Prenatal tobacco and postbirth second-hand smoke exposure and dental caries in children.

OBJECTIVES: Second-hand smoke (SHS) exposure has been identified as a risk factor for several childhood health problems including dental caries. The purpose of this study was to examine the association of postbirth SHS exposure and dental caries and to determine whether the association is independent of prenatal tobacco exposure, sugar consumption and dental utilization. METHODS: NHANES 2013-2014 and 2015-2016 were used to examine the research question in 1733 children, 4-11 years old with full primary or mixed dentition and serum cotinine levels below 10 ng/mL. Weighted multivariable logistic regression models were developed to examine the independent association between SHS exposure and the prevalence of (i) any dental caries experience and (ii) any decayed teeth. RESULTS: Children exposed to postbirth SHS differed from children not exposed regarding decayed teeth prevalence in the total sample (OR = 1.80, 95% CI: 1.20, 2.71) and mixed dentition (OR = 1.86, 95% CI: 1.20, 2.90) after confounder adjustment. However, no association was found in the primary dentition or between SHS exposure and total caries experience. CONCLUSIONS: The findings partially show that postbirth SHS is associated with dental caries in children. However, the inconsistencies in findings across the three samples and between the two outcome measures, dental caries experience and decayed teeth prevalence raise questions regarding the validity of the hypothesis. Further, the findings suggest that postbirth SHS is likely a marker for true causes of dental caries and the association is likely confounded with other factors associated with dental caries.

Development of the Knowledge Related to Oral Health Literacy for Spanish Speakers Scale.

The Hispanic population has one of the highest levels of untreated oral disease of any linguistic or ethnic population in the United States. Research examining the factors leading to such outcomes is limited. Since health literacy has been identified as a mediator of health disparities, it is important to identify the most appropriate tool to assess it. The Knowledge Related to Oral Health Literacy model for Spanish speakers (KROHL-S) is an inclusive framework to evaluate oral health knowledge and other modifiable factors at the individual level among the Hispanic population as related to oral health literacy. KROHL-S intends to provide concrete, practical information to help customize interpersonal interactions and educational experiences to individuals' needs and capabilities. The questionnaire that will allow the creation of the KROHL-S scale consists of orally administered open-ended questions to measure knowledge that is condition specific (caries, periodontal disease, oral cancer, tooth loss, and malocclusion) and domain that is knowledge specific (identification of condition, causes, prevention, treatment, general knowledge). Implementation of the KROHL-S framework will provide in depth information that could be shared among health care providers and the creation of patient-centred initiatives.

Development of a tongue-tie case definition in newborns using a Delphi survey: The NYU-Tongue-Tie Case Definition.

OBJECTIVE: The primary purpose of this study was to develop an operational definition of the oral condition of ankyloglossia (also called tongue-tie) that occurs in newborns (i.e., age birth-6 months) and that could consistently be used in research studies. STUDY DESIGN: This 4-round Delphi survey developed the consensus New York University-Tongue-Tie Case Definition (NYU-TTCD) by using a panel of ankyloglossia treatment experts. RESULTS: This tongue-tie case definition (TTCD) was carefully created in a step-wise manner from the bottom up by expert panelists over 4 rounds of inquiry. As a functioning case definition, it offers the diagnostician 2 separate pathways to identifying a newborn as being tongue tied. One pathway requires but a single pathognomonic anatomic feature, and the other pathway requires a single functional deficit accompanied by at least 2 of 12 other diagnostic items (functional, anatomic, or behavioral). CONCLUSIONS: This Delphi survey, as administered to a panel of ankyloglossia treatment experts, produced the first consensus case definition of tongue-tie for newborns (i.e., age birth-6 months) for use in epidemiologic research studies ranging from descriptive prevalence studies to clinical trials. Next-step studies should establish the validity, reliability, and utility of this novel NYU-TTCD case definition for epidemiologic and clinical purposes.

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly.

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

Researcher Requests for Inappropriate Analysis and Reporting: A U.S. Survey of Consulting Biostatisticians.

Background: Inappropriate analysis and reporting of biomedical research remain a problem despite advances in statistical methods and efforts to educate researchers. Objective: To determine the frequency and severity of requests biostatisticians receive from researchers for inappropriate analysis and reporting of data during statistical consultations. Design: Online survey. Setting: United States. Participants: A randomly drawn sample of 522 American Statistical Association members self-identifying as consulting biostatisticians. Measurements: The Bioethical Issues in Biostatistical Consulting Questionnaire soliciting reports about the frequency and perceived severity of specific requests for inappropriate analysis and reporting. Results: Of 522 consulting biostatisticians contacted, 390 provided sufficient responses: a completion rate of 74.7%. The 4 most frequently reported inappropriate requests rated as "most severe" by at least 20% of the respondents were, in order of frequency, removing or altering some data records to better support the research hypothesis; interpreting the statistical findings on the basis of expectation, not actual results; not reporting the presence of key missing data that might bias the results; and ignoring violations of assumptions that would change results from positive to negative. These requests were reported most often by younger biostatisticians. Limitations: The survey provides information on the reported frequency of inappropriate requests but not on how such requests were handled or whether the requests reflected researchers' maleficence or inadequate knowledge about statistical and research methods. In addition, other inappropriate requests may have been made that were not prespecified in the survey. Conclusion: This survey suggests that researchers frequently make inappropriate requests of their biostatistical consultants regarding the analysis and reporting of their data. Understanding the reasons for these requests and how they are handled requires further study. Primary Funding Source: U.S. Department of Health and Human Services.

Oral health knowledge, attitudes, and practices (KAP) in rural Haiti: a 40-year follow-up study.

This paper reports the changed findings over a 40-year period on oral health knowledge, attitudes, and practices (KAP) of a very remote and rural population living the Jeremie region of Haiti. The far-sighted investigators of that original 1970 survey stated in their published 1972 paper that our "…findings are descriptive, but have to be accepted tentatively rather than definitively because time was short, transportation was difficult, and the small sample that had to be used could not random." They further insightfully stated their hopes that their "…results may be regarded as an anthropological cultural baseline from which to review further findings concerning Haitian dental beliefs." The two follow-up surveys in 1997 and 2010 using the same exact KAP questionnaire on the same population of rural Haitians living in the Jeremie region fulfilled the extraordinary vision of those two initial investigators, Dr. Wesley Young (a nationally renowned U.S. public health dental academician) and Paul Rundberg (then a dental student at the University of Kentucky).

Identifying bioethical issues in biostatistical consulting: findings from a US national pilot survey of biostatisticians.

OBJECTIVES: The overall purposes of this first US national pilot study were to (1) test the feasibility of online administration of the Bioethical Issues in Biostatistical Consulting (BIBC) Questionnaire to a random sample of American Statistical Association (ASA) members; (2) determine the prevalence and relative severity of a broad array of bioethical violations requests that are presented to biostatisticians by investigators seeking biostatistical consultations; and (3) establish the sample size needed for a full-size phase II study. DESIGN: A descriptive survey as approved and endorsed by the ASA. PARTICIPANTS: Administered to a randomly drawn sample of 112 professional biostatisticians who were ASA members. PRIMARY AND SECONDARY OUTCOME MEASURES: The 18 bioethical violations were first ranked by perceived severity scores, then categorised into three perceived severity subcategories in order to identify seven 'top tier concern violations' and seven 'second tier concern violations'. RESULTS: Methodologically, this phase I pilot study demonstrated that the BIBC Questionnaire, as administered online to a random sample of ASA members, served to identify bioethical violations that occurred during biostatistical consultations, and provided data needed to establish the sample size needed for a full-scale phase II study. The No. 1 top tier concern was 'remove or alter some data records in order to better support the research hypothesis'. The No. 2 top tier concern was 'interpret the statistical findings based on expectation, not based on actual results'. In total, 14 of the 18 BIBC Questionnaire items, as judged by a combination of 'severity of violation' and 'frequency of occurrence over past 5 years', were rated by biostatisticians as 'top tier' or 'second tier' bioethical concerns. CONCLUSION: This pilot study gives clear evidence that researchers make requests of their biostatistical consultants that are not only rated as severe violations, but further that these requests occur quite frequently.

Delayed tooth emergence in children infected with human immunodeficiency virus.

OBJECTIVE: There is limited evidence that early deficits in growth might be reflected in tooth emergence in children infected with human immunodeficiency virus (HIV). The purpose of this study was to prospectively evaluate tooth emergence timing between children positive and negative for HIV in the exposed and unexposed groups, respectively. STUDY DESIGN: A longitudinal study of children positive for HIV and HIV-negative household peers, aged 2 to 15 years was conducted between 1993 and 1996. Emergence status was determined for the maxillary and the mandibular permanent first molars and the central and lateral incisors. A multivariable, discrete time, proportional hazards model was fitted to the data. Median age of emergence for each of the six pairs of teeth was calculated using the parameter estimates from the regression model. RESULTS: A total of 116 participants (62 HIV positive, 54 HIV negative) completed six examinations over the 36-month study period. Statistical differences in tooth emergence timing were observed for five of the six tooth pairs, with children positive for HIV being less likely to have emergence of the corresponding tooth compared with the children negative for HIV. Age differences for each tooth pair ranged from 0.7 to 1.5 years, with a median emergence age difference of 1.03 years. CONCLUSIONS: Delayed tooth emergence of the permanent dentition was observed in children with HIV.

Assessment of readiness of dental faculty and students in Kuwait to implement a smoking cessation counseling curriculum.

AIMS AND OBJECTIVES: The goal of this study was to assess the readiness of both dental faculty and dental students in Kuwait to implement a smoking cessation counseling curriculum. MATERIALS AND METHODS: The study population included all faculty and students in their clinical training years at the Faculty of Dentistry, Kuwait University. The survey instrument was a 42-item questionnaire. Data analysis involved employing various methods of descriptive statistics. RESULTS: Students and faculty reported that their general knowledge of what to include in a cessation message was excellent. Students reported and anticipated more clinical barriers than did the faculty. Both students and faculty agreed strongly that they were willing to refer patients for cessation in their clinical practice, faculty were much less willing to prescribe medications for cessation as compared to students. The majority of students and faculty disagreed with the statement that performing cessation was easy. Responses showed that the use of the 5 A's has not penetrated well into clinical practice for either the students or the faculty. CONCLUSIONS: Clinical students and faculty members believe smoking cessation counseling to be effective; however, their activity was mostly limited to asking patients if they smoked and both reported their knowledge of cessation counseling to be only fair.

Psychosocial impact of anterior dental esthetics on periodontal health, dental caries, and oral hygiene practices in young adults.

This study sought to determine whether the self-perceived image of a young adult's anterior dental esthetics is linked with periodontal health, dental caries, and oral hygiene practices. Two hundred subjects were assessed via a clinical examination, including intraoral photographs. The subjects were questioned about their demographics and oral hygiene practices and given the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) to measure their self-perceived variables related to dental esthetics. A high PIDAQ score indicates a negative image of one's own dental esthetics, while a low PIDAQ score indicates a positive outlook. A self-perceived negative psychosocial impact of anterior dental esthetics was detected in subjects with higher levels of dental caries and visible gingival inflammation in the anterior region of the mouth.

Revisiting the status of oral health services in adult PM&R programs: a 40-year follow-up survey.

PURPOSE: This survey compared the status of oral health service access and needs for adult Physical Medicine & Rehabilitation (PM&R) patients over a 40-year period. METHODS: This report compares two surveys (1974 vs. 2014) of Directors of PM&R residency programs in the United States. The same 14 survey questions used in 1974 survey were repeated in 2014, with four new questions added. RESULTS: The major comparative findings about oral health services were that while perceived need remained high and availability and adequacy of dental care remained low, program directors indicated a slightly lessened desirability, feasibility and overall support for the concept of integrating oral health services into their PM&R program in the 2014 survey. CONCLUSION: These findings show that 40 years has not brought better access to oral health care for adult PM&R patients, only a slightly lessened enthusiasm in the program directors. Future research should explore the reasons underlying these disappointing outcomes.

Skills in assessing the professional literature (SAPL): a 7-year analysis of student EBD performance.

PURPOSE: The primary goal of this project was to describe the level of knowledge acquisition using detailed test performance outcomes of the EBD SAPL curriculum over its first 7-years of implementation at the NYU College of Dentistry. A secondary goal was to compare performance outcomes impact of the full 60 h base SAPL curriculum as taught to 4-year DDS students vs an abbreviated 30 h base SAPL curriculum as taught to 3-year Advanced Placement DDS students. METHODS: The findings for the period 2004-2010 are reported for 1647 dental students (63.6% 4-year DDS students, 36.3% 3-year Advanced Placement DDS students). The database consisted of the score earned by each student on each individual question of the SAPL course's 4 h final examination in which each student read an original research article and answered all questions on the Literature Analysis Form. RESULTS: The major findings were overall high performance by both groups of students (SAPL exam scores of 85.8 vs 83.7, respectively) as well as very similar outcomes between these two student groups on: 1) recognizing research design elements and on interpreting those design elements for clinical application, 2) detailed performance of knowledge within the specific five traditional sections of research articles, and 3) detailed performance across 18 identified research design topics. CONCLUSION: In conclusion, both course formats appear to be highly effective for their respective student groups, but should not be interpreted as evidence favoring the shorter format given the different characteristics of the two student groups.

Effect of early childhood protein-energy malnutrition on permanent dentition dental caries.

OBJECTIVES: The objective of this study is to determine the effect of early childhood protein-energy malnutrition (ECPEM) on decayed, missing, filled tooth (DMFT) scores in the permanent dentition of rural Haitian adolescents aged 11-19 years (n = 1,006). METHODS: We used data from a retrospective cohort that was developed from the Haitian Health Foundation database and merged records on weight-for-age covering the birth through 5-year-old period for all enrolled participants. Dental examinations and interviewer-administered structured questionnaires on demographic and socioeconomic status, and relative sugar consumption were completed in 1,058 participants aged 11-19 years. The ECPEM was defined based on weight-for-age of the subjects during their first 5 years of life that were converted to Z-scores based on the National Center for Health Statistics referent database. Descriptive statistics were calculated. DMFT was regressed on ECPEM adjusting for age, sex, current body mass index Z-score, socioeconomic status, relative sugar consumption, and number of permanent teeth present assuming a Poisson distribution. RESULTS: Questionable malnutrition [rate ratio (RR) = 0.72; 95 percent confidence interval (CI), 0.61-0.86] and malnutrition (RR = 0.58; 95 percent CI, 0.49-0.69) were associated with a statistically significant lower DMFT in Haitian adolescents. CONCLUSIONS: ECPEM status is inversely associated with DMFT in Haitian participants. Further follow-up of these same participants will be recommended to evaluate the potential caries catch-up effect.

What constitutes a proper routine oral cancer examination for patients at low risk? Findings from a Delphi survey.

OBJECTIVE: A Delphi survey was used to develop a consensus opinion regarding what should constitute a routine oral cancer examination performed by general dentists when examining patients at low risk for oral cancer. STUDY DESIGN: This Delphi survey consisted of 5 rounds and used, as the expert panel, a stratified national sample of academically based US oral surgeons, oral pathologists, and oral medicine specialists, that is, the persons who teach the identification and diagnosis of oral cancer to all future general practitioners. RESULTS: After defining the population at low risk for oral cancer and the examination frequency in rounds 1 and 2, in rounds 3 to 5 the panelists evaluated and debated 28 proposed examination elements. They reached consensus agreement to include 25 of those elements and to exclude 2 of them, but the panel did not achieve consensus on the remaining element. CONCLUSION: The panel reached consensus agreement on 25 recommended elements for an annual examination of patients at low risk for oral cancer.

Prevention of root caries: a literature review of primary and secondary preventive agents.

PURPOSE: This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. METHOD: Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010. RESULTS: In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%. CONCLUSION: For 1° prevention of root caries the recommended "best choice" is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended "best choice" is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.

HPV, oropharyngeal cancer, and the role of the dentist: a professional ethical approach.

Human papillomavirus (HPV) is an emerging risk factor for oropharyngeal cancer, especially among younger patients, and must be thoughtfully addressed by the dental community. The professional ethical decision-making model first advanced by Ozar and Sokol for use by dentists at chairside (define the dilemma, assess the facts, identify and rank the alternatives, and choose a course of action) was modified to delineate clearly inputs, considerations, and feedback loops based on what is professionally and ethically at stake in advising patients. As the link between HPV and oropharyngeal cancer is established through scientific studies, the role of the dentist in primary and secondary prevention will be crucial. In the absence of definitive evidence, the professional ethical decision-making framework presented here allows dentists to systematically work through available alternatives. Ultimately, the role of the dentist is to use discretion in choosing a professional and ethical course of action for each patient.

Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings.

Effective provider-patient relationships are vital for positive patient health outcomes. This analysis assessed sociodemographic differences in fears and mistrust related to the provider-patient relationship, which may contribute to unwillingness to participate in cancer screenings (CSs). The data are from a stratified, random-digit dial telephone questionnaire of non-institutionalized households in New York, Maryland, and Puerto Rico. Statistically significant results indicate that Hispanics, compared with Whites, were nearly two times more likely to report that fear of being a "guinea pig" and lacking trust in medical people would make them unwilling to participate in CSs. Additionally, those with less education were over two times more likely to indicate a fear of being embarrassed during the screening would make them unwilling to participate in CSs. These results highlight areas where health professionals can improve interactions with their patients and be attentive to their fears and/or mistrusts to promote CSs utilization.

The first-choice standard of care for an edentulous mandible: a Delphi method survey of academic prosthodontists in the United States.

BACKGROUND: In 2002 and 2009, two consensus statements-one from a symposium in Canada and one from England-were issued that recommended that the first-choice standard of care for an edentulous mandible should be the two implant-retained mandibular overdenture (IRMOD). The authors conducted a survey to determine if, in 2011, U.S. academic prosthodontic experts' opinions were aligned with those in the two consensus statements. METHODS: The authors administered a Delphi method survey to an expert panel of 16 nationally representative academic prosthodontists to determine if there is consensus on the first-choice standard of care for an edentulous mandible between the IRMOD and a conventional mandibular complete denture (CD). Consensus agreement was defined as a 70 percent agreement level among the panelists. RESULTS: The panel attained consensus favoring the IRMOD for nine of the 10 parameters assessed-retention, stability, speech, masticatory efficiency, comfort while eating soft foods and hard foods, confidence in intimate situations, satisfaction and self-esteem. The exception was esthetics for which only a majority (51-69 percent) favored the IRMOD. CONCLUSIONS: The panelists reached consensus that they would recommend an IRMOD instead of a CD as the first-choice standard of care for patients who are healthy or have mild systemic disease, but not for patients with severe systemic disease. CLINICAL IMPLICATIONS: Surveyed academic prosthodontists recommend an IRMOD as the first choice standard of care when restoring an edentulous mandible of a healthy patient or a patient with mild systemic disease.

Influence of scary beliefs about the Tuskegee Syphilis Study on willingness to participate in research.

OBJECTIVES: To assess whether scary/alarming beliefs about details on the Tuskegee Syphilis Study (TSS) are associated with willingness and/or fear to participate in biomedical research. METHODS: Scary beliefs about TSS were examined for 565 Black and White adults who had heard of the TSS. Multivariate analyses by race were used to measure association. RESULTS: No association between scary beliefs and willingness or fear to participate in research was found (P > 0.05). CONCLUSIONS: These findings provide additional evidence that awareness or detailed knowledge about the TSS does not appear today to be a major factor influencing Blacks' willingness to participate in research.