Association of tooth loss with morbidity and mortality by diabetes status in older adults: a systematic review.

OBJECTIVE: This systematic review assesses the association of tooth loss (TL), as the exposure, with morbidity and mortality by diabetes mellitus (DM) status, as the outcome, in older adults. BACKGROUND: Individuals with DM have higher prevalence of severe TL and increased risk of developing morbidities and mortality. No systematic review has evaluated the association between TL with morbidity and mortality by DM status. MATERIAL AND METHODS: Comprehensive searches used multiple publication databases containing reports published between 01/01/2000 and 04/21/2021. Two authors independently evaluated included studies for quality and risk of bias using the Critical Appraisal Skills Programme (CASP) checklist for cohort and Center for Evidence-Based Medicine (CEBM) critical appraisal sheet for cross-sectional studies, while a third author arbitrated decisions to resolve disagreements. RESULTS: Thirteen studies met the inclusion criteria: eight cross-sectional and five cohort. Qualitative review of the included studies indicated TL is associated with increased incidence and prevalence of DM. TL is also associated with DM-related morbidities including greater prevalence of heart disease, diabetic retinopathy, metabolic syndrome; poorer health-related quality of life; poorer survival of participants with chronic kidney disease; and increased medical expenditure. Overall, the quality of the evidence reviewed was medium, as per the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. CONCLUSIONS/PRACTICAL IMPLICATIONS: This review found significant associations of TL with prevalence and incidence of DM and adverse DM-related outcomes. An interprofessional team-care approach that includes an oral health component could benefit the prevention and management of DM.

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services.

A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.

A systematic review of silver diamine fluoride: Effectiveness and application in older adults.

OBJECTIVE: This systematic review examines the effectiveness of silver diamine fluoride (SDF) in the management of caries in older adults. BACKGROUND: Silver diamine fluoride has been extensively researched and proven effective for caries prevention and arrest in children. Limited studies support its effectiveness in adult and older adult populations. MATERIALS AND METHODS: Multiple databases were searched according to specified inclusion-exclusion criteria. Quality assessment used modified Centre for Evidence-Based Medicine worksheets. RESULTS: Three randomised controlled trials were identified that addressed the effectiveness of SDF on root caries in older adults, but none addressed coronal caries. Root caries prevented fraction and arrest rate for SDF were significantly higher than placebo. The prevented fraction for caries prevention for SDF compared to placebo was 71% in a 3-year study and 25% in a 2-year study. The prevented fraction for caries arrest for SDF was 725% greater in a 24-month study and 100% greater than placebo in a 30-month study. No severe adverse effects were observed. CONCLUSION: This systematic review evaluates the use of SDF for both root caries prevention and arrest in older adults. Existing reports of SDF trials support effectiveness in root caries prevention and arrest, remineralization of deep occlusal lesions and treatment of hypersensitive dentin.

Root Caries in Older Adults.

Older adults are retaining an increasing number of natural teeth, and nearly half of all individuals aged 75 and older have experienced root caries. Root caries is a major cause of tooth loss in older adults, and tooth loss is the most significant negative impact on oral health-related quality of life for the elderly. The need for improved preventive efforts and treatment strategies for this population is acute.

Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children.

The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.

Cost-effectiveness analysis design for interventions to prevent children's oral disease.

Introduction: In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. Methods: The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. Results: All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Conclusions: Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.

Calibration and reliability testing of a novel asynchronous photographic plaque scoring system in young children.

OBJECTIVES: The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. METHODS: Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. RESULTS: All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). CONCLUSIONS: The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.

Democracy's backsliding in the international environment.

If the end of the 20th century was defined by the relatively widespread acceptance of democracy, the second decade of the 21st century is marked by concerns about backsliding in new and established democracies alike and by a notable decline in foreign support for democracy around the world. As democracy's global tailwinds shift to headwinds, scholars have an opportunity to better understand how experience with even superficial forms of democratic institutions across a diverse set of contexts influences citizen behavior when formal democratic institutions erode or disappear. This shift also provides the opportunity to examine whether citizen movements alone-absent external support-are sufficient to check newly emboldened autocrats.

Caregiver acceptability and preferences for early childhood caries preventive treatments for Hispanic children.

OBJECTIVE: The objective of this study was to determine caregiver treatment acceptability and preferences for five preventive dental treatments for early childhood caries in young Hispanic children. METHODS: We interviewed 211 parents/caregivers of Hispanic children attending Head Start programs regarding their acceptability of, and preferences for, five standard preventive dental treatments for young children. Treatments assessed were toothbrushing with fluoride toothpaste, fluoride varnish, and xylitol in food for children, and xylitol gum and chlorhexidine rinse for mothers. The interview assessment included presentation of illustrated cards with verbal description of treatment, photograph/video clip, and treatment samples. Parents rated the acceptability of each treatment (1-5 scale) and treatment preferences within each of 10 possible pairs. Individual treatment preferences were summed to create overall preference scores (range 0-4). RESULTS: All treatments were rated as highly acceptable, however, there were differences (range 4.6-4.9; Friedman chi-square = 23.4, P < 0.001). Chlorhexidine, toothbrushing, and varnish were most acceptable, not different from each other, but more acceptable than xylitol in food (P < 0.05). Summed treatment preferences revealed greater variability (means ranged 1.4-2.6; Friedman chi-square = 128.2, P < 0.001). Fluoride varnish (2.6) and toothbrushing (2.5) were most highly preferred, and differences between preferences for xylitol in food (1.4), xylitol gum (1.5), and chlorhexidine (2.1) were all significant (P < 0.001). Preferences for chlorhexidine were also significantly greater than those for the xylitol products (P < 0.001). CONCLUSIONS: All five treatments were highly acceptable, however, when choosing among treatments overall, fluoride varnish and toothbrushing were favored over other treatments.

Developing an acceptability assessment of preventive dental treatments.

OBJECTIVES: Early childhood caries (ECC) is very prevalent among young Hispanic children. ECC is amenable to a variety of preventive procedures, yet many Hispanic families underutilize dental services. Acceptability research may assist in health care planning and resource allocation by identifying patient preferences among efficacious treatments with the goal of improving their utilization. The purposes of this study were (a) to develop a culturally competent acceptability assessment instrument, directed toward the caregivers of young Hispanic children, for five preventive dental treatments for ECC and (b) to test the instrument's reliability and validity. METHODS: An instrument of five standard treatments known to prevent ECC was developed, translated, reviewed by focus groups, and pilot tested, then tested for reliability The instrument included illustrated cards, brief video clips, and samples of the treatments and was culturally appropriate for low-income Hispanic caregivers. In addition to determining the acceptability of the five treatments individually, the treatments were also presented as paired comparisons. RESULTS: Focus groups and debriefing interviews following the pilot tests established that the instrument has good face validity. The illustrated cards, product samples, and video demonstrations of the five treatments resulted in an instrument possessing good content validity. The instrument has good to excellent test-retest reliability, with identical time 1-time 2 responses for each of the five treatments 92 percent of the time (range 87 to 97 percent), and the same treatment of the paired comparisons preferred 75 percent of the time (range 61 to 90 percent). CONCLUSIONS: The acceptability instrument described is reliable and valid and may be useful in program planning efforts to identify and increase the utilization of preferred ECC preventive treatments for target populations.

Voter information campaigns and political accountability: Cumulative findings from a preregistered meta-analysis of coordinated trials.

Voters may be unable to hold politicians to account if they lack basic information about their representatives' performance. Civil society groups and international donors therefore advocate using voter information campaigns to improve democratic accountability. Yet, are these campaigns effective? Limited replication, measurement heterogeneity, and publication biases may undermine the reliability of published research. We implemented a new approach to cumulative learning, coordinating the design of seven randomized controlled trials to be fielded in six countries by independent research teams. Uncommon for multisite trials in the social sciences, we jointly preregistered a meta-analysis of results in advance of seeing the data. We find no evidence overall that typical, nonpartisan voter information campaigns shape voter behavior, although exploratory and subgroup analyses suggest conditions under which informational campaigns could be more effective. Such null estimated effects are too seldom published, yet they can be critical for scientific progress and cumulative, policy-relevant learning.

Educational and career pathways of dental hygienists: comparing graduates of associate and baccalaureate degree programs.

The purpose of this study was to compare the educational and career pathways of graduates from associate degree (A.S./A.A.) and baccalaureate degree (B.S./B.A.) entry-level dental hygiene (DH) programs. A thirty-item, closed-ended questionnaire was mailed to a random sample of 1,352 dental hygienists who were educated and licensed in California between 1990 and 2000. The response rate was 76 percent. Approximately half of the respondents had a degree prior to entering the DH program, and the elapsed time between degrees was greater for A.S./A.A. graduates (p=0.05). More B.S./B.A. graduates had earned or were seeking master's and other more advanced degrees: 11.9 percent versus 4.3 percent. Graduates from both types of programs were involved in professional and community organizations and held leadership positions. Most were currently practicing in the traditional clinical setting, with means of 3.6 and 3.3 days/week for the A.S./A.A. and B.S./B.A. graduates, respectively (p<0.05). More B.S./B.A. graduates held DH faculty positions (30.3 percent versus 4.3 percent, p<0.05) and other non-DH teaching positions (14.9 percent versus 8.6 percent, p<0.05) and had greater involvement with research (8.0 percent versus 3.6 percent, p<0.05). The two groups did not differ in regard to other dental and DH-related positions. In conclusion, graduates from B.S./B.A. programs are more likely to have positions in nontraditional settings.

Integrative Health: An Interprofessional Standardized Patient Case for Prelicensure Learners.

Introduction: Integrative health care and complementary medicine are widely used by the U.S. population, yet health professions learners are typically inadequately educated to counsel patients on the use of these approaches. This interprofessional standardized patient exercise (ISPE) provides learners the opportunity to discuss various health care professionals' roles in caring for a patient interested in integrative health strategies, and to collaborate on a care plan. Utilizing this ISPE format aligns with the principles of integrative health as it requires interprofessional collaboration to address the multifaceted needs of patients. Methods: The ISPE is approximately three hours in duration, and required of all UCSF, third-year dentistry, physical therapy, and medical students; second-year nurse practitioner students, and fourth-year pharmacy students. Social work, nutrition, and chaplain trainees also participated. Working in interprofessional teams of 4-5 learners, team members discuss case information, interview the standardized patient (SP) individually, jointly formulate a care plan, and, discuss the plan with the SP. The experience is debriefed with a facilitator. Results: In 2016-17, 520 learners participated in the ISPE. They agreed that they learned about the roles of other health care professionals (M = 5.24 on a six-point scale, SD = 1.27), and that they would recommend the ISPE to fellow students in their profession (M = 5.25, SD = 1.30). Discussion: Students appreciated the ability to observe learners from other health professions interacting with the SP, and how different perspectives and expertise were integrated to create a comprehensive care plan. The exercise can be adapted to accommodate local health professions learners.

Prevention of tooth loss and dental pain for reducing the global burden of oral diseases.

Population ageing is a global phenomenon and is predicted to become one of the most significant social transformations of the 21st century. The anticipated demographic shift provides governments the opportunity to proactively align policies with the estimated demands for housing, transportation, social protection, and health and well-being. Oral health is a fundamental component of health and physical and mental well-being, and is influenced by the individual's changing experience, perceptions, expectations and ability to adapt to circumstances. As such, prevention of oral disease and maintenance of oral health contributes to the systemic health, well-being, and quality of life of older adults. Dental caries, periodontal disease, and tooth loss in older adults are global health concerns because they are highly prevalent worldwide, socio-economic inequalities contribute to these diseases, many of the risk factors are modifiable, and these diseases result in compromised oral health-related quality of life. Oral care must be tailored to the needs and level of dependency of older adults through the use of evidence-based approaches and inter-professional collaboration. The persistence of between countries and within countries oral health disparities indicate that population-based policies are also needed to address the underlying social, environmental, and economic causes of oral diseases.

An evaluation of the San Francisco Department of Human Services Welfare Dental Program.

OBJECTIVE: To evaluate the welfare-to-work San Francisco Personal Assisted Employment Services (PAES) Dental Program. METHODS: A cohort of 377 study participants in the novel PAES Dental Program were followed through their baseline examination, rehabilitative dental treatment, follow-up exam, and completion of patient satisfaction survey. A framework of structure, process, and outcome measures was used to evaluate the success of the Dental Program. Chi square test, logistic regression, and paired t-test were used to analyze the levels of participation and satisfaction in the program. RESULTS: Of the 377 study participants, 265 (70%) completed their rehabilitative dental treatment. Those who completed their dental treatment had more missing teeth and fewer decayed teeth at baseline than those who did not complete their treatment. High levels of patient satisfaction were reported for the Dental Program. Ninety-seven percent of 173 respondents felt that they had been treated with respect, 92% were satisfied with the scheduling of their appointments, 91% were satisfied with their Dental Program experience, and 90% felt that their chief complaint had been solved. CONCLUSION: The PAES Dental Program provided high levels of patient satisfaction for process and outcome measures.

Genuine, suppressed and faked facial behavior during exacerbation of chronic low back pain.

Facial activity was examined as 60 female and 60 male chronic low back pain patients responded to a painful range of motion exercise during a scheduled physical examination. Subsequently, they were asked to fake the facial response to the movement inducing the most pain or to attempt to suppress evidence that they were experiencing pain when this same movement was again repeated. Facial behavior was measured using the Facial Action Coding System. Self-reports of pain also were provided. The genuine expression was consistent with that observed in previous research, but minor differences indicated that the facial display of pain reflects differences between sources of pain, social context in which pain is induced and individual differences among patients. Considerable voluntary control over the facial expression of pain was observed, although the faked expression was more an intensified caricature of the genuine expression, and an attempt to suppress the facial grimace of pain was not entirely successful as residual facial activity persisted. Self-reports were only moderately correlated with facial behavior.