Carious status and socio-behavioral risk factors among 12 year-old children in South-Central region in Romania.

BACKGROUND: Regular screenings at children population level are necessary in order to assess communities' need for education, prevention, as well as early detection and intervention programs The study aims to assess dental caries experience and oral health-related behaviors among Romania children from the South and Central region. METHODS: The cross-sectional study conducted in 2019-2020 is part of the national survey "Romanian Oral Health Survey", under the endorsement of the World Health Organization (WHO). The stratified, randomized and representative sample included 98 children of 12 years of age. The assessment included a clinical examination, using International Caries Detection and Assessment System (ICDAS) and the Oral Health Questionnaire for Children recommended by the World Health Organization. RESULTS: Results revealed that the frequency of caries-free children among 12 year-olds was 36.7% and the mean DMFT was 2.89. Regarding the oral health-related habits, 38.8% of children brushed twice daily; the consumption of sugary foods multiple times per day has been frequently met and 11.2% at the age of 12 never visited the dental office. CONCLUSIONS: The findings revealed that caries prevalence was high and behaviors negatively influence oral health. The presented data are of utmost importance for Romanian policy makers to promote oral health education among children, to support consistent preventive oral health campaigns and to stimulate dental attendance, irrespective of children' living areas or gender.

In Vivo Performance of Visual Criteria, Laser-Induced Fluorescence, and Light-Induced Fluorescence for Early Caries Detection.

This study aims to compare the diagnostic reliability of ICDAS-II visual criteria, light-induced fluorescence (using the VistaCam iX, Dürr Dental, Bietigheim-Bissingen, Germany), and laser-induced fluorescence (using the DIAGNOdent Pen, KaVo, Biberach, Germany) on occlusal caries. Permanent and temporary molars were selected according to the inclusion criteria. Out of 160 teeth that met the inclusion criteria, 139 were chosen and examined by two previously trained and calibrated examiners. The kappa value was 0.95 for both VistaCam iX and DIAGNOdent Pen. Results from visual examination and the readings of the two fluorescence devices were computed, lesions being divided into non-cavitated, enamel lesions, and lesions extended to dentin. All statistical analyses were performed using R (version 4.2.2). Spearman's rank correlation was computed to assess the relationship between the scores of diagnostics reliabilities of the three methods mentioned above. There was a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.25, between VistaCam iX and ICDAS II, and a positive, not statistically significant Spearman's rank correlation coefficient, ρ = 0.11, between DiagnoDent Pen and ICDAS II. Considering the temporary teeth, there was a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.52, between VistaCam iX and DiagnoDent Pen; a positive, statistically significant Spearman's rank correlation coefficient, ρ = 0.35, between VistaCam iX and ICDAS II; and the lowest, not statistically significant Spearman's rank correlation coefficient, ρ = 0.16, between DiagnoDent Pen and ICDAS II. Conclusions: In conclusion, ICDAS II and light-induced fluorescence are better diagnostic methods than the laser-induced fluorescence devices for detecting occlusal caries. Clinical Significance: This study may support clinicians in selecting the most efficient tool for diagnosing carious lesion in the earliest stages possible. Furthermore, such technologies raise the availability for more preventive approaches, as opposed to invasive procedures.

Link between Oral Health, Periodontal Disease, Smoking, and Systemic Diseases in Romanian Patients.

(1) Background: The link between oral and systemic health is becoming increasingly obvious. Oral diseases, particularly periodontitis, have been linked to various diseases including diabetes and cardiovascular disease, among others. This survey aimed to assess the oral health condition of individuals, considering both their overall health and periodontal status, by performing oral examinations and collecting data using questionnaires. (2) Methods: After obtaining approval from the University's Ethics Committee, the study was carried out from 2021 to 2022 at the Department of Oral Health, located in the Emergency Municipal Hospital in Timisoara, Timis County, Romania. Bivariate correlations were performed using nonparametric Spearman's Rho using SPPS software version 23. To assess the importance of smoking frequency related to the severity of periodontitis diagnosis, the ANOVA Simple test (one-way) and Hochberg GT2 post hoc analysis were utilized. The chi-squared test was employed for nominal variables. A significance level of 0.05 (alpha = 0.05) was adopted for all statistical tests. (3) Results: There is a significant positive association between the frequency of systemic disease and the severity of the periodontitis diagnosis taken as a total, Rho (242) = 0.151, p < 0.05, and taken as a stage, Rho (242) = 0.199, p < 0.01, thus as the severity of the diagnosis increases, the patient presents comorbidities. Hochberg GT2 post hoc analysis indicates that the non-smoking group has statistically significantly lower diagnostic severity (Mdif = -0.81, p = 0.01), with a strong effect size (Cohen's d = 0.73). (4) Conclusions: The findings are increasingly indicating a potential association between oral diseases and a range of systemic diseases. The impact of periodontal disease on the quality of life is significant, especially in individuals with associated systemic conditions and present risk factors.

Total Antioxidant Capacity of Saliva and Its Correlation with pH Levels among Dental Students under Different Stressful Conditions.

(1) Background: This cross-sectional study conducted at the Faculty of Dental Medicine, Timisoara, Romania, between December 2022 and February 2023 aims to assess salivary total antioxidant capacity and pH levels in dental students experiencing non-stressful and stressful situations and explore potential correlations between these factors. (2) Methods: Saliva samples were collected during two different periods: before an Oral Health course and before the Oral Health exam, under stressful conditions. Ethical principles were followed, and informed consent was obtained. Data on age, gender, health status, drug use, smoking habits, and anxiety levels were recorded. Saliva was collected using the draining method and pH was measured using indicator paper strips. Total antioxidant capacity (TAC) was determined using a commercial assay kit. Statistical analysis involved descriptive statistics, Student's t-test to compare pH and TAC between study groups, and Pearson's correlation coefficient to analyze the correlation between salivary pH and TAC within each group, with p < 0.05 indicating significance. (3) Results: This study involved 80 participants, comprising 26 males and 54 females, all enrolled in the 5th year of the Oral Health course, with ages ranging from 20 to 53 and a mean age of 23.62 (±4.19) years. Pearson's correlation results show a statistically significant negative relationship between the STAI test and TAC during the stress-free period (-0.02 **, N = 80, p < 0.01). (4) Conclusions: There are variations in saliva's antioxidant capacity in response to different stress conditions. Dental students experienced a higher level of stress before academic assessments compared to the non-stress period during the course.

Dental Caries, Oral Health Behavior, and Living Conditions in 6-8-Year-Old Romanian School Children.

Dental caries still have a high prevalence in Romania. The aim of this paper is to determine the prevalence of caries in children (aged 6 to 8 years) correlated with individual-level predictors and socio-economic variables. A stratified, randomized nationally representative sample was established, taking into consideration the total number of preschool children and based on administrative units and residence. Self-assessment was performed by means of the Oral Health Questionnaire for Children (WHO). Examinations were conducted by 10 standardized examiners, with International Caries Detection and Assessment System (ICDAS) caries codes higher than 3 considered as dentinal caries, missing teeth as MT, and restorations as FT. DMFT and SiC indexes were calculated accordingly. The dataset for each outcome variable was analyzed by the Hurdle approach analyzed. The gender distribution was similar (47.22% male and 52.78% female), with 42.65% residing in rural areas. The mean DMFT value for the sample was 4.89 and SiC index 9.83. A negative association could be seen between DMFT and the father's level of education (ß = −0.33, SE = 0.07, p < 0.01) as well as the mother's education (ß = −0.25, SE = 0.07, p < 0.01). In conclusion, caries prevalence is very high in Romania as compared to the World Health Organization (WHO) recommendation for this age group in correlation with socio-economic factors and oral health behavior.

The Impact of Parental Education on Schoolchildren's Oral Health-A Multicenter Cross-Sectional Study in Romania.

The present study is part of the first national oral health survey for children in Romania. The aim of this study was to determine caries prevalence in correlation with the level of the parents' education, preventive behavior, and socioeconomic parameters in 11-14-year-old schoolchildren in Romania. A cross-sectional epidemiological survey was designed and conducted in 2019-2020. The sampled children were selected from 49 schools distributed in rural and urban areas of Romania, including its capital. Data were collected using the Oral Health Questionnaire for Children developed by the World Health Organization and described in the WHO Oral Health Surveys-Basic Methods, 5th edition, 2013, after positive informed consent. To express prevalence and severity of carious lesions, International Caries Detection and Assessment System (ICDAS) criteria were recorded in school for 814 schoolchildren (388 boys and 426 girls) aged between 11 and 14 years old (mean age 12.29 ± 0.6). Elements regarding the specificity of the child (gender, age, and parental education) were tabulated against preventive behavior. The parents' education was correlated with three clinical indices in order to assess the existence or lack of certain significant differences among schoolchildren in Romania. In terms of correlation between the mother's education and preventive behavior, results showed a significant positive correlation in case of dental check-ups (rs = 0.08 *, p < 0.05), brushing (rs = 0.02 **, p < 0.01), and use of different types of dental hygiene aids (rs = 0.06 **, p < 0.01) and a negative correlation with tooth pain or discomfort (rs = -0.01 **, p < 0.01). A statistically significant positive relationship was highlighted between the mother's education and the presence of restorations (rs = -0.09 **, p < 0.01). Regarding the father's education, there was a positive relationship with oral hygiene behavior (rs = 0.18 **, p < 0.01) but a negative relationship with the D3T index (rs = -0.18 **, p < 0.01). In conclusion, there was a strong correlation between the parents' education, preventive behavior, and oral health status of Romanian schoolchildren.

Caries Prevalence Associated with Oral Health-Related Behaviors among Romanian Schoolchildren.

Oral health-related behaviors and living conditions play an important role in general and oral health. This study aimed to evaluate caries prevalence and severity in schoolchildren residing in rural and urban areas of Romania, and to correlate these with oral health-related behaviors. An estimation of the required sample size was conducted (sampling error of ±3% at a 95% confidence level), followed by the stratification of administrative units and then the selection of 49 schools. The Hurdle approach was used to analyze the dataset, requiring two sets of analyses for each outcome variable: a multilevel binary model to predict prevalence, and a multilevel Poisson analysis using only non-zero values. The mean and standard deviation (SD) for the dentinal caries index was 4.96 (5.33). Girls were more likely to have non-zero restoration codes (ß = 0.14, SE = 0.08, p < 0.05). Low education levels of each parent were associated with an increased likelihood of having non-zero carious tooth surfaces (ß = 0.23, SE = 0.06, p = 0.01; ß = 0.22, SE = 0.06, p < 0.01). The presence of cavities was predicted by the consumption of carbonated soft drinks (ß = 0.19, SE = 0.07, p < 0.01), candies (ß = 0.13, SE = 0.06, p < 0.01), sweetened milk (ß = 0.12, SE = 0.06, p < 0.05), tea (ß = 0.16, SE = 0.08, p < 0.05), or cocoa (ß = 0.13, SE = 0.06, p < 0.05). Furthermore, the non-zero values of the dentinal caries index were more likely in rural schools (ß = -0.37, SE = 0.11, p < 0.01), and a negative association between the county development index and the fillings/restorations index (ß = -0.01, SE = 0.01, p < 0.05) was also established. The outcome of this research highlights that the presence of caries (dentinal caries index) in Romanian schoolchildren is influenced by their socioeconomic background, as well as their specific consumption behaviors.

Pediatric Dentists' Service Provisions in South-East Europe during the First Wave of COVID-19 Epidemic: Lessons Learned about Preventive Measures and Personal Protective Equipment Use.

INTRODUCTION: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. METHOD: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. RESULTS: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study-among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. CONCLUSIONS: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

A WHO Pathfinder Survey of Dental Caries in 6 and 12-Year Old Transylvanian Children and the Possible Correlation with Their Family Background, Oral-Health Behavior, and the Intake of Sweets.

To our knowledge, recent oral health data in Romania is poor, as no comprehensive oral health surveys have been carried out in the last five years. The present cross-sectional oral health survey aimed to assess the dental health status in 6 and 12-year old children from Transylvania, in correlation with their family background, oral-health behavior, and the intake of sweets. The study was conducted on 290 children from nine schools in the Transylvanian region of Romania. The study consisted of the clinical examination of children, recording of data in an International Cavity Detection and Assessment System (ICDAS) chart, and a questionnaire referring to the child's parental education, frequency, and motivation of visits to the dentist, dental care habits, and the intake of sweets. Our results indicated that the most prevalent ICDAS scores recorded in 6-year-old children were "0A" (p = 0.001464), "03" (p = 0.00366), "05" (p = 0.005563), "06" for rural areas. Restorations were statistically more prevalent in the urban population (p = 0.000076). The ICDAS score for 12-year old children was "03" (p = 0.003614) and prevalent in the urban area. The ICDAS score for the rural area was "04" (p = 0.0056). Comparing dental health status with family background demonstrated a strong correlation for the group of 6-year-old children, and a lack of correlation for the 12-year-old children. The number of dental visits corelated with the parents' backgrounds, and was higher in the urban population. Frequent hygiene habits (toothbrushing) were statistically correlated with lower ICDAS scores: "04" (p = 0.016482), "05" (p = 0.039127), "06" (p = 0.010785). Eating habits in both age groups were associated with statistically significant differences of "03", "04", "05", "06", "0A" in the ICDAS score. The obtained results provided clarification on the dental health situation in Romania and the potential risk factors of caries among the population, and therefore it could be used as a starter point for future studies to investigate, in depth, the effects of various variables on cavities found in Transylvanian schoolchildren.

Study Protocol for an Online Questionnaire Survey on Symptoms/Signs, Protective Measures, Level of Awareness and Perception Regarding COVID-19 Outbreak among Dentists. A Global Survey.

The Centres for Disease Control and Prevention and the World Health Organization have developed preparedness and prevention checklists for healthcare professionals regarding the containment of COVID-19. The aim of the present protocol is to evaluate the impact of the COVID-19 outbreak among dentists in different countries where various prevalence of the epidemic has been reported. Several research groups around the world were contacted by the central management team. The online anonymous survey will be conducted on a convenience sample of dentists working both in national health systems and in private or public clinics. In each country/area, a high (~5-20%) proportion of dentists working there will be invited to participate. The questionnaire, developed and standardized previously in Italy, has four domains: (1) personal data; (2) symptoms/signs relative to COVID-19; (3) working conditions and PPE (personal protective equipment) adopted after the infection's outbreak; (4) knowledge and self-perceived risk of infection. The methodology of this international survey will include translation, pilot testing, and semantic adjustment of the questionnaire. The data will be entered on an Excel spreadsheet and quality checked. Completely anonymous data analyses will be performed by the central management team. This survey will give an insight into the dental profession during COVID-19 pandemic globally.

In vitro evaluation of laser fluorescence devices for caries detection through stereomicroscopic imaging.

The aims of this study were to determine the diagnostic accuracy and reproducibility of the laser fluorescence device (LF), and the relationship between laser fluorescence readings taken at the entrance of the fissure, ICDAS visual examination caries detection system and the histological depth of the lesion. Two hundred and forty teeth (122 human third molars and 118 bicuspids) were selected from 62 patients enrolled in the study. Visual and LF examinations (Diagnodent, Kavo, Biberach, Germany) of the occlusal surfaces were performed in vivo. After tooth extraction, histological sections were evaluated by stereomicroscopy in vitro. Statistical analysis was performed using multiple statistical methods (SPSS ver. 17). Intra-examiner reproducibility for the LF measurements was excellent: intra-class-correlation coefficient (ICC) for LF was 0.957. Kappa values for each examiner's reproducibility were 0.74-0.82. The diagnostic performance of the LF device gave a good overall diagnostic accuracy according to ICDAS II codes and histological values as indicated by the area under the ROC curve of 0.707 and 0.709 respectively. The results of the study showed acceptable diagnostic accuracy for the laser fluorescence device. This supports the view that dentists can be site specific in applying fluorescence-based devices to multiple discrete sites within the same surface. In conclusion, these diagnostic methods have different characteristics, indications and limitations for use. In order to detect caries on occlusal surfaces thoroughly, a combination of methods would be the best practice moderated by clinical knowledge and experience.