Qualitative study on barriers and coping strategies for dental care in autistic children: Parents' perspective.

BACKGROUND: Children with autism spectrum disorders (ASD) face challenges in home oral care, accessing a dentist and accepting dental treatment. AIM: To determine the barriers to dental care for autistic children in Singapore through the experiences and opinions of their parents. DESIGN: A qualitative exploratory approach comprising semistructured interviews and a focus group discussion was used. Audio recordings were transcribed and coded into themes using NVivo 12 software. RESULTS: Participants were 23 parents of autistic children aged 3-12 years. The following barriers were identified: (1) Sensory, physical and parental knowledge issues are related to toothbrushing difficulties and use of nonoptimally fluoridated toothpaste in autistic children. (2) Accessing dental services was hindered by a lack of parental knowledge on the importance of an early dental home, parental apprehension about the child's acceptance of dental care, lack of information on specialised dentists and perceived high cost of dental visits. Parental suggestions for improvements included understanding the child's sensory profile, more information on finding a suitable dentist and subsidisation of costs for multiple acclimatisation visits. CONCLUSION: Caregivers' education, information about specialised dentists and the availability of specific dental care resources for autistic children in Singapore are needed for optimising their dental care.

Occupational and speech therapists' perceptions of their role in dental care for children with autism spectrum disorder: A qualitative exploration.

BACKGROUND: Children with autism spectrum disorder (ASD) have challenges in home oral care, accessing a dentist and accepting dental treatment. Occupational therapists (OTs) and speech therapists (STs) are likely to be involved earlier in managing communication, behavioural and sensory processing issues. AIM: To determine perceived issues, barriers and potential solutions to dental care for children with ASD in Singapore from the perspective of OTs and STs. DESIGN: Semi-structured interviews and a focus group discussion involving OTs and STs who treat children with ASD were conducted. Audio recordings were transcribed and coded into themes using the NVivo 12 software. RESULTS: Emergent themes indicated that: (i) OTs and STs have important roles in recognition of issues with toothbrushing, oral pathology and harmful oral habits; (ii) OTs and STs were able to identify reasons for difficulties in oral home care for children with ASD and offer helpful strategies; and (iii) OTs and STs can play a role in pre-dental visit preparations but lack a clear dental referral pathway. CONCLUSIONS: OTs and STs exclusively assist in the early identification and referrals of children with ASD to the dentist. Interprofessional collaboration with dentists should be further explored to aid in the provision of preventive dental advice.

Temporomandibular dysfunction experience is associated with oral health-related quality of life: an Australian national study.

BACKGROUND: There are very few studies of the association between temporomandibular dysfunction (TMD) and oral health-related quality of life (OHRQoL) in a representative sample from the Asia-Pacific region. Accordingly, we aimed to quantify the association of TMD with OHRQoL dimensions and overall measurement scores in a representative sample of Australian adults while accounting for a range of confounders, and statistically estimating whether TMD experience is meaningfully associated with OHRQoL. METHOD: Australia's National Survey of Adult Oral Health 2004-2006 data were used. The outcome variables were the Oral Health Impact Profile (OHIP-14) domains and overall scores while the main exposure was self-reported Diagnostic Criteria Question for TMD. The analysis accounted for confounders including oral health status obtained from the oral examination, demographics, socioeconomics, health behaviours and health including perceived stress subscales of the PSS-14. We conducted complex samples analysis while using Cohen's f2 effect size to estimate whether the association is meaningful. RESULTS: TMD prevalence was 9.9% (95% CI: 8.4-11.6%) among 4133 Australian adults. TMD experience was associated with impairments to the seven OHIP-14 OHRQoL domains (P < .05) with higher impairments observed in physical pain (B = 0.82, 95% CI: .45-1.20, P < .001), psychological discomfort (B = 0.68, 95% CI: .29-1.06, P = .001) and psychological disability (B = 0.52, 95% CI: .20-.84, P = .001) in adjusted multivariate analyses. The difference in the mean OHIP-14 scores for those reporting TMD (Mean = 13.1, 95% CI: 12.0-14.0) and those who did not (Mean = 6.6, 95% CI: 6.0-6.8) was significant (t = 7.51, P < .001). In an adjusted multivariable model for OHIP-14 scores, TMD experience was associated with higher OHIP-14 scores (B = 3.34, 95% CI: 1.94-4.75, P < .001) where the Cohen's f2 was .022. Further, perceived stress subscales: perceived distress and perceived control were associated with TMD experience and OHIP-14 scores (P < .05). CONCLUSION: Lower OHRQoL was observed in Australian adults who reported TMD experience but with small clinical importance which might support considering TMD in regular dental care. The higher impairments observed in physical pain, psychological discomfort and psychological disability domains of OHRQL can help clinicians and researchers focus their attention on these domains. The confounding effect exhibited by the perceived stress subscale might support their inclusion in future TMD and OHRQoL research.

Dentin-derived alveolar bone graft for alveolar augmentation: A systematic review.

Introduction: Application of alveolar bone graft (ABG) in alveolar augmentation is done to prevent excessive bone resorption due to tooth extraction, missing teeth, or other diseases/conditions affecting the alveolar bone. The use of autogenous dentin-derived ABG has been considered as the composition of dentin appears to be nearly analogous to that of bone. Objective: This systematic review aims to assess the efficacy of dentin-derived ABG for alveolar augmentation of post-extraction sockets or other alveolar bone defects by evaluating volume gain and histomorphometric data. Material and methods: A search of systematic literature was conducted in Pubmed, Scopus, Web of Science, and Embase from database inception to October 2023. The review included both randomized controlled trials (RCT), pilot studies, clinical trials, and retrospective studies reporting on dentin-derived ABG use for alveolar augmentation. Results: Overall, 298 articles were obtained from the initial search. From these articles, 21 articles met the inclusion criteria and were included for descriptive analysis. All of the studies indicated low risk of bias. Studies of dentin-derived ABG, which used bone-derived grafts as the control group, have shown significantly higher percentages of new bone formation, gain in vertical and horizontal dimensions, and less reduction in dimensions. Conclusions: Dentin-derived ABG was effective in volume maintenance, indicating promising results via histomorphometric and radiographic analysis.

Degrees of xerostomia? A Rasch analysis of the Xerostomia Inventory.

OBJECTIVE(S): The global demographic changes resulting in an ageing population require attention on xerostomia, as its prevalence appears to increase with age. The Xerostomia Inventory (XI) is a 11-item instrument developed to evaluate the symptoms and behavioural components of xerostomia, while a shortened 5-item version named Summated Xerostomia Inventory (SXI) was later proposed. The aim of the present study was to evaluate the construct validity of the XI and whether the SXI can provide a shortened version. Since previous studies focused only on dimensionality and reliability, we employed modern psychometric methodology to investigate properties such as differential item functioning (DIF) and targeting. STUDY DESIGN: The XI was applied to 164 middle-aged to older adults who participated in a randomized controlled trial to investigate the effects of alcohol-containing mouth rinse in Singapore. The psychometric properties of the XI were investigated with the Rasch model (Partial Credit Model). Overall model fit was evaluated with a summary chi-square statistic. Item fit was evaluated with the Fit Residual, and values between -2.5 and 2.5 are considered acceptable. DIF by sex was evaluated through a two-way ANOVA of the residuals. RESULTS: After collapsing the categories of "Hardly ever" and "Fairly often", the test of global fit (χ2 (30) = 34.32, P = .27) indicated overall fit to the Rasch model. Since Fit Residuals were between -2 and 2, the fit of individual items was also adequate. No DIF was found between men and women, and targeting was adequate (µ = -0.56). CONCLUSION: The current study expanded the evidence on the XI and SXI validity and provides new implications for practice: a 3-point categorization ("Never," "Occasionally" and "Very often") should be preferred rather than the original 5-point categorization; the XI and SXI scores can be compared between men and women and will reflect true differences in xerostomia rather than measurement bias.

Third molor extractions among Australian adults: findings from the 2013 National Dental Telephone Interview Survey.

OBJECTIVES: To identify, over the previous 12 months, whether: (i) dental insurance is associated with a higher number of third molar extractions (TME); (ii) single versus multiple TME is associated with self-rated oral health; and (iii) TME when 18-25 years of age is associated with fewer days absent from work because of dental problems. METHODOLOGY: Australia's 2013 National Dental Telephone Interview Survey, which included: socio-demographics; and number of extractions, reasons for extractions, self-rated oral health and days absent from work because of dental problems, all in the past 12 months. RESULTS: The majority of TME recipients were female [56.6%, standard error (SE) = 6.0%], 18-25 years of age (63.0%, SE = 5.4%), held a tertiary qualification (73.9%, SE = 5.4%), had a total annual household income of ≥$60,000 (58.3%, SE = 6.4%), were dentally insured (52.6%, SE = 6.2%) and received multiple TME (60.9%, SE = 8.5%). Number of TME was associated with having dental insurance [B = 0.97: 95% confidence interval (95% CI): 0.5-1.5] and days of work absence because of dental problems (B = 1.10; 95% CI: 0.26-1.94). Receiving single TME versus multiple TME was not associated with self-rated oral health (B = -0.25; 95% CI: -0.76 to 0.25). Receiving TME when 18-25 years of age versus when older than 25 years of age was not associated with days absent from work because of dental problems (B = 0.48; 95% CI: -0.37 to 2.33). CONCLUSION: Dental insurance was associated with a higher TME count without improving self-reported oral health in the short-term. Using age as a justification for prophylactic TME might be questionable because, receiving TME when 18-25 years of age versus when older than 25 years of age did not reduce days absent from work because of dental problems.

Interleukin-17 Gene Expression and Serum Levels in AsthmaDegenerative Model.

Asthma is one of the most common chronic respiratory diseases. It is associated with significant morbidity and shows an increasing prevalence over time. Accumulating evidence suggests that interleukin (IL)-17 has a key role in severe asthma. The aim of the study was to determine quantitatively gene expression of IL-17 in peripheral blood mononuclear cells (PBMN) & the level of IL-17 in the serum of asthmatic patients, to correlate the level of IL-17 with the severity of asthma and to compare between gene expression of IL-17 and its serum level. Forty (40) asthmatic patients were enrolled and subdivided into 2 subgroups; controlled & uncontrolled asthma according to GINA, 2014. In addition, twenty (20) healthy control subjects were included. Blood samples were subjected to real time PCR assays for IL-17 mRNA gene expression and serum was tested by ELISA for estimation of IL-17 serum levels. Significant higher serum IL-17 levels were found in patients with uncontrolled asthma compared to patients with controlled asthma and healthy control group. Mean serum IL-17 value was 87.24 pg/ml in uncontrolled asthma, 75.9 pg/ml in controlled asthma and 47.0 pg/ml in healthy group (P= 0.00). IL-17 mRNA gene expression levels (ΔΔ Ct) were also significantly elevated in uncontrolled asthma compared to patients with controlled asthma and healthy control group. Mean IL-17 mRNA gene expression levels were 33.7 units in uncontrolled asthma, 7.0 in controlled asthma and 0.30 in healthy group (P=0.00).

Exploring and modelling impacts of third molar experience on quality of life: a real-time qualitative study using Twitter.

OBJECTIVES: This study had two objectives: (i) to explore and model domains describing the real-time impact of third molars (TMs) on quality of life (QoL); and (ii) to assess the percentage coverage, in some generic health-related quality of life (HRQoL) and oral health-related quality of life (OHRQoL) instruments, of the TM QoL domains identified in this study. METHODOLOGY: A global cross-sectional sample of tweets containing 'wisdom tooth' over a 1-week period retrieved 3,537 tweets. After random quota sampling, classification and filtering, only 843 tweets were included in the thematic analysis. A TM QoL model was constructed based on the associations of the identified domains. Domains for the selected generic HRQoL and OHRQoL instruments were plotted against the domains identified in the study to calculate the percentage coverage for each. RESULTS: The QoL domains identified were pain (n = 348, 41%), mood (n = 173, 20%), anxiety and fear (n = 54, 7%), enjoying food (n = 41, 4%), coping (n = 37, 4%), daily activities (n = 34, 4%), sleep (n = 24, 2%), social life (n = 19, 2%), physical health (n = 17, 2%), ability to think (n = 9, 1%), self-care (n = 8, 1%) and sporting & recreation (n = 2, <1%). The Assessment Quality of Life instrument (AQoL-8D) covers 87% of the TM QoL domains, while the rest of the HRQoL and OHRQoL instruments cover 33-60%. CONCLUSION: This study shows how Twitter can be used to obtain real-time QoL data, which might be used to model how TMs impact on QoL. The TM QoL domains identified in the study were generally under-represented among the generic OHRQoL instruments assessed while, the HRQoL AQoL-8D covered most of the TM QoL domains. The QoL domains identified in the study might be used to develop a new OHRQoL measure for TMs.

Effect of immunotherapy on fungal allergy: a case report.

Candida is presented. Systemic immunotherapy with a Tricophyton/Candida vaccin was completely cleared the urticaria/angioedema and decreased specific IgE from more than 100 KUA/I to 7.6 to Tricophyton and from 4.5 KUA/I to 0.7 KUA to Candida after immunotherapy.

Third Molars on the Internet: A Guide for Assessing Information Quality and Readability.

BACKGROUND: Directing patients suffering from third molars (TMs) problems to high-quality online information is not only medically important, but also could enable better engagement in shared decision making. OBJECTIVES: This study aimed to develop a scale that measures the scientific information quality (SIQ) for online information concerning wisdom tooth problems and to conduct a quality evaluation for online TMs resources. In addition, the study evaluated whether a specific piece of readability software (Readability Studio Professional 2012) might be reliable in measuring information comprehension, and explored predictors for the SIQ Scale. METHODS: A cross-sectional sample of websites was retrieved using certain keywords and phrases such as "impacted wisdom tooth problems" using 3 popular search engines. The retrieved websites (n=150) were filtered. The retained 50 websites were evaluated to assess their characteristics, usability, accessibility, trust, readability, SIQ, and their credibility using DISCERN and Health on the Net Code (HoNCode). RESULTS: Websites' mean scale scores varied significantly across website affiliation groups such as governmental, commercial, and treatment provider bodies. The SIQ Scale had a good internal consistency (alpha=.85) and was significantly correlated with DISCERN (r=.82, P<.01) and HoNCode (r=.38, P<.01). Less than 25% of websites had SIQ scores above 75%. The mean readability grade (10.3, SD 1.9) was above the recommended level, and was significantly correlated with the Scientific Information Comprehension Scale (r=.45. P<.01), which provides evidence for convergent validity. Website affiliation and DISCERN were significantly associated with SIQ (P<.01) and explained 76% of the SIQ variance. CONCLUSION: The developed SIQ Scale was found to demonstrate reliability and initial validity. Website affiliation, DISCERN, and HoNCode were significant predictors for the quality of scientific information. The Readability Studio software estimates were associated with scientific information comprehensiveness measures.

Nasal allergies in the Middle Eastern population: results from the "Allergies in Middle East Survey".

BACKGROUND: Chronic respiratory diseases such as asthma and allergic rhinitis (AR) are a major public health problem in developing countries including those in the Middle East. However, to date, there is a paucity of information related to physician-diagnosed AR in this region. The Allergies in Middle East Survey was undertaken to help clarify and broaden the understanding of physician-diagnosed AR across Egypt, Iran, Lebanon, Saudi Arabia, and the United Arab Emirates. The survey explores the frequency of physician-diagnosed AR, prevalence and types of associated symptoms, the impact on quality of life (QOL), current treatment practices, and therapy expectations. METHODS: In total, 7411 households in five countries (Egypt, Lebanon, Saudi Arabia, Iran and the United Arab Emirates) were screened to identify individuals that were ≥4 years old with a physician diagnosis of AR and either symptoms and/or treatment in the past 12 months. A total of 501 respondents from the five countries completed the survey. Standardized questionnaires were used to make comparisons across the regions; however, the data collection procedures were tailored for each country. The sample was probability based to ensure valid statistical inference to the population. RESULTS: Ten percent of the Middle East population surveyed had a physician diagnosis of AR, with 65% of respondents stating that their allergies were intermittent in nature. An otolaryngologist or allergist diagnosed the majority of the individuals surveyed. Runny nose, nasal and throat itching, postnasal drip, and nasal congestion or stuffed up nose were the most common and bothersome symptoms of AR. The majority of survey participants (58% of the overall survey population) with AR reported that the condition had an impact on their daily private and professional life. Seventy-two percent of adults reported that their AR symptoms limited their work/school activities and 35% reported that their AR interfered with and caused them to miss work or school within the past 12 months. One factor, in addition to the outward AR symptoms, that could have contributed to these function impairments may have been sleep disturbances. Although a secondary symptom to AR, sleep disturbances (difficulty getting to sleep, waking up during the night or lack of a good night's sleep) were shown in this survey to be extremely troubling in ∼15% of AR sufferers. In the past year >90% of patients reported taking a medication of any type for their AR, with nearly a 4:1 ratio of patients taking a prescription medication versus an over-the-counter (OTC) medication in the past 4 weeks. Over 75% of survey respondents reported taking an intranasal corticosteroid (INCS) in the last 4 weeks and the satisfaction rate of INCS medications was similar to that reported for OTC medications. The most common reasons cited for dissatisfaction with INCS medications were inadequate effectiveness, bothersome side effects (e.g., unpleasant taste and retrograde drainage into the pharynx), decreased effectiveness with chronic use, and failure to provide 24-hour relief. CONCLUSION: These data show that AR is common in the Middle East region as elsewhere in the world. Many patients with AR in Middle East region suffer from their symptoms (e.g., runny nose, nasal itching, nasal congestion, postnasal drip, and other symptoms) on all or most days during the times of the year that their allergies are worst. These symptoms have been shown to reduce QOL and performance at work/school to a significant degree. Additionally, the survey data underscore a considerable treatment gap with current therapies for AR and that many AR patients still have not found adequate effectiveness with currently available medications. Thus, through identification of disease impact on the Middle East population and highlighting treatment gaps, clinicians in the Middle East may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.

Nasal allergies in the Middle Eastern population: Results from the "Allergies in Middle East Survey".

BACKGROUND: Chronic respiratory diseases such as asthma and allergic rhinitis (AR) are a major public health problem in developing countries including those in the Middle East. However, to date, there is a paucity of information related to physician-diagnosed AR in this region. The Allergies in Middle East Survey was undertaken to help clarify and broaden the understanding of physician-diagnosed AR across Egypt, Iran, Lebanon, Saudi Arabia, and the United Arab Emirates. The survey explores the frequency of physician-diagnosed AR, prevalence and types of associated symptoms, the impact on quality of life (QOL), current treatment practices, and therapy expectations. METHODS: In total, 7411 households in five countries (Egypt, Lebanon, Saudi Arabia, Iran and the United Arab Emirates) were screened to identify individuals that were ≥4 years old with a physician diagnosis of AR and either symptoms and/or treatment in the past 12 months. A total of 501 respondents from the five countries completed the survey. Standardized questionnaires were used to make comparisons across the regions; however, the data collection procedures were tailored for each country. The sample was probability based to ensure valid statistical inference to the population. RESULTS: Ten percent of the Middle East population surveyed had a physician diagnosis of AR, with 65% of respondents stating that their allergies were intermittent in nature. An otolaryngologist or allergist diagnosed the majority of the individuals surveyed. Runny nose, nasal and throat itching, postnasal drip, and nasal congestion or stuffed up nose were the most common and bothersome symptoms of AR. The majority of survey participants (58% of the overall survey population) with AR reported that the condition had an impact on their daily private and professional life. Seventy-two percent of adults reported that their AR symptoms limited their work/school activities and 35% reported that their AR interfered with and caused them to miss work or school within the past 12 months. One factor, in addition to the outward AR symptoms, that could have contributed to these function impairments may have been sleep disturbances. Although a secondary symptom to AR, sleep disturbances (difficulty getting to sleep, waking up during the night or lack of a good night's sleep) were shown in this survey to be extremely troubling in ∼15% of AR sufferers. In the past year >90% of patients reported taking a medication of any type for their AR, with nearly a 4:1 ratio of patients taking a prescription medication versus an over-the-counter (OTC) medication in the past 4 weeks. Over 75% of survey respondents reported taking an intranasal corticosteroid (INCS) in the last 4 weeks and the satisfaction rate of INCS medications was similar to that reported for OTC medications. The most common reasons cited for dissatisfaction with INCS medications were inadequate effectiveness, bothersome side effects (e.g., unpleasant taste and retrograde drainage into the pharynx), decreased effectiveness with chronic use, and failure to provide 24-hour relief. CONCLUSION: These data show that AR is common in the Middle East region as elsewhere in the world. Many patients with AR in Middle East region suffer from their symptoms (e.g., runny nose, nasal itching, nasal congestion, postnasal drip, and other symptoms) on all or most days during the times of the year that their allergies are worst. These symptoms have been shown to reduce QOL and performance at work/school to a significant degree. Additionally, the survey data underscore a considerable treatment gap with current therapies for AR and that many AR patients still have not found adequate effectiveness with currently available medications. Thus, through identification of disease impact on the Middle East population and highlighting treatment gaps, clinicians in the Middle East may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL.