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Oral submucous fibrosis (OSF) is a chronic, progressive and potentially malignant oral mucosal disease. Patients often have a habit of chewing betel nuts. Areca catechu has been listed as a Class 1 carcinogen by the International Agency for Research on Cancer (IARC), and its main active component, arecoline, is classified as a Group 2B carcinogen by the IARC. The World Health Organization (WHO) categorises OSF as an oral potentially malignant disorder (OPMD). The present guideline describes the risk factors, clinical symptoms and clinical signs of OSF. Clinical staging, auxiliary examination methods, basis for diagnosis and differential diagnosis and the need to improve bad lifestyle habits are proposed and addressed, and local treatment drugs, therapies, dosage and course of treatment, possible adverse reactions, and oral treatment drugs, dosage and course of treatment are proposed. The guideline also addresses the indications for surgical treatment, alternative non-drug treatment methods, selection of treatment plans for different clinical stages, criteria for efficacy evaluation, and preventive measures.

Aim: Lesbian, gay, bisexual, transgender, and queer (LGBTQ), female sex workers (FSW), and heterogenders are those unconventional groups of the society who are identified with major unacceptance. Thus, the present study is conducted to assess and compare the oral health status, substance abuse pattern and nicotine dependence using Fagerstrom nicotine dependence scale (FNDP) among the LGBTQ, FSW, and heterogender in a defined location of Gautam Buddha Nagar, district in West U.P., Materials and Methods: The present exploratory research included three study groups, the LGBTQ, FSW, and heterogenders (HG) residing in the same habitat. Purposive snowball sampling was conducted for the accessibility of the unapproachable population in the defined geographical location at Gautam Budha Nagar, district in West Uttar Pradesh. The data collection of a total of 177 participants was done using a pre-validated, pretested proforma consisting of three different parts including WHO oral health assessment form for adults, 2013, questionnaire regarding pattern of substance abuse and FNDS. Data were recorded and statistically analyzed using SPSS., Results: Prevalence of oral health disorders including dental caries, periodontal disease as well as oral mucosal lesions were more commonly found among the LGBTQ participants followed by FSW and the differences were found to be statistically significant. In context of altered habits, 100% of the participants in the present study were reported with smokeless tobacco habits whereas majority of the FSW were reported with a habit of smoking tobacco., Conclusion: In addition to belonging to ethnic and sexual minority, and having minimal or low education status, and low socioeconomic status, the present study groups are reported to have suboptimal access to quality healthcare and are further reported with high level of substance abuse as well as nicotine dependence., Clinical Significance: The present study is an attempt to provide base line data for further research and provide data to the policy makers so as to increase the healthcare access to the present groups. How to cite this article: Sharma S, Shukla S, Kamate SK, et al . An Exploratory Research Comparing Oral Health, Pattern of Substance Abuse and Nicotine Dependence among LGBT, Female Sex Workers and Heterogenders. J Contemp Dent Pract 2023;24(12):991-997.

Background: Human papillomavirus-associated oral epithelial dysplasia (HPV-OED) is a distinct oral epithelial disorder characterized by viral cytopathic changes caused by transcriptionally active high-risk HPV. The aim of the present study was to report 5 additional cases from Latin America., Methods: Clinical data from five patients with HPV-OED were obtained from the archives of three oral pathology services from Brazil and Chile. All cases were submitted to morphological, p16 expression and in situ hybridization (ISH) for HPV analyses., Results: Four patients were male and one patient was female, with a mean age of 55.4 years. Four patients were HIV seropositive and two were smokers. Three cases affected the buccal mucosa and commissure, one of which had an additional plaque in the soft palate, and one case each occurred on the floor of mouth and lower labial mucosa. Most cases presented as well-demarcated white plaques with a verrucous surface. One case presented multiple lesions ranging from normal to white-colored slightly elevated plaques with a cobblestone surface. Peripheral mucosal pigmentation was observed in two cases. All five cases presented with the characteristic microscopic features of HPV-OED, including severe dysplasia with numerous karyorrhectic and apoptotic cells, full-thickness "block positivity" for p16 and high Ki-67 index (> 90%) sharply demarcated from the adjacent non-dysplastic epithelium. Wide-spectrum DNA ISH-HPV was positive in 4 cases. All patients were treated with conservative surgical excision with no signs of recurrence after a mean of 39-month follow-up., Conclusion: This represents the first series of HPV-OED from Latin America; most cases presented as well-demarcated papillary white plaques affecting the buccal mucosa and commissure of HIV-positive middle-aged men, two of them exhibiting peripheral pigmentation caused by reactive melanocytes. The typical microscopic findings of HPV-OED were observed in all cases, which also showed strong p16 positivity in a continuous band through the full thickness of the epithelium and high Ki67., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Oral cancer screening plays a vital role in the prevention and control of oral cancer. This study aimed to determine the prevalence of oral potentially malignant disorders (OPMDs) in the Nepalese community., Methods: A cross-sectional study was conducted in six purposively selected districts in Nepal from May to December 2019. It utilized a camp-based approach, where a standardized questionnaire was administered through face-to-face interviews. Screening of oral cancer was performed by direct visualization and palpation. The study included adults aged 18 years and above, while those already diagnosed with oral cancer were excluded. Logistic regression was used to find out the association between OPMDs and the related variables., Results: A total of 1930 participants with a mean age of 44.3 years (SD=15.1) underwent oral cancer screening. Among them, 32% were current tobacco users, 2% were ex-users, and 11% were alcohol consumers. OPMDs, including suspected cancer, were identified in 139 (7.2%, 95% CI=6.1-8.4) participants. The most common lesion detected was leukoplakia (4.2%), followed by submucous fibrosis (1.5%), erythroplakia (0.9%), and palatal changes due to reverse smoking (0.1%). Additionally, 10 participants were suspected of having oral cancer. Older age group (AOR=7.00; 95% CI=2.76-17.77), male gender (AOR=2.52; 95% CI=1.58-4.02), tobacco chewers (AOR = 14.30; 95% CI=8.82-23.19), and smokers (AOR=4.67; 95% CI=2.88-7.57)) were identified as predictors of OPMDs., Conclusion: This study revealed a high prevalence of OPMDs in Nepal, highlighting the need for oral cancer screening. The findings emphasize the importance of developing strategies to reduce tobacco use and implementing tobacco cessation intervention programs in Nepal to alleviate the burden of oral cancer.

The aetiology of oral mucosal diseases, such as recurrent aphthous ulcer (RAU), oral lichen planus (OLP) and burning mouth syndrome (BMS), involves many factors, and it remains difficult for clinicians to effectively relieve disease symptoms and formulate coping strategies. With the rapid development of psychology, the role of mental and psychological factors in RAU, OLP and BMS has gradually attracted researchers attention, but the specific mechanism has not been completely determined. This narrative review describes the potential neurobiological mechanism of oral mucosal diseases and detailed psychological factors after introducing relevant research into psychological factors and oral mucosal diseases. Future research strategies and innovations needed to understand and treat oral mucosal diseases and psychological factors, as well as how to prevent oral mucosal diseases by regulation of the neuroendocrine system, are also discussed., Competing Interests: Declaration of conflicting interestsThe authors declare that there are no conflicts of interest.

Objectives: Oral cancer is a leading cause of morbidity and mortality. Screening and mobile Health (mHealth)-based approach facilitates early detection remotely in a resource-limited settings. Recent advances in eHealth technology have enabled remote monitoring and triage to detect oral cancer in its early stages. Although studies have been conducted to evaluate the diagnostic efficacy of remote specialists, to our knowledge, no studies have been conducted to evaluate the consistency of remote specialists. The aim of this study was to evaluate interobserver agreement between specialists through telemedicine systems in real-world settings using store-and-forward technology., Materials and Methods: The two remote specialists independently diagnosed clinical images (n=822) from image archives. The onsite specialist diagnosed the same participants using conventional visual examination, which was tabulated. The diagnostic accuracy of two remote specialists was compared with that of the onsite specialist. Images that were confirmed histopathologically were compared with the onsite diagnoses and the two remote specialists., Results: There was moderate agreement (k= 0.682) between two remote specialists and (k= 0.629) between the onsite specialist and two remote specialists in the diagnosis of oral lesions. The sensitivity and specificity of remote specialist 1 were 92.7% and 83.3%, respectively, and those of remote specialist 2 were 95.8% and 60%, respectively, each compared with histopathology., Conclusion: The diagnostic accuracy of the two remote specialists was optimal, suggesting that "store and forward" technology and telehealth can be an effective tool for triage and monitoring of patients., Clinical Relevance: Telemedicine is a good tool for triage and enables faster patient care in real-world settings., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, which may course in a protean clinical manifestation; being skin and mucous membranes frequently affected by the disease. Syphilis may mimic other conditions causing delay in diagnosis and treatment. The clinical characteristics of oral syphilis associated to nutritional deficiencies are unfrequently reported; thus, the purpose of this manuscript is to describe the oral findings observed in a patient with synchronous syphilis and nutritional deficiencies, in order to maintain a high index of suspicion and continued familiarity with oral manifestations, as well as to consider the prozone phenomenon in suspected cases of syphilis. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a systematic review of the literature to evaluate the methodological aspects of population‐based studies on the prevalence of oral mucosal lesions (OMLs). Methods: Two reviewers independently conducted a literature search in three databases (PubMed, Web of Science and Scopus) and extracted data using a standardized form. Data on the following characteristics of the included studies were collected: sample size; age of participants; references used to define the diagnostic criteria, training of the examiners, and data collection; type, grouping and characteristics of the lesions; and lesions excluded and measures of agreement between examiners. Data were analysed descriptively, and data synthesis was performed for each of the studies included in the analysis. A quality analysis of the studies was conducted, and the risk of bias was evaluated. Results: A total of 29 studies were included in the analysis. Most of the published studies on the prevalence of OMLs were performed in Asian countries. The sample sizes ranged from 255 to 39 206. The World Health Organization guidelines were followed by most of the studies, in terms of design, examiner training and data collection. Approximately 25% of the studies did not determine inter‐examiner reliability. Moreover, almost half of the studies included did not report the response rate nor did they present the results with the appropriate confidence intervals. Conclusions: Several important points need to be improved in population‐based studies focusing on the prevalence of OMLs. In particular, these studies should adequately report the response rate and findings, and to a lesser extent, the diagnostic criteria and training of the examiners. We encourage more research in this field and reinforce the importance of standardized studies to facilitate the comparison of different findings. PROSPERO registration number: CRD42018099386. [ABSTRACT FROM AUTHOR]

Oral lesions are rarely seen in neonates, but they are closely related to dentists, pediatricians and dermatologists. Studies have been conducted to classify these oral lesions, but a standard treatment regimen and a generally accepted classification have not been performed. Newborns' mouths are unique in terms of many features, and the lesions that occur due to developmental events in the period of birth usually involve benign mucosal conditions. While Bohn's nodules, Epstein pearls and gingival cysts are the most frequently observed cystic lesions in studies, orabial lesions related to candida and herpes simplex viruses are mostly observed in relation to infection. In addition to these, tumoral cases such as lesions caused by trauma, hemangioma, lymphangioma and congenital epulis; autoimmune illnesses such as pemphigus vulgaris; benign situations such as geographical tongue, ankyloglossia, macroglossia and malign neoplasms such as malignant melanoma and rhabdomyosarcoma are also observed in oral areas. Oral mucosal lesions may be a clue for early diagnosis of systemic diseases, especially in newborns and children. Therefore, it is necessary to avoid inappropriate treatment and investigation and to have information about all the lesions that can be seen in order to reach the correct diagnosis. In the case of a lesion that occurs in the oral region, dentists are the primary centers of concern for parents. In addition, the number of studies on neonatal oral lesions in the literature is very few, and in this review, the lesions that may be encountered in the clinic, the incidence, etiology, clinical findings, differential diagnoses and treatment methods of these lesions were collected. [ABSTRACT FROM AUTHOR]

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Objective: To detail a scoping review on the global and regional relative frequencies of oral mucosal disorders in the children based on both clinical studies and those reported from biopsy records. Materials and Methods: A literature search was completed from 1 January 1990 to 31 December 2018 using PubMed and EMBASE. Results: Twenty clinical studies (sample size: 85,976) and 34 studies from biopsy services (40,522 biopsies) were included. Clinically, the most frequent conditions were aphthous ulcerations (1.82%), trauma‐associated lesions (1.33%) and herpes simplex virus (HSV)‐associated lesions (1.33%). Overall, the most commonly biopsied lesions were mucoceles (17.12%), fibrous lesions (9.06%) and pyogenic granuloma (4.87%). By WHO geographic region, the pooled relative frequencies of the most common oral lesions were similar between regions in both clinical and biopsy studies. Across regions, geographic tongue (migratory glossitis), HSV lesions, fissured tongue and trauma‐associated ulcers were the most commonly reported paediatric oral mucosal lesions in clinical studies, while mucoceles, fibrous lesions and pyogenic granuloma were the most commonly biopsied lesions. Conclusions: The scoping review suggests data from the clinical studies and biopsy records shared similarities in the most commonly observed mucosal lesions in children across regions. In addition, the majority of lesions were benign in nature. [ABSTRACT FROM AUTHOR]

Introduction: Monoclonal antibodies against proprotein‐convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a newly‐introduced therapeutic approach against hypercholesterolemia. Clinical trials have reported few adverse effects of PCSK9 inhibitors and there are no reports of oral adverse effects. We present the case of a patient that showed gingival discomfort on eating and toothbrushing, coupled with the presence of gingival ischemia and petechiae, 3 days after a subcutaneous abdominal injection of 75‐mg alirocumab for hypercholesterolemia, and contemplate on their possible pathogenesis. Case Presentation: Αn 81‐year‐old male presented with gingival discomfort during eating and toothbrushing, 3 days after receiving a subcutaneous abdominal injection of alirocumab. Intraoral examination revealed that the anterior free and attached gingiva of both jaws appeared pale and the surrounding mucosa showed confluent petechiae that were more evident on the anterior palatal gingiva. The patient was asked to brush his teeth with a soft toothbrush and use a mouthwash containing hydrogen peroxide three times daily. At the 8‐day re‐examination he was symptom‐free, and the mucosa appeared totally normal. At the 5‐month follow‐up visit he reported having the same symptoms after each one of the 12 doses of alirocumab he received. Conclusions: Adverse dugs effects associated with subcutaneous injection of alirocumab may manifest in the gingiva. Therefore, oral and periodontal examination should be included in the regular follow‐up of patients medicated with this drug. [ABSTRACT FROM AUTHOR]

Elderly people, especially those institutionalized in long-term care facilities, are at risk of various oral diseases. The aim of the study was to determine the incidence of hyposalivation and colonization/oral fungal infection of oral cavity with yeasts, as well as dental status in institutionalized and non-institutionalized elderly. The study included 280 institutionalized and 61 non-institutionalized elderly people. Salivary flow rate, oral colonization with yeasts/oral infection and dental status were assessed and compared between the groups. The institutionalized elderly had a significantly lower salivary flow rate (p=0.035). Oral colonization with yeasts was more frequently found in institutionalized elderly (p

Permanent immunosuppression is necessary to prevent rejection after kidney transplantation. However, it may predispose patients to different conditions and diseases including oral lesions. The most common benign oral lesions in kidney transplant recipients are gingival hyperplasia, oral candidiasis, hairy leukoplakia and saburral tongue. Oral form of Kaposi sarcoma, although rarely, can also be seen in kidney transplant patients. In this review, we present the incidence, etiology, clinical findings, diagnosis and treatment options for these lesions. For kidney transplant recipients, it is important to maintain good oral hygiene and care, as well as regular professional control by the dentist. This approach can reduce the number and severity of oral lesions.

Background: In India, people commonly approach pharmacies rather than health professionals for their common ailments including oral health problems. Aim: To assess the type of medication and advice to clients without prescription provided for common oral health problems by pharmacists in Davangere city. Materials and Methods: A cross-sectional survey was conducted in which ten simulated clients visited pharmacy outlets and presented with different oral problems to the pharmacists. The response of the pharmacists was recorded and analyzed. Results: Pharmacists mostly dispensed antibiotics (44.4%), antipyretics (33.4%), mouth wash (60%), and Vitamin B complex (66.6%) for tooth ache, tooth ache with fever, bad breath, and ulcer. Seven pharmacists refused to provide medications without prescription from a dentist. Twenty six (42.6%) pharmacists recommended the subjects to visit a dentist, whereas 35 (57.4%) did not. Conclusion: Pharmacists provided medications to the simulated clients who came without prescription from a dentist. More than half of them did not recommend the clients to visit a dentist.

Background: the analysis of the oral health situation is a community-health service dialogue that offers a comprehensive vision of the health situation, to jointly establish the action plans needed to achieve a positive modification.Objective: to determine the oral health status in patients of Pueblo III family doctor’s office, municipality of Jobabo, Las Tunas, from September 2017 to January 2018.Methods: a descriptive, cross-sectional study was carried out. The universe was made up of the 1250 inhabitants and the sample was randomly selected and included 285 patients, distributed in 120 families. The following variables were studied: sociodemographic items, epidemiological classification, etiological factors and oral diseases. The information obtained during the study was recorded in the family and individual oral health medical histories, and it was processed according to descriptive statistics.Results: the female sex (53,3 %) and the 35 to 59 age group (35,4 %) were mostly represented. The sick people constituted 56,8 % of the sample and the 35 to 59 age group showed the highest number of cases. The following conditions were diagnosed: dental caries, (46 %), chewing dysfunction, (41,1 %), periodontal lesions (35,1 %) and dental malocclusions (15,1 %). No premalignant or malignant lesions were detected in the studied families.Conclusions: the research determined the oral health status of the studied population, identifying the following main problems: deficient oral hygiene, dental caries and chewing dysfunction.

Abstract Introduction The aging population phenomenon is occurring on a global scale; aging affects all of the structures of organisms, including the oral cavity. Objective To estimate the frequency of oral lesions, according to the clinical and histopathologic diagnoses, and to describe the sociodemographic profile of the elderly treated at the referral centers of oral lesions of public universities in Bahia, Brazil. Methods A descriptive epidemiologic study with transverse characteristics was conducted with elderly patients between August 2010 and January 2012. A form was used to collect data. The descriptive analysis consisted of calculating the simple and relative frequencies of sociodemographic variables and oral lesions. Results The population was predominantly black women, and the minority of elderly people were retired. Fibroid (13%) and squamous cell carcinoma (145%) were more prevalent clinical diagnoses, with squamous cell carcinoma (30.7%) and fibrous hyperplasia more prevalent histopathologic diagnoses. Conclusion A prevention policy needs to be implemented to reduce new cases of oral lesions in Bahia, Brazil and to aid in early diagnosis and appropriate treatment of oral lesions.

BACKGROUND: Patients with diabetes mellitus have been associated with a number of changes in the oral cavity, such as gingivitis, periodontitis, mucosal diseases, salivary dysfunction, altered taste, and burning mouth. OBJECTIVES: To determine the prevalence of oral mucosal lesions in patients with diabetes mellitus. METHODS: A cross-sectional observational study between August and October 2012 with a convenience sampling was performed for 51 patients with diabetes mellitus (type 1 and type 2). The study consisted of two phases: 1) a questionnaire application; 2) intraoral clinical examination. For the analysis of data, we used descriptive statistics, Fisher's exact test in bivariate analysis (significance level of 0.05), and Poisson Regression. RESULTS: The prevalence of oral lesions was 78.4%. Traumatic ulcers (16.4%) and actinic cheilitis (12.7%) were the most prevalent lesions. The lips (35.3%) and tongue (23.5%) were the most common location. The bivariate analysis showed an association with the type of diabetes, and two variables (age and comorbidity) were quite close to the significance level. In the Poisson Regression analysis, only diabetes type 2 remained significant after adjusting the model. CONCLUSIONS: The results of this study show a high prevalence of oral mucosal lesions in diabetic patients. The oral mucosal lesions are mostly associated with diabetes type 2.

Oral lichen planus (OLP) and oral lichenoid reaction (OLR) are clinically and histopathologically similar diseases. Whereas OLP is a consequence of T cell mediated autoinflammatory process to a still unknown antigen, OLR might be caused by drugs, dental restorative materials and dental plaque. Pubmed was searched and 24 publications published over the last three years regarding etiology, diagnosis and malignant alteration were included in this study. Patients with OLR who have amalgam fillings near lesions should have them replaced, i.e. when possible they should be referred to patch test, as well as when drug-induced OLR are suspected. OLR lesions induced by drugs should disappear when the offending drug has been discontinued. Histology finding in OLR consists of more eosinophils, plasma cells and granulocytes in comparison to OLP lesions. Furthermore, OLP lesions showed more p53, bcl-2 and COX-2 positivity when compared to OLR. OLP is characterized by infiltration, atrophic epithelium, rete pegs and Max Joseph spaces, while deep infiltration into connective tissue and hyperkeratosis were the criteria for making the diagnosis of OLR. The number of degranulated mastocytes in the reticular layer, as well as the number of capillaries was higher in OLR in comparison to OLP. It seems that OLR are more prone to malignant alteration in comparison to OLP.

Background: Oral erythroplakia (OE) is a rare oral potentially malignant disorder, that has a high rate of malignant transformation. The definition of OE still lacks uniformity. In particular, lesions that look clinically like erythroplakias, but are histopathologically diagnosed as squamous cell carcinomas are still sometimes called erythroplakias. The purpose of this study is to present demographic and clinicopathologic features of a series of OEs and clinically oral erythroplakia -like squamous cell carcinomas (OELSCC), to study their differences and to discuss the definition of OE., Methods: A multicenter retrospective case series of OEs and OELSCCs. Descriptive statistics were used to analyze the data., Results: 11 cases of OEs and 9 cases of OELSCCs were identified. The mean age of the OE patients was 71 years and 72.7% were female, while the mean age of the OELSCC patients was 69 years, and all were female. 9% of the OE and 22% of the OELSCC patients had smoked or were current smokers. 72.7% of the OEs and 55.5% of OELSCCs were uniformly red lesions. 63.6% of the OE and 22% of the OELSCC patients had a previous diagnosis of oral lichenoid disease (OLD). The malignant transformation rate of OE was 9% in a mean of 73 months., Conclusions: OE and OELSCC may arise de novo or in association with OLD. Tobacco and alcohol use were not prevalent in the present cases. The clinical features of OEs and OELSCC are similar, but symptoms, uneven surface and ulceration may be more common in OELSCCs than in OEs. Clinical recognition of OE is important since it may mimic other, more innocuous red lesions of the oral mucosa. The diagnosis of OE requires biopsy and preferably an excision. Clarification of the definition of OE would aid in clinical diagnostics., (© 2023. The Author(s).)

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M. Kaeberlein is Chief Science Officer at Optispan, a company focused on developing solutions for science-based preventative and longevity medicine. Optispan is not currently engaged in any oral health or rapamycin-related projects. C. Perissinotto is a research consultant to Papa Health. As part of this presentation, M. Ryder discussed research and results from several FDA clinical trials that were developed, supervised, and supported by the company formerly known as Cortexyme Inc/Quince Therapeutics (now Lighthouse Phama). M. Ryder was a former member of the Clinical Advisory Board of Cortexyme Inc., where he assisted in the design of these studies and preparation of manuscripts, holds stock, and received consulting fees. L.D. Slashcheva is an employee of Apple Tree Dental but has no financial conflicts of interest in representing the organization.

This study aimed to explore the pathways that can influence cigarette smoking among adolescents. This population-based cohort followed a random sample of 12-year-old adolescents from southern Brazil for 6 years. Regular cigarette smoking was assessed through a self-reported question, previously used in the Brazilian National Survey of Scholar Health. We also gathered data on bullying, dental caries at baseline, incidence of caries, sex, friend network, and Sense of Coherence (SOC). Socioeconomic and demographic characteristics were also collected. Structural equation modeling was used to evaluate the pathways. Of the 1,134 adolescents examined at baseline, 768 were re-evaluated (67.7% retention rate). The prevalence of smoking was 37.6%. This prevalence was directly affected by low SOC (SC: -0.14, p < 0.01), low household income (SC: -0.12, p < 0.01), and male sex (SC: 0.15, p < 0.01). Presence of dental caries at baseline indirectly influenced the occurrence of dental bullying at follow-up via the incidence of dental caries (SC: 0.01, p < 0.05). Dental bullying indirectly influenced cigarettes consumption via SOC (SC: 0.62, p < 0.05). Friend network also indirectly influenced the consumption of cigarettes via SOC (SC: 0.32, p < 0.05). Psychosocial factors influence adolescent cigarette consumption through its higher direct and indirect effects (via bullying). In addition, behavioral, sociodemographic, and clinical factors also influence the occurrence of smoking.