High burden of CMV infections after simultaneous pancreas-kidney transplantation-a nationwide cohort study.

Cytomegalovirus (CMV) infections remain a common problem after solid-organ transplantation. We characterized the burden of CMV infections, and adverse events of CMV prophylaxis after simultaneous pancreas-kidney transplantation (SPK). We included all SPK patients (n = 236) since 2010 in our country. Immunosuppression was ATG, tacrolimus, mycophenolate, and steroids. Valganciclovir prophylaxis was given to all CMV D+/R- patients for six months, and to seropositive SPK patients for three months since February 2019. CMV DNAemia was monitored with quantitative PCR from plasma. Among D+/R- SPK recipients, post prophylaxis CMV infection was detected in 41/60 (68%) during follow-up. In seropositive SPK recipients with no prophylaxis, CMV infection was detected in 53/95 (56%), vs. 28/78 (36%) in those who received 3 months of prophylaxis (P = 0.01). CMV was symptomatic in 35 (15%) patients, of which 10 required hospitalization. Mean duration of viremia was 28 days (IQR 21-41). Leukopenia was detected in 63 (46%) of the 138 patients with valganciclovir prophylaxis. 7/122 (6%) of the CMV infections detected were defined as refractory to treatment, and three patients had confirmed ganciclovir resistance. SPK recipients experience a high burden of CMV infections despite CMV prophylaxis. Leukopenia is common during valganciclovir prophylaxis.

Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis.

BACKGROUND: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. OBJECTIVE: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. METHODS: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. RESULTS: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors' lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users' ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. CONCLUSIONS: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. TRIAL REGISTRATION: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-051166.

Impact of Pregestational Obesity on the Oral Health-Related Quality of Life in Brazilian Pregnant Women: A Cohort Study.

The oral health-related quality of life of pregnant women and its effects on health conditions are important topics to be investigated in scientific research. The objective of this study was to evaluate the impact of pre-pregnancy obesity on oral health-related quality of life (OHRQoL) in pregnant women. A prospective cohort study was carried out with 93 pregnant women who were evaluated in the 2nd trimester of pregnancy (T1) and after delivery (T2). The following were analyzed: dental caries (DMFT), OHRQoL (OHIP-14), anthropometric data (BMI), socioeconomic, demographic, oral hygiene behavioral habits and the use of dental services. Unadjusted and adjusted Poisson regression analyses were performed to determine the impact of predictors on OHRQoL. The results of the adjusted analysis showed lower education relative risk (RR) (1.37; 95%CI 1.02-1.83; <0.00), low income (RR 2.19; 95%CI 1.63-2.93; <0.00) and higher BMI pre-pregnancy (RR 1.03; 95% CI 1.01-1.04; <0.00) were associated with worse OHRQoL in postpartum pregnant women. Flossing was a predictor of better OHRQoL at T2 (RR 0.73; 95%CI 0.57-0.93; <0.01). Higher BMI, low education, low income and inadequate oral hygiene habits were predictors of worse OHRQOL of pregnant women after the birth of the baby.

Very Low Frequency of Pathological Findings in One-year Protocol Biopsies of Uneventful Standard Risk Kidney Transplant Recipients: Results From the Nordic Protocol Biopsy Study.

Background: The clinical significance of kidney transplant protocol biopsies has been debated. We studied the frequency of borderline changes and T cell-mediated rejection (TCMR) in 1-y protocol biopsies in standard risk kidney transplant recipients. Methods: Consecutive non-HLA-sensitized recipients of kidney transplants between 2006 and 2017, who underwent a protocol biopsy at 1 y in 2 national transplant centers were studied retrospectively (N = 1546). Donor-specific HLA antibodies (DSAs), graft function (plasma creatinine), and proteinuria were measured at the time of 1-y protocol biopsy. The occurrence of subclinical acute TCMR (i2t2v0 or higher) or borderline changes suspicious of TCMR (i1t1v0 or higher) in the protocol biopsy was studied, together with frequency of findings causing changes in the composite score iBox. Results: Subclinical acute TCMR was detected in 30 of 1546 (1.9%) of the protocol biopsies, and borderline or TCMR in 179 of 1546 (12%). Among patients with no history of acute rejection, and no proteinuria or DSA, TCMR was detected in only 1 of 974 (0.1%) and borderline or TCMR in only 48 of 974 (4.9%) patients at 1 y. In the absence of proteinuria (<30 mg/g, or equivalent as measured with a negative dipstick proteinuria) or DSA, or history of acute rejection, only 50 of 974 (5.1%) biopsies showed any lesions significant for the iBox score. Conclusions: The likelihood of pathological findings in 1-y protocol biopsies in non-HLA-sensitized patients without previous immunological events is low. Clinical usefulness of protocol biopsies seems limited in these patients.

Infection-Related Hospitalizations After Simultaneous Pancreas-Kidney Transplantation Compared to Kidney Transplantation Alone.

The total burden of infections after transplantation has not been compared in detail between recipients of simultaneous pancreas-kidney transplantation (SPK) and kidney transplantation alone (KTA). We compared infection-related hospitalizations and bacteremias after transplantation during 1- and 5-year follow-up among 162 patients undergoing SPK. The control group consisted of 153 type 1 diabetics undergoing KTA with the inclusion criteria of donor and recipient age < 60, and BMI < 30. During the first year, SPK patients had more infection-related hospitalizations (0.54 vs. 0.31 PPY, IRR 1.76, p = <0.001) and bacteremias (0.11 vs. 0.01 PPY, IRR 17.12, p = <0.001) compared to KTA patients. The first infection-related hospitalizations and bacteremias occurred later during follow-up in KTA patients. SPK was an independent risk factor for infection-related hospitalization and bacteremia during the first year after transplantation, but not during the 5-year follow-up. Patient survival did not differ between groups, however, KTA patients had inferior kidney graft survival. SPK patients are at greater risk for infection-related hospitalizations and bacteremias during the first year after transplantation compared to KTA patients, however, at the end of the follow-up the risk of infection was similar between groups.

Probable sleep and awake bruxism in adolescents: A path analysis.

BACKGROUND: Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes. AIM: To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents. DESIGN: A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis. RESULTS: PSB and PAB are related to each other, with moderate and positive correlation (ß = .390). Poor sleep quality and higher household income had a direct effect on both PSB (ß = -.138; ß = .123, respectively) and PAB (ß = -.155; ß = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (ß = -.102). Adolescents that drool on the pillow (ß = .184) and/or have agitated sleep (ß = .104) tend to have PSB. CONCLUSION: Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study.

OBJECTIVE: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. METHODS: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). RESULTS: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. CONCLUSIONS: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

Structural Relationships between Asthma and Dental Caries in Children: A Birth Cohort Study in Southern Brazil.

INTRODUCTION: There is an inconclusive causal association between asthma symptoms and dental caries in the primary dentition. This study aimed to investigate, using SEM (structural equation modeling), a possible causal relation between asthma and dental caries in the primary dentition. METHODS: Using data from the 2004 Pelotas Birth Cohort Study, a sub-sample of 1,303 individuals was selected. Dental caries was clinically evaluated at 5 years old based on decayed, missing, and filled tooth (dmft) index criteria. Asthma-related symptoms (wheezing and shortness of breath) at 1- and 4-year-olds composed a latent variable and were the main exposures to caries occurrence. SEM was used to identify possible direct, indirect, and mediated effects of asthma in primary dentition dental caries. RESULTS: The general prevalence of caries at age 5 was 1.95 (SD: 3.56). When comparing the dmft values for children with asthma symptoms and those without, they presented similar values in both periods where asthma symptoms were evaluated (1- and 4-year-old). SEM analysis showed that asthma was neither directly nor indirectly related to dental caries. CONCLUSION: Asthma, using a latent variable constructed based on asthma symptoms, showed no causal effect on dental caries occurrence in the primary dentition.

Assessment of studies on oral manifestations and COVID-19: a meta-research study

This study aimed to evaluate how different study designs influences the presence and characteristics of diagnosis of oral manifestations in patients with COVID-19. Methods: This study is a meta-search conducted with studies evaluating the relationship between patients with oral manifestations and COVID-19. A search was conducted in three databases (PubMed, Web of Science, and Scopus), using terms specific to COVID-19 and oral lesions, including only primary studies. Study selection was undertaken by two reviewers independently. A descriptive analysis was performed. Results: The results included 55 studies in the data synthesis analysis. Most of the studies were case reports and case series. Some of the studies did not relate a biological test to confirm COVID-19. The ulcer lesion and that clinical examination by specialists were the most reported lesion in case reports and case series studies, while taste alterations and patient self-report were more reported in observational studies. Conclusions: This review concluded that the oral lesions in patients with COVID-19 differ according to the study design. The lack of high-quality scientific evidence in the dental literature on COVID-19 makes the findings inconsistent by the lack of sample selection criteria, diagnostic criteria and classification of oral lesions

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study

ABSTRACT Objective: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. Methods: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). Results: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. Conclusions: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o quanto a necessidade de tratamento ortodôntico é percebida pelos pacientes e pelo ortodontista, bem como os possíveis impactos na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) ao longo do tratamento ortodôntico convencional em pacientes adolescentes. Métodos: A amostra foi composta por 55 adolescentes. A percepção dos pacientes e ortodontistas em relação à má oclusão foi avaliada pelo Índice de Necessidade de Tratamento Ortodôntico (IOTN). A QVRSB foi avaliada pelo questionário Child-OIDP (Child-Oral Impacts on Daily Performances) antes da colagem do aparelho ortodôntico convencional (T0); e nos seguintes intervalos de tempo: após uma semana (T1), um mês (T2), três meses (T3), seis meses (T4) e após o término do tratamento ortodôntico (T5). Resultados: Adolescentes que apresentavam grandes necessidades de tratamento ortodôntico apresentaram baixa QVRSB, segundo sua autopercepção (p=0,003) e segundo a percepção do ortodontista (p<0,001), quando comparados com pacientes com necessidades pequenas e moderadas . Houve diferença estatisticamente significativa na QVRSB entre os intervalos de tempo T0 e T1 (p=0,021), T2 e T3 (p<0,001), T3 e T4 (p=0,033) e T0 e T 5 (p<0,00 2 ). Ao final do tratamento, todos os participantes avaliados relataram melhora na QVRSB. Conclusões: Concluiu-se que adolescentes e ortodontistas concordaram quanto à percepção da necessidade de tratamento ortodôntico. Na primeira semana e no primeiro mês de tratamento ortodôntico, houve impacto negativo na QVRSB. Após três meses, foi detectada uma melhora na QVRSB, que progrediu ao longo do tempo.

Association between dental environment stress and sense of coherence in dental students: a cross-sectional study.

The aim of this study was to explore associated variables with sense of coherence (SOC), and dental environment stress (DES) in a sample of dental students. All undergraduate (n = 474) and graduate (n = 105) dental students enrolled in the first semester of 2020 at a public university in southern Brazil were invited to participate. Data collection was performed by an online questionnaire, which included information related to sociodemographic and educational characteristics, biopsychosocial factors, aspects related to feelings experienced in the COVID-19 pandemic, and the SOC scale. The study outcome (DES) was measured by a validated tool. Linear regression analyses were performed to identify the associations between the outcome and all independent variables. A total of 408 students were included (response rate: 70.5%). The overall mean score of the DES scale was 73.95 (SD: 24.13). Students with higher SOC scores were observed to have significantly lower DES scores (ßGRADUATE: -0.376; 95%: -0.482 to -0.271; ßUNDERGRADUATE: -0.478; 95%:-0.658 to -0.297). Female undergraduate students (ß: 11.788; 95%CI: 7.161-16.415) had higher DES scores compared with undergraduate male students. In addition, the presence of anxiety symptoms when providing dental care to patients with symptoms or suspected COVID-19 infection was associated with higher DES scores (ß: 10.460; 95%CI: 5.644-15.277) among undergraduate dental students. The level of stress was higher in non-white undergraduate students than white (ß: 8.912; 95%CI: 3.581-14.244). Among both undergraduate and graduate dental students, higher SOC scores were associated with lower DES.

The first 10 years of simultaneous pancreas-kidney transplantation in Finland.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPK) is an option for patients with type 1 diabetes (T1D) and kidney failure but can be associated with a high complication rate. Here we describe our 10-year experience since the launch of the SPK program. METHODS: This retrospective study included consecutive patients with T1D receiving SPK from March 14, 2010 to March 14, 2020 at Helsinki University Hospital. Portocaval anastomosis (i.e., systemic venous drainage) and enteric exocrine drainage were used. A specific team was trained for both pancreas retrieval and transplantation, postoperative care was standardized to include somatostatin analogues, antimicrobial treatment, and preoperatively initiated chemothrombopropylaxis. During program maturation donor criteria were expanded and logistical processes improved to minimize cold ischemia time. Clinical data were collected from a nationwide transplantation registry and patient records. RESULTS: A total of 166 SPKs were performed (median 2 per year in the first 3 years, 17.5 per year for the following 4 years, and 23 per year for the past 3 years). Seven patients (4.1%) died with a functioning graft with a median 43 months follow-up. One-year pancreas graft survival was 97.0%, 3-year pancreas graft survival was 96.1% and 5-year was 96.1%. Mean HbA1c was 36 mmol/mol (SD 5.57) and creatinine was 107 µmol/L (SD 34.69) at 1-year after transplantation. All kidney grafts were functioning at the end of follow-up. Complications required re-laparotomy in 39 (23%) patients, mostly due to a pancreas graft related problem (N = 28). No pancreas or kidney graft failure from thrombosis occurred. CONCLUSION: A planned, step-wise development of an SPK program offers a safe and effective treatment for patients with T1D and kidney failure.

Direct relations between sense of coherence and oral health-related quality of life in adolescents.

OBJECTIVE: To verify the relations between sense of coherence (SOC) and dental caries on oral health-related quality of life (OHRQoL) of adolescents. SUBJECT AND METHODS: A cross-sectional sample of 768 adolescents nested in a cohort study was evaluated. SOC was measured using Antonovsky's scale. Dental caries was collected considering the decayed, missing, and filled teeth index (DMFT). OHRQoL was collected through the Child Perception Questionnaire. Demographic, socioeconomic, and use of service variables were also collected. The mediation effects between variables were tested by structural equation modeling. RESULTS: The average age of the individuals was 17.5 years. Individuals with high SOC scores had a positive impact on OHRQoL (ß-coefficient = -0.573, p < 0.00). Individuals with high DMFT (ß-coefficient = 0.080, p = 0.034) and dental pain (ß-coefficient = 0.079, p = 0.039) negatively impacted OHRQoL. Still, adolescents who had dental pain (ß-coefficient = 0.112, p = 0.005), mothers with lower education levels (ß-coefficient = -0.114, p = 0.004), lower household income (ß-coefficient = -0.131, p = 0.003), and those who visited the dentist (ß-coefficient = 0.109, p = 0.005) exhibited a higher DMFT index. CONCLUSIONS: SOC and dental caries had a direct effect on OHRQoL, indicating that oral conditions and psychosocial characteristics are important contributors to OHRQoL.

Association between dental environment stress and sense of coherence in dental students: a cross-sectional study

Abstract The aim of this study was to explore associated variables with sense of coherence (SOC), and dental environment stress (DES) in a sample of dental students. All undergraduate (n = 474) and graduate (n = 105) dental students enrolled in the first semester of 2020 at a public university in southern Brazil were invited to participate. Data collection was performed by an online questionnaire, which included information related to sociodemographic and educational characteristics, biopsychosocial factors, aspects related to feelings experienced in the COVID-19 pandemic, and the SOC scale. The study outcome (DES) was measured by a validated tool. Linear regression analyses were performed to identify the associations between the outcome and all independent variables. A total of 408 students were included (response rate: 70.5%). The overall mean score of the DES scale was 73.95 (SD: 24.13). Students with higher SOC scores were observed to have significantly lower DES scores (βGRADUATE: -0.376; 95%: -0.482 to -0.271; βUNDERGRADUATE: -0.478; 95%:-0.658 to -0.297). Female undergraduate students (β: 11.788; 95%CI: 7.161-16.415) had higher DES scores compared with undergraduate male students. In addition, the presence of anxiety symptoms when providing dental care to patients with symptoms or suspected COVID-19 infection was associated with higher DES scores (β: 10.460; 95%CI: 5.644-15.277) among undergraduate dental students. The level of stress was higher in non-white undergraduate students than white (β: 8.912; 95%CI: 3.581-14.244). Among both undergraduate and graduate dental students, higher SOC scores were associated with lower DES.

Conhecimento dos pais em relação à avulsão dentária em escolares: um estudo transversal / Parental knowledge on tooth avulsion in schoolchildren: a cross-sectional study

Objetivo: Avaliar o conhecimento dos pais em relação à avulsão dentária em escolares. Métodos: Os dados foram obtidos de um levantamento epidemiológico realizado com pais de escolares de 12 anos, por um questionário. Os participantes foram questionados sobre aspectos sociodemográficos da família, histórico de traumatismo dentário da criança e necessidade de tratamento, e condutas de urgência a serem adotadas em caso de avulsão. Análises descritivas e comparativas foram realizadas pelo programa estatístico STATA. Resultados: Participaram do estudo 354 pais, dentre os quais 32% relataram que seu filho já havia sofrido algum traumatismo dentário, e destes, 28% necessitou tratamento odontológico em função do trauma. Quando perguntados sobre a melhor conduta frente à avulsão, somente 2,8% identificou o reimplante imediato do elemento; para o transporte do dente avulsionado ao dentista, 19,6% respondeu que deveria ser imerso em saliva ou leite e, quando questionados sobre o tempo indicado para o atendimento de urgência, 70,6% apontou que deveria ser em até 30 minutos. Não houve diferença estatísticamente significante entre o conhecimento e fatores sociodemográficos (p > 0,05). Conclusão: Evidencia-se um conhecimento insuficiente dos pais sobre os procedimentos de urgência em caso de avulsão.

Aim: To assess parents' knowledge regarding tooth avulsion in schoolchildren. Methods: Data were obtained from an epidemiological survey conducted with parents of 12-year-old schoolchildren, using a questionnaire. Participants were questioned about sociodemographic aspects of the family, the child's history of traumatic dental injuries and the need for treatment, and urgent measures to be taken in case of tooth avulsion. Descriptive analyzes were performed using the STATA statistical program. Results: A total of 354 parents participated in the study, with 32% reporting that their child had already experienced some traumatic dental injury. Among these, 28% required dental treatment due to the injury. When asked about the best approach to tooth avulsion, only 2.8% identified immediate reimplantation of the tooth. Regarding transporting the avulsed tooth to the dentist, 19.6% responded that it should be immersed in saliva or milk. When asked about the recommended time for emergency care, 70.6% said it should be within 30 minutes. Conclusion: Parents' insufficient knowledge about emergency procedures in the case of tooth avulsion is evident.

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

ABSTRACT Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities' dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making.

Development and validation of a short form of the BOHLAT-P.

The authors developed and validated a short form of the Brazilian Oral Health Literacy Assessment Task for Paediatric Dentistry (BOHLAT-P). Data included responses from 200 parents of preschoolers to sociodemographic and oral health service access questions on the BOHLAT-P, the Brazilian Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), and the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS). Data on the preschoolers' dental caries experience (ICDAS-II) were also included. An item response theory-based approach was employed to develop the short form, while confirmatory factor analysis evaluated the instrument dimensionality. The validity and reliability of the short form were tested by statistical analysis using BREALD-30, B-ECOHIS, and sociodemographic and dental caries experience data. The short form (BOHLAT-P-30) comprises 30 items, is unidimensional, and presents better model fit estimates (TLI = 0.94; CFI = 0.94; RMSEA = 0.05) than those of the BOHLAT-P. Moreover, BOHLAT-P-30 demonstrated excellent reliability (Cronbach's alpha = 0.91; intraclass correlation coefficient [ICC] = 0.95). BOHLAT-P-30 scores were positively correlated with BREALD-30 scores (r = 0.71), with the number of years of schooling (r = 0.60), and with the number of hours spent reading (r = 0.33). BOHLAT-P-30 scores were negatively correlated with B-ECOHIS scores (r = -0.21), and with the number of teeth with cavitated caries (r = -0.18). After controlling for confounding factors, BOHLAT-P-30 scores were not found to be associated with caries presence, or with the number of teeth with cavitated caries. The BOHLAT-P-30 had properties similar to those of the BOHLAT-P, and proved to be a valid measure to assess the OHL of Brazilian parents.

Social Economic Disadvantage and Untreated Dental Caries: Findings from a Cohort Study in Adolescents.

This study aimed to assess the impact of determinants of the individual and contextual level on the untreated dental caries during adolescence. A cohort study was started in 2012 with a random sample of 1,134 12-year-old adolescents in the city of Santa Maria, RS, Brazil. The adolescents were clinically evaluated by calibrated dentists and investigated variables: contextual, demographic, socioeconomic factors, dental service use, toothache, and subjective variables. After 2 years (T2) and 6 years (T3), the same adolescents were reevaluated (retention rate of 67.9% and 67.8%, respectively). Untreated dental caries (component "D" of the DMFT index) was the outcome and was collected at all three times. Multilevel Poisson regression analyses considered repeated measures (level 1 - times), nested to adolescents (level 2), were used to assess the association between predictors (baseline) and untreated dental caries. High neighborhood's mean income was associated with the lowest risk of dental caries. Low household income (incidence rate ratio [IRR] 1.57; confidence interval 95% [CI]: 1.35-1.82), low mother education (IRR 1.19; 95% CI: 1.03-1.38), toothache (IRR 1.73; 95% CI: 1.47-2.03), and poor self-perception of oral health (IRR 1.19; 95% CI: 1.07-1.32) were risk factors for untreated dental caries. In conclusion, our results showed that socioeconomic disadvantages and oral conditions in early adolescence are risk factors for untreated caries among adolescents.

Association among headache, temporomandibular disorder, and awake bruxism: A cross-sectional study.

OBJECTIVE: To evaluate the association between headache, myofascial temporomandibular disorder (TMD), and awake bruxism (AB). BACKGROUND: Bruxism seems to act as a risk factor for TMD and its associated comorbidities, such as headaches. METHODS: In total, 406 medical records of individuals who sought care at a university dental clinic were screened. The Research Diagnostic Criteria for Temporomandibular Disorders was used to assess and diagnose TMD, as well as to obtain self-reports of AB and headache. RESULTS: The sample consisted of 307 medical records. About 72.5% (221/305) of the sample reported having headaches, and 67.4% (180/267) and 68.4% (210/307) were diagnosed with AB and TMD, respectively. Individuals who reported having AB (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.09-4.7) and who were diagnosed with myofascial TMD (OR, 2.53; 95% CI, 1.15-5.5) were more likely to have had headaches in the past 6 months when compared with patients without myofascial TMD and bruxism. Also, individuals who self-reported headache were 2.27 times (95% CI, 1.09-4.7) more likely to have AB and 2.45 times (95% CI, 1.13-5.34) more likely to have myofascial pain than individuals without headaches. CONCLUSIONS: Individuals with myofascial TMD, headaches, or AB were more likely to have at least one of the other conditions.

Machine Learning in the Diagnosis and Prognostic Prediction of Dental Caries: A Systematic Review.

We performed a systematic review to evaluate the success of machine learning algorithms in the diagnosis and prognostic prediction of dental caries. The review protocol was a priori registered in the PROSPERO, CRD42020183447. The search involved electronic bibliographic databases: PubMed/Medline, Scopus, EMBASE, Web of Science, and grey literature until December 2020. We excluded review articles, case series, case reports, editorials, letters, comments, educational methodologies, assessments of robotic devices, and articles with less than 10 participants or specimens. Two independent reviewers selected the studies and performed the assessment of the methodological quality based on standardized scales. We summarize data on the machine learning algorithms used; software; performance outcomes such as accuracy/precision, sensitivity/recall, specificity, area under the receiver operating characteristic curve (AUC), and positive/negative predictive values related to dental caries. Meta-analyses were not performed due to methodological differences. Our review included 15 studies (10 diagnostic studies and 5 prognostic prediction studies). Cross-sectional design studies were predominant (12). The most frequently used statistical measure of performance reported in diagnostic studies was AUC value, which ranged from 0.745 to 0.987. For most diagnostic studies, data from contingency tables were not available. Reported sensitivities were higher in low risk of bias prognostic prediction studies (median [IQR] of 0.996 [0.971-1.000] vs. unclear/high risk of bias studies 0.189 [0-0.340]; p value 0.025). While there were no significant differences in the specificity between these subgroups, we concluded that the use of these technologies for the diagnosis and prognostic prediction of dental caries, although promising, is at an early stage. The general applicability of the evidence was limited given that most models were developed outside the real clinical setting with a prevalence of unclear/high risk of bias. Researchers must increase the overall quality of their research protocols by providing a comprehensive report on the methods implemented.