Dental caries prevalence in children with congenital heart disease - a systematic review

Aim Poor oral health is related with bacteraemia that may lead to endocarditis in children with congenital heart disease (CHD). The aim of this study was to conduct a systematic literature review to compare caries prevalence in children ( Material and methods A literature search of studies from two online databases (Pubmed (MEDLINE) and Scopus) published from January 2000 to October 2019 using Medical subject heading terms Congenital Heart Disease, Congenital Heart Defect, and Caries was done, and manual search from the reference lists of selected publications. PICO (Patient/Population, Intervention, Comparison group, and Outcome) criteria was applied. Quality of the publications was assessed with the modified Newcastle-Ottawa scale. Results The search resulted in 151 articles of which nine fulfilled the inclusion criteria. Caries prevalence was significantly higher in children with CHD compared to healthy children in three out of nine studies. Information on predisposing background factors was limited but difference in caries prevalence was not attributed to SES. The quality of the studies varied. Conclusions Although evidence is limited, the current literature indicates that children with CHD experience a higher caries prevalence compared to healthy children.Peer reviewe

Parental perceptions and experiences of an oral health care promotion intervention for children with congenital heart defects

Purpose Congenital heart disease (CHD) is one of the most common congenital anomalies in children. Children with major CHD are at risk for developing endocarditis. Acute endocarditis may be life threatening and lead to heart failure. The purpose of this study was to explore parental perceptions and experiences of an early oral health promotion intervention (OHPI) targeting children with major CHD at risk for developing endocarditis later in life, and use this information to examine intervention feasibility. Methods Nine parents (three fathers and six mothers) participating in a one and a half year OHPI were purposefully selected for qualitative evaluation of intervention feasibility using semi-structured interviews. The interviews were analysed with an inductive content analysis method. Results The analysis resulted in four main categories and 14 subcategories that describe parental perceptions and experiences of the OHPI. The four main categories were timing of first intervention contact, effortlessness of intervention process, individuality of support, and relevancy of support. Conclusion Parents of children with CHD perceived the OHPI as important and feasible to be implemented in daily life in children with systemic diseases overall. Further studies on timing of first contact and use of additional Web-based support are needed.Peer reviewe

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

<p>Abstract</p> <p>Background</p> <p>Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent.</p> <p>Methods</p> <p>Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan.</p> <p>Results</p> <p>We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle.</p> <p>Conclusion</p> <p>This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.</p

Oral health and behavior in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder and has a substantial impact on many situations in the child s daily life. The present thesis investigates the behavior of children with ADHD in a dental setting that is, behavior management problems (BMP), interaction between child and dentist, dental anxiety, and stress and the oral health of these children compared to a control group. The specific aims of this thesis were to test the hypotheses that children with ADHD display more BMP during dental treatment, display more problems in the interaction process with the dentist, exhibit a higher degree of dental anxiety, have a different stress reaction (measured as salivary cortisol) during a dental recall visit and a different diurnal cortisol variation, have a higher prevalence of caries and gingivitis, and have poorer oral health behavior than children in a control group. All children born in 1991 (n=555) in one Swedish municipality were screened for behavior, attention, and learning problems with Conner s 10-item questionnaire and a questionnaire focused on executive and learning problems. Thirty-five children fulfilled the criteria for ADHD and were classified according to whether they had ADHD of the combined, inattentive, or hyperactive-impulsive type. Children with no behavior, attention, and learning problems from the same population constituted a control group. In the first study, dental records of the subjects were obtained and data regarding notes on BMP between 3 and 10 yr of age were compiled. The children underwent a clinical dental examination at age 11 yr, and bite-wing radiographs were taken. The parents completed the Dental Subscale of Children s Fear Survey Schedule (CFSS-DS).In the ADHD group, the prevalence of BMP increased between age 7 and 9 yr. A significant difference between the groups was found at age 8. Compared to controls, children with ADHD had a significantly higher number of decayed, missing, or filled surfaces (DMFS, 1.0 ± 1.5 vs 2.0 ± 3.0, P = 0.032) and decayed surfaces (DS, 0.5 ± 0.9 vs 1.7 ± 3.6, P = 0.016). Differences between the groups in CFSS-DS scores were nonsignificant. In the second study, the dental recall visit at age 11 was recorded on video and analyzed in detail. Interaction between the dentist and the child was scored as verbal and nonverbal initiatives and responses. Compared to the children in the control group, the children with ADHD made significantly more initiatives, especially initiatives that did not focus on the examination or the dentist. The children with ADHD made fewer verbal responses and had more missing responses. These problems in communication resulted in less two-way communication between the dentist and the children with ADHD than between the dentist and the children in the control group. In the third study, the children, all age 13, underwent a clinical dental examination and completed two questionnaires on dietary habits and dental hygiene habits. Differences between the groups regarding DMFS, DS, initial caries lesions, and gingival inflammation were nonsignificant. Forty-eight percent in the ADHD group brushed their teeth every evening compared to 82% in the control group. Corresponding frequencies for brushing the teeth every morning were 48% and 75%. Children with ADHD were 1.74 times more likely to eat or drink more than five times a day than children in the control group. In the fourth study, the children, all age 13, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one before the dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity-impulsivity had significantly lower cortisol levels than controls 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. The correlation between CDAS scores and cortisol concentrations before the dental examination was significant in both the ADHD and the control groups. In conclusion, this thesis found that children with ADHD compared to a control group have more dental behavior management problems; exhibit more problems interacting with the dentist, with particular difficulties staying focused on the examination; do not exhibit a higher degree of dental anxiety, except if the child has several symptoms of hyperactivity or impulsivity; have a blunted cortisol reaction, if the child has several symptoms of hyperactivity or impulsivity; have a higher caries prevalence and incidence at age 11, but not statistically significantly higher at age 13; do not have a higher prevalence of gingivitis; and have poorer oral health behavior

Analysis of behavior and communication during dental appointments in children with attention and learning problems

Attention and learning problems in children are common and have a substantial impact on many situations in the child s daily life. The present thesis investigates the prevalence of behavior management problems (BMP) and the characteristics of communication during dental appointments in a group of children with attention and learning problems compared to a control group. The thesis comprises a retrospective dental record study of BMP and a prospective, detailed video analysis of the behavior of a group of children during a dental recall visit. The first aim was to investigate whether children with attention and learning problems had more dental behavior management problems (BMP), more cancelled and missed appointments, and more traumatic dental injuries compared with a control group. The second aim was to make a detailed analysis of behavioral interactions between the dentist and the child patient with attention and learning problems. All children born in 1991 (n=555) in one Swedish municipality were screened for attention and learning problems with Conner s 10-item questionnaire and a questionnaire focused on executive and learning problems. The dental records of 128 screen-positive index cases and 131 screen-negative control cases were studied from 1 year of age until the child turned 10. BMP on at least one occasion were more common in the index group than in the control group (54% vs. 37%). The percentage of appointments at which the children exhibited BMP was also higher in the index group (13% vs. 7%). No differences were found concerning cancelled or missed appointments or dental traumatic injuries between the two groups. The dental recall visit at 11 years of age for 65 index cases and 60 control cases was recorded on video and analyzed. The interaction between the dentist and the child was scored as verbal and nonverbal initiatives and responses. Total examination time was significantly longer in the index group. The children in the index group took significantly more initiatives, had significantly fewer verbal responses, were less coordinated between verbal and nonverbal responses, and had more missing responses than the children in the control group. In conclusion, the results of this thesis show that children with attention and learning problems had significantly more behavior management problems compared to a control group. The problems in communication observed in the children with attention and learning problems resulted in less two-way communication between the dentist and the child and poorer timing compared to the interaction between the dentist and the children in the control group

A receptor subtype involved in neuropeptide-Y-induced food intake

Neuropeptide Y (NPY) is a powerful stimulant of food intake and is proposed to activate a hypothalamic 'feeding' receptor distinct from previously cloned Y-type receptors. This receptor was first suggested to explain a feeding response to NPY and related peptides, including NPY2-36, that differed from their activities at the Y1 receptor. Here we report the expression cloning of a novel Y-type receptor from rat hypothalamus, which we name Y5. The complementary DNA encodes a 456-amino-acid protein with less than 35% overall identity to known Y-type receptors. The messenger RNA is found primarily in the central nervous system, including the paraventricular nucleus of the hypothalamus. The extent to which selected peptides can inhibit adenylate cyclase through the Y5 receptor and stimulate food intake in rats correspond well. Our data support the idea that the Y5 receptor is the postulated 'feeding' receptor, and may provide a new method for the study and treatment of obesity and eating disorders