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.

Prevalence and socio-behavioral determinants of early childhood caries in children 1-5- year- old in Iran.

AIM: According to the World Health Organization (WHO), early childhood caries (ECC) is still considered a major global health problem despite the general improvement in oral health practice. This study aimed to assess ECC's prevalence, severity, and key social and behavioral determinants in Iranian children 1-5- years of age. METHOD: This cross-sectional study recruited Iranian 1-5-year-olds with a three-stage stratified clustered sampling method. After providing consent, parents were interviewed using a validated questionnaire, including questions on child characteristics and behavioral factors. Each child underwent a dental examination by one of four trained and calibrated dentists. Associations between key covariates of interest and primary outcome measures were assessed by multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling after weightings were applied. Statistical analysis was performed using SPSS V25 and Stata V14.2 software packages. A p-value ≤ 0.05 was considered significant. RESULTS: The mean age of 909 participants was 41.1±1.2 months, 48.6% were male, and 38.1% lived in rural areas. The overall prevalence of ECC was 53.2% and mean dmft score was 2.7± 0.3. Key determinants associated with ECC included living rurally (p = 0.009, OR = 2.13), consuming sweet drinks, sugary snacks, or both [p-value = 0.02 (OR = 2.53), and p-value<0.001 (OR = 4.96), respectively], and visible plaque (p<0.001, OR = 3.41). Covariates associated with dmft scores included residing in rural regions (p = 0.02, IRR = 1.31), having both sugary snacks and sweet drinks (p = 0.02, IRR = 1.85) compared to those had none, and visible dental plaque (p<0.001, IRR = 2.06). CONCLUSIONS: The prevalence of dental caries in children is high in Iran. The increase of ECC prevalence and severity from toddlers to preschoolers emphasizes on the critical importance of early interventions in toddlers. Improving access to care for rural children is essential along with the need to change dietary and self-care behaviors through multilevel efforts.

Effectiveness of mouthwashes on reducing SARS-CoV-2 viral load in oral cavity: a systematic review and meta-analysis.

BACKGROUND: The risk of SARS-COV-2 transmission is relatively high during dental procedures. A study was conducted to investigate the effects of mouthwashes on SARS-COV-2 viral load reduction in the oral cavity. METHODS: A systematic search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane library for relevant studies up to 20 July, 2022. Randomized and non-randomized clinical trial and quasi-experimental studies evaluating patients with Covid-19 infection (patients) who used mouthwashes (intervention) compared to the same patients before using the mouthwash (comparison) for reducing the SARS-COV-2 load or increasing the cycle threshold (Ct) value (outcome) were searched according to PICO components. Three independent reviewers conducted literature screening and data extraction. The Modified Downs and Black checklist was used for quality assessment. A meta-analysis was performed with a random effects model in the Revman 5.4.1software using the mean difference (MD) of cycle threshold (Ct) values. RESULTS: Of 1653 articles, 9 with a high methodological quality were included. A meta-analysis indicated that 1% Povidone-iodine (PVP-I) was an effective mouthwash for reducing the SARS-COV-2 viral load [MD 3.61 (95% confidence interval 1.03, 6.19)]. Cetylpyridinium chloride (CPC) [MD 0.61 (95% confidence interval -1.03, 2.25)] and Chlorhexidine gluconate (CHX) [MD -0.04 95% confidence interval (-1.20, 1.12)] were not effective against SARS-COV-2. CONCLUSION: Using mouthwashes containing PVP-I may be recommended for reducing the SARS-COV-2 viral load in the oral cavity of patients before and during dental procedures, while the evidence is not sufficient for such effects for CPC and CHX-containing mouthwashes.

Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

A scoping review on the association of early childhood caries and maternal gender inequality.

AIM: The objective of this scoping review is to present current evidence regarding the association between early childhood caries (ECC) and maternal-related gender inequality. METHODS: Two independent reviewers performed a comprehensive literature search using three databases: EMBASE, PubMed, and Web of Science. Literature published in English from 2012 to 2022 was included in the search and was restricted to only primary research by using the following key terms: "dental caries", "tooth decay", "gender", "sex", "preschool", "toddler," and "infant". The included studies were limited to those reporting an association between ECC and maternal aspects related to gender inequality. Titles and abstracts were screened, and irrelevant publications were excluded. The full text of the remaining papers was retrieved and used to perform the review. The critical appraisal of selected studies was guided by the Joanna Briggs Institute (JBI) Critical Appraisal Tools. RESULTS: Among 1,103 studies from the three databases, 425 articles were identified based on publication years between 2012 and 2022. After full-text screening, five articles were included in the qualitative analysis for this review. No published study was found regarding a direct association between ECC and maternal gender inequality at the level of individuals. Five included studies reported on the association between ECC and potential maternal-gender-related inequality factors, including the mother's education level (n = 4), employment status (n = 1), and age (n = 1). Regarding the quality of the included studies, out of five, two studies met all JBI criteria, while three partially met the criteria. CONCLUSIONS: Based on the findings of this scoping review, evidence demonstrating an association between gender inequality and ECC is currently limited.

Self-reported experience of orofacial injury, preventive practice, and knowledge of Iranian adolescent martial art athletes towards sports-related orofacial injuries.

BACKGROUND: Increased engagement of adolescents in martial arts exposes them to a relatively high risk of experiencing orofacial injuries. We evaluated self-reported experience of orofacial injuries, preventive practice, and knowledge of management of sport-related orofacial injuries and related factors in adolescent Karate and Taekwondo athletes in Iran. METHODS: This cross-sectional study was conducted on Iranian martial arts athletes including Karate and Taekwondo aged 11-17-year-old in 2020 via an online questionnaire. The anonymous self-administrated questionnaire had four parts: background (age, gender, duration of sports activity, training sessions per week, and previous education on orofacial injury); self-reported experience of orofacial injury; preventive practice including mouthguard and helmet use; and knowledge of emergency management of orofacial injuries. Preventive practice and knowledge scores were calculated by summing up the scores of corresponding questions (possibly range 0-7). A linear regression model and the Pearson correlation served for statistical analysis. RESULTS: Totally, 295 athletes with a mean age of 14.56 ± 1.91 years participated in the study. A quarter (n = 74, 25.1%) of athletes stated that they had received training on prevention of orofacial injuries. Only 3.7% (n = 11) of the participants reported the use of custom-made mouthguards, and 62% (n = 183) reported a positive history of orofacial injuries. A significant relationship existed between self-reported orofacial injury and age (ß = - 0.32, p < 0.001), hours of training per week (ß = 0.12, p = 0.037), type of sport (ß = 0.11, p = 0.049), and previous training on orofacial injuries (ß = - 0.14, p = 0.010). No difference existed in the history of orofacial injury between females (n = 114) and males (n = 69) (p = 0.374). The mean score of self-reported preventive practice and knowledge of management of orofacial injuries was 3.53 ± 1.82 (out of 7) and 1.67 ± 1.10 (out of 7), respectively. Age (ß = 0.19, p = 0.002) and history of orofacial injury (ß = - 0.15, p = 0.010) were associated with the score of self-reported preventive practice. Female athletes (ß = 0.11, p = 0.048) and athletes who exercised more per week (ß = 0.15, p = 0.012) had significantly more knowledge on management of orofacial injuries. CONCLUSION: Adolescent athletes had relatively undesirable preventive practices and a distinct lack of knowledge. The high occurrence of self-reported orofacial injuries indicates the importance of more education and stricter rules for the athlete population.

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.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey.

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics' and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics' and institutions' attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = -1.31, p = 0.006) and upper-middle income (UMICs) (B = -0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = -0.55, p < 0.0001) and in research only (B = -1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = -0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Impact of career choice motivation on academic burnout in senior dental students: A cross-sectional study.

BACKGROUND: Motivation triggers all human activities including learning and lack of career motivation can lead to decreased efficiency. This study assessed the association between academic burnout and career choice motivation in senior dental students. METHODS: This cross-sectional study was performed on senior dental students of all four dental schools in Tehran in 2017. Dental students voluntarily filled out a 33-item questionnaire that comprised three sections. The first section included the Burnout Clinical Subtype Questionnaire (BCSQ-SS) with 12 questions addressing academic burnout. The second section consisted of 8 questions about career choice motivation, and the third section concentrated on 13 questions dealing with demographics. The individual scores of each section and the total scores were reported. The factor analysis of 8 questions about dental career choice motivation yielded 3 factors of social status and security, altruism, and others' advice motivations. The data were analyzed using regression test. RESULTS: Totally, 131 students filled out the questionnaire (response rate = 86%). The total score of academic burnout was 38.89% ± 1.13%. The highest and the lowest burnout scores belonged to the domains of "overload" (46.69%± 1.46%) and "neglect" (31.98%± 1.32%), respectively. The most and the least frequently mentioned source of motivation for choosing dentistry were high income and failing to enter other fields, respectively. The burnout score was higher in students with altruism motivations (P = 0.007) and lower in students with others' advice motivations (P = 0.004). The burnout score was higher in students with inadequate or moderate financial support from the family and lower in students whose mothers' educational level was high-school diploma or lower. CONCLUSION: Senior dental students in Tehran encountered different levels of academic burnout. In the present study, low financial support and altruism as career choice motivations were associated with higher level of academic burnout.

Development and evaluation of a gamified smart phone mobile health application for oral health promotion in early childhood: a randomized controlled trial.

BACKGROUND: This study aimed to design a gamified smartphone application (app) and assess its efficacy for education of mothers regarding oral healthcare of their children. METHODS: In this pretest-posttest controlled clinical trial, a simple app and a gamified version of it were designed to enhance the oral health knowledge and practice of mothers. The app contains information about early childhood caries, health diet, sugars, baby-oral hygiene, fluoride effect, fluoride toothpaste, tooth-brushing training video and regular dental visits. The opinion of experts and 3 mothers were obtained and both apps were revised accordingly. The intervention was implemented on mothers of preschoolers referring to the specialty dental clinic of Tehran School of Dentistry in 2019. The mothers were randomly allocated to the simple app or gamified app group. Before the intervention, all mothers filled out a questionnaire regarding oral health knowledge and practice, and their demographics were collected. The plaque index (PI) of children was also measured. The mothers filled out the same questionnaire 1 month after the intervention, and the PI of children was measured again. Paired t test and linear regression model were used for statistical analysis of the data. RESULTS: Totally, 58 mother and child pairs entered the study; 40% of children were boys. The mean age of children was 4.7 ± 1.2 years. The mean knowledge score of mothers in the pretest was 10.5 and 11.3 in simple app and gamified app group, respectively, which changed to 13.1 and 14.3, respectively in the posttest. The mean practice score of mothers was 4.4 and 4.8 in simple app and gamified app groups, respectively in the pretest, which changed to 8.5 and 8, respectively in the posttest. The mean dental plaque index of children in the pretest was 0.8 and 1 in simple app and gamified app groups, respectively, which changed to 0.5 and 0.5, respectively in the posttest. Children had better Plaque control in gamified app group (P < 0.05). CONCLUSION: After 1 month, both apps effectively improved the oral-health knowledge and practice of mothers while oral hygiene as a result of plaque control was superior in children of mothers using the gamified app. Trial registration IRCT, IRCT20131102015238N2. Registered 24 February 2019-Retrospectively registered, https://fa.irct.ir/trial/36600 .

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.

Impact of Health Promotion Interventions on Early Childhood Caries Prevention in Children Aged 2-5 Years Receiving Dental Treatment Under General Anesthesia.

Aim: This study was conducted to evaluate the impact of health promotion interventions on early childhood caries prevention in 2-5 year-olds receiving dental treatment under general anesthesia. Materials and Methods: Thirty-seven mother-child couples presenting to the clinic of the Dental School of Tehran University of Medical Sciences for treatment under general anesthesia were randomly divided to two groups: 19 couples in the pamphlet and fluoride varnish four times a year, and 18 couples in the pamphlet plus six phone call reminders and fluoride varnish four times a year. A standard questionnaire on demographics and children oral health-related practice of parents was completed by respondents. On children's oral examination, the Simplified Oral Hygiene Index (OHI-S), dmft, and the presence of new white spot lesions (WS) were recorded in both phases. At the final stage, Early Childhood Oral Health Impact Scale (ECOHIS) was completed by parents. The length of follow-up was 24 months. Results: In both groups, there was an increase in the number of mothers who knew how to brush their children's teeth as well as the number of mothers who brushed their children's teeth (P < 0.05). In the reminder group, an improvement occurred in the mothers' perception of their perceived ability to make their children brush their teeth twice a day (P = 0.03). Clinical examination revealed a significant decrease in the OHI-S (from 1.9 ± 0.8 to 1.15 ± 0.5) and the number of WS (from 8.5 ± 5.5 to 0.08 ± 0.5) in both groups on the follow-up visit. The mean dmft was 11.0 ± 4.0 with a mean d component of 10.56 ± 4 at the baseline, which decreased significantly to 1.44 ± 1.96 after dental treatment. No significant increase was seen in new caries in the intervention groups. There was no significant difference in the ECOHIS score between the two groups. Conclusion: The similar impact of both interventions suggests the possibility of applying the simpler one, i.e., the educational pamphlet, fluoride varnish and frequent follow-ups. However, in the reminder group, the mothers' perception of their perceived ability to make children brush their teeth twice a day was improved.

Burn out among Iranian dental students: psychometric properties of burnout clinical subtype questionnaire (BCSQ-12-SS) and its correlates.

BACKGROUND: Burnout Clinical Subtype Questionnaire (BCSQ-12-SS) is a short valid questionnaire for assessment of burnout in students. The aim of the present study was to evaluate the psychometric properties of Persian-translated version of the BCSQ-12-SS and assess the burn out clinical subtypes and their correlates in dental students. METHODS: In this psychometry study, the BCSQ-12-SS questionnaire in domains of overload (4 questions), lack of development (4 questions), and neglect (4 questions) was translated to Persian and back-translated. Six experts determined the content and face validity of the Persian version. The questionnaire was then piloted on 167 dental students of Tehran University of Medical Sciences in 2016. Data were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) for construct validity and Linear Regression modeling in IBM SPSS and AMOS SPSS. To assess reliability, the questionnaire was filled out by 15 students twice and Kappa coefficient and Composite Reliability (CR) were calculated. RESULTS: Content validity Ratio (CVR) and Content Validity Index (CVI) values and Cronbach's alphas were all over 0.8. Kappa coefficient ranged from 65 to 82.5%. The average burnout score was 29.6 out of maximum score of 60. There were no significant differences in burnout scores across the different semesters (8,10 and 12). Financial support by the family significantly affected the total score of burnout and lack of development. In addition, gender, mother's education, residential status of student, preparing for post graduate exam and financial support by the family affected the overload. CONCLUSION: The BCSQ-12-SS has good psychometric properties and therefore can be used to assess burnout in IRANIAN dental students. The BCSQ-12-SS may provide an opportunity to identify individuals at risk for burn out and provide counseling to assist in dental student development.

Oral health status and its determinants among opiate dependents: a cross-sectional study.

BACKGROUND: In addition to numerous general health problems, drug dependents manifest various oral health disorders. Our aim was to investigate the oral health status and its determinants among in-treatment opiate dependents. METHODS: As part of a comprehensive cross-sectional survey on opiate dependents admitted to methadone maintenance centers in Tehran, Iran, we conducted a clinical study in two centers from different socioeconomic areas. A trained dentist conducted face to face interviews and clinical oral examinations based on World Health Organization (WHO) criteria for Decayed, Missing, Filled Teeth (DMFT) index and Community Periodontal Index (CPI) on volunteer patients. Student's t-test, Mann-Whitney U, Kruskal Wallis, and Chi2 tests, in addition to linear and logistic regression models served for statistical analysis (p < 0.05). RESULTS: A total of 217 patients (98% men), with a mean age of 43.6 years (SD 12.3) participated in the study. Opium was the main drug of abuse reported by 70% of the participants followed by crystalline heroin (22%). Of the participants, 24.4% were totally edentulous. The mean DMFT score of participants was 20.3 (SD 7.8). Missing teeth comprised the main part of the index followed by decayed and filled teeth. Older patients (p < 0.001) and the patients with a lower socioeconomic status (p = 0.01) had higher DMFT scores. None of the dentate patients had a healthy periodontium. Maximum CPI mostly consisted of shallow pockets (66%) followed by calculus in 15%, deep pockets in 11%, and bleeding in 8% of the participants. Older participants (p = 0.02) and those who started drug abuse at a younger age (p = 0.01) were more likely to develop periodontal pockets. CONCLUSIONS: Opiate dependents had a poor oral health status in terms of the dentition status and periodontal health. Missing teeth comprised the main part of their dental caries history and none had a healthy periodontium. Oral health care should be integrated into the package of general health services available in treatment centers.

Evaluation of an educational intervention in oral health for primary care physicians: a cluster randomized controlled study.

BACKGROUND: Family physicians are in frequent contact with patients, and their contribution to oral health promotion programs could be utilized more effectively. We implemented an oral health care (OHC) educational seminar for physicians and evaluated its impact on their knowledge retention in OHC. METHODS: We conducted an educational trial for primary care physicians (n = 106) working in Public Health Centers in Tehran city. We launched a self-administered questionnaire about pediatric dentistry, general dental, and dentistry-related medical knowledge and backgrounds. Physicians in intervention group A (n = 38) received an educational intervention (Booklet, Continuous Medical Education (CME), and Pamphlet), and those in group B (n = 32) received only an OHC pamphlet. Group C (n = 36) served as the control. A post-intervention survey followed four months later to measure the difference in the physicians' knowledge; the Chi-square test, ANOVA and linear regression analysis served for statistical analysis. RESULTS: The intervention significantly increased the physicians' oral health knowledge scores in all three domains and their total knowledge score (p <  0.001). Those physicians who had lower knowledge scores at the baseline showed a higher increase in their post-intervention knowledge. The models showed no associations between the background variables and the knowledge change. CONCLUSION: The primary care physicians' OHC knowledge improved considerably after an educational seminar with a reminder. These findings suggest that OHC topics should be included in physicians' CME programs or in their curriculum to promote oral health, especially among non-privileged populations.

Qualitative exploration of barriers and facilitators of dental service utilization of pregnant women: A triangulation approach.

BACKGROUND: Pregnant women are vulnerable to a wide range of oral health conditions that could be harmful to their own health and future child. Despite the usefulness of regular dental service utilization in prevention and early detection of oral diseases, it is notably low among pregnant women. In this qualitative study, we aimed to explore barriers and facilitators influencing pregnant women's dental service utilization. METHODS: Using a triangulation approach, we included pregnant women (n = 22) from two public health centers, midwives (n = 8) and dentists (n = 12) from 12 other public centers in Tehran (Iran). Data was gathered through face-to-face semi-structured interviewing and focus group discussion methods. The analysis of qualitative data was performed using conventional content analysis with MAXQDA10 software. RESULTS: Reported barriers of dental service utilization among pregnant women were categorized under emerging themes: Lack of knowledge and misbelief, cost of dental care, physiological changes, fear and other psychological conditions, time constraint, dentists' unwillingness to accept pregnant women treatment, cultural taboos and lack of interprofessional collaboration. Solutions proposed by dentists, midwives and pregnant women to improve dental care utilization during pregnancy were categorized under three themes: Provision of knowledge, financial support and establishing supportive policies. CONCLUSIONS: Understanding perceived barriers of dental service utilization during pregnancy can serve as baseline information for planning and formulating appropriate oral health education, financial support, and legislations tailored for lower income pregnant women, midwives and dentists in countries with developing oral health care system.

Comparison between autogenous iliac bone and freeze-dried bone allograft for repair of alveolar clefts in the presence of plasma rich in growth factors: A randomized clinical trial.

PURPOSE: This study aimed to compare the effectiveness of alveolar cleft repair using iliac bone and freeze-dried bone allograft (FDBA) in the presence of plasma rich in growth factors (PRGF). MATERIALS AND METHODS: Patients with unilateral alveolar cleft (n = 32) were randomly allocated to either the iliac plus PRGF group or the FDBA plus PRGF group. CBCT images were obtained before and 6 months after the surgery to assess the regenerated bone volume. Paired t-tests and two-way analysis of variance (ANOVA) were applied to analyze the data using SPSS 16.0 software. RESULTS: The patients' mean age was 15 ± 5.7 years (range = 8-27). In the iliac plus PRGF group, the mean volume of cleft before the surgery and the mean regenerated bone volume 6 months after were 1.67 ± 0.66 and 1.14 ± 0.47 cm3, respectively. The corresponding values were 1.5 ± 0.54 and 0.72 ± 0.23 cm3 in the FDBA plus PRGF group. The remaining bone to cleft volume ratio was not associated with grafting time (secondary or tertiary) and the original cleft volume. Iliac bone reinforced with PRGF was more successful than FDBA plus PRGF in repairing alveolar cleft (p = 0.007). CONCLUSION: Due to the poor performance of the allograft, autografts should still be preferred in spite of possible donor site morbidity.