Early childhood caries, climate change and the sustainable development goal 13: a scoping review.

BACKGROUND: Sustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC). METHODS: The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported. RESULTS: The initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation. CONCLUSION: The evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Association between early childhood caries and parental education and the link to the sustainable development goal 4: a scoping review.

BACKGROUND: The goal of the United Nations Sustainable Development Goal (SDG) 4 is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The aim of this scoping review was to map the current evidence on the association between the prevalence of early childhood caries (ECC) and parental education; and to identify possible pathways by which parental education may protect against ECC. METHODS: The two questions that guided this review were: what is the existing evidence on the association between maternal and paternal education and ECC; and what are the pathways by which parental education protects against ECC? The initial search was conducted in January 2023 in PubMed, Web of Science and Scopus. Articles published in English between January 2000 and October 2022 that reported on the association between parental education and ECC were screened, and the extracted data were compiled, summarized, and synthesized. Review papers and non-primary quantitative research papers were excluded from the full-text review. Open coding was applied to develop a conceptual framework. RESULTS: In total, 49 studies were included: 42 cross-sectional, 3 case-control and 4 cohort studies. The majority (91.8%) reported on the associations between ECC and maternal (n = 33), paternal (n = 3), and parental (n = 9) level of education, and 13 (26.7%) reported on the association between parental education and the severity of ECC. Mothers with more than primary school education (n = 3), post-secondary/college/tertiary education (n = 23), and more than 4-12 years of education (n = 12) had children with lower risk for ECC. Two studies reporting on parental education found an association between maternal but not paternal education and ECC. The review suggests that achieving the SDG 4.1 may reduce the risk of ECC. Possible pathways by which maternal education protects from ECC were feeding practices, oral hygiene practices, and the use of dental services. CONCLUSION: The study findings suggests that higher maternal educational level may reduce the risk for the consumption of cariogenic diet, poor oral hygiene practices and poor use of dental services for caries prevention. However, the association between paternal education and ECC was not consistently observed, with significant associations less frequently reported compared to maternal education. Future studies are needed to define the magnitude and modifiers of the impact of maternal education on the risk for ECC.

Molar incisor hypomineralisation: A survey of awareness and management strategies among Libyan dentists in Benghazi.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a developmental enamel defect in the first permanent molars and frequently in the incisors. It poses a unique challenge to the dental practitioner because of its nature, clinical presentations and treatment strategies. AIM: This study assessed the perception of Libyan dentists in Benghazi regarding MIH and its management. DESIGN: Paper-based, self-administered questionnaires were distributed to dentists in Benghazi, Libya. The questionnaires investigated the awareness of MIH, knowledge of MIH aetiology, clinical challenges of MIH treatment and choices of restorative management. Descriptive statistics, chi-squared test and binary logistic regression analysis were performed at a significance level of ≤.05. RESULTS: A total of 389 questionnaires were completed and analysed, giving an overall response rate of 76% (389/511). Most participants were female (85%, 332), with an average of 6.05 (SD = 6.24) years of experience. The majority of participants (67%) recognised MIH in their practice. Statistically significant differences in the awareness of MIH and its prevalence were observed according to the type of practice (p ≤ .001) and experience of dentists (p ≤ .001). Dentists working in public dental practice were less familiar with MIH and less likely to report it. Likewise, novice dentists were less aware of MIH than more experienced colleagues. The most reported aetiological factor in MIH was genetics by 60.2% of respondents, followed by environmental contamination (47.6%) and fluorides (42.9%). Most participants (92.3%) considered MIH a clinical problem. Aesthetics and diagnosis were the most reported challenging aspects (59.4% and 44.2%, respectively). The most commonly selected restorative options were high-fluoride glass ionomer cement (43.2%) and preformed metal crowns (41.6%). CONCLUSION: The majority of participants reported awareness of the existence of MIH condition. Nevertheless, variations in estimating MIH prevalence and its proper treatment, as well as factors influencing its treatment and diagnosis, were recorded. It is recommended that the current dental curriculum is reviewed, and scientific evidence providing dental practitioners with updated information on the diagnosis and clinical management of MIH should be circulated.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China.

Background: Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments. Methods: We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific. Results: Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries. Conclusions: The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

A scoping review linking early childhood caries to violence, neglect, internally displaced, migrant and refugee status.

BACKGROUND: The aim of the scoping review was to identify and synthesize the available literature concerning the relationship between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC) as it relates to the United Nation's Sustainable Development Goal 16 (SDG 16). METHODS: Data regarding the links between the status of refugees, migrants, and internally displaced persons (IDPs) and Early Childhood Caries (ECC), and the associations between ECC and maternal and child exposure to physical and sexual abuse, insecurity, crime, exploitation, torture, and displacement were extracted. The search was carried out in January 2023 across three databases (PubMed, Web of Science, and Scopus). Only publications in English with accessible full texts were included. Descriptive statistics were utilized to summarize the categories of the retrieved papers, and graphical representation was employed for visualization purposes. The relationships between the publications and each of the 10 targets of Sustainable Development Goal 16 (SDG 16) were also assessed. RESULTS: Forty-five studies were reviewed. Most studies (42.2%) originated from the Americas Regions, while no studies were identified from the Africa Region. A significant portion (46.7%) of the papers focused on abuse, violence, and neglect as risk factors for ECC. Migrants, refugees, and IDPs were the most investigated populations (44.4%). Only one study specifically focused on IDPs and migrants respectively. The prevalence of untreated caries was higher among migrants, refugees, and IDPs compared to the host community, ECC was more prevalent among children who experienced abuse, neglect, or were in protective care. The was no clear direction on the associations between ECC and intimate partner violence, adverse childhood experiences, and wars. In terms of the SDGs, the reviewed publications addressed four targets (SDG16.1, SDG16.2, SDG16.3, and SDG16.5) out of the ten targets outlined in SDG 16. CONCLUSION: There is available evidence regarding the connections between ECC and war, refugees, migration, violence, and neglect, as outlined in SDG 16. Future studies are needed to investigate how forced movements directly affects ECC status, how disruptions of peace and stability is a risk factor for ECC, and the associations between ECC and other indicators related to SDG 16 targets.

Untreated dental caries among Libyan children during and after the war and in internally displaced person camps.

OBJECTIVES: The present study assessed whether living in a conflict zone and in internally displaced person (IDP) camps were associated with the number of untreated caries in primary, permanent and all teeth in Libyan children and whether these associations differed by parents' educational attainment. METHODS: Cross-sectional studies were conducted in Benghazi, Libya, in 2016/2017 during the war and in 2022 after the war including children in schools and in IDP camps in the same setting. Self-administered questionnaires and clinical examinations were used for data collection from primary schoolchildren. The questionnaire collected information on children's date of birth, sex, level of parental education and school type. The children were also asked to report on how often they consumed sugary drinks and whether they brushed their teeth regularly. In addition, untreated caries in primary, permanent and all teeth were assessed according to World Health Organization criteria at the dentine level. Multilevel negative binomial regression models were used to assess the relation between dependent variables (untreated caries in primary, permanent and all teeth) and living environment (during and after the war and living in IDP camps) and parental educational attainment adjusted for oral health behaviours and demographic factors. The modifying effect of parental educational attainment (no, one and both parents university educated) on the association between living environment and the number of decayed teeth was also assessed. RESULTS: Data were available from 2406 Libyan children, 8-12 years old (mean = 10.8, SD = 1.8). The mean (SD) number of untreated decayed primary teeth was 1.20 (2.34), permanent teeth = 0.68 (1.32) and all teeth = 1.88 (2.50). Compared to children living in Benghazi during the war, children living in the city after the war had significantly greater number of decayed primary (adjusted prevalence ratio [APR] = 4.25, p = .01) and permanent teeth (APR = 3.77, p = .03) and children in IDP camps had significantly greater number of primary teeth (APR = 16.23, p = .03). Compared to children whose both parents were university-educated, those with no university-educated parents had a significantly greater number of decayed primary teeth (APR = 1.65, p = .02) and significantly less number of decayed permanent (APR = 0.40, p < .001) and all teeth (APR = 0.47, p < .001). There was a significant interaction between parental education and living environment in the number of all decayed teeth in children who lived in Benghazi during the war: children whose both parents were non-university-educated had significantly less number of all decayed teeth (p = .03) with no interaction effect in those living in Benghazi after the war or in IDP camps (p > .05). CONCLUSION: Children living in Benghazi after the war had more untreated decay in primary and permanent teeth than children during the war. Having parents with no university education was associated with greater or less untreated decay depending on the dentition. These variations were most pronounced among children during the war in all teeth with no significant differences in after-war and IDP camps groups. Further research is required to understand how living in war environment influenced oral health. In addition, children affected by wars and children living in IDP camps should be identified as target groups for oral health promotion programs.

Association between dental caries and obesity among Libyan schoolchildren during the armed conflict in Benghazi.

BACKGROUND: Dental caries and Obesity in children are issues of public health concern. Even though researching the relationship between these two noncommunicable diseases has been conducted for many years, the results remain equivocal. This paper aimed to examine the association between dental caries and obesity among 12-year-old schoolchildren living in war-affected environment in Benghazi. METHODS: A secondary analysis of a cross-sectional study was conducted to determine the prevalence of caries among 12-year-old school children in Benghazi in 2017 during the armed conflict that affected the city. The data extracted for the analysis included sociodemographic of the participants (gender, maternal education and school type), caries experience (DMFT index), and anthropometric measures (height in cm, weight in kg, BMI and Z score for BMI). Comparisons of anthropometric measures were conducted according to caries experience. Linear regression models were developed to determine the association between Body Mass Index and Z score as outcome variables, caries as an explanatory variable, and covariates (gender, maternal education and school type). Beta coefficient (ß) and 95% confidence intervals were calculated. All statistical tests were conducted at p ≤ 0.05. RESULTS: There were 782 children with a mean (SD) BMI of 20.7 SD5.09 and an average z (SD) score of 0.56 SD1.51. Also, 159 (20%) children had obesity. No significant association was observed between caries and anthropometric measures. However, higher BMI was observed in children from a private school (p ≤ 0.001***), females (p ≤ 0.001***) and self-reported regular sugary drinks consumers (p ≤ 0.001***). CONCLUSION: The present study shows no significant association between dental caries and anthropometric measures. However, the study findings support the notion of tackling sugar intake as a common risk factor for caries and obesity, which should be encouraged in the Libyan culture.

Awareness of sports-related dental emergencies and prevention practices among Libyan contact sports coaches: A cross-sectional study.

Background and aims: Despite the high incidence rate of dental trauma and its possible devastating physical and psychological consequences on children, little is known about sport-related dental trauma and its prevention and management among Libyan sports coaches. The present study aimed to assess the knowledge and attitude of Benghazi contact sports coaches regarding sport-related dental trauma and its prevention and management. Methods: A cross-sectional study design was used. Two hundred and thirty-one contact sports coaches were recruited from different public and private youth sports centers across Benghazi. The data were collected using a self-administered questionnaire translated into Arabic and piloted to evaluate its validity and clarity. In addition, Mann-Whitney U, Kruskal-Wallis, and χ 2 tests were used to check associations between the variables. Results: A total of 151 contact sports coaches returned a completed questionnaire; the majority of coaches (74%) have seen orofacial injuries during their coaching career, whereas less than half of them (47%) personally experienced these injuries. Only one participant said he would preserve the tooth in milk, and four indicated that they would replant it. Most coaches (89.4%) knew what a mouthguard is, but 53.6% would recommend its use, and these were more likely to have previously used mouthguards (p ≤ 0.001). About 41.1% received previous training on TDIs-related emergencies. Higher knowledge scores were observed among coaches who previously received training (p = 0.023). Conclusion: The findings of this study indicate low awareness of how to manage and prevent orofacial injuries among Libyan contact sports coaches, even though they commonly encounter these injuries and believe in mouthguards' effectiveness. Previous training on managing emergencies and experience appeared to influence the coaches' knowledge. Training coaches on preventing TDIs and their early management in sports fields should be an implemented policy and a prerequisite to obtaining a training license.

Career expectations and the motivating factors for studying dentistry in Libya.

INTRODUCTION: This study investigated entry-level dental students' motives for studying dentistry at the University of Benghazi (UoB), Libya and career expectations among recent UoB graduates in an atypical context during the time of political unrest and identified factors associated with these motives.  METHODS: A cross-sectional survey was conducted in 2021-2022 for all entry-level dental students and recent dental graduates of UoB. A self-administered survey explored motives for studying dentistry, career expectation and associated factors. The questions were adopted from previous studies and pre-validated for use among Libyan students. Motives and career expectations were summarized, and their association with potential associated factors were assessed using chi-square test at p ≤ 0.05. RESULTS: One hundred eighty-four entry-level students and 156 recent graduates completed the surveys, response rates = 73.6% and 62.4%, respectively. The main motives to study dentistry were the desire to work in the healthcare field (183, 99.4%), interest in scientific knowledge (178, 96.7%) and because there were various dental specialities (168, 91.3%). The most common career expectations were setting up a business (107, 68.6%) and establishing a dental clinic (105, 67.3%). In addition, preference for working in the public sector (106, 67.9%), work-life balance (102, 65.4%) and financial gain (94, 60.3%) were the main factors associated with career expectations. CONCLUSION: The main motive to join a dental school in Libya was academic interest. However, recent graduates showed more pragmatic expectations related to private practice ownership.

Dental Fluorosis and Its Associated Factors Amongst Libyan Schoolchildren.

BACKGROUND: Little is known about dental fluorosis (DF) in Benghazi, Libya, where the public water supply is naturally fluoridated. OBJECTIVE: The study aims to investigate the distribution of DF and its related risk factors and impact on oral health-related quality of life (OHRQoL) and the association between DF and caries amongst Libyan school children. METHODS: A cross-sectional survey was carried out amongst 12-year-old schoolchildren in the city of Benghazi. Dean's and decayed, missing, and filled surfaces (DMF) indices were used to assess the severity of DF and dental caries. In addition, a self-administered questionnaire was used to collect sociodemographic and behavioural information and OHRQoL using the Child Oral Health Impact Profile-Short Version 19 (COHIP-SF19). RESULTS: Out of 1125 children who participated in the study, 15%, 7.8%, 2.2%, and 0.4% of participants were coded as having questionable, mild, moderate, and severe DF, respectively. Children enrolled in private schools were less likely to have DF (odds ratio, 0.55; 95% confidence interval, 0.35-0.83; P = .007). Moderate-severe DF was associated with more decayed surfaces and DMF scores and low scores for COHIP-SF19 and its socioemotional well-being subscale. CONCLUSIONS: The data demonstrate that rates of DF are relatively low in naturally fluoridated areas in Libya. DF amongst Libyan schoolchildren was associated with social disparities, higher caries rates, and negative impacts on OHRQoL.

Cross-cultural adaptation of the Arabic version of the DHEQ-15.

OBJECTIVES: Many patients who suffer from Dentine Hypersensitivity (DH) often go undiagnosed because they do not consider DH as serious problem that requires treatment. The use of patient-reported outcome measures can help in diagnosis and management of DH problems. The aim of the present study was to adapt cross-culturally the original English version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) for use in Arabic-speaking countries. METHODS: An Arabic version of DHEQ-15 was first developed by forward-backward translation and piloted among a group of dental patients. A cross-sectional study design was then used to test the psychometric properties of the Arabic DHEQ-15 in a wider convenience sample of Libyan dental patients diagnosed with DH. Confirmatory factor analysis was used to test the three-dimensional distribution of the subscales. The significance level of all statistical tests was set at p ≤ 0.05. RESULTS: The Arabic DHEQ-15 demonstrated good face and content validity. A total of 462 participants aged, on average, 39.2 ± 12.9 years took part in the psychometric testing of the Arabic DHEQ-15. The overall Cronbach's alpha of the questionnaire was 0.91, and overall Interclass correlation coefficient (ICC) for test-retest repeatability was 0.914. Participants with more severe DH had a significantly higher DHEQ-15 score than those with less severe DH (p < 0.001). Those who reported better global rating of their oral health had lower scores on the Arabic DHEQ-15 (p < 0.001). Confirmatory factor analysis confirmed three subscales of the Arabic DHEQ-15. CONCLUSIONS: The Arabic DHEQ-15 has been developed and further testing has demonstrated acceptable levels of psychometric properties in an Arabic population. The Arabic DHEQ-15 is a reliable measure of the quality-of-life impact of DH for use with Arabic-speaking populations.

Determinants of caries experience and the impact on the OHRQOL of 6-year-old Libyan children: a cross-sectional survey.

OBJECTIVE: The current study aimed to assess the caries experience and associated factors and its impact on the oral health-related quality of life (OHRQoL) among 6-year-old Libyan children. METHODS: A cross-sectional survey including 706 six-year-old children was conducted in 2017 in Benghazi, Libya. Data were collected through a self-administered questionnaire assessing socioeconomic status and oral health behaviours, and the Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS) to assess the OHRQoL. Clinical examination assessed caries experience at tooth level (dmft) and the number of decayed, missing due to caries and filled teeth (dt, mt and ft). Poisson regression analysis was performed to determine the association between dmft scores and the independent predictors. Linear regression analysis was conducted for ECOHIS scores with the children's gender, SES and OHB. The statistical significance was set to ≤ 0.05. RESULTS: Data were available for 706 children. Caries prevalence (dt) and dmft of ≥ 1 were 69.1% and 71% respectively. The mean ± SD dmft score was 3.23 ± 3.32. There was a significant and direct association between dmft scores and daily consumption of sugary snacks (B = 1.27, P = 0.011) and a significant inverse association with teethbrushing twice daily (B = 0.80, P = 0.041). There was a significant and direct association between A-ECOHIS and dmft (B = 1.14, P ≤ 0.001) and a significant and inverse association between A- ECOHIS and high and intermediate family income compared to low income (B = -3.82, P = 0.0001 and B = -2.06, P = 0.028). CONCLUSIONS: 6-year-old Libyan children had a relatively high caries experience an untreated decay with impact on OHRQoL. Social disparities, sugar consumption patterns and oral hygiene practices were associated with high caries experience.

An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries.

BACKGROUND: Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. METHODS: Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3-5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3-5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. RESULTS: Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3-5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = - 3.71, 95% CI: - 5.51, - 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: - 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). CONCLUSIONS: Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey.

BACKGROUND: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries. METHODS: We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries. RESULTS: Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007). CONCLUSIONS: Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity.

OBJECTIVE: COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors. METHODS: We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms). RESULTS: 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11). CONCLUSIONS: COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

Governance, maternal well-being and early childhood caries in 3-5-year-old children.

BACKGROUND: This study assessed the direct, indirect and total effect of distal - political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3-5 year old children. METHODS: Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women's opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis. RESULTS: Voice and accountability (ß = - 0.60) and GNI per capita for females (ß = - 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (ß =0.40) and higher percentage of female legislators, senior officials and managers (ß = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (ß = - 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (ß = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (ß = - 0.49), political stability/absence of terrorism (ß = 0.34) and higher female GNI (ß = - 0.33) had the greatest effects on ECC prevalence. CONCLUSION: Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.

Happiness among dentists: a multi-scale, multi-national study from 21 countries.

OBJECTIVES: The extent to which dentists are happy with their profession and their life has not been well studied. The present study aimed to explore the level of happiness, satisfaction with life and psychological well-being among a sample of dental professionals from 21 countries. MATERIALS AND METHODS: The sample comprised 2,200 dentists from 21 countries. Three scales - Subjective Happiness Scale (SHS), Satisfaction With Life Scale (SWLS), and Affect Balance Scale (ABS) - were used to measure the subjective responses. Data related to demographic and social characteristics were recorded. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Scales were correlated, and multiple linear regression analyses were employed to identify the independent determinants of SHS, SWLS and ABS. Data were analysed using the SPSS software program; a value of P <0.05 was considered significant. RESULTS: The overall mean scores of SHS, SWLS and ABS were 18.53 ± 5.06, 23.06 ± 6.25 and 1.26 ± 2.40, respectively, with significant differences found across countries: dentists working in Croatia, Peru and Serbia recorded the highest scores, unlike dentists practicing in Yemen, Syria, and Iraq, who recorded the lowest scores. There were significant, moderately positive correlations between the various scales: SHS and SWLS: r = 0.535, P < 0.001; SHS and ABS: r = 0.58, P < 0.001; and SWLS and ABS: r = 0.533, P < 0.001. Country of practice, age, qualification and monthly income were the significant independent predictors of SHS, SWLS and ABS. CONCLUSION: Country of residence and social characteristics were associated with dentists' responses regarding their feelings and subjective well-being.

Changes in dental caries and sugar intake before and during the conflict in Libya: A natural experiment.

OBJECTIVES: The primary aim of this study was to investigate the impact of reduced sugar consumption on caries experience among 12-year-old Libyan schoolchildren during the Libyan conflict, in comparison to preconflict data collected in the same water-fluoridated setting from a similar age group. A further aim was to investigate the socio-demographic and behavioural factors which may impact caries levels during the conflict. METHODS: A natural experiment in which dental caries data before and during the Libyan conflict, over a 9-year period, was compared. A cross-sectional survey was conducted between December 2016 and February 2017 to collect during-conflict data comparable to preconflict data collected in 2007. A random sample of 1134, 12-year-olds were recruited from public schools in Benghazi. Epidemiological examinations were undertaken by three trained examiners to measure dental caries. Questionnaires addressing socio-demographic and behaviours related to oral health were completed by participants. Data were analysed using SPSS 24, at P ≤ .05. RESULTS: In the during-conflict period, caries prevalence was 42.8% and mean DMFT was 1.09 (SD ± 1.57). These figures were significantly lower than the caries prevalence and severity reported in the preconflict group (P < .001). Logistic regression analysis indicated that male children, those who frequently consumed sugary drinks, who drank bottled water (low fluoride) and whose fathers had relatively lowly occupations were more likely to have dental caries (all P < .05). CONCLUSIONS: This study indicates that decreased levels of sugar intake during the Libyan conflict are associated with a decline in dental caries prevalence and severity. This provides some support for the notion that reducing sugar intake is still an important factor in caries prevention and control even when fluorides are available in public water and toothpaste.

Women's economic empowerment, participation in decision-making and exposure to violence as risk indicators for early childhood caries.

OBJECTIVES: In view of the association between early childhood caries (ECC])and maternal social risk factors, this study tried to determine if there were associations between indicators of processes, outputs and outcomes of women's empowerment, and the prevalence of ECC. METHODS: In this ecological study, indicators measuring the explanatory variables - economic empowerment, decision-making and violence against women - were selected from the Integrated Results and Resources Framework of the UN-Women Strategic Plan 2018-2021 and WHO database. Indicators measuring the outcome variables - the prevalence of ECC for children aged 0 to 2 years, and 3 to 5 years - were extracted from a published literature. The general linear models used to determine the association between the outcome and explanatory variables were adjusted for economic level of countries. Regression estimates (B), 95% confidence intervals and partial eta squared (η2) were calculated. RESULTS: Countries with more females living under 50% of median income had higher prevalence of ECC for 3 to 5-year olds (B = 1.82, 95% CI = 0.12, 3.52). Countries with higher percentage of women participating in their own health care decisions had higher prevalence of ECC for 0 to 2-year-olds (B = 0.85, 95% CI = 0.03, 1.67). Countries with higher percentage of women participating in decisions related to visiting family, relatives and friends had higher prevalence of ECC for 3 to 5-year-olds (B = 0.67, 95% CI = 0.03, 1.32). None of the indicators for violence against women was significantly associated with the prevalence of ECC. CONCLUSION: Empowerment of women is a welcome social development that may have some negative impact on children's oral health. Changes in policies and norms are needed to protect children's oral health while empowering women.