BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation.
POLICY POINTS: Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta-analyses. Instead of promoting evidence-based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools. Suboptimal systematic reviews and meta-analyses can be harmful given the major prestige and influence these types of studies have acquired. The publication of systematic reviews and meta-analyses should be realigned to remove biases and vested interests and to integrate them better with the primary production of evidence. CONTEXT: Currently, most systematic reviews and meta-analyses are done retrospectively with fragmented published information. This article aims to explore the growth of published systematic reviews and meta-analyses and to estimate how often they are redundant, misleading, or serving conflicted interests. METHODS: Data included information from PubMed surveys and from empirical evaluations of meta-analyses. FINDINGS: Publication of systematic reviews and meta-analyses has increased rapidly. In the period January 1, 1986, to December 4, 2015, PubMed tags 266,782 items as "systematic reviews" and 58,611 as "meta-analyses." Annual publications between 1991 and 2014 increased 2,728% for systematic reviews and 2,635% for meta-analyses versus only 153% for all PubMed-indexed items. Currently, probably more systematic reviews of trials than new randomized trials are published annually. Most topics addressed by meta-analyses of randomized trials have overlapping, redundant meta-analyses; same-topic meta-analyses may exceed 20 sometimes. Some fields produce massive numbers of meta-analyses; for example, 185 meta-analyses of antidepressants for depression were published between 2007 and 2014. These meta-analyses are often produced either by industry employees or by authors with industry ties and results are aligned with sponsor interests. China has rapidly become the most prolific producer of English-language, PubMed-indexed meta-analyses. The most massive presence of Chinese meta-analyses is on genetic associations (63% of global production in 2014), where almost all results are misleading since they combine fragmented information from mostly abandoned era of candidate genes. Furthermore, many contracting companies working on evidence synthesis receive industry contracts to produce meta-analyses, many of which probably remain unpublished. Many other meta-analyses have serious flaws. Of the remaining, most have weak or insufficient evidence to inform decision making. Few systematic reviews and meta-analyses are both non-misleading and useful. CONCLUSIONS: The production of systematic reviews and meta-analyses has reached epidemic proportions. Possibly, the large majority of produced systematic reviews and meta-analyses are unnecessary, misleading, and/or conflicted.
BACKGROUND: Previous studies have shown that children's nonnutritive sucking habits may lead to delayed development of their oral anatomy and functioning. However, these findings were inconsistent. We investigated associations between use of bottles, pacifiers, and other sucking behaviors with speech disorders in children attending three preschools in Punta Arenas (Patagonia), Chile. METHODS: Information on infant feeding and sucking behaviors, age starting and stopping breast- and bottle-feeding, pacifier use, and other sucking behaviors, was collected from self-administered questionnaires completed by parents. Evaluation of speech problems was conducted at preschools with subsequent scoring by a licensed speech pathologist using age-normative standards. RESULTS: A total of 128 three- to five-year olds were assessed, 46% girls and 54% boys. Children were breastfed for an average of 25.2 (SD 9.6) months and used a bottle 24.4 (SD 15.2) months. Fifty-three children (41.7%) had or currently used a pacifier for an average of 11.4 (SD 17.3) months; 23 children (18.3%) were reported to have sucked their fingers. Delayed use of a bottle until after 9 months appeared to be protective for subsequent speech disorders. There was less than a one-third lower relative odds of subsequent speech disorders for children with a delayed use of a bottle compared to children without a delayed use of a bottle (OR: 0.32, 95% CI: 0.10-0.98). A three-fold increase in relative odds of speech disorder was found for finger-sucking behavior (OR: 2.99, 95% CI: 1.10-8.00) and for use of a pacifier for 3 or more years (OR: 3.42, 95% CI: 1.08-10.81). CONCLUSION: The results suggest extended use of sucking outside of breastfeeding may have detrimental effects on speech development in young children.
BACKGROUND: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status. METHODS/DESIGN: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child's diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity. DISCUSSION: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it's approach and findings will be extremely informative.
BACKGROUND: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
UNLABELLED: Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment. OBJECTIVES: To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES). METHODS: Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need. RESULTS: Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions. CONCLUSIONS: Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.
BACKGROUND: The purpose of this study was to assess information available in the dental literature on oral health-related cultural beliefs. In the US, as elsewhere, many racial/ethnic minority groups shoulder a disproportionate burden of oral disease. Cultural beliefs, values and practices are often implicated as causes of oral health disparities, yet little is known about the breadth or adequacy of literature about cultural issues that could support these assertions. Hence, this rigorous assessment was conducted of work published in English on cultural beliefs and values in relation to oral health status and dental practice. Four racial/ethnic groups in the US (African-American, Chinese, Filipino and Hispanic/Latino) were chosen as exemplar populations. METHODS: The dental literature published in English for the period 1980-2006 noted in the electronic database PUBMED was searched, using keywords and MeSH headings in different combinations for each racial/ethnic group to identify eligible articles. To be eligible the title and abstract when available had to describe the oral health-related cultural knowledge or orientation of the populations studied. RESULTS: Overall, the majority of the literature on racial/ethnic groups was epidemiologic in nature, mainly demonstrating disparities in oral health rather than the oral beliefs or practices of these groups. A total of 60 relevant articles were found: 16 for African-American, 30 for Chinese, 2 for Filipino and 12 for Hispanic/Latino populations. Data on beliefs and practices from these studies has been abstracted, compiled and assessed. Few research-based studies were located. Articles lacked adequate identification of groups studied, used limited methods and had poor conceptual base. CONCLUSION: The scant information available from the published dental and medical literature provides at best a rudimentary framework of oral health related ideas and beliefs for specific populations.
AIM: To synthesize the literature on the influence of family/parents characteristics on periodontal diseases in children and adolescents. METHODS: An electronic search for relevant literature published between 2007 and 2017 was undertaken in PubMed, Embase, Cinahl and Cochrane databases; the search was updated in April 2018. Two reviewers independently reviewed the abstracts of these; of which, 43 articles were reviewed in full. RESULTS: Of the 746 retrieved titles, 649 remained after removing duplicates. Thirty articles met the inclusion criteria, and 13 were excluded. Also, two were included from the updated search. Data from the reviewed articles indicate that all three indicators of parent's socioeconomic status (income, education and occupation) are significantly associated with periodontal diseases in children. Better periodontal status was observed in children of parents with higher SES than those whose parents were of lower SES. Although the association between parent's smoking practices, level of periodontal diseases and children's periodontal status was explored only in few studies, findings indicate that children exposed to passive smoking and having parents with periodontal diseases are more likely to present with periodontal diseases as well. CONCLUSIONS: Most of the studies considered socioeconomic factors and had not attempted to explore the impact of parental psychosocial variables on periodontal diseases in children. The literature indicates that these variables significantly influence health practices, including oral hygiene practices, which could ultimately affect periodontal health. More studies are required to explore the association of these variables with periodontal outcomes in children.
This study investigated, for the first time, the masticatory capability of preschool children using natural foods, and the impact of an early oral health alteration (early childhood caries: ECC) on the granulometry of ready-to-swallow food boluses. Thirteen children with ECC were compared to 13 preschool children with a healthy oral condition. Oral health criteria and NOT-S scores (Nordic Orofacial dysfunction Test-Screening) were recorded. For each child, number of masticatory cycles (Nc), chewing time (Ti), and frequency (Fq = Nc/Ti) were recorded during mastication of raw carrot (CAR), cheese (CHS) and breakfast cereals (CER) samples. Food boluses were collected by stopping children at their food-dependent individual swallowing threshold (Nc), and the median food bolus particle size value (D50) was calculated. Correlations were sought between oral health and masticatory criteria. In the ECC group, mean Fq values were significantly decreased for all three foods (p ≤ .001) and mean D50 values were significantly increased (p ≤ .001) compared to the control group (i.e., D50 CAR = 4,384 μm ± 929 vs. 2,960 μm ± 627). These alterations were related to the extent of ECC. The NOT-S mean global score was significantly increased in children with ECC (2.62 ± 1.37 vs. 1 ± 0.91 in the control group, p ≤ .01), due to "Mastication and swallowing" domain impairment. This study gives granulometric normative values for three foods in preschool children and shows the impact of ECC on D50 values. The progression of children's masticatory capability after dental treatment, and the impact of such modifications of sensory input on future eating habits should be explored.
OBJECTIVE: This study estimated the prevalence, distribution and associated factors of tooth erosion in Brazilian schoolchildren. STUDY DESIGN: A cross-sectional study was carried out in a representative sample of children aged 8-12-years-old from public and private schools. Six calibrated examiners assessed tooth erosion (O'Sullivan index) and other oral conditions (dental trauma, enamel defects, plaque, dental caries and dental crowding). Socio-demographic and behavioral data were collected using questionnaires. Interviews were conducted in children and in parents. Data were analyzed using Poisson regression model considering the cluster sample (Prevalence Ratio-PR; 95% Confidence Interval-CI). RESULTS: A total of 1,210 children participated and were examined. Tooth erosion was observed in 25.1% of the children. Lesions were mostly observed in enamel and less than a half of the buccal surface was affected. The type of school and age were significant associated with higher prevalence of tooth erosion and dental crowding was associated with less probability of tooth erosion significantly. Acidic food or drinks were not associated with dental erosion. CONCLUSION: The prevalence of tooth erosion in the studied population was high. Erosive lesions were not severe, confined in enamel. Tooth erosion was associated with age, type of school, socioeconomic level and dental crowding.
This study examined the prevalence, characteristic features, and complications associated with the occurrence of unerupted permanent incisors among children and adolescents attending a university dental teaching hospital. A retrospective review was performed of the clinical records of children and adolescents who attended the Prince Philip Dental Hospital, Hong Kong between 2005 and 2014. All patients who had at least one unerupted permanent incisor tooth were included. A total of 266 subjects with 320 unerupted permanent incisors were identified. The prevalence of unerupted permanent incisors among children and adolescents was 2.0%. Permanent maxillary central incisors (70.6%) were the most commonly affected teeth. The most common cause for unerupted incisors were dilacerations (n = 83, 36.7%) for maxillary central incisors; developmental dental anomalies (n = 22; 30.6%) together with unfavorable root development (n = 22; 30.6%) for maxillary laterals incisors; and abnormal tooth/tissue ratio (n = 11, 50.0%) for mandibular incisors. A majority of unerupted incisors presented with complications the most common being ectopic/displacement/rotation of the unerupted incisors (46.6%), loss of space (36.9%) and midline shift (27.5%). In conclusion, the causes were distinct for different manifestations of unerupted permanent incisors. As the majority of unerupted incisors presented with complications, a systematic and organized method of history taking as well as clinical and radiographic examinations is mandatory in the diagnosis of unerupted permanent incisors.
BACKGROUND: Children born with unilateral cleft lip and palate (UCLP) are reported to display several dental anomalies including agenesis, supernumeraries, as well as variations in dental size, shape, and path of eruption. The extensive sample of individuals with UCLP included in the Scandcleft randomized control trials offers the opportunity to study more rare conditions, which is seldom possible with limited samples. OBJECTIVES: The aim was to study dental anomalies at 8 years of age in children born with UCLP included in the Scandcleft randomized control trials. METHODS: Panoramic and intraoral radiographs from 425 individuals (279 males and 146 females) with a mean age of 8.1 years were assessed by four orthodontists regarding dental anomalies. RESULTS: Agenesis was found in 52.5 per cent and supernumerary teeth in 16.9 per cent of the participants. The cleft lateral was missing in 43.8 per cent and was found peg shaped in 44.7 per cent. The distribution of ectopic eruption was 14.6 per cent, mainly affecting maxillary first molars, while transposition was found in 3.4 per cent of the individuals. In addition, infraocclusion of one or several primary molars was registered in 7.2 per cent of the participants. CONCLUSION: We conclude that 8-year-old children born with UCLP display multiple dental anomalies. The Scandcleft sample allowed rarely studied conditions such as infraocclusion of primary molars and transposition to be studied in children born with UCLP. TRIAL REGISTRATION: ISRCTN29932826.
Edentulism is usually associated with the aging patient. However, total or partial tooth loss also affects young individuals, mainly as a result of trauma, decay, anodontia, or congenital and acquired jaw defects involving the alveolar processes. For elderly patients, the use of oral implants has become an accepted treatment modality for edentulism, and most of today's knowledge regarding implants is based on such practice. There has been hesitation to perform implant therapy for growing children; hence, few children to date have been provided with implant-supported construction. Consequently, little is known about the outcome of the osseointegration procedure in young patients, and until now, only a limited number of case presentations have been reported. This article reviews the current literature to discuss the use of dental implants in growing patients and the influence of maxillary and mandibular skeletal and dental growth on the stability of those implants. The literature review was performed through Science Direct, Wileys Blackwell Synergy, PubMed, Google, Embase, Medknow publications, and Springer for references published from 1963 to 2011. It is recommended to wait for the completion of dental and skeletal growth, except for severe cases of ectodermal dysplasia.
BACKGROUND: The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse? METHODS: Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis. RESULTS: Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship. CONCLUSION: Women's perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.
OBJECTIVE: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. METHODS: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. RESULTS: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. CONCLUSION: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.
Background. Early childhood caries (ECC) is a public health problem due to its impact on children's health, development, and wellbeing. The objective of this study was to assess the caries experience in 3-5-year-old children and to evaluate the relationship with their mothers' practices regarding feeding and oral hygiene habits in Kanpur. Method. A cross-sectional survey was undertaken on 2000 (974 boys and 1026 girls) children aged 3-5 years from a random sample of preschools in Kanpur district, India. Dental caries experience was recorded using WHO criteria. A pretested questionnaire with 9 questions was used for collecting information regarding mothers' practices regarding feeding and oral hygiene practices. Chi-square test (χ (2)) and Student's t-test were used for statistical analysis. Results. The prevalence of ECC was 48% with mean dmft of 2.03 ± 2.99. Boys (57%) were affected more than girls (43%) which was found to be statistically significant (P < 0.05). Caries prevalence was high and statistically significant (P < 0.05) among those who were breast fed for longer duration, during nighttime, those falling asleep with bottle, and those fed with additional sugar in milk. Conclusion. Determining the role of feeding practices on early childhood caries can help in the development of appropriate oral health promotion strategies.
Introduction: . Three preschool aged Caucasian males, diagnosed with ectodermal dysplasia, were treated with interim removable dentures in order to replace missing teeth, reclaim vertical dimension, and improve function and aesthetics. The main challenges faced were patient cooperation, dental and skeletal characteristics, and parental expectations. Two years post-treatment, both patients and parents reported excellent adaptation to prosthesis and satisfaction with aesthetics. Conclusion: Rehabilitation of oligodontia may be challenging due to accompanying oral findings, dentofacial growth considerations, and behavioral issues. Establishment of good rapport between patients, parents, and clinician is the key for the success of the treatment even with the use of nonpharmacological behavioral management techniques.
BACKGROUND: There is a dearth of published literature that demonstrates the impact and effectiveness of school-based oral health education (OHE) program in Bangladesh and it is one of the most neglected activities in the field of public health. Keeping this in mind, the objectives of this study were to assess the effectiveness of OHE program in: 1) increasing oral health knowledge, attitude, and practices and 2) decreasing the prevalence of untreated dental caries among 6-8 grade school students in Bangladesh. METHODS: This intervention study was conducted in Araihazar Thana, Narayanganj district, Bangladesh during April 2012 to March 2013. The total participants were 944 students from three local schools. At baseline, students were assessed for oral health knowledge, attitude and practices using a self-administered structured questionnaire and untreated dental caries was assessed using clinical examination. Follow up study was done after 6 months from baseline. McNemar's chi-square analysis was used to evaluate the impact of OHE program on four recurrent themes of oral health between the baseline and follow-up. Multiple logistic regression analyses were used to determine the impact of the intervention group on our outcome variables. RESULTS: Significant improvement was observed regarding school aged adolescents' self-reported higher knowledge, attitude and practices scores (p < 0.001) at follow-up compared with baseline. The prevalence of untreated dental caries of the study population after the OHE program was significantly (p < 0.01) reduced to 42.5 %. Multiple logistic regression analyses showed that the OHE intervention remained a significant predictor in reducing the risk of untreated dental caries (adjusted odds ratio [AOR] =0.51; 95 % confidence interval [CI] = 0.37, 0.81). In the follow-up period participants were 2.21 times (95 % CI = 1.87, 3.45) more likely to have higher level of knowledge regarding oral health compared to baseline. Compared with baseline participants in the follow-up were 1.89 times (95 % CI = 1.44-2.87) more likely to have higher attitude towards oral health. In addition, OHE intervention was found to be significantly associated with higher level of practices toward oral health (AOR = 1.64; 95 % CI = 1.12, 3.38). CONCLUSIONS: This study indicated that OHE intervention was effective in increasing i) knowledge, ii) attitude, and iii) practices towards oral health; it also significantly reduced the prevalence of untreated dental caries among school aged adolescents from grade 6-8 in a deprived rural area of Bangladesh.
In the present study, the internal adaptation of dentin-composite interfaces with various resin composite materials under conditions of thermomechanical loading was analyzed nondestructively using micro-computed tomography (micro-CT), and these results were compared with analyses of microgaps after sectioning. Additionally, the correlation of internal adaptation with polymerization shrinkage strain and stress was evaluated. Four nonflowable resins, Gradia Direct (GD), Filtek P90 (P9), Filtek Z350 (Z3), and Charisma (CH), and two flowable resins, SDR (SD) and Tetric N-Flow (TF) were used. First, the polymerization shrinkage strain and stress were measured. Then, Class I cavities were prepared in 48 premolars. They were divided randomly into six groups, and the cavities were filled with composites using XP bond. To evaluate the internal adaptation, tooth specimens were immersed in a 25% silver nitrate solution, and micro-CT analysis was performed before and after thermomechanical loading. The silver nitrate penetration (%SP) was measured. After buccolingual sectioning and rhodamine penetration of the specimen, the rhodamine penetration (%RP) was measured using a stereo-microscope. One-way analysis of variance was then used to compare the polymerization shrinkage strain, stress, %SP, and %RP among the groups at a 95% confidence level. A paired t-test was used to compare the %SP before and after thermomechanical loading. Pearson correlation analysis was used to compare the correlation between polymerization shrinkage strain/stress and %SP or %RP to a 95% confidence level. Evaluation of the polymerization shrinkage strain demonstrated that P9 < Z3 ≤ GD < CH ≤ SD < TF (p<0.05); similarly, evaluation of the polymerization shrinkage stress showed that P9 ≤ GD ≤ Z3 ≤ CH ≤ SD < TF (p<0.05). The %SP showed that P9 ≤ GD ≤ Z3 < CH ≤ SD < TF (p<0.05) before loading and that P9 ≤ GD ≤ Z3 ≤ CH ≤ SD < TF (p<0.05) after loading. There was a significant difference between the before-loading and after-loading measurements in all groups (p<0.05). Additionally, there was a positive correlation between the %SP and the %RP (r=0.810, p<0.001). Conclusively, the polymerization shrinkage stress and strain were found to be closely related to the internal adaptation of the resin composite restorations. The newly proposed model for the evaluation of internal adaptation using micro-CT and silver nitrate may provide a new measurement for evaluating the internal adaptation of restorations in a nondestructive way.
There is general agreement that excessive stress to the bone-implant interface may result in implant overload and failure. Early failure of the implant due to excessive loading occurs shortly after uncovering the implant. Excess load on a final restoration after successful implant integration can result in physical failure of the implant structure. Many clinicians believe that overload of dental implants is a risk factor for vertical peri-implant bone loss and/or may be detrimental for the suprastructure in implant prostheses. It has been documented that occlusal parafunction, such as, bruxism (tooth grinding and clenching) affects the outcome of implant prostheses, but there is no evidence for a causal relation between the failures and overload of dental implants. In spite of this lack of evidence, often metal restorations are preferred instead of porcelain for patients in whom bruxism is presumed on the basis of tooth wear. The purpose of this paper is to discuss the importance of the occlusal scheme used in implant restorations for implant longevity and to suggest a clinical approach and occlusal materials for implant prostheses in order to prevent complications related to bruxism.