Development of a parents' short form survey of their children's oral health.

BackgroundParents play an important role in their children's oral health behaviors, provide oral health access, initiate prevention, and coping strategies for health care.AimThis paper develops a short form (SF) to assist parents to evaluate their children's oral health status using Patient-Reported Outcome Measurement Information System (PROMIS) framework that conceptualized health as physical, mental, and social components.DesignSurveys of parents were conducted at dental clinics in Los Angeles County, together with an on-site clinical examination by dentists to determine clinical outcomes, Children's Oral Health Status Index (COHSI), and referral recommendations (RRs). Graded response models in item response theory were used to create the SF. A toolkit including SF, demographic information, and algorithms was developed to predict the COHSI and RRs.ResultsThe final SF questionnaire consists of eight items. The square root mean squared error for the prediction of COHSI is 7.6. The sensitivity and specificity of using SF to predict immediate treatment needs (binary RRs) are 85% and 31%.ConclusionsThe parent SF is an additional component of the oral health evaluation toolkit that can be used for oral health screening, surveillance program, policy planning, and research of school-aged children and adolescents from guardian perspectives

Access to Oral Health Care: Professional and Societal Considerations

Abstract: Access to health care is a complex subject with vast personal, economic, political, and societal ramifications. Issues concerning the rights and responsibilities of health care professionals-collectively and as individual members of a profession-comprise an important topic within ongoing debates concerning access to care, and constituted the overarching focus of the deliberations that form the basis of this publication. This article provides definitions of key terms; data concerning demography, oral health status, and use of dental services for children and seniors; and a contextual framework for examining broad underlying professional and societal considerations. It concludes with reflections on joint responsibilities and guiding principles that apply to dental professionals and government agencies charged with administering public benefits programs and the consequences likely to ensue if these vital stakeholders fail to respect fundamental principles of professionalism and economics

Computerized adaptive testing and short form development for child and adolescent oral health patient-reported outcomes measurement.

ObjectivesTo develop computerized adaptive testing (CAT) and short forms of self-report oral health measures that are predictive of both the children's oral health status index (COHSI) and the children's oral health referral recommendation (COHRR) scales, for children and adolescents, ages 8-17.Material and methodsUsing final item calibration parameters (discrimination and difficulty parameters) from the item response theory analysis, we performed post hoc CAT simulation. Items most frequently administered in the simulation were incorporated for possible inclusion in final oral health assessment toolkits, to select the best performing eight items for COHSI and COHRR.ResultsTwo previously identified unidimensional sets of self-report items consisting of 19 items for the COHSI and 22 items for the COHRR were administered through CAT resulting in eight-item short forms for both the COHSI and COHRR. Correlations between the simulated CAT scores and the full item bank representing the latent trait are r = .94 for COHSI and r = .96 for COHRR, respectively, which demonstrated high reliability of the CAT and short form.ConclusionsUsing established rigorous measurement development standards, the CAT and corresponding eight-item short form items for COHSI and COHRR were developed to assess the oral health status of children and adolescents, ages 8-17. These measures demonstrated good psychometric properties and can have clinical utility in oral health screening and evaluation and clinical referral recommendations

How do mothers living in socially deprived communities perceive oral health of young children? : a qualitative study

This qualitative study aims to explore and gain an in-depth understanding of the knowledge and perceptions of mothers living in Greater Western Sydney (GWS), one of Australia’s most socioeconomically disadvantaged regions, regarding the factors that influence oral health of young children. Mother–child dyads (n = 45) were purposively selected from a population-based cohort study in GWS. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and subsequently analyzed using thematic analysis. Five main themes emerged from the interviews: (1) beliefs about child oral health and first set of teeth; (2) awareness and attitudes towards oral health services; (3) identification of caries risk and protective factors; (4) broader cultural and social class influences on childhood oral health practices; and (5) the influence of parental self-confidence, self-efficacy, and perceived control. Overall, mothers reported having limited knowledge and awareness on the importance of baby teeth, child’s first dental visit, and seeking oral health care. Oral health and preventative practices in children were reported to be influenced by past dental experiences, culture and social class, and parental factors. The empirical findings of this study bring our attention to the critical factors that influence child oral health and the opportunities for co-creating child oral health promotion by targeting mothers

Development of toolkits for detecting dental caries and caries experience among children using self-report and parent report.

ObjectivesTo develop child- and parent-reported toolkits for active caries and caries experience in children and adolescents, ages 8-17.MethodsA sample of 398 child/parent dyads recruited from 12 dental practices in Los Angeles County completed a computer-assisted survey that assessed oral health perceptions. In addition, children received a dental examination that identified the presence or absence of active caries and caries experience. A Multiple Adaptive Regression Splines model was used to identify a subset of survey items associated with active caries and caries experience. The splines and coefficients were refined by generalized cross-validation. Sensitivity and specificity for both dependent variables were evaluated.ResultsEleven child self-reported items were identified that had sensitivity of 0.82 and specificity of 0.45 relative to active caries. Twelve parent-reported items had a sensitivity of 0.86 and specificity of 0.50. Seven child self-reported items had a sensitivity of 0.86 and specificity of 0.34, and 11 parent-reported items had a sensitivity of 0.86 and specificity of 0.47 for caries experience.ConclusionsThe survey items identified here are useful in distinguishing children with and without active caries and with and without caries experience. This research presents a path towards using children's and their parents' reports about oral health to screen for clinically determined caries and caries exposure. The items identified in this study can be useful when clinical information is unavailable

Hummingbird flight stability and control in freestream turbulent winds.

Airflow conditions close to the Earth’s surface are often complex, posing challenges to flight stability and control for volant taxa. Relatively little is known about how well flying animals can contend with complex, adverse air flows, or about the flight-control mechanisms employed by animals to mitigate wind disturbances. Several recent studies have examined flight in the unsteady von Kármán vortex streets that form behind cylinders, generating flow disturbances that are predictable in space and time; these structures are relatively rare in nature, as they occur only in the immediate, downstream vicinity of an object. In contrast, freestream turbulence is characterized by rapid, unpredictable flow disturbances across a wide range of spatial and temporal scales, and is nearly ubiquitous in natural habitats. Hummingbirds are ideal organisms for studying the influence of freestream turbulence on flight, as they forage in a variety of aerial conditions and are powerful flyers. We filmed ruby-throated hummingbirds (A. colubris) maintaining position at a feeder in laminar and strongly turbulent (intensity ~15%) airflow environments within a wind tunnel, and compared their mean head, body, tail and wing kinematics, as well as variability in these parameters. Hummingbirds exhibited remarkably stable head position and orientation in both smooth and turbulent flow while maintaining position at the feeder. However, the hummingbird’s body was less stable in turbulent flow and appeared to be most sensitive to disturbances along the mediolateral axis, displaying large lateral accelerations, translations, and rolling motions during flight. The hummingbirds mitigated these disturbances by increasing mean wing stroke amplitude and stroke plane angle, and by varying these parameters asymmetrically between the wings, and from one stroke to the next. They also actively varied the orientation and fan angle of the tail, maintaining a larger mean fan angle when flying in turbulent flow; this may improve their passive stability, but likely incurs an energetic cost due to increased drag. Overall, we observed many of the same kinematic changes noted previously for hummingbirds flying in a von Kármán vortex street, but we also observed kinematic changes associated with high force production, similar to those seen during load-lifting or high-speed flight. These findings suggest that flight may be particularly costly in fully mixed, freestream turbulence, the flow condition that hummingbirds are likely to encounter most frequently in natural habitats.Organismic and Evolutionary Biolog

Social Buffering of Pesticides in Bumblebees: Agent-Based Modeling of the Effects of Colony Size and Neonicotinoid Exposure on Behavior Within Nests

Neonicotinoids are a globally prevalent class of pesticides that can negatively affect bees and the pollination services they provide. While there is evidence suggesting that colony size may play an important role in mitigating neonicotinoid exposure in bees, mechanisms underlying these effects are not well understood. Here, a recently developed agent-based computational model is used to investigate how the effects of sub-lethal neonicotinoid exposure on intranest behavior of bumblebees (Bombus impatiens) are modulated by colony size. Simulations from the model, parameterized using empirical data on bumblebee workers exposed to imidacloprid (a common neonicotinoid pesticide), suggest that colony size has significant effects on neonicotinoid-sensitivity within bumblebee nests. Specifically, differences are reduced between treated and untreated workers in larger colonies for several key aspects of behavior within nests. Our results suggest that changes in both number of workers and nest architecture may contribute to making larger colonies less sensitive to pesticide exposure

Evidence-based clinical practice guideline for the use of pit-and-fissure sealants

AbstractBackgroundThis article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces.Types of Studies ReviewedThis is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions.ResultsThe guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others.Conclusions and Practical ImplicationsThese recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents

Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars

AbstractBackgroundNational Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.Type of Studies ReviewedThe authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsOf 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.Conclusions and Practical ImplicationsAvailable evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials

Patient-Reported oral health outcome measurement for children and adolescents

BACKGROUND: Oral health is an important component of daily functioning and well-being. A comprehensive patient-reported oral health measure is needed to gauge the impact of oral health status on children and adolescents. This study aims to develop oral health item banks and associated short-form surveys for children and adolescents 2–17 year olds. METHODS: Using children and adolescents, ages 2–17 years, selected from diverse dental sites in Greater Los Angeles Area, we propose to develop state-of-the-science methods to create oral health item banks to effectively measure oral health outcomes for children and adolescents. Methods include a literature review of existing measures, focus groups, cognitive interviews, drafting and field testing of survey items, and evaluation of the psychometric properties of the measures. RESULTS: Based on the systematic literature search and focus groups, we identified core (physical health, mental health, and social function domains) and peripheral (e.g., need and access) oral health domains. We then drafted survey items and revised them based on 66 cognitive interviews (27 children/adolescents and 39 parents) with 39 families. The revised items will be administered in a field test of 500 children and adolescents ages 2–17, and their parents. CONCLUSIONS: The qualitative methods used in the initial phases of the project (focus group and cognitive interviews) are the initial steps in the development of oral health item banks and associated short-form surveys for children and adolescents. The oral health items can potentially be used to create effective computerized adaptive test and/or create ad hoc short forms targeting specific areas of oral health to survey large populations of children with much less cost compared with traditional clinical oral health examination