Dental caries in Rwanda: A scoping review.

Background and Aims: Dental caries is an infectious disease affecting virtually all nations, including Rwanda. In Rwanda, the burden of dental caries is an issue of public health concern. To ensure the progressive eradication of the current dental caries burden in Rwanda through an evidence-based approach, it is imperative to have an overview of the scientific research landscape of dental caries in the country. This study-a scoping review-aims to review the available evidence and gaps on dental caries in Rwanda. Methods: This scoping review was reported based on the Preferred Reporting Items for systematic reviews and meta-analyses extension for Scoping Reviews checklist. A systematic search of 11 databases was done to scoop out all literature relevant to the topic. Based on the review's selection criteria, a total of eight peer-reviewed journal articles were included in the review. The extracted data were collated, summarized, and presented as results. Results: The analysis of the data extracted from the included articles revealed a high prevalence of dental caries (ranging from 42.42% to 71.5%) in Rwanda. Also, the major pathogens causing dental caries in Rwanda as well as the impact of dental caries on the physical health and quality of life of Rwandans were identified in this review. Furthermore, the reported operative treatment options for dental caries in Rwanda were predominantly nonconservative. Also, no intervention study has been conducted on dental caries in Rwanda. Conclusion: The findings in this review identify the need for massive public health interventions on dental caries in Rwanda.

School-Based Interventions on Dental Trauma: A Scoping Review of Empirical Evidence.

INTRODUCTION: Accidents involving sports or leisure activities, falls, blows from objects, acts of interpersonal violence, and accidents can all result in dental trauma (also known as traumatic dental injuries [TDIs]). School children are one of the population groups that are highly vulnerable to TDIs. Multiple school-based interventions have been conducted around the world on the prevention and management of TDIs; however, no known scoping review has been conducted to map the evidence. Hence, this study aimed to conduct a scoping review of existing school-based interventions on TDIs. METHODS: This scoping review adopted the research design presented by Arksey and O'Malley. Eight research databases-PubMed, SCOPUS, APA PsycINFO, CINAHL Ultimate, AMED (The Allied and Complementary Medicine Database), Child Development & Adolescent Studies, Psychology and Behavioral Sciences Collection, and SPORTDiscuss-were searched to retrieve literature relevant to the scoping review question. Some of the retrieved literature existed in duplicate and was deduplicated using Rayyan software. Twenty papers that fulfilled the inclusion criteria were selected and reviewed. RESULTS: A total of 526 publications were retrieved from the eight databases searched in this scoping review. Ninety-seven publications were duplicates and were removed. After the two-stage screening of the deduplicated copies, only 20 peer-reviewed journal articles were relevant and included in the review. The selected studies sampled a total of 7152 participants whose ages ranged between 9 and 62 years (mean = 10.56 to 46.5; standard deviation = ±0.97 to ±8.1). The findings obtained from the reviewed journal articles revealed that pupils are at high risk of dental trauma and they are more likely to sustain these injuries during school activities. In addition, inadequate understanding, poor attitudes, and low experiential knowledge of dental trauma were found among educators, parents, and even school pupils. The evidence of long-term knowledge retention and a high knowledge score in the experimental groups buttresses the need for continuous first-aid education on dental trauma. CONCLUSIONS: The application of multiple educational approaches or modalities in schools will reinforce and promote good first-aid skills and management practices that are essential for preserving traumatized teeth.

Assessing the association between periodontitis and premature birth: a case-control study.

BACKGROUND: Premature delivery is among the leading causes of perinatal mortality and morbidity in developed societies, which is an important obstetrics problem. Maternal periodontitis is a prevalent condition that has been suspected to be associated with adverse pregnancy outcomes such as premature birth. However, there are still conflicting results about this possible relationship, therefore this study was designed to test the association between maternal periodontitis and premature birth. This study also provides information about a new screening tool recommended for use by nurses and midwives to screen for periodontal diseases during antenatal consultations in order to improve the health of mothers and children. METHODS: A retrospective case-control study was conducted at 12 health facilities in the Southern Province of Rwanda from February to August, 2018. A total of 555 women in the postpartum period were enrolled in the study. Cases and controls were enrolled in a ratio of 1:2; each enrolled case of preterm birth was followed by 2 unmatched control subjects that were next on the register and who delivered at term gestation. A total of 185 cases of preterm deliveries and 370 controls of term delivery were enrolled in the study. Multivariate regression analysis was used and the independent variables were hierarchically entered in three groups: The first group involved demographic variables that were put in the regression model as Step 1. The second group was made up of other potential risk factors that were placed in the regression model as the second step. Periodontitis was entered in the final regression step, as it was hypothesized as the main predictor variable. RESULTS: A statistically significant association was found between periodontitis and premature birth. Women who had periodontitis had 6 times the odds of giving birth to premature birth infants compared to women who had no periodontitis (OR: 6.360, 95% CI 3.9, 10.4). CONCLUSION: The study results indicate that periodontitis is strongly associated with premature birth. Preventive solutions including the use of a periodontitis screening tool for nurses and midwives during antenatal care consultations, are highly recommended.

Quorum sensing: a new prospect for the management of antimicrobial-resistant infectious diseases.

INTRODUCTION: Quorum-sensing (QS) is a microbial cell-to-cell communication system that utilizes small signaling molecules to mediates interactions between cross-kingdom microorganisms, including Gram-positive and -negative microbes. QS molecules include N-acyl-homoserine-lactones (AHLs), furanosyl borate, hydroxyl-palmitic acid methylester, and methyl-dodecanoic acid. These signaling molecules maintain the symbiotic relationship between a host and the healthy microbial flora and also control various microbial virulence factors. This manuscript has been developed based on published scientific papers. AREAS COVERED: Furanones, glycosylated chemicals, heavy metals, and nanomaterials are considered QS inhibitors (QSIs) and are therefore capable of inhibiting the microbial QS system. QSIs are currently being considered as antimicrobial therapeutic options. Currently, the low speed at which new antimicrobial agents are being developed impairs the treatment of drug-resistant infections. Therefore, QSIs are currently being studied as potential interventions targeting QS-signaling molecules and quorum quenching (QQ) enzymes to reduce microbial virulence. EXPERT OPINION: QSIs represent a novel opportunity to combat antimicrobial resistance (AMR). However, no clinical trials have been conducted thus far assessing their efficacy. With the recent advancements in technology and the development of well-designed clinical trials aimed at targeting various components of the, QS system, these agents will undoubtedly provide a useful alternative to treat infectious diseases.

Assessment of the Knowledge, Attitude and Practices of Nurses and Midwives Working at Antenatal Clinics in the Southern Province of Rwanda on Periodontal Diseases: A Cross-Sectional Survey.

INTRODUCTION: Oral health is considered an important component of general health; the mouth cannot be considered in isolation from the rest of the body. Studies indicate an association between periodontitis and preterm and lowbirth weight outcomes. One of the opportunities to improve the oral health care of pregnant women during antenatal care consultations is through collaboration with nurses and midwives. It can be of importance if nurses/midwives are equipped with the right knowledge, attitude and practices regarding oral health. Therefore, this study assessed the existing knowledge, attitude and practices of nurse/midwives working in antenatal clinics in 12 selected health facilities in the Southern Province of Rwanda on periodontal diseases. PATIENTS AND METHODS: A descriptive cross-sectional study was done on 79 nurses and midwives working at antenatal care clinics and maternity wards. An ANOVA test was used to compare knowledge, attitude and practices mean scores of nurses/midwives about periodontal diseases and their management. A correlation test was also used to ascertain the relationship among knowledge, attitude, practices and other continuous variables. RESULTS: The average age of nurses/midwives was M=33.57, SD=6.1. Nurses had limited knowledge about oral health of pregnant women and had some misunderstandings about oral health, although they had good attitudes. Age, length of service as a nurse or midwife and length of service in antenatal care had no effect on the knowledge, practice and attitude scores of the nurses/midwives. The ANOVA test did not find any significant difference in means for knowledge, attitude, practice and education level (p=0.69, 0.93, 0.27), respectively. CONCLUSION: Although nurses/midwives have good attitude regarding the management of periodontal diseases of pregnant women, their knowledge is insufficient and it is highly recommended that oral diseases can be included in their curriculum so that they can be in the best position to advise/screen for periodontal diseases during pregnancy.

Impact of maternal periodontitis on preterm birth and low biirth weight in babies: results of a scoping review

Background Periodontitis has been documented as public health concern but its association with preterm and low birth weight remains uncertain, thus the objective of this scoping review is to summarize the most recent published evidence related to the impact of periodontitis on preterm birth and low birth weight in order to improve public awareness and to inform policies for oral health during pregnancy. Methods Hinari, PubMed, and Google Scholar were searched to acquire the published literature. The retrieved studies included cross-sectional, case control studies and randomized controlled trials with available full text published in English from 2008 to 2019. Results After combining the key words, 333 articles were identified with only 133 eligible articles published from 2008 to 2019. After reviewing the available 50 full text articles, duplicates were removed and 15 studies fully met the inclusion criteria. There were 13 articles that supported the association between maternal periodontitis and preterm low birth weight while 2 found no evidence to support the association. Conclusion The results of this scoping review contribute to an increasing body of evidence to support the hypothesis that maternal periodontal disease may be a risk factor for preterm delivery and low birth weight.

Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.

Effects of vitamin D status on oral health.

Normal humans of all ages have the innate ability to produce vitamin D following sunlight exposure. Inadequate vitamin D status has shown to be associated with a wide variety of diseases, including oral health disorders. Insufficient sunlight exposure may accelerate some of these diseases, possibly due to impaired vitamin D synthesis. The beneficial effects of vitamin D on oral health are not only limited to the direct effects on the tooth mineralization, but are also exerted through the anti-inflammatory functions and the ability to stimulate the production of anti-microbial peptides. In this article, we will briefly discuss the genesis of various oral diseases due to inadequate vitamin D level in the body and elucidate the potential benefits of safe sunlight exposure for the maintenance of oral and general health.