Patients' perspectives on the use of artificial intelligence in dentistry: a regional survey.

The use of artificial intelligence (AI) in dentistry is rapidly evolving and could play a major role in a variety of dental fields. This study assessed patients' perceptions and expectations regarding AI use in dentistry. An 18-item questionnaire survey focused on demographics, expectancy, accountability, trust, interaction, advantages and disadvantages was responded to by 330 patients; 265 completed questionnaires were included in this study. Frequencies and differences between age groups were analysed using a two-sided chi-squared or Fisher's exact tests with Monte Carlo approximation. Patients' perceived top three disadvantages of AI use in dentistry were (1) the impact on workforce needs (37.7%), (2) new challenges on doctor-patient relationships (36.2%) and (3) increased dental care costs (31.7%). Major expected advantages were improved diagnostic confidence (60.8%), time reduction (48.3%) and more personalised and evidencebased disease management (43.0%). Most patients expected AI to be part of the dental workflow in 1-5 (42.3%) or 5-10 (46.8%) years. Older patients (> 35 years) expected higher AI performance standards than younger patients (18-35 years) (p < 0.05). Overall, patients showed a positive attitude towards AI in dentistry. Understanding patients' perceptions may allow professionals to shape AI-driven dentistry in the future.

Knowledge, Dental Anxiety, and Patient Expectations During the COVID-19 Pandemic

Abstract Objective: To assess the knowledge, dental anxiety, and expectations regarding dental services during the COVID-19 pandemic. Material and Methods: The respondents were Indonesian citizens above 18 years old. An online Google survey was administered using a structured questionnaire with a snowball sampling technique. Survey items comprised knowledge related to COVID-19, dental anxiety assessed using the modified DAS (Dental Anxiety Scale) and expectations regarding dental services using four dimensions of dental service quality. All questionnaires were tested for reliability and indicated acceptable and good agreement. The data were analyzed descriptively. Results: A total of 553 responses were analysed. Most respondents were female (72.9%), 76.7% knew of recommendations to postpone dentist visits and 86.8% knew methods of preventing COVID-19 transmission. More than 70% of respondents knew the precaution procedures in the dental office during COVID-19, and only 27.9% had moderate-severe anxiety. Most respondents' expectations regarding dental services during the pandemic era were related to the quality domain of reliability and responsiveness. Conclusion: Respondents knew about COVID-19 transmission and prevention, emergency conditions warranting a visit to the dentist and the procedures used at the dental office. Most respondents stated that they were not anxious about visiting a dentist during the pandemic. The respondents expect the dentist to provide sufficient information to improve oral health and treatment plan.

Held still or pressured to receive dental treatment: self-reported histories of children and adolescents treated by non-specialist dentists in Hordaland, Norway.

AIM: This study aimed to estimate the prevalence of a self-reported history of restraint in children and adolescents when receiving dental care by non-specialist dentists and to assess differences in dental fear and anxiety (DFA), intra-oral injection fear, and trust in dentists between patients with and without a self-reported history of restraint. METHODS: An electronic cross-sectional survey was distributed to all 9 years old (n = 6686) and 17 years old (n = 6327) in the Public Dental Service in Hordaland County, Norway, in 2019. For statistical evaluation, we generated descriptive statistics and Mann-Whitney U tests. RESULTS: The response rate ranged between 43.5 and 59.9% for the different questions. The prevalence of a self-reported history of being held still against one's will during dental treatment and pressured to undergo dental treatment against one's will was 3.6% and 5.1%, respectively. In general, these patients reported higher DFA, and higher intra-oral injection fear compared with those without such histories of restraint. Patients who had reported being held still against their will during dental treatment had significantly higher distrust in dentists than those who did not report restraint (p < 0.001). CONCLUSION: To feel pressured to receive dental treatment and to be held still against one's will overlap with the concepts of psychological and physical restraint. Patients with a self-reported history of restraint recorded significant differences in DFA, intra-oral injection fear, and trust in dentists compared to those who did not report restraint. Future studies should explore the role that restraint may play in relation to a patient's DFA, intra-oral injection fear, and trust in dentists.

[Perceptions of the organization and the practice of dental healthcare by the professionals working in prisons]. / Perceptions de l'organisation et de la pratique des soins buccodentaires en milieu carcéral par les professionnels.

INTRODUCTION: Few studies have been conducted on the role and position of dental surgeons in prisons. Interestingly though, dental surgeons perform in a peculiar working environment, since the organizations are divided into two administrative structures: penitentiary and hospital administrations. Stakeholders’ perceptions of both the current oral healthcare organization in prisons and the interactions between prison and hospital administrations’ professionals will be at the core of this study. PURPOSE OF RESEARCH: This article aims at assessing hospital and penitentiary administration agents’ perceptions of oral healthcare practice in prison. This assessment is based on the analysis of 18 semi-structured interviews with prison directors, integration and probation officers, coordinating physicians and dentists. To do this, three analytical categories were established containing first contextual elements, second each professional culture and last actual and potential interactions. RESULTS: Dentists were identified as specific agents within prison’ sanitary units because of the separation between dentistry and other medical specialties. Indeed, the relation to the body, to self-image and self-esteem along with the specific positioning regarding medical secrecy and expertise required by prison staff make dentistry practice a separate field in prison. CONCLUSION: The results of this study highlight dentists’ specific positioning in prison sanitary units. They could be identified as helpful intermediaries in the building of interactions between penitentiary and hospital administrations thanks to the specificity of the dentistry practice which simultaneously provides health care and promotes the reconstruction of self-image and self-esteem, which are key factors of reintegration.

Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour.

Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups. Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. One hundred and seventy participants completed standardized questionnaires about dental anxiety (Dental Anxiety Scale (DAS), and dental self-efficacy perceptions (dSEP)). They also answered newly composed questionnaires on oral hygiene behaviours and attitudes, current and childhood dental experiences as well as parental oral hygiene education and care. Four independent factors, namely attitude towards oral hygiene, attitude towards one's teeth, sense of care and self-inspection of one's teeth were extracted from these questionnaires by rotating factor analysis. The results of the questionnaires were correlated by means of linear regressions. Dental anxiety was related to current negative emotions when visiting a dentist and negative dental-related experiences during childhood. High DAS scores, infantile and current negative experiences showed significant negative correlations with the attitude towards oral hygiene and one's teeth. Dental anxiety and current negative dental experiences reduced participants' dental self-efficacy perceptions as well as the self-inspection of one's teeth. While parental care positively influenced the attitude towards one's teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one's teeth and parental care. Dental anxiety, dental experiences, parents' care for their children's oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one's own oral cavity as well as the autonomous control of one's own dental health. Therefore, oral hygiene instruction and the development of patient-centred preventive approaches should consider these factors.

Dental Therapists in the United States: Health Equity, Advancing.

BACKGROUND: Dental therapists (DTs) are primary care dental providers, used globally, and were introduced in the United States (US) in 2005. DTs have now been adopted in 13 states and several Tribal nations. OBJECTIVES: The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care. METHODS: The study compiled a comprehensive document library on the dental therapy movement including literature, grant documents, media and press, and gray literature. Key stakeholder interviews were conducted across the spectrum of engagement in the movement. Dedoose software was used for qualitative coding. Themes were assessed within a holistic model of oral health equity. FINDINGS: Health equity is a driving force for dental therapy adoption. Community engagement has been evident in diverse statewide coalitions. National accreditation standards for education programs that can be deployed in 3 years without an advanced degree reduces educational barriers for improving workforce diversity. Safe, high-quality care, improvements in access, and patient acceptability have been well documented for DTs in practice. CONCLUSION: Having firmly taken root politically, the impact of the dental therapy movement in the US, and the long-term health impacts, will depend on the path of implementation and a sustained commitment to the health equity principle.

Predictors of use of dental care by children in north-central Appalachia in the USA.

Use of dental services in childhood, especially preventive care, is associated with many important oral health outcomes throughout life. The Andersen behavioral model of healthcare utilization posits that predisposing characteristics, enabling resources, and need factors predict utilization in oral and other healthcare domains. Inequities that produce lower utilization of dental services in north-central Appalachia have been documented in comparison to the USA generally. Additionally, within Appalachia, there are disparities, such as those across different states related to varying public policies and resources supporting healthcare. Predictors of dental utilization in Appalachia have been a focus in adults, but less so in children. The aim of the current study was to understand predictors of dental utilization in children in north-central Appalachia in order to inform future research about how to intervene to address these disparities. In this study, there were 1,178 children, ages 1 through 10 years, from selected representative counties in West Virginia and Pennsylvania, along with a parent/caregiver, who were part of the Center for Oral Health Research in Appalachia (COHRA1) cohort. Use of dental services by their child was indicated by parents/caregivers, who also reported on sociodemographic, dental care-related anxiety and fear, and values and attitudes associated with oral healthcare. Results indicated that use of professional dental services by children was related to child age, dental anxiety and fear, and parental oral health values and attitudes. Older children in this age group, those who evidenced more dental care-related anxiety and fear, and whose parent/caregiver placed higher value on oral health and healthcare for themselves, were more likely to have had a dental visit in the past year.

Pediatric patients' reasons for visiting dentists in all WHO regions.

BACKGROUND: Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral health-related quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists' assessment, the study aimed to evaluate whether pediatric dental patients' oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. METHODS: Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns fit into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients' oral health problems and prevention needs were computed. FINDINGS: Data from 101 dentists treating children only and 523 dentists treating children and adults were included. For 90% of pediatric patients, their current oral health problems fit well in the four OHRQoL dimensions. For 91% of oral health problems they intended to prevent in the future were related to these dimensions as well. Both numbers increased to at least 96% when experts analyzed dentists´ explanations of why some oral health problems would not fit these four categories. CONCLUSIONS: The study revealed the four fundamental components of dental patients, i.e., the four OHRQoL dimensions (Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact) are also applicable for pediatric patients, regardless of whether they have current or future oral health concerns, and should be considered when measuring OHRQoL in the pediatric dental patient population.

Association Between Tobacco Smoking, Dental Status and Self-perceived Oral Health in Elderly Adults in Colombia.

Tobacco smoking is responsible for several health problems, including mouth diseases. The aim of the present study was to establish the association between smoking and dental status and self-perceived oral health in a large group of elderly Colombian adults. Analysis of 18,937 survey records of participants aged ≥ 60 years old was conducted. Information regarding age, sex, skin color, socioeconomic level, education, marital status, denture use, partial tooth loss or edentulism, Geriatric Oral Health Assessment Index (GOHAI) and tobacco smoking was retrieved from the database. A descriptive analysis and multivariate logistic regression analysis were performed. Half of the participants were edentulous in the maxilla while mandibular teeth were more frequently retained in more than 60% of the participants. After adjusting for sex and age, smoking consistently increased the odds of partial or complete edentulism in the maxilla (OR 1.05; 95% CI 1.02-1.09) and mandible (OR 1.04; 95% CI 1.00-1.08). Nonetheless, the increase in the odds in the mandible was not statistically significant. The habit of smoking was associated with increased tooth loss that in the long-term may result in poor oral health affecting the quality of life of elderly people.

Ensino em saúde LGBTQI+ para alunos de odontologia: uma revisão sistemática / LGBTQI + healtheducation for dental students: a systematic review

Objetivo: investigar, na literatura odontológica, estudos que abordem diferentes aspectos do ensino de temas LGBTQI+ (Lésbicas, Gays, Bissexuais, Transexuais, População Quer, Intersexo e outros) nos cursos de odontologia e quais são as abordagens pedagógicas sugeridas para reduzir preconceitos e discriminação no atendimento odontológico. Metodologia: uma busca foi conduzida nas bases de dados PubMed, Scopus, Web of Science e BVS/Bireme, até julho de 2017. Após a remoção de duplicatas, dois revisores independentes conduziram a seleção dos artigos. Resultados: a busca inicial resultou em 924 títulos. Após leitura completa, apenas oito completaram os critérios de inclusão. Os artigos incluídos nesta revisão demonstraram que alunos, lideranças estudantis e administradores reconhecem medidas de suporte, apoio e inclusão existentes. Algumas instituições apresentaram em seu currículo temas relacionados com a população LGBTQI+, porém, relacionadas frequentemente com doenças. Essa cobertura é apontada como fraca e insuficiente para o atendimento qualificado. Apenas dois estudos apresentaram métodos para o ensino de questões LGBTQI+; entretanto, apenas um avaliou qualitativamente seus resultados. Conclusão: existe uma grande carência de estudos que descrevam abordagens e métodos de ensino de temas LGBTQI+ na odontologia.(AU)

Objective: to investigate in the dental literature studies addressing different aspects of LGBTQI+ (Lesbians, Gays, Bisexuals, Transsexuals, Queer Population, Intersex and others) education topics and the approaches used to reduce inequalities and prejudices in dental care. Methods: a search was conducted in the PubMed, Scopus, Web of Science and BVS/Bireme databases, until July 2017. After removing duplicates, two independent reviewers conducted the selection of articles. Results: the initial search resulted in 924 titles. After complete reading, eight studies completed the inclusion criteria. The articles included in this review demonstrated that students, student leaders and administrators recognize support and inclusion measures. Some institutions presented topics related to the LGBTQI+ population in their curriculum, but often related to diseases. This approach was identified as weak and insufficient for a qualified service. Only two studies presented methods for teaching LGBTQI+, but only one assess qualitative results. Conclusions: there is a lack of studies that approach the education of LGBTQI+ topics mainly related to teaching methodologies.(AU)

Desarrollo de un plan integral para la adquisición de la competencia de comunicación en el grado en Odontología de la Universidad del País Vasco: un reto institucional / Development of a comprehensive plan for the acquisition of communication skills in the degree in dentistry at the University of the Basque Country: an institutional challenge

INTRODUCCIÓN: La praxis de la odontología requiere el desarrollo adecuado de las habilidades de comunicación, competencia transversal que ha de estar garantizada durante los estudios de grado. Esto supone un reto institucional, por cuanto las facultades han de poner los mecanismos académicos para evaluar el nivel de desarrollo de dichas habilidades. MÉTODOS: Se plantea un plan integral de carácter colaborativo para el desarrollo de las habilidades comunicativas en el grado en Odontología de la Universidad del País Vasco/Euskal Herriko Unibertsitatea, que contempla cuatro fases: a) recogida y socialización de la información sobre el desarrollo de la competencia; b) diseño de desarrollo trasversal y vertical de la competencia; c) implementación y análisis de resultados; y d) recogida de evidencias del proceso y divulgación de los resultados. RESULTADOS: Tras la detección de las fortalezas y debilidades, se definieron 40 habilidades comunicacionales, estructuradas en cinco bloques (comunicación oral con pacientes/familiares, comunicación oral con otros profesionales, comunicación escrita con pacientes/familiares, comunicación escrita con otros profesionales sanitarios y técnicas de comunicación odontólogo-paciente) y tres niveles de desempeño (identificación de la información, desempeño con alta supervisión y desempeño autónomo con moderada supervisión). Para su desarrollo, se diseñaron 19 actividades formativas y de evaluación, actualmente en implementación. CONCLUSIÓN: El plan se está desarrollando con éxito, y las evidencias del proceso, recogidas en un portafolio, servirán para el seguimiento de la titulación

INTRODUCTION: The practice of dentistry requires the proper development of communication skills, which must be guaranteed during undergraduate studies. This is an institutional challenge, because the schools have to put the academic mechanisms to evaluate the level of development of these skills. METHODS: The University of the Basque Country (UPV/EHU) is developing a comprehensive collaborative plan that includes four phases: a) collection and socialization of information on the current situation of the development of communication skills; b) design of a training plan to improve these skills, c) training plan implementation and results assessment, and d) gathering evidence of the process and dissemination of the results. RESULTS: After the detection of strengths and weaknesses in communication, we defined a total of 40 communication skills, structured in five blocks (oral communication with patients/family members; oral communication with other professionals; written communication with patients/family members; written communication with other health professionals, and dentist-patient communication techniques) and three levels of performance (identifying information, performance with high supervision, autonomous with moderate supervision). For its development, 19 training and evaluation activities were designed, currently being implemented. CONCLUSION: The plan is being developed successfully and the evidence of the process, collected in a portfolio, will be used to monitor the degree

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

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

What Happens at a Dental Surgery When the Patient is a Child with Autism Spectrum Disorder? An Italian Study.

Oral health care can be a difficult experience for a child with Autism Spectrum Disorder (ASD), for their family and for the dentist. The purpose of this study is to provide an understanding of the challenges experienced by the three aforementioned figures during oral care treatment. A cohort of 275 parents of typical development children (TD), 57 parents of children with ASD (3-15 years old) and by 61 dentists, completed two different multiple choices questionnaires. The data obtained show a great difficulty in the treatment of children with ASD as seen by the dentists and by the parents. This is due to: caregivers' demographic issues; difficulties encountered before and during the dental examination; scarce presence of experts in ASD treatment.

O sofrimento psicológico de pacientes com patologias bucais à perspectiva da Psicologia / Psychological distress of patients with oral pathologies in the perspective of Psychology

Objetivo: Investigar as naturezas do sofrimento psicológico ocasionado por problemas bucais. Métodos: Esta pesquisa adotou uma abordagem qualitativa e caráter exploratório-descritivo, utilizando-se da entrevista semiestruturada e da observação assistemática como instrumentos de coleta de dados. Para a análise dos dados da pesquisa foi utilizada a análise do conteúdo e a amostra da pesquisa foi de 25 participantes, entre homens e mulheres, que buscaram atendimento odontológico em uma clínica de Manaus, Amazonas, Brasil nos meses de maio e junho de 2020. Resultados: todos os participantes foram afetados psiquicamente pela existência de problemas bucais, o que gerou problemas de autoestima e autoimagem. Com o início do tratamento, os participantes relataram uma melhora na autoestima, não minimizando, contudo, outros tipos de sentimentos provenientes do problema bucal, como desconforto, dores e bullying. Conclusão: Problemas bucais podem gerar sofrimento psicológico aos pacientes, prejudicando sua autoimagem, acarretando, muitas das vezes, no isolamento e dificuldade em relacionar-se com outras pessoas. Portanto, um sorriso harmonioso é importante não somente por questões estéticas, mas para que o indivíduo se sinta bem consigo mesmo.

Aim:To investigate the nature of psychological distress caused by oral problems. Methods: This research adopted a qualitative approach and exploratory-descriptive design, employing, as data collection tools, a semi-structured interview and an unsystematic observation. For the research's data analysis, content analysis was used, and the research sample featured 25 participants, between men and women, who sought out dental care in a Manaus, Amazonas, Brazil dental clinic between May and June 2020. Results: All the participants were affected psychologically by the existence of oral problems, which led to self-esteem and self-image problems. With the start of treatment, the participants reported an improvement in self-esteem and self-image, not minimizing, however, other types of feelings that come with oral problems, like discomfort, pain, and bullying. Conclusion: Oral problems can cause psychological pain to the patients, harming their self-esteem and self-image, often leading to isolation and trouble interacting with other people. Therefore, a harmonious smile is important not only for esthetic reasons, but also for individuals to feel good about themselves.

Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT.

BACKGROUND: Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. OBJECTIVES: To test effectiveness and assess the cost-benefit of different dental recall intervals over a 4-year period. DESIGN: Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost-benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. SETTING: UK primary care dental practices. PARTICIPANTS: Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. INTERVENTIONS: Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. MAIN OUTCOMES: Clinical - gingival bleeding on probing; patient - oral health-related quality of life; economic - three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. RESULTS: A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of -0.91 (95% confidence interval -5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of -0.98 (95% confidence interval -5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval -3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval -1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. LIMITATIONS: Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. CONCLUSIONS: Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. FUTURE WORK: Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN95933794. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.

Traditionally, dentists have encouraged both patients at low risk and patients at high risk of developing dental disease to attend their dental practices for regular 6-month 'check-ups'. There is, however, little evidence available for either patients or dentists to use when deciding on the best dental recall interval (i.e. time between dental check-ups) for maintaining oral health. In this study, we wanted to find out, for adult patients who regularly attend the dentist, what interval of time between dental check-ups maintains optimum oral health and represents value for money. A total of 2372 adults who regularly attended 51 different dental practices across Scotland, Northern Ireland, England and Wales were involved. Patients aged 18 years or over who received all or part of their care as NHS patients were randomly allocated to groups to receive a check-up either every 6 months, at an individualised recall interval based on their own risk of oral disease (risk-based recall), or every 24 months (if considered at low risk by their dentist). The recruited adults completed questionnaires at their first trial appointment and then every year of the 4-year study. Their attendance at recall appointments was recorded and they received a clinical assessment taken by study staff at the end of their involvement at year 4. After 4 years, there was no evidence of a difference in the oral health of patients allocated to a 6-month or variable risk-based recall interval. For patients considered by their dentists to be suitable for a 24-month recall interval, there was no difference between those in the 24-month, 6-month or risk-based recall intervals. However, people greatly value and are willing to pay for frequent dental check-ups. The recall strategy that offers the best value for money to patients and the NHS, therefore, depends on what people and decision-makers wish to value within a health-care system.

Oral hygiene practices and utilization of oral healthcare services among in-school adolescents in Calabar, Cross River State, Nigeria.

INTRODUCTION: oral health mirrors an individual´s general health, hence, proper care should be taken to prevent oral diseases and conditions. An estimated 3.9 billion people worldwide are affected by oral conditions, and adolescents are at increased risk due to diet choices and hormonal changes. This study aimed at determining the oral hygiene practices, awareness and utilization of oral healthcare services among in-school adolescents in Calabar Municipality. METHODS: a descriptive cross-sectional study design was employed in studying these variables among in-school adolescents (10-19 years) in secondary schools (JSS1-SSS2) using a self-administered, semi-structured questionnaire. Data were entered and analyzed with EPI-Info. Cross tabulations of variables were conducted using Chi-square test with significance level of 5%. RESULTS: a total of 335 students participated in the study with 228 (68.1%) and 136 (40.6%) reporting that they are aware of and have utilized oral healthcare services (OHS), respectively. There was no statistically significant association between age (p=0.923), gender (p=0.351) and type of school (p=0.497) respectively with awareness and utilization of OHS. Toothache/pain and presumed good dental health respectively were the main reasons for the usage and non-utilization of these services. Time-to-use of oral health services after the onset of toothache/pain was within five days (75.7%). CONCLUSION: the utilization rate of OHS did not match up to the level of awareness of these services with pain being the main driver for utilization. Increased awareness of oral healthcare through health education and oral healthcare demonstrations among adolescents is highly recommended as part of school health programs.

Benefits of Oral Health Education at Women, Infant, and Children (WIC) Clinic Visits: Assessments of Parent's Oral Health Beliefs, Behaviors and Dental Access in O'ahu, Hawai'i.

Improving oral health outcomes in Hawai'i for children and families remains a high priority. Children in the state are leading the nation with the highest caries rates, while women before, during, and after pregnancy are failing to receive regular and necessary dental care resulting in poor health outcomes. To answer for this need, an educational intervention was conducted among families enrolled in the Kapi'olani Medical Center for Women and Children's Women, Infant, and Children program (WIC) in O'ahu. The project included the following activities: (1) identification the oral health beliefs and behaviors of families, (2) providing oral health education to families, and (3) reassessing beliefs and behaviors in 3-6 months to document the impact of theeducation session. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women. Of the 81 families, 40 representing84 children completed the follow-up oral health questionnaire. Results of the assessment and education demonstrated a positive impact on the family's oral health behaviors. Parents were 6.61 times as likely to report using fluoride toothpaste in the follow-up visit compared to their initial visit (95% confidence interval [CI] = 3.12-14.00). Additionally, statistically significant changes were noted in the frequency of children's daily tooth brushing (odds ratio [OR] = 2.15, 95% CI = 1.33-3.46), as well as in the incidence of children receiving fluoride varnish application over time (OR = 2.66, 95% CI = 1.50-4.73). These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai'i.

The extent and nature of dental anxiety in Australians experiencing homelessness.

High dental anxiety is a major barrier to accessing dental care and has been found to be experienced to a greater extent in the homeless population. No studies have investigated the extent and nature of dental anxiety in Australians experiencing homelessness and was the aim of this study. Participants were recruited from four not-for-profit organisations in inner Brisbane using convenience and snowball sampling. The Dental Anxiety Questionnaire (DAQ) and the Index of Dental Anxiety and Fear (IDAF-4C+ ) questionnaire and oral health screening were completed by people experiencing homelessness in Brisbane, Australia, and compared to population norms. Descriptive statistics were calculated, and non-overlapping confidence intervals considered significantly different. The majority of the participants (n = 66) were male, a current smoker, unemployed and living in government supported housing. Most of the participants rated their oral health as poor/fair (n = 46, 71.9%) and their oral function as good or higher (n = 34, 53.1%). Using the single-item DAQ, 28.2% (n = 19) of people experiencing homelessness had high dental anxiety, compared to 16% of the general Australian population. The mean summed IDAF-4C+ fear module score was 18.02 (CI 15.60-20.43), which was significantly higher than the Australian population (µ = 14.40, CI 13.93-14.86). The highest mean score in the IDAF-4C+ stimulus module was feeling embarrassed or ashamed as anxiety inducing (µ = 2.27, CI 1.89-2.64) and was significantly different from the general Australian population (µ = 1.40, CI 1.33-1.47). The poorer overall self-rated oral health by the homeless population may induce feelings of embarrassment or shame, highlighting the differing psychosocial aspect to dental anxiety experienced by this population. Managing dental anxiety is needed to improve accessing to dental care for this population. Multidisciplinary care from social workers, mental health workers and dental practitioners may be beneficial in managing fear.

Access to Dental Care and Depressive Illness: Results from the Korea National Health Nutrition Examination Survey.

Background and Objectives: Recent evidence suggests that oral health is associated with various systemic diseases including psychiatric illnesses. This study examined the association between depression and access to dental care in Korean adults. Materials and Methods: A cross-sectional evaluation was performed using data from the Sixth Korea National Health and Nutrition Examination Survey 2014. The general characteristics of the participants, the current depression status, and issues with access to dental care were collected to evaluate the factors for not being able to make dental visits according to care needs. Results: The study population comprised a total of 5976 participants who were 19 years of age and older and represented 40.7 million Koreans. A multivariable logistic regression analysis with weighted observations revealed that participants with current depressive illness were about two times more likely to express that they could not make dental visits in spite of their perceived care needs (adjusted odds ratio (OR) = 2.097; 95% confidence interval (CI) 1.046-4.203). The reasons for not making dental visits included financial problems, perceived importance of the dental problem, and fear of visiting dental professionals. Conclusions: Korean adults with current depressive illness were less likely to make dental visits when they had dental care needs. To improve dental health accessibility for patients with depressive illness, coordinated efforts can be considered involving multidisciplinary health care professionals.

Imaginarios, creencias y actitudes que influyen en la consulta odontopediátrica en menores de 3 años / Social imaginary, beliefs and attitudes that influence the pediatric dental consultation in children under 3 years old

Los niños menores de 3 años son llevados a la consulta médica de forma rutinaria. Sin embargo, la consulta odontológica es muy infrecuente a esta edad. Por otro lado, los elementos que median en la decisión de consultar o no al dentista en esta etapa son hasta el momento poco conocidos. El objetivo de este estudio cualitativo fue identificar imaginarios, creencias y actitudes que podrían intervenir en la decisión de realizar una consulta odontopediátrica en pacientes menores de 3 años. Se aplicaron 10 entrevistas semi-estructuradas a mujeres profesionales, madres de niños entre 8 y 36 meses. Luego, se realizaron 4 entrevistas grupales en profundidad a 13 mujeres que no habían participado en la entrevista inicial. A pesar del alto nivel educativo de las madres se detectó un importante desconocimiento en temas de salud oral. Las madres sub-dimensionan el potencial de la consulta odontopediátrica en esta etapa. En segundo lugar, las madres consideran que una consulta odontopediátrica en este período es abrumadora considerando las altas demandas de esta etapa de la maternidad. Es importante mejorar los conocimientos de salud oral en este grupo de la población y modificar estrategias de prevención y promoción de la salud en preescolares.

Parents of children under 3 years old frequently take their children to medical check-ups. However, dental check-ups are infrequent at this age. The reasons behind this behavior are not well known. The present qualitative study aimed to identify social imaginary, attitudes and beliefs that may influence the decision to consult a pediatric dentist in parents of children under 3 years old. Semi-structured interviews were applied to 10 working mothers that had children between 8 and 36 months. These interviews allowed the identification of the most significant issues to be explored in this study. Afterwards, a total of 13 mothers who did not participate in the initial interviews were divided in 4 groups and in-depth group interviews were performed. Mothers involved in this study had a high educational level. However, their knowledge concerning oral health issues was very poor. Moreover, a frequent finding in this study was the notion that a dental consultation at this stage is considered to be overwhelming by these women because of their very demanding duties . It is important to increase the knowledge regarding oral health topics in this group and to modify policies about oral health at this stage of a child's life.