Topical fluoride as a cause of dental fluorosis in children.

BACKGROUND: This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth. SEARCH METHODS: We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis. MAIN RESULTS: We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25). AUTHORS' CONCLUSIONS: Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children's exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.

Can oral microbiome predict low birth weight infant delivery?

OBJECTIVES: This study aimed to identify the oral microbiota factors contributing to low birth weight (LBW) in Chinese pregnant women and develop a prediction model using machine learning. METHODS: A nested case-control study was conducted in a prospective cohort of 580 Chinese pregnant women, with 23 LBW cases and 23 healthy delivery controls matched for age and smoking habit. Saliva samples were collected at early and late pregnancy, and microbiome profiles were analyzed through 16S rRNA gene sequencing. RESULTS: The relative abundance of Streptococcus was over-represented (median 0.259 vs. 0.116) and Saccharibacteria_TM7 was under-represented (median 0.033 vs. 0.068) in the LBW case group than in controls (p < 0.001, p = 0.015 respectively). Ten species were identified as microbiome biomarkers of LBW by LEfSe analysis, which included 7 species within the genus of Streptococcus or as part of 'nutritionally variant streptococci' (NVS), 2 species of opportunistic pathogen Leptotrichia buccalis and Gemella sanguinis (all LDA score>3.5) as risk biomarkers, and one species of Saccharibacteria TM7 as a beneficial biomarker (LDA= -4.5). The machine-learning model based on these 10 distinguished oral microbiota species could predict LBW, with an accuracy of 82 %, sensitivity of 91 %, and specificity of 73 % (AUC-ROC score 0.89, 95 % CI: 0.75-1.0). Results of α-diversity showed that mothers who delivered LBW infants had less stable salivary microbiota construction throughout pregnancy than the control group (measured by Shannon, p = 0.048; and Pielou's, p = 0.021), however the microbiome diversity did not improve the prediction accuracy of LBW. CONCLUSIONS: A machine-learning oral microbiome model shows promise in predicting low-birth-weight delivery. Even in cases where oral health is not significantly compromised, opportunistic pathogens or rarer taxa associated with adverse pregnancy outcomes can still be identified in the oral cavity. CLINICAL SIGNIFICANCE: This study highlights the potential complexity of the relationship between oral microbiome and pregnancy outcomes, indicating that mechanisms underlying the association between oral microbiota and adverse pregnancy outcomes may involve complex interactions between host factors, microbiota, and systemic conditions. Using machine learning to develop a predictive model based on specific oral microbiota biomarkers provides a potential for personalized medicine approaches. Future prediction models should incorporate clinical metadata to be clinically useful for improving maternal and child health.

Developing and assessing the efficiency of VOSER software in recording dental caries according to WHO's criteria 2013.

Background/purpose: World Health Organization (WHO) oral health survey manual is the main guideline for most oral health surveys worldwide. It has been updated several times since 1971; however, using papers and pens for data recording remains unchanged. This study aimed to develop the Vietnam Oral Survey Electronics Recorder (VOSER) to record dental caries data based on the WHO 2013 criteria and assess its reliability and efficiency. Materials and methods: VOSER was developed and tested for reliability and efficiency by performing clinical examinations on 365 school children in three key indicator age groups: 120 5-year-old students with primary dentition, 123 8-year-old students with mixed dentition, and 122 12-year-old students with permanent dentition. One gold standard examiner and two trained clerks examined these children using either WHO's paper survey form or VOSER's digital form for dental caries. Recording time, spreadsheet time, DMFT/S, and dmft/s were analyzed to compare the efficiency of VOSER to the paper form. Cohen's Kappa, intraclass correlation coefficient, and Wilcoxon signed-rank test were adopted in the data analyses. Results: Median time of using VOSER was significantly shorter than the standard time in all three dentitions (P < 0.001). Cohen's Kappa values between data collected by VOSER and paper form showed almost perfect agreements (0.927-0.958). DMFT/S and dmft/s values calculated from data collected by both methods had good to excellent reliabilities (0.791-0.997). Conclusion: VOSER is efficient and reliable for conducting dental caries surveys according to the WHO 2013 criteria and should be utilized in the era of digital technology.

Rasch validation of the oral health impact profile for temporomandibular disorders.

OBJECTIVES: This study examined the metric properties of the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD) using Factor/Rasch analyses and created a short-form version of the measure. SUBJECTS AND METHODS: Aggregated OHIP-TMD data were obtained from a cross-sectional study involving 844 TMD patients with diagnostic criteria for TMDs defined conditions. The dimensionality of the OHIP-TMD was first evaluated with exploratory factor analysis. An eigenvalue >1.0 and oblique oblimin rotation were applied for extracting the factors. Rasch analysis was subsequently performed on the primary dimension using the ConQuest software. RESULTS: Multi-dimensionality of the OHIP-TMD was observed with the primary dimension comprising ten items. Adequate fit to the Rasch model was noted after deleting item 8 with infit/outfit mean-square values ranging from 0.75 to 1.40 logits. Item difficulty ranged from -0.75 to 1.05 logits, while participants' ability to respond varied from -4.55 to 5.19 logits. The respondent spread was slightly skewed and satisfactory item-response targeting was present. CONCLUSIONS: The 22-item OHIP-TMD demonstrated multi-dimensionality with the primary dimension consisting of nine reliable items with adequate fit to the Rasch model. The 9-item short-form version of the OHIP-TMD (SOHIP-TMD) is a promising tool for evaluating OHRQoL.

Family behavior theory-based intervention via mobile messaging to improve oral health of adolescents: study protocol for a cluster randomized controlled trial.

BACKGROUND: Due to some unique physical, social and psychological features in the adolescent population, adolescents can be a time of heightened caries activity and periodontal disease. Oral health-related behaviors can be modified to improve oral health status. The family networks and the built environment can promote or inhibit health behaviors. The aim of this study is to implement and evaluate a behavior theory-based, integrated family intervention via mobile messaging to improve oral health of adolescents. METHODS: This is a three-arm parallel-design cluster-randomized controlled trial. This trial will allocate 12 local secondary schools (clusters) in Hong Kong to three test or comparison groups with a ratio 1:1:1. The enrolled Form II to IV students (ages 12 to 15) will be eligible for participation. The intervention to three study groups will be (i) Health Belief Model (HBM)-based mobile messaging to the adolescents and their parents, which will consist of several blocks of HBM-based messages and reinforcement during 24 weeks; (ii) same HBM-based messaging to adolescents only; and (iii) delivering e-version of oral health education pamphlets to adolescents. The primary outcome will be caries increment 2 years post-intervention. Changes in oral health self-efficacy and behaviors, oral hygiene, and gingival status will be the secondary outcomes. DISCUSSION: No school dental care service is available to secondary school students in Hong Kong. This study will be the first to test a theory-driven and family-engaged preventive intervention among adolescents in Hong Kong. Findings will contribute to developing a low-cost, feasible, and efficient oral health preventive program for adolescents. TRIAL REGISTRATION: ClinicalTrials.gov NCT05448664 . Registered on 7 July 2022.

Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants.

Importance: Platelet transfusion is commonly performed in infants to correct severe thrombocytopenia or prevent bleeding. Exploring the associations of platelet transfusion, platelet count (PC), and mean platelet volume (MPV) with intraventricular hemorrhage (IVH) and in-hospital mortality in preterm infants can provide evidence for the establishment of future practices. Objectives: To evaluate the associations of platelet transfusion, PC, and MPV with IVH and in-hospital mortality and to explore whether platelet transfusion-associated IVH and mortality risks vary with PC and MPV levels at the time of transfusion. Design, Setting, and Participants: This retrospective cohort study included preterm infants who were transferred to the neonatal intensive care unit on their day of birth and received ventilation during their hospital stay. The study was conducted at a neonatal intensive care unit referral center in Beijing, China, between May 2016 and October 2017. Data were retrieved and analyzed from December 2020 to January 2022. Exposures: Platelet transfusion, PC, and MPV. Main Outcomes and Measures: Any grade IVH, severe IVH (grade 3 or 4), and in-hospital mortality. Results: Among the 1221 preterm infants (731 [59.9%] male; median [IQR] gestational age, 31.0 [29.0-33.0] weeks), 94 (7.7%) received 166 platelet transfusions. After adjustment for potential confounders, platelet transfusion was significantly associated with mortality (hazard ratio [HR], 1.48; 95% CI, 1.13-1.93; P = .004). A decreased PC was significantly associated with any grade IVH (HR per 50 × 103/µL, 1.13; 95% CI, 1.05-1.22; P = .001), severe IVH (HR per 50 × 103/µL, 1.16; 95% CI, 1.02-1.32; P = .02), and mortality (HR per 50 × 103/µL, 1.74; 95% CI, 1.48-2.03; P < .001). A higher MPV was associated with a lower risk of mortality (HR, 0.83; 95% CI, 0.69-0.98; P = .03). The platelet transfusion-associated risks for both IVH and mortality increased when transfusion was performed in infants with a higher PC level (eg, PC of 25 × 103/µL: HR, 1.20; 95% CI, 0.89-1.62; PC of 100 × 103/µL: HR, 1.40; 95% CI, 1.08-1.82). The platelet transfusion-associated risks of IVH and mortality varied with MPV level at the time of transfusion. Conclusions and Relevance: In preterm infants, platelet transfusion, PC, and MPV were associated with mortality, and PC was also associated with any grade IVH and severe IVH. The findings suggest that a lower platelet transfusion threshold is preferred; however, the risk of a decreased PC should not be ignored.

CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE TREATMENT WITH OR WITHOUT PRIOR SILVER DIAMINE FLUORIDE APPLICATION.

OBJECTIVE: To investigate the short-term and long-term changes in parental satisfaction and oral health-related quality of life (OHRQoL) of preschool children after receiving atraumatic restorative treatment (ART) with or without prior silver diamine fluoride (SDF) application. METHODS: In a randomized controlled trial, preschool children with cavitated dentine caries lesions in their primary teeth were randomly assigned into two groups to receive either application of SDF solution or placebo (tonic water) on the caries lesions 10 weeks before receiving ART restorations. The information on parental satisfaction and OHRQoL of the children were collected through self-completed questionnaires at baseline, the 6-month and the 24-month follow-up. A five-point scale, from 1 (very dissatisfied) to 5 (very satisfied), was used by parents to indicate their satisfaction with their child's dental conditions. A higher parental satisfaction score indicates that parents were more satisfied with their child's dental condition. In addition, the Chinese version of Early Childhood Oral Health Impact Scale (ECOHIS) was adopted to assess the children's OHRQoL, and a higher ECOHIS score indicates greater negative impacts of oral health on the child's OHRQoL. RESULTS: A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. After placement of ART restorations, at 6-month and 24-month follow-up, parental satisfaction scores with their child's dental health status were significantly higher compared with those at baseline (P <.001) indicating the parents were more satisfied at follow-ups. Regarding OHRQoL, no statistically significant changes were found in the child impact section (CIS), family impact section (FIS) and total ECOHIS scores in both study groups at the 6-month follow-up. In contrast, at the 24-month follow-up, the CIS (P = .025) and total ECOHIS scores (P = .015) of the children in the control group were significantly higher than those at baseline (greater negative impacts), but not the FIS score. CONCLUSION: In this study, after one-off placement of ART restorations irrespective of prior SDF application, short-term and long-term parental satisfaction with their child's dental health status was improved, but not the children's OHRQoL.

Can mHealth promotion for parents help to improve their children's oral health? A systematic review.

OBJECTIVE: This systematic review evaluated the effectiveness of oral health education using mHealth approach to parents for improving their children's oral health. DATA: Twelve studies were included after the screening and five studies in the data synthesis. The sample size varied from 34 to 1055. There was a very low level of evidence showing that mHealth approach could increase parents' knowledge and improve their brushing behaviors for children when compared to a negative control group. There was a low level of evidence showing mHealth approach could be more effective than printed material in increasing the parents' oral health knowledge. SOURCES: This systematic review was registered on PROSPERO (#CRD42021289324) with no funding support. STUDY SELECTION: Studies targeting parents/caregivers of children age 12 or under were included. Interventions should be oral health promotion delivered via mobile devices. Study outcomes were parents' oral health knowledge, attitude and behaviors, and children's oral health status. Eight electronic databases/registration platforms: PubMed, Cochrane Library, Embase, WoS, Global Health, Engineering Village 2, WHO ICTRP and ClinicalTrials.gov were lastly searched on 6th Oct 2021. The risk of bias tools used were RoB 2.0, ROBINS-I and NIH quality assessment tool for pre-post study. Meta-analysis using a fixed-effect model or vote counting based on the direction of effect was performed. CONCLUSION: All included studies had a high risk of bias. Low/very low certainty of evidence existed that the mHealth approach could improve parents' oral health knowledge. However, there lacks evidence to show the effects of mHealth intervention exerted on other outcomes. CLINICAL SIGNIFICANCE: The mHealth intervention could be a good approach to improve the parent's oral health knowledge. However, the theoretical model must be considered when designing the educational content. More research should be conducted to test the effectiveness of mHealth approaches on children's oral health status.

Health belief model for empowering parental toothbrushing and sugar intake control in reducing early childhood caries among young children-study protocol for a cluster randomized controlled trial.

BACKGROUND: It has been recognized that oral health education for parents is critical for preventing early childhood caries (ECC). Few parents practiced caries prevention procedures for their children in daily life, though. A novel intervention scheme using mobile messages will be developed in this study under the framework of the health belief model (HBM). The objective of the present randomized clinical trial (RCT) is to evaluate the effectiveness of the new scheme in promoting oral health of young children by reducing dental caries. METHODS: This RCT will involve 26-36 child care centers or kindergartens with nursery classes (clusters) located in Hong Kong. A total of 518-628 child-parent dyads (child age 18-30 months) will be recruited and randomly allocated at the cluster level into the test or control group with a 1:1 ratio. For parents in the test group, the intervention will consist of a set of HBM-based text messages sent regularly in 48 weeks. A standard text message will be sent to the parents in the control group in the first week. The primary outcome will be dental caries measured by dmft/dmfs of the children after 2 years (around 4 years of age). The secondary outcomes will be toothbtushing and sugar intake. DISCUSSION: HBM-based intervention via a low-cost text messaging vehicle may serve as a viable way to empower parents to establish proper oral health behaviors for their children and safeguard the oral health of children in Hong Kong. TRIAL REGISTRATION: ClinicalTrials.gov NCT04665219 . Registered on 11 December 2020.

RANDOMIZED CONTROLLED TRIALS IN DENTAL JOURNALS ON CHILDREN AND ADOLESCENTS: A BIBLIOMETRIC ANALYSIS.

BACKGROUND: Randomized controlled trials (RCTs) in dentistry provide essential evidence for dentists to practice evidence-based dentistry. This study aimed to analyze the scientific impacts of the RCTs conducted among children and adolescents published in dental journals and summarize the main contents of these studies. METHODS: An electronic literature search was conducted in the database Web of Science (WoS) Core Collection by two independent reviewers in June 2020, without an initial time limit. Articles reporting on RCTs conducted among children and adolescents in dental fields were identified. The most cited articles (the top 100 articles based on total citation counts and citation density) were selected. The bibliometric data were exported from the database WoS for further analysis. The citation counts were cross-checked in Google Scholar. In addition, the main content of the included RCTs was extracted and summarized. RESULTS: A total of 132 papers published in 28 journals reporting on RCTs in dentistry on children and adolescents were included in this study. The mean total citation count (within WoS) of the included RCTs was 60.0, ranging from 17 to 300, and the mean citation density value was 4.6, ranging from 1.3 to 15.0. The majority of the articles were in the thematic field of cariology (n = 79, 59.8%). Other thematic fields, orthodontology (20.5%), endodontology (5.3%), behavior science and quality of life (5.3%), oral and maxillofacial surgery (3.8%), oral hygiene (3.8%) and periodontology (1.5%) were involved as well. Around one-fifth of the articles (n = 23) were produced by the United States, and the included articles were most cited by the publications (n = 1937) from the United States as well. CONCLUSIONS: A wide range of dental topics were covered in the included RCTs conducted among children and adolescents. These top-cited RCTs mainly focus on the thematic field of cariology. The United States is an influential country with a large number of publication outputs and citations.

The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis.

BACKGROUND: Computer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution. METHODS: In a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis. RESULTS: From December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively. CONCLUSION: Our results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8-17 cases.

Dynamic Observation of the Effect of Maternal Caries on the Oral Microbiota of Infants Aged 12-24 Months.

Aim: To provide a dynamic description of the oral microbial composition in mothers with and without dental caries and their children aging 12-24 months. Methodology: A total of 20 pairs of mothers and their children aged 12 months were included and followed up at 18 and 24 months of age. Ten mothers with dental caries(MEG) and their children(CEG) were in the exposure group, and ten caries-free mothers(MCG) and their children(CCG)in control group. Supragingival plaque biofilm samples were collected and DNA was extracted for bacterial 16S rRNA gene sequencing. Results: A total of 18 pairs completed follow-ups. At a 3% divergence level, the number of common operational taxonomic units found between the mothers and children increased as the children aged. Proteobacteria, Bacteroidetes, Firmicutes, Fusobacteria, and Actinobacteria accounted for more than 80% phyla of each group. A microbial community structure analysis showed that the differences between mothers and children were significant in all groups except for the MEG24 and CEG24 groups. Conclusions: Oral microbiota of children was more like their mothers' with increasing age, regardless of whether the mothers had dental caries. Mothers with dental caries may have a greater influence on the oral microbiota of children's than those without dental caries as children age.

The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults.

BACKGROUND: This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults. METHODS: OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test-retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (ß) and 95% confidence intervals (CI) were reported. RESULTS: One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (rs = 0.76, P < 0.01). MCID was determined by participants who reported "a little improved" in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach's alpha of the transition scale was 0.87, and many items had a test-retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (ß = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (ß = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts. CONCLUSIONS: The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study's older adults perceived a lower intensity of OHIDL. CLINICAL RELEVANCE: The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.

Association between dental conditions, sliver diamine fluoride application, parental satisfaction, and oral health-related quality of life of preschool children.

OBJECTIVES: To investigate the associations between dental conditions, sliver diamine fluoride (SDF) application, parental satisfaction, and oral health-related quality of life (OHRQoL) of preschool children. MATERIALS AND METHODS: In a clinical trial conducted in Hong Kong, preschool children who had carious lesions into dentine were randomly assigned to receive an application of SDF solution or placebo on their caries lesions 10 weeks before they received restorations. Additionally, a random sample of caries-free children was also recruited. Parents of the study children rated their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) 10 weeks after SDF or placebo application. Besides, the Chinese version of the Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL. RESULTS: There were 127, 133, and 154 children in the SDF, placebo, and caries-free groups, respectively. The parents whose child had 4 or more decayed teeth reported lower satisfaction scores (mean = 2.0 ± 0.7) with their child's dental health status compared with those of parents whose child had fewer (mean = 2.6 ± 0.9) or no (mean = 3.7 ± 0.7) decayed teeth (p < 0.001). These parents also reported higher C-ECOHIS scores. However, there was no significant difference in parental satisfaction and children's OHRQoL between the SDF and placebo groups (p > 0.05). CONCLUSIONS: In this study population, parental satisfaction and children's OHRQoL were associated with children's dental caries status but not with SDF application. CLINICAL RELEVANCE: This study provides valuable information about the factors, including SDF application, that can influence parental satisfaction and OHRQoL of preschool children.

Three-Dimensionally Printed Patient-Specific Surgical Plates Increase Accuracy of Oncologic Head and Neck Reconstruction Versus Conventional Surgical Plates: A Comparative Study.

BACKGROUND: Surgeons are pursuing accurate head and neck reconstruction to enhance aesthetic and functional outcomes after oncologic resection. This study aimed to investigate whether accuracy of head and neck reconstruction is improved with the use of three-dimensionally (3D)-printed patient-specific surgical plates compared with conventional plates. METHODS: In this comparative study, patients were prospectively recruited into the study group (3DJP16) with 3D-printed patient-specific surgical plates. The patients in control group with conventional surgical plates were from a historic cohort in the same unit. The primary end point of the study was the accuracy of head and neck reconstruction. The secondary end points were accuracy of osteotomy, intraoperative blood loss, total operative time, and length of hospital stay. RESULTS: The study recruited of 33 patients, including 17 in the study group and 16 in the control group. The patients' baseline characteristics were similar between the two groups. The absolute distance deviation of the maxilla or mandible was 1.5 ± 0.5 mm in the study group and 2.1 ± 0.7 mm in the control group [mean difference, - 0.7 mm; 95% confidence interval (CI) - 1.1 to - 0.3; p = 0.003], showing superior accuracy of reconstruction for the patients with 3D-printed patient-specific surgical plates. Improved accuracy of reconstruction also was detected in terms of bilateral mandibular angles and bone grafts. Concerning the secondary end points, the accuracy of the osteotomy was similar in the two groups. No difference was found regarding intraoperative blood loss, total operative time, or length of hospital stay. CONCLUSIONS: This is the first study to prove that compared with conventional plates, 3D-printed patient-specific surgical plates improve the accuracy of oncologic head and neck reconstruction.

Factors affecting success rate of atraumatic restorative treatment (ART) restorations in children: A systematic review and meta-analysis.

OBJECTIVES: Aim of this systematic review was to summarize the factors that affect the success rate of atraumatic restorative treatment (ART) restorations in children. DATA/SOURCES: Two independent reviewers conducted a literature search in the databases PubMed, Medline and Web of Science until October 2019 with no initial time limit. Articles reporting on clinical outcomes of ART restorations placed in children were included. STUDY SELECTION: A total of 67 articles were included in this review reporting on clinical outcomes of ART restorations placed in children in 47 studies. The overall estimated success rate and 95 % confidence interval (CI) of ART restorations were 0.71 (0.65-0.77) and 0.67 (0.56-0.78) at the 12-month and the 24-month follow-up, respectively. Operator was one of the significant factors associated with the success rate of ART restorations. ART restorations placed by dental students/therapists had a significantly lower success rate compared with those placed by dentists. Besides, type of restoration (single-surface vs. multiple-surface restoration) was also associated with the success rate of ART restorations. Other factors including dentition, restorative material, clinical setting, and moisture control method had no significant influence on the success rate of ART restorations in children. CONCLUSION: It is concluded that ART approach can be used to manage cavitated caries lesions in children. Operator and type of restoration are significant factors influencing the success rate of ART restorations. CLINICAL SIGNIFICANCE: This study provides valuable information on the factors that affect success rate of ART restorations in children, which helps clinicians to make informed decisions on provision of ART restorations in children.

Arresting early childhood caries using silver and fluoride products - A randomised trial.

OBJECTIVE: The aim of this randomised non-inferiority clinical trial was to compare the effectiveness of semi-annual (every six months) applications of 25 % silver nitrate (AgNO3) solution followed by 5 % sodium fluoride (NaF) varnish to semi-annual applications of 38 % silver diamine fluoride (SDF) solution in arresting early childhood caries (ECC). METHODS: Three-year-old children with active cavitated carious lesions were recruited and randomly assigned to two intervention groups. Children in Group A received semi-annual applications of 25 % AgNO3 solution followed by 5 % NaF varnish on carious lesions. Children in Group B received semi-annual applications of 38 % SDF solution followed by a placebo varnish. One trained dentist assessed ECC status at baseline and in all follow-up examinations. An independent operator performed the interventions. The dentist, the children, and their caretakers were blinded to the intervention allocation. Data were analysed using a non-inferiority test. Group A's non-inferiority would be accepted if the lower limit of the 95 % confidence interval (CI) for the difference in the mean number of arrested decayed surfaces (ds) was greater than -0.5. RESULTS: At baseline, 1,070 children were recruited, and 535 children were assigned to each group. After 30 months, the mean arrested ds in Groups A (n = 447) and B (n = 433) were 3.7 ± 3.6 and 3.6 ± 3.7, respectively (p = 0.694). The difference in the mean arrested ds between the two groups was 0.088 (95 % CI: -0.351 to 0.526). CONCLUSION: Semi-annual application of 25 % AgNO3 followed by 5 % NaF is at least as effective as the semi-annual application of 38 % SDF in arresting ECC. CLINICAL SIGNIFICANCE: Silver and fluoride products are effective in arresting caries. As a simple, non-invasive, and inexpensive strategy, it can be used in young children, elderly adults, and people with special needs.

Effectiveness of a family-centered behavioral and educational counselling approach to improve periodontal health of pregnant women: a randomized controlled trial.

BACKGROUND: Poor oral hygiene and high hormone levels during pregnancy can lead to a deterioration in periodontal health. This study assessed the effectiveness of a family-centered behavioral and educational counselling program on improving the periodontal health of women during pregnancy and postpartum. METHODS: A randomized controlled trial was conducted among pregnant women (10th-22nd gestational week) and their husbands. Participating families were randomized into test and control groups. Intervention in the test group included explanation of oral health education (OHE) pamphlets, oral hygiene instruction, individualized feedback, and proposed solutions to overcome barriers in self-care. Reinforcements were implemented in the 3rd trimester of pregnancy and six months postpartum. In the control group, only OHE pamphlets were distributed. The assessed outcomes were bleeding on probing (BOP), periodontal pocket (Poc), loss of clinical attachment (LoA), and Visible Plaque Index (VPI). The data collection was carried out at baseline (T0), in the 32nd gestational week (T1), and 12 months postpartum (T2). RESULTS: Altogether 589 pregnant women were recruited, and 369 attended all three visits (test:188; control:181). In the test group, the mean VPI score at T0 was 0.19, which decreased to 0.14 at T1 and 0.15 at T2. In the control group, the mean VPI decreased from 0.19 at T0 to 0.16 at T1, but increased to 0.22 at T2. A main effect of time and intervention and an interaction between time and intervention were detected (all p < 0.05), indicating that the intervention effect differed between T1 and T2. The test group showed a significantly greater decrease over time than the control group did. Similarly, the mean BOP% decreased more significantly over time in the test group (T0:57%, T1:46%, T2:35%) than in the control group (T0:58%, T1:52%, T2:46%). For Poc and LoA, there were improvements in both study groups at 12 months postpartum, compared with during pregnancy (p < 0.001). CONCLUSIONS: Providing family-centered, behavioral, and educational counselling to pregnant women at an early stage of pregnancy and with reinforcements can improve their oral hygiene and reduce gingival inflammation. The effect can be sustained over an extended period and is greater than that of distributing oral health leaflets alone. TRIAL REGISTRATION: Clinicaltrials.gov , #NCT02937194. Registered 18 October 2016. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02937194?cond=Family-centered+oral+health+promotion+for+new+parents+and+their+infants&draw=2&rank=1.

Do predetermined surgical margins compromise oncological safety in computer-assisted head and neck reconstruction?

OBJECTIVES: Computer assisted head and neck reconstruction has gained popularity over the past few years. In computer assisted surgery (CAS), surgical margins are predetermined in virtual surgery and resection guides are designed to be fitted intra-operatively. However, concerns have been raised regarding the oncological safety of predetermined surgical margins. Therefore, the aim of this study was to compare surgical margins, recurrence and survival outcomes in patients underwent CAS and non-CAS in head and neck reconstruction. METHODS: We retrospectively reviewed the patients underwent oral and maxillofacial malignancies surgical excision and free flap reconstruction from October 2014 to December 2019 by the same chief surgeon. Patients were divided into two groups depending on whether CAS and predetermined surgical margins were adopted. The primary outcome was surgical resection margin and the secondary outcomes included recurrence and survival. RESULTS: A total of 66 subjects were recruited with 37 in the CAS group and 29 in the non-CAS group. The follow-up rate was 100%. The average follow-up time was 24.5 months. No significant difference in resection margin was identified between the groups (p = 0.387). Tumor staging, margin status, perineural invasion, lymphovascular invasion and extranodal extension were identified as significant factors influencing survival. Both before and after adjustment for these prognostic factors identified, CAS and non-CAS group showed no significant difference in survival outcome. CONCLUSION: Predetermined surgical margins do not compromise oncological safety in terms of resection margin, disease recurrence and patient survival.

A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach.

OBJECTIVE: To compare the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with atraumatic restorative treatment (ART) approach. METHOD: Cavitated dentine caries lesions in preschool children were randomly allocated to two groups to be applied with either 38% silver diamine fluoride (SDF) solution or tonic water (control) ten weeks before being restored with the ART approach. Status of the restorations were assessed every six months by a blinded independent examiner. Multilevel logistic regression and multilevel survival analyses were conducted to assess the restoration success rates. RESULTS: A total of 194 children (SDF group, 101; control group, 93) were included, with 260 and 249 ART restorations placed in the SDF and the control groups, respectively. At 24-month follow-up, 88 (87 %) and 84 (90 %) children remained in the SDF and the control groups, respectively. There was no significant difference between the ART restoration success rates of the two study groups (p > 0.05). The success rate of ART restorations was associated with the class of restorations. Class I restorations had the highest success rate (∼50 %), followed by Class V (∼35 %), Class II (∼15 %) and Class III (<10 %). Besides, the mean time used to place an ART restoration in a SDF-treated caries lesion was shorter than that in untreated lesion (4.8 vs. 5.1 min, p = 0.006). CONCLUSION: Prior SDF application does not significantly affect the success rate of ART restorations placed in primary teeth. Besides, it is faster to place ART restorations in caries lesions that have been previously treated with SDF. CLINICAL SIGNIFICANCE: Prior application of silver diamine fluoride solution on cavitated dentine caries lesions in primary teeth can shorten the average time required to place an ART restoration while not jeopardizing the success rate of the restorations.