Unique dietary and oral hygiene behaviors in a cohort with clinically severe obesity: A cross sectional study.

BACKGROUND: An association between increased risk of dental caries with increased levels of clinically severe obesity has been reported. Data linking body mass index (BMI) and dietary behaviors, including at-risk dietary factors and oral hygiene habits, are lacking in a cohort with clinically severe obesity. This study aimed to explore the dietary and oral hygiene behaviors in individuals with clinically severe obesity attending a hospital-based obesity service. METHODS: Adult patients attending a hospital-based obesity service in Greater Western Sydney with clinically severe obesity were invited to participate in a self-administered survey, which collected data on their nutritional and oral hygiene behaviors. Demographic data (age, gender) and BMI were extracted from the participants' medical records. The primary outcome was the relationship between BMI and frequency of toothbrushing. RESULTS: Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire. The median BMI of the cohort was 49.1 kg/m2 (interquartile range [IQR]: 43.2-57.3 kg/m2) and median age 51 (IQR: 39-63) years. BMI was not significantly correlated with individual oral health behaviors (p > .05). Many participants reported dietary risk behaviors, which have the potential to influence their oral health. CONCLUSIONS: While oral health behaviors were not associated with increasing BMI, patients with clinically severe obesity in this study reported unique dietary behaviors and mixed oral hygiene habits that may complicate nutritional and dental management. Awareness of these behaviors among clinicians including dental professionals is required in this cohort.

Australian Dentist's Knowledge and Perceptions of Factors Affecting Radiographic Interpretation.

BACKGROUND: Errors of interpretation of radigraphic images, also known as interpretive errors, are a critical concern as they can have profound implications for clinical decision making. Different types of interpretive errors, including errors of omission and misdiagnosis, have been described in the literature. These errors can lead to unnecessary or harmful treat/or prolonged patient care. Understanding the nature and contributing factors of interpretive errors is important in developing solutions to minimise interpretive errors. By exploring the knowledge and perceptions of dental practitioners, this study aimed to shed light on the current understanding of interpretive errors in dentistry. METHODS: An anonymised online questionnaire was sent to dental practitioners in New South Wales (NSW) between September 2020 and March 2022. A total of 80 valid responses were received and analysed. Descriptive statistics and bivariate analysis were used to analyse the data. RESULTS: The study found that participants commonly reported interpretive errors as occurring 'occasionally', with errors of omission being the most frequently encountered type. Participants identified several factors that most likely contribute to interpretive errors, including reading a poor-quality image, lack of clinical experience and knowledge, and excessive workload. Additionally, general practitioners and specialists held different views regarding factors affecting interpretive errors. CONCLUSION: The survey results indicate that dental practitioners are aware of the common factors associated with interpretive errors. Errors of omission were identified as the most common type of error to occur in clinical practice. The findings suggest that interpretive errors result from a mental overload caused by factors associated with image quality, clinician-related, and image interpretation. Managing and identifying solutions to mitigate these factors are crucial for ensuring accurate and timely radiographic diagnoses. The findings of this study can serve as a foundation for future research and the development of targeted interventions to enhance the accuracy of radiographic interpretations in dentistry.

Water fluoridation in Australia: A systematic review.

Water fluoridation is considered a safe and effective public health strategy to improve oral health. This review aimed to systematically summarize the available evidence of water fluoridation in Australia, focusing on the history, health impacts, cost effectiveness, challenges, and limitations. A systematic search was conducted on the Ovid Medline, Web of Science, Scopus, ProQuest Central, Cinahl, and Informit databases to identify literature on water fluoridation in Australia. A grey literature search and backward snowballing were used to capture additional literature. Primary studies, reviews, letters, and opinion papers were included in the quantitative analysis and summarized based on the year of publication and geographical location. The data were extracted from primary studies and summarized under three subheadings: history, community health impacts and the limitations and challenges. Water fluoridation in Australia was first implemented in 1953 in Tasmania. Most states and territories in Australia embraced water fluoridation by 1977 and currently, 89% of the Australian population has access to fluoridated drinking water. Studies report that water fluoridation has reduced dental caries by 26-44% in children, teenagers, and adults, benefiting everyone regardless of age, income, or access to dental care. It has been recognized as a cost-effective intervention to prevent dental caries, especially in rural and low-income areas. Water fluoridation as a public health measure has faced challenges, including political and public opposition, implementation and maintenance costs, access and equity, communication and education, and ethical concerns. Variations in research activities on water fluoridation across Australian states and territories over the last seven decades can be due to several factors, including the time of implementation, funding, and support. Ongoing monitoring and research to review and update optimal fluoride levels in drinking water in Australia is warranted to ensure sustainable benefits on oral health while preventing any adverse impacts.

Poor dental service utilization in those with clinically severe obesity: A neglected issue with solutions needed.

Data linking body mass index (BMI) and dental service utilization with oral and general health, quality of life, wellbeing, and mental health are lacking. Adult patients with clinically severe obesity attending a hospital-based obesity service in Greater Western Sydney were invited to participate in a cross-sectional survey that collected data on dental utilization and visiting patterns, dental anxiety, and oral health-related quality of life (OHRQoL). General health data were obtained from participants' medical records. Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire, and 74 (91.3%) answered additional screening questions related to their general wellbeing and mental health. Of the participants, 50 (61.7%) reported that their last dental visit was more than 1 year ago, 43 (53.1%) visited only as needed and 22 (27.2%) participants reported favourable dental visiting patterns. Twenty-four (29.6%) participants reported high levels of dental anxiety, and low levels of OHRQoL compared with national data. Screening questions suggested low general wellbeing and poor mental health in this patient cohort. Within this group, BMI was not significantly correlated with any of the variables of dental service utilization, dental anxiety, OHRQoL, wellbeing, or mental health (p > .05). There was a negative correlation between dental anxiety and dental utilization (p < .05). Patients with clinically severe obesity reported poor dental utilization, low OHRQoL, and high levels of dental anxiety. This study highlighted the frequency of medical complications, lack of wellbeing, and poor mental health, which were evident in this cohort and may complicate dental management.

Employability in health professional education: a scoping review.

BACKGROUND: The concept of employability can help educators understand the variability in the career outcome of graduates. Within the health professional education (HPE) literature, various conceptions of employability are used and implied. This review considers how the concept 'employability' is depicted and characterised in HPE literature. METHODS: A scoping review was conducted. The authors searched Medline, Web of Science and Scopus databases for English language literature relevant to employability in HPE. Arksey and O'Malley's review protocol and the criteria defined in the preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews Checklist (PRISMA-ScR) were used with methodological guidance provided by Levac et al. and Peters et al. with the exception of formal stakeholder consultation. RESULTS: The search resulted in 158 articles, of which 34 articles were included in this review. Charting the included articles revealed that within the set of articles, there is much diversity in study design, geographical setting and health profession. Three conceptions of employability were identified: acquiring a professional job, sustaining employment and thriving in the workforce. CONCLUSION: Conceptions of employability in HPE are largely focused on listing skills and capabilities for entry into employment and sustaining a career. To address gaps in research, structural contributions to employability and institutional strategies to promote conditions for thriving in disruption should be explored.

BUCCAL INFILTRATION WITH 4% ARTICAINE MAY BE AN ALTERNATIVE OPTION TO INFERIOR ALVEOLAR NERVE BLOCK WITH 2% LIDOCAINE FOR PULP THERAPY IN PRIMARY MANDIBULAR MOLARS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review. Sunny P Tirupathi, Srinitya Rajasekhar, Mayuri Ganesh, Abhishek Vamshi, David Tyro, Int J Clin Pediatr Dent. 2021;14(3):420-425. SOURCE OF FUNDING: The authors did not state any funding support. TYPE OF STUDY/DESIGN: Systematic review.

Perceptions and attitudes of dental practitioners towards impacts of Covid 19 pandemic on clinical dentistry: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic challenged all healthcare providers including dental practitioners. This cross-sectional study aimed to investigate the dental practitioners' perceptions and attitudes towards the impacts of COVID-19 on their professional practice, career decision and patient care. METHODS: Data was collected from dental practitioners registered in New South Wales (NSW), Australia using an online survey. RESULTS AND CONCLUSION: Responses received from 206 dental practitioners revealed their perceptions and attitudes towards COVID-19 infection risk, clinical guidelines, and measures adopted to deliver patient care. Majority of participants perceived the risk of infection in dentistry was higher compared with other health professionals. Most dental practices have followed guidelines received from professional associations and adopted multiple measures such as providing hand sanitizer, social distancing, and risk screen, to ensure safe delivery of oral health care. Over 80% of dental practitioners raised concerns on patients' accessibility to dental care during the pandemic. Despite tele-dentistry was introduced, almost half of the participants did not recognize tele-dentistry as an effective alternative. Moreover, negative impacts of COVID-19 pandemic on dental practitioner's professional career have been reported, including lower practice safety, reduction in working hours and income. Noteworthy, one quarter of participants even considered changing their practice environment, moving sectors or even leaving their career in dentistry. However, majority of the dental practitioners are willing to stay in their current practice environment and continue their career in dentistry. Our observations demonstrate the systematic disruption to dental practice faced in Australia due to the COVID-19 pandemic. Providing dental practitioners with timely educational training and support is important to minimise negative impacts of the challenges and to optimise dental care.

LIMITED EVIDENCE SUGGESTS THAT END STAGE KIDNEY DISEASE AND HEMODIALYSIS MAY IMPACT SALIVARY FLOW RATE AND COMPOSITION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Rodrigues RP, Vidigal MT, Vieira WA, Nascimento GG, Sabino-Silva R, Blumenberg C, Siqueira MF, Siqueira WL, Paranhos LR. Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis. Journal of Nephrology. 2022 Mar 2:1-29. SOURCE OF FUNDING: The work has been partially funded by CAPES-Finance Code 001. The authors have also acknowledged The Brazilian National Council for Scientific and Technological Development (CNPq) and Minas Gerais State Agency for Research and Development, Brazil (FAPEMIG) for the support. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Retrospective analysis of the outcomes of pulpotomies in traumatised permanent anterior teeth.

BACKGROUND/AIM: Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the pulp. The aim of this study was to determine the pulp outcomes of permanent teeth with complicated crown fractures treated with pulpotomy in a hospital-setting and to identify potential factors which may influence the outcomes. MATERIAL AND METHODS: Data for this retrospective study were extracted from dental records of patients with complicated crown fractures and treated with pulpotomies at a single centre between 1 January 2015 and 30 August 2019. Pulp outcomes were determined, and the associations between the outcome and independent variables were assessed using the Chi-Square test of independence and the Point-Biserial Correlation Test. Predictors of outcome were identified using the binary logistic regression model. RESULTS: The overall success of pulpotomy in managing traumatised permanent teeth was 61%, which was lower than those previously reported. Pulp healing was seen in 54.1% and 73.7% of teeth treated with partial pulpotomies and coronal pulpotomies, respectively. The presence of a radiographically detectable dentine bridge (p < .01) and longer clinical experience of the clinician (p < .04) was significantly associated with successful outcomes. The history of pain and the stage of root development were identified as significant predictors of the outcome. CONCLUSION: Pulpotomy is a viable treatment modality for complicated crown fractures in the paediatric population. However, appropriate case selection and further training may be required to ensure improved pulp healing outcomes. A longer follow-up period should be considered to identify late-stage complications.

HOST-DERIVED SALIVARY BIOMARKERS DEMONSTRATE POTENTIALS FOR THE DIAGNOSIS OF PERIODONTAL DISEASES.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Sukriti KC. Wang XZ, Gallagher JE. Diagnostic sensitivity and specificity of host-derived salivary biomarkers in periodontal disease amongst adults: Systematic review. J Clin Periodontol 2020;47(3):289-308. doi:10.1111/jcpe.13218. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review.

INTRACANAL CRYOTHERAPY MAY REDUCE POSTOPERATIVE ENDODONTIC PAIN.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of Intracanal Cryotherapy in Root Canal Therapy: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Durre Sadaf, Muhammad Zubair Ahmad, Igho J Onakpoya, J Endod. 2020 Dec;46(12):1811-1823.e1. SOURCE OF FUNDING: The authors did not claim any funding support. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Hantavirus infection as a risk factor for chronic kidney disease of unknown aetiology (CKDu) and its prevalence in endemic areas of Sri Lanka since 2010 according to a retrospective serological analysis.

Background. Chronic kidney disease of unknown aetiology (CKDu) is a major public health problem in Sri Lanka, especially among agrarian communities. Although the cause of CKDu is still unknown, hantavirus infection has been proposed as a risk factor.Methods. This study was performed using serological samples collected from two CKDu-endemic areas, Anuradhapura (2010) and Badulla districts (2010 and 2016), and a non-endemic area, Matale (2016) district. The presence of anti-Thailand orthohantavirus IgG antibodies was investigated in serum samples. Hantavirus seroprevalence and demographic data were epidemiologically analysed.Results. Seroprevalence was higher in CKDu patients (40.6-60.0 %) and healthy individuals in CKDu-endemic areas (17.6-25.5 %) than in healthy individuals in non-endemic areas (3.0 %). Statistically significant odds ratios (ORs) for hantavirus infection in CKDu patients were detected in CKDu-endemic areas [ORs: 3.2 and 3.1; 95 % confidence interval (CI): 1.8-5.5 and 1.8-5.2 in Anuradhapura and Badulla districts in 2010; and OR: 4.4, 95 % CI: 2.3-8.5 in 2016 in Badulla district). Furthermore, the OR for hantavirus infection in Badulla district has increased in the last decade from 3.1 (95 % CI: 1.8-5.3) to 4.4 (95 % CI: 2.3-8.5).Conclusion. Hantavirus infection has been prevalent in two distant CKDu-endemic areas since 2010. The observed significant association of hantavirus seropositivity with CKDu indicates a possible role of hantavirus infection in CKDu pathogenesis.

Chlorhexidine and Sodium Hypochlorite Provide Similar Antimicrobial Effect in Root Canal Disinfection.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-Ngoen T, Garami A, Mikó A, Varga G, Lohinai Z. Antimicrobial Efficacy of Chlorhexidine and Sodium Hypochlorite in Root Canal Disinfection: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Endod. 2020 Aug;46(8):1032-1041.e7. doi: 10.1016/j.joen.2020.05.002. Epub 2020 May 12. PMID: 32413440. SOURCE OF FUNDING: The Hungarian Human Resources Development Operational Program, the Higher Education Excellence Program of the Hungarian Ministry of Human Capacities to the Therapy Research Module of Semmelweis University, National Research, Development and Innovation Office, Hungarian Scientific Research Fund and the Economic Development and Innovation Operative Programme Grant. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

The Influence of fluoride on chronic kidney disease of uncertain aetiology (CKDu) in Sri Lanka.

Fluoride is an element that is widely distributed in the environment. The involvement of fluoride in pathogenesis of Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a much-debated topic. This study aimed to investigate the fluoride concentration in drinking water in CKDu affected areas in Sri Lanka and to evaluate the possible effect of renal impairment on serum fluoride levels in CKDu patients. Drinking water (n = 60) from the common water sources from two CKDu prevalent areas and serum samples of CKDu patients (n = 311) and healthy controls (n = 276) were collected. Both environmental and biological samples were analysed for the concentration of fluoride. The fluoride concentration in over 95% of drinking water samples was below the WHO guideline of 1.5 mg/L. Serum fluoride concentrations in majority of the unaffected and early-stage CKDu patients (stages 1 and 2, eGFR >60 ml/min/1.73m2) were below the normal upper concentration of 50 µg/l and significantly higher levels were observed in patients in late stages of CKDu compared to the healthy controls. The available guidelines for drinking water are solely based on healthy populations with normal renal function. But, it is evident that once the kidney function is impaired, patients enter a vicious cycle as fluoride gradually accumulates in the body, further damaging the kidney tissue. Thus, close monitoring of serum fluoride levels in CKDu patients and establishing health-based target guidelines for fluoride in drinking water for the CKDu patients are recommended to impede the progression to end stage renal disease.

Corticosteroids Can Be Effective in Reducing Postoperative Endodontic Pain.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systemic Review and Meta-analysis. Shamszadeh S, Shirvani A, Eghbal MJ, Asgary S. J Endod 2018;44(7):1057-1065. SOURCE OF FUNDING: The authors' own institution, Shahid Beheshti University of Medical Sciences. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Knowledge, Attitudes and Practice Behaviour of Midwives Concerning Periodontal Health of Pregnant Patients.

Maternal gum disease is associated with adverse pregnancy outcomes such as preterm birth and low birthweight. This study aims to evaluate the knowledge, attitudes and practice behaviour of Australian midwives regarding the periodontal health of pregnant women to inform interprofessional antenatal care. This was an observational, cross-sectional study. We circulated an online questionnaire to Australian midwives from August 2018 to February 2019. Key outcome variables were knowledge, attitudes, and practice behaviours related to oral health. Key predictor variables were years of practice, practice location, and dental history. We summarized responses with frequency tables and assigned tallied scores for analysis using non-parametric statistical tests. 100 responses were analysed, including from rural (n = 23) and urban (n = 77) midwives. Eighty percent of midwives agreed that maternal dental care can positively affect pregnancy outcomes. Fluoridated toothpaste use (19.1%) was incorrectly answered to prevent gum disease more often than psychological stress control (7.9%), a correct answer. Rural midwives demonstrated a significantly higher knowledge score (p = 0.001) and significantly more positive practice behaviours towards oral health (p = 0.014) than urban midwives. Australian midwives have positive attitudes towards antenatal oral health but misunderstand gum disease aetiology and prevention. This study highlights areas to improve interprofessional education for optimal oral health and pregnancy outcomes.

A Tale of Two Teaching Methods: Students' Clinical Perspectives on Administering Dental Local Anesthetics.

Various preclinical methodologies have been adopted by dental and oral health programs to develop student competence in administering dental local anesthetics (LA). Student-to-student practice is the most common preclinical training method. However, manikin simulation models have been introduced to avoid possible complications and ethical concerns with student-to-student injections. In 2017, the methodology was changed in the Bachelor of Oral Health program at The University of Sydney School of Dentistry in Australia from student-to-student practice to manikin simulation models. The aim of this study was to compare the students' learning experience, perceived confidence, and anxiety in giving their first injections to patients in these two preclinical training methods. A mixed-methods cohort design was used to compare the 2016 (n = 42) and 2017 (n = 32) oral health students' experiences and perceptions and evaluate students' clinical experience after commencing LA practice on patients. Students completed a questionnaire about their perceived level of confidence and anxiety before and after their first LA to a child and an adult for both infiltration and inferior alveolar nerve b lock (IANB) injections. Focus groups were conducted to further investigate the students' experience. The results showed that the perceived confidence and anxiety of the two cohorts did not differ significantly from each other. Although students found it difficult to transition into clinical practice without having experienced LA themselves, the manikin simulation practice provided a safe learning platform that avoided ethical and legal concerns. These findings support the use of manikin simulation models as an alte rnative method for dental local anesthetic preclinical training.

Storage media and not extraction method has the biggest impact on recovery of bacteria from the oral microbiome.

Next Generation sequencing has greatly progressed the exploration of the oral microbiome's role in dental diseases, however, there has been little focus on the effect of sample storage conditions and their interaction with DNA extraction method. Dental plaque samples collected from 20 healthy participants were pooled and stored in either 75% ethanol or Bead solution for up to 6-months at -80 °C, prior to DNA extraction with either QIAamp (non-bead beating) or PowerSoil (bead-beating) kit, followed by Illumina sequencing of 16S rRNA gene. We found that storage media and not extraction method had the biggest influence on the diversity and abundance of the oral microbiota recovered. Samples stored in Bead solution, independent of the extraction kit, retrieved higher diversity (PowerSoil p = 1.64E-07, QIAamp p = 0.0085) and had dissimilar overall ecologies as indicated by lower level of shared diversity (PowerSoil p = 0.0000237, QIAamp p = 0.0088). Comparatively, samples stored in Bead solution and extracted with PowerSoil recovered a higher abundance of Streptococcus species. These data indicate that Bead solution can preserve the oral microbiome in dental plaque reliably, for periods of up to 6-months at -80 °C, and is compatible, with either a bead-beating or non-bead beating DNA extraction method.

Periodontitis May Be Associated With Chronic Kidney Disease, but Evidence on Causal Association Is Limited.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The directional and nondirectional associations of periodontitis with chronic kidney disease: A systematic review and meta-analysis of observational studies. Zhao D, Khawaja AT, Jin L, Li K-Y, Tonetti M, Pelekos G. J Perio Res 2018; 53(5):682-704. SOURCE OF FUNDING: The authors' own institution, University of Hong Kong. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.