Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

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Health literacy interventions and outcomes: an updated systematic review.

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject’s education, subject’s income, subject’s occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries.

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A Systematic Review of Socioeconomic Indicators and Dental Caries in Adults

https://www.worldcocoafoundation.org/wp-content/uploads/files_mf/ferrazzano2009.pdf

Anti-cariogenic effects of polyphenols from plant stimulant beverages (cocoa, coffee, tea).

Aim: To synthesise the current evidence for the associations between breastfeeding and dental caries with respect to specific windows of early childhood caries risk. Methods: Systematic review meta-analyses and narrative synthesis following searches of PubMed CINAHL and EMBASE databases. Results: Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding) had a reduced risk of caries (OR 0.50; 95%CI 0.25 0.99 I2 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed 12 months those fed nocturnally or more frequently had a further increased caries risk (five studies OR 7.14; 3.14 16.23 I2 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed bottle-fed and children not bottle or breastfed alongside specific breastfeeding practices consuming sweet drinks and foods and oral hygiene practices limiting our ability to tease out the risks attributable to each. Conclusion: Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months. ©2015 The Authors. Open Access.

/pdf/breastfeeding-and-the-risk-of-dental-caries-a-systematic-3z17hcnrhj.pdf

Breastfeeding and the risk of dental caries: a systematic review and meta-analysis

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the “Consolidated Standards of Reporting Trials” (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

https://www.mdpi.com/2072-6643/5/7/2530/pdf

The Use of Probiotic Strains in Caries Prevention: A Systematic Review

This survey assessed the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in Lombardy, Italy. Moreover, an analysis of the answers gathered in areas with different prevalence of the disease was carried out. All Lombardy's dentists were sent an online ad hoc questionnaire. The questionnaire was divided into four domains: personal data, precautionary measures (before patient arrival; in the waiting room; in the operating room), awareness, and perception. Three thousand five hundred ninety-nine questionnaires were analyzed. Five hundred two (14.43%) participants had suffered one or more symptoms referable to COVID-19. Thirty-one subjects were positive to the virus SARS-CoV-2 and 16 subjects developed the disease. Only a small number of dentists (n = 72, 2.00%) were confident of avoiding infection; dentists working in low COVID-19 prevalence areas were more confident than those working in the Milan area and high prevalence area (61.24%, 61.23%, and 64.29%, p < 0.01 respectively). The level of awareness was statistically significantly higher (p < 0.01) in the Milan area (71.82%) than in the other areas. This survey demonstrated that dentists in the COVID-19 highest prevalence area, albeit reported to have more symptoms/signs than the rest of the sample, were the ones who adopted several precautionary measures less frequently and were the more confident of avoiding infection.

https://www.mdpi.com/1660-4601/17/11/3835/pdf

COVID-19 Outbreak in North Italy: An Overview on Dentistry. A Questionnaire Survey.

This paper describes the dental health status of Italian 4-year-olds in 2004/2005 and analyzes the association between caries in preschool children and some background characteristics in children and

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

No recent data on the experience of caries among Italian 12-year-olds are available. In 2004, an epidemiological survey called 'National Pathfinder among Children's Oral Health in Italy' was promoted and carried out. This study reports the actual oral health status of Italian 12-year-olds according to gender, residence area and geographical distribution. Clinical examinations were carried out from March 2004 to April 2005, according to WHO criteria, and included dental caries (decay at the dentinal lesion level) and Community Periodontal Index (CPI). 5,342 children (2,670 males, 2,672 females) were examined by 7 ad hoc calibrated raters. Dental caries experience was found in 43.1% (95% CI 41.8-44.4%) of the study population. The mean DMFT score was 1.09 (95% CI 0.98-1.21). Significant differences (p < 0.05) were observed among geographical sections for DT, FT and DMFT. An inverse relationship was observed between mean DMFT and gross national product per capita (p < 0.001). Gingival bleeding was observed in 23.8% of children, while 28.7% had calculus. Significant differences in CPI scores among sections were found throughout the sample in both males and females (p < 0.001). Over the past two decades, mean DMFT fell from over 5 to its present level, halving every decade; consequently, the recorded level of dental caries has become aligned with that in other Western European countries. Nevertheless, differences in DMFT values remain between children from different socioeconomic backgrounds.

National Pathfinder survey of 12-year-old Children's Oral Health in Italy.

Background/Aims: Traditionally, tobacco is considered as part of the military culture A cross-sectional survey was designed to clarify if smoking habit increases the caries risk in

Does Smoking Increase Risk for Caries? A Cross-Sectional Study in an Italian Military Academy

Purpose: Dental care in Italy is carried out mainly by private professionals and therefore the collection of epidemiological data on dental health is not often possible. Thus, the aim of this study was to collect the DMFT and CPITN values in a population of young Italian male subjects, namely call-up soldiers and cadets, and relate them to the socio-economic status of the subjects. 
Material and Methods: The sample was made up of two groups from different Italian academies: call-up soldiers: 1184 male call-up soldiers aged from 19 to 25; cadets: 2477 cadets aged from 19 to 25. The level of education was evaluated by means of a questionnaire which the soldiers had to fill in before being examined. Two trained dentists carried out the epidemiological survey following WHO guidelines. Data elaboration was carried out at the 'WHO Collaboration Centre of Milan for Epidemiologist and Community Dentistry'. Data on DMFT were compared by ANOVA. A p value < 0.01 was considered as statistically significant. 
Results: The mean DMFT value observed was 3.69 ± 3.31. The differences between the two groups were statistically significant for D e F components (p < 0.05). The caries-free rate is lower in the call-up soldiers group (12.57%) than that reported for the cadets group (25.26%) and the difference was statistically significant (p < 0.01). Statistically significant differences were observed in DMFT values between the two groups stratified by educational level. A healthy periodontium was observed in more than 50% of the sample. In the call-up soldiers group, 40.95% had healthy periodontal conditions; 40.25% of the subjects showed bleeding on probing; 19.03% presented with calculus; and 2.77% presented periodontal pockets 4–5 mm deep. In the cadets group, 57.95% had healthy periodontal conditions; 38.18% of the subjects showed bleeding on probing; 3.52% presented with calculus; and 0.35% presented periodontal pockets 4–5 mm deep. The differences in proportion between the two groups were always statistically significant except for the bleeding score where an almost similar percentage for both groups was recorded. 
Conclusion: The results showed that call-up soldiers have a higher DMFT index and the D value is higher in less educated subjects. Bleeding on probing did not vary either between call-up soldiers and cadets or among socio-economic subgroups. Such results have underlined the need of a systematical information campaign on oral hygiene in Italian schools.

A. Senna

Papers

COVID-19 Outbreak in North Italy: An Overview on Dentistry. A Questionnaire Survey.

National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds.

National Pathfinder survey of 12-year-old Children's Oral Health in Italy.

Does Smoking Increase Risk for Caries? A Cross-Sectional Study in an Italian Military Academy

Socio-economic influence on caries experience and CPITN values among a group of Italian call-up soldiers and cadets.