Food insecurity is associated with lower diet quality among dental students.

PURPOSE: Food insecurity is associated with lower diet quality, adverse health outcomes, and academic difficulty among undergraduate students. The objective was to identify the relationship between food security status and diet quality in dental students. METHODS: All dental students attending Howard University (n = 286) or the University of Iowa (n = 326) during the fall 2021 semester were invited to complete a cross-sectional survey designed to query demographics, food security status (i.e., United States Department of Agriculture's ten item Adult Food Security Module), and diet quality (i.e., short Healthy Eating Index). The survey was administered using the Qualtrics platform. RESULTS: Response rates were similar for Howard (32.5%) and Iowa (29.4%). Students with food insecurity (46.0%) were slightly older and more likely to be Black or other, first generation professional/graduate students, and receive financial aid than peers with food security (p < 0.050). Food insecurity was associated with lower intakes of fruits and vegetables (p ≤ 0.005), higher intakes of added sugars (p < 0.001), and lower diet quality (p = 0.003). In linear regression analyses that controlled for other variables, food insecurity (p = 0.012), school site (p = 0.027), and gender (p = 0.039) were predictive of lower diet quality. CONCLUSIONS: The inability to procure adequate and appropriate foods was associated with marginal dietary habits (i.e., less than ideal food choices and eating behaviors) and lower diet quality in dental students. Both marginal dietary habits and lower diet quality increase chronic disease risk and may present a barrier to academic success. Addressing food insecurity among dental students is necessary to ensure equitable opportunities for a healthy workforce in the future.

Clinical Vignettes, Part II: Eyes, Teeth, and Bone.

Microvascular occlusions caused by sickle cell disease (SCD) can affect all ocular and orbital structures. Sickle cell retinopathy (SCR) is the most common ophthalmic manifestation of SCD. Fortunately, most individuals with SCR are visually asymptomatic. Vision loss in SCD most commonly occurs as a consequence of proliferative sickle cell retinopathy (PSR), in which pathologic retinal neovascularization occurs. To prevent significant vision loss and blindness, which can occur from complications of PSR, regular retinopathy surveillance screening examinations and consistent follow-up with a retina specialist are recommended. Scatter laser photocoagulation is the current gold-standard treatment to prevent vision threatening progression of PSR. Patients with sickle cell disease should have regular checkups with their dental care provider. Patients should be educated on the importance of proper dental care, a healthy diet, and the need for early intervention if they suspect any dental problems or are having dental pain. If any dental procedures that involve surgery or sedation are planned, it is critical to consult with the hematologist before the procedure is started. Prophylactic antibiotics may have to be prescribed before invasive dental procedures, such as extractions or periodontal surgery but is best determined by discussions between the dental care provider and the hematologist. Osteonecrosis is a highly prevalent skeletal complication of sickle cell disease that affects all genotypes. Risk factors for osteonecrosis include older age, HbSS genotype with concomitant alpha-thalassemia trait, frequent vaso-occlusive episodes, history of acute chest syndrome, elevated body mass index, and low white blood cell counts. Osteonecrosis causes progressive joint damage and associates with chronic pain, frequent acute care visits, and overall poor health-related quality of life. Current consensus guidelines recommend analgesics, physical therapy, and early consideration of joint arthroplasty in sickle cell-related osteonecrosis, although surgery may be deferred until late adolescence after growth plates have fused.

Fear of COVID-19 among dental students at a Historically Black College and University (HBCU).

OBJECTIVE: To examine fear levels of COVID-19 among dental students at a Historically Black College and University (HBCU). Participants-162 first through fourth year dental students who were enrolled at the HBCU dental school between January 27, 2021 and May 3, 2021. METHODS: Students completed an online survey that included the Fear of COVID-19 Scale (FCV-19S) and information on demographic variables. RESULTS: Associations were observed between the fear of COVID-19 and the dental student's gender, ethnicity, marital status and self-rated health. Those in the highest quartile for the fear scale were less likely to be African American and more likely to be Asian or Pacific Islander, Hispanic or of Middle Eastern descent as compared to those in the lowest quartile. CONCLUSION: Dental students at an HBCU are a population particularly vulnerable to fear of COVID-19 possibly due to the high demands and mental stress of dental school.

Sugar-Sweetened Beverage Consumption and Caries Prevalence in Underserved Black Adolescents.

Purpose: The purpose of this study was to examine the association between sugar-sweetened beverage (SSB) consumption and dental caries prevalence among underserved Black adolescents. Methods: This was a cross-sectional study of 545 Black adolescents, ages 12 to 17 years, who participated in the Howard Meharry Adolescent Caries Study (HMACS). The outcome was dental caries prevalence, measured using the decayed, missing, and filled permanent tooth surfaces (DMFS) index. Participants were recruited from middle and high schools in Washington, D.C., USA, and Nashville, Tenn., USA. Questionnaires were used to assess beverage intake, demographic, and health-related behavioral characteristics. The multivariable analysis used marginalized zero-inflated Poisson regression (MZIP) stratified by toothbrushing frequency to estimate adjusted mean caries ratios (MRs), adjusted odds ratios (ORs), and 95 percent confidence intervals (95 percent CIs). Results: The mean age of the participants was 14.1 years. Participants in the highest quartile for SSB consumption had a higher caries ratio than those in the lowest quartile [MR equals (=) 1.59, 95 percent CI equals 1.15 to 2.20] and a lower odds of not being at risk for caries (OR = 0.24, 95 percent CI = 0.09 to 0.61). These findings were only observed among those brushing once a day or less (n =202). Conclusions: Among Black adolescents in this study who brushed once a day or less, high levels of sugar-sweetened beverage consumption were associated with greater caries prevalence and a reduced likelihood of remaining caries-free than those with lower levels of SSB consumption. Future studies will focus on interventions to reduce SSB consumption.

Food Insecurity, Meal Behaviors, Beverage Intake, and Body Mass Index in Underserved Adolescents.

OBJECTIVE: Associations between food insecurity, meal patterns, beverage intake, and body mass index (BMI) were investigated using data from the Howard Meharry Adolescent Caries Study. METHODS: Secondary analyses of food security status used the Wilcoxon rank sum, chi-square, and Fisher's exact tests. RESULTS: The group of adolescents (n=627) was 42.1% male, 14.2±1.9 years, 86.9% African American, and 19.9% food-insecure. Meal frequency, meal structure, most beverage intake, and BMI did not differ by food-security status. Adolescents from Washington, DC were more likely to be food insecure than adolescents from Nashville, TN (P=0.003). Most had unstructured meal patterns and irregular breakfast intake. Median milk intake was below and sugar-sweetened beverage intake above dietary recommendations. CONCLUSIONS: This study extends our knowledge concerning food insecurity in urban African American adolescents and suggests public health initiatives designed to encourage meal structure, increase milk intake, and reduce sugar-sweetened beverage intake can improve diet quality of underserved youth.

The contrasting short-term effects of COVID-19 on dental care practices in the United States.

OBJECTIVES: The study utilized a cross-sectional survey to determine the short-term effects of the COVID-19 pandemic on dental care practices. The authors hypothesized that the effects of the pandemic would indicate differences based on the ethnicity of the participating dentist. MATERIALS AND METHODS: The survey was available online between June 1, 2020 and July 10, 2020, a period when many dental offices remained closed, and for the most part, unable to provide non-emergency dental care. The link to the survey was made available to dentists through outreach to several national dental organizations. Descriptive statistics summarized the characteristics of the entire sample and Fisher's exact test was used to examine respondents' answers stratified by ethnicity using frequencies and percentages. RESULTS: All ethnic groups reported decreased revenue and African American dentists were the least likely to report a decrease in revenue compared to White and Other ethnic groups (84.2%, 87.2% and 92.9%). African American dentists were the most likely to report willingness to contribute to a task force to address the new challenges resulting from COVID-19 when compared to White and Other ethnic groups (46.4%, 18.8%, and 29.6%, respectively). African American dentists were more likely to indicate a need for a stronger connection to academic programs as compared to White or Other dentists in order to address current and future challenges (12.3%, 0.0%, and 9.1%). CONCLUSION: The COVID-19 pandemic has affected dental practices differently, highlighting racial disparities, and strategies that factor in the race or ethnicity of the dentist and the communities in which they practice need to be considered to ensure that underserved communities receive needed resources.

An Approach to Engaging Schools In Oral Health Initiatives: The Howard Meharry Adolescent Caries Study (HMACS).

Use of community-based participatory research (CBPR) principles can help identify strategies for development and implementation of studies that can address oral health disparities disfavoring African American youth. This paper summarizes approaches of the Howard Meharry Adolescent Caries Study (HMACS) to provide sustained oral health services beyond the life of a research study.

Reducing Dental Plaque Scores in Long-term Care Facilities Using a Checklist and Random Inspections: A Pilot Study.

The development and use of tailored interventions in overcoming barriers to optimum health in long-term care facility residents is of the highest importance. One successful approach to improving health outcomes is the use of a checklist by health care providers. Despite the evidence of the success of such checklists in nursing and medicine, there is little evidence on their use in improving dental outcomes. This study investigated whether an intervention comprising the daily use of a checklist for oral care by nursing staff supplemented by random inspections by a charge nurse resulted in lower dental plaque scores in patient participants at a long-term care facility (n=19) as compared with in those at another long-term care facility that did not receive the intervention (n=13). All participants received a dental cleaning at baseline. At a follow-up examination at 6 to 8 weeks post-baseline, significant differences were observed in the plaque scores between the participants at each location, with the median plaque scores in those undergoing the intervention being less than half of those in the patients that did not (20.8% vs. 52.8%, p<0.001). After adjusting for age in a linear regression model, this difference remained significant. The use of a daily checklist for oral care supplemented by random inspections by a charge nurse was associated with lower plaque scores (p<0.001). These results warrant further research, including prospective studies aimed at establishing how use of both clinical supervision and a checklist for oral health may influence plaque scores in geriatric patients in long-term care facilities over time.

Depression and the Likelihood of Hospital Admission from the Emergency Department among Older Patients with HIV.

OBJECTIVE: The objective was to determine if depression was associated with an increased likelihood of hospital admission following an emergency department (ED) visit among older patients diagnosed with HIV. METHODS: We performed secondary analysis of data from the Nationwide Emergency Department Sample (NEDS) in the United States using multivariable Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). We included adults aged 50 years and older, diagnosed with HIV using International Classification of Diseases, 9th revision (ICD-9-CM) codes. We controlled for demographic characteristics, hospital characteristics, and comorbid conditions in the analysis. RESULTS: In the final multivariable model, there was a 45% increase in the likelihood of hospital admission following an ED visit among older patients with HIV diagnosed with depression compared with those not diagnosed with depression (PR = 1.45, 95% CI = 1.39-1.52). CONCLUSIONS: Depression was associated with hospital admission among adults aged 50 and over.

Depression and hospital admission in older patients with head and neck cancer: analysis of a national healthcare database.

OBJECTIVES: The aim the study was to determine whether the presence of depression was associated with an increased likelihood of hospital admission among adult patients 50 years and over diagnosed with head and neck cancer (HNC) visiting emergency departments (EDs) in the United States. BACKGROUND: Head and neck cancer is associated with high morbidity and mortality. In patients with cancer, depression is predictive of increased mortality and the effect remains after adjusting for comorbidities. Patients with cancer who are depressed are less likely to participate in treatment decisions and to seek social support which can lead to worsening overall health outcomes among patients with HNC. MATERIALS AND METHODS: We performed secondary analysis of data from the Nationwide Emergency Department Sample (NEDS) in the United States using multivariable Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). We included adults aged 50 years and older, diagnosed with HNC using International Classification of Diseases, 9th revision (ICD-9-CM) codes. We controlled for demographic, clinical and hospital characteristics in the multivariable models. RESULTS: In the final multivariable model for adults 50 years and over, male HNC patients with depression were 28% (CI = 21-36%) more likely to be admitted following an ED visit and female HNC patients with depression were 31% (CI = 20-42%) more likely to be admitted. In stratified analysis, the association was strongest for males with specific HNC of the oral cavity who were 56% (CI = 25-94%) more likely to be admitted. CONCLUSION: Depression is associated with hospital admission among adults aged 50 and over with HNC.

Hospital admissions for pneumonia more likely with concomitant dental infections.

OBJECTIVE: The objective of this study is to determine if the presence of dental infection is associated with an increased likelihood of hospital admission following an emergency department (ED) visit among patients diagnosed with pneumonia. We hypothesized that the presence of a dental infection may worsen the clinical symptoms in ED patients diagnosed with pneumonia and are using hospital admission as a marker of worsening clinical severity. MATERIALS AND METHODS: We analyzed the data from the 2008 Nationwide Emergency Department Sample and used Poisson regression with robust estimates of variance to obtain prevalence ratios (PRs) with the appropriate adjustments for complex survey sampling. RESULTS: In the final multivariable model, there was a 19% increase in the likelihood of hospital admission following an ED visit among pneumonia patients diagnosed with dental infection compared to those without dental infection (PR = 1.19, 95% CI = 1.11-1.27). In an exploratory multivariable analysis, pneumonia patients diagnosed with dental caries had a 29% increase in the likelihood of admission compared to those not having dental caries (PR = 1.29, 95% CI = 1.23-1.34). These findings remained consistent in a subgroup analysis among patients with less clinically severe forms of pneumonia. CONCLUSIONS: Dental infections may worsen the clinical symptoms in ED patients with pneumonia increasing their likelihood for hospital admission. Dental caries may be a marker for poor oral hygiene and increased dental plaque rather than serve directly as a source of respiratory pathogens. CLINICAL RELEVANCE: The findings suggest that an increased focus on preventive oral health may reduce the need for admission following an ED visit for patients diagnosed with pneumonia.

Dentists consider medical screening important and are willing to incorporate screening procedures into dental practice.

SUBJECTS: Subjects were 1945 respondents from a survey sent out to 7400 general dentists practicing in the United States (26% response rate). The 7400 dentists were from a random sample generated from the American Dental Association (ADA) master file, which included ADA members and nonmembers. Among respondents, 82.3% were male, 85.7% were white, and 84.8% were 40 years of age or older. The study sample was different from the total sampling frame of US practicing dentists in that the respondents in this sample included older individuals, fewer women, and fewer Asian Americans and African Americans. KEY RISK/STUDY FACTOR: No one independent variable was identified, as the study was exploratory and not driven by a specific hypothesis. Demographic information was obtained about each respondent's sex, age, race/ethnicity, location of practice, and years in practice. MAIN OUTCOME MEASURE: No one outcome was identified, as the purpose of the study was to obtain information about dentists' attitudes, acceptance of, and perceived barriers to performing medical screening in a dental setting. The questionnaire included 5 Likert scale questions that used a 5-point response scale as follows: 1 = very important/very willing, 2 = somewhat important/somewhat willing, 3 = not sure, 4 = somewhat unimportant/somewhat unwilling, and 5 = very unimportant/very unwilling. A Friedman 2-way nonparametric analysis of variance (ANOVA) was used for the analyses with Wilcoxon-Mann-Whitney mean rank sum value provided when the ANOVA test yielded a significant difference. MAIN RESULTS: The authors combined the first 2 responses "very important" and "somewhat important" to create one variable "important" to score Questions 1 and 2. As a result, most thought it was important to conduct screening for hypertension (85.8%), cardiovascular disease (76.8%), diabetes mellitus (76.6%), hepatitis (71.5%), and human immunodeficiency virus (68.8%). The authors combined the responses "very willing" and "somewhat willing" to create one variable "willing" to score Question 3. The result was that most were willing to conduct screening that yielded immediate results (83.4%), to discuss results immediately with the patient during the dental visit (76.0%), or refer a patient for a medical consultation (96.4%). Only 45.9% were willing to send samples to a laboratory for testing. Using the same coding scheme for Question 4 as was used for Question 3, the authors found that most respondents (87.7%) were willing to collect oral fluids and blood pressure measurements (90.8%). Respondents were less willing to collect blood via finger stick (55.9%) or measure height and weight (57.4%). For Question 5, 54.7% thought that having insurance coverage was "very important" in deciding whether to incorporate medical screening into dental practice, compared with 75.4% for the variable categorized as time, 76.1% for the variable costs, 82.4% for the variable liability, and 83.5% for the variable described as patient willingness. According to the authors, the results suggest that having insurance is the least important barrier to incorporating screening into the dental practice. The authors also performed subgroup analysis according to sex and years of practice, observing some differences with the former but none with the latter. Women were more willing to test for hypertension, cardiovascular disease, and diabetes mellitus and thought that having insurance coverage was more important compared with men when considering whether to incorporate medical screening into dental practice. No mention was made of subgroup analysis according to locale (urban, suburban, and rural). Comparing the mean rank sums, insurance was significantly less important than time, cost, liability, or a patient's willingness when deciding whether or not to incorporate screening (P < .001). CONCLUSIONS: Most respondents thought that chairside screening for medical conditions was important and were willing to conduct screening for specified medical conditions in a dental setting.

Adaptation of the Communication Skills Attitude Scale (CSAS) to dental students.

The purpose of this study was to adapt the twenty-six-item Communication Skills Attitude Scale (CSAS) developed for medical students for use among dental students and to test the psychometric properties of the modified instrument. The sample consisted of 250 students (an 80.1 percent response rate) in years D1 to D4 at a dental school in Washington, DC. The mean age of participants was 26.6 years with a range from twenty-one to forty-two years. Slightly more than half of the participants were female (52.4 percent) and were African American or of African descent (51.7 percent). Principal components analysis was used to test the psychometric properties of the instrument. The index that resulted measured both positive and negative attitudes toward learning communications skills. The final twenty-four-item scale had good internal consistency (Cronbach's alpha=0.87), and the study obtained four important factors-Learning, Importance, Quality, and Success-that explained a significant portion of the variance (49.1 percent). Stratified analysis by demographic variables suggested that there may be gender and ethnic differences in the students' attitudes towards learning communication skills. The authors conclude that the CSAS modified for dental students, or DCSAS, is a useful tool to assess attitudes towards learning communication skills among dental students.

Acupuncture may be no more effective than sham acupuncture in treating temporomandibular joint disorders.

PURPOSE/QUESTION: To compare the effectiveness of acupuncture-type treatments to sham acupuncture in patients with temporomandibular joint disorder. SOURCE OF FUNDING: One of the authors was supported by a Pusan National University research grant; otherwise, no direct external funding was identified. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data. LEVEL OF EVIDENCE: Level 1: Good-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.