Using smartphone video “selfies” to monitor change in toothbrushing behavior after a brief intervention: A pilot study

Background: Attempts to refine toothbrushing (TB) technique, an ingrained habit in adults, can meet with some challenges. Recently, the role of proactive interference as a barrier to improving the learning of proper brushing has been proposed. This pilot feasibility study was designed to investigate TB behavior and to see how it changes after training. Smartphone video “selfies” (SPVSs) are increasingly being used in the medical field to assess, monitor, and determine the progression of diseases. Materials and Methods: We used SPVS to study TB skills in a small sample of volunteers. Over a period of 14 days, after a one-time group training session, we observed TB behavior of volunteers using self-captured SPVS. Results: Following the brief intervention, we observed an 8% of improvement in TB skills. Discussion: To the best of our knowledge, this is the first report using SPVS to study TB behavior. We demonstrated initial feasibility of using SPVS in the dental setting. We observed modest improvements in toothbrushing accuracy and quality, and we generated important experiences about the use of Selfies for TB monitoring and intervention, and some interesting insights about where in the toothbrushing is more or less effective. Conclusion: Further investigation using a larger sample size is needed to thoroughly assess the effectiveness of this approach to improve TB skills and better understand the role of proactive interference

Pandemic intake questionnaire to improve quality, effectiveness, and efficiency of outpatient neurologic and developmental care at the Kennedy Krieger institute during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic uniquely affects patients with neurologic and developmental disabilities at the Kennedy Krieger Institute. These patients are at increased risk of co-morbidities, increasing their risk of contracting COVID-19. Disruptions in their home and school routines, and restrictions accessing crucial healthcare services has had a significant impact.MethodsA Pandemic Intake questionnaire regarding COVID-19 related medical concerns of guardians of patients was distributed using Qualtrics. Data from May-December 2020 were merged with demographic information of patients from 10 clinics (Center for Autism and Related Disorders (CARD), Neurology, Epigenetics, Neurogenetics, Center for Development and Learning (CDL) Sickle Cell, Spinal Cord, Sturge-Weber syndrome (SWS), Tourette's, and Metabolism). A provider feedback survey was distributed to program directors to assess the effectiveness of this intervention.ResultsAnalysis included responses from 1643 guardians of pediatric patients (mean age 9.5 years, range 0–21.6 years). Guardians of patients in more medically complicated clinics reported perceived increased risk of COVID-19 (p < 0.001) and inability to obtain therapies (p < 0.001) and surgeries (p < 0.001). Guardian responses from CARD had increased reports of worsening behavior (p = 0.01). Providers increased availability of in-person and virtual therapies and visits and made referrals for additional care to address this. In a survey of medical providers, five out of six program directors who received the responses to this survey found this questionnaire helpful in caring for their patients.ConclusionThis quality improvement project successfully implemented a pre-visit questionnaire to quickly assess areas of impact of COVID-19 on patients with neurodevelopmental disorders. During the pandemic, results identified several major areas of impact, including patient populations at increased risk for behavioral changes, sleep and/or disruptions of medical care. Most program directors reported improved patient care as a result

Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART

<div><p>Background</p><p>The contribution of HIV-infection to periodontal disease (PD) is poorly understood.  We proposed that immunological markers would be associated with improved clinical measures of PD.</p> <p>Methods</p><p>We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥1 site with periodontal probing depth (PPD) ≥5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥4.0mm, and bleeding on probing (BOP) at ≥4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD.</p> <p>Results</p><p>Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log₁₀ copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of <i>Porphyromonas gingivalis</i> (p=0.027), and BOP in subjects with higher baseline levels of <i>Porphyromonas gingivalis</i> or <i>Treponema denticola</i> (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD.</p> <p>Conclusion</p><p>Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.</p> </div

Associations of <i>Toll-Like Receptor</i> and <i>β-Defensin</i> Polymorphisms with Measures of Periodontal Disease (PD) in HIV+ North American Adults: An Exploratory Study

<div><p>Polymorphisms in toll-like receptor (<i>TLR</i>) and β-defensin (<i>DEFB</i>) genes have been recognized as potential genetic factors that can influence susceptibility to and severity of periodontal diseases (PD). However, data regarding associations between these polymorphisms and PD are still scarce in North American populations, and are not available in HIV+ North American populations. In this exploratory study, we analyzed samples from HIV+ adults (n = 115), who received primary HIV care at 3 local outpatient HIV clinics and were monitored for PD status. We genotyped a total of 41 single nucleotide polymorphisms (SNPs) in 8 <i>TLR</i> genes and copy number variation (CNV) in <i>DEFB4</i>/<i>103A</i>. We performed regression analyses for levels of 3 periodontopathogens in subgingival dental plaques (<i>Porphyromonas gingivalis</i> [<i>Pg</i>], <i>Treponema denticola</i> [<i>Td</i>], and <i>Tannerella forsythia</i> [<i>Tf</i>]) and 3 clinical measures of PD (periodontal probing depth [PPD], gingival recession [REC], and bleeding on probing [BOP]). In all subjects combined, 2 SNPs in <i>TLR1</i> were significantly associated with <i>Td</i>, and one SNP in <i>TLR2</i> was significantly associated with BOP. One of the 2 SNPs in <i>TLR1</i> was significantly associated with <i>Td</i> in Caucasians. In addition, another SNP in <i>TLR1</i> and a SNP in <i>TLR6</i> were also significantly associated with <i>Td</i> and <i>Pg</i>, respectively, in Caucasians. All 3 periodontopathogen levels were significantly associated with PPD and BOP, but none was associated with REC. Instrumental variable analysis showed that 8 SNPs in 6 <i>TLR</i> genes were significantly associated with the 3 periodontopathogen levels. However, associations between the 3 periodontopathogen levels and PPD or BOP were not driven by associations with these identified SNPs. No association was found between <i>DEFB4</i>/<i>103A</i> CNV and any periodontopathogen level or clinical measure in all samples, Caucasians, or African Americans. Our exploratory study suggests a role of <i>TLR</i> polymorphisms, particularly <i>TLR1</i> and <i>TLR6</i> polymorphisms, in PD in HIV+ North Americans.</p></div

Association Between Periodontopathogen Levels and <i>TLR</i> SNPs^*.

<p>Association Between Periodontopathogen Levels and <i>TLR</i> SNPs^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164075#t002fn001" target="_blank">*</a>}.</p

Diagrammatic Representation of Instrumental Variable Analysis.

<p>Instrumental variable models use associations C and A to estimate the relationship between an exposure/risk factor and an outcome (B). Note that the instrument is not supposed to have a direct effect on the outcome, hence this line (C) is dashed. Abbreviations: <i>Pg</i>, <i>Porphyromonas gingivalis</i>; <i>Td</i>, <i>Treponema denticola</i>; <i>Tf</i>, <i>Tannerella forsythia</i>; PPD, periodontal probing depth; BOP, bleeding on probing.</p