Topical fluoride as a cause of dental fluorosis in children.

BACKGROUND: This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth. SEARCH METHODS: We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis. MAIN RESULTS: We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25). AUTHORS' CONCLUSIONS: Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children's exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.

Clinical interventions with various agents to prevent early childhood caries: A systematic review with network meta-analysis.

BACKGROUND: Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However, the rank of the effectiveness of clinical interventions is equivocal. AIM: To summarize and rank the effectiveness of clinical interventions using different agents for primary prevention of early childhood caries (ECC). DESIGN: Two reviewers independently searched PubMed, Embase, and Cochrane Library to identify randomized controlled trials with at least 12-month follow-up. The network meta-analysis (NMA) on different agents was based on a random-effects model and frequentist approach. Standardized mean differences (SMD) with 95% CI of the caries increment were calculated in terms of either dmft or dmfs and used in the NMA. Caries incidences at the child level were compared using odds ratios (ORs) with 95% CI. The effectiveness of the agents was ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: After screening 3807 publications and selection, the NMA finally included 33 trials. These trials used either a single or combination of agents such as fluorides, chlorhexidine, casein phosphopeptide-amorphous calcium phosphate, probiotics, xylitol, and triclosan. Compared with control, fluoride foam (FF; SMD -0.69, 95% CI: -1.06, -0.32) and fluoride salt (F salt; SMD -0.66, 95% CI: -1.20, -0.13) were effective in preventing caries increment. Probiotic milk plus low fluoride toothpaste (PMLFTP; OR 0.34, 95% CI: 0.15, 0.77), FF (OR 0.48, 95% CI: 0.37, 0.63), fluoride varnish (FV; OR 0.63, 95% CI: 0.48, 0.81), and fluoride varnish plus high fluoride toothpaste (FVHFTP; OR 0.73, 95% CI: 0.57, 0.93) were effectively preventing caries incidence. According to the SUCRA, FF ranked first in preventing caries increment, whereas PMLFTP ranked first in preventing caries incidence. CONCLUSION: Fluoride foam, F salt, PMLFTP, FV, and FVHFTP all effectively reduce caries increment or caries incidence in preschool children, but the evidence indicates low degree of certainty. Considering the relatively small number of studies, confidence in the findings, and limitations in the study, clinical practitioners and readers should exercise caution when interpreting the NMA results.

Masticatory function of stroke patients: A systematic review with meta-analysis.

PURPOSE: The present systematic review and meta-analysis aimed to summarise the current information on the masticatory function of stroke patients. METHODS: Four electronic databases (Medline, Embase, CINAHL and Web of Science) were searched for relevant observational studies and clinical trials (up to Jun 2021) on the masticatory function of stroke patients. Two reviewers independently performed study selection and quality assessments (using JBI Critical Appraisal Checklist). Meta-analysis was conducted for the comparison of bite force and masticatory performance using standardised mean difference (SMD). Of the 3837 records identified, nine studies, corresponding to 11 papers and 302 participants, were included in the analysis. RESULTS: The maximum bite force of stroke patients was significantly lower than that of the healthy individuals (SMD -0.52, 95% CI: -0.95 to -0.08, P = .02). There was no significant difference between the ipsi-lesional and the contra-lesional sides of the same stroke patient (SMD 0.13, 95% CI: -0.14 to 0.39, P = .34). Stroke patients had lower masticatory performance than healthy people (SMD -0.97, 95% CI: 0.57 to 1.37, P < .00001), and the contra-lesional side was worse than the ipsi-lesional side. Electromyographic analysis indicated that muscle activation of stroke patients was poorer than the healthy individuals, and stroke patients seem to exhibit dysfunction in the recruiting and firing of motor units. CONCLUSIONS: Stroke patients have lower maximum bite force and masticatory performance than healthy people, with masticatory performance being the most affected.

Teaching of silver diamine fluoride for the management of dental caries and hypersensitivity - situation in the Southeast Asia dental schools.

BACKGROUND: Using silver diamine fluoride (SDF) for caries management has raised dentists' interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA. METHODS: An online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF. RESULTS: A total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82-97%), followed by for arresting early noncavitated lesions (69-82%), for preventing new caries development (66-79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available. CONCLUSION: SDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.

Relationship between chronic periodontitis and inflammatory cytokines in patients undergoing maintenance hemodialysis.

OBJECTIVES: To investigate the correlation between serum and gingival crevicular fluid (GCF) levels of inflammatory cytokines and the association with periodontal parameters in patients with maintenance hemodialysis (MHD) and healthy control. MATERIALS AND METHODS: Patients who were undergoing MHD were enrolled as the MHD group. Healthy individuals who underwent oral examination were selected as the control group after matching for the MHD group. All participants underwent a full-mouth periodontal evaluation, and the levels of eight inflammatory cytokines, including IL-1ß, IL-17, IL-6, IL-8, and tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-8 (MMP-8), and C-reactive protein (CRP), in the GCF and serum were measured. RESULTS: A total of 63 MHD patients and 75 healthy persons were included. The prevalence of moderate/severe periodontitis was significantly higher in the MHD group than in the control group (88.9 vs. 66.7%, P < 0.05). The GCF levels of CRP, TNF-α, MCP-1, and MMP-8 were higher in patients in the MHD group with moderate/severe periodontitis than in the control group (P < 0.05). Serum CRP, MCP-1, TNF-α, and MMP-8 levels were positively correlated with the GCF CRP levels (P < 0.05). The GCF and serum CRP levels were positively correlated with the periodontal clinical parameters (P < 0.05). CONCLUSIONS: Serum CRP, MCP-1, TNF-α, and MMP-8 may relate with the GCF CRP levels. The GCF and serum CRP levels correlated positively with the periodontal clinical parameters, including the VPI, PPD, and CAL, indicating that CRP may play an important role between periodontitis and ESRD. CLINICAL RELEVANCE: The present study indicated that GCF and serum CRP levels correlated positively with the periodontal clinical parameters, and the CRP levels may be selected as an indicator to evaluate the severity of inflammation and the effectiveness, prognosis of periodontal treatment in ESRD patients.

Effect of strontium-doped bioactive glass-ceramic containing toothpaste on prevention of artificial dentine caries formation: an in vitro study.

BACKGROUD: Root caries in aging population was prevalent worldwide. Due to the absence of enamel and specific structure of dentine, bacteria are able to penetrate further into dentine at an earlier stage of lesion development. The aim of this study was to investigate the effect of adding of a strontium-doped bioactive glass-ceramic (HX-BGC) to a fluoride-free toothpaste on prevention of formation of artificial dentine caries. METHODS: Thirty-six human tooth specimens were allocated to three groups (n = 12 per group). Group 1 treated with slurry containing a fluoride-free toothpaste and 5% HX-BGC, Group 2 was treated with fluoride-free toothpaste slurry, and Group 3 received deionized water as a negative control. The specimens were subjected to four cycles (15 h demineralization and 8 h remineralization for one cycle) of biochemical cycling. A mixed suspension of five bacteria species (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Actinomyces naeslundii) were prepared in brain heart infusion broth with 5% sucrose and used as acidic challenge in biochemical cycling. Subsequently, surface morphology of the dentine lesion was assessed by scanning electron microscopy, while the lesion depths and mineral loss were assessed by micro-computed tomography. RESULTS: The mean lesion depths in dentine in Groups 1 to 3 were 87.79 ± 16.99 µm, 101.06 ± 10.04 µm and 113.60 ± 16.36 µm, respectively (p = 0.002). The mean amounts of mineral loss in Groups 1 to 3 were 0.82 ± 0.10 g/cm3, 0.89 ± 0.09 g/cm3 and 0.96 ± 0.11 g/cm3, respectively (p = 0.016). No obvious differences in the surface morphology were seen among the groups. CONCLUSION: Addition of strontium-doped bioactive glass-ceramic to fluoride-free toothpaste has potential to reduce formation of dentine lesions.

CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE TREATMENT WITH OR WITHOUT PRIOR SILVER DIAMINE FLUORIDE APPLICATION.

OBJECTIVE: To investigate the short-term and long-term changes in parental satisfaction and oral health-related quality of life (OHRQoL) of preschool children after receiving atraumatic restorative treatment (ART) with or without prior silver diamine fluoride (SDF) application. METHODS: In a randomized controlled trial, preschool children with cavitated dentine caries lesions in their primary teeth were randomly assigned into two groups to receive either application of SDF solution or placebo (tonic water) on the caries lesions 10 weeks before receiving ART restorations. The information on parental satisfaction and OHRQoL of the children were collected through self-completed questionnaires at baseline, the 6-month and the 24-month follow-up. A five-point scale, from 1 (very dissatisfied) to 5 (very satisfied), was used by parents to indicate their satisfaction with their child's dental conditions. A higher parental satisfaction score indicates that parents were more satisfied with their child's dental condition. In addition, the Chinese version of Early Childhood Oral Health Impact Scale (ECOHIS) was adopted to assess the children's OHRQoL, and a higher ECOHIS score indicates greater negative impacts of oral health on the child's OHRQoL. RESULTS: A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. After placement of ART restorations, at 6-month and 24-month follow-up, parental satisfaction scores with their child's dental health status were significantly higher compared with those at baseline (P <.001) indicating the parents were more satisfied at follow-ups. Regarding OHRQoL, no statistically significant changes were found in the child impact section (CIS), family impact section (FIS) and total ECOHIS scores in both study groups at the 6-month follow-up. In contrast, at the 24-month follow-up, the CIS (P = .025) and total ECOHIS scores (P = .015) of the children in the control group were significantly higher than those at baseline (greater negative impacts), but not the FIS score. CONCLUSION: In this study, after one-off placement of ART restorations irrespective of prior SDF application, short-term and long-term parental satisfaction with their child's dental health status was improved, but not the children's OHRQoL.

Relationship between periodontal disease and male infertility: A case-control study.

OBJECTIVES: To compare the prevalence of chronic periodontitis between men who had semen abnormalities and those who had normozoospermia through a case-control study. MATERIALS AND METHODS: Male patients who visited the assisted reproduction clinic of a large general hospital and were diagnosed with semen abnormalities were included in the case group. The control group was composed of patients of the same clinic with normozoospermia. The semen analysis included sperm concentration, count and progressive and total motility, which were measured in the laboratory. A questionnaire and clinical periodontal examination were conducted for all participants. Logistic regression was performed to explore the relationship between chronic periodontitis and male infertility. RESULTS: A total of 192 participants were included: 63 participants (32.8%) had some type of semen abnormality (case group), while 129 participants (67.2%) had normozoospermia (control group). The case group had a significantly higher prevalence of moderate/severe periodontitis than the control group (33.3% vs. 17.8%, p = .012). The logistic regression showed that participants who had moderate/severe periodontitis had a greater chance of having semen abnormalities after adjusting for other confounding factors (OR = 3.377, p = .005). CONCLUSIONS: Periodontitis is associated with semen abnormalities and sperm motility in men.

Trend on dental caries status and its risk indicators in children aged 12 years in China: a multilevel analysis based on the repeated national cross-sectional surveys in 2005 and 2015.

BACKGROUND: This study aimed to explore the trend and risk indicators for dental caries of children aged 12 years in China based on national oral health survey data in 2005 and 2015. METHODS: Research data were from the two latest national oral health surveys conducted in mainland China, including 30 and 31 provinces, autonomous regions, and municipalities in 2005 and 2015, respectively. Children aged 12 years were clinically examined for dental caries and dental fluorosis according to the World Health Organization criteria. Sociodemographic characteristics and oral health-related behaviours were collected using questionnaires. Multilevel zero-inflated negative binomial regression model was used to investigate the association between dental caries severity and dental fluorosis, sociodemographic characteristics, and oral health-related behaviours. RESULTS: The final analyses included 12,350 and 27,818 children surveyed in 2005 and 2015, respectively. The standardized prevalence of dental caries increased from 27.05% (95% confidence interval [CI], 24.25-28.85) in 2005 to 37.92% (95% CI, 34.94-40.90) in 2015, and the respective standardized mean decayed, missing, filled teeth (DMFT) index scores increased from 0.50 (standard deviation [SD], 1.04) to 0.83 (SD, 1.45) (P < 0.001). Fujian province had the highest increase in dental caries, followed by Liaoning, Heilongjiang, Hainan, and Yunnan. Results revealed that children who were girls, more frequently experienced dental pain, and had more recent dental visits, had significantly higher DMFT scores after adjusting for the survey year and other variables (all P < 0.05). CONCLUSIONS: Dental caries of 12-year-old children in China deteriorated from 2005 to 2015, particularly in the northeast and southwest regions. Dental caries was associated with sex, dental pain, and dental service utilization.

Association between dental conditions, sliver diamine fluoride application, parental satisfaction, and oral health-related quality of life of preschool children.

OBJECTIVES: To investigate the associations between dental conditions, sliver diamine fluoride (SDF) application, parental satisfaction, and oral health-related quality of life (OHRQoL) of preschool children. MATERIALS AND METHODS: In a clinical trial conducted in Hong Kong, preschool children who had carious lesions into dentine were randomly assigned to receive an application of SDF solution or placebo on their caries lesions 10 weeks before they received restorations. Additionally, a random sample of caries-free children was also recruited. Parents of the study children rated their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) 10 weeks after SDF or placebo application. Besides, the Chinese version of the Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL. RESULTS: There were 127, 133, and 154 children in the SDF, placebo, and caries-free groups, respectively. The parents whose child had 4 or more decayed teeth reported lower satisfaction scores (mean = 2.0 ± 0.7) with their child's dental health status compared with those of parents whose child had fewer (mean = 2.6 ± 0.9) or no (mean = 3.7 ± 0.7) decayed teeth (p < 0.001). These parents also reported higher C-ECOHIS scores. However, there was no significant difference in parental satisfaction and children's OHRQoL between the SDF and placebo groups (p > 0.05). CONCLUSIONS: In this study population, parental satisfaction and children's OHRQoL were associated with children's dental caries status but not with SDF application. CLINICAL RELEVANCE: This study provides valuable information about the factors, including SDF application, that can influence parental satisfaction and OHRQoL of preschool children.

Patient-reported outcome measures for masticatory function in adults: a systematic review.

OBJECTIVE: The aim of this systematic review was to critically evaluate the Patient-Reported Outcome Measures (PROMs) for masticatory function in adults. METHODS: Five electronic databases (Medline, Embase, Web of Science Core Collection, CINAHL Plus and APA PsycINFO) were searched up to March 2021. Studies reporting development or validation of PROMs for masticatory function on adults were identified. Methodological quality of the included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline. RESULTS: Twenty-three studies investigating 19 PROMs were included. Methodological qualities of these studies were diverse. Four types of PROMs were identified: questions using food items to assess masticatory function (13 PROMs), questions on chewing problems (3 PROMs), questions using both food items and chewing problems (2 PROMs) and a global question (1 PROM). Only a few of these PROMs, namely chewing function questionnaire-Chinese, Croatian or Albanian, food intake questionnaire-Japanese, new food intake questionnaire-Japanese, screening for masticatory disorders in older adults and perceived difficulty of chewing-Tanzania demonstrated high or moderate level of evidence in several psychometric properties. CONCLUSIONS: Currently, there is no PROM for masticatory function in adults with high-level evidence for all psychometric properties. There are variations in the psychometric properties among the different reported PROMs. Trial Registration PROSPERO (CRD42020171591).

The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults.

BACKGROUND: This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults. METHODS: OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test-retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (ß) and 95% confidence intervals (CI) were reported. RESULTS: One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (rs = 0.76, P < 0.01). MCID was determined by participants who reported "a little improved" in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach's alpha of the transition scale was 0.87, and many items had a test-retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (ß = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (ß = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts. CONCLUSIONS: The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study's older adults perceived a lower intensity of OHIDL. CLINICAL RELEVANCE: The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.

RANDOMIZED CONTROLLED TRIALS IN DENTAL JOURNALS ON CHILDREN AND ADOLESCENTS: A BIBLIOMETRIC ANALYSIS.

BACKGROUND: Randomized controlled trials (RCTs) in dentistry provide essential evidence for dentists to practice evidence-based dentistry. This study aimed to analyze the scientific impacts of the RCTs conducted among children and adolescents published in dental journals and summarize the main contents of these studies. METHODS: An electronic literature search was conducted in the database Web of Science (WoS) Core Collection by two independent reviewers in June 2020, without an initial time limit. Articles reporting on RCTs conducted among children and adolescents in dental fields were identified. The most cited articles (the top 100 articles based on total citation counts and citation density) were selected. The bibliometric data were exported from the database WoS for further analysis. The citation counts were cross-checked in Google Scholar. In addition, the main content of the included RCTs was extracted and summarized. RESULTS: A total of 132 papers published in 28 journals reporting on RCTs in dentistry on children and adolescents were included in this study. The mean total citation count (within WoS) of the included RCTs was 60.0, ranging from 17 to 300, and the mean citation density value was 4.6, ranging from 1.3 to 15.0. The majority of the articles were in the thematic field of cariology (n = 79, 59.8%). Other thematic fields, orthodontology (20.5%), endodontology (5.3%), behavior science and quality of life (5.3%), oral and maxillofacial surgery (3.8%), oral hygiene (3.8%) and periodontology (1.5%) were involved as well. Around one-fifth of the articles (n = 23) were produced by the United States, and the included articles were most cited by the publications (n = 1937) from the United States as well. CONCLUSIONS: A wide range of dental topics were covered in the included RCTs conducted among children and adolescents. These top-cited RCTs mainly focus on the thematic field of cariology. The United States is an influential country with a large number of publication outputs and citations.

Validation of the Oral Health Impact on Daily Life Questionnaire (OHIDL) among Hong Kong older adults.

BACKGROUND: The Oral Health Impact on Daily Life Questionnaire (OHIDL) was developed through a qualitative study to measure oral health-related quality of life, including intensity and bother measurements, among older adults in Hong Kong. The instrument comprises 20 items divided into eight domains. OBJECTIVES: This study describes the psychometric properties of the OHIDL and refines the instrument through validity and reliability testing. MATERIALS AND METHODS: The OHIDL was administered to older adults who attended dental clinics for general dental treatments. Items with low discriminant ability were to be eliminated. Construct validity was assessed through convergent, divergent and factorial validity. Criterion validity was investigated by assessing the correlation between the measurements and the global questions. Reliability was assessed with Cronbach's alpha. RESULTS: In total, 306 participants (mean age: 69.6 years) completed the interviews. Two items for which over 90% of the participants reported no impact and two items with poor discriminant validity were eliminated. Both intensity and bother measurements demonstrated good construct and criterion validity, with the intensity measurement showing better performance being selected for the OHIDL to reduce the respondents' burden. The intensity measurement also showed satisfactory internal consistency. CONCLUSIONS: The refined OHIDL with 16 items in seven domains is valid and reliable in measuring the oral health impacts on daily life among Hong Kong older adults.

Structural equation model for parental influence on children's oral health practice and status.

BACKGROUND: Children's oral health status (OHS) can be influenced by their oral health practices and many parental factors. This study aimed to investigate pathways from parental factors to oral health practices and status of children in Hong Kong. METHODS: Using a combination of random and purposive sampling of Hong Kong households, 432 families with children aged 5-7 participated in a cross-sectional survey. Data on socioeconomic status, smoking, and oral health knowledge, attitudes, and practices, as well as OHS of parents and parents' knowledge of and attitudes towards their children's oral health, were collected through a questionnaire. Tooth status, periodontal status, and oral hygiene data were also collected through clinical examination. Correlations of oral health behaviors (OHB) and OHS within families were assessed by confirmatory factor analysis. A conceptual model of the parental influences on children's oral health practices and status was tested by a structural equation model (SEM). Chi-square test, chi-square/df, nonnormed fit index, comparative fit index, and root mean square error of approximation were used to assess the model fit. RESULTS: Fit indexes for confirmatory factor analysis and SEM showed good fit. Positive correlations of OHB and OHS were found within the families that ranged from 0.74 to 0.98 for OHB and 0.30 to 0.43 for OHS. SEM showed better socioeconomic status of mothers led to better oral health knowledge and attitude (γ = 0.75, P < 0.001) and also towards their children's better oral health knowledge and attitude (γ = 0.44, P < 0.01). Parents' attitudes towards their children's oral health (ß = 0.40, P = 0.04) and mothers' OHB (ß = 0.60, P < 0.001) were positively associated with OHB of children. Positive OHB of children (ß = - 0.48, P < 0.01) in turn led to better oral health. CONCLUSIONS: Correlations of OHB and OHS between mothers and children were stronger than those of fathers. Children's OHS was directly affected by their mothers' OHB, which in turn were affected by parents' oral health knowledge, attitudes, and practices.

Effect of silver diamine fluoride solution application on the bond strength of dentine to adhesives and to glass ionomer cements: a systematic review.

BACKGROUND: Silver diamine fluoride (SDF) solution gains increasing popularity in arresting dentine caries in clinical practice. The aim of this systematic review was to summarize the findings from laboratory studies on the influence of SDF application on the bond strength of dentine to various adhesives and to glass ionomer cements (GICs). METHODS: Two independent reviewers conducted a literature search in the databases Medline, Ovid, PubMed and Web of Science until 15th August 2019 using the search keywords ['bond strength'] AND ['silver diamine fluoride' OR 'silver diammine fluoride' OR 'SDF' OR 'silver fluoride' OR 'diamine silver fluoride']. Articles investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs were included in this review. Information on how SDF application influenced the bond strength was extracted from the included articles. Besides, related information, e.g. test method of bond strength, concentration and brand of SDF, type of adhesive system and GIC, testing dental substrate, protocol of specimen preparation, and failure mode was also reviewed. RESULTS: A total of 13 articles were included in this review, with 8 and 6 studies investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs, respectively. Sound dentine as well as demineralized dentine created by chemical methods, e.g. immersing in a demineralizing solution, was commonly adopted as the testing dental substrate. The microtensile bond strength (mTBS) test was the predominant method employed. However, the bond strength values had large variations among studies, ranging from <10 to 162 Mpa. Regarding the bond strength to different adhesives, 4 studies indicated that SDF application followed by rinsing with water had no significant influence. However, another 4 studies reported reduced bond strength after SDF application. Regarding the bond strength to GICs, 4 studies concluded that SDF application had no adverse impact on the bond strength. CONCLUSIONS: No solid conclusion can be drawn on the effect of SDF application on the bond strength of dentine to adhesives and to GICs due to the high degree of variation of the included studies.

Effectiveness of a family-centered behavioral and educational counselling approach to improve periodontal health of pregnant women: a randomized controlled trial.

BACKGROUND: Poor oral hygiene and high hormone levels during pregnancy can lead to a deterioration in periodontal health. This study assessed the effectiveness of a family-centered behavioral and educational counselling program on improving the periodontal health of women during pregnancy and postpartum. METHODS: A randomized controlled trial was conducted among pregnant women (10th-22nd gestational week) and their husbands. Participating families were randomized into test and control groups. Intervention in the test group included explanation of oral health education (OHE) pamphlets, oral hygiene instruction, individualized feedback, and proposed solutions to overcome barriers in self-care. Reinforcements were implemented in the 3rd trimester of pregnancy and six months postpartum. In the control group, only OHE pamphlets were distributed. The assessed outcomes were bleeding on probing (BOP), periodontal pocket (Poc), loss of clinical attachment (LoA), and Visible Plaque Index (VPI). The data collection was carried out at baseline (T0), in the 32nd gestational week (T1), and 12 months postpartum (T2). RESULTS: Altogether 589 pregnant women were recruited, and 369 attended all three visits (test:188; control:181). In the test group, the mean VPI score at T0 was 0.19, which decreased to 0.14 at T1 and 0.15 at T2. In the control group, the mean VPI decreased from 0.19 at T0 to 0.16 at T1, but increased to 0.22 at T2. A main effect of time and intervention and an interaction between time and intervention were detected (all p < 0.05), indicating that the intervention effect differed between T1 and T2. The test group showed a significantly greater decrease over time than the control group did. Similarly, the mean BOP% decreased more significantly over time in the test group (T0:57%, T1:46%, T2:35%) than in the control group (T0:58%, T1:52%, T2:46%). For Poc and LoA, there were improvements in both study groups at 12 months postpartum, compared with during pregnancy (p < 0.001). CONCLUSIONS: Providing family-centered, behavioral, and educational counselling to pregnant women at an early stage of pregnancy and with reinforcements can improve their oral hygiene and reduce gingival inflammation. The effect can be sustained over an extended period and is greater than that of distributing oral health leaflets alone. TRIAL REGISTRATION: Clinicaltrials.gov , #NCT02937194. Registered 18 October 2016. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02937194?cond=Family-centered+oral+health+promotion+for+new+parents+and+their+infants&draw=2&rank=1.

Interpreting Poisson Regression Models in Dental Caries Studies.

Oral epidemiology involves studying and investigating the distribution and determinants of dental-related diseases in a specified population group to inform decisions in the management of health problems. In oral epidemiology studies, the hypothesis is typically followed by a cogent study design and data collection. Appropriate statistical analysis is essential to demonstrate the scientific association between the independent factors and the target variable. Analysis also helps to develop and build a statistical model. Poisson regression and its extensions have gained more attention in caries epidemiology than other working models such as logistic regression. This review discusses the fundamental principles and basic knowledge of Poisson regression models. It also introduces the use of a robust variance estimator with a focus on the "robust" interpretation of the model. In addition, extensions of regression models, including the zero-inflated model, hurdle model, and negative binomial model, and their interpretation in caries studies are reviewed. Principles of model fitting, including goodness-of-fit measures, are also discussed. Clinicians and researchers should pay attention to the statistical context of the models used and interpret the models to improve the oral and general health of the communities in which they live.

Effect of Silver Nitrate and Sodium Fluoride with Tri-Calcium Phosphate on Streptococcus mutans and Demineralised Dentine.

This study investigated the effect of 25% silver nitrate (AgNO3) and 5% sodium fluoride (NaF) varnish with functionalized tri-calcium phosphate (fTCP) on a Streptococcus mutans (S. mutans) biofilm and dentine caries lesion. Demineralised dentine specimens were treated with 25% AgNO3 and 5% NaF + fTCP (Group 1), 25% AgNO3 and 5% NaF (Group 2), 25% AgNO3 (Group 3), or water (Group 4). The specimens were subjected to a S. mutans biofilm challenge after treatment. The biofilm was then studied via scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony forming units (CFU). The specimens were assessed by micro-computed tomography, X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). SEM and CLSM revealed less biofilm in Groups 1 to 3. The log10 CFU of Groups 1 to 4 were 4.5 ± 0.7, 4.4 ± 0.9, 4.4 ± 0.9, and 6.7 ± 1.0, respectively (Groups 1, 2, 3 < 4, p < 0.001). The lesion depths of Groups 1 to 4 were 212.6 ± 20.1 µm, 280.8 ± 51.6 µm, 402.5 ± 61.7 µm, and 497.4 ± 67.2 µm, respectively (Groups 1 < 2 < 3 < 4, p < 0.001). XRD demonstrated silver chloride formation in Groups 1, 2, and 3. FTIR found the amide I: HPO42− values of the four groups were 0.22 ± 0.05, 0.25 ± 0.05, 0.41 ± 0.12, and 0.64 ± 0.14, respectively (Groups 1, 2 < 3 < 4; p < 0.001). In conclusion, this study revealed that AgNO3 and NaF + fTCP reduced the damage of dentine caries by cariogenic biofilm.