Dental Visits for Autistic Children: A Qualitative Focus Group Study of Parental Perceptions.

INTRODUCTION: Patient groups who pose behavioral challenges during dental attendance may be offered more restricted dental treatment options. Unsuccessful participation with dental visit tasks and demands has been commonly reported for autistic children. OBJECTIVES: This study aimed to examine parental perceptions of difficulties associated with dental attendance and oral care for autistic children and young adults, to highlight reported challenges and potential adaptations, and to identify interventions that will encourage positive experiences of dental attendance. METHODS: Qualitative data were gathered through 2 focus groups with parents of primary school and secondary school pupils with autism, interviewed in separate groups. Questions about parents' perceptions of dental attendance and oral care were asked. The groups were audio-recorded and transcribed verbatim. The transcripts were analyzed and initial codes generated. Development of subthemes and themes followed a process of thematic analysis. RESULTS: Parental perceptions, which confirmed data from other studies, included the need for understanding and training, awareness of sensory issues, recognition of the individuality of autistic traits, time and clarity for communication, and factors affecting the confidence of parents to advocate in the clinical environment. Focus group participants identified the critical value of empathizing with an autistic perspective and highlighted the importance of positive oral health messages. They also noted the lack of understanding regarding the complexity of altering self-imposed, ritualistic dietary regimes and attempting to enact good dental preventive habits for their children. CONCLUSIONS: Analysis of data from parent focus groups provided a greater understanding of the needs and responsivity required for successful dental visits for autistic children and young adults. A range of potential interventions was identified and incorporated within a model of needs. Interventions based on Partnership Working, System Change, and Training of Dental Staff could be effective in reducing challenges posed by dental attendance for many children with autism. KNOWLEDGE TRANSFER STATEMENT: Sensory sensitivities, communication difficulties, comorbid intellectual disability, and dental anxiety are barriers to successful participation during dental attendance for autistic children. This research proposes that interventions supporting Partnership Working, System Change, and Training of Dental Staff can reduce challenges posed by dental attendance. The model of interventions developed as part of this project can be used by oral care teams to help reduce barriers and improve the success of dental visits for autistic children.

Caries Detection with Near-Infrared Transillumination Using Deep Learning.

Dental caries is the most prevalent chronic condition worldwide. Early detection can significantly improve treatment outcomes and reduce the need for invasive procedures. Recently, near-infrared transillumination (TI) imaging has been shown to be effective for the detection of early stage lesions. In this work, we present a deep learning model for the automated detection and localization of dental lesions in TI images. Our method is based on a convolutional neural network (CNN) trained on a semantic segmentation task. We use various strategies to mitigate issues related to training data scarcity, class imbalance, and overfitting. With only 185 training samples, our model achieved an overall mean intersection-over-union (IOU) score of 72.7% on a 5-class segmentation task and specifically an IOU score of 49.5% and 49.0% for proximal and occlusal carious lesions, respectively. In addition, we constructed a simplified task, in which regions of interest were evaluated for the binary presence or absence of carious lesions. For this task, our model achieved an area under the receiver operating characteristic curve of 83.6% and 85.6% for occlusal and proximal lesions, respectively. Our work demonstrates that a deep learning approach for the analysis of dental images holds promise for increasing the speed and accuracy of caries detection, supporting the diagnoses of dental practitioners, and improving patient outcomes.

[The impact of bulimia nervosa on oral health: A systematic review of the literature]. / De invloed van boulimia nervosa op de mondgezondheid: een systematisch literatuuronderzoek.

Eating disorders represent a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. Eating disorders manifest themselves through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is more often due to anti-depressant medication than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivaryflow rate and do not affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases.

Targeted lung cancer screening selects individuals at high risk of cardiovascular disease.

BACKGROUND: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a targeted community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention. METHODS: The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score. RESULTS: Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6 ± 5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r = 0.26, p < 0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n = 714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n = 714) (p < 0.001). QRISK2 score was significantly higher in those with CAC (p < 0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n = 310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention. DISCUSSION: Opportunistic CVD risk assessment within a targeted lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.

Polymerase Chain Reaction Assay for Detection of Stenotrophomonas maltophilia in Cheese Samples Based on the smeT Gene.

Stenotrophomonas maltophilia is an emerging opportunistic pathogen linked not only to bacteremia, sepsis, and pneumonia but also to severe chronic enteritis. Persons with the impaired immune system are prone to be infected by S. maltophilia since its pathogenicity seems to be more associated with the host immune system than with the acquisition of specific virulence genes. In the dairy chain, S. maltophilia is linked to clinical and subclinical bovine mastitis in dairy cows, and it has been identified in cheese, and raw and pasteurized milk. There are reports of misidentification of S. maltophilia by commercial systems and PCR assays using primers based on the 23S rRNA and smeD genes, so the smeT gene is an alternative to identifying S. maltophilia by PCR due to its specificity to the S. maltophilia species. The present study reports an alternative species-specific PCR assay based on the smeT gene designed to identify S. maltophilia in cheese samples. We performed in silico and in vitro analyses to check the specificity of the primer pair. In silico analysis showed specificity of the primer pair to the species level. In vitro analysis was performed by testing the primer pair against pools of bacteria grown from 33 fresh Minas cheese samples acquired in the city of Rio de Janeiro, Brazil, without unspecific amplification.

Randomised Controlled Clinical Trial Investigating The Impact of Implementation Planning on Behaviour Related to The Diet.

There is a perceived gap between dietary advice given by health practitioners and adherence to the advice by patients. We investigated whether a behaviour change technique (implementation-planning) was more effective than standard-of-care diet advice at reducing dietary acid intake using quantitative erosive tooth wear progression as an objective clinical outcome. This study was a randomised controlled, double-blind, single-centre clinical trial in the UK. Participants (n = 60) with high dietary acid intake (≥2 daily), were recruited and randomly assigned (1:1) to receive either implementation-planning or standard-of-care diet advice in a single clinical session. Questionnaires and impressions were taken at baseline and 6 months later. Dental casts were scanned using laser profilometry and superimposed using surface-matching software. Data were analysed per protocol and intention-to-treat using independent t-tests and Mann-Whitney tests. The intervention group reduced their dietary acid intake between meals to 1 intake per day compared to 2 intakes per day for the controls and demonstrated reduced dental hard tissue volume loss (-0.00 mm3 (SD = 0.01)) compared to controls (-0.07 mm3 (SD 0.17)), p = 0.049. This paper supports the use of implementation planning in clinical practice and presents a non-invasive method of intervention assessment in behaviour change. Larger trials are needed to confirm the generalisability of results.

The impact of bulimia nervosa on oral health: A review of the literature.

Eating disorders are a potentially life-threatening group of mental disorders, which affect a patient's relationship with food and their body. This manifests itself through chaotic and disordered eating habits. One such eating disorder is bulimia nervosa, which has a lifetime prevalence of 1%. While there is consensus that bulimic behaviour directly causes dental erosion due to vomiting and acidic food choices, there is less clear evidence for a direct link between bulimia nervosa and dental caries, although there does still appear to be an association. Reduced salivary flow rate is a common feature among bulimics, but this is often due to anti-depressant medication rather than dietary habits or vomiting, and the effects are largely limited to unstimulated whole salivary flow rate and don't affect stimulated whole salivary flow rate. Parotid enlargement is present in a number of cases but this tends to be a minority. Further research is required given the limitations of current studies, especially gender imbalances among the populations studied and a lack of clear focus on bulimia nervosa.

Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety.

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.

Building Oral Health Research Capacity in India: Identifying Barriers and Enablers Using Mixed Methods.

Knowledge Transfer Statement: This article will provide a brief overview of the methods in finding barriers and enablers in doing oral health research in India. This mixed-methods approach can be used by researchers in finding barriers and enablers in doing oral health research in other developing countries and building oral health research capacities.

Differences by age and sex in general dental practitioners' knowledge, attitudes and behaviours in delivering prevention.

PURPOSE: To assess sex and age differences in NHS dentists' knowledge, attitudes and behaviours in providing preventive care. MATERIALS AND METHODS: A cross-sectional questionnaire survey was conducted with dentists working in North London, UK. RESULTS: The sample displayed limited knowledge in certain key aspects of prevention, but expressed generally positive attitudes towards preventive care. More female and younger dentists reported that a child should attend the dentist before the age of 3 years (p = 0.03 and p = 0.04, respectively). No other differences in knowledge or attitudes were found by age and sex. The majority of the sample reported routinely providing oral hygiene (95.7%), diet (85.4%) and smoking cessation advice (76.7%), but provision of alcohol advice was much less common (38%). A significantly higher proportion of younger dentists were more likely to give diet advice (p = 0.03) and smoking cessation support (p = 0.009) than their older colleagues. Female dentists were more likely to provide fissure sealants (p = 0.04), diet advice (p = 0.02) and smoking cessation support (p = 0.03). The main perceived barriers were related to organisational factors including insufficient remuneration (86.3%), lack of time (84%) and poor patient compliance (66%). There were no significant differences in perceived barriers by sex, but younger dentists were significantly more likely to identify poor patient compliance as a barrier (p = 0.02). CONCLUSION: Although dentists in this study may lack some core preventive knowledge, many expressed very positive attitudes towards prevention and reported to be routinely offering a range of preventive measures. Younger and female dentists tended to engage more frequently in preventive activities.

Consensus statement: Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Planning for future provision of dental services in prison: an international proposal of two systems.

This article describes a proposal for the future organisation of the delivery of dental and oral health services for prisoners. This vision is based on an analysis of the existing prison dental programmes in England and the United States (Federal Bureau of Prisons, [FBOP]), together with discussions from two key individuals from both countries who championed changes to prison dental services and have published in the field of prison dental services. Both countries have similar visions. Some of the suggested work has already been addressed in the past (for example, introduction of state of the art dental facilities in the UK prison setting), some are in process (for example, electronic patients' records) and some may be addressed in the near future (for example, prisoners' involvement with the services provided for them). Some of the expressed visions for the future in this article are driven by evidence-based literature and dental workforce policy.

Multidisciplinary team working in an adult male prison establishment in the UK.

The first two articles in this series exploring the oral and dental health of male prisoners in the UK demonstrated how the general and oral health of prisoners is compromised compared to those of a similar age who are not prisoners. In caring for the oral health needs of this group the high demand for emergency dental services often precludes the delivery of preventive and routine care. Comprehensive oral care for this population requires a level of training to gain the skills and knowledge to manage prisoners' complex medical, dental and social needs and the heightened dental anxiety that prisoners exhibit. The type of training that might be required for prison dentistry will be discussed in the final article. This article will describe a number of cases selected to demonstrate the complex problems presented by male prisoners in Her Majesty's Prison (HMP), Brixton. This article will also discuss the establishment of a primary care inter-professional relationship network (IRN) developed within a prison setting involving a dentist and other healthcare professionals. After informal discussions between the dentist and other prison healthcare professionals, it became apparent that vulnerable patients were not accessing dental services. These patients also cancel/fail to attend their dental appointments more frequently. In order to improve access and provision of dental care for this group of prisoners, an IRN was developed between the dentist, diabetic nurse, forensic psychology team, communicable disease lead, general medical practitioner (GMP), prison officers and healthcare manager within HMP Brixton. The nature of the IRN is presented along with reviews with relevant patient cases. The IRN allowed information sharing between professionals and an open care culture. The network was valued by prisoners. Prison populations show higher rates of general and oral disease, therefore an IRN can help to identify vulnerable groups and allow healthcare providers to give appropriate, targeted and focused care in a timely fashion.

Oral health of adult prisoners and factors that impact on oral health.

The first article in this series identified the medical and mental health issues among male patients in comparison to the general population. This article will discuss the oral health of male prisoners and those factors that impact upon their oral health including barriers to care. In general, the oral health of prisoners is poorer than that of age matched controls. A variety of factors including health related behaviours and pre-confinement access to dental services can influence this.

An overview of the prison population and the general health status of prisoners.

This article is the first in a series of four, which explore the oral and dental health of male prisoners in the United Kingdom. The series comprises: an overview of the general and oral health status of male prisoners, a discussion on how multi-disciplinary team working can be used to benefit the care of patients in prison environments and a description of the future planning of dental services for male prisoners. The oral health of prisoners is linked to their general health status, due in part to the presence of common risk factors such as smoking, drinking alcohol and in some cases use of recreational drugs, poor dietary and poor oral hygiene habits. Barriers to healthcare services can all have an effect on oral disease in this group. This paper highlights some of the common medical problems that oral healthcare providers face when treating prisoners in male UK prison establishments.

A variant in ANKK1 modulates acute subjective effects of cocaine: a preliminary study.

This study aimed to evaluate whether functional variants in the ankyrin repeat and kinase domain-containing 1 (ANKK1) gene and/or the dopamine receptor D2 (DRD2) gene modulate the subjective effects (reward or non-reward response to a stimulus) produced by cocaine administration. Cocaine-dependent participants (N = 47) were administered 40 mg of cocaine or placebo at time 0, and a subjective effects questionnaire (visual analog scale) was administered 15 min prior to cocaine administration, and at 5, 10, 15 and 20 min following administration. The influence of polymorphisms in the ANKK1 and DRD2 genes on subjective experience of cocaine in the laboratory was tested. Participants with a T allele of ANKK1 rs1800497 experienced greater subjective 'high' (P = 0.00006), 'any drug effect' (P = 0.0003) and 'like' (P = 0.0004) relative to the CC genotype group. Although the variant in the DRD2 gene was shown to be associated with subjective effects, linkage disequilibrium analysis revealed that this association was driven by the ANKK1 rs1800497 variant. A participant's ANKK1 genotype may identify individuals who are likely to experience greater positive subjective effects following cocaine exposure, including greater 'high' and 'like', and these individuals may have increased vulnerability to continue using cocaine or they may be at greater risk to relapse during periods of abstinence. However, these results are preliminary and replication is necessary to confirm these findings.

Levels of agreement between student and staff assessments of clinical skills in performing cavity preparation in artificial teeth.

OBJECTIVE: To determine the level of agreement between staff and students' assessment of clinical skills in performing tasks related to cavity preparation on a traditional dental manikin. METHODS: Two studies were conducted with two successive student cohorts: Study 1-138 year 1 BDS students in a 2009/10 cohort and Study 2-135 students in a 2010/11 cohort. Staff members and students rated the students' performance in preparing a cavity on a traditional dental manikin using artificial teeth: hand-held (Study 1) and located in a lower jaw (Study 2). A 5-item criterion-related scoring rubric was developed. The rubric assessed students' abilities to hold the instrument correctly, determine the angle of entry to the tooth, remove the caries, conserve healthy tissues and avoid pulp exposure. RESULTS: Agreement between the students' self-assessment and the staff's assessment was high for three of the five criteria (i.e. removal of artificial caries on the cavity wall, removal of artificial caries from the cavity floor and avoidance of pulp exposure). Levels of agreement for the remaining two criteria were moderate. A change in task difficulty affected the levels of agreement between staff and students, such that the more difficult the task, the greater the discrepancy in ratings. CONCLUSIONS: Students tend to overrate the quality of their performance when compared with staff ratings. Task difficulty has an impact on levels of agreement.

Plasma brain derived neurotrophic factor (BDNF) and response to ketamine in treatment-resistant depression.

Ketamine produces rapid antidepressant effects in treatment-resistant depression (TRD), but the magnitude of response varies considerably between individual patients. Brain-derived neurotrophic factor (BDNF) has been investigated as a biomarker of treatment response in depression and has been implicated in the mechanism of action of ketamine. We evaluated plasma BDNF and associations with symptoms in 22 patients with TRD enrolled in a randomized controlled trial of ketamine compared to an anaesthetic control (midazolam). Ketamine significantly increased plasma BDNF levels in responders compared to non-responders 240 min post-infusion, and Montgomery-Åsberg Depression Rating Scale (MADRS) scores were negatively correlated with BDNF (r=-0.701, p = 0.008). Plasma BDNF levels at 240 min post-infusion were highly negatively associated with MADRS scores at 240 min (r = -0.897, p=.002), 24 h (r = -0.791, p = 0.038), 48 h (r = -0.944, p = 0.001) and 72 h (r = -0.977, p = 0.010). No associations with BDNF were found for patients receiving midazolam. These data support plasma BDNF as a peripheral biomarker relevant to ketamine antidepressant response.

Assessment of safety, cardiovascular and subjective effects after intravenous cocaine and lofexidine.

The primary objective of this study was to determine the safety of lofexidine, an α2 receptor agonist, alone and concurrent with cocaine in non-treatment seeking cocaine-dependent or cocaine-abusing participants. After screening, eligible participants received double-blind, randomized infusions of saline and 20mg of cocaine on Day 1, and saline and 40mg of cocaine on Day 2. Subjects were randomized and started receiving daily administration of placebo (N=4) or lofexidine on Day 3 and continued on this schedule until Day 7. Two dosing regimens for lofexedine were investigated: 0.8 QID (N=3) and 0.2mg QID (N=11). On Days 6 and 7, subjects received double-blind infusions of saline and 20mg of cocaine on Day 6, and saline and 40mg of cocaine on Day 7. The data reveal a notable incidence of hemodynamic-related AEs over the course of the study. Two of the three participants at the 0.8mg dose level discontinued, and five of 11 participants at the 0.2mg dose level were withdrawn (or voluntarily discontinued) after hemodynamic AEs. Subjective effects and cardiovascular data were derived from all participants who were eligible to receive infusions (i.e., did not meet stopping criteria) on Days 6 and 7 (6 received lofexidine 0.2mg, QID and 4 received placebo, QID). As expected, cocaine significantly increased heart rate and blood pressure, as well as several positive subjective effects. There was a trend for lofexidine to decrease cocaine-induced cardiovascular changes and cocaine-induced ratings for "any drug effect", "good effects", and "desire cocaine", but sample size issues limit the conclusions that can be drawn. Despite the trends to reduce cocaine-induced subjective effects, cardiovascular AEs may limit future utility of lofexidine as a treatment for this population.