Visual attention to food cues and dental caries-Are they associated?

BACKGROUND: The role of diet has a key role in dental caries. Attention to food cues can be an indicator for food choices. AIM: This study investigates children's visual attention to images with healthy and unhealthy food cues and correlates it with that of their parents and with their dental caries status using eye-tracking technology. DESIGN: A total of 30 children with and without dental caries and their 30 parents were calibrated to the eye-tracking device (Tobii Nano Pro) to ensure standardisation. Participants viewed matching images of healthy and unhealthy food cues, whereas an eye-tracking device tracked their eye movements. Children had a dental examination and were classified as children with dental caries (n = 15) and their parents (n = 15), and children without dental caries (n = 15) and their parents (n = 15). RESULTS: In children with dental caries, visual attention duration was longer to healthy foods than to unhealthy foods. Likewise, parents of children with dental caries spent longer time looking at healthy foods than unhealthy foods. CONCLUSION: Our preliminary findings indicate a significant association between children's visual attention to healthy and unhealthy food cues and their dental caries status. This underscores the need for further investigation into the correlation between children's and their parents' visual attention to food, particularly in the context of children with dental caries. Such exploration holds promise for informing targeted interventions in food choice education.

Understanding Children's Attention to Dental Caries through Eye-Tracking.

Visual attention is a significant gateway to a child's mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children's oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children's eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants' previously viewed ROI informed their subsequently considered ROI. Hence, an individual's HMM was estimated from their eye movement data using a variational Bayesian approach to determine the optimal number of ROIs automatically. Consequently, this data-driven approach generated the visual task participants' most representative eye movement patterns. Preschool children exhibited two different eye movement patterns, distributed (78%) and selective (21%), which was statistically significant. Children switched between images with more similar probabilities in the distributed pattern while children remained looking at the same ROI than switching to the other ROI in the selective pattern. Nevertheless, all children exhibited an equal starting fixation on the right or left image and noticed teeth. The study findings reveal that most preschool children did not have an attentional bias to images with and without dental caries. Furthermore, only a few children selectively fixated on images with dental caries. Therefore, selective eye-movement patterns may strongly predict preschool children's sustained visual attention to dental caries. Nevertheless, future studies are essential to fully understand the developmental origins of differences in visual attention to common oral health presentations in children. Finally, EMHMM is appropriate for assessing inter-individual differences in children's visual attention.

Understanding children's attention to traumatic dental injuries using eye-tracking.

BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth. MATERIALS AND METHODS: An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs). RESULTS: Two different eye movement patterns (distributed and selective) were identified (p < .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw. CONCLUSIONS: Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.

Eye-tracking in dentistry: what do children notice in the dental operatory?

OBJECTIVES: To determine, using eye-tracking technology, (i) what children notice the most when they look at images of dental operatories and (ii) the effect of distractors on gaze pattern. MATERIALS AND METHODS: Forty-one children aged 4-12 years (21 girls, 19 boys) viewed 13 images of dental operatories taken from different perspectives on a computer screen. One child was excluded due to calibration issues with the eye-tracking equipment. Areas of interest (AOI's) were pre-defined on each image, then a Tobii X2-60 eye-tracking camera was used to track the location of participant's gaze. Count of participants to fixate and mean length of fixation (LOF) for each AOI were measured. RESULTS: Significant differences in the mean LOF was noticed for bracket tables, handpieces, and the dental chair. Significantly differences in mean LOF between different areas of the images were noted where distractors (cartoons) were added. CONCLUSIONS: When viewing images of dental operatories on a computer screen, children fixated most on the bracket tables, handpieces, and dental chairs. The addition of distractors was able to change where they looked. Eye-tracking was able to effectively assess where the children looked. CLINICAL RELEVANCE: The findings demonstrate that children have inherent preferences for where they fixate when viewing images of a dental operatory. This has not previously been known and will allow customization of dental operatories where children will be treated.

Role of Marginal Ridge Shape and Contact Extent in Proximal Caries Between Primary Molars.

OBJECTIVES: To determine different combinations of marginal ridge shape (MRS) and contact extents in nature of the contact between primary molars and its correlation with the presence of carious lesions on radiographic examination of approximal surfaces. STUDY DESIGN: Retrospective study of 347 clinical records, including photographs and bitewing radiographs, were assessed for intact MRS and caries extent. The carious lesions were scored (0-5, Mejàre scoring system) radiographically and correlated to the intact MRS on clinical photographs, and strength of associations quantified using logistic regression analysis and chi-square tests. RESULTS: Primary molars, 848(contact extent), and 757(MRS) were analyzed. Combination of straight-convex(35.4%) MRS was more common (p<0.001). None of the approximal surfaces were caries-free for straight and straight MRS with 36.4% of both approximal surfaces exhibiting caries in enamel, and 38.2% of one approximal surface exhibiting caries in dentin. Approximately 90% of the primary molars with substantial contacts exhibited carious lesions in the enamel and 80% with light contacts exhibited carious lesions in the dentin (p<0.001). CONCLUSION: Six different combinations of intact MRS were identified. Combination of concave-convex shapes exhibited caries extending into dentin. Substantial and/or light contacts between primary molars showed higher caries experience in the approximal surfaces.

Unusual sequelae of a subluxated primary incisor on its permanent successor tooth.

Traumatic dental injuries (TDIs) such as subluxations of primary teeth can have significant consequences on their developing successors. The purpose of this report is to present a 3-year-old boy who encountered subluxation injuries to his primary incisors which subsequently had an unusual consequence on the permanent successor. On the day of the TDI, based on clinical and radiographic examinations, a diagnosis of subluxation of teeth 52, 51 and 61 was made. By age 5, the patient reported that tooth 51 had exfoliated, and consequently, tooth 11 had erupted into the oral cavity, but it was very loose. Eventually, the patient lost the crown of tooth 11 during his routine daily activities. Furthermore, radiographic examination at age 11 revealed a small root-like structure in the tooth 11 region. It is very unusual to have premature loss of a permanent incisor following subluxation to its predecessor. Therefore, the present case serves as a good example to emphasize that even minor TDIs are of considerable importance as they may lead to unexpected consequences.

Visual interpretation of clinical images among dental students using eye-tracking technology.

BACKGROUND: Tele-consultations are increasingly used for screening and diagnosis. Only a few studies have assessed dental students' visual attention to clinical images. AIM: To (i) determine dental students' gaze behavior, visual fixations, and diagnostic competence while viewing clinical images, and (ii) explore potential opportunities to strengthen the teaching-learning approaches. DESIGN: Tobii Pro Nano-device captured the eye-tracking data for 65 dental undergraduate students in this cross-sectional study. The predetermined areas of interest (AOI) for all five clinical photographs were uploaded onto Tobii software. All participants used a think-aloud protocol with no restrictions to view time. RESULTS: A total of 325 clinical pictures were analyzed, and the average view time was 189.25 ± 76.90 s. Most participants started at the center of the image (three frontal photos), spent a significant share of their view time on prominent findings, did not follow a systematic pattern, and exhibited diagnostic incompetence. Also, most participants followed a "Z" viewing pattern (oscillating movement from left to right) for the remaining two pictures. CONCLUSIONS: Subjects frequently fixated on the prominent AOI, however, failed to make the correct diagnosis. Their view patterns revealed no sequential viewing. Therefore, emphasizing knowledge about common dental abnormalities and focusing on full coverage of clinical pictures can improve dental students' diagnostic competence and view patterns.

Reporting Eye-tracking Studies In DEntistry (RESIDE) checklist.

OBJECTIVES: To (i) provide a scoping review of eye-tracking studies in dentistry, and (ii) propose a "Reporting Eye-tracking Studies in DEntistry" (RESIDE) checklist to facilitate standard reporting of eye-tracking studies. DATA: A comprehensive search of six distinct electronic databases was undertaken. SOURCES: Pubmed, OVID, Wed of Knowledge, Scopus, Cochrane and Google Scholar were used to identify studies that employed eye-tracking technology and dentistry as a subfield STUDY SELECTION: 42 studies met the inclusion criteria. Most studies exhibited several inconsistencies or failed to report on the appropriate items in the RESIDE checklist. These essential components include ethical approval, sample size calculation, location and setting, eye-tracking device attributes, participant calibration, sequence of events, and eye-tracking metrics (quantitative, qualitative and data details). CONCLUSIONS: Evaluation of the published eye-tracking studies in this scoping review provides empirical data, highlighting the inconsistencies and limitations. Importantly, it illustrates the applicability of the RESIDE Checklist, which provides a comprehensive list of reporting elements to assist authors and reviewers of eye-tracking studies in dentistry. Also, RESIDE provides a framework to overcome critical issues to ensure high-quality scientific publications. CLINICAL SIGNIFICANCE: A minimum threshold should be applied before accepting eye-tracking studies for publication in the future. RESIDE checklist promotes transparent and reproducible scientific communication about eye-tracking applications to dentistry. In addition, it provides a comprehensive list of reporting elements to assist authors and reviewers in ensuring high-quality scientific publications.

Eye movement analysis of children's attention for midline diastema.

No previous studies have investigated eye-movement patterns to show children's information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators' perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children's ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children's ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6-4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Visual interpretation of panoramic radiographs in dental students using eye-tracking technology.

PURPOSE: While eye-tracking technology is a validated tool in the field of education it is still in its infancy in the field of Pediatric Dentistry. The primary aim of this study was to determine dental undergraduates' search patterns and visual fixations while viewing panoramic radiographs (PR) using an eye-tracker. The secondary aim was to decide on the potential opportunities to enhance teaching-learning strategies when studying these radiographs. METHODS: Sixty-five dental undergraduates in the final year of their dental education consented to and participated in this study. A Tobii Pro Nano screen-based eye-tracking camera was mounted to the lower edge of a laptop with five different PR uploaded onto the Tobii Studio software. Regions of Interest (ROIs) were pre-determined for the five PR. The participants (17 males and 48 females) viewed all the PR images with no time restrictions and a "think-aloud" protocol was exercised. RESULTS: The average view time for the PR was 245.58 ± 106.7 s. Participants spent significantly less time examining the surrounding structures (14.85 s) than the dentitions (primary: 97.58 s and permanent: 37.58 s). Males demonstrated a slightly higher view time (290.88 ± 97.7 s) than females (229.53 ± 106.05 s). CONCLUSIONS: The results revealed that though the participants focused on the ROI, most of them failed to make the correct diagnosis. In addition, the search patterns of the participants unveiled no sequential viewing of PR. Hence the need to revise the teaching-learning strategies for the systematic interpretation of PR images in the dental curriculum is warranted.

Presence of Interproximal Carious Lesions in Primary Molars.

Purpose: The purposes of this study were to determine the presence of interproximal carious lesions in the primary molars and assess the risk to adjacent and contralateral surfaces when caries is detected in one quadrant. Methods: Clinical records of high caries-risk children, including bitewing radiographs, were assessed for interproximal caries and the extent of marginal ridge breakdown. The carious lesions were scored radiographically by two calibrated examiners with excellent inter- and intraexaminer reliability. Correlations for the presence of adjacent surface caries and caries in another quadrant were determined by employing the strength of the associations, as quantified using chi-square analysis. Results: A total of 1,290 pairs of primary molars (A and B, I and J, K and L, S and T) were included. Only eight percent of interproximal surfaces were caries-free. Approximately 70 percent of the adjacent surfaces (A and B, I and J, K and L, and S and T) exhibited carious lesions in the enamel when there was enamel caries in one quadrant. Furthermore, 90 percent of the adjacent surfaces exhibited caries in the dentin if one adjacent interproximal surface exhibited dentinal caries. Conclusions: In high caries-risk children, only a small proportion of surfaces remain caries-free, and the adjacent surface caries prevalence remains high at 70 percent to 80 percent. The presence of interproximal caries in one quadrant is a good indicator of caries in the other quadrants, as is the marginal ridge breakdown which indicates the proximity to the pulp.

Eye-tracking in dentistry: What do children notice in the dentist?

OBJECTIVES: To determine, using eye-tracking technology, what children notice the most when they look at the dentist. METHODS: A total of 41 children viewed 10 images of dentists of different genders and ethnicities, and wearing different attires, on a computer screen. Due to calibration issues with the eye tracking equipment, data from one child was excluded thus resulting in a final sample of 40 children (21 females; 19 males). Participants were aged 4-12 years. A Tobii X2-60 eye-tracking camera was used, which follows the location of participants' gaze as they look at images on a screen. Areas of interest (AOI's) were pre-defined on each image (e.g. eyes, mouth, shirt). Other images were displayed between dentist images with no consecutive dentist images displayed. Number of participants to fixate and mean length of fixation for each AOI were measured. RESULTS: Visual assessment illustrated that the dentist's face had the highest concentration of fixations, followed by attire. The circum-oral area has significantly more fixations than the eyes. The number of fixations and the mean length of fixation were both longer for the face than for the attire, and for the circum-oral area compared to the eyes. Distractors such as pens and ties exhibited more and longer fixations compared to images without distractors. CONCLUSIONS: Children fixated most on the dentist's face particularly the circum-oral area, followed by attire. Distractors were able to draw the children's gaze. Importantly, eye-tracking was an effective tool in assessing where children look on dentists' images. CLINICAL SIGNIFICANCE: This research will provide an understanding of where children focus when they look at a dentist. This has not previously been known and will allow dentists to modify how they present themselves and interact with child patients.