Salivary Cortisol and Anxiety in Canadian Dentists over 1 Year of COVID-19.

The dental profession has endured unprecedented disruption amid COVID-19. Novel stressors have included a high risk of occupational exposure to COVID-19, financial losses, and stricter infection prevention and control requirements. The present study investigated the longitudinal impact of COVID-19 on the stress and anxiety levels of a cohort of Canadian dentists (N = 222) between September 2020 and October 2021. Salivary cortisol was selected as a biomarker of mental stress, and 10 sets of monthly saliva samples (2,131 in total) were self-collected, sent to our laboratory in prepaid courier envelopes, and analyzed by enzyme-linked immunosorbent assay. To assess COVID-19 anxiety, 9 monthly online questionnaires were administered, comprising a general COVID-19 anxiety instrument and 3 items regarding the impact of dentistry-related factors. Bayesian log-normal mixed effect models were fitted to estimate the longitudinal trajectory of salivary cortisol levels and their association with the disease burden of COVID-19 in Canada. After accounting for age, sex, vaccination status, and the diurnal rhythm of cortisol secretion, a modest positive association was found between dentists' salivary cortisol levels and the count of COVID-19 cases in Canada (96% posterior probability). Similarly, the self-reported impact of dentistry-related factors, such as fear of getting COVID-19 from a patient or coworker, was greatest during peaks of COVID-19 waves in Canada; however, general COVID-19 anxiety decreased consistently throughout the study period. Interestingly, at all collection points, the majority of participants were not concerned about personal protective equipment. Overall, participants reported relatively low rates of psychological distress symptoms in relation to COVID-19, a result that should be reassuring for the dental community. Our findings strongly suggest a link between self-reported and biochemical measurements of stress and anxiety in Canadian dentists during the COVID-19 pandemic.

Multimedia information intervention and its benefits in partners of the head and neck cancer patients.

We aimed to investigate the levels of anxiety, depression, satisfaction with information provision and cancer-related knowledge in partners of head and neck cancer (HNC) patients receiving a Multimode Comprehensive Tailored Information Package (MCTIP). A non-randomised, controlled trial was conducted with partners of HNC patients recruited at two academic hospitals in Montreal. The Test participants received the MCTIP, while the Control participants received information in an ad hoc manner. All participants were evaluated using the Hospital Anxiety and Depression Scale (HADS), Satisfaction with Cancer Information Profile and a cancer knowledge questionnaire at baseline, and 3 and 6 months later. Data were analysed using descriptive statistics, t-test and chi-square test, and mixed model analysis to test the impact of the intervention. A total of 31 partners of HNC patients participated in this study and completed all the evaluations. The partners in the Test group experienced significantly lower levels of anxiety (P = 0.001) and depression (P = 0.003) symptoms and were more satisfied (P = 0.002) with cancer information provided than partners in the Control group. Providing tailored information seems to have positive outcomes regarding anxiety, depression, and satisfaction in partners of HNC patients. Larger randomised studies are warranted to validate these effects.

Reproducibility and diagnostic outcomes of two visual-tactile criteria used by dentists to assess caries lesion activity: a cross-over study.

UNLABELLED: The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment. TRIAL REGISTRATION: ISRCTN65592532.

Do multimedia based information services increase knowledge and satisfaction in head and neck cancer patients?

OBJECTIVES: To investigate the impact of a Multimode Comprehensive Tailored Information Package (MCTIP) on Head and Neck (H&N) cancer patients' knowledge and satisfaction. METHODS: A non-randomized controlled trial was conducted at two participating hospitals. One hospital delivered the MCTIP and the second hospital provided normal care. The study was approved by local ethical committees. Patients with Stage III and IV cancer in the H&N region were recruited between their diagnosis and treatment. All participants were evaluated at baseline, 3 and 6months later using the Satisfaction with Cancer Information Profile (SCIP) and a Cancer Knowledge questionnaire. Data were analyzed using descriptive statistics, T tests, chi square tests and finally linear mixed model analyses to test the potential impact of the intervention. RESULTS: A total of 103 participants participated in this study and complete data at all time points were collected for 96. The Test group reported higher levels of Cancer Knowledge and Satisfaction at all time points (p<0.001 with all comparisons) compared to the Control group. CONCLUSION: Our study demonstrated an association between receiving the multimedia based tailored information and higher levels of satisfaction and cancer knowledge compared to those who receive information in ad hoc manner. IMPLICATIONS: Exploring patients' informational needs is necessary before planning information services to them.

An investigation of the effect of tailored information on symptoms of anxiety and depression in Head and Neck cancer patients.

OBJECTIVE: To investigate if tailored information provision decreases symptoms of anxiety and depression in late stage Head and Neck (H&N) cancer patients. METHODS: This non-randomized, controlled trial was conducted with stage III or IV H&N cancer patients. Subjects were recruited at two academic health centers in Montreal. At the test center, subjects received the Multimode Comprehensive Tailored Information Package (MCTIP), while at the control center, they received normal information provision. Participants were evaluated using the Hospital Anxiety and Depression Scale (HADS) at baseline and 3 and 6 month later. Data were analyzed using descriptive statistics then T tests and chi square tests to compare group differences and finally mixed model analysis to test differences in outcome variables. RESULTS: A total of 103 subjects were recruited and of them 96 (47 tests and 49 controls) participants completed baseline, 3 and 6 month evaluations. The test group experienced lower levels of anxiety (p = 0.001) and depression (p = 0.089) than the control group. CONCLUSION: The subjects receiving tailored information had lower levels of anxiety than their counterparts. In addition, depression showed a reduction in the expected direction in the test group. PRACTICE IMPLICATIONS: Our results need to be further confirmed using a randomized approach in different samples but they suggest benefits for stage III and IV H&N cancer patients receiving tailored, multi-modal information concerning their cancer.

Socio-economic inequalities and oral health in Canada and the United States.

This paper describes and compares the magnitude of socio-economic inequalities in oral health among adults in Canada and the US over the past 35 years. We analyzed data from nationally representative examination surveys in Canada and the US: Nutrition Canada National Survey (1970-1972, N = 11,546), Canadian Health Measures Survey (2007-2009, N = 3,508), The First National Health and Nutrition Examination Survey (1971-1974, N = 13,131), and National Health and Nutrition Examination Survey (2007-2008, N = 5,707). Oral health outcomes examined were prevalence of edentulism, proportion of individuals having at least 1 untreated decayed tooth, and proportion of individuals having at least 1 filled tooth. Sociodemographic indicators included in our analysis were place of birth, education, and income. Data were age-adjusted, and survey weights were used to account for the complex survey design in making population inferences. Our findings demonstrate that oral health outcomes have improved for adults in both countries. In the 1970s, Canada had a higher prevalence of edentulism and dental decay and lower prevalence of filled teeth. This was also combined with a more pronounced social inequality gradient among place of birth, education, and income groups. Over time, both countries demonstrated a decline in absolute socio-economic inequalities in oral health.

Tooth erosion with low severity does not impact child oral health-related quality of life.

BACKGROUND: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, no study has addressed the impact of this condition on child oral health-related quality of life (COHRQoL). This study assessed the impact of tooth erosion on COHRQoL. METHODS: This study followed a cross-sectional design, with a multistage random sample of 944 11- to 14-year-old children representative of Santa Maria, a southern city in Brazil. They were examined for recording the prevalence and severity of tooth erosion by 2 examiners. Children completed the Brazilian version of Child Perceptions Questionnaire (CPQ(11-14)) and data about socioeconomic variables of the target population were collected by means of a structured questionnaire. The Poisson regression model using robust variance was performed to assess the association between the predictor variables and the outcomes. RESULTS: Prevalence of tooth erosion (7.2%) and severity were low. Poisson regression models showed a distinct gradient in mean CPQ(11-14) scores by socioeconomic indicators. Children with tooth erosion with low levels of severity did not report higher means in the total scores or domains of CPQ(11-14). CONCLUSION: The presence of tooth erosion of low severity did not have a significant negative impact on the children's perception of oral health or on their daily performance.

Better oral health related quality of life: type of prosthesis or psychological robustness?

UNLABELLED: Sense of coherence (SOC) is an individual-based coping characteristic and believed to influence a person's ability to adapt to life stressors, such as edentulism and using complete denture. Thus, SOC may mediate the effect of prosthetic treatment on quality of life. OBJECTIVES: 1. To simultaneously test the effect of type of treatment and sense of coherence on oral health related quality of life (OHRQoL) in edentate elders and to identify any interaction. 2. To report the level of sense of coherence among a sample of edentate elders. METHODS: Data were collected and analysed cross-sectionally at a 1-year follow-up from 173 edentulous elders who had randomly received mandibular-implant overdentures or conventional dentures, both opposed by new conventional maxillary dentures. The dependent outcome variable, oral health related quality of life, was measured using the Oral Health Impact Profile (OHIP-20). Independent variables included SOC and prosthesis type, as well as socio-demographic variables. SOC was evaluated using the 13-item likert scale of The Orientation to Life questionnaire. RESULTS: The group mean SOC score was 70.28 (SD=9.6). Married or coupled people had significantly higher SOC scores than those who were separated, single or divorced (p=0.04). General linear model analyses demonstrated that there was a statistically significant main effect for type of prosthesis, F(1.169)=0.71, p=0.008, with no interaction with SOC. CONCLUSION: The results of this study suggest that, in edentulous elders, SOC does not mediate the effect of the type of prosthetic treatment on oral health related quality of life.

Preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10.

AIM: The aim of the study was to perform a preliminary validation of the Brazilian version of the Child Perceptions Questionnaire 8-10 (CPQ 8-10). METHODS: The sample used to test the measurement equivalence was made up of 59 children from 8 to 10 years of age at the Federal University of Minas Gerais, Brazil. The CPQ 8-10 was administered, and clinical exams were performed by a single examiner, calibrated for the diagnosis of dental caries (Kappa= 0.98) and malocclusion (weighted Kappa and intraclass correlation coefficient = 0.66-1.00). The children were divided into three groups according to their clinical condition (22 with cavitated carious lesions; 20 with malocclusion; 17 with both oral conditions). STATISTICS: The internal consistency of the instrument was assessed by Cronbach's alpha Coefficient. The Intraclass correlation coefficient (ICC) was used for the test-retest reliability (40 children). Discriminant validity was determined using the Kruskal-Wallis test. RESULTS: An assessment of the psychometric properties revealed the instrument to be reliable (Cronbach's alpha=0.92 for the total scale and 0.63-0.85 for the subscales), exhibiting excellent stability (ICC=0.96 for the total scale and 0.79-0.95 for the subscales). Construct validity was demonstrated through the significant correlations between the global indicators and subscales. There were statistically significant differences between the clinical groups regarding the total scale, thereby demonstrating discriminant validity (p=0.03). CONCLUSIONS: The preliminary validation of the Brazilian version of the CPQ 8-10 showed valid and reliable for use on Brazilian children.

Family Impact Scale (FIS): psychometric properties of the Brazilian Portuguese language version.

AIM: Evaluate the psychometric properties of the Brazilian version of the Family Impact Scale (FIS). METHODS: Following translation and cross-cultural adaptation, the FIS was tested on 123 parents-caregivers of children between 11 and 14 years of age with dental caries and malocclusions. The parents were recruited from the Paediatric Dental and Orthodontic clinics where their children were receiving dental care. Psychometric properties were assessed through internal consistency, test-retest reliability, construct validity and discriminant validity. RESULTS: The mean FIS score was 6.97 (SD 7.81) for the dental caries group and 7.25 (SD 7.70) for the malocclusion group. The FIS score was unable to discriminate different family impact caused by children's oral health conditions. Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.79. Test-retest reliability revealed good reproducibility (ICC 0.83). Construct validity was good, demonstrating highly significant correlations between parent's perceptions regarding the overall wellbeing indicator for their children and the total FIS and subscales. Financial burden demonstrated no significant correlation with global indicators. CONCLUSIONS: Overall psychometric results for the Brazilian version of the FIS confirm it as a reliable, valid questionnaire for assessing the family impact caused by children's oral conditions.

Relationship between mothers' sense of coherence and oral health status of preschool children.

OBJECTIVE: The aim of the present study was to investigate the relationship between mothers' sense of coherence (SOC) and oral health status in a representative sample of 5-year-old preschool children. METHODS: A cross-sectional study was conducted in Belo Horizonte (Brazil) on a sample of 546 mothers and their 5-year-old children, randomly selected from preschools. Data were collected through questionnaires (mothers), the short version of Antonovsky's SOC scale (SOC-13) and clinical dental examinations (children). Simple and multiple logistic regression analyses were performed on the data. The following 8 outcome variables were selected: dental caries, filled and missing teeth, dental pulp exposure due to caries, dental root fragment, visible plaque, gingivitis and supragingival calculus. The examination was carried out by 2 trained, calibrated examiners. RESULTS: Mothers with a lower SOC were more likely to have children with decayed teeth (OR = 1.59, 95% CI = 1.01-2.29), dental pulp exposure (OR = 1.99, 95% CI = 1.06-3.77) or filled teeth (OR = 1.85, 95% CI = 1.12-3.06) regardless of the child's social class and gender. CONCLUSION: The data indicate that mothers' SOC is an important psychosocial determinant of the oral health status among preschool children.

Testing responsiveness to change for the early childhood oral health impact scale (ECOHIS).

OBJECTIVES: The Early Childhood Oral Health Impact Scale (ECOHIS) is a recently developed oral health-related quality of life instrument designed to assess the impact of oral health problems in 0-5-year-old children. It has previously been validated as discriminative instrument. The goal of this study was to investigate the responsiveness to change of the ECOHIS. METHODS: Data were collected from a convenience sample of 101 parents of 0-5-year-old children attending a hospital dental clinic for dental treatment. The ECOHIS was completed by parents prior to dental treatment and 2 weeks later. Subjects were also asked a global transition judgement concerning change between the second and first completion of the ECOHIS instrument. Responsiveness to change of the ECOHIS was analysed through: (i) a comparison of ECOHIS change scores with a global transition judgment by study subjects; (ii) an assessment of the statistical significance of within-group change in scores over time for groups reporting improvement, stability and deterioration; (iii) an estimation of the ECOHIS's sensitivity; and (iv) an investigation the effect size of the ECOHIS. RESULTS: Of the 101 subjects recruited, 94 had full datasets. Their data were used for the analyses reported in this paper. Pre- and post-treatment distributions of ECOHIS scores were strongly distributed towards no oral health impacts. Among the 94 subjects, 51.1% reported improvement, 42.6% reported no change and 6.4% reported deterioration following treatment, using the global transition judgement. The mean ECOHIS change scores for these three groups were -0/9, +0.7 and +6.5 respectively, although none of the within-group changes were statistically significant. The effect size for those reporting improvement was small (0.15) but for those reporting deterioration was moderate-to-large (0.69). Sensitivity ranged from 0.61-0.79 depending on the size of the cut-off point, with a change of 3 points demonstrating the best sensitivity to false positive ratio (0.79 versus 0.41 respectively). CONCLUSION: In this sample with low levels of problems, the ECOHIS has demonstrated some limited ability to respond to change. Further work in a larger sample with higher levels of problems is needed to investigate the instrument's ability to respond to change when it has occurred.

Life-course epidemiology: concepts and theoretical models and its relevance to chronic oral conditions.

Etiological models that predominantly emphasize current adult life styles, such as smoking, diet and lack of exercise have recently been seriously challenged by a growing body of evidence that disturbed early growth and development, childhood infection, poor nutrition, and social and psychosocial disadvantage across the life-course affect chronic disease risk, including chronic oral disease. This relatively new area of research is called life-course epidemiology. The life-course framework for investigating the aetiology and natural history of chronic disease proposes that advantages and disadvantages are accumulated throughout life generating differentials in health along the life-course, but most importantly later in life. Furthermore, its dynamic framework brings together the effects of intrinsic factors (individual resources) with extrinsic factors (environmental factors). The aim of this paper is to give an overview of this new epidemiological approach and to discuss how the life-course framework has been applied to chronic oral conditions.

Chewing indicators between adults with Down syndrome and controls.

Down syndrome induces a neuromotor deficiency that affects the orofacial musculature, and thus could be implicated in the feeding difficulties affecting people with this disease. This study aimed to investigate the differences in chewing indicators between a group of 11 adults with Down syndrome and a group of 12 healthy subjects without Down syndrome. Chewing ability was evaluated by means of video recordings taken during a standardized meal that included 10 natural foods. The variables collected were masticatory time, number of masticatory cycles, chewing frequency, number of open masticatory cycles, and number of food refusals. There were several differences in both directions for masticatory time and number of masticatory cycles between the two groups. In addition, with the exception of purée, the group with Down syndrome had significantly lower mean chewing frequency than the reference group, and was unable to eat all the foods presented.

Clinical evaluation of mastication: validation of video versus electromyography.

BACKGROUNDS AND AIMS: The ability to evaluate masticatory function in people with neurological disabilities is important as this function is often compromised in these groups. However, current standard techniques are often impossible in such groups due to cognitive difficulties. This study is a validation of several variables read from standardised video recordings of mastication as indicators of masticatory function. METHODS: Fifteen healthy, fully dentate male subjects were recorded using EMG and by video simultaneously. An evaluation was undertaken of the video parameters (i) to compare their validity against the electromyographic parameters, (ii) to test intra-rater and inter-rater reliability and (iii) to test the ability to discriminate between four model foods differing in hardness. RESULTS: Masticatory time and the number of masticatory cycles counted on video were found to be valid and reliable indicators. In addition, the number of active chewing cycles performed with an open mouth and identification of the chewing side, were found to have reasonable validity and reliability. The former may allow discrimination between food types. CONCLUSION: As an alternative to the complex evaluation of masticatory function, observation of certain parameters from video recording could be an alternative for use in uncooperative patients.

Video evaluation for mastication validation in persons with Down's syndrome.

This article reports the second stage of a validation process. It investigates the discriminatory ability of three video indicators of mastication for a group of people with Down's syndrome, representing a target group with neurological disabilities. The variables were generated through video recordings of 11 adults with Down's syndrome and 12 healthy subjects eating four natural foods varying in hardness. The collected variables were masticatory time, number of masticatory cycles, and number of open masticatory cycles. The analytical approach attempts to test four hypotheses exploring the variations of the video indicators according to food hardness for both groups. It was demonstrated that masticatory time and the number of masticatory cycles have very strong, positive correlations and the number of open masticatory cycles has a fair, positive correlation with the food hardness rankings for both groups. Video evaluation of the test variables using real foods in people with Down's syndrome was found to be a valid means of evaluating aspects of their masticatory function.

Results of a feasibility study for a psycho-educational intervention in head and neck cancer.

BACKGROUND: With survival rates for people with head and neck (H&N) cancers static during the past 30 years and the enormous burden of psychosocial impacts they suffer well documented, the testing of psychosocial interventions in this group is a priority. OBJECTIVE: To test the feasibility of providing a psycho-educational intervention for people with H&N cancer. METHODOLOGY: A prospective non-randomised design was used. Subjects were patients with H&N cancer. They were offered the Nucare coping strategies program in one of three formats: small group and one-to-one formats with therapists; and a home format, with material for home use, without a therapist. Outcomes measures (quality of life (QOL) and anxiety and depression) were collected at baseline and following the intervention. Analyses were performed using non-parametric statistics. RESULTS: Of 128 people invited to participate, 66 agreed, 59 completed the intervention and 50 had outcomes data. Following the intervention, there were significant improvements in physical and social functioning and global QOL, and reduced fatigue, sleep disturbance and depressive symptoms. CONCLUSIONS: These data suggest that the intervention is desired by the target group, feasible to deliver after cancer therapy and may have some beneficial effects, although an appropriately designed study is required to confirm this.

Teaching head and neck cancer patients coping strategies: results of a feasibility study.

To test the feasibility of providing a psycho-educational intervention for people with head and neck (H&N) cancer. A prospective non-randomized design was used. Subjects were patients with H&N cancer. They were offered the Nucare coping strategies program in one of three formats: small group and one-to-one formats with therapists; and a home format, with material for home use, without a therapist. Outcomes measures (quality of life (QOL) and anxiety and depression) were collected at baseline and following the intervention. Analyses were performed using non-parametric statistics. Of 128 people invited to participate, 66 agreed, 59 completed the intervention and 50 had outcomes data. Following the intervention, there were significant improvements in physical and social functioning and global QOL, and reduced fatigue, sleep disturbance and depressive symptoms. These data suggest that the intervention may have some beneficial effects, although an appropriately designed study is required to confirm this.

Alcohol consumption is associated with improved health-related quality of life in head and neck cancer patients.

The study aim was to investigate the relationship between alcohol consumption and health-related quality of life (HRQL) in post-therapeutic head and neck cancer patients. A cross-sectional study design was used with a sample of 191 subjects. Data were collected through interview and chart review. Alcohol consumption was evaluated through the dichotomous response to the question "During the past month have you drunk alcohol on one or more occasions?" HRQL was evaluated through the EORTC QLQ-C30 and H&N35 instruments. Data were also collected concerning sociodemographic and clinical variables. Multivariate regression was used to evaluate the hypothesized association. Of 28 domains comprising the EORTC QLQ-C30 and H&N35 instruments, eight were significantly associated with alcohol consumption, while 19 of the 20 remaining domains showed a tendency towards an association. Alcohol drinking was associated with significantly better physical and role functioning, and better global HRQL, plus less fatigue, pain, problems swallowing, dry mouth and feelings of illness. This suggests that, while the study findings are limited by its design and the sample bias, despite alcohol's role as an aetiological factor, it may be reasonable to drink a little as one recovers from head and neck cancer.