Development and acceptability of behavioral interventions promoting mothers' brushing of pre-school children's teeth: The preparation phase of the multi-phase optimization strategy framework.

BACKGROUND: Early childhood caries can be prevented through regular parental-supported toothbrushing, indicating the importance of behavior modification interventions targeting parents. Mobile oral health (m-oral health) interventions are gaining increased popularity although their production is not always based on solid theoretical frameworks and evidence about the efficacy of individual intervention components is not available. The Multiphase Optimization Strategy (MOST) offers a framework to develop complex m-oral health interventions and assessing the efficacy of individual components. AIM: This study describes the development and assesses the acceptability of 3 intervention components using MOST to promote mothers' brushing of their preschool children's teeth. METHODS: The Theory of Planned Behavior guided the development of 3 components: motivational interviewing (MI), storytelling videos (STVs), and oral health promotion messages (OHPMs). A researcher received training to conduct MI. Twenty-four OHPMs were developed, and 14 STVs scripts were developed based on the "And, But, Therefore" framework. A feasibility pilot study was conducted to determine the optimization objective and assess mothers' preferences regarding the frequency and timing of receiving the intervention components. The mothers participated in a semi-structured interview to assess the acceptability of the components using 7 open-ended questions based on the framework of acceptability and thematic analysis was used to analyze the qualitative data. The mothers also responded to questions assessing the perceived and experienced acceptability of the components using close-ended questions. Descriptive statistics were presented as means and standard deviations for continuous variables and median and interquartile range for categorical variables. RESULTS: Sixteen mothers were included. The mothers expressed positive affective attitude towards the interventions. They felt the components served as "good reminders" to brush their children's teeth. However, "time" was a burden for the mothers. 80% of the mothers preferred receiving the OHPMs and STVs once per week, from 8 pm to 2 am (50%), and 60% indicated they can set 15-30 min to receiving the interventions. CONCLUSION: The 3 components were acceptable to the mothers. The OHPMs and STVs will be sent to the mothers once per week, between 8 pm to 2 am. The MI and follow-up phone calls will be limited to 15 min.

Factors affecting contraceptive use among currently married women in Iraq in 2018.

Level of contraceptive use is one of the primary proximate determinants of fertility level. Among Arab countries, Iraq experiences high fertility rates, especially among adolescents. According to the 2018 Iraq Multiple Indicator Cluster Survey (IMICS 2018), 52.8% of currently married Iraqi women used a contraceptive method (36.1% used modern methods, and 16.7% used traditional methods). A multiple multinomial logistic regression model was adopted to investigate the demographic, socioeconomic, fertility, and cultural determinants of contraceptive use among currently married, nonpregnant Iraqi women based on the 2018 Iraq Multiple Indicator Cluster Survey data. The main findings indicated that women using modern contraceptive methods had more children, did not experience the death of a child, and had no desire for more children. Moreover, they were married before age 21, had at least an upper secondary education, had access to mass media, used the internet, belonged to a low or middle wealth category, and lived in urban Kurdistan. Kurdish women prefer to use traditional methods. The results suggest that family planning programmes should target women who live in southern/central areas of Iraq, as they were the least likely to use contraceptives, and motivate Kurdish women to use modern contraceptives rather than traditional contraceptives.

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults.

BACKGROUND: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions' association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. METHODOLOGY: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents' educational level). Multilevel binary logistic regression was used for analysis. RESULTS: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). CONCLUSION: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study.

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = - 0.03, 95% CI - 0.05, - 0.02) and higher compulsive checking and reassurance-seeking (B = - 0.02, 95% CI - 0.03, - 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = - 0.02, 95% CI - 0.03, - 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.

Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey.

(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.

Cigarettes' use and capabilities-opportunities-motivation-for-behavior model: a multi-country survey of adolescents and young adults.

The use of cigarettes among adolescents and young adults (AYA) is an important issue. This study assessed the association between regular and electronic-cigarettes use among AYA and factors of the Capability-Motivation-Opportunity-for-Behavior-change (COM-B) model. A multi-country survey was conducted between August-2020 and January-2021, Data was collected using the Global-Youth-Tobacco-Survey and Generalized-Anxiety-Disorder-7-item-scale. Multi-level logistic-regression-models were used. Use of regular and electronic-cigarettes were dependent variables. The explanatory variables were capability-factors (COVID-19 status, general anxiety), motivation-factors (attitude score) and opportunity-factors (country-level affordability scores, tobacco promotion-bans, and smoke free-zones) controlling for age and sex. Responses of 6,989-participants from 25-countries were used. Those who reported that they were infected with COVID-19 had significantly higher odds of electronic-cigarettes use (AOR = 1.81, P = 0.02). Normal or mild levels of general anxiety and negative attitudes toward smoking were associated with significantly lower odds of using regular-cigarettes (AOR = 0.34, 0.52, and 0.75, P < 0.001) and electronic-cigarettes (AOR = 0.28, 0.45, and 0.78, P < 0.001). Higher affordability-score was associated with lower odds of using electronic-cigarettes (AOR = 0.90, P = 0.004). Country-level-smoking-control policies and regulations need to focus on reducing cigarette affordability. Capability, motivation and opportunity factors of the COM-B model were associated with using regular or electronic cigarettes.

Oral manifestations in young adults infected with COVID-19 and impact of smoking: a multi-country cross-sectional study.

Background: Oral manifestations and lesions could adversely impact the quality of people's lives. COVID-19 infection may interact with smoking and the impact on oral manifestations is yet to be discovered. Objectives: The aim of this study was to assess the self-reported presence of oral lesions by COVID-19-infected young adults and the differences in the association between oral lesions and COVID-19 infection in smokers and non-smokers. Methods: This cross-sectional multi-country study recruited 18-to-23-year-old adults. A validated questionnaire was used to collect data on COVID-19-infection status, smoking and the presence of oral lesions (dry mouth, change in taste, and others) using an online platform. Multi-level logistic regression was used to assess the associations between the oral lesions and COVID-19 infection; the modifying effect of smoking on the associations. Results: Data was available from 5,342 respondents from 43 countries. Of these, 8.1% reported COVID-19-infection, 42.7% had oral manifestations and 12.3% were smokers. A significantly greater percentage of participants with COVID-19-infection reported dry mouth and change in taste than non-infected participants. Dry mouth (AOR=, 9=xxx) and changed taste (AOR=, 9=xxx) were associated with COVID-19- infection. The association between COVID-19-infection and dry mouth was stronger among smokers than non-smokers (AOR = 1.26 and 1.03, p = 0.09) while the association with change in taste was stronger among non-smokers (AOR = 1.22 and 1.13, p = 0.86). Conclusion: Dry mouth and changed taste may be used as an indicator for COVID-19 infection in low COVID-19-testing environments. Smoking may modify the association between some oral lesions and COVID-19-infection.

Child discomfort and parental acceptability of silver diamine fluoride and alternative restorative treatment: A randomized controlled clinical trial.

OBJECTIVES: To compare pain perception of young children treated with SDF and ART, as well as their parents' acceptability of both modalities. METHODS: Eighty, 3 to 8-years old children, having at least one deciduous asymptomatic tooth with active caries, as defined by the ICDAS II scores 4, 5, 6 were randomly assigned into two groups; SDF for caries arresting in the test group, and ART for caries removal in the control group. Pain perception was assessed using Sound, Eye, Motor scale (SEM), whereas parental acceptability was assessed using a self-administered questionnaire. RESULTS: Patients treated with SDF reported significantly less discomfort and pain compared to the ART group, with a mean SEM of 3.70 ± 1.47 and 6.18 ± 3.06, respectively (p < 0.001). A significantly higher mean parental acceptability score was detected for SDF treatment (31.85 ± 2.30) than ART treatment (26.75 ± 3.60), p < 0.001, with regard to the treatment duration, child comfortability and quality of treatment (p < 0.001). The only dimension showing more satisfaction for the ART treatment was esthetics of anterior teeth (p= 0.01). CONCLUSIONS: Parental acceptability was higher for the SDF caries treatment of primary teeth compared to ART treatment, especially in relation to the shorter intervention time, child comfortability and acceptance as well as quality of treatment. CLINICAL SIGNIFICANCE: The shorter average time needed and the ease of application of SDF on cavitated primary lesions, in addition to parental acceptability, place SDF in an advantageous position over the ART on clinical level.

Comparison of two minimally invasive restorative techniques in improving the oral health-related quality of life of pregnant women: a six months randomized controlled trial.

BACKGROUND: Women tend to delay dental treatment due to misconceptions regarding the safety of dental procedures during pregnancy which may negatively affect their quality of life. Minimally invasive restorative techniques offer alternatives for caries treatment and can improve their oral health-related quality of life (OHRQoL) during this stage. METHODS: A randomized controlled clinical trial was conducted in 2019 and included 162 pregnant women visiting public family health centers in Alexandria, Egypt, with mild to moderate dental pain due to caries. Participants were randomly assigned into Papacarie-Duo group (n = 82) and ART group (n = 80). The outcome variable was percent change in OHRQoL (oral health impact profile, OHIP-14) after 6 months. T test/Mann Whitney U test were used to compare groups and a multivariable linear regression analysis was conducted to evaluate the factors affecting the outcome variable. RESULTS: A significant reduction (P < 0.002) was noted in OHIP-14 between baseline and 6 months indicating improvement in OHRQoL in the Papacarie-Duo and ART groups (16.26% and 18.91%, P = 0.120 in bivariate analysis). Multiple linear regression revealed significantly greater reduction in OHIP-14 scores in the Papacarie-Duo than the ART group (regression coefficient = 4.03, 95% confidence interval: 0.652, 7.409, P = 0.020). CONCLUSION: Minimally invasive restorative techniques, such as ART and chemo-mechanical caries removal using Papacarie- Duo can improve the OHRQoL of pregnant women suffering from mild to moderate pain due to dental caries. Significantly more improvement was noted in the Papacarie-Duo group after adjusting all other variables. Trial registration ID NCT04619264 ( https://clinicaltrials.gov/ ); November 6 2020, retrospective registration. ( https://clinicaltrials.gov/ct2/show/NCT04619264?term=NCT04619264&draw=2&rank=1 ).

The impact of minimally invasive restorative techniques on perception of dental pain among pregnant women: a randomized controlled clinical trial.

BACKGROUND: The public dental care sector is striving to fulfill the preventive and restorative needs of Egyptians, including pregnant women, who may not receive timely care due to misconceptions about dental treatment during pregnancy. Because of this, they are likely to suffer dental pain, with higher risk of infection affecting their offsprings. AIM OF THE STUDY: To compare the effectiveness of chemo-mechanical caries removal using Papacarie-Duo and Atraumatic Restorative Treatment (ART) in reducing dental pain among pregnant women. MATERIALS AND METHODS: A randomized controlled clinical trial was conducted, in 2019, and included 162 pregnant women visiting family health centers in Alexandria, Egypt, with dental pain due to dental caries not extending to pulp. Patients were randomly assigned to Papacarie-Duo group (n = 82) and ART group (n = 80) after stratification by number of treated surfaces. The outcome variables were reduction in pain assessed using Visual Analogue Scale (VAS), satisfaction with treatment, and time taken for dental caries removal. T test/ Mann Whitney U test were used to compare groups and Freidman test was used to compare change across time. RESULTS: Pain reduction was significantly greater in the Papacarie-Duo than the ART group (81.55% and 69.43%, P = 0.001). Patients in the Papacarie-Duo group were significantly more satisfied with treatment than those in the ART, immediately after treatment (mean = 9.60 and 8.00, P = < 0.01) and after 6 months (mean = 9.63 and 8.16, P = < 0.01). Significantly less excavation time was recorded in the Papacarie-Duo group than in the ART group (mean = 10.38 and 11.56 min, P = < 0.01). CONCLUSION: Chemo-mechanical caries removal using Papacarie-Duo is more effective in reducing dental pain, in pregnant women, and is associated with more satisfaction and less excavation time than ART. TRIAL REGISTRATION: ID NCT04573608 ( https://clinicaltrials.gov/ ); 5/10/2020, retrospective registration.

Parenting practices and oral health status in rural areas in Egypt: a household survey.

BACKGROUND: Parenting practices influence children's health and development. The present study assessed the association between parenting practices and oral health status of children living in rural areas in Egypt. METHODS: A cross-sectional household survey including 190 households and 392 children was conducted from May 2019 to January 2020 in four villages in Egypt. Data were collected through clinical examination and interview-based questionnaires of children. Clinical examination assessed caries (DMFT and dft), oral hygiene and gingival condition. Parenting practices were assessed using the short version of the Alabama Parenting Questionnaire (APQ) and oral health practices were assessed using the WHO questionnaire-child form. Four linear regression models were used to assess the relationship between four outcome variables (oral health indicators: (DMF, df, plaque and gingival indices) and parenting practices and oral health behaviors (exposure) after adjusting for potential confounders. Regression coefficients (B), 95% confidence intervals (CI) and model adjusted R2 were calculated. RESULTS: Complete questionnaires and clinical data were available for 392 children (response rate = 86.34%). The mean (SD) age = 9.93 (3.05) with 54.60% females. Most children (67.60%) had caries in their primary teeth, mean ± SD of df = 2.94 ± 3.10, while only 27.30% had caries in their permanent teeth, mean DMF ± SD = 0.57 ± 1.13. There was a statistically significant difference between parenting practices of both fathers and mothers (p < 0.001, < 0.001, < 0.001, 0.008 and < 0.001 for the five parenting constructs). The adjusted R2 of the models that included parenting practices (for DMF = 0.168, for df = 0.400, for plaque index = 0.061 and for gingival index = 0.090) were similar to the models that included oral health behaviors (for DMF = 0.197, for df = 0.421, for plaque index = 0.059 and for gingival index = 0.084). CONCLUSION: The association between oral health status and parenting practices which- although not statistically significant- was similar in impact to that between oral health behaviors and oral health status, highlighting the importance of parenting practices to oral health.

The recent increase in contraceptive discontinuation in Egypt.

This study sought to establish whether recent changes in discontinuation of contractive use and switching in Egypt can be considered an important cause of the unexpected increase in overall fertility and slight fall in contraceptive prevalence in the country. The analysis was based on calendar data from the 2008 and 2014 Egyptian DHS. Single/multiple decrement life tables were built to calculate contraceptive discontinuation rates and examine these by reasons for discontinuation focusing on three methods: IUDs, pills and injectables. The unit of the analysis was 'segment of use', defined as a continuous period of use/non-use of a contraceptive method (in months). It was found that over the period 2008-2014 the rise in the 'all method' discontinuation rate was mainly due to the shift away from IUDs to hormonal methods, which have higher discontinuation rates. Segments of use were more likely to be discontinued for 'method/service-related' reasons than for 'reduced need' reasons. This was due to an increase in contraceptive failure and side-effect/health concerns. Also, 'the desire to get pregnant' increased to become the second highest reason-specific discontinuation rate. This has coincided with a recent increase in ideal family size in Egypt. About half of the women who reported discontinuing for reasons related to method/services switched to another method, while the rest became subject to the risk of an unintended pregnancy. The rate of switching, rather than stopping use, increased for IUDs, remained the same for pills and increased slightly for injectables, indicating an improvement in switching behaviour. However, a marked high percentage of switchers moved to less-effective methods. If these issues are not addressed, many women in Egypt have an unmet need for contraception, leading to an increase in unintended pregnancies. Specific interventions that would greatly benefit the family planning programme in Egypt include improvement in counselling at the time of IUD insertion and removal and the reduction in failure rates for hormonal methods.

Dentists' intention to report suspected violence: a cross-sectional study in eight Arab countries.

OBJECTIVES: This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour. METHODS: A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders. RESULTS: The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report. CONCLUSION: Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries.

Arab dentists' refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools.

OBJECTIVE: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention. MATERIALS AND METHODS: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients. RESULTS: The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54). CONCLUSIONS: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

Factors affecting student participation in extra-curricular activities: A comparison between two Middle Eastern dental schools.

OBJECTIVE: This study was conducted to assess the level of participation of dental undergraduate students in extracurricular activities (ECAs) and the factors affecting this participation. METHODS: The study included dental students enrolled in undergraduate programs at the Faculty of Dentistry, Alexandria University, Egypt, and the College of Dentistry, University of Dammam, Saudi Arabia. A questionnaire was developed to collect background information about students, their participation in ECAs, and time allocated for these activities. Students were asked about their perceptions of the relationship between ECAs and academic studies, and their reasons for participating in and satisfaction with ECAs. RESULTS: The study included 199 students from Alexandria and 146 students from Dammam, with response rates of 99.5% and 73%, respectively. The percentages of those reporting ECA participation were 27.1% and 43.8%, respectively, mostly in community service, sports, and social activities. About 60% of students did not think that ECAs affected their studies, although the perceived difficulty of balancing ECAs and academics was associated with lower odds of participation (odds ratio = 0.51). Most students participated in ECAs to socialize and make friends, and the majority was dissatisfied with school-organized ECAs (52% and 59%, respectively). Gender and/or perceived relation between ECAs and academic studies affected actual participation in ECAs in one school but not the other. CONCLUSIONS: ECA participation among these students was low. Gender and perception of ECAs in relation to academic studies affected ECA participation differently in the two schools. Better planning and management of ECAs that incorporate students' preferences and reasons for participation is needed. Gender issues and the relationship between ECAs and academic performance should be addressed in relation to school and social characteristics.

Association of Healthy Eating, Juice Consumption, and Bacterial Counts with Early Childhood Caries.

PURPOSE: To investigate the association of healthy diet, snacking, and bacterial count with early childhood caries in a group of preschool children in Alexandria, Egypt. METHODS: Sixty preschoolers were divided into three groups: (1) caries-free children; (2) children with early childhood caries (ECC); and (3) children with severe early childhood caries (S-ECC). Saliva was cultured to determine bacterial counts. A questionnaire collected information about background, oral health practices, and snacking habits. A 24-hour food recall form assessed dietary intake and was analyzed using the Health Eating Index 2005. RESULTS: Compared to caries-free children, children with ECC and S-ECC had significantly lower odds of drinking juices (odds ratio equals 0.10 and 0.02). Caries-free children had significantly higher Healthy Eating Index values than children with ECC and S-ECC (P=0.003 and P<0.0001). Total streptococci and Streptococcus mutans counts were significantly higher in children with ECC and S-ECC (P<0.0001 for all), whereas Streptococcus sanguis counts were lower (P=0.04 and P=0.01). CONCLUSIONS: Drinking juices was associated with less early childhood caries and severe early childhood caries among preschoolers. Snacking on sweets was associated with more S-ECC. Healthy eating, brushing, and bacterial counts were not significantly associated with ECC or S-ECC in multivariate regression.

Assessment of the Accuracy of Two Dental Screening Methods Used in a School Setting.

PURPOSE: To assess the accuracy of two screening methods used by dentists in the Health Insurance Organisation in Alexandria, Egypt aiming at identifying children who need referral for treatment. MATERIALS AND METHODS: The study included 45 dentists who examined 30 children using exclusively visual screening (VS) and visual screening with tongue blade (VSTB). A benchmark dentist examined the same group of children using mirror and probe (MP). VS and VSTB were compared to MP. Sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively) were calculated. The effect of dentist's gender, year of graduation and having postgraduate studies on the accuracy of the two methods was assessed. RESULTS: VS had greater accuracy than VSTB. Both methods had a Sn and Sp>82%. The PPV of both methods was >97%, whereas that of NPV was ≤44%. Males and recent graduates performed better than females and senior dentists when using VS and VSTB methods. CONCLUSIONS: It is questionable whether screening using VS or VSTB can ensure effective referral of children for treatment. Further studies are needed to assess other aspects of screening, including whether referred children actually seek care and whether screening improves children's oral health.

Assessment of the Healthy Eating Index-2005 as a predictor of early childhood caries.

BACKGROUND: Early childhood caries (ECC) is a multifactorial disease resulting mainly from a time-specific interaction of micro-organisms with sugars on a tooth surface. AIM: The purpose of this study was to assess the relationship of dietary intake, as measured by the Healthy Eating Index-2005 (HEI-2005) to ECC. DESIGN: Cross-sectional analytical study. METHODS: Sixty preschool children were equally divided into three groups according to their caries experience [Group 1: caries-free children, group 2: children with ECC, group 3: children with severe early childhood caries (S-ECC)]. The decayed (non-cavitated or cavitated), missing (due to caries) and filled tooth surfaces (dmfs) score was determined through visual dental examination for each child. Questionnaires were collected recording the demographic characteristics of the families as well as 24-h food recall forms capturing the dietary intake of the children during the previous day. Accordingly, the HEI-2005 score was calculated for each child. RESULTS: The caries experience of the children in this study was significantly associated with their age. Caries-free children showed significantly higher 'Whole fruit', 'Milk', 'Sodium' and total HEI-2005 scores. CONCLUSIONS: The study findings illustrate the prominent protective role played by healthful dietary practices against dental caries in preschool children.