Tag: pubmed

BMC Oral Health. 2026 Jul 4. doi: 10.1186/s12903-026-09154-0. Online ahead of print.

ABSTRACT

OBJECTIVE: With the advancement of artificial intelligence (AI), large language models (LLMs) have become an alternative source of information in dentistry. These LLMs, which can be trained on large data sets, can answer medical questions and provide references, but they can pose problems in terms of ethics and accurate information. This research aims to evaluate the accuracy of five different LLMs in diagnosis and treatment planning in the field of restorative dentistry.

METHODOLOGY: The 20 most common cases encountered in a restorative dentistry clinic were formulated into questions. The validity of the questions was assessed using the Lawshe Content Validity Index. The questions were posed to five different LLMs: ChatGPT-5, Deepseek V3.2, Claude Sonnet 4.5, Microsoft Copilot, and Google Gemini 3 Flash. Each model was asked to create a diagnosis and treatment plan for each case. The responses were evaluated by 42 restorative dentistry specialists using a Likert Scale. Additionally, the accuracy of the references provided in the responses was evaluated by the article authors. The obtained data were analyzed using the non-parametric Kruskal-Wallis test, and the Dunn multiple comparison test was applied in cases where significant differences were detected.

RESULTS: Statistically significant differences were found between the models for 15 out of 20 questions (p < 0.05). A significant difference was also found in terms of total median scores (p < 0.001), with Google Gemini 3 Flash (median:83) and ChatGPT-5 (median:81) achieving the highest scores. Reference quality was evaluated using a four-category framework. Claude Sonnet 4.5 and Google Gemini 3 Flash demonstrated the highest proportions of accurate and relevant references (85.7% and 84.2%, respectively), while DeepSeek V3.2 exhibited the highest fabrication rate (55.6%).

CONCLUSIONS: Based on specialist-evaluated response quality, no model demonstrated consistent and superior performance across all clinical scenarios. LLMs appear to have potential as supplementary information resources for clinicians in restorative dentistry; however, their clinical integration, impact on patient outcomes, and real-world usability remain to be established in future research.

PMID:42399936 | DOI:10.1186/s12903-026-09154-0

BMC Oral Health. 2026 Jul 4. doi: 10.1186/s12903-026-09169-7. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 shows marked variation in clinical severity. Identifying demographic and clinical factors associated with severity is particularly important in conflict-affected, resource-limited settings. This study assessed the relationship between COVID-19 symptom severity and selected variables, including sex, age, marital status, and dental plaque index, among patients in northwest Syria.

METHODS: This cross-sectional analytical study was conducted from 12 October to 23 November 2021 in three COVID-19 isolation centers in northwest Syria. Sixty adult patients with confirmed SARS-CoV-2 infection were enrolled through consecutive screening with purposive quota balancing by clinical severity category, resulting in 20 patients in each of the mild, moderate, and severe groups. Demographic data were recorded, and oral examination was performed by one trained examiner to assess plaque index using the modified Greene-Vermillion index. Associations were analyzed using Spearman’s rank correlation, Pearson correlation, Kruskal-Wallis H test, and chi-squared test, with statistical significance set at p ≤ 0.05.

RESULTS: The sample included 38 females (63.3%) and 22 males (36.7%), aged 18-82 years. COVID-19 severity was significantly associated with sex, with greater severity among males (Spearman’s ρ = – 0.428, p = 0.001). Age showed a weak but significant positive correlation with severity (Pearson’s r = 0.287, p = 0.026). Marital status was also associated with severity (Spearman’s ρ = 0.329, p = 0.010), although this relationship appeared to be strongly confounded by age. Dental plaque index showed a moderate positive association with COVID-19 severity (Spearman’s ρ = 0.533, 95% CI: 0.307-0.702; p < 0.001), indicating that higher plaque accumulation was associated with more severe symptoms.

CONCLUSION: In this conflict-affected humanitarian setting, male sex, older age, and higher dental plaque index were significantly associated with increased COVID-19 symptom severity. These findings are preliminary and should be interpreted cautiously because of the cross-sectional design, small sample size, and limited data on potential confounders. Nevertheless, the study contributes evidence from an underrepresented crisis-affected population and suggests that oral health assessment may have value as part of broader COVID-19 risk evaluation in resource-constrained settings.

PMID:42399931 | DOI:10.1186/s12903-026-09169-7

BMC Oral Health. 2026 Jul 3. doi: 10.1186/s12903-026-08864-9. Online ahead of print.

ABSTRACT

BACKGROUND: Oroantral communication (OAC) and its chronic form, oroantral fistula (OAF), are significant complications primarily associated with the extraction of maxillary posterior teeth. Delayed diagnosis or inadequate primary management often leads to persistent maxillary sinusitis and secondary morbidities. Despite their clinical relevance, there is a lack of evidence regarding the factors influencing dentists’ diagnostic accuracy and therapeutic decision-making. This study provided a nationwide evaluation of dentists’ objective knowledge, clinical approaches, and self-perceived competence regarding the management of OAC and OAF in Turkey.

METHODS: This nationwide cross-sectional study included 400 dentists, divided into two equal groups: 200 general dental practitioners (Group 1) and 200 participants in the oral and maxillofacial surgery group (Group 2). A structured 35-item questionnaire collected data on professional experience and OAC/OAF-related knowledge across three subdomains: general, diagnostic, and treatment-oriented. Furthermore, the survey assessed clinical referral thresholds and self-perceived educational and diagnostic competence using a specialized scale. Statistical analysis included comparative tests and multiple linear regression models to identify independent predictors of clinical knowledge levels.

RESULTS: Group 2 demonstrated significantly higher scores across all knowledge subdomains compared to Group 1 (p < 0.05), with mean total scores of 0.81 ± 0.08 and 0.57 ± 0.12, respectively. Significant disparities were observed in etiology, preoperative risk assessment, and radiographic interpretation. Group 1 exhibited a higher tendency toward referral-based management, while Group 2 more frequently performed direct clinical management. Multiple linear regression revealed that being in Group 2, prior postgraduate training, and previous clinical case experience were independent positive predictors of higher knowledge scores. Conversely, a lack of preference for specific closure materials was a negatively associated with overall knowledge.

CONCLUSIONS: Knowledge levels regarding OAC/OAF management were significantly associated with professional group and clinical exposure. While Group 2 showed higher overall proficiency, knowledge gaps were also identified in specific domains. Within the context of dental education and clinical practice in Turkey, these findings support the need for strengthened undergraduate and postgraduate educational approaches to improve preparedness for OAC/OAF management.

PMID:42399919 | DOI:10.1186/s12903-026-08864-9

BMC Med. 2026 Jul 3. doi: 10.1186/s12916-026-05009-1. Online ahead of print.

ABSTRACT

BACKGROUND: Leflunomide (LEF) shows promising effect in Takayasu arteritis (TAK), but evidence from randomized controlled trials is lacking. This study aims to investigate the efficacy and safety of LEF versus placebo combined with prednisone for the treatment of TAK.

METHODS: This is a multicenter, randomized, double-blind, placebo-controlled trial at six sites across China, conducting from December 22, 2016, to November 4, 2022. A total of 116 eligible patients were recruited and randomized 1:1 to receive LEF (20 mg/d, p.o.) or matched placebo for 24 weeks, with all patients having initial prednisone of 0.6 mg/kg/d and following a taper starting at week 4. By week 24, patients in the LEF group who did not achieve clinical remission discontinued the study; all other patients (both LEF and placebo groups) received LEF (20 mg/d) from week 25 to week 52. The primary outcome was clinical remission at week 24. Secondary outcomes were time-to-clinical remission, mean prednisone dose at week 24, clinical remission in those who switched to LEF from week 25, disease recurrence and time-to-recurrence, imaging changes, and safety.

RESULTS: Fifty-four and 57, 45 and 48 patients were included in LEF and placebo group of modified intention-to-treat (mITT) and per-protocol set (PPS). In mITT set, clinical remission was achieved in 44/54 (81.5%) LEF- and 45/57 (78.9%) placebo-treated patients (risk difference: 2.6, 95%CI: -12.5, 17.2) at week 24. The same trend was observed in the sensitivity analyses. Post hoc analyses indicated greater risk differences (LEF minus placebo) in the female subgroup, ≤ 40 years subgroup, refractory subgroup, systemic symptoms subgroup, imaging type II subgroup and in those achieving the composite endpoint of both clinical remission and stable/improved imaging. At week 24, LEF group had a lower mean prednisone dose (mean difference: -2.1, [-4.3, 0.1] mg/d). Adverse events were observed in 13 (24.5%) LEF- and 22 (39.3%) placebo-treated patients. Serious adverse events were reported in six LEF- and four placebo-treated patients. One death was reported in placebo group.

CONCLUSIONS: Although the primary endpoint was not met, our results still provide evidence supporting LEF as a potential alternative treatment option for TAK.

TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02981979.

PMID:42399917 | DOI:10.1186/s12916-026-05009-1

BMC Public Health. 2026 Jul 3. doi: 10.1186/s12889-026-28303-2. Online ahead of print.

ABSTRACT

INTRODUCTION: There are still some gaps in the knowledge about food insecurity (FI) as a determinant of quality of life (QoL); for example, it is not known whether there is a dose‒response relationship, whether these associations occur longitudinally, and how they behave in a population where the target audience is not composed of people affected by health problems.

METHODS: This work prospectively analyzed the association between QoL and FI in individuals living in a socioeconomically disadvantaged Brazilian municipality between 2014 and 2019. This was a longitudinal prospective cohort study involving 225 individuals from families residing in a municipality with high social vulnerability in the northeast semiarid region of Brazil. The present study considered QoL as the dependent variable and food insecurity (FI) as the main independent variable. Multivariate analyses were conducted using mixed-effects regression, separately for each QoL domain.

RESULTS: Baseline results showed mean QoL domain scores of 70.62 for Social Relationships, 69.42 for Physical Health, 64.77 for the Psychological domain, and 57.55 for the Environmental domain. Among these, only the Physical Health domain exhibited a statistically significant change at follow-up, with a mean reduction of 2.9 points. Multivariate analysis demonstrated an inverse association between FI and QoL scores in the Psychological and Environmental domains. Under conditions of moderate FI, scores declined by 4.728 points in the Psychological domain (p = 0.041) and 7.610 points in the Environmental domain (p = 0.000) over time. At the severe FI level, these reductions were more pronounced, reaching 9.465 points (p = 0.003) and 10.138 points (p = 0.000), respectively.

CONCLUSION: The results presented in this cohort support the hypothesis that the phenomenon of FI was associated with poorer QoL outcomes over time.

PMID:42399910 | DOI:10.1186/s12889-026-28303-2

BMC Public Health. 2026 Jul 3. doi: 10.1186/s12889-026-28292-2. Online ahead of print.

ABSTRACT

BACKGROUND: Sociodemographic characteristics, health status, and access to health care are important determinants of health behaviors and may shift during periods of health system disruption such as the COVID-19 pandemic. This study aimed to examine whether these determinants were associated with self-medication and whether the prevalence of self-medication changed in Türkiye before and during the COVID-19 pandemic.

METHODS: This study used data from the Türkiye Health Survey conducted in 2019 (n = 16,253) and 2022 (n = 21,444), which was designed to provide national-level estimates for Türkiye. Descriptive analyses and chi-square tests were used to compare the prevalence of self-medication across survey periods. Multivariable modified Poisson regression models with robust variance were estimated separately for the pre-COVID-19 and during-COVID-19 periods to identify factors associated with self-medication and to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals. To assess whether associations differed between the two periods, pooled modified Poisson regression models were constructed including an indicator for survey period and interaction terms between the COVID-19 period and selected determinants. The statistical significance of interaction effects was evaluated using global Wald chi-squared tests.

RESULTS: The prevalence of self-medication increased significantly from the pre-COVID-19 period (34.9%) to the during-COVID-19 period (38.8%) (p < 0.001). In pooled analyses, self-medication remained more prevalent during the COVID-19 period (aPR = 1.11, 95% CI: 1.08-1.14). Across both survey periods, higher prevalence of self-medication was observed among women, individuals with higher educational attainment, those reporting moderate or severe bodily pain, individuals with long-standing illness, tobacco or alcohol users, and those experiencing unmet health care needs due to waiting lists. Global interaction tests indicated that the associations of educational attainment, age group, and health insurance coverage with self-medication differed significantly between the pre- and during-COVID-19 periods, whereas the associations with gender, long-standing illness, and self-perceived health remained stable.

CONCLUSIONS: Self-medication prevalence was higher during the COVID-19-period survey in Türkiye, and the associations between self-medication and several sociodemographic and health-related determinants differed between survey periods. These findings suggest that changes in health care access and perceived health needs occurring during public health crises may be associated with differences in self-medication patterns, highlighting the importance of monitoring self-medication behaviors and supporting vulnerable population groups.

PMID:42399909 | DOI:10.1186/s12889-026-28292-2

BMC Med Educ. 2026 Jul 3. doi: 10.1186/s12909-026-09837-w. Online ahead of print.

ABSTRACT

BACKGROUND: The American Medical Association’s Declaration of Professional Responsibility is an important covenant obligating present-day physicians to transcend personal beliefs and affiliations to advocate for changes that alleviate suffering and promote human health. Despite this recognition of advocacy as a pillar of physician duty, advocacy training in undergraduate medical education remains variable across institutions, elective in nature, and often insufficient in developing trainees’ professional identities and competence as health advocates.

METHODS: Educators at the UCLA David Geffen School of Medicine designed and delivered a novel half-day session required for all first-year medical students to nurture their professional identities as health advocates and empower them with knowledge, skills, and attitudes (KSA) needed to give voice to issues impacting the patients and communities they serve. Students attended a shared didactic followed by two focused workshops. The session was conducted annually from 2023-2025. Pre- and post-session data was collected after each iteration to evaluate changes in KSA.

RESULTS: A total of 509 first-year medical students participated in the session from 2023-2025 with 477 (94%) partaking in the session synchronously. All 509 participants (100%) completed at least one survey, and 361 (71%) completed both pre- and post-surveys. Pooled data showed that participation led to statistically significant improvement on a 7-point Likert scale at similar rates in all three cohorts in each of the measured domains: knowledge (Δ1.45, p < 0.001), skills (Δ1.37, p < 0.001), and attitudes (Δ0.44, p < 0.001).

CONCLUSIONS: A required half-day advocacy session supported trainees in developing their professional identities and acquiring foundational KSA needed to fulfill their roles as health advocates. Implementing this session across institutions can broaden its impact. Longitudinal data collection can clarify its long-term influence on physician engagement in advocacy and on health outcomes of patients and communities.

PMID:42399901 | DOI:10.1186/s12909-026-09837-w

BMC Public Health. 2026 Jul 3. doi: 10.1186/s12889-026-28360-7. Online ahead of print.

ABSTRACT

BACKGROUND: Smartwatches and other wearable technologies have become increasingly popular for health monitoring, offering potential benefits in the early detection of cardiac arrhythmias such as atrial fibrillation (AF). Despite their expanding use, limited data exist regarding public perceptions and usage patterns of these devices in Saudi Arabia. Understanding these perceptions is essential to inform strategies for digital health integration and preventive cardiovascular care.

OBJECTIVE: This study aimed to evaluate public perceptions, usage patterns, and factors influencing acceptance of smartwatches for early detection of cardiac arrhythmias among adults in Saudi Arabia.

METHODS: A cross-sectional study was conducted between May and October 2023 across five major regions of Saudi Arabia. A total of 459 adults aged ≥ 22 years participated through structured face-to-face interviews using a validated questionnaire adapted from prior studies. Descriptive statistics summarized demographic characteristics and usage trends, while Poisson regression analysis identified determinants of positive perceptions toward wearable technologies.

RESULTS: Nearly half of the respondents (46.4%) reported using wearable devices for health monitoring, with smartwatches being the most preferred (42.0%). Among smartwatch users, (35.2%) had received notifications of cardiac arrhythmia through their devices. Most participants (76.5%) expressed willingness to use smartwatches for arrhythmia detection, and (48.1%) strongly agreed that wearable technologies could contribute to the early diagnosis and monitoring of arrhythmia. Younger adults (22-51 years) demonstrated significantly more positive perceptions compared to those > 51 years (p < 0.05). Previous experience with wearables was also a significant predictor of favorable perception (p = 0.015). Educational level showed a positive but non-significant trend (p = 0.061), while gender and cardiovascular history were not associated with perception.

CONCLUSION: The Saudi public shows a high level of awareness and positive perception toward using smartwatches for early cardiac arrhythmia detection. Younger age and prior experience with wearables were the strongest predictors of acceptance, underscoring the importance of digital literacy and user familiarity. Integrating smartwatches into preventive cardiology and public health initiatives-supported by education and clinical validation-may enhance early arrhythmia detection and promote proactive heart health management in Saudi Arabia.

PMID:42399898 | DOI:10.1186/s12889-026-28360-7

BMC Public Health. 2026 Jul 3. doi: 10.1186/s12889-026-28387-w. Online ahead of print.

ABSTRACT

Pre-pregnancy overweight and gestational diabetes mellitus (GDM) increase the risk of accelerated fetal growth, but the effect of their individual or combined exposure on infant growth trajectory remains unclear. Clarifying whether these exposures will lead to sustained or time-limited growth patterns is essential for developing tailored, time-sensitive early childhood monitoring strategies.Methods We analyzed a population-based cohort of 16,712 mother-infant pairs from Jiangsu Province (2024) using longitudinal data. Infant weight was measured at birth, 1, 3, and 6 months. Linear mixed effects models were employed to examine the independent and joint associations of pre-pregnancy overweight and GDM with infant weight-for-age z-scores (WAZ), examining how the associations changed with infant age.Results Pre-pregnancy overweight showed a strong, positive association with higher infant WAZ (β = 0.160, 95% CI: 0.130 to 0.191), with no statistically significant change over time (overweight × age interaction: β = 0.005, 95% CI: 0.000 to 0.009; P = 0.060). In contrast, GDM alone had a statistically significant but relatively small initial effect (β = 0.065, 95% CI: 0.031 to 0.100), which significantly attenuated from birth to 6 months (GDM × age interaction: β = -0.008, 95% CI: -0.013 to -0.002; P = 0.006). The combined exposure yielded the highest initial β coefficient (β = 0.217, 95% CI: 0.175 to 0.259) and the most rapid attenuation (combined × age interaction: β = -0.017, 95% CI: -0.023 to -0.010; P < 0.001). At 6 months of age, the adjusted mean WAZ remained highest in the combined exposure group. The combined effect was approximately additive in magnitude (β_combined ≈ β_OW + β_GDM), and additive interaction metrics (RERI = 0.001, 95% CI: -0.112 to 0.114; AP = 0.005, 95% CI: -0.582 to 0.592; S = 1.01, 95% CI: 0.88 to 1.15) indicated no statistical additive interaction, with confidence intervals including the null values.Conclusions Different growth patterns were found in this study: pre-pregnancy overweight showed no statistically significant attenuation over the study period, while GDM’s influence was time‑limited. The combined exposure presents peak early risk that moderates over time. Clinically, infants exposed to both maternal pre-pregnancy overweight and GDM (the combined exposure group) should receive the most intensive growth monitoring during the first six months of life. These findings highlight the necessity of developing targeted monitoring protocols and implement risk stratification and personalized interventions based on maternal metabolic profiles.

PMID:42399897 | DOI:10.1186/s12889-026-28387-w

BMC Oral Health. 2026 Jul 3. doi: 10.1186/s12903-026-09071-2. Online ahead of print.

ABSTRACT

BACKGROUND: To investigate the effects of low-level laser therapy and misoprostol on orthodontic tooth movement (OTM), external root resorption, root length, alveolar bone mineral density (BMD), and osteoclast activity.

METHODS: Thirty-six female Wistar albino rats were divided into misoprostol, laser, and control groups. OTM was induced using a nickel-titanium closed-coil spring between the maxillary incisor and first molar for 21 days. Following euthanasia, tooth displacement, root length, root resorption, and BMD were analyzed using micro-computed tomography. BMD was assessed around the mesial root in tension, compression, apical mesial, and apical distal regions. Osteoclastic activity was evaluated immunohistochemically.

RESULTS: The laser and misoprostol groups showed greater OTM than the control group, without statistical significance (p > 0.05). Root length and root resorption did not differ significantly among groups (p > 0.05). BMD values were similar across groups (p > 0.05), although within-group comparisons showed higher values in tension areas and lower values in compression areas. Osteoclast counts were significantly higher in the laser group (p < 0.05).

CONCLUSIONS: Under the conditions of this study, low-level laser therapy did not result in a statistically significant increase in tooth movement; however, it may influence the cellular mechanisms underlying orthodontic tooth movement, as reflected by increased osteoclast activity, and may modulate bone remodeling without increasing root resorption. Although BMD tended to decrease in the compression areas and increase in the tension areas, the findings were inconsistent in the apical regions.

PMID:42399896 | DOI:10.1186/s12903-026-09071-2