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Poor Health Literacy (HL) amongst the public could underly suboptimal acceptance of health promotion and disease prevention advice. This scoping review aimed to investigate any association between the population´s HL and health status centered on Oral Medicine (OM) Studies reporting patients´ HL levels and health outcomes linked to the OM field were selected using Medline/PubMed, Scopus, and Embase databases. Rayyan and EndNote 20 software were used for article selection, and the results were descriptively analyzed. Of the 697 studies, ten assessed patients´ HL, and knowledge/awareness linked to OM conditions. Oral and oropharyngeal cancers have been the most studied pathologies. Low HL levels and sociodemographic factors were associated with knowledge gaps on oral diseases. Furthermore, subjects with limited HL use prevention and oral health promotion services less frequently than the average citizen. Inadequate HL in public at large has been widely researched in the medical and dental field, with most studies showing adverse health consequences. However, further studies are needed on patients with oral and maxillofacial diseases, especially those treated at OM services. There is a need for improved oral HL amongst the public and for improved communication skills between patients and professionals. [ABSTRACT FROM AUTHOR]

The present study evaluated a national social marketing campaign (SMC) conducted in 2008, with the ultimate aim of improving control of oral cancer in Sri Lanka. The approach was based on our published Risk Factor Model (RFM). Social marketing tools were developed to educate the public on the major risk factors for oral cancer. A cross-sectional community-based cluster survey was carried out in 2013 by interviewing 491 citizens >25 years of age to assess any improvements to the level of disease awareness in the community. Changes in the number of case presentations were obtained from registrations at Government Hospital Dental Clinics (GHDC) from the year 2008–2015. A random sample of 491 members of the public was interviewed in 2013. Most (93%) were aware of oral cancer; but only 45.4% of oral potentially malignant disorders (OPMD). Statistically significant improvements were observed on awareness of oral cancer and OPMD and of the risk factors for oral cancer. A marked increase in the detection of oral leukoplakia and of oral cancer occurred in the GHDC surveillance system in the years 2012 and 2013, at the time the SMC campaign was implemented. The improvement in public awareness of oral cancer and of its major risk factors, and the changed public behavior seen in the increased attendance at healthcare facilities for mouth examination, may be attributed, at least in part, to our SMC. Such Risk Factor-based approaches to social marketing are proposed for control of oral cancer. [ABSTRACT FROM AUTHOR]

Oral diseases, including cancers, affect 3.5 billion people globally and remain largely untreated in low- to middle-income countries because of lack of resources. In Papua New Guinea (PNG), oral cancer has, for many decades, been identified as the most common cancer in men, but as the GLOBOCAN 2018 data are estimates extrapolated from surrounding countries, the real prevalence of this disease is not known. The PNG National Health Plan (2011-2020) highlights the need to improve health care, but oral health is not identified as a priority. Alcohol, tobacco, and areca nut/betel quid, which are the social and commercial determinants of oral cancer, are common risk factors, and there are robust data linking these risk factors to oral cancer in PNG. Our recent Global Challenges Research Fund Workshop on Oral Cancer, held in Port Moresby, PNG, brought together a number of researchers in oral cancer epidemiology and translational science with clinicians from PNG to assess the current situation and plan ways to move forward. In this article, we will review the literature on oral cancer in PNG, and make suggestions as to how, collaboratively, we can address the issues identified, ultimately, for the benefit of the people of PNG. [ABSTRACT FROM AUTHOR]

Objective: Chronic destructive periodontitis, a cause of systemic inflammation, affects some 10% to 15% of adults across the globe, with severity of disease increasing with age. The aim of this study was to explore the relationship between periodontitis and oral hygiene habits and upper aerodigestive tract (UADT) cancers.Study Design: We conducted a case-control study, which included 240 UADT cancer cases and 240 controls matched by gender and age (±5 years) from 2 different hospitals in Pune, India. In-person interviews and intraoral examinations were conducted for all patients.Results: Severe periodontitis and greater than 5 missing teeth were associated with a significant risk of UADT cancers (adjusted odds ratio [OR] 2.25, 95% confidence interval [CI] 1.12-4.91; adjusted OR 3.28, 95% CI 1.95-5.49). Among the self-reported oral hygiene habits, dental checkups only at the time of pain was associated with an elevated risk for UADT cancers (adjusted OR 4.12; 95% CI 2.63-6.47). Topical application of mishri (black powder obtained by roasting and grinding tobacco) on gums (adjusted OR 3.06; 95% CI 1.75-5.35) and toothbrushing frequency less than once daily; (adjusted OR 2.09; 95% CI 1.27-3.45) were also associated with an elevated risk. Furthermore, the habit of ever chewing tobacco was associated with an elevated risk of severe periodontitis.Conclusions: Severe periodontitis is associated with an elevated risk for UADT cancers, and tobacco chewing strengthens this association in this population. [ABSTRACT FROM AUTHOR]

Objectives: The role of immune function in susceptibility to medication-related osteonecrosis of the jaws (MRONJ) remains unclear. This study investigated whether full blood counts, as a measure of systemic health and immune function, predict the development of MRONJ.Study Design: A case-control study was conducted in Brisbane, Australia. A total of 57 cases diagnosed with MRONJ from January 2010 to March 2017 were identified from hospital records and individually matched with up to 4 controls using primary disease, sex, age, and antiresorptive therapy (total sample = 249). Demographic and clinical data were extracted and associations were investigated using conditional logistic regression.Results: A total of 67% of cases and 65% of controls reported at least 1 result outside of the laboratory reference range (odds ratio = 0.7; 95% confidence interval: 0.3, 1.5; P = .29). The most commonly reported abnormal results were low hemoglobin (53% of cases, 48% of controls) and low hematocrit (33% of cases, 25% of controls). There were no significant differences between groups in any of the reported parameters.Conclusions: Patients taking antiresorptive medications often return blood test results outside the standard laboratory reference range. Altered blood counts were not limited to patients who developed MRONJ and do not appear to be clinically useful in identifying patients at high risk for this condition. [ABSTRACT FROM AUTHOR]

Background: Studies have consistently reported that parenting practices have an impact on eating styles which determine obesity levels in children. However, to the best knowledge of the authors, there is no study that evaluates the association of parenting practices on gingivitis in children using path analysis to evaluate if oral health-related behavior mediates this association. This study aims to test a model of parenting and family demographic factors that could account for gingivitis in children, with a focus on the mediational roles of oral health-related behaviors and oral hygiene status.Methods: Clinical examination of oral hygiene status and gingivitis was conducted using simplified oral hygiene and modified Community Periodontal Indices, respectively, on sixth-grade school children (n = 1,539) of Medak District in Telangana State, India. Children also answered a questionnaire consisting of five closed-ended questions on oral health-related behavior. Parents responded to queries related to socioeconomic status (SES), family structure, number of children, oral health-related behavior, and parenting practices.Results: Prevalence of gingival bleeding was 92.4%. Power assertion parenting (representing coercive or controlling parenting practices) had a negative effect on oral hygiene status (β = 0.044; P = 0.07), and also had an indirect effect on gingival bleeding (β = 0.011; P = 0.05). Oral hygiene status was positively associated with the extent of gingival bleeding (β = 0.24; P = 0.01). Children living in families with lower SES had worse oral hygiene (β = -0.101; P = 0.01) and gingival bleeding status (β = -0.024; P = 0.01).Conclusion: Power assertion parenting had a deleterious effect on the extent of gingival bleeding via a worse oral hygiene status of children, but SES was also important for predicting oral hygiene and gingival bleeding. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to measure quality of life (QOL) in patients with upper aerodigestive tract (UADT) cancer in comparison with hospital-based controls. We also assessed the impact of various clinical predictors at time of diagnosis of disease/cancer on QOL in these patients.Study Design: A case-control study was conducted (N = 480) with 240 UADT cancer cases and 240 controls matched by gender and age (≥5 years) from 2 different hospitals in Pune, India. The University of Washington Quality of Life Questionnaire was used to measure QOL and was administered through face-to-face interviews. Various QOL domains were analyzed by using one-way analysis of variance and Bonferroni adjustments for post hoc comparisons.Results: Cases had significantly lower scores across all domains of QOL compared with controls. Overall, the most affected domains were anxiety and mood. Cancer site significantly influenced QOL, with patients with cancers of the oropharynx and hypopharynx having the worst mean scores across all domains. Patients with stage IV cancer had the worst mean scores across the majority of the QOL domains. Our findings highlight the complex interactions between individual and clinical predictors that have an impact on QOL.Conclusions: QOL needs to be incorporated as an important outcome measure in an individualized approach to therapeutic and palliative care planning to enable a better quality of survival of patients with UADT cancers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop and evaluate the validity and reliability of a quality-of-life (QoL) questionnaire for patients with oral potentially malignant disorders (OPMDs).Study Design: For item generation, 15 personal interviews and three focus group discussions were conducted with OPMD patients existing QoL questionnaires were reviewed, and inputs from specialist clinicians (n = 10) were considered. Data collected from patients were analyzed by using NVivo. This led to the identification of themes, item writing, scaling, item reduction, formatting, and pretesting of the newly developed questionnaire. The validity and reliability of the questionnaire were assessed in a separate sample of 300 patients (150 each of patients with OPMD and healthy individuals).Results: Sixty items were generated from the qualitative data and by reviewing existing questionnaires. After item reduction, the final questionnaire comprised 20 questions, which could be categorized under four domains. Exploratory factor analysis revealed a four-factor structure conforming to the four domains. The OPMD QoL questionnaire exhibited good discriminant and convergent validity, with OPMD patients reporting poorer QoL compared with healthy individuals and correlating significantly with existing questionnaires designed for similar purposes respectively.Conclusions: Our OPMD QoL questionnaire was found to be valid and reliable. We recommend that it be applied in epidemiologic and treatment studies of these disorders. [ABSTRACT FROM AUTHOR]

There is a paucity of literature on quality of life (QoL) in patients with oral potentially malignant disorders (OPMDs) despite these conditions being relatively common, chronic, and potentially debilitating. The aim of this paper is to systematically review the literature on QoL in patients with OPMDs. A search from electronic databases PUBMED, MEDLINE, and CINAHL Plus retrieved 180 titles after removing duplicates, and a further 4 papers were identified by hand searching. Study of the abstracts identified 25 truly relevant articles, which were studied in full. Of these, 14 met our strict inclusion criteria. Most studies were cross-sectional; most were from Europe and have evaluated QoL in patients with oral lichen planus (OLP). The findings differ but, overall, do not provide evidence that patients with OPMDs have a poorer QoL compared with healthy patients. Several things may explain this apparently surprising conclusion. First, the quality of most articles was moderate or weak; second, most studies assessed QoL only in patients with OLP and cannot be generalized to all patients with OPMDs; last, direct comparisons between patients with OPMD and healthy controls were rarely included. The validity of the QoL instrument used for patients with OLP was frequently inadequate. [ABSTRACT FROM AUTHOR]

Collaboration between dental technicians and other members of the dental care team is essential to achieve optimal outcomes for patients in prosthetic care. Interprofessional education can be effective in improving attitudes, communication, and practices within such teams. This study compared and contrasted the perceptions of role, responsibilities, communication, and teamworking of dental technology students in a traditional curriculum with those in an interprofessional curriculum, both in Aus-tralia. A social demographic questionnaire and two standard self-report measures were used to collect data from each year group of the two programs. Thirty to thirty-two of the thirty-nine students enrolled in a traditional dental technology program and nine-teen to twenty-two of twenty-five students enrolled in an interprofessional curriculum completed surveys. Statistical analysis of self-report measures identified a significant difference in professional identity, development of roles, and perception of enhanced opportunities for collaboration of dental technologists with the wider oral health professions in those undertaking the interprofes-sional curriculum. This study suggests that interprofessional learning can shift traditional attitudes and, potentially, improve op-portunities for collaboration between dentists and dental technicians. It also supports the idea that adoption of an interprofessional curriculum can significantly enhance communication and teamwork skills essential for readiness in the workplace. [ABSTRACT FROM AUTHOR]

Clinical placements away from the dental school are now an integral and important component of dental education in-ternationally. This article presents feedback from students on their experience in a remote rural clinical placement in Australia by year cohorts 2009, 2010, and 2011. An online feedback survey instrument and compulsory reflective journals were analyzed both by calendar year cohort and amongst individual student groups. The information obtained suggests that overall this was a very positive experience for most students and the clinical experience gained was valued highly. Many students wrote positively about their cultural experiences and the knowledge they gained of life in a remote rural area. Many were pleased with the contribution they made to the oral health treatment needs of the community. Concerns related to the lower patient flow and the inferior quality of equipment compared to that in the main university clinic and with delays in maintaining and repairing equipment. While the overall outcome was positive, significant challenges face all stakeholders to maintain and enhance the clinical and social experi-ences of these future practitioners. The true impact of the placement will only be realized when graduates are confident to venture into clinical practice settings in rural locations. [ABSTRACT FROM AUTHOR]

The assessment of clinical competence in health disciplines is a critical issue. Universities have a responsibility to graduate students who can demonstrate fitness to practice because clinical competence relates directly to the quality of patients' care-the quality of their treatment, their health outcomes, and their experience. In respect of the last of these, this article argues that the nature of what we term "clinical competence" ought to recognize the patient before the medical/dental condition or clinical intervention and, in order to achieve this, dental education should adopt learning, teaching, and assessment strategies that develop integrated learning outcomes consistent with a paradigm of comprehensive care. The article describes the ways in which this paradigm has been operationalized in the learning, teaching, and assessment strategies at Griffith University in Australia. It places a particular focus upon the assessment methods used in the Bachelor of Oral Health program. In this way, the article aims to illustrate ways that the quality of the assessment of clinical competence can, and should, be improved. While this is a work in progress, this description may be useful for educators at other academic dental institutions who wish to adopt, adapt, and develop similar approaches. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the longitudinal relationships between the outcome measurements of changes in lifetime cumulative attachment loss (cLCAL) and changes in probing depth (cPD) in relation to potential risk factors or other risk markers for periodontal disease progression from a cohort of 100 young males. In order to account for the hierarchical data structure, and to explore explicitly the site, tooth, and subject levels simultaneously, multilevel modeling was undertaken. Methods: The analyses were undertaken in two parts. Within a previous article, the absolute levels of disease were analyzed in relation to potential risk factors; within this article, changes in disease are analyzed in relation to these factors. Each analytical approach yielded substantively different insights. Results: Subject-level risk factors had limited predictive value for cLCAL/cPD throughout the 30-month observation period. Tooth position demonstrated a near linear relationship for both outcomes, with disease increasing from anterior to posterior teeth. Supragingival plaque had no significant effect on cLCAL/cPD, while subgingival calculus and bleeding on probing were negatively associated with cLCAL/cPD. In contrast to the outcomes LCAL/PD, supragingival calculus had no significant protective effect on cLCAL/cPD. There was no significant influence of smoking in this cohort. Conclusions: This study provides, for a relatively young cohort, considerable insights into the factors associated with longitudinal patterns of early-life periodontal disease at all levels of the natural hierarchy of sites within teeth within subjects. Furthermore, it is demonstrated how multilevel modeling can provide considerable insight into some of the inconsistencies and controversies found in the previous periodontal literature. [ABSTRACT FROM AUTHOR]

Background: Statistical analyses of periodontal data that average site measurements to subject mean values are unable to explore the site-specific nature of periodontal diseases. Multilevel modeling (MLM) overcomes this, taking hierarchical structure into account. MLM was used to investigate longitudinal relationships between the outcomes of lifetime cumulative attachment loss (LCAL) and probing depth (PD) in relation to potential risk factors for periodontal disease progression. Methods: One hundred males (mean age 17 years) received a comprehensive periodontal examination at baseline and at 12 and 30 months. The resulting data were analyzed in two stages. In stage one (reported here), the absolute levels of disease were analyzed in relation to potential risk factors; in stage two (reported in a second paper), changes in disease patterns over time were analyzed in relation to the same risk factors. Each approach yielded substantially different insights. Results: For absolute levels of disease, subject-level risk factors (covariates) had limited prediction for LCAL/PD throughout the 30-month observation period. Tooth position demonstrated a near linear relationship for both outcomes, with disease increasing from anterior to posterior teeth. Sites with subgingival calculus and bleeding on probing demonstrated more LCAL and PD, and supragingival calculus had an apparently protective effect. Covariates had more "explanatory power" for the variation in PD than for the variation in LCAL, suggesting that LCAL and PD might be generally associated with a different profile of covariates. Conclusion: This study provides, for a relatively young cohort, considerable insights into the factors associated with early-life periodontal disease and its progression at all levels of the natural hierarchy of sites within teeth within subjects. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that the use of index teeth may underestimate the prevalence of chronic periodontitis in adults. However, there is little information on the effect of using index teeth to estimate the prevalence of early periodontitis in younger adults and the effect this may have on planning treatment needs and health care resources. The aim of this study was to compare full mouth examination with partial examination using index teeth in a group of young British males. Methods: One hundred subjects aged between 16 and 20 years (mean 17 years) on entry to the study were examined at baseline, 12 months later, and 30 months later. Lifetime cumulative attachment loss (LCAL] ≥1 mm was measured on the mesio-buccal, disto-buccal, mesio-lingual, and disto-lingual surfaces of all teeth, excluding third molars. All data were entered into a database. The indices used to express LCAL were prevalence, denned as the percentage of subjects with LCAL ≥1 mm, 2 mm. or 3 mm, and extent, defined as the percentage of sites with LCAL ≥1 mm, 2 mm, or 3 mm. Two sets of index teeth were chosen to compare with full mouth recordings, Ramfjord index teeth and the Periodontal Index for Treatment (PIT) teeth. Results: The prevalence of LCAL ≥1 mm was similar (approaching 100%) for the full mouth and both partial mouth recordings. However, as LCAL increased from a minimum of 1 to 3 mm, partial mouth recording resulted in an underestimation of the prevalence of disease. LCAL ≥2 mm was underestimated by up to 22%, and LCAL ≥3 mm by up to 36%. The extent of LCAL was less affected by partial mouth recording, in that the percentage of sites with no sign of early attachment loss was underestimated by up to 11%. However, the percentage of sites with LCAL ≥1 mm and 2 mm were overestimated by 11% and, 7% respectively. Conclusions: These data indicate that the use of index teeth in epidemiological studies which include young adults may result in an underestimation of the prevalence of early periodontitis and an overestimation of the extent. [ABSTRACT FROM AUTHOR]

Background: Site-specific attachment level change, detected from sequential physical probing measurements, is currently the most common method of determining the progression/regression or stability of disease status in subjects with chronic adult periodontitis. The sensitivity and accuracy of detection is dependent on the type of probe used, the recording method, the measurement error, and the method of data analysis. In recent years, there has been world-wide interest in developing instruments and methods to minimize measurement error. Published data report disturbingly wide variation in the prevalences and rates of site-specific attachment level change which are difficult to reconcile with biological likelihood. The present paper aims to summarize the salient points from the key studies and to compare the results. Methods: The literature between 1982 and 1997 was reviewed for studies in which site-specific attachment level change was detected by physical probing methods in patients with chronic adult periodontitis. Results: The review documents 23 studies by probe generation, compares methods and results and summarizes the results according to the thresholds and probe type used. The 23 studies used an array of probe types from the 3 probe generations. Conclusions: From this review, we conclude that: 1) There are surprisingly few papers which have addressed the question of site-specific attachment level change in untreated chronic adult periodontitis. 2) There are considerable differences in the probes used, in the thresholds achieved, in the number of measurements taken, in the number of subjects and sites studied, and in the duration of the studies. Valid comparisons between studies are, therefore, rarely possible. 3) Only 8 out of 23 papers from 1982 to 1997 have adequate data. Most papers report only losing sites and therefore ignore many of the measurements recorded. Only one paper describes losing sites, gaining sites, and sites showing exacerbation/remission patterns of change. 4) The range of changes described show such variation that it has to be concluded that we cannot reliably detect site-specific attachment level change by physical probing and thus, at the end of the 20th century, we have no clear idea of the natural history of this disease. [ABSTRACT FROM AUTHOR]

Background: Longitudinal site-specific attachment level change (SSAC), identified from serial relative attachment level measurements (RAL), is the principal indicator of progression/regression of periodontal diseases. Many variables confound RAL reproducibility and affect measurement error. The Option-4 algorithm was designed to reduce measurement error and improve accuracy and sensitivity of SSAC detection. The study aimed to evaluate the performance of the Option-4 algorithm. Methods: A precalibrated clinician recorded full mouth RAL with a third generation disc probe on 4 occasions over 6 months in 16 subjects (mean age 48.1 years) with moderately advanced chronic adult periodontitis (2,312 sites). Option-4 allowed up to 4 RAL recordings per site per visit until 2 values had differences ≤ 1.0 mm and their mean was ≤ 1.0 mm from the previous visit mean: the clinician made the selection if these criteria were unfulfilled. Results: Within-visit agreement ≤ 1.0 mm was ≥ 99.6%: all within-visit correlation coefficients = 0.98 (P < 0.001). At each visit, mean difference in Option-4 values was < 0.05 mm, mean absolute difference (ignoring direction) was ≤ 0.34 mm. Mean site-specific variances ranged from 0.092 mm² to 0.097 mm² across all visits. Subject thresholds for site-specific attachment level change (from estimated 95% confidence limits of visit 1 data) ranged from 0.52 mm to 0.67 mm. Linear SSAC (by linear regression) and between-visit patterns of SSAC were investigated. SSAC was detected in 100% subjects and at 51.0% measured sites. Linear SSAC (R² ≥ 0.90: P ≤ 0.05) occurred at 105 sites (4.5%): 32 sites (1.4%) deteriorated, 73 sites (3.1%) improved. Between-visit SSAC occurred at 1,074 sites (46.5%): 391 sites (16.9%) deteriorated, 295 sites (12.8%) improved, and 388 sites (16.8%) showed exacerbation/remission patterns. Conclusions: The Option-4 algorithm produced high RAL agreement. Site-specific attachment level change was detected in both directions in 100% subjects and at 51.0% measured sites. [ABSTRACT FROM AUTHOR]