Search Results (1,487)

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

Background/Objectives: This study aimed to assess oral health values, oral hygiene habits, preventive dental attendance, and lifestyle-related risk factors among students at the University of Osijek and to compare findings between students enrolled in health-related and non-health-related study programs. Methods: A cross-sectional survey was conducted among 331 students (186 health-related and 145 non-health-related). Participants were recruited using a convenience sampling approach. Data were collected using an anonymous questionnaire comprising demographic information, oral health–related behaviors, and the Croatian version of the Oral Health Values Scale (OHVS-CRO). Group differences were analyzed using nonparametric statistical tests. Results: Students enrolled in health-related study programs reported significantly more favorable oral hygiene behaviors, including more frequent toothbrushing, greater use of dental floss, interdental brushes, and mouthwash, as well as more regular preventive dental attendance (all p < 0.05). They also achieved significantly higher OHVS-CRO scores across all domains and on the total scale (median total score: 42 vs. 40; p < 0.001). No significant differences were observed regarding smoking, alcohol consumption, or refined sugar intake. Conclusions: Students enrolled in health-related study programs demonstrated higher oral health values and more favorable oral health-related behaviors than students enrolled in non-health-related study programs. These findings suggest an association between educational orientation and oral health values and behaviors and may inform future oral health promotion initiatives targeting university students. Full article

Background/Objectives: The critical role of oral hygiene in overall health has driven efforts to improve oral hygiene practices. Novel devices employing electric-based technologies have emerged as powerful allies to conventional mechanical approaches for plaque control. NeoPill is a novel electric oral hygiene device designed to assist individuals with fixed orthodontic appliances in maintaining oral hygiene efficiently. The device utilizes direct current (DC) to facilitate bacterial removal from tooth surfaces and gingival tissues. Although the antimicrobial effects of electric-based devices, including NeoPill, are recognized, evidence concerning their impact on salivary biochemical parameters is scarce, especially in relation to oxidative stress. This pilot study aimed to evaluate the effects of NeoPill-derived DC on the redox status of saliva samples obtained from smokers. Methods: Saliva samples were analyzed after a 30-s exposure to NeoPill-derived DC and compared with untreated samples. Salivary pH, buffering capacity, and total protein concentration were measured, along with key salivary biomarkers of oxidative stress and antioxidant capacity. Results: The applied treatment did not significantly affect salivary pH, buffering capacity, or total protein content. Furthermore, NeoPill-derived DC treatment did not induce reactive oxygen species production or lipid peroxidation. No changes were observed in reducing power, glutathione-dependent defense, or the activities of antioxidant enzymes, including catalase and superoxide dismutase. Conclusions: These findings suggest that NeoPill-derived DC does not alter the redox status of smokers’ saliva under the applied conditions. However, it should be noted that this is a preliminary study with a small sample size, which represents a key limitation. Full article

Introduction: Oil pulling therapy has gained increasing attention as a natural oral hygiene practice; however, evidence regarding its clinical effectiveness remains limited and inconclusive. This study aimed to evaluate the effects of oil pulling therapy on dental plaque regrowth and tooth discoloration compared with chlorhexidine. Materials and Methods: One hundred systemically healthy dental students were randomly allocated to five groups: chlorhexidine, coconut oil, black cumin seed oil, terebinth oil, and distilled water. Following professional prophylaxis, participants refrained from mechanical oral hygiene for four days and used their assigned intervention twice daily. Plaque accumulation was assessed using the Turesky modification of the Quigley–Hein Plaque Index, gingival inflammation using the Gingival Index, and tooth color using CIELAB color difference measurements. Data were analyzed using one-way ANOVA or Kruskal–Wallis test with appropriate post hoc tests, depending on the distribution of data. Results: Plaque scores differed significantly among groups (p < 0.001), with chlorhexidine showing superior plaque inhibition compared with all oil-based interventions and distilled water. Gingival index values were lowest in the chlorhexidine group, although differences among oil groups were not statistically significant. Tooth discoloration was significantly greater with chlorhexidine than with all oil-based interventions (p < 0.001). Conclusions: Oil pulling therapies demonstrated lower anti-plaque efficacy than chlorhexidine but resulted in less tooth discoloration. These findings suggest that oil pulling may serve as an adjunct rather than an alternative to conventional plaque control. Full article

Background/Objectives: Dental caries in primary dentition is strongly related to daily oral hygiene routines and sugar-related dietary behavior. This study assessed oral hygiene and dietary behaviors associated with the clinical severity of carious lesions in primary dentition. Methods: This observational, cross-sectional, clinical-record-based study assessed 448 pediatric dental records from children examined in Craiova, Romania. After applying predefined eligibility criteria, 400 parent–child pairs were included. Children were aged 3–6 years and had primary or early mixed dentition with predominant primary teeth. Carious lesions were classified as absent, incipient, cavitated non-complicated caries, or advanced caries with pulpal/periapical involvement. The primary analysis focused on toothbrushing onset and frequency, toothbrush and toothpaste type, night feeding duration, sweets intake, and sweetened or carbonated beverage intake. Logistic regression was used to identify factors associated with higher odds of major carious lesions. Secondary clinical-record variables were analyzed exploratorily. Results: Carious lesions were recorded in 331 children, while 69 children were caries-free. Incipient caries, cavitated non-complicated caries, and advanced caries with pulpal/periapical involvement were recorded in 99, 116, and 116 children, respectively. Child age and sex were not significantly associated with caries severity. In the adjusted model, delayed toothbrushing onset (OR = 1.464; 95% CI: 1.148–1.866; p = 0.002) and sweetened beverage consumption (OR = 2.488; 95% CI: 1.561–3.963; p < 0.0005) remained independently associated with major carious lesions after Bonferroni correction. Conclusions: In this sample, major carious lesions in primary dentition were associated mainly with modifiable postnatal behaviors, particularly delayed initiation of toothbrushing and sweetened beverage intake. Due to the cross-sectional design, the findings should be interpreted as associations, not causal relationships. Full article

Background/Objectives: Benzydamine hydrochloride (B-HCl) is a non-steroidal anti-inflammatory agent with antimicrobial properties that may be beneficial in oral biofilm control. The aim of this study was to evaluate the effect of a 0.15% B-HCl mouthrinse on dental plaque accumulation and gingival inflammation under short-term conditions of restricted mechanical oral hygiene. Methods: Fifty periodontally healthy female subjects (aged 16–27 years) were randomly assigned (1:1) to receive either a 0.15% B-HCl mouthrinse or a placebo. Following professional prophylaxis, subjects rinsed with 15 mL twice daily for 30 s and refrained from all other oral hygiene procedures for 3 days. Full-Mouth Plaque Score (FMPS) was the primary outcome, and Full-Mouth Bleeding Score (FMBS) was the secondary outcome, recorded at baseline (Day 0) and Day 3. This study was conducted in accordance with CONSORT guidelines. Results: All subjects (n = 50) completed the study. FMPS increased significantly in both groups (p < 0.001). However, plaque accumulation at Day 3 was significantly lower in the B-HCl group compared with placebo (47.9% vs. 73.8%, p < 0.001), representing an absolute reduction of 25.9% and a relative reduction of 35.1%. No statistically significant differences were observed between groups in FMBS at Day 3 (p = 0.180). Conclusions: A 0.15% B-HCl mouthrinse reduced dental plaque accumulation compared with placebo during a 3-day period of restricted mechanical oral hygiene (mean difference: 25.9%; 95% CI: 16.1% to 35.7%). Given the short study duration, the anti-inflammatory properties of B-HCl could not be adequately evaluated. Longer-term studies are needed to determine whether B-HCl provides clinically meaningful benefits as an adjunct to mechanical oral hygiene. Trial registration: ClinicalTrials.gov (Identifier: NCT07565766). Full article

Oral manifestations are common in people living with HIV (PLWH) and may affect oral health-related quality of life (OHRQoL), while data from Greece remain limited. This multicenter prospective cohort study evaluated oral health status and OHRQoL among PLWH and explored associations with antiretroviral therapy (ART) and clinical factors. Overall, 370 PLWH from seven referral centers were included. Participants underwent oral examination, with oral hygiene assessed using the Simplified Oral Hygiene Index (OHI-S), and completed the Oral Health Impact Profile-14 (OHIP-14). Statistical analyses were performed using IBM SPSS Statistics v29.0, while multinomial and binary logistic regression identified predictors of oral hygiene status and OHRQoL, respectively. Most participants were male (76.5%), had CD4 counts ≥ 200 cells/μL (95.4%), and were receiving ART (98.6%). Annual dental check-ups, daily tooth brushing, mouthwash use, and dental floss use were reported by 54.1%, 69.5%, 31.9%, and 23.8%, respectively. The median OHI-S score was 2.0 (IQR:1.5–2.7), with 16.9% having poor OHI-S; the median OHIP-14 score was 11 (IQR: 7–15), with 64.4% reporting poor OHRQoL. Male sex was associated with lower odds of poor OHRQoL (OR = 0.377; p = 0.006), whereas ART regimen independently predicted poor OHRQoL. These findings support patient-centered oral healthcare within HIV care. Full article

Background/Objectives: Cognitive impairment can compromise toothbrushing and other oral self-care functions, increasing the risk of oral diseases and related complications. However, how toothbrushing ability declines across stages of cognitive impairment remains unclear. This study aimed to describe functional deficits in toothbrushing among older adults with different levels of cognitive function. Method: Sixty-five older adults (14 cognitively healthy and 51 with documented cognitive impairment) were classified into five cognitive levels based on Standardized Mini-Mental State Examination scores. Participants completed a toothbrushing task as they normally would at home. Performance was videotaped, coded, and evaluated across four domains (task initiation, completion, thoroughness, and quality) with total scores reflecting overall toothbrushing ability. Overall performance, functional deficits, and assistance needs were analyzed in relation to cognitive levels. Results: Participants averaged 76.5 years of age. Toothbrushing ability declined gradually with worsening cognitive impairment, followed by a sharp deterioration at the profound stage (e.g., SMMSE ≤ 5). Compared with cognitively healthy participants (n = 14), those with mild cognitive impairment (MCI, n = 20) or mild (n = 10), moderate (n = 10), or severe dementia (n = 11) lost an average of 3%, 8%, 12%, and 37% of overall toothbrushing ability, respectively. Brushing efficiency declined earlier and more rapidly, decreasing by 13% in MCI and up to 46% in severe dementia (p < 0.001). All participants with MCI or mild dementia completed the task independently, whereas 20% with moderate dementia and 80% with severe dementia required assistance to initiate or complete the task. Conclusions: Overall toothbrushing ability remains relatively preserved until the later stages of cognitive impairment, but brushing quality deteriorates much earlier and quicker. These findings highlight the importance of early caregiver–patient partnerships, functionally tailored oral self-care rehabilitation, and personalized caregiver training to support oral hygiene among older adults with cognitive impairment. Full article

(1) Background: Obesity and dental caries disproportionately affect low-income South Asian (SA) immigrant children in the US. This CHALO! study aimed to reduce the risk of obesity and oral health risk in young SA children in the US. (2) Methods: CHALO! is a randomized controlled trial. A total of 350 low-income Bangladeshi mothers of 6-month-old children were recruited and randomized to intervention or control. Intervention participants received six home visits and six phone calls from trained community health workers who delivered health education and support. The primary outcome was frequency of combined bottle/sippy cup use over 18 months measured via self-report. Secondary outcomes included sugar consumption, maternal feeding practices, oral hygiene practices, and dental utilization measured via self-report. Secondary clinical outcomes included the presence of dental caries at follow-up (12 months post baseline) assessed through intra-oral camera, and obesity risk, measured as weight gain velocity, at each 6-month period. (3) Results: Bottle/sippy-cup use increased less in the intervention group (Poisson rate ratio = 0.36, 95% CI: 0.34–0.39, p < 0.0001) vs. controls (Poisson rate ratio = 0.58, 95% CI: 0.56–0.61), and while consistent results were noted in sugar consumption, oral hygiene practices, dental visits, and other secondary outcomes, no difference was found in caries prevalence or weight gain velocity. (4) Conclusions: The intervention improved self-reported bottle use and child diet in the intervention group. There were no significant changes in caries prevalence or weight gain velocity. Social context, particularly social networks, may act as a barrier to adopting new healthy behaviors, impacting changes in caries and obesity outcomes. Full article

Background: Childhood oral hygiene behaviors are crucial to preventing oral diseases and can influence the development and progression of malocclusions. The World Health Organization (WHO) Oral Health Questionnaire is a standardized tool for assessing oral hygiene behaviors, oral health-related behaviors, and preventive dental awareness in children. Aim: This study aimed to assess oral hygiene behaviours and examine associations between WHO Oral Health Questionnaire variables and Angle malocclusion classes among children aged 6–9 years. Materials and Methods: This cross-sectional study included 90 children aged 6–9 years from the Pristina region, Kosovo. Data were collected using the WHO Oral Health Questionnaire for Children, which assessed oral hygiene habits, toothbrushing frequency, fluoride awareness, dental attendance, dietary behaviors, oral symptoms, and oral-health-related quality of life. Malocclusion was classified according to Angle classification into Class I, II, and III malocclusions with 3D intraoral scanners, Aerolscan 3. Descriptive statistical analysis, Chi-square (χ²) test, Spearman correlation analysis, and reliability analysis using Cronbach’s Alpha were performed using SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and Statistica 7.1 (StatSoft Inc., Tusla, OK, USA). Results: Most participants reported regular oral hygiene practices, with 46.7% brushing their teeth two or more times daily. However, limited awareness regarding fluoride-containing toothpaste was observed, as most children answered “don’t know” regarding fluoride use. Occasional toothache or oral discomfort was reported by 33.3% of participants, while 23.3% reported dissatisfaction with dental appearance. Difficulty biting hard foods was present in 34.4% of children. Reliability analysis of the Q10 section demonstrated moderate internal consistency (Cronbach’s Alpha = 0.500). Chi-square analysis demonstrated no statistically significant association between Angle malocclusion classes and WHO questionnaire variables (p > 0.05). The highest χ² value was observed for tooth-cleaning frequency (Q7) (χ² = 11.97; p = 0.152), although the association remained statistically non-significant. Psychosocial impact questions and oral health-related quality of life questions also demonstrated no statistically significant association with malocclusion classes. Conclusions: oral hygiene practices, preventative oral health practices, and oral health-related experiences were comparatively similar among children in different Angle malocclusion classes. Although there were no statistically significant correlations found between malocclusion classes and WHO questionnaire variables, the results show that some children have psychosocial concerns about their dental appearance and insufficient awareness of preventive oral health. The WHO Oral Health Questionnaire is a useful epidemiological tool for evaluating pediatric oral health behaviors and may help build youth orthodontic and preventive oral health policies. Full article

Background: The oral microbiome has emerged as a potential contributor to cardiovascular physiology through its role in the enterosalivary nitrate–nitrite–nitric oxide pathway. Oral nitrate-reducing bacteria convert dietary nitrate into nitrite, which can subsequently be reduced to nitric oxide, a signaling molecule associated with vascular tone, endothelial function, platelet activity, and blood pressure regulation. Disruption of this pathway has been associated with reduced nitric oxide bioavailability and impaired vascular responses. Methods: This narrative review summarizes current evidence regarding the relationship between the oral microbiome, nitrate metabolism, and cardiovascular function. Relevant literature was identified through searches of PubMed/MEDLINE and Google Scholar up to May 2026. Evidence from mechanistic, observational, and interventional human studies was reviewed and synthesized thematically. Results: Available evidence suggests that oral nitrate-reducing bacteria may influence nitric oxide bioavailability and vascular function. Studies have reported associations between oral microbiome disruption and changes in blood pressure, endothelial responsiveness, plasma nitrite concentrations, and other surrogate cardiovascular markers. However, findings remain heterogeneous and are influenced by factors such as diet, oral hygiene practices, smoking status, medication use, oral health, and underlying cardiometabolic conditions. Most studies are limited by small sample sizes, short intervention durations, and reliance on surrogate outcomes rather than major cardiovascular events. Conclusions: The oral microbiome may influence cardiovascular health through its role in nitrate metabolism and nitric oxide bioavailability. However, current evidence is largely limited to surrogate vascular outcomes, while data on major cardiovascular events remain scarce. Further longitudinal and interventional studies are needed to clarify causality and evaluate microbiome-targeted interventions. Full article

Obesity and dental caries are highly prevalent chronic conditions with significant global health impact. Although an association between these diseases has been suggested, the nature of this relationship remains unclear. This state-of-the-art review aims to synthesize current evidence on the interplay between obesity and dental caries, focusing on shared risk factors, salivary alterations and underlying biological mechanisms. Evidence indicates that obesity and dental caries share common behavioral and socioeconomic determinants, namely unhealthy dietary patterns with high intake of free sugars, poor oral hygiene habits and social disadvantage. Salivary alterations observed in obesity may also create a more cariogenic oral environment. Additionally, inflammatory mediators, oxidative stress markers and changes in the oral microbiome suggest biologically plausible links between both conditions. However, current data does not support a direct causal relationship, but rather a complex multifactorial interaction between obesity and dental caries driven by shared risk factors and modifiable behaviors. Preventive strategies should adopt an integrated approach targeting shared determinants, particularly diet, oral hygiene habits and socioeconomic status. Nevertheless, the predominance of cross-sectional evidence limits causal inference, highlighting the need for longitudinal studies that simultaneously assess obesity and dental caries, and that address salivary biomarkers using standardized methodologies across different age groups to clarify underlying mechanisms and assess their clinical relevance. Full article

Ventilator-associated pneumonia (VAP) is linked to high mortality rates, especially in developing countries. This cross-sectional survey study was conducted across three central hospitals in the Hail region of Saudi Arabia, King Salman Specialist Hospital, Hail General Hospital, and King Khalid Hospital, to assess the knowledge and adherence of intensive care unit (ICU) healthcare practitioners to the ventilator bundle (VB) for VAP prevention. It also looked at the practitioners’ perceived barriers to effective VB deployment. The study (n = 86) revealed significant disparities in VAP prevention knowledge across educational levels regarding the recommended degree of head-of-bed (HOB) elevation (p < 0.001), the use of endotracheal tubes with extra lumens for subglottic drainage (p < 0.001), and the protective effects of 0.12% chlorhexidine gluconate antiseptic oral rinse (p = 0.019). Professional experience significantly influenced knowledge of non-standard VB components (p < 0.001), the recommended frequency of awakening and spontaneous breathing trials (SBTs) (p < 0.001), and knowledge of extra-lumen tubes (p = 0.038) and kinetic beds vs. standard beds (p = 0.005). Significant differences were found between professional categories regarding knowledge of hand hygiene performance (p = 0.032), the correct degree of HOB elevation (p = 0.007), and patient positioning (semi-recumbent vs. supine) (p = 0.023). Years of experience significantly impacted reported compliance with institutional VB (p = 0.013), adherence to oral care protocols (p = 0.035), and the assessment of sedation depth (p = 0.002). While basic measures like HOB elevation practice and DVT prophylaxis showed universal reported compliance (100%), significant performance gaps were identified in more complex tasks, such as interrupting continuous sedative infusions and performing SBTs as recommended (p < 0.001), particularly among novice practitioners. The primary implementation barrier preventing full compliance with the VB was identified as educational deficit, which was prioritized as the most important area for quality improvement, highlighting the need for targeted training for newly hired ICU staff. Full article

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 (aMMP-8) levels, and patient-reported outcomes over 6 months. Methods: A randomized, controlled, parallel-group clinical trial included 40 systemically healthy adults with generalized gingivitis and was reported in accordance with CONSORT 2025 guidelines. Following professional oral hygiene according to the Guided Biofilm Therapy (GBT) protocol, participants were randomly allocated to ABX or 0.12% CHX, used twice daily for 14 days. Clinical parameters, including Full-Mouth Bleeding Score (FMBS, primary outcome), Full-Mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (REC), and Modified Lobene Stain Index (MLSI), were recorded at baseline, 2 weeks, 1, 3, and 6 months. Salivary aMMP-8 levels were assessed at baseline and 2 weeks. Heavy smokers were excluded, and smoking status was evaluated as a potential covariate. Non-parametric tests were applied (p < 0.05). Results: Both groups showed significant reductions in FMBS and FMPS over time (p < 0.05), with no intergroup differences for the primary outcome at any follow-up at the patient level. Patient-level analyses did not reveal consistent differences across secondary parameters. At the tooth level, lower FMPS values were observed in the trial group at 2 weeks and 1 month (p < 0.05), with earlier PPD reduction. CAL, and REC remained stable. Salivary aMMP-8 levels decreased significantly in both groups without intergroup differences. Patient-reported outcomes were comparable. Smoking status was balanced between groups and was not significantly associated with treatment allocation or the main clinical outcomes. Conclusions: No significant differences were observed between ABX and CHX for the main clinical and molecular outcomes, supporting its potential use as an adjunct in gingivitis management. Full article

Background: This study analyzed the association between caries increment and clinical, salivary, bacteriological, and behavioral risk markers in a two-year follow-up study of schoolchildren in Mexico City. Methods: A two-year follow-up study was conducted in elementary schoolchildren, where 118 schoolchildren aged 7–10 years at baseline (50% boys) participated in the follow-up. Toothbrushing frequency, sugar consumption, and dental caries indices were recorded according to WHO criteria. Salivary secretion rates, buffering capacity (Dentobuff^®), and cariogenic bacterial counts (Dentocult SM and LB^®) were also measured. Logistic regression was applied to analyze associations between caries increment and risk markers. Results: The mean baseline caries indices were dmft 4.8 (SD 4.0) and DMFT 0.6 (SD 0.9). Children were classified into three caries experience groups: caries-free, filled-teeth, and caries-active. After two years, baseline caries-free children had a lower caries increment in permanent teeth (0.2, SD 0.7) than other groups (p < 0.0001). However, the caries increment was similar between groups (p = 0.0827). Logistic regression revealed associations with toothbrushing frequency [OR = 2.77, p = 0.026], S. mutans counts [OR = 3.38, p = 0.050], and Lactobacillus counts [OR = 2.91, p = 0.029]. Conclusions: Children with low toothbrushing frequency and high cariogenic bacterial counts developed more caries lesions than those with better oral hygiene and lower bacterial levels. Greater emphasis should be placed on promoting oral hygiene and reducing bacterial load in the oral cavity. Full article