudi Arabia: A retrospective cohort study.

Objectives: The first permanent molar (FPM) is considered the tooth most susceptible to caries, as it is the first permanent tooth to erupt in the oral cavity, making it susceptible to environmental conditions that may appear as caries, hypoplasia, or hypomineralization. Several treatment options are available for managing deep caries, including root canal treatment (RCT). However, there is a lack of data on the success and failure rates of RCT in FPM among children. This study aimed to determine the success and failure rates of RCT in FPM among children and related factors. Methods: This retrospective cohort study was conducted at three major centers in Jeddah, Saudi Arabia. Children aged 9-18 years who underwent an RCT between 2010 and 2019 were included. Clinical and radiographic examinations were also performed. Results: Based on the loose criteria, most of the evaluated teeth (79.6%) were successfully treated. The treatment failed in only 20.4% of participants. Older patients and teeth with acceptable restoration quality had an increased success rate compared to younger patients and teeth with unacceptable restoration quality. A shorter time lapse between treatment and assessment resulted in a lower success rate compared to a longer time lapse. Based on strict criteria, 72.9% of the patients were successfully treated. The use of a microscope and teeth with acceptable restoration quality resulted in an increased success rate compared to teeth treated without the microscope and with unacceptable restoration quality. Conclusions: The success rate of this procedure was high. Several factors, including older age, acceptable restoration quality, and the use of a microscope, increase the probability of success.

Differences in risk indicators associated with electronic cigarette use and tobacco smoking among adolescents and young people in Nigeria.

INTRODUCTION: The study determined the proportion of adolescents and young persons (AYP) in Nigeria who use e-cigarettes and smoke tobacco; and identified factors associated with the use of e-cigarettes and tobacco smoking. METHODS: AYP aged 11-23 years were recruited to participate in an online survey. The independent variables were respondents' health, HIV and COVID-19 status and their level of anxiety. The dependent variables were tobacco smoking and use of e-cigarettes. Binary logistic regression was used to determine the associations between the dependent and independent variables after adjusting for confounders (age, sex, educational level and vulnerability status). RESULTS: There were 2206 respondents of which 568 (19.8%) used e-cigarettes and 787 (27.4%) smoked tobacco. Individual (18-23 years, having a health condition, high anxiety and being vulnerable) and familial (having father, mother, siblings or friends who used e-cigarettes) factors were associated with both the use of e-cigarettes and tobacco smoking. Tobacco smoking was a significant risk indicator for e-cigarettes use and vice versa. COVID-19 infection (adjusted OR, AOR: 3.602) and living with HIV (AOR: 1.898) were associated with higher odds of using e-cigarettes. Males (AOR: 1.577), 15-17 years (AOR: 6.621) and moderate anxiety (AOR: 2.500) were associated with higher odds of tobacco smoking. AYP with health conditions had higher odds of using e-cigarettes (AOR: 1.514) while AYP with moderate anxiety had lower odds of using e-cigarettes (AOR: 0.627). CONCLUSION: The proportion of AYP in Nigeria who used e-cigarettes and smoked tobacco is high. Public health interventions that target the common risk factors for e-cigarettes use and tobacco smoking among AYP in Nigeria are urgently needed.

Differences in Oral Lesions Associated with Tobacco Smoking, E-Cigarette Use and COVID-19 Infection among Adolescents and Young People in Nigeria.

COVID-19 infection is associated with oral lesions which may be exacerbated by tobacco smoking or e-cigarette use. This study assessed the oral lesions associated with the use of e-cigarettes, tobacco smoking, and COVID-19 among adolescents and young people in Nigeria. A national survey recruited 11-23-year-old participants from the 36 States of Nigeria and the Federal Capital Territory, Abuja. Data were collected using Survey Monkey®. Binary logistic regression analysis was conducted. Statistical significance was set at p-value less than 0.05. There were 2870 participants, of which 386 (13.4%) were tobacco smokers, 167 (5.8%) e-cigarette users, and 401 (14.0%) were both e-cigarette and tobacco users; and 344 (12.0%) had ever tested positive to COVID-19. Adolescents and young people who smoked tobacco had more than twice the odds of reporting gingival inflammation, oral ulcers, dry mouth, and changes in taste than those who did not smoke. Those who used e-cigarettes had 1.5 times higher odds of reporting oral lesions. Respondents who had COVID-19 infection had higher odds of reporting gingival inflammation and lower odds of reporting dry mouth than those who did not have COVID-19 infection. These findings were significant, and may help clinicians to screen for tobacco use and COVID-19 among adolescents and young people in Nigeria.

Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey.

(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.

Cigarettes' use and capabilities-opportunities-motivation-for-behavior model: a multi-country survey of adolescents and young adults.

The use of cigarettes among adolescents and young adults (AYA) is an important issue. This study assessed the association between regular and electronic-cigarettes use among AYA and factors of the Capability-Motivation-Opportunity-for-Behavior-change (COM-B) model. A multi-country survey was conducted between August-2020 and January-2021, Data was collected using the Global-Youth-Tobacco-Survey and Generalized-Anxiety-Disorder-7-item-scale. Multi-level logistic-regression-models were used. Use of regular and electronic-cigarettes were dependent variables. The explanatory variables were capability-factors (COVID-19 status, general anxiety), motivation-factors (attitude score) and opportunity-factors (country-level affordability scores, tobacco promotion-bans, and smoke free-zones) controlling for age and sex. Responses of 6,989-participants from 25-countries were used. Those who reported that they were infected with COVID-19 had significantly higher odds of electronic-cigarettes use (AOR = 1.81, P = 0.02). Normal or mild levels of general anxiety and negative attitudes toward smoking were associated with significantly lower odds of using regular-cigarettes (AOR = 0.34, 0.52, and 0.75, P < 0.001) and electronic-cigarettes (AOR = 0.28, 0.45, and 0.78, P < 0.001). Higher affordability-score was associated with lower odds of using electronic-cigarettes (AOR = 0.90, P = 0.004). Country-level-smoking-control policies and regulations need to focus on reducing cigarette affordability. Capability, motivation and opportunity factors of the COM-B model were associated with using regular or electronic cigarettes.