What is the impact of nicotine pouches on oral health: a systematic review.

BACKGROUND: Increase in nicotine pouch (NP) users, particularly among the young, is a matter of concern requiring a comprehensive understanding of its short- and long-term oral health implications. The objective of this research was to systematically review potential oral side-effects associated with NP usage. METHODS: This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Scopus, Cochrane Trial, and Google Scholar) were searched for relevant studies up to February 2024. Modified Newcastle-Ottawa Scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool were used to assess the quality and bias of the included studies. RESULTS: Three studies were included for this review, two from Europe and one from USA, and considered of a total of 190 participants. All studies were deemed to have a high risk of bias. Participants used NP for periods ranging from 1 month to 10 years. Among these studies, only one study provided information on the usage pattern between 1 and 5 units for an average of 11 ± 7 min per session. Oral mucosal changes at the site of placement were common among NP users. Oral lesions varied from slight wrinkling to various white lesions, seemingly related to the NP units consumed per day and their duration of usage. Other oral side effects included dry mouth, soreness, gingival blisters, and a strange jaw sensation. CONCLUSIONS: Research on the use of NP and its effect on oral health are currently limited. The use of NP should take into consideration the short-and-long-term effects, especially on oral health. Further studies are crucial to understand oral health implications associated with NP usage. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number CRD 42,024,500,711.

The association between smoking and smokeless tobacco use with dental caries among Pakistani patients.

BACKGROUND: Tobacco use is widely recognised as a significant risk factor for oral cancer and periodontal diseases. However, the relationship between various types of tobacco use and dental caries has been inconsistent. This study aimed to determine the association between smoking and smokeless tobacco and dental caries among patients in a tertiary care hospital in Quetta, Pakistan. METHODS: This cross-sectional study was conducted from November 2020 to March 2021 among patients in a tertiary care hospital in Quetta, Pakistan. Oral examinations and interviews were performed according to the WHO Oral Health Survey basic methods (5th edition) to determine dental caries status, tobacco use, and oral health behaviours. The odds ratio and binary logistic regression were analysed to assess the association between the types (smoking tobacco, smokeless tobacco, and use of both types), duration, and frequency of tobacco use and high caries level (DMFT ≥ 5). RESULTS: Four hundred participants aged 18-65 were included, and 67.8% were tobacco users. Use of both smoking and smokeless tobacco (aOR = 14.7, 95%CI = 1.87-115.96, p = 0.011), smokeless tobacco only (aOR = 5.90, 95%CI = 1.89-18.37, p = 0.002), and smoking only (aOR = 2.18, 95%CI = 1.23-3.88, p = 0.008) were associated with significantly increased risk of high caries. Using tobacco for longer periods and more frequently daily also significantly increases the risk of high caries. CONCLUSION: Smoking and smokeless tobacco are significantly associated with high dental caries after adjusting for other factors. Due to the high severity of dental caries and the high prevalence of tobacco use among Pakistani patients in this study, it is highly recommended to strengthen policies aimed at reducing tobacco usage, including smokeless forms.

E-cigarette use, perceived risks, attitudes, opinions of e-cigarette policies, and associated factors among Thai university students.

INTRODUCTION: Although many countries, including Thailand, currently ban the sale of e-cigarettes, their use continues to rise, especially among young adults. Since the study of e-cigarette use among university students is limited, this study aimed to determine factors associated with e-cigarette use and explore university students' attitudes toward e-cigarettes, perceived risk, and opinion of e-cigarette policies. METHODS: This cross-sectional study was conducted among undergraduate students using convenience sampling in a university, in central Thailand from November 2022 to February 2023. A self-administered online questionnaire was distributed to 19 faculties representing health sciences, science and technology, social and arts faculties, and the International College. RESULTS: A total of 548 students completed the online questionnaire, and 20.4% reported ever using e-cigarettes, while 40% of e-cigarette users were unsure about the nicotine content. About 28% agreed, and 22% were unsure whether e-cigarettes could help quit smoking. Most students perceived that e-cigarettes are addictive and harmful, while about half of the participants agreed with the policy related to e-cigarettes in Thailand. Students with positive attitudes towards e-cigarettes were more likely to use e-cigarettes (AOR=1.15; 95% CI: 1.08-1.22), and those with lower perceived risk (AOR=0.89; 95% CI: 0.82-0.96) and who disagreed with e-cigarettes policy (AOR=0.93; 95% CI: 0.89-0.97) were more likely to use e-cigarettes. Personal income and having friends who use e-cigarettes were the significant predictors for e-cigarette use, while studying in the faculty of science and technology was a predictor of using e-cigarettes last month. CONCLUSIONS: Although the perceived risk was high, about half of the students thought that e-cigarettes could help them quit smoking and were unsure or disagreed with e-cigarette banning policies. Attitude, perceived risk, policy opinions, personal income, and having friends who used e-cigarettes, were associated with e-cigarette use. Thus, correcting misunderstandings and increasing risk perceptions about e-cigarettes must be advocated among university students.

Knowledge, Attitudes, and Practices Towards ECC Prevention in Thai Medical Personnel.

OBJECTIVE: This study aimed to identify the knowledge, attitudes, and practices related to the prevention of early childhood caries (ECC) amongst medical personnel in well-baby clinics (WBC). METHODS: Participants were 152 health care professionals, including public health officers, nurses, and physicians, working in WBC in Chonburi Province, Thailand. Participants completed a 6-part online questionnaire asking about demographic data, knowledge and attitudes related to ECC, ECC prevention practices, collaboration, referral systems, and suggestions for improving collaboration between dental and medical personnel in WBC. RESULTS: Whilst most participants had high levels of knowledge about oral care instructions, tooth brushing frequency, and cariogenic foods and beverages, they knew less about recommendations for timing of the first dental visit, fluoride concentration in toothpaste, and the time for exfoliation of primary teeth. There were significant differences in the proportions of correct answers to questions related to the first dental visit and bottle feeding and in total knowledge scores between physicians and other health care professionals. Most participants demonstrated a positive attitude towards ECC prevention. More than 70% of participants always advise parents on oral hygiene and nutrition related to ECC prevention, but only 29% always refer patients to see dental personnel. Attitudes, collaboration, and referral systems were significantly associated with ECC prevention practices, but not knowledge. CONCLUSIONS: This study demonstrates that attitudes, collaboration, and referral systems are key contributors to ECC prevention amongst Thai medical personnel. In addition to training programmes, consistent interprofessional policy and referral systems should be formulated, especially in primary care settings.

Effects of the salivary gland massage program in older type 2 diabetes patients on the salivary flow rate, xerostomia, swallowing and oral hygiene: A randomized controlled trial.

AIM: To evaluate the effect of a salivary gland massage program to improve salivary flow, swallowing, and oral hygiene in older type 2 diabetes patients. METHODS: This randomized control trial consisted of 73 older diabetes patients with a low salivary flow; 39 and 34 in intervention and control groups, respectively. The intervention group received a salivary gland massage from a trained dental nurse, whereas the control group received a dental education. The salivary flow rates were collected using spit methods at baseline, 1-month and 3-month follow up. All participants were examined for the objective and subjective symptoms of xerostomia, the Simplified Debris Index and the Repetitive Saliva Swallowing Test. RESULTS: After 3 months, the resting (0.32 vs 0.14 mL/min, P < 0.001) and stimulating salivary flow (3.66 vs 2.83 mL/min, P = 0.025) in the intervention group was significantly higher than the control group. The objective symptoms in the intervention group were significantly lower than the control group after 3 months (1.41 vs 2.26, P = 0.001). The participants who were able to swallow least three times in the Repetitive Saliva Swallowing Test in the intervention group increased by 35.89% after 3 months, whereas the control group increased by 8.82%. Oral hygiene was improved in both groups, but the changes in the intervention were significantly greater than in the control group. CONCLUSIONS: The 3-month salivary glands massage program increases the salivary flow rate, and affects swallowing, objective dry mouth symptoms and oral hygiene in older patients with type 2 diabetes. Geriatr Gerontol Int 2023; 23: 549-557.

Effect of dentures and dietary advice on protein intake in older Thai adults with missing posterior occluding teeth.

OBJECTIVE: To compare the effectiveness of dentures with dietary advice and dentures alone on protein intake in older Thai adults. BACKGROUND: Dentures combined with nutritional advice may improve protein intake in older adults with posterior tooth loss. However, evidence is limited, especially in developing countries. METHODS: A randomised-control trial including 69 older adults with less than four pairs of posterior occluding teeth was conducted for 3 months. The experimental group received dentures and dietary advice based on the Health Belief Model (HBM); the control group received dentures alone. Three-day dietary records were collected and protein intake was assessed using INMUCAL-NUTRIENTS V.4.0 software at baseline, 1 month, and 3 months after the intervention. Data were analysed using a t-test, Mann-Whitney U test, chi-square test, and repeated-measure ANOVA. RESULTS: Both groups reported significantly increased protein intake (control group = 0.4, 0.5, 0.6 g kg BW-1 d-1 , intervention = 0.4, 0.6, 0.7 g kg BW-1 d-1 , at baseline, 1 month and 3 months, respectively). However, participants in the experimental group had significantly higher total protein (36.3 vs. 39.8 g/d, P = .032) and animal protein intake (18.9 vs. 23.2 g/day, P = .020) than those in the control group at 3 months after the intervention; plant protein intake was similar (10.9 vs. 11.5 g/day, P = .923). In addition, the HBM scores of the experimental group were higher than those of the control group after the intervention (P < .001). CONCLUSION: Dentures combined with dietary advice significantly increased the total and animal protein intake of older people with posterior tooth loss more than dentures alone. To maintain optimal protein intake, dental practitioners should incorporate dietary advice when providing dental prostheses to older adults with posterior tooth loss.

What factors influence mothers' behavior regarding control of their children's sugary snack intake?: An application of the Theory of Planned Behavior.

OBJECTIVE: The aim of this study was to examine the factors influencing mothers' behavior regarding control of their children's sugary snack intake based on the Theory of Planned Behavior. METHODS: We used a self-administered questionnaire to collect data from the mothers of preschool children on the factors related to their behaviours influencing control of their children's sugary snack intake, namely attitudes, subjective norms, perceived behavioural control, self-efficacy, age, income and educational level. Spearman's rank correlation coefficient and multiple regression were used to analyse the relationships between the mother's behaviours and the predicting variables. RESULTS: In total, 293 mothers from the Pediatric Dental Clinic, Mahidol University, participated. The factors significantly related to controlling sugary snack intake were self-efficacy (r = 0.425, P < 0.01), perceived behavioural control (r = 0.361, P < 0.01), attitude (r = 0.302, P < 0.01) and subjective norms (r = 0.211, P < 0.01). For belief-based measures, control beliefs were the most significant factors related to behaviour, followed by normative beliefs but not behavioural beliefs. Having time and the child's willingness were perceived as important control factors, while family and other mothers were significant referents for mothers in controlling sugary snack behaviour. Multiple linear regression analysis revealed that self-efficacy (ß = 0.339, P < 0.001), attitude (ß = 0.190, P = 0.002) and mother's age (ß = 0.110, P = 0.043) were significant predictors in controlling the child's sugary snack intake. CONCLUSION: The factors influencing mothers regarding control of their children's sugary snack intake were self-efficacy, attitude and age of the mother. Oral health education on controlling children's sugary snack intake should focus on developing the mother's self-efficacy and perception of control. The results may not be generalisable to mothers in different cultures or socio-economic status.

WHO Global Consultation on Public Health Intervention against Early Childhood Caries.

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

Caries with Dental Fluorosis and Oral Health Behaviour Among 12-Year School Children in Moderate-Fluoride Drinking Water Community in Quetta, Pakistan.

OBJECTIVE: To determine the prevalence of dental caries and its relationship with dental fluorosis, oral health behaviour and dietary behaviour among 12-year school children in moderate-fluoride drinking water community in Quetta, Pakistan. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Government and private schools of Quetta, from November 2012 to February 2013. METHODOLOGY: Atotal of 349 children aged 12-year from 14 randomly selected schools were included. The data collection was done on questionnaire designed for children. Dental caries status was examined by using WHO criteria. RESULTS: Dental caries was found in 81 children (23.2%) with mean DMFT0.61. Boys had 1.6 times more chance to have dental caries than girls. Dental fluorosis was found in 63.6% of children with majority of moderate degree (50.5%). Dental fluorosis status was found significantly associated with dental caries status in children. The children who had mild, moderate and severe fluorosis, had 4 times more chances to develop caries than those who did not have fluorosis. There was no significant association between children's caries status and use of paste, brushing habit, miswak, and visit to the dentist. The use of pastries and juices had a direct relation with the children's dental caries status. CONCLUSION: Dental caries in children of Quetta is not so much frequent as compared to the fluoride deficient countries. However, the high prevalence of moderate dental fluorosis and consumption of pastries and juices resulted in dental caries.

PREVALENCE, SEVERITY AND FACTORS ASSOCIATED WITH DENTAL FLUOROSIS AMONG CHILDREN AGED 8-10 YEARS IN BANGKOK, THAILAND.

This study aimed to evaluate the prevalence and factors associated with dental fluorosis in permanent incisors among children aged 8-10 years in Bangkok, Thailand. We studied 707 children selected by stratified randomization and examined each of them to determine their Dean's fluorosis index. Parents of the studied children were asked to fill out a questionnaire. The study was conducted from July to October 2014. Chi-square test and multiple logistic regression analysis were used to study the association between various factors and fluorosis among study subjects. Dental fluorosis was found in 18.4% of subjects. Sixteen point one percent and 2.3% of 707 subjects had very mild fluorosis and mild fluorosis, respectively. Factors significantly associated with dental fluorosis were family income (aOR=1.77; 95% CI: 1.10-2.86, p=0.02) and history of taking fluoride supplements (aOR=1.66; 95% CI: 1.07-2.61, p=0.03). This study indicated that the prevalence of fluorosis had increased in Bangkok, but the majority was very mild level.

DENTAL FLUOROSIS AND ITS RELATION TO SOCIOECONOMIC STATUS, PARENTS' KNOWLEDGE AND AWARENESS AMONG 12-YEAR-OLD SCHOOL CHILDREN IN QUETTA, PAKISTAN.

This study aimed to determine the prevalence of dental fluorosis and its relationship to socioeconomic status, knowledge, and awareness among 12-year-old school children in Quetta, Pakistan. A cross sectional study was conducted among 349 school children aged 12 years in Quetta, Pakistan. By interviewing children and questionnaire for parents, socioeconomic status, knowledge, and awareness of fluorosis were collected. Dental fluorosis was examined using Dean's Index and Community Fluorosis Index. Prevalence of dental fluorosis was high (63.6%) among children with a majority of moderate and mild degree at 32.1% and 27.5%, respectively. The community fluorosis index was 1.6. While most children and parents had low-to-moderate levels of fluorosis knowledge, the majority of them worried about dental fluorosis. Most parents (84.8%) were uncertain about the condition of fluorosis in their children, and 87.4% did not know about fluorosis before. Dental fluorosis was found significantly associated with gender, family income, and parents' awareness (p ≤ 0.05). Multivariate analysis indicated that gender, and parent's awareness significantly predicted children's dental fluorosis. Knowledge and basic information regarding dental fluorosis is lacking in the community. Efforts in dissemination and communication about dental fluorosis should be increased in order to raise awareness and prevent the dental fluorosis in Pakistan.

Oral health conditions and behaviors among hearing impaired and normal hearing college students at Ratchasuda College, Nakhon Pathom, Thailand.

This study aimed to explore oral health and oral health related behaviors among hearing impaired and normal hearing students at Rachasuda College. The association between socioeconomic factors, hearing status, oral health behaviors, oral hygiene levels and dental caries status were also examined. The students filled out a self-administered questionnaire with assistance of a sign language video to obtain personal and behavior information. A total of 180 students, 83 normal hearing and 97 hearing impaired students completed the questionnaire and underwent an oral examination. The prevalences of caries were 53.6% and 50.6% among students with hearing impairment and normal hearing, respectively (p=0.354). After age stratification, the hearing impaired students aged 18-21 years had significantly less filled teeth (p=0.012), and those older than 21 years had less missing teeth due to caries than normal-hearing students (p=0.023). Poor oral hygiene was found in 51.8% and 42.2% of normal and hearing-impaired students, respectively (p=0.365). Caries status was significantly associated with maternal education level (OR 3.56; 95% CI: 1.52-8.32) and oral hygiene (OR 3.26; 95% CI: 1.64-6.45). The high prevalence of dental caries and poor oral hygiene among college students is alarming. Hearing impairment did not appear to affect the prevalences of these conditions compared to those with normal hearing. Oral health education tools need to be developed and utilized for both normal hearing and hearing impaired college students in Thailand.

Barriers and facilitating factors among lay health workers and primary care providers to promote children's oral health in Chon Buri Province, Thailand.

This study explored the barriers and facilitating factors among lay health workers (LHWs) and primary care providers (PCPs) in implementing a multi-level program to promote children's oral health care in a rural Thai community. Twelve focus groups and 11 in-depth interviews were conducted with LHWs and PCPs who implemented the program from January 2008 to January 2009. The findings showed that the PCPs encountered the constraints of time and human resources, lack of ownership, and problem of coordination with the district hospital. The barriers among LHWs during home visits were related to their assumption of caregiver's knowledge, some conflicting beliefs, and limited counseling skills. The facilitating factors were the training program, caregivers' positive feedback, and available resources such as brochures and toothbrushes. The PCPs identified LHWs as the main facilitators of the program and indicated that policy should be developed for better integrating oral health services in local health Centers. This study provides a better understanding of the barriers and facilitating factors to promote children's oral health in rural Thai communities. While the barriers to integrating oral health activities to primary care are complex, the use of LHWs to promote the children's oral health was feasible and should be supported.

The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children.

Abstract. This study reports the effects of a pilot multi-level oral health intervention on caregivers' oral health practices and their determinants. Quasi-experimental, pretest-posttest evaluations using a comparison group design were employed to evaluate the effectiveness of a proposed intervention for promoting caregiver oral health behavior. The intervention consisted of three components: home visits by lay health workers (LHWs), enhancing oral health education and services at health centers, and community mobilization. These components were designed to target factors at intrapersonal, interpersonal, organizational and community levels based on a Social Ecological Model (SEM). Four oral health behaviors associated with early childhood caries (infant bottle feeding, tooth brushing, snack consumption and fluoride use), and multi-level determinants were assessed during pre- and post-tests. The one-year intervention demonstrated a positive effect on tooth brushing, using toothpaste, and fluoride supplements, but did not have a significant effect on bottle feeding and snack consumption among children. The intervention also had no effect on dental caries; in fact caries increased in both control and experimental groups. The caregiver knowledge, attitudes, outcome expectations, and self-efficacy towards these behaviors were significantly increased in the experimental group after intervention. Caregivers in the experimental group received greater social support by LHWs and health center staff than those in the control group (p < 0.001). The program had an impact on integrating oral health services at health centers and community participation in children's oral health. These findings confirm multi-level factors influence reported oral health behavior, but not outcomes in terms of caries. Process evaluation is needed to determine actual implementation levels, barriers and suggests for modification of the program in the future to improve outcomes in terms of caries.