How did CariesCare International performed under pandemic conditions in children: 1-year multicenter single-group interventional study (preprint)

Background:In 2020, CariesCare International (CCI) -derived from ICCMS- was plannedto be tested for caries-control effectiveness in children by means of a multicenter randomized clinical trial (RCT). Nevertheless, due to the pandemic, RCTs proved unfeasible and aerosol-generating procedures (AGP) were associated with a spread of COVID-19. Consequently, the study design required to be modified to a single-interventional study and CCI had to be adapted excluding AGP and reducing on-site consultation (CCI-adapted). Objective: This 12-month multicenter single-group interventional study aimed at assessing the effect of a pandemic CCI-adapted protocol on caries control in children. Methods: Twenty-one Latin American and European centers with n³20 3-8-year-old children per center were invited to participate; 17 obtained IRB and signed written informed consents. Trained examiners assessed at baseline (T0) and 1-year follow-up (T1y) (blind to the intervention): CCI-caries risk, oral-health-related practices; dmf/DMFS with ICDAS-merged-Epi visual caries severity and activity criteria; dental sepsis and toothache. Individual- and tooth-surface-level personalized care plan was then performed by dental practitioners previously trained in CCI-adapted. After 5 months, parents’ and dentists’ dental-care-process acceptance (Treatment Evaluation Inventory) was assessed. The one-year caries-control effect of CCI-adapted was assessed in terms of tooth-surface and individual-level caries-progression control; oral-health behavior improvement, and caries-care system acceptability. Results: Sixteen centers finished the study (94.1%; Latin America: n=13; Europe: n=3), with 337 children (78.6%;mean age of 5.5±1.6 years). There was a T0 to T1y significant decrease (p<0.05) in the mean number of tooth surfaces with caries lesions (7.7±9.1 to 2.8±4.6), with active caries lesions (6.8±8.8 to 0.8±2.2), and a tooth-surface caries-progression control of 99.3%. In the majority of children there was a significant (p<0.05) control of: caries progression (79.5%), high-caries risk (86.6%), and non-adequate oral-health behavior (72.7%). There was a very high (parents) and a high-very high (dentists) acceptability of CCI. Conclusion: Given the challenge of the pandemic, this single-group interventional CCI-adapted study showed one-year control of caries progression, caries risk, and high parents’ and dentists’ CCI acceptance. Trial registration:Retrospectively‐registered‐ClinicalTrials.gov NCT04666597 07/12/2020 (Protocol version 2): https://register.clinicaltrials. gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h

Evaluation of Internet users' interest in paediatric dental problems during the COVID-19 pandemic.

BACKGROUND: The coronavirus (COVID-19) pandemic had a significant impact on dental care providers; patients had trouble accessing routine dental care due to concerns about dentist and patient safety. People spent more time at home due to lockdown restrictions and a growth in individuals working from home. This increased the likelihood of looking for dental care information on the Internet. In the present study the aim was to compare the trends of Internet searches about paediatric dentistry before and after the pandemic. METHODS: The monthly variation in relative search volume (RSV) and the lists of paediatric dentistry-related queries were determined from December 2016 to December 2021 using Google Trends. Two separate datasets were obtained before and after the pandemic. One-way ANOVA was used to determine whether there was a significant difference in RSV scores between the first 2 years of COVID-19 and the first 3 years before COVID-19. T-tests were used for bivariate comparisons. RESULTS: There was a statistically significant increase in queries regarding dental emergencies, especially toothache (p < 0.01) and dental trauma (p < 0.05). The RSV of paediatric dentistry queries increased over time (p < 0.05). Other queries about recommended dental procedures during the pandemic, such as the Hall technique and stainless steel crowns, showed an increasing trend. However, these were not statistically significant (p > 0.05). CONCLUSIONS: More searches were carried out, related to dental emergencies, on the Internet during the pandemic. Moreover, non-aerosol generating procedures such as the Hall technique became increasingly popular according to the frequency of searches carried out.

The lockdown effect: The impact of the COVID-19-related confinement on the nature of dental emergencies and the number of patients seen at the Geneva university hospital's dental clinic.

PURPOSE: The aim of this retrospective case study was to evaluate the impact of the COVID-19 confinement on consultation number and nature of dental emergencies. MATERIALS AND METHODS: The investigators implemented a retrospective case-control study and enrolled a sample of patients who presented to the University Hospital of Geneva for dental emergencies during the COVID-19 confinement from March 16 to April 26, 2020. They were compared to a matched case-control group treated in 2018 and 2019. The predictor variable was the COVID-19 confinement. The outcome variables were consultation number and nature of dental emergencies. Other study variables included age, gender, socio-economic status, delay from symptoms to consultation and type of treatment. Descriptive and bivariate statistics were computed and significance level was set at ≤ 0.05. RESULTS: The study sample was composed of 1104 patients, with 386 in the case-study and 718 in the control group. No significant change in patient numbers was observed. In the case-study group patients were significantly younger (P= 0.004), had a significantly higher proportion of acute toothache and dental infections (P= 0.01), the main reason for consultation was pain or swelling (P= 0.01) and the delay from first symptoms to consultation was shorter compared to the controls (P=0.008). CONCLUSION: The COVID-19 confinement had no impact on the consultation number of dental emergencies. However, changes in emergency type were noted, with an increase in acute toothaches and infections and patients waited less time between the onset of symptoms to consultation.

Effect of the COVID-19 Mitigation Measure on Dental Care Needs in 17 Countries: A Regression Discontinuity Analysis.

Objectives: The effect of COVID-19 mitigation measures on different oral health care needs is unclear. This study aimed to estimate the effect of COVID-19 mitigation measures on different types of oral health care utilization needs and explore the heterogeneity of such effects in different countries by using real-time Internet search data. Methods: Data were obtained from Google Trends and other public databases. The monthly relative search volume (RSV) of the search topics "toothache," "gingivitis," "dentures," "orthodontics," and "mouth ulcer" from January 2004 to June 2021 was collected for analysis. The RSV value of each topics before and after COVID-19 was the primary outcome, which was estimated by regression discontinuity analysis (RD). The effect bandwidth time after the COVID-19 outbreak was estimated by the data-driven optimal mean square error bandwidth method. Effect heterogeneity of COVID-19 on dental care was also evaluated in different dental care categories and in countries with different human development index (HDI) rankings, dentist densities, and population age structures. Results: A total of 17,850 monthly RSV from 17 countries were used for analysis. The RD results indicated that advanced dental care was significantly decreased (OR: 0.63, 95% CI: 0.47-0.85) after the COVID-19 outbreak, while emergency dental care toothache was significantly increased (OR: 1.54, 95% CI: 0.99-2.37) 4 months after the COVID-19 outbreak. Compared to the countries with low HDI and low dentist density, the effect was much more evident in countries with high HDI and high dentist density. Conclusions: COVID-19 mitigation measures have different effects on people with various dental care needs worldwide. Dental care services should be defined into essential care and advanced care according to specific socioeconomic status in different countries. Targeted health strategies should be conducted to satisfy different dental care needs in countries.

COVID-19 Effects on Income and Dental Visits: A Cross-sectional Study.

OBJECTIVES: In April 2020, the Japanese government declared a state of emergency owing to the outbreak of the novel coronavirus disease (COVID-19) pandemic, which resulted in reduced workforce and job losses. Furthermore, income is one of the most consistent predictors of dental visits. Therefore, this study examined the association between income changes and dental clinic visits during the COVID-19 state of emergency in Japan. METHODS: An online, self-reported cross-sectional survey about health activities including dental visits during the first COVID-19 state of emergency was conducted in Osaka, Japan (June 23 to July 12, 2020). Among participants with toothaches, the assessment for the association between "refrained from visiting a dentist despite wanting treatment for toothache during the state of emergency (refrained treatment)" and income changes before and after the state of emergency using a multivariate Poisson regression model adjusted for sex, age, self-rated health, frequency of regular dental visits, and employment status. RESULTS: Among 27,575 participants, 3,895 (14.1%) had toothaches, and 1,906 (6.9%) reported refrained treatment. Among people with decreased income (n = 8,152, 29.6% of overall participants), the proportions of the refrained treatment group were 8.0% (income decreased by 1%-49%), 9.9% (50%-99% decreased), and 9.1% (100% decreased). Among participants with toothache, after adjusting for all variables, compared with participants with no income change, we observed significantly higher prevalence ratios (PRs) for refrained treatment in those who experienced a decreased income owing to COVID-19 (1%-49% decrease: PR = 1.08; 95% confidence interval [CI], 1.005-1.17; 50%-99% decrease: PR = 1.18; 95% CI, 1.06-1.32; 100% decrease: PR = 1.18; 95% CI, 1.04-1.33). CONCLUSION: Decreased income was associated with refrained dental treatment during the COVID-19 state of emergency in Osaka, Japan. The economic damage related to the COVID-19 pandemic could lead to oral health inequalities. KNOWLEDGE TRANSFER STATEMENT: Our study found that individuals with decreased income owing to COVID-19 before and after the state of emergency showed significantly higher prevalence ratios for refraining from visiting a dentist despite wanting treatment for toothache. We believe that our study makes a significant contribution because it provides novel, basic data that economic damages related to the COVID-19 pandemic might expand to oral health inequalities.

Guardian Reports of Children's Sub-optimal Oral Health Are Associated With Clinically Determined Early Childhood Caries, Unrestored Caries Lesions, and History of Toothaches.

Background: Parents'/guardians' perceptions of their children's oral health are useful proxies of their clinically determined caries status and are known to influence dental care-seeking behavior. In this study, we sought to examine (1) the social and behavioral correlates of fair/poor child oral health reported by guardians and (2) quantify the association of these reports with the prevalence of early childhood caries (ECC), unrestored caries lesions and toothaches. Methods: We used guardian-reported child oral health information (dichotomized as fair/poor vs. excellent/very good/good) obtained via a parent questionnaire that was completed for n = 7,965 participants (mean age = 52 months; range = 36-71 months) of a community-based, cross-sectional epidemiologic study of early childhood oral health in North Carolina between 2016 and 2019. Social, demographic, oral health-related behavioral data, and reports on children's history of toothaches (excluding teething) were collected in the same questionnaire. Unrestored ECC (i.e., caries lesions) was measured via clinical examinations in a subset of n = 6,328 children and was defined as the presence of one or more tooth surfaces with an ICDAS ≥ 3 caries lesion. Analyses relied on descriptive and bivariate methods, and multivariate modeling with average marginal effect (A.M.E.) estimation accounting for the clustered nature of the data. Estimates of association [prevalence ratios (PR) and adjusted marginal effects (AME) with 95% confidence intervals (CI)] were obtained via multilevel generalized linear models using Stata's svy function and accounting for the clustered nature of the data. Results: The prevalence of fair/poor oral health in this sample was 15%-it increased monotonically with children's age, was inversely associated with parents' educational attainment, and was higher among Hispanics (21%) and African Americans (15%) compared to non-Hispanic whites (11%). Brushing less than twice a day, not having a dental home, and frequently consuming sugar-containing snacks and beverages were significantly associated with worse reports (P < 0.0005). Children with fair/poor reported oral health were twice as likely to have unrestored caries lesions [prevalence ratio (PR) = 2.0; 95% confidence interval (CI) = 1.8-2.1] and 3.5 times as likely to have experienced toothaches [PR = 3.5; 95% CI = 3.1-3.9] compared to those with better reported oral health. Conclusions: Guardian reports of their children's oral health are valuable indicators of clinical and public health-important child oral health status. Those with fair/poor guardian-reported child oral health have distinguishing characteristics spanning socio-demographics, oral-health related practices, diet, and presence of a dental home.

Evaluation of Internet Users' Interests for Paediatric Dental Problems during the COVID-19 Pandemic (preprint)

Background: The outbreak of pandemic coronavirus (COVID-19) had a significant impact on dental care providers; patients had trouble accessing routine dental care due to concerns about the safety of dentists and patients. Therefore, people spend more time at home due to lockdown and working from home, which increases their likelihood of looking for dental care information on the Internet. The present study aims to compare the trends of Internet searches for paediatric dentistry queries before and after COVID-19. Design: The weekly variation of relative search volume (RSV) and the lists of paediatric dentistry-related queries were determined from December 2018 through December 2020 using Google Trends. Two separate data sets were obtained before and after the pandemic. It compared COVID-19's first year to the year before COVID-19. The data sets were analyzed using paired t-test. Results There was a statistically significant increase in queries about dental emergencies, especially toothache and dental trauma (p  0.05). Conclusions People search for many more emergency queries on the Internet due to their limited access to dental care providers. Also, non-aerosol generating procedures such as Hall Techniques are becoming much more popular.

Digital surveillance: The interests in toothache-related information after the outbreak of COVID-19.

OBJECTIVES: The aim of this ecological study was to analyze the relationship of social restriction measures and people's interest in searching toothache-related information on the Internet. MATERIALS AND METHODS: The following indicators Stringency Index (SI), Years Lived with Disability (YLDs) for untreated caries in permanent teeth, Google market share, Internet penetration, and relative search volume (RSV) for the Topic "Toothache" in Google Trends were determined for 21 countries with available data, from April 2018 to May 2020. Statistical analysis was performed using Mann-Whitney U test, t-Student test, Pearson's Chi-square test, and Spearman and Pearson's cross-correlation tests (α = 0.05). RESULTS: Relative search volume values increased significantly after restriction measures in all countries, except for Japan. Higher RSV values were found among 11 countries that presented a cross-correlation between RSV and SI with r≥│0.6│. The most common queries were linked to the treatment and self-resolution of toothache, with a sudden increase of searches that combined the symptom with COVID-19. CONCLUSIONS: The interests in toothache-related digital information were associated with social restriction measures. These results allow the identification of dental demands of distinct populations, contributing to the planning of specific public health policies during and after the pandemic period.

Analysis of tweets on toothache during the COVID-19 pandemic using the CrystalFeel algorithm: a cross-sectional study.

BACKGROUND: Reasons such as the lack of information on the COVID-19 disease, lack of proven treatment for it, uncertainty about the duration of the pandemic, or social isolation affect people's mental health. This study aimed to analyze the emotional type and intensity in tweets on toothache posted during the COVID-19 pandemic. METHODS: Using the Twitter Search API, we collected tweets in English associated with the keywords "Corona, Toothache" "Corona, Tooth, Pain" "Corona, Dental Pain" "Covid-19, Toothache" "Covid-19, Tooth, Pain" and "Covid-19, Dental Pain" posted between March 11, 2020 and June 30, 2020 all around the world. After the relevant inclusion and exclusion criteria were applied, 426 posts were selected and analyzed using the CrystalFeel algorithm, a sensitivity analytical technology with proven accuracy. The chi-square test (SPSS v23, IBM) was used to compare emotions and emotional intensities according to the words used. RESULTS: It was determined that 80.3% of the participants experienced fear and 61.7% had a negative emotional intensity. There was no statistically significant difference between the distributions of emotions according to the words without time distinction (p = 0.136). There was a statistically significant difference between the distributions of emotional intensity according to the words without time distinction (p = 0.006). The keyword "Corona, Toothache" was used the most frequently by 30.8% of the participants. CONCLUSIONS: This study is the first to analyze the emotional reactions of individuals who experienced toothaches during the COVID-19 pandemic using the CrystalFeel algorithm. Monitoring the social media posts of individuals experiencing toothache during the pandemic will help reduce fear and anger emotions and design public information messages that are compatible with the target group's needs.

Impact of Coronavirus disease 2019 on patients with toothache: Analysis of tweets on Weibo.

OBJECTIVE: The aim of this study is to investigate the impact of Coronavirus disease 2019 (COVID-19) on toothache patients through posts on Sina Weibo. METHODS: Using Gooseeker, we searched and screened 24,108 posts about toothache on Weibo during the dental clinical closure period of China (February 1, 2020-February 29, 2020), and then divided them into 4 categories (causes of toothache, treatments of toothache, impacts of COVID-19 on toothache treatment, popular science articles of toothache), including 10 subcategories, to analyze the proportion of posts in each category. RESULTS: There were 12,603 postings closely related to toothache. Among them, 87.6% of posts did not indicate a specific cause of pain, and 92.8% of posts did not clearly indicate a specific method of treatment. There were 38.9% of the posts that clearly showed that their dental treatment of toothache was affected by COVID-19, including 10.5% of the posts in which patients were afraid to see the dentists because of COVID-19, and 28.4% of the posts in which patients were unable to see the dentists because the dental clinic was closed. Only 3.5% of all posts were about popular science of toothache. CONCLUSIONS: We have studied and analyzed social media data about toothache during the COVID-19 epidemic, so as to provide some insights for government organizations, the media and dentists to better guide the public to pay attention to oral health through social media. Research on social media data can help formulate public health policies.

Socioeconomic behaviors on dental professions: a Google Trends investigation in Italy.

INTRODUCTION: Dental profession has expanded, and the knowledge that oral health affects systemic health is of greater concern to patients. The purpose of this study is to understand the demand for dental treatments in Italy, knowing if there is any correlation between socioeconomic condition and oral rehabilitation typology. Moreover, focusing on the requested rehabilitations type and on finding alternatives, unconventional solutions. EVIDENCE ACQUISITION: The research was conducted using an important research database defined Google Trends, with search terms such as "dolore denti" (toothache). A statistical analysis has been conducted in this study evaluation Pearson Correlation Coefficient. EVIDENCE SYNTHESIS: The results divided region by region provide data that reflect the socio-economic conditions of the population concerned. Other results have been obtained from government source, to learn about the economic situations of the individual regions, for this reason the GDP was examined. Furthermore, there are important results regarding the parasanitary professions to which patients, for economic reasons, tend to refer. CONCLUSIONS: This study will surely be an excellent starting point to investigate professional abuse and above all to assess the needs of the different regions.

Association of COVID-19-imposed lockdown and online searches for toothache in Iran.

BACKGROUND: Novel coronavirus disease-2019 (COVID-19) has impacted populations in many ways worldwide, including access to oral health services. This study aims to assess the association between lockdown due to COVID-19 and online searches for toothache in Iran using Google Trends (GT). METHODS: We investigated GT online searches for toothache within the past five years. The time frame for data gathering was considered as the initiation and end dates of the national lockdown in Iran. We performed one-way ANOVA statistical test to compare relative search volumes (RSVs) between the year 2020 and 2016-2019 for the whole country. Then we investigated the possible association of RSVs in provinces with dentists' density, prevalence of current daily smokers, Human Development Index (HDI), Internet access, and fluoride concentration in water using linear regression. RESULTS: When comparing 2020 with the previous four years, there was a rise of 2020 RSVs versus all previous years combined and each year (P < 0.001 for all of them). In the linear model for the year 2020, HDI (B = - 3.29, 95% CI: (- 5.80, - 0.78), P = 0.012) had a strong negative relationship with provincial RSVs. HDI mostly had strong positive relationship with provincial RSVs in prior years. Fluoride concentration (B = - 0.13, 95% CI: (- 0.24, - 0.03), P = 0.017) and dentists' density (B = - 0.04, 95% CI: (- 0.25, 0.17), P = 0.669) were also negatively associated with RSVs in 2020. These associations were mostly negative in the previous years as well. Internet access (B = 0.36, 95% CI: (- 0.38, 1.09), P = 0.325) and prevalence of daily smokers (B = 0.33, 95% CI: (0.13, 0.53), P = 0.002) were positively associated with RSVs. CONCLUSION: The RSVs for toothache in 2020 have increased due to COVID-19-imposed lockdown compared with the same period in the past four years. This increase was related to socioeconomic factors.

The association between lockdown due to COVID-19 epidemic and searches for toothache using Google Trends in Iran (preprint)

Objective: To assess the association between the lockdowns due to COVID-19 and online searches for toothache in Iran using Google Trends (GT). Methods: We investigated GT online searches for the search term within the past five years. The time frame for data gathering was considered as the initiation and end dates of lockdown in Iran. Relative search volumes (RSVs) for online Google Search queries in 2019 was considered as the control. We performed one-way ANOVA statistical test to identify whether there is a statistical difference for RSV scores between the year 2020 and 2016-2019 for the whole country. Then we investigated the possible association of RSVs in provinces with dentists density, prevalence of current daily smokers, Human Development Index (HDI), Internet access, and fluoride concentration in water with linear regression. A p-value<0.05 was considered as statistically significant. Results: When comparing 2020 with previous four years, there is a statistically significant difference between RSVs of 2020 with all previous years combined and each of these years (P<0.001 for all of them). In the linear model for the year 2020, HDI (B=-3.29, 95% CI: (-5.80, -0.78), P=0.012), fluoride concentration (B=-0.13, 95% CI: (-0.24, -0.03), P=0.017), and prevalence of daily smokers (B=0.33, 95% CI: (0.13, 0.53), P=0.002) were significantly associated with RSVs. These covariates were not statistically significant for other years, except for Internet access in 2016 (B=-1.13, 95% CI: (-2.26, 0.00), P=0.050). Conclusion: The RSVs for toothache in 2020 have significantly increased due to COVID-19-imposed lockdowns compared to the same period of the year in the past four years. knowing that this period mostly overlaps with the national holidays of Nowruz in Iran, reinforces the impacts of lockdowns on people CSB about toothache. In the subnational scale, the RSVs were significantly correlated with HDI, fluoride concentration, and number of daily smokers which emphasizes the role of socioeconomic factors in dental health and care-seeking behaviour.

The association between COVID-19-imposed lockdowns and online searches for toothache using Google Trends (preprint)

Objective To assess the association between the lockdowns due to COVID-19 and global online searches for toothache using Google Trends (GT). Methods We investigated GT online searches for the search terms toothache and tooth pain, within the past five years. The time frame for data gathering was considered as the initiation and end dates of national/regional lockdowns in each country. Relative search volumes (RSVs) for online Google Search queries in 2019 was considered as the control. We analysed data after normalising based on the Internet penetration rate. We used one-way ANOVA to identify statistical difference for RSVs between 2020 and 2016-2019 for each country. A linear regression model was used to assess whether there is a correlation between RSVs in 2020 and gross domestic production, COVID-19 deaths, dentists' density, YLDs of oral conditions, Internet access, lockdown duration, Education Index, and dental expenditure per capita. Results The results of worldwide RSVs for toothache and tooth pain also showed significantly higher values in 2020 compared to the previous four years. Of 23 included countries in our study, 16 showed significantly increased RSVs during the lockdown period compared to the same periods in the past four years. There was a statistically significant relationship between difference of RSVs means in 2020 and in 2016-2019 combined with percent of urban residency (B=-1.82; 95% CI: (-3.38, -0.26); p=0.026) and dental expenditure per capita (B=-0.42; 95% CI: (-0.80, -0.05); p=0.031) (R2=0.66). Conclusion Generally, the interest in toothache and tooth pain has significantly increased in 2020 compared to the last four years. This could implicitly reinforce the importance of dental care, as urgent medical care worldwide. Governments' expenditure on oral healthcare and the rate of urban residency, could be mentioned as important factors to direct general populations' online care-seeking behaviour with regard to dental pain.