The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada.

BACKGROUND: Children with special healthcare needs (SHCN) often require specialized interventions due to their disabilities. Dental general anesthesia (DGA) is a treatment modality, which improves their access to care but concerns about repeated DGAs persist. AIM: This study investigated DGA utilization in children with SHCN and identified factors associated with multiple DGAs in Alberta, Canada (2010-2020). DESIGN: This retrospective population-based study used administrative data encompassing all children (<18 years) undergoing DGA in publicly funded facilities. Children were identified as SHCN based on their diagnosis codes and categorized into behavioral/psychiatric disorders, mental/intellectual disabilities, physical disabilities, systemic conditions, syndromes/congenital anomalies, physical-mental disabilities, and disabilities with medical conditions. RESULTS: This study analyzed 3884 DGA visits for children with SHCN, predominantly males aged 6-11 and from low-income families. Mental/intellectual disabilities were prevalent (31.8%), and autism was the leading disease. Caries was the primary dental diagnosis across all groups, whereas pulp problems were higher in psychiatric/behavioral disorders (23.6%), and periodontal problems were more common in physical-mental disabilities (13.2%). 28.7% had multiple DGAs, with younger age, disabilities with medical conditions, mental/intellectual disabilities, and initial pulp treatments, increasing the likelihood of multiple DGAs. CONCLUSION: This study highlights the importance of individualized prevention and less conservative treatments for younger children to reduce oral health disparities.

Potential of magnetic quinoa biosorbent composite and HNO3 treated biosorbent for effective sequestration of chromium (VI) from contaminated water.

The present study aims to prepare novel quinoa biosorbent (QB), acid activated QB (QB/Acid) and its nanocomposite with magnetic nanoparticles (QB/MNPs) for batch scale Cr removal from contaminated water. The Cr adsorption was systematically studied at different pH (2-9), adsorbent dosage (1-3 g/L), initial concentration (25-200 mg/L), contact time (180 min) and competing ions in water. Maximum Cr adsorption was observed onto QB/MNPs (57.4 mg/L), followed by QB/Acid (46.35 mg/g) and QB (39.9 mg/g). The Cr removal by QB/MNPs was higher than QB/Acid and QB. Results revealed that the highest Cr removal was obtained at optimum pH 4, 25 mg/L, and 2 g/L dosage. The FTIR spectra displayed various functional groups on adsorbents surface serving as a potential scaffold to remove Cr from contaminated water. The equilibrium and kinetic Cr adsorption data best fitted with Freundlich and pseudo-second order models, respectively (R2 ≥ 0.96). The QB/MNPs showed excellent reusability in five adsorption/desorption cycles (4.7% decline) with minor leaching of Fe (below threshold level). The coexisting ions in groundwater showed an inhibitory effect on Cr sequestration (5%) from water. The comparison of Cr adsorption by QB/MNPs and QB/Acid showed better potential for Cr sequestration than various previously explored adsorbents in the literature.

Quinoa is a cereal crop and after harvesting quinoa straws are either burnt or thrown away which can cause several environmental problems. It would be beneficial to utilize quinoa straws and its modified forms as adsorbents for the water remediation. Therefore, current study aims to estimate the adsorption capacity of quinoa biomass as biosorbent (QB) and its modifications (QB/Acid and QB/MNPs) to treat Cr (VI) contaminated water. The influence of various parameters governing the Cr removal from water has been evaluated. The reusability of QB/MNPs has also been evaluated for its economical use without losing effectiveness for Cr removal from water. The comparison of Cr adsorption by QB/MNPs and QB/Acid showed better adsorption potential for Cr sequestration than various previously explored adsorbents in the literature.

Multiple cases in case-based learning: A qualitative description study.

INTRODUCTION: Case-based learning is widely used in health professions education to improve clinical learning, but little is known about how best to approach multiple cases in this active learning strategy. Our study explored dental student views of multiple case-based learning in oral pathology. MATERIALS AND METHODS: Qualitative description informed the study design. Data were collected through semi-structured, individual interviews with twenty-one third- and fourth-year dental students who participated in multiple case-based learning seminars. Data were analysed using inductive, manifest thematic analysis. RESULTS: Themes were identified at approach and case levels. Approach-level themes included preparing students for clinical practice and board exams and maximising exposure (e.g., to lesions/conditions), knowledge application, and engagement within the time allotted for the learning session. Case-level themes included using challenging but manageable cases, linking cases to lecture content, providing the necessary clinical information to solve the cases, and ensuring that cases were authentic and common with non-typical presentations. Aspects of themes encompassed definitions of case characteristics, benefits, conditions of implementation, and recommendations for improvement. CONCLUSION: Cases should be considered individually, collectively, purposefully, and contextually in multiple case-based learning. Evaluations of learning and behavioural outcome are needed to further establish the effectiveness of approaches and case characteristics in multiple case-based learning.

Dental Caries in Children with Attention Deficit/Hyperactivity Disorder: A Meta-Analysis.

OBJECTIVES: The aim of the study was to evaluate whether children with attention deficit/hyperactivity disorder (ADHD) are more affected by dental caries than children without ADHD by means of a systematic review and meta-analysis. DESIGN: Electronic searches were performed in 4 databases (PubMed, Embase, Scopus, and Web of Science) in July 2021. Grey literature search in OpenGrey, a search in Google Scholar, and searches in the reference list of included articles were also conducted. The eligibility criteria were observational studies in which children with ADHD were compared with children without ADHD with respect to the dental caries. Study selection, data extraction, and risk of bias assessment, applying the Joanna Briggs tool were performed by 2 reviewers independently. Meta-analysis and assessment of heterogeneity among studies were conducted with the meta-package of RStudio using the R programming language (R Core Team, Vienna, Austria). Results of meta-analysis were provided in mean difference (MD), odds ratio (OR), and confidence intervals (CIs). For assessment of heterogeneity, Baujat plot and influence analysis plot were obtained. RESULTS: Thirteen studies were included and 10 were incorporated into meta-analyses. The meta-analysis showed that children with ADHD had a higher decayed, missing, and filled teeth (DMFT) index than their peers without ADHD (I2 = 42%; MD = 0.75 [0.38-1.13]). For decayed, missing, and filled surfaces (I2 = 0; MD = 0.39 [-0.02 to 0.80]) and decayed surfaces (ds) (I2 = 0%; MD = 0.35 [-0.63 to 1.33]), no difference between groups was observed. In addition, children with ADHD had higher odds of having dental caries than their healthy peers (OR = 3.31 [1.25, 8.73]; I2 = 0%). After assessment of heterogeneity among studies, sensitivity analysis was conducted for DMFT. One study was removed and the significant difference between groups remained. Children with ADHD had a significantly higher DMFT index than their peers without ADHD (MD = 0.98 [CI = 0.75, 1.20]; I2 = 0%) Risk of bias ranged from low to high. CONCLUSION: The main shortcoming of the included studies is the high risk of bias regarding the strategies to deal with confounding factors. Within its limitations, this systematic review and meta-analysis demonstrated that children with ADHD were more likely to develop dental caries than their healthy counterparts. FUNDING: No funding. REGISTRATION: CRD42021238923.

The relationship between nitrous oxide sedation and psychosocial factors in the pediatric outpatient setting.

BACKGROUND: Moderate sedation using nitrous oxide (N2 O) has become common in pediatric dentistry. However, less is known regarding the role of patients' characteristics and psychosocial factors in their cooperative behavior during dental procedures with N2 O. AIMS: This study aimed to examine pediatric dental patients' behaviors while undergoing N2 O sedation and to measure the associations between child's cooperative behavior and demographic, physiological responses, and psychosocial factors. METHODS: In this within-subject observational study, participants received 40% N2 O/O2 , by nasal hood, for non-surgical dental procedures. The main outcome measure was the extent of cooperative behaviors, as assessed by the Frankl scale at five timepoints, namely T1: pre-administration of N2 O, T2: post-administration of N2 O, T3: dental injection, T4: dental treatment, and T5: post-procedure administration of 100% O2 . Predictors included age, sex, psychosocial factors reported using the Parenting Style and Dimension Questionnaire and Spence Children Anxiety Scale, as well as pulse rate, respiratory rate, and oxygen saturation. The Wilcoxon signed-rank test and generalized estimation equation were used for data analyses. RESULTS: In 80 children with a mean age of 7.2 (2.2) years, administration of N2 O was significantly associated with cooperative behaviors (odds ratio [OR]:2.62, confidence interval [CI]: 1.46-4.70, p = .001) when adjusted for other predictors. There was no interaction between any of the predictors and N2 O sedation on behaviors. Except for the authoritative parenting style (OR: 1.96, CI: 1.16-3.31, p = .012), which predicted more cooperative behaviors, other predictors were not associated with behavioral outcomes. CONCLUSION: In children sedated with N2 O, behavior was independent of the child's demographic and psychosocial factors. While sedated, demographics, vital signs, and anxiety did not contribute to behavior management. However, screening for parenting style may help predict the child's behavioral response.

Demographic and Clinicopathologic Distribution of Oral Cavity and Oropharyngeal Cancer in Alberta, Canada: A Comparative Analysis.

OBJECTIVES: The aims of this study were to determine demographic profiles, tumour characteristics and treatment factors related to oral cavity and oropharyngeal cancer (OCC and OPC) and comparatively analyze these cancers in the adult population of Alberta, Canada, over 12 years. METHODS: Demographic, tumour characteristics and treatment data regarding OCC and OPC incidence in Alberta residents ≥18 years in 2005-2017 were extracted from the Alberta Cancer Registry database. Age-standardized incidence and mortality rates (ASIR and ASMR) were computed. RESULTS: Among 3448 OCC and OPC cases, mean (standard deviation) age at diagnosis was 63.9 (14.4) and 60.1 (10.2) years, respectively. There was a male predilection for both OCC (58.2%) and OPC (81.7%). With some fluctuations, ASIR remained the same for OCC but increased for OPC. ASMR increased for both. The most common site for OCC was tongue and for OPC tonsil. Squamous cell carcinoma was the most common diagnosis for OCC and OPC. Involvement of at least 1 lymph node was observed in 38.5% of OCC and 85.8% of OPC cases. For 45.2% of OCC and 82.3% of OPC cases, diagnosis occurred at stage IV. The most common initial treatments for OCC were surgery, alone or combined with radiation, whereas radiation with chemotherapy was the main treatment modality for OPC. CONCLUSION: The incidence of OPC in younger males was higher than that of OCC. Although incidence of OPC per 100 000 population increased over the 12-year study period, it remained largely unchanged for OCC. For both cancers, initial diagnoses were made at advanced stages, with almost twice as many stage IV OPC cases than OCC cases.

Behavioural change as a theme that integrates behavioural sciences in dental education.

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

Associations between perceived self-efficacy and oral health behaviours in adolescents.

OBJECTIVES: Self-efficacy is a strong health predictor as it affects patients' certainty about their ability to perform recommended behaviours to improve their health. The aim of this study was to examine the associations between perceived self-efficacy and oral health behaviours among adolescents. METHODS: A convenience sample of adolescents aged 12 to 18 years old was recruited from the University of Alberta dental clinic. Demographics, oral health behaviours, self-rated oral health and task-specific and general self-efficacy were assessed using a questionnaire with three sections. For the comparisons of outcomes across different categories, Student t-test, multivariate regression and chi-squared tests were used. RESULTS: A total of 252 adolescents with average (SD) age of 14 (1.7) years participated in the study; 60% were girls; 81% were born in Canada; 56% were White; and 61% had dental coverage. Demographic characteristics had no significant correlation with general self-efficacy. However, correlation coefficients indicated that younger adolescents had higher dietary self-efficacy (negative correlation), girls had higher toothbrushing and dental visit self-efficacy, and those with dental coverage had higher dental visit self-efficacy. A significant association was found between toothbrushing, dietary habits and dental visits self-efficacy (subscales of task-specific self-efficacy) and their respective outcomes (frequency of toothbrushing, sugar intake and regular dentist visits). General self-efficacy was significantly associated with frequency of toothbrushing and participant's self-rated oral health. CONCLUSION: Higher task-specific and general self-efficacy correlated with better oral health behaviours among adolescents. Therefore, behavioural interventions should be designed to enhance self-efficacy among adolescents in order to improve their oral health outcomes.

Perceived Effectiveness and Applicability of Think-Pair-Share Including Storytelling (TPS-S) to Enhance Clinical Learning.

Problem: Think-pair-share (TPS) is a teaching strategy that promotes active and collaborative learning; however, the effectiveness and applicability of this strategy in its original or altered form remain to be established, especially in health professions education. As a first step in this direction, the objective of our study was to examine the perceived effectiveness and applicability of TPS including storytelling (TPS-S) in an oral pathology seminar from the perspectives of students, seminar instructors, and peer instructors (experienced instructors who observed the seminar). Intervention: Prompts for individual thinking (T), pair discussion (P), and class sharing (S) included clinical case-based questions related to diagnosis and management and wildcards with additional information about the cases. In addition to the traditional TPS phases, the experiences of the leading instructor in dealing with the cases discussed in the seminar were shared through storytelling to model good practices in clinical diagnosis and management. Context: Our study was conducted in the School of Dentistry at the University of Alberta. Participants in this mixed-method study included third (Y3) and fourth (Y4) year dental students (n = 55) in their clinical training, seminar instructors (n = 2), and peer instructors (n = 3). Data from students, seminar instructors, and peer instructors were obtained through the Student Evaluation of Educational Quality (SEEQ) questionnaire, journaling, and interview, respectively. Descriptive statistics were performed to analyze SEEQ dimensions and statements (factors). MANOVA was used to determine significant differences between Y3 and Y4 students for SEEQ dimensions and ANOVA to identify the factors that accounted for significant differences. Qualitative data were analyzed using inductive content analysis. Impact: Participants positively valued the TPS-S seminar. Students rated all SEEQ dimensions between good and very good and regarded the seminar as superior to traditional lectures. Perceived conditions that facilitated the implementation of TPS-S included the use of real-life clinical cases, instructor facilitation skills, and the scaffolded structure of the seminar. Perceived conditions that hindered the implementation of TPS-S included unequal participation of Y3 and Y4 students, time constraints, and issues related to student pairing. Lessons learned: TPS-S was perceived as effective to improve clinical learning and applicable to dental clinical education as long as its implementation matches the characteristics of the learning context. Further evidence is needed to empirically demonstrate the effectiveness and applicability of TPS-S.

Oral Cavity and Oropharyngeal Cancer Surveillance and Control in Alberta: A Scoping Review.

OBJECTIVES: This scoping review provides a comprehensive overview of oral cavity cancer (OCC) and oropharyngeal cancer (OPC) in Alberta. METHODS: A database search was conducted up to 2018 using Web of Science, Scopus, Medline, PubMed and Embase, along with a manual search of gray literature. Data from the Alberta Cancer Foundation's dedicated fund for research, Cancer Surveillance and Reporting and Alberta Cancer Registry were also collected. RESULTS: Our review included 8 published papers and 14 other sources, including data on 3448 OCC and OPC patients from Surveillance and Reporting and Alberta Cancer Registry. Cancer registry data (2005-2017) showed that most OCC and OPC lesions were diagnosed at an advanced clinical stage, with a significantly large number of advanced OPC lesions in stage IV (OCC 45.2%, OPC 82.4%); 47.9% of these patients died. Survival rates were lowest in rural and First Nations areas. In Alberta, 35% of HPV-associated cancers were linked to OPCs, which were more prevalent in men and younger age groups. No routine public oral cancer screening program currently exists in Alberta. General practitioners and dentists refer patients to specialists, often with long waiting times. CONCLUSION: OCC and OPC patients in Alberta continue to be diagnosed in stage IV and experience high mortality rates.

Health Information Seeking Among Immigrant Families in Western Canada.

PURPOSE: Studies on immigrant populations' access to healthcare in Canada tend to focus on adults and usually concentrate on specific ethnic groups, particularly South Asians and Chinese. This study sought to present the experiences of immigrant parents when they access health services for their children focusing specifically on the various sources of information that they used to improve their children's health. DESIGN AND METHOD: This qualitative study was carried out in Edmonton, Alberta between April to October 2018. Fifty parents, chosen using purposive sampling participated in one-on-one semi-structured interviews. Interviews were recorded digitally, transcribed verbatim, and analyzed thematically. RESULTS: We developed three main themes from the data: Accessing social networks for informational support, the role of professionals in accessing health care information, and navigating and evaluating information sources. The study demonstrates that immigrant families consulted various sources of information in order to meet their children's healthcare needs. The most common source was the Internet followed by friends and family members, and health care professionals. DISCUSSION: Findings suggest that health information that is disseminated using the Internet needs to be made available in multiple languages to facilitate communication to persons who are not fluent in English nor French. Also, policy makers and health care professionals must increase focus on informal sources of health care information.

Oral health status of patients infected with human immunodeficiency virus and related factors, Iran: a cross-sectional study.

BACKGROUND: Human immunodeficiency virus (HIV) continues to be a major global issue. HIV-infected patients commonly experience oral health problems. This study aimed to assess oral health status of the patients and its related factors in Shiraz, Iran. METHODS: In this cross-sectional study, by using simple random sampling, 250 HIV-infected patients were selected from Shiraz Voluntary Counseling and Testing Center in 2019. Patients' decayed, missing, and filled tooth (DMFT) index, plaque index (PI), and community periodontal index (CPI) were determined. Associations between patients' characteristics and the above-mentioned indices were examined by using Pearson correlation, one-way ANOVA, chi-square, and independent sample T test. The effect of possible confounding factors was controlled by using multiple linear regression and logistic models. RESULTS: Of the 222 participants, 111 (50%) had 15 or more missing teeth and 79 (35.6%) were edentulous. Their mean (SD) DMFT and PI were 20.71 (10.74) and 1.11 (0.79), respectively. About 40% of them had healthy gingiva. DMFT (p < 0.001), PI (p < 0.001), and CPI (p = 0.002) were significantly worse in men than women. The patients' DMFT and edentulous status were significantly associated with their age (both p < 0.001) and duration of disease (p = 0.001 and p = 0.008, respectively). Unemployed patients had the worst DMFT, PI, and CPI (all p < 0.001) and the highest percentage of edentulous individuals (p = 0.003). All examined indices were significantly worse in cigarette smokers, alcoholics, addicts, and patients with a previous history of imprisonment (all p < 0.001). The odds ratio of being edentulous was 5.74 times in addicted patients than in non-addicted ones (p < 0.001). The odds increased 0.11 with every year that the patients' age increased (p < 0.001). Multiple linear regression models also showed that the addicted patients had significantly more scores in DMFT index, PI, and CPI (all p < 0.001). CONCLUSIONS: Overall, oral health status of the HIV-infected patients was unsatisfactory. Therefore, effective interventional programs are needed for prevention and early treatment of dental problems among this population, especially for more vulnerable groups such as older men with low socioeconomic status, and those with high-risk behaviors.

Influence of Sponsorship Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study.

BACKGROUND: In this meta-epidemiological study, we aimed to examine associations between treatment effect size estimates and sponsorship bias in oral health randomized clinical trials. METHODS: We selected oral health related meta-analyses that included a minimum of five randomized controlled trials. We extracted data, in duplicate, related to influence of sponsorship bias. We quantified the extent of bias associated with influence of sponsorship on the magnitude of effect size estimates of continuous variables using a two-level meta-meta-analytic approach with random-effects models to allow for intra- and inter-meta-analysis heterogeneity. RESULTS: We initially identified 540 randomized trials included in 64 meta-analyses. Risk of sponsorship bias was judged as being "unclear" in 72.8% (n = 393) of the trials, while it was assessed as "low" in 16.7% (n = 90) and as "high" in 10.6% (n = 57) of the trials. Using a meta-epidemiological analysis (37 meta-analyses, including 328 trials that analyzed 85,934 patients), we identified statistically significant larger treatment effect size estimates in trials that had "high or unclear" risk of sponsorship bias (difference in treatment effect size estimates=0.10; 95% confidence intervals: 0.02 to 0.19) than in trials that had "low" risk of sponsorship bias. CONCLUSIONS: We identified significant differences in treatment effect size estimates between dental trials based on sponsorship bias. Treatment effect size estimates were 0.10 larger in trials with "high or unclear" risk of sponsorship bias. PRACTICAL IMPLICATIONS: Clinicians should have an adequate knowledge of sponsorship bias in a clinical trial and be able to estimate the degree to which the conclusions of a systematic review are synthesized and interpreted, based on trials with low risk of sponsorship bias.

Antiatherogenic properties of high-density lipoproteins from arterial plasma are attenuated as compared to their counterparts of venous origin.

BACKGROUND AND AIMS: High-density lipoprotein (HDL) particles play atheroprotective roles by their ability to efflux cholesterol from foam cells and to protect low-density lipoproteins (LDLs) from oxidative damage in the arterial intima. We hypothesized that antioxidative properties of HDLs can be attenuated in the oxygen-rich prooxidative arterial environment, contributing to the development of atherosclerosis. To evaluate this hypothesis, we compared antioxidative activity of HDLs from arterial and venous plasmas. METHODS AND RESULTS: Arterial and venous blood samples were simultaneously obtained from 16 patients (age 68 ± 10 years; 75% males) presenting with ischemic or valvular heart disease. Major HDL subfractions and total HDLs were isolated by density gradient ultracentrifugation and their chemical composition and the capacity to protect LDLs from in vitro oxidation were evaluated. HDL-cholesterol, triglycerides and apolipoprotein (apo) B-100 levels were slightly but significantly reduced by -4 to -8% (p < 0.01) in the arterial vs. venous samples. Total mass of HDL subpopulations was similar and HDL subpopulations did not reveal marked compositional differences between the arterial and venous circulation. Potent antioxidative activity of the small, dense HDL3c subpopulation was significantly reduced in the particles of arterial origin vs. their counterparts from venous plasma (increase of +21% in the propagation rate of LDL oxidation, p < 0.05). Interestingly, antioxidative properties of venous HDLs were enhanced in statin-treated patients relative to untreated subjects. CONCLUSION: Antioxidative properties of small, dense HDLs from arterial plasma are attenuated as compared to the particles of venous origin, consistent with the development of atherosclerosis in the arterial wall.

Impact evaluation of a school-based oral health program: Kuwait National Program.

BACKGROUND: This study evaluated the relationship between enrolment in a school-based oral health prevention program (SOHP) and: 1) children's dental health status and oral health-related quality of life (OHRQoL), and 2) mothers' oral health (OH) knowledge, attitude, practice, and OHRQoL. METHODS: This cross-sectional study, in the Kuwait Capital, included 440 primary school children aged 11 to 12 years and their mothers. Participants were classified into two groups: SOHP and non-SOHP. The SOHP group had been enrolled in the prevention program for at least 3 years: children had twice-a-year applications of fluoride varnish and fissure sealants if needed; mothers had, at least, one oral health education session. The non-SOHP group had negative consents and had not been exposed to the prevention program activities. Dental examinations were performed at schools using portable dental units. Caries experience was determined using the decayed (D/d), missing (M/m), and filled (F/f) teeth (T/t)/surface (S/s) indices. Children's OHRQoL was assessed using a self-administered validated Child Perceptions Questionnaire 11-14 (CPQ11-14). Mothers' OH knowledge, attitude, practice, and OHRQoL were also assessed. After Bonferroni correction, a p-value of less than 0.05 was considered statistically significant for caries experience measures while a p-value of less than 0.013 was considered statistically significant for OHRQoL subscales and mothers' OH knowledge, attitude, practice, and OHRQoL. RESULTS: Mean (SD) DT/dt, DMFT/dmft and DMFS/dmfs were 1.41 (1.66), 2.35 (2.33), and 4.41 (5.86) for SOHP children, respectively. For non-SOHP children, the means were 2.61 (2.63), 3.56 (3.05), and 7.24 (7.78), respectively. The difference between the SOHP and non-SOHP was statistically significant (p <  0.001). Children enrolled in the program had a higher number of sealed and restored teeth. No significant differences were found in CPQ11-14 scores or subscale scores between the two groups. No significant difference in mothers' OH knowledge, attitude, practices or OHRQoL was found between SOHP and non-SOHP groups (P > 0.013). CONCLUSION: Enrolment in the SOHP prevention services was associated with a positive impact on children's caries level with no significant impact on mothers' knowledge, attitude, practice, or OHRQoL.

Influence of blinding on treatment effect size estimate in randomized controlled trials of oral health interventions.

BACKGROUND: Recent methodologic evidence suggests that lack of blinding in randomized trials can result in under- or overestimation of the treatment effect size. The objective of this study is to quantify the extent of bias associated with blinding in randomized controlled trials of oral health interventions. METHODS: We selected all oral health meta-analyses that included a minimum of five randomized controlled trials. We extracted data, in duplicate, related to nine blinding-related criteria, namely: patient blinding, assessor blinding, care-provider blinding, investigator blinding, statistician blinding, blinding of both patients and assessors, study described as "double blind", blinding of patients, assessors, and care providers concurrently, and the appropriateness of blinding. We quantified the impact of bias associated with blinding on the magnitude of effect size using a two-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity. RESULTS: We identified 540 randomized controlled trials, included in 64 meta-analyses, analyzing data from 137,957 patients. We identified significantly larger treatment effect size estimates in trials that had inadequate patient blinding (difference in treatment effect size = 0.12; 95% CI: 0.00 to 0.23), lack of blinding of both patients and assessors (difference = 0.19; 95% CI: 0.06 to 0.32), and lack of blinding of patients, assessors, and care-providers concurrently (difference = 0.14; 95% CI: 0.03 to 0.25). In contrast, assessor blinding (difference = 0.06; 95% CI: -0.06 to 0.18), caregiver blinding (difference = 0.02; 95% CI: -0.04 to 0.09), principal-investigator blinding (difference = - 0.02; 95% CI: -0.10 to 0.06), describing a trial as "double-blind" (difference = 0.09; 95% CI: -0.05 to 0.22), and lack of an appropriate method of blinding (difference = 0.06; 95% CI: -0.06 to 0.18) were not associated with over- or underestimated treatment effect size. CONCLUSIONS: We found significant differences in treatment effect size estimates between oral health trials based on lack of patient and assessor blinding. Treatment effect size estimates were 0.19 and 0.14 larger in trials with lack of blinding of both patients and assessors and blinding of patients, assessors, and care-providers concurrently. No significant differences were identified in other blinding criteria. Investigators of oral health systematic reviews should perform sensitivity analyses based on the adequacy of blinding in included trials.

Identifying a Potential Summary Measure for Overall Caries Level in Children Examined with the International Caries Detection and Assessment System.

OBJECTIVE: To identify a potential summative summary measure that reflects a patient's overall caries level in children examined with the International Caries Detection and Assessment System (ICDAS). SUBJECTS AND METHODS: Participants were 1- to 15-year-old children from Kuwait, Brazil, and Spain. Children's teeth were examined using the ICDAS. Multiple measures of central tendency and dentition-specific indices were considered as potential summative measures. The relationship between the summative measures and number of caries lesions was evaluated considering degrees of caries severity using Spearman's correlation analysis. The results were generated using the Kuwaiti sample and were cross-validated using the Brazilian and Spanish samples. RESULTS: A total of 2,808 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in primary, mixed, and permanent dentitions. The total ICDAS score of 51 buccal (B), 61B, 54 occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, and 85O surfaces in primary dentition and the total ICDAS score of 14O, 16 lingual (L), 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, and 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations with the number of caries lesions at different caries severity levels. CONCLUSIONS: Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dental stages. Total ICDAS scores of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for a patient's overall caries level with high diagnostic accuracy.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE: To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS: Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS: The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS: As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.

ORAL HEALTH STATUS OF IMMIGRANT AND REFUGEE CHILDREN IN NORTH AMERICA: A SCOPING REVIEW.

OBJECTIVES: The aim of this scoping review was to assess the oral health status of the children of refugees and immigrants ("newcomers"); the barriers to appropriate oral health care and use of dental services; and clinical and behavioural interventions for this population in North America. METHODS: Explicit inclusion and exclusion criteria were used in searching electronic databases to identify North American studies between 2007 and 2014 that reported oral health status, behaviours and environment of children of newcomers. Additional studies from 1995-2008 were found in a recently published review. Pertinent data from all selected studies were summarized. RESULTS: Overall, 32 relevant North American studies were identified. In general, children of newcomers exhibit poorer oral health compared with their non-newcomer counterparts. This population faces language, cultural and financial barriers that, consequently, limit their access to and use of dental services. Intervention programs, such as educational courses and counseling, targeting newcomer parents or their children are helpful in improving the oral health status of this population. CONCLUSIONS: Children of newcomers are suffering from poor oral health and face several barriers to use of dental care services. The disparity in dental caries between children of newcomers and their counterparts can be reduced by improving their parents' literacy in the official language(s) and educating parents regarding good oral health practices. An appropriate oral health policy remains crucial for marginalized populations in general and newcomer children in particular.

Relationship Between Oral Health Knowledge, Attitude and Practices of Primary School Teachers and Their Oral Health-related Quality of Life: A Cross-sectional Study.

PURPOSE: To measure oral health (OH) knowledge, attitude and practices (KAP) of primary school teachers and to evaluate the relationship between these measures and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: A total of 1013 school teachers from all regions of Kuwait were randomly selected in this cross-sectional study. A questionnaire on demographics, knowledge, attitude, practices and OHRQoL was used. Frequencies and means (SD) were used for data description. Correlations between KAP and OHRQoL were evaluated using Pearson's correlation coefficient. Associations between practice-specific knowledge and its corresponding practice as well as knowledge and practices and OHRQoL were determined using the chi-squared test. RESULTS: About 71% of the participants were females, 57% were 30-50 years old, and 75% had a college education. The mean (95%CI) knowledge score was 60.2% (57.2-62.0), ranging from 15.4% to 93%. The well-known OH facts were the importance of brushing twice a day with fluoridated toothpaste, the cariogenic effect of sticky, sugary foods and snacks, as well as the damage that soft drinks can cause to teeth. The least known facts were replacement frequency of toothbrush, parent's supervision of children's brushing and the benefit of regular flossing. Weak but significant correlations were found between KAP components and OHRQoL (p < 0.05). All practice-specific OH knowledge was significantly associated with its practice, except brushing and flossing (p > 0.05). Self-esteem was the mostly frequently affected OHRQoL construct by improper OH practices. CONCLUSION: Oral health knowledge by itself is not enough to change improper OH practices. Developing behaviourchanging interventions based on OHRQoL outcomes may be beneficial.