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Objectives: The objectives of this study were to measure the association of general and oral health-related behaviours with living conditions and to explore the interrelationships between general and oral health-related behaviours in Chinese urban adolescents. Methods: A cross-sectional survey of 2662 adolescents was conducted in eight Chinese provincial capitals. The response rate was 92%. The study population was selected through multistage cluster sampling and comprised three age groups: 11, 13 and 15 years. Data on oral and general health, lifestyles as well as living conditions were collected by means of self-administered structured questionnaires. Several additive indices were constructed from answers to the questions on specific behaviour, and participants were categorized according to scores on each component of health-related behaviour for statistical analyses by frequency distributions, regression analyses and factor analyses. Results: Oral health-related behaviours among adolescents were associated with socioeconomic status of parents, school performance and peer relationships. The odds of a dental visit was 0.63 in adolescents of poorly educated parents and the corresponding figure for regular oral hygiene practices was 0.62. Odds of tobacco use was 3 for adolescents with poor performance in school while odds of consuming sugary foods/drinks was 1.3. Adolescents with high levels of preventive oral health practices also demonstrated general health-promoting behaviours. In factor analysis of general and oral health-related behaviours, three factors were isolated: (a) risk behaviours (loadings 0.48-0.66), (b) health-promoting behaviours (loadings 0.60-0.64) and (c) help-seeking behaviours (loadings 0.56-0.67). Conclusion: The findings support a multidimensional model of health behaviour. Several approaches and multiple methods should be applied in oral health education in order to modify behaviours that affect oral health. [ABSTRACT FROM AUTHOR]

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]

Schools provide an important setting for promoting health, as they reach over 1 billion children worldwide and, through them, the school staff, families and the community as a whole. Health promotion messages can be reinforced throughout the most influential stages of children's lives, enabling them to develop lifelong sustainable attitudes and skills. Poor oral health can have a detrimental effect on children's quality of life, their performance at school and their success in later life. This paper examines the global need for promoting oral health through schools. The WHO Global School Health Initiative and the potential for setting up oral health programmes in schools using the health-promoting school framework are discussed. The challenges faced in promoting oral health in schools in both developed and developing countries are highlighted. The importance of using a validated framework and appropriate methodologies for the evaluation of school oral health projects is emphasized. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]

This paper outlines the burden of oral diseases worldwide and describes the influence of major sociobehavioural risk factors in oral health. Despite great improvements in the oral health of populations in several countries, global problems still persist. The burden of oral disease is particularly high for the disadvantaged and poor population groups in both developing and developed countries. Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related oral disease and orodental trauma are major public health problems worldwide and poor oral health has a profound effect on general health and quality of life. The diversity in oral disease patterns and development trends across countries and regions reflects distinct risk profiles and the establishment of preventive oral health care programmes. The important role of sociobehavioural and environmental factors in oral health and disease has been shown in a large number of socioepidemiological surveys. In addition to poor living conditions, the major risk factors relate to unhealthy lifestyles (i.e. poor diet, nutrition and oral hygiene and use of tobacco and alcohol), and limited availability and accessibility of oral health services. Several oral diseases are linked to noncommunicable chronic diseases primarily because of common risk factors. Moreover, general diseases often have oral manifestations (e.g. diabetes or HIV/AIDS). Worldwide strengthening of public health programmes through the implementation of effective measures for the prevention of oral disease and promotion of oral health is urgently needed. The challenges of improving oral health are particularly great in developing countries. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]

Diseases probably have their roots in a complex chain of environmental and behavioural events which are shaped by broader socioeconomic determinants. Most studies of sociobehavioural risk factors in dental caries have been carried out in industrialized countries, but such reports from low- and middle-income countries have been published in recent years. World Health Organization international collaborative studies and other international studies of social factors in dental caries using the same methodology provide empirical evidence of social inequality in oral health across countries and across oral health care systems. The paper highlights the challenges to dental public health practice, particularly the importance of risk assessment in estimating the potential for prevention. In future public health programmes, systematic risk factor assessment may therefore be instrumental in the planning and surveillance of oral health promotion and oral disease intervention programmes. [ABSTRACT FROM AUTHOR]

Oral health is related to diet in many ways, for example, nutritional influences on craniofacial development, oral cancer and oral infectious diseases. Dental diseases impact considerably on self-esteem and quality of life and are expensive to treat. The objective of this paper is to review the evidence for an association between nutrition, diet and dental diseases and to present dietary recommendations for their prevention. Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases. However, the most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion. Dental erosion is increasing and is associated with dietary acids, a major source of which is soft drinks. Despite improved trends in levels of dental caries in developed countries, dental caries remains prevalent and is increasing in some developing countries undergoing nutrition transition. There is convincing evidence, collectively from human intervention studies, epidemiological studies, animal studies and experimental studies, for an association between the amount and frequency of free sugars intake and dental caries. Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries. Fluoride reduces caries risk but has not eliminated dental caries and many countries do not have adequate exposure to fluoride. It is important that countries with a low intake of free sugars do not increase intake, as the available evidence shows that when free sugars consumption is <15-20 kg/yr ( approximately 6-10% energy intake), dental caries is low. For countries with high consumption levels it is recommended that national health authorities and decision-makers formulate country-specific and community-specific goals for reducing the amount of free sugars aiming towards the recommended maximum of no more than 10% of energy intake. In addition, the frequency of consumption of foods containing free sugars should be limited to a maximum of 4 times per day. It is the responsibility of national authorities to ensure implementation of feasible fluoride programmes for their country. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of the present study was to describe the self-assessment of gingival health conditions in pregnant women, their oral hygiene behaviour and dental visiting habits, and to analyse self-care practices of pregnant women in relation to perceived gingival problems. MATERIAL AND METHODS: The study group comprised 1935 pregnant women living in two areas of Denmark consecutively recruited from August 1998 to March 1999. The survey data were based on telephone interviews. Questions in the interview concerned general health, lifestyles, socioeconomic conditions, gingival conditions, oral hygiene and utilisation of dental health services. RESULTS: One-third of the study population perceived signs of gingival inflammation; 5% of the pregnant women assessed their gingiva as poor, while 95% reported good or 'normal' gingival condition. Ninety six per cent brushed their teeth at least twice a day and nine out of 10 were regular users of the dental-care system. Twenty-seven per cent of those women with pregnancy gingivitis responded to the symptoms by, for example, seeing a dentist or intensifying the oral hygiene habits. CONCLUSION: Despite a high level of self-efficacy among the pregnant women as for oral health and oral health care combined with a high level of oral hygiene and dental visiting habits, there seems to be a substantial need for increased awareness of gingival oral health. [ABSTRACT FROM AUTHOR]

Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non-Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result. OBJECTIVES: The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences. MATERIALS AND METHODS: The study was conducted in Copenhagen as a cross-sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires. RESULTS: Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3.5 dmfs (decayed, missed and filled surfaces) and 13.8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self-care practices of children and parents. These socio-behavioural factors may help to explain the differences in dental caries prevalence and severity. CONCLUSIONS: Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies. [ABSTRACT FROM AUTHOR]

Chronic diseases and injuries are the leading health problems in all but a few parts of the world. The rapidly changing disease patterns throughout the world are closely linked to changing lifestyles, which include diets rich in sugars, widespread use of tobacco, and increased consumption of alcohol. In addition to socio-environmental determinants, oral disease is highly related to these lifestyle factors, which are risks to most chronic diseases as well as protective factors such as appropriate exposure to fluoride and good oral hygiene. Oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world, and as for all diseases, the greatest burden of oral diseases is on disadvantaged and socially marginalized populations. The severe impact in terms of pain and suffering, impairment of function and effect on quality of life must also be considered. Traditional treatment of oral diseases is extremely costly in several industrialized countries, and not feasible in most low-income and middle-income countries. The WHO Global Strategy for Prevention and Control of Noncommunicable Diseases, added to the common risk factor approach is a new strategy for managing prevention and control of oral diseases. The WHO Oral Health Programme has also strengthened its work for improved oral health globally through links with other technical programmes within the Department for Noncommunicable Disease Prevention and Health Promotion. The current oral health situation and development trends at global level are described and WHO strategies and approaches for better oral health in the 21st century are outlined. [ABSTRACT FROM AUTHOR]

In Central and Eastern Europe oral health systems are in transition due to the economic and political changes. The aim of the present study was to highlight the long-term trend in dental caries prevalence of Hungarian children. A WHO National Pathfinder Survey of oral health status was conducted in 1996 which included 6-year-olds (n = 900) and 12-year-olds (n = 900). Similar surveys were performed in 1985 (age 6-7, n = 895; age 12, n = 893) and in 1991 (age 5-6, n = 898; age 12, n = 898) and the surveys were based on the same sites and examination criteria. Clinical data were collected by trained dental examiners according to the WHO Basic Methods. In 1996, 73% of 5-6-year-olds and 84.5% of 12-year-olds were affected by dental caries. At age 5-6 the mean dmft was 4.5 and at age 12 the DMFT was 3.8. In both groups, the d/D-components were high (5-6 years: dt/dmft = 89%; 12 years: DT/DMFT = 45%). For children aged 5-6, the mean caries experience increased from 1991 (3.7 dmft) to 1996 (4.5 dmft) (P<0.01) whereas DMFT of 12-year-olds declined from 5.0 in 1985 and 4.3 in 1991 (P<0.01). The differences in caries experience by urbanization level were reduced over time. In 1996, 72% of 12-year-olds had gingival bleeding (CPI scores 1+2), and 23% had moderate/severe malocclusion. In conclusion, in order to meet the need for dental care in schoolchildren in Hungary health authorities are encouraged to revitalize the school dental services. Implementation of community-based health promotion is needed to control oral disease in Hungarian children. [ABSTRACT FROM AUTHOR]

In this study, a total of 57 patients with rupture of the anterior cruciate ligament and persistent functional instability of the knee had their anterior cruciate ligament reconstructed with a Dacron prosthesis between November 1984 and February 1987. The patients, 43 males and 14 females with a mean age 26 years (range, 16 to 42), were followed for 2 to 4 years (mean, 34 months). In total, 30 patients had concomitant knee ligament or meniscal lesions. Postoperatively, the knee was not immobilized, but was actively trained in a cast brace. At followup, 54 of the patients were examined, and 71% had a good or excellent result according to the Lysholm score. The Tegner activity score improved in 33 patients and 15 achieved their preinjury sporting activity level. The instability, as measured by the anterior drawer sign and the Lachman test, declined from 3.3 to 2.1. Ten prostheses had ruptured at a mean of 11 months (range, 3 to 21). One patient had a deep postoperative infection, another developed chronic synovitis, and one incurred reflex dystrophic changes. [ABSTRACT FROM AUTHOR]

Abstract Background The two homologous iron-binding lobes of transferrins are thought to have evolved by gene duplication of an ancestral monolobal form, but any conserved synteny between bilobal and monolobal transferrin loci remains unexplored. The important role played by transferrin in the resistance to invading pathogens makes this polymorphic gene a highly valuable candidate for studying adaptive divergence among local populations. Results The Atlantic cod genome was shown to harbour two tandem duplicated serum transferrin genes (Tf1, Tf2), a melanotransferrin gene (MTf), and a monolobal transferrin gene (Omp). Whereas Tf1 and Tf2 were differentially expressed in liver and brain, the Omp transcript was restricted to the otoliths. Fish, chicken and mammals showed highly conserved syntenic regions in which monolobal and bilobal transferrins reside, but contrasting with tetrapods, the fish transferrin genes are positioned on three different linkage groups. Sequence alignment of cod Tf1 cDNAs from Northeast (NE) and Northwest (NW) Atlantic populations revealed 22 single nucleotide polymorphisms (SNP) causing the replacement of 16 amino acids, including eight surface residues revealed by the modelled 3D-structures, that might influence the binding of pathogens for removal of iron. SNP analysis of a total of 375 individuals from 14 trans-Atlantic populations showed that the Tf1-NE variant was almost fixed in the Baltic cod and predominated in the other NE Atlantic populations, whereas the NW Atlantic populations were more heterozygous and showed high frequencies of the Tf-NW SNP alleles. Conclusions The highly conserved synteny between fish and tetrapod transferrin loci infers that the fusion of tandem duplicated Omp-like genes gave rise to the modern transferrins. The multiple nonsynonymous substitutions in cod Tf1 with putative structural effects, together with highly divergent allele frequencies among different cod populations, strongly suggest evidence for positive selection and local adaptation in trans-Atlantic cod populations.

Abstract Background Sepsis and complications to sepsis are major causes of mortality in critically ill patients. Rapid treatment of sepsis is of crucial importance for survival of patients. The infectious status of the critically ill patient is often difficult to assess because symptoms cannot be expressed and signs may present atypically. The established biological markers of inflammation (leucocytes, C-reactive protein) may often be influenced by other parameters than infection, and may be unacceptably slowly released after progression of an infection. At the same time, lack of a relevant antimicrobial therapy in an early course of infection may be fatal for the patient. Specific and rapid markers of bacterial infection have been sought for use in these patients. Methods Multi-centre randomized controlled interventional trial. Powered for superiority and non-inferiority on all measured end points. Complies with, "Good Clinical Practice" (ICH-GCP Guideline (CPMP/ICH/135/95, Directive 2001/20/EC)). Inclusion: 1) Age ≥ 18 years of age, 2) Admitted to the participating intensive care units, 3) Signed written informed consent. Exclusion: 1) Known hyper-bilirubinaemia. or hypertriglyceridaemia, 2) Likely that safety is compromised by blood sampling, 3) Pregnant or breast feeding. Computerized Randomisation: Two arms (1:1), n = 500 per arm: Arm 1: standard of care. Arm 2: standard of care and Procalcitonin guided diagnostics and treatment of infection. Primary Trial Objective: To address whether daily Procalcitonin measurements and immediate diagnostic and therapeutic response on day-to-day changes in procalcitonin can reduce the mortality of critically ill patients. Discussion For the first time ever, a mortality-endpoint, large scale randomized controlled trial with a biomarker-guided strategy compared to the best standard of care, is conducted in an Intensive care setting. Results will, with a high statistical power answer the question: Can the survival of critically ill patients be improved by actively using biomarker procalcitonin in the treatment of infections? 700 critically ill patients are currently included of 1000 planned (June 2008). Two interim analyses have been passed without any safety or futility issues, and the third interim analysis is soon to take place. Trial registration number at clinicaltrials.gov: Id. nr.: NCT00271752).

Dental caries remain a public health problem for many developing countries and for underprivileged populations in developed countries. This paper outlines the historical development of public health approaches to the use of fluoride and comments on their effectiveness. Early research and development was concerned with waterborne fluorides, both naturally occurring and added, and their effects on the prevalence and incidence of dental caries and dental fluorosis. In the latter half of the 20th century, the focus of research was on fluoride toothpastes and mouth rinses. More recently, systematic reviews summarizing these extensive databases have indicated that water fluoridation and fluoride toothpastes both substantially reduce the prevalence and incidence of dental caries. We present four case studies that illustrate the use of fluoride in modern public health practice, focusing on: recent water fluoridation schemes in California, USA; salt fluoridation in Jamaica; milk fluoridation in Chile; and the development of 'affordable' fluoride toothpastes in Indonesia. Common themes are the concern to reduce demands for compliance with fluoride regimes that rely upon action by individuals and their families, and the issue of cost. We recommend that a community should use no more than one systemic fluoride (i.e. water or salt or milk fluoridation) combined with the use of fluoride toothpastes, and that the prevalence of dental fluorosis should be monitored in order to detect increases in or higher-than-acceptable levels. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]

Infectious salmon anemia (ISA) is an infectious disease primarily affecting farmed Atlantic salmon, Salmo salar , which is caused by the ISA virus (ISAV). ISAV belongs to the Orthomyxoviridae family. The disease is a serious condition resulting in reduced fish welfare and high mortality. In this study, we designed an amplicon-based sequencing protocol for whole genome sequencing of ISAV. The method consists of 80 ISAV-specific primers that cover 92% of the virus genome and was designed to be used on an Illumina MiSeq platform. The sequencing accuracy was investigated by comparing sequences with previously published Sanger sequences. The sequences obtained were nearly identical to those obtained by Sanger sequencing, thus demonstrating that sequences produced by this amplicon sequencing protocol had an acceptable accuracy. The amplicon-based sequencing method was used to obtain the whole genome sequence of 12 different ISAV isolates from a small local epidemic in the northern part of Norway. Analysis of the whole genome sequences revealed that segment reassortment took place between some of the isolates and could identify which segments that had been reassorted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Spilsberg, Leithaug, Christiansen, Dahl, Petersen, Lagesen, Fiskebeck, Moldal and Boye.)

Infectious salmon anaemia virus (ISAV) can cause severe systemic infection in Atlantic salmon (Salmo salar L.), and a timely diagnosis is critical. Conventional real-time reverse transcription PCR (RT-qPCR) assays target unspliced RNA from either ISAV segment 7 or 8 and provide data on viral load. Here, we evaluate a TaqMan one-step RT-qPCR assay that detects explicitly a spliced messenger RNA (mRNA) of ISAV segment 7, thus providing evidence of active viral transcription. Assay performance was comparable with existing unspliced segment 7 and segment 8 assays. PCR efficiency as evaluated from dilutions of a synthetic DNA fragment was 98 % (R 2 = 1.00). The assay also performed well on clinical heart samples with PCR efficiency of 108 % (R 2 = 1.00). Finally, evaluation on kidney samples from experimental infection revealed higher levels of active transcription for high-virulent compared to low-virulent ISAV. At early, peak, and late infection, mean ratios of spliced to unspliced segment 7 RNA were 3.0 % (± 0.7), 1.7 % (± 0.3), and 1.5 % (± 0.1) for the low virulent and 9.4 % (± 2.2), 4.7 % (± 0.8), and 6.2 % (± 0.1) for the high virulent isolate, respectively. By detection and quantification of active ISAV transcription, this assay may provide a more detailed understanding of ISAV infection dynamics., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: The aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine., Methods: A quasi-experimental study (2016-2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05)., Results: In both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children., Conclusions: The project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy., Competing Interests: Conflict of interest None disclosed., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The collective awareness and acknowledgment of mental health challenges affecting all of us across our society is a trend that can inform targeted future interventions. Mental health conditions have only worsened during the past three years, secondary to the COVID-19 (SARS-CoV-2) pandemic. In the workplace, 67 percent of those surveyed reported at least one mental health symptom over the past year, demonstrating an increase from 59 percent in 2019. 1 Recent findings approximate that first responders have a higher incidence (>30 percent) of developing mental health conditions, including depression, suicidal ideation, alcohol/drug abuse, and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.2 A 2021 survey of more than 26,000 members of the public health workforce highlighted that 53 percent of respondents reported mental health symptoms, including PTSD, depression, anxiety, and suicidal ideation.3 A repeat survey in 2022 showed similar troubling trends.4 The hospital-based workforce has found increased mental health concerns as well, with employees leaving these professional settings to get a better hold on their mental health and support their work-life balance.

Data from the WHO show that the oral health situation for children in the Balkan region of Europe is poor. This study aims to identify obstacles that prevent the implementation of an effective oral health program for children in the Balkan area. The study investigates the challenges that people encounter in increasing awareness, attending to dental care, and complying with examinations., Methods: This qualitative study targeted experts in preventive dentistry and oral health promotion in four countries in the Balkan region. Purposive sampling was used to recruit the participants. Data were collected in 2021 using individual in-depth interviews with participants from Albania, Bosnia and Herzegovina, Croatia, and Serbia. The study applied the thematic analysis method., Results: The experts reported four main challenges that hindered the implementation of a prevention program and regular patient attendance: (1) lack of knowledge, (2) the exclusion of oral health from overall health, (3) organization of services, and (4) skepticism of fluoride. The participants identified knowledge gaps among the general population, dental staff, and other health professionals regarding the prevention of oral diseases., Conclusion: The findings of this study may be used to promote and improve oral health among children in the identified areas and to benefit people in the region and elsewhere. This study sheds light on the existing barriers in a region where people lack information., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Karamehmedovic, Petersen, Agdal and Virtanen.)

Purpose: The intention of the study was to evaluate whether Sub-Saharan schoolteachers may play a key role in oral health promotion of primary schoolchildren, particularly in terms of prevention of HIV/AIDS-related oral health problems., Materials and Methods: The study examined the level of knowledge about oral disease and the prevention of HIV/AIDS oral lesions amongst schoolteachers of Tanzania and Burkina Faso, identified their sources of information, and evaluated their ability for HIV/AIDS intervention. A multi-centre cross-sectional study was implemented in the two Sub-Saharan African countries. Participants comprised primary school teachers selected by stratified cluster sampling: 261 teachers from Tanzania and 313 teachers from Burkina Faso. All participants completed a structured questionnaire prepared for self-administration. The questions were designed from a standardised questionnaire developed by the World Health Organization., Results: Most teachers knew about the principal causes of the major oral diseases and the means of disease prevention. Nearly all teachers (95.6%) were aware of HIV/AIDS and they knew (92.3%) a virus was the direct cause of AIDS. Teachers were well informed of the general symptoms of HIV/AIDS, although oral symptoms were mentioned less often. In all, 17.6% of schoolteachers reported that children suffering from HIV/AIDS were found in their classes and 10.3% of teachers were conscious of students receiving anti-retroviral therapy (ART). Knowledge about the disease seemed to reflect mass media as a source, while teacher colleagues and health personnel played a somewhat lesser role in communication. In total, 83.2% emphasised that they should teach children about HIV/AIDS and the mouth. Schoolteachers from Tanzania (70.5%) were more often engaged in classroom-based oral health education than were the Burkinabe teachers (53.9%)., Conclusion: The study confirms that schoolteachers may be a relevant source in the fight against HIV/AIDS among children. However, they would benefit from interaction with health personnel.

Infectious salmon anaemia virus (ISAV) binds circulating Atlantic salmon erythrocytes, but the relevance of this interaction for the course of infection and development of disease remains unclear. We here characterise ISAV-erythrocyte interactions in experimentally infected Atlantic salmon and show that ISAV-binding to erythrocytes is common and precedes the development of disease. Viral RNA and infective particles were enriched in the cellular fraction of blood. While erythrocyte-associated ISAV remained infectious, erythrocytes dose-dependently limited the infection of cultured cells. Surprisingly, immunostaining of blood smears revealed expression of ISAV proteins in a small fraction of erythrocytes in one of the examined trials, confirming that ISAV can be internalised in this cell type and engage the cellular machinery in transcription and translation. However, viral protein expression in erythrocytes was rare and not required for development of disease and mortality. Furthermore, active transcription of ISAV mRNA was higher in tissues than in blood, supporting the assumption that ISAV replication predominantly takes place in endothelial cells. In conclusion, Atlantic salmon erythrocytes bind ISAV and sequester infective virus particles during infection, but do not appear to significantly contribute to ISAV replication. We discuss the implications of our findings for infection dynamics and pathogenesis of infectious salmon anaemia.

Purpose: 1. To assess the oral health status and health behaviour of 5- to 6-year-oldchildren and the influence of socio-behavioural factors on oral health among children, and 2. evaluate dental knowledge and attitudes related to oral health promotion of children among mothers and schoolteachers in Palestine., Materials and Methods: This cross-sectional survey was carried out in 2017, and recruited samples of children (n = 3939, 53.8% boys, 44.8% girls) from 61 primary schools, their mothers and schoolteachers (n = 53). Participants were selected randomly by multistage stratified cluster sampling. Calibrated dentists performed oral examinations of 5- to 6-year-old schoolchildren based on WHO criteria. Mothers and teachers completed WHO self-administrated questionnaires to assess children's oral health behaviour, as well as their knowledge and attitudes towards children's dental care., Results: Caries prevalence of primary teeth was 83.4% and caries experience was high (dmf-s = 11.17). One-fourth of children suffered from pain or discomfort from teeth, and 57.7% of children had seen a dentist within the past 12 months, frequently due to pain or problems. Consumption of sugars was frequent and only 19.7% brushed their teeth every day. Neglect of dental visits, infrequent toothbrushing, being a child from families of urban settings and high socioeconomic status were greatly affected by caries. Mothers and schoolteachers had mostly positive attitudes towards school-based oral health care. However, the availability of dental health education materials was extremely low., Conclusion: The establishment of school-based oral health programmes, including effective use of toothpaste containing fluoride for caries prevention, is greatly needed to improve the oral health of Palestinian children. The introduction of fluoridated school milk is highly recommended. The establishement of school programmes should encompass active involvement of schoolteachers and mothers to promote the development of healthy lifestyles and sustainable oral health behaviours among schoolchildren. Provision of materials for health education by schoolteachers and mothers is urgently needed.

The nonvirulent infectious salmon anaemia virus (ISAV-HPR0) is the putative progenitor for virulent-ISAV, and a potential risk factor for the development of infectious salmon anaemia (ISA). Understanding the transmission dynamics of ISAV-HPR0 is fundamental to proper management and mitigation strategies. Here, we demonstrate that ISAV-HPR0 causes prevalent and transient infections in all three production stages of Atlantic salmon in the Faroe Islands. Phylogenetic analysis of the haemagglutinin-esterase gene from 247 salmon showed a clear geographical structuring into two significantly distinct HPR0-subgroups, which were designated G2 and G4. Whereas G2 and G4 co-circulated in marine farms, Faroese broodfish were predominantly infected by G2, and smolt were predominantly infected by G4. This infection pattern was confirmed by our G2- and G4-specific RT-qPCR assays. Moreover, the HPR0 variants detected in Icelandic and Norwegian broodfish were never detected in the Faroe Islands, despite the extensive import of ova from both countries. Accordingly, the vertical transmission of HPR0 from broodfish to progeny is uncommon. Phylogenetic and statistical analysis suggest that HPR0 persists in the smolt farms as "house-strains", and that new HPR0 variants are occasionally introduced from the marine environment, probably by HPR0-contaminated sea-spray. Thus, high biosecurity-including water and air intake-is required to avoid the introduction of pathogens to the smolt farms.

This study analyzed the trend in self-reported dentate status over 30 years (1987-2017) among Danish adults, the self-reported frequencies of preventive dental visits undertaken annually during the period 1987-2013, and the self-reported use of the 2016 recall scheme for preventive dental check-ups. The impact of social determinants (education, employment, civil status, and ethnic background) on these dental outcome variables in 2017 was explored. Questionnaire data were obtained from the Danish Health and Morbidity Surveys conducted from 1987-2017, and they were analyzed by tri-variate frequency distributions and multivariate analyses. The prevalence of complete tooth loss was 17.7% in 1987 but 3.4% in 2017. The frequency of adults having 20 or more teeth grew markedly from 1987 (65.9%) to 2017 (85.1%). Educational inequality in dentate status persisted over the period. The frequency of preventive dental visits at least annually increased from 1987 to 2013, although visits were less frequent for young people. In 2017, preventive dental check-ups were reported in intervals: less than 12 months (56.4%), 12-18 months (18.9%), 19-24 months (4.8%), and more than 24 months (5.2%). In 2017, dentate status and preventive dental check-ups varied profoundly by social determinants. In conclusion, social policies should be implemented to tackle the persistent inequities in dentate status and public health policies should target Universal Health Coverage., (© 2021 European Journal of Oral Sciences.)

Objectives: The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries., Methods: Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data., Results: Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare., Conclusions: The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion., (© 2020 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Salmon gill poxvirus (SGPV) can cause serious gill disease in Atlantic salmon ( Salmo salar L.) and represents a significant problem to aquaculture industries in Northern Europe. Here, a single-tube multi-locus variable-number tandem-repeat (VNTR) analysis (MLVA) genotyping assay, targeting eight VNTR loci, was developed for studying the epizootiology of SGPV. Through MLVA typing of SGPV positive samples from 180 farmed and wild Atlantic salmon in Northern Europe, the first molecular population study of this virus was undertaken. Comparison of resulting MLVA profiles by cluster analysis revealed considerable micro-diversity, while only a limited degree of specific clustering by country of origin could be observed, and no clustering relating to the severity of disease outbreaks. Phylogenetic analysis, based on genomic data from six SGPV specimens (three Norwegian, one Scottish, one Faroese and one Canadian), complemented and corroborated MLVA by pointing to a marked transatlantic divide in the species, with one main, relatively conserved, SGPV lineage as predominant in Europe. Within certain fjord systems and individual freshwater salmon smolt farms in Norway, however, discrete MLVA clustering patterns that prevailed over time were observed, likely reflecting local predominance of specific SGPV sub-lineages. MLVA typing was also used to refute two suspected instances of vertical SGPV transmission from salmon broodstock to offspring, and to confirm a failed disinfection attempt in one farm. These novel insights into the previously undocumented population structure of SGPV provide important clues, e.g., regarding the mechanisms underlying spread and recurrence of the virus amongst wild and farmed salmon populations, but so far no indications of more or less virulent SGPV sub-lineages have been found. The MLVA scheme represents a highly sensitive genotyping tool particularly well suited for illuminating SGPV infection routes, and adds to the relatively low number of MLVA protocols that have so far been published for viral species. Typing is reasonably inexpensive, with a moderate technological requirement, and may be completed within a single working day. Resulting MLVA profiles can be readily shared and compared across laboratories, facilitating rapid placement of samples in an international ezpizootiological context., (Copyright © 2020 Gulla, Tengs, Mohammad, Gjessing, Garseth, Sveinsson, Moldal, Petersen, Tørud, Dale and Dahle.)

Aim: To compare the efficacy of 10-20-30 training versus moderate-intensity continuous training (MICT) on HbA1c, body composition and maximum oxygen uptake (V˙O 2 max) in male patients with type 2 diabetes (T2D)., Materials and Methods: Fifty-one male participants with T2D were randomly assigned (1:1) to a 10-20-30 (N = 26) and a MICT (N = 25) training group. Interventions consisted of supervised cycling three times weekly for 10 weeks, lasting 29 minutes (10-20-30) and 50 minutes (MICT) in a local non-clinical setting. The primary outcome was change in HbA1c from baseline to 10-week follow-up., Results: Of 51 participants enrolled, 44 (mean age 61.0 ± 6.8 [mean ± SD] years, diagnosed 7.5 ± 5.8 years, baseline HbA1c 7.4% ± 1.3%) were included in the analysis. Training compliance was 84% and 86% in 10-20-30 and MICT, respectively. No adverse events occurred during the intervention. HbA1c decreased (P <0.001) by 0.5 (95% CI -0.72 to -0.21) percentage points with training in 10-20-30, with no change in MICT. The change in 10-20-30 was greater (P <0.05) than in MICT. Visceral fat mass decreased (P <0.05) only with 10-20-30 training, whereas total fat mass decreased (P <0.01) and V˙O 2 max increased (P <0.01) with training in both groups., Conclusions: Ten weeks of 10-20-30 training was superior to MICT in lowering HbA1c, and only 10-20-30 training decreased visceral fat mass in patients with T2D. Furthermore, 10-20-30 training was as effective as MICT in reducing total fat mass and increasing V˙O 2 max, despite a 42% lower training time commitment., (© 2020 John Wiley & Sons Ltd.)

Purpose: Improved oral health of children is noted in most Western countries, but this coincides with a high burden of oral disease in several countries of Central and Eastern Europe. The purpose of the present study was to describe the current level of dental caries in Hungarian children aged 5, 6, and 12 years and to assess the long-term trends in caries over 30 years. In addition, the report aims to highlight the oral health habits of 12-year-old children in Hungary., Materials and Methods: A representative survey was undertaken in 2016-2017 according to the WHO Pathfinder methodology, which was also applied in previous national oral health surveys of 1985, 1991, 1996, 2001, and 2008. Children of 5-6 and 12 years were sampled systematically in all surveys over 30 years. Data were gathered through clinical examinations and a questionnaire used for 12-year-olds., Results: In 2016-2017, 42.6% of 5- to 6-year-olds were caries free, with the proportion lower in rural than urban settings. Approximately four primary teeth were affected by caries among children aged 5-6 years. Most of the disease burden consisted of untreated caries. Caries experience was higher for children living in rural areas. At age 12, about two permanent teeth suffered from caries, and the D-component of the caries index was high. The percentage of caries-free 6-year-olds grew from 9% in 1985 to 42.6% in 2016-2017. In 1985, 12-year-olds had on average 5 teeth affected by caries, and after 30 years, the level of caries declined to 2.3 DMFT in 2016-2017. The responses to the questionnaire showed that 11.9% of 12-year-olds visited the dentist because of oral pain or discomfort and 40.5% were dissatisfied by the appearance of their teeth. About 40% of children consumed soft drinks or sweets/candy, several times a day., Conclusions: Hungary has not yet achieved the WHO goals for children aged 5-6. While Hungary accomplished the WHO goal for oral health of 12-year-olds by the year 2000, it is seems unrealistic for the country to achieve the WHO goal for 12-year-olds by the year 2020. For better oral health of children, strong emphasis should be given to population-directed oral disease prevention, including the reduction of sugar consumption and implementing public health programmes for the effective use of fluoride.

Purpose: The first large-scale epidemiological survey on dental caries in Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008, 2013 and 2017, using the same methodology. The aim of the study was to examine the trend of caries in 12-year-olds in Slovenia during a 30-year time period. The changes over time in caries experience were compared with disease trends observed in other European countries. Study Populations and Methods: The WHO National Oral Health Pathfinder Survey was applied in all seven surveys (1987-2017). The surveys were carried out in all nine geographical regions of Slovenia. For each subject, the caries experience and presence of sealants were recorded., Results: The mean DMFT of 12-year-olds decreased significantly from 5.1 in 1987 to 1.5 in 2017 (p < 0.0001). The percentage of persons with sealed teeth increased from 6% in 1987 to 94% in 2017, and the percentage of caries-free persons increased from 6% to 42%., Conclusion: The implementation of a nation-wide preventive programme was determined to significantly contribute to the effective control of caries and continuously improve the oral health of Slovenian children. In an international perspective, the Slovenian achievements in disease prevention in terms of caries prevalence reduction may be important for other countries of the region.

Oral/dental healthcare delivery in the post-pandemic era will be different, with challenges to overcome and positive opportunities to take. Managing the needs, wants and expectations of all stakeholders must be communicated and actioned effectively, moving forwards. It is the responsibility of all stakeholders to work together to help provide high quality, evidence-based pragmatic oral healthcare delivery for the future. Patient-focused, team-delivered, minimum intervention oral healthcare (MIOC) is applicable to all patients at all stages of their lives and underpins long-term delivery of better oral and systemic health to all. Guidance, peer-support, whole-team training along with agile commissioning and suitable incentivisation will need to support the paradigm shift to prevention-based MIOC clinical practice.

The commercial production of lumpfish Cyclopterus lumpus L. is expanding with the increased demand for their use as cleaner fish, to control sea-lice numbers, at marine Atlantic salmon Salmo salar L. aquaculture sites throughout Northern Europe. A new ranavirus has been isolated from lumpfish at multiple locations in the North Atlantic area. First isolated in 2014 in the Faroe Islands, the virus has subsequently been found in lumpfish from Iceland in 2015 and from Scotland and Ireland in 2016. The Icelandic lumpfish ranavirus has been characterized by immunofluorescent antibody test, optimal growth conditions and transmission electron microscopy. Partial sequences of the major capsid protein gene from 12 isolates showed 99.79-100% nt identity between the lumpfish ranaviruses. Complete genome sequencing from three of the isolates and phylogenetic analysis based on the concatenated 26 iridovirus core genes suggest these lumpfish ranavirus isolates form a distinct clade with ranaviruses from cod Gadus morhua L. and turbot Scophthalmus maximus L. isolated in Denmark in 1979 and 1999, respectively. These data suggest that these viruses should be grouped together as a new ranavirus species, European North Atlantic Ranavirus, which encompasses ranaviruses isolated from marine fishes in European North Atlantic waters.

Gill diseases cause serious losses in farming of Atlantic salmon and the number of agents involved increases. Salmon gill poxvirus (SGPV) and the gill disease in causes where SGPV apparently was the only disease-causing agent were initially characterized. Recently, it was further shown that SGPV can be a common denominator in widely different multifactorial gill diseases. Here, we present the challenge of diagnosing gill disease with SGPV in salmon fry of 0,3-5 grams. Apoptosis of gill lamellar epithelial cells and hemophagocytosis was also observed in fry similar to findings in smolts and grow-out fish. Using our newly developed immunohistochemistry method, we further demonstrate that some of the apoptotic epithelial cells covering the oral cavity were positive for SGPV. Thus, SGPV is not restricted to respiratory epithelium alone and may infect the fish at very early life stages. Furthermore, as the cases examined here are from Norway, Faroe Island and Scotland, we show that SGPV is more widespread than previously reported., (© 2018 John Wiley & Sons Ltd.)

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups., (© 2018 The World Health Organization.)

Background: Asthma in paediatric populations is one of the highest public health concerns. In this study of children and adolescents, we hypothesized that low levels of physical activity (PA) would show associations with asthma that vary by asthma outcome. The objective was to assess whether PA was associated with ever asthma and/or current asthma ., Methods: Analyses were based on 4824 Danish schoolchildren aged 11-15 years old (48.7% boys) participating in the HBSC survey. The study variables were (1) physician-diagnosed asthma ( ever asthma) and (2) physician-diagnosed asthma plus wheezing and/or physician or hospital consultation for wheezing (current asthma) . Associations with PA by gender were analysed with multivariate logistic regression using the "variance covariance (vce) cluster" method., Results: The prevalence of ever asthma was 14.3% (boys) and 12.8% (girls), and that of current asthma was 6.8% (boys) and 7.0% (girls). Boys with current asthma showed important differences in low and high PA. We found inverse associations between low PA and ever asthma , odds ratio [95% confidence interval] male: .55 [.30; .99] and female: .47 [.24; .93], and current asthma, male: .27 [.12; .60] ( P linear trend  = .007) and female: .32 [.11; .94]., Conclusions: The lowest activity levels showed significant inverse associations with asthma, regardless of the definition. For boys, the more stringent ( current asthma ) of the two paediatric asthma definitions revealed a significant trend with PA, and the direction of associations shifted to positive as weekly PA increased., Competing Interests: In Denmark, when questionnaire-based population studies do not involve human biological material, the ethical authority is the local institution. As is customary for the HBSC [48] survey, we obtained ethical approval from each school’s board of parents and students’ council, and we informed the students – orally and in writing – that their participation was voluntary and anonymous. The HBSC protocol complied with the Declaration of Helsinki II.Not applicable because individual data are not presented in the manuscript.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Political conflicts in the Palestinian Territories (PT) have resulted in systematic deterioration of socio-economic conditions and health. The World Health Organization (WHO) has emphasised the negative impacts of social crisis on children' oral health and quality of life., Objectives: To assess the prevalence and trends in dental caries and poor gingival health of schoolchildren in the PT through the scholastic years 1998/1999 to 2012/2013., Methods: This is a retrospective study. Prevalence data on dental caries of primary and permanent dentitions among children 6, 12 and 16 years of age were gathered from annual oral health reports of the School Dental Health Programme (SDHP)-Ministry of Health. Caries was recorded according to WHO methods and criteria. Decayed, missing and filled teeth indices for primary (dmft) and permanent (DMFT) teeth were calculated. Gingival health status was examined according to the Community Periodontal Index (scores 1 and 2). Statistical analysis used SPSS., Results: In 2012/2013, dental caries prevalence rates and the index scores among schoolchildren were as follows, respectively: 56.4% and 2.7 dmft at age 6; 42.0% and 1.4 DMFT at age 12; and 38.7% and 1.7 DMFT at age 16. For all age groups, the d/D-component of the caries indices was high. Trends of dental-caries prevalence, caries experience and gingival bleeding were fairly constant over time from 1998/1999., Conclusion: The SDHP was established in order to prevent and control oral diseases among schoolchildren in the PT. The Programme is fairly passive and the survey indicates an urgent need for reorientation of activities towards population-based prevention and health promotion. The application of the WHO Health Promoting Schools concept is highly recommended., (© 2017 FDI World Dental Federation.)

Objective: The purpose of the present study was to explore intervals between regular dental examination and the time dentists spent for examination and preventive dental care of children in 1996 and 2014., Participants and Methods: In Denmark, Norway and Sweden, random samples of dentists working with children were included, while in Iceland all dentists were mailed questionnaires. Complete information was provided by 1082 of 1834 dentists (64%) in 1996 and 1366 of 2334 dentists (59%) in 2014. Results were assessed using chi-square and analysis of variance with post-hoc tests., Results: Some trends were consistent in all countries, but considerable differences in routines between the countries persisted during the period. The most used and maximum planned recall intervals were on average 14.8 (sd 4.8) and 18.5 (sd 4.6) months in 2014, respectively 3.1 and 3.5 months longer than in 1996 (p⟨0.05). In 2014 dentists used ample time delivering preventive care to children. Dentists reported spending significantly more time providing preventive care for caries risk children than for other children both in 1996 and 2014. Concurrent with extended intervals, dentists reported spending longer performing routine examinations in three of the four countries in 2014 than in 1996., Conclusions: This study of trends in dental care delivered by dentists during recent decades showed moves towards extended recall intervals and preventive care individualized according to caries risk. In addition, extending intervals could necessitate more time for a routine dental examination., (Copyright© 2018 Dennis Barber Ltd.)

The burden of oral disease is high in populations across the world. This is because of high consumption of free sugars. The WHO Guideline on Sugars Intake for Adults and Children recommended limiting free sugars to no more than 5% energy intake to protect oral health throughout the life-course. The objectives of this paper are to consider the implications of the Guideline for dental health practice and to advocate use of the common risk factor approach when providing dietary advice. As part of a broad range of actions needed to reduce free sugars intake, improved education for dental health professionals and supporting patients to eat less free sugars are key actions for the dental profession. All dental health professionals should have the skills and confidence to provide their patients with healthier eating advice, including how to limit free sugars intake. It is therefore important that dental health professionals receive adequate education in diet and nutrition, and there is a need for dental educational regulating bodies to define the content of the dental curriculum with respect to nutrition. All patients, or their parents or carers, should receive dietary advice to reduce free sugars within the context of a healthy diet for the prevention of all NCDs. Dietary advice should: (i) focus on reducing the amount of free sugars consumed; (ii) be tailored according to the patient's body mass status (eg underweight, overweight, normal weight); (iii) encourage the consumption of fresh fruits and vegetables, nuts, seeds, and wholegrain starch-rich foods; (iv) discourage the consumption of foods high in saturated fat and salt; and (v) discourage the consumption of all drinks containing free sugars. The dental health professional has an opportunity to support patients to reduce their intake of free sugars-such advice and support will have positive impacts beyond the mouth., (© 2017 The World Health Organization.)

Purpose: This report intends to review the global burden of oral disease among older people and to examine their oral health needs. The evidence on the inter-relationships between poor oral health conditions of older people, general health and quality of life is highlighted. Finally, WHO strategies to improve oral health of older people are reviewed., Methods: The information relevant to this review was extracted from the WHO Global Oral Health Data Bank, the PubMed database, and the Cochrane Library. Surveys were carried out according to the criteria recommended by the WHO epidemiological manual Oral Health Surveys - Basic Methods. In addition, global data were sought on coverage of oral health care among older people. Finally, WHO policy documents on health care for aged people were gathered through the WHO website., Results: Across the globe, many older people suffer from oral pain or discomfort. Poor oral health during old age is mostly manifest in high caries experience, high prevalence rates of advanced periodontal disease, severe tooth loss, dry mouth, and oral pre-cancer/cancer. In both developing and developed countries, the burden of disease is particularly high among underprivileged and disadvantaged older people. In numerous countries, high proportions of the aged population are not covered by primary oral health care; this is mainly the case in low and middle income countries due to a critical shortage of dentists., Conclusions: In 2015, the WHO published the World Report on Ageing and Health, which outlines a framework for action to foster healthy ageing. The policies are highly relevant to the improvement of oral health. Transformation of oral health systems away from a disease-based curative model and towards disease prevention, as well as the provision of older-person-centred integrated care are required. Moreover, wide-ranging public health action on ageing is urgently needed.