Performance of a pre-administration infection screening questionnaire in patients with rheumatoid arthritis administered biological disease-modifying antirheumatic drugs.

AIM: Pre-administration screening of active infections is imperative for the safe use of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). However, a standardized screening method is lacking. We therefore implemented a novel systematic screening method with a simple predetermined questionnaire on infections and assessed its effectiveness. METHODS: We retrospectively reviewed medical records of individuals for whom intravenous bDMARDs were administered for RA from January 2016 to April 2019. We evaluated the performance of the new screening method based on physicians' assessments. In addition, a survey was administered to nurses, regarding their assessment of the usefulness of this new screening. The incidence of infections was also assessed. RESULTS: A total of 1636 cases underwent this new screening. The new screening method showed high sensitivity (0.97) and specificity (0.89) with a negative predictive value of 99.9%, as determined based on the physician's decision. Administration of bDMARDs was postponed in 37 (2.5%) patients, and there was only one case in which the screening failed to note an active infection. The nurses' survey demonstrated high agreement (87.5%) about the usefulness of this screening on the grounds of clarity, simplicity, ease, and time-saving effects. There was no significant increase in infections after implementation of this method. CONCLUSIONS: Systematic screening with a predetermined simple questionnaire is effective as an infection screening method, with a high negative predictive value. This approach contributes to high satisfaction of nurses and a time-efficient practice by focusing on screen-positive cases without increasing infections.

Prevalence and risk factors of halitosis in Japanese school children.

BACKGROUND: Little data are available regarding halitosis in Japanese children. The aim of the current study was to investigate the prevalence and risk factors associated with halitosis in Japanese elementary and junior high school children. METHODS: The subjects consisted of 520 elementary (1st-6th grade: boys, n = 284; girls, n = 236) and 248 junior high (7th-9th grade: boys, n = 136; girls, n = 112) school children aged 6-15 years in Saitama Prefecture, Japan. A self-administered questionnaire survey; halitosis measurement using an organoleptic assessment method; and clinical oral examination were conducted. RESULTS: Overall, 44.9% of subjects had halitosis. The proportion of boys with halitosis was 43.6% and that of girls was 46.6%. On logistic regression analysis, grade and tongue coating were significant predictors of halitosis. The 7th-9th graders were significantly more likely to have halitosis than 1st-3rd graders (OR, 1.83; P = 0.007). Subjects with area of tongue coating score 2 or 3 were 5.51-fold more likely to present with halitosis (P < 0.001) than those with area of tongue coating score 0 or 1. Similarly, subjects with thickness of tongue coating score 2 or 3 were 3.28-fold more likely to have halitosis than those with thickness of tongue coating score 0 or 1 (P < 0.001). CONCLUSIONS: Halitosis in the school children is not a rare condition; instead, its occurrence is relatively high. Therefore, inclusion of a halitosis prevention and management component in school oral health programs would lead to the promotion of overall oral health.

Evaluation of English Websites on Dental Caries by Using Consumer Evaluation Tools.

PURPOSE: To evaluate the quality of patient-oriented online information about dental caries using existing consumer evaluation tools and to judge the efficacy of these tools in quality assessment. MATERIALS AND METHODS: The websites for the evaluation were pooled by using two general search engines (Google and Yahoo!). The search terms were: 'dental caries', 'tooth decay' and 'tooth cavity'. Three assessment tools (LIDA, DISCERN and FRES) were used to evaluate the quality of the information in the areas of accessibility, usability, reliability and readability. RESULTS: In total, 77 websites were analysed. The median scores of LIDA accessibility and usability were 45.0 and 8.0, respectively, which corresponded to a medium level of quality. The median reliability scores for LIDA (12.0) and DISCERN (20.0) both corresponded to low level of quality. The readability was high with the median FRES score 59.7. CONCLUSION: The websites on caries had good accessibility, usability and readability, while reliability of the information was poor. The LIDA instrument was found to be more convenient than DISCERN and can be recommended to lay people for quick quality assessment.

Factors associated with clinical and perceived oral malodor among dental students.

The objective of this study was to determine the prevalence of and factors associated with clinical and perceived oral malodor among dental students. Clinical oral malodor was measured in 163 Malaysian dental students using organoleptic method and Oral ChromaTM and they were asked about their perception of self-oral malodor. Oral examination was performed to assess oral health status. Statistical analyses were performed using SPSS version 19.0. There were 52.7% students who had clinical oral malodor, while 19.0% students perceived they had oral malodor. The sensitivity (0.244) of self-perceived oral malodor was lower than its specificity (0.870). Tongue coating was closely associated with clinical oral malodor whereas high plaque index was closely associated with perceived oral malodor. These results showed that clinical oral malodor was prevalent among dental students, but students' perception of oral malodor did not always reflect actual clinical oral malodor. Furthermore, associating factors of clinical oral malodor differ from perceived oral malodor. The importance of controlling clinical oral malodor with proper tongue cleaning should be emphasized and dental students should be taught on the differences between clinical and perceived oral malodor in order to manage this problem.

Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomized clinical trial.

BACKGROUND: Breath odor is a nuisance problem for many people around the world. Bad breath affects social interactions of people in daily life by causing personal discomfort and emotional stress. There are chemical and mechanical methods for controlling oral malodor. Many studies of various mouth rinse applications and tongue cleaning procedures have been conducted. However, few studies have compared the effect of simultaneous chemical and mechanical procedures on the reduction of volatile sulfur compounds (VSCs) in subjects with oral malodor. The purpose of this study was to assess the effects of different oral hygiene procedures on reduction of VSCs in subjects with oral malodor. METHODS: Thirty male volunteers who matched with study criteria were divided randomly into two groups. Both groups performed tooth brushing, mouth washing with chlorine dioxide, tongue cleaning and combination of those in different sequence for five weeks. Total VSCs of subjects were measured with a Breathtron®, and oral health status was also examined. Quantitative analyses were performed using the Statistical Package for Social Science (SPSS 16.0). RESULTS: There were no significant differences in oral health status between the two groups at the baseline. No significant decrease in oral malodor was detected after one week of tooth brushing. Significant reductions in VSCs were shown by adding mouthwash or tongue cleaning to tooth brushing from the second week to fourth week (P <0.01). The greatest reduction in VSCs was found at the fifth week after the practice of all three oral hygiene regimens. CONCLUSIONS: Tooth brushing alone does not significantly reduce oral malodor. Mouth washing and tongue cleaning significantly reduce oral malodor, but combining tooth brushing, mouth washing and tongue cleaning regimens is most effective for oral malodor reduction. The results of this study could contribute to the formulation of appropriate preventive strategies against oral malodor not only for the general public but also for dental professionals serving as oral malodor-related service providers. TRIAL REGISTRATION: Registration number - ClinicalTrials.gov NCT02113137 . Registration date - April 7th, 2014.

Evaluation of a Russian version of the oral health literacy instrument (OHLI).

BACKGROUND: Oral health literacy has become a popular research area in the last decade; however, to date no health literacy instruments in the Russian language exist. The objectives of this study were to develop a Russian version of the Oral Health Literacy Instrument (OHLI) and to examine its reliability and validity. METHODS: A convenience sample of patients who visited the dental division of the district hospital in Belarus was used in the study. The OHLI, created originally in English, was modified to adapt it to characteristics of routine dental services in Belarus and then translated into Russian, followed by back-translation. Participants completed a self-administered socio-demographic questionnaire, an oral health knowledge test and the Russian version of the OHLI (R-OHLI). Bivariate and multivariate statistical analyses, including multiple regression modeling, were performed to examine reliability and validity of the R-OHLI. RESULTS: Participants were 281 adult patients aged from 18 to 60 years, with a mean age of 33.1 ± 12.2; 64.1% of them were women. Cronbach's alpha values for the two sections (reading comprehension and numeracy) and the total R-OHLI were 0.853, 0.815 and 0.895, respectively. The mean total R-OHLI score was 77.2 ± 14.5; the mean reading comprehension and numeracy scores were 39.5 ± 7.5 and 37.8 ± 8.8, respectively. The R-OHLI was significantly correlated to the oral health knowledge test. Pearson's correlation coefficients between the oral health knowledge test and the reading comprehension, numeracy and total R-OHLI were 0.401, 0.258, and 0.363, respectively (p < 0.001). Women, participants with a university degree, and those who visited a dentist at least once a year had significantly (p < 0.05) higher mean scores for each section (reading comprehension, numeracy) and for total R-OHLI compared to their counterparts. CONCLUSIONS: The R-OHLI showed good internal consistency and test-retest reliability. It was significantly associated with the oral health knowledge test, socio-demographic and behavioral factors. Therefore, the R-OHLI was proved to be a reliable and valid oral health literacy instrument for Russian-speaking people.

[Influence of tobacco on dental and oral diseases].

Oral cavity is an entrance of the human body and it is directly exposed by the smoke of tobacco. Thus oral cavity is the place where many disorders appear due to tobacco; such as periodontal disease, oral cancer, tooth loss, melanin pigmentation etc. Smoking also carries a poor prognosis of dental treatment. A smoking cessation or support intervention at dental setting has benefits because it is easy to motivate the smoking patients by showing them direct influence of tobacco on their oral health, possible to follow up the patients regularly, and feasible to start quitting before a substantial harm of tobacco to general health. It is important that various fields of health professionals co-operate closely to promote smoking cessation.

Keratin Expression in Mammary Paget's Disease in situ with Intraductal Invasion.

We performed immunohistochemical studies of epithelial keratins in intraductal carcinoma in situ (IDCIS) in mammary Paget's disease (MPD). K7, K8 and K18 were expressed in IDCIS in MPD. However, K19 was not expressed in IDCIS in MPD. Interestingly, K17 was expressed in some tumor cells in IDCIS. K17, a hyperproliferative keratin, may suggest ductal invasion and poor prognosis in MPD.

Associations between oral health behavior and anxiety about water fluoridation and motivation to establish water fluoridation in Japanese residents.

Since 1972, community water fluoridation programs have not been practiced in Japan. Risk perception among the population plays an important role in the implementation of water fluoridation programs. The oral health behavior of Japanese children has changed, especially due to recent increases among children in the use of fluoridated products and fluoride applications by dentists. The purpose of this study was to examine the associations between oral health behavior, risk perception, and the desire to implement water fluoridation among Japanese residents. We distributed a questionnaire survey (response rate: 92.8%) to mothers with children aged two or three years (n = 573). There was a correlation between anxiety and level of motivation to implement water fluoridation (Spearman coefficient: 0.355, P < 0.001). Exposure to various fluoride experiences was higher in the "not anxious" group. The motivation level was significantly higher in subjects who had a better understanding of the effectiveness of fluoride, those who used fluoride tooth paste, and those whose children received fluoride applications from dentists. We conclude that increased knowledge of and experience with fluoride might help decrease the perception of risk and increase motivation for implementing water fluoridation among the general public.

[Health information on oral malodor in Japanese newspaper articles].

OBJECTIVES: Mass media is an important source for the general public to obtain health information. Newspapers especially have the advantages of providing a variety of information to a broad range of age groups, with wide regional coverage of both urban and rural areas. The purposes of this study were to review the oral malodor information in Japanese newspapers and to investigate peoples' knowledge on the causes of oral malodor. METHODS: The Nikkei Database was used to select articles published in five major newspapers over a period of 12 years from 1993 to 2004. "Oral malodor" was used as a key search word. A total of 386 articles which contained oral malodor information were identified and used for the analysis. A questionnaire survey was conducted for the patients who visited a fresh breath clinic (n=295). RESULTS: The average number of articles per year was 32.2 +/- 7.3 and there was not a significant difference among years and months. There were only 25 articles (6.5%) with the central theme of oral malodor. More than half of the articles introduced anti-oral malodor products. The causes of oral malodor were described in 35% of the articles (n=134). Periodontal disease (n=57), tongue coating (n=35), otorhinolaryngological diseases (n=19), stomach problems (n=14) and psychological factors (n=21) were described as the causes of malodor. Only 35 articles (26%) described the treatment and prevention of halitosis. According to the questionnaire survey, 39% of the patients answered that they did not know the causes of malodor. Less than half knew that oral problems were related with malodor. DISCUSSION: It was revealed that the information about oral malodor in newspapers was not enough both quantitatively and qualitatively; people had little information about oral malodor. It is suggested that dental professionals should be aware of the importance of media advocacy to provide appropriate oral health information to the public.

[Dental students' smoking behavior and their attitude towards smoking].

This study investigated dental students' smoking behavior and their attitudes, in order to provide programs to patients for giving up smoking. A questionnaire survey was conducted on dental students from November 2003 to February 2004. The subjects were 69 third-grade and 80 fifth-grade students of Tokyo Medical and Dental University. The following results were obtained. (1) The smoking rate of dental students was 19.4% (Male: 31.3%, Female: 5.8%). (2) About forty-three percent of the students had started smoking before entering the university. However, most of the students who smoked had started after entering the university. The smoking rate and number of cigarettes smoked of fifth-grade students were significantly higher than those of third-grade students. (3) Dental students recognized the health risks of smoking more than the general public, especially concerning periodontal disease. (4) Only 5.4% of students answered that they would actively provide advice and instructions about the health hazards of tobacco to patients who smoked. (5) The rate of students who answered that they had enough knowledge to conduct smoking cessation programs for patients was 21.5%. (6) Students who smoked showed positive attitudes towards dentists' smoking behaviors and had passive attitudes towards smoking cessation programs conducted by dentists. These results show it is necessary to conduct smoking cessation programs soon after entering university and to provide more lectures on tobacco and health issues as well as practical training programs about giving up smoking in the dental education curriculum.

Coverage by Japanese newspapers of oral health messages on the prevention of dental caries.

The purpose of this study was to estimate the coverage and quality of information on dental caries prevention in Japanese newspapers. Newspaper articles were searched using database during 10 years from 1993 to 2002. From five major newspapers, 440 articles concerning dental caries prevention were selected and used for analysis. The number of caries prevention articles was related to National Oral Health Week, which was held in June of each year, and the introduction of new policy or government statements on oral health issues. Major sources of articles came from manufacturing companies (29.3%), staff of universities (27.7%), and other dental specialists (20.2%). Caries prevention articles appeared frequently in the health columns (35.7%) followed by news articles (20.0%) and business columns (17.7%). Dietary control (47.5%) was the most frequently described preventive method. Plaque control was referred to in 40.9% of articles, and information about improvement of host factors was provided in 40.0%. Among them, fluoride information was included in 30.0%. Clearly wrong information against evidence based were found in 24 articles. It is important that newspapers provide accurate information with a supportive evidence base. Dental professionals in Japan should be aware of the importance of media advocacy in order to provide appropriate oral health information to the public.