Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014

Fissure caries inhibition with a CO2 9.3-μm short-pulsed laser-a randomized, single-blind, split-mouth controlled, 1-year clinical trial

OBJECTIVES

The objective of this randomized, single-blind, split-mouth controlled, clinical trial was to evaluate whether the use of a short-pulsed 9.3-μm CO₂ laser increases the caries resistance of occlusal pit and fissures in addition to fluoride therapy over 12 months.

MATERIALS AND METHODS

A total of 60 participants, average age 13.1 years, were enrolled. At baseline, second molars were randomized into test and control, and assessed by ICDAS, SOPROLIFE, and DIAGNOdent. An independent investigator irradiated test molars with a CO₂ laser (wavelength 9.3 μm, pulse duration 4 μs, pulse repetition rate 43 Hz, beam diameter 250 μm, average fluence 3.9 J/cm², 20 laser pulses per spot). Test molars received laser and fluoride treatment, control teeth fluoride alone. Fluoride varnish was applied at baseline and at 6 months. After 6 and 12 months, teeth were again assessed.

RESULTS

A total of 57 participants completed the 6-month and 51 the 12-month recall. Laser-treated surfaces showed very slight ICDAS improvements over time with ICDAS change - 1 in 11% and 8%, no changes (ICDAS change 0) in 68% and 67%, and slightly worsened (ICDAS change 1) in 19% and 24% at 6- and 12-month recalls, respectively, and worsened by two scores in 2% at both recall time points. Control teeth showed significantly higher ICDAS increases, with 47% and 25% showing ICDAS change 0, ICDAS change 1 in 49% and 55%, and ICDAS change 2 in 4% and 20% at 6- and 12-month recalls, respectively. Differences in ICDAS changes between the groups were statistically significant (P = 0.0002 and P < 0.0001; Wilcoxon's signed-rank test, exact). A total of 22% of the participants developed ICDAS 3 scores on the control teeth.

CONCLUSIONS

Microsecond short-pulsed 9.3-μm CO₂ laser irradiation markedly inhibits caries progression in pits and fissures in comparison with fluoride varnish alone.

CLINICAL RELEVANCE

The 9.3-μm CO₂ laser irradiation of pits and fissures enhances caries resistance.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02357979.

Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial

AIMS

To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application.

DESIGN

A stratified, parallel-group, three-arm individually randomized controlled pilot trial.

SETTING

Two Los Angeles area Early Head Start (EHS) sites.

PARTICIPANTS

36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds.

INTERVENTIONS

Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks.

OUTCOMES

Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs.

FINDINGS

Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16.

CONCLUSIONS

Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT03862443.

Unmet Dental Care Need and Associated Barriers by Race/Ethnicity among US Adults

INTRODUCTION

Ability to access needed dental care may vary among population subgroups. We assessed 1) the differences in the proportions of adults who reported unmet dental care needs in the past 12 months and the associated barriers (structural, financial, and cognitive) in 2015 to 2016 versus 2003 to 2004 by race/ethnicity and 2) the subgroups that are more likely to report unmet dental care needs.

METHODS

Data of 10,029 respondents aged ≥19 y from the 2003-2004 and 2015-2016 National Health and Nutrition Examination Surveys were used. Chi-square tests assessed the differences in the proportions of adults who reported not getting the needed dental care between the periods. A multiple logistic regression model was run to identify characteristics that were significantly associated with unmet need after adjusting for other factors.

RESULTS

Overall, 19.4% of the adults reported an unmet dental care need in 2015 to 2016, as compared with 21% in 2003 to 2004. The overall unmet dental care need decreased only in the Hispanic groups (34% to 28%, P = 0.045) between 2003-2004 and 2015-2016. Between the periods, unmet need decreased among Hispanics aged 19 to 64 y (35% to 28%, P = 0.02), Hispanics with some college education or above (33.5% to 21.0%, P = 0.008), and nonpoor Hispanic adults (29.8% to 20.4%, P = 0.048). No significant differences were observed in the proportions of adults reporting structural (P = 0.09), financial (P = 0.86), or cognitive (P = 0.07) barriers between the periods. When compared with their counterparts, nonelderly adults, women, Hispanics, adults with a high school education, those with less than a high school education, and poor adults were significantly more likely to report unmet dental care needs.

CONCLUSIONS

Racial and ethnic disparities in accessing and receiving the needed dental care still exist. Financial barriers to dental care are the most commonly cited reasons for not getting the needed dental care.

KNOWLEDGE TRANSFER STATEMENT

The results of the study will inform policy makers, public health planners, and dental professionals about subgroups that still face difficulty in receiving the dental care they need. Policy makers should develop new policies to mitigate the financial barriers that are still prevalent. Dental professionals can mitigate the public's cognitive and financial barriers by educating the community through outreach programs and by providing services to low-income populations at reduced charges or through alternative payment plans.

Disparities in Access to Oral Health Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

Dentists' Adoption of Silver Diamine Fluoride among 1- to 5-Year-Old Children in North Carolina

BACKGROUND

A natural experiment was conducted to observe the adoption of silver diamine fluoride (SDF) by Medicaid-enrolled dentists in North Carolina (NC). The purpose of this study was to describe the sociocontextual and community health characteristics where dentists adopted SDF, determine the association between SDF use and general anesthesia (GA) use, and examine the changes in GA utilization following implementing SDF reimbursement.

METHODS

NC Medicaid initiated SDF reimbursement in 2016 for children ages 1 to 5 y. This cross-sectional time series study used aggregate NC Medicaid claims, including geographic data, from 2014 to 2018. All dentists who provided GA and/or SDF to children ages 1 to 5 y were included. County health ranking data described social and community health indicators. Descriptive statistics, spatial data techniques, and multivariable methods were used.

RESULTS

From 2016 to 2018, the number of dentists using SDF increased from 35 to 258, or 637%, whereas the number of dentists using GA increased from 179 to 211, or 17%. SDF utilization spread outward from areas of good social and health indicators to areas of poorer indicators. SDF utilization increased from 0.35 to 0.65 per 1,000 children, whereas GA utilization decreased from 2.57 to 2.47 per 1,000 children. GA utilization was positively associated with SDF utilization and poorer county health ranking but did not change before and after SDF implementation.

CONCLUSION

Early adopters of SDF in NC practiced in areas with positive social and community health indicators. Over time, SDF was adopted in resource-poor communities. It remains too early to determine the public health impacts of SDF treatment on GA utilization.

KNOWLEDGE TRANSFER STATEMENT

Policy makers and clinicians can use the results of this study to develop geographically targeted interventions that could lead to clinically and cost-effective public health programs.

Complex Systems Model of Dynamic Mechanisms of Early Childhood Caries Development

Early childhood caries (ECC) is a largely preventable condition that occurs when children develop caries in their primary teeth before the age of six. National trends of ECC indicate that prevalence is decreasing, but disparities between various sociodemographic groups may be increasing, despite intervention efforts. Dynamic mechanisms in caries development are hypothesized to be responsible for the observed population distributions of disease. Agent-based models (ABMs) have been utilized to explore similar hypotheses in many areas of health research. Therefore, we developed an ABM of ECC development mechanisms and examined population outcomes of hypothetical preventive intervention scenarios. We found that risk-based targeting had minimal impact on population averages or disparities and was largely due to the strength of the dynamic mechanisms among those considered to be at high caries risk. Universally increasing intervention access reduced population caries prevalence, but increased disparities between different groups of caries risk profiles. We show that population distributions of ECC can emerge as a result of dynamic mechanisms that have been shown to drive disease development. Understanding the effectiveness of a proposed intervention in relation to the hypothesized mechanism(s) that contributes to the outcome of interest is critical to future efforts to address population disparities in ECC.

Pediatric Dentists' Educational Experiences, Attitudes, and Professional Behavior Concerning Resin Infiltration: Implications for Dental Education

Minimally invasive dentistry (MID) is receiving increased attention. Resin infiltration (RI) is one micro-invasive technique for treating initial caries by sealing white spot lesions on tooth surfaces. The aims of this study were to assess pediatric dentists' RI-related educational experiences, attitudes, and professional behavior and to determine if their educational experiences were significantly related to their professional attitudes and behavior regarding RI. This cross-sectional study used an online survey to collect data from members of the American Academy of Pediatric Dentistry (AAPD) in March-April 2017. Of the 2,367 AAPD members invited to participate, 43 emails could not be delivered, and 273 surveys were completed, for a response rate of 11.8%. While only 9% of the 273 respondents reported that their classroom-based dental education had informed them about RI and only 1% that it had prepared them well to use RI with pediatric patients, higher percentages said they had been informed/prepared well by their classroom-based (24%) and clinical residency education (12%). The majority wanted to learn more about RI (71%) and would like to take a related CE course (59%). The respondents' average RI-related attitudes were positive (on five-point scale with 1=worst attitude: Mean=3.84). Regarding use of RI, 28% of respondents said they used RI sometimes and 4% often/very often, with 64% considering implementing RI in their clinics. Graduation year did not correlate with RI attitudes and use. However, the more education about RI the respondents had received during their residency (r=0.20; p<0.01) and in professional development after graduation (r=0.34; p<0.001), the more they used RI in their own work. This study found that the pediatric dentists' RI-related education was positively correlated with their professional behavior. Increasing predoctoral, resident, and continuing professional education about RI should therefore be considered.

Nursing Students’ Assessment and Parent Reports of Their Children’s Oral Health Behaviors as Predictors of Tooth Decay Risk—A Cross-Sectional, Correlational Study

Aim:

The aim of this study is to evaluate the relationship between children’s tooth decay risk score and a dental examination and parent reports of oral health practices.

Materials and Methods:

A cross-sectional correlational study utilizing data from an oral health assessment was performed by undergraduate nursing students and parents completed the permission forms.

Results:

Four hundred and fifty-six children received an oral health assessment. None of the percentages were found to be at high risk for tooth de cay and 21% were referred for further evaluation and dental treatment. Twenty-seven % of parents reported that their child was not being seen by a dentist and 49% reported that they had not established recommended tooth brushing practices in early childhood. In this analysis, the physical examination measures accounted for a significant amount of risk: R2 = 0.55, F(5,317) = 7.62, P < .00. The parent report measures offered little predictive power beyond the examination: R2 = 0.029, F(7,310) = 3.01, P = .00.

Conclusions:

These findings identify a need for a broader perspective to inform oral risk assessment and interventions to address oral health disparities. A social determinant of health framework would improve nursing students’ competency to identify children in need of early intervention. Oral health promotion at the family and community level would improve the preventive oral health practices.

Trends of children being given advice for dental checkups and having a dental visit in the United States: 2001-2016

INTRODUCTION

The objectives of this study were to describe trends of children being given dental checkup advice by primary care providers (PCPs) and having dental visits and to assess factors associated with being given dental checkup advice and having a dental visit.

METHODS

Data were from the annual, cross-sectional Medical Expenditure Panel Survey (MEPS) from 2001 to 2016. The sample included 126,773 children ages 2-17 years. We used predictive margins to estimate the probability of being given dental checkup advice and having a dental visit. We examined time trends of the proportion of children being given dental checkup advice from PCPs, as well as trends in the proportion of children having a dental visit from 2001 to 2016. Multiple logistic regression was used to assess the association between being given dental checkup advice and having a dental visit.

RESULTS

Overall, the proportion of children being given dental checkup advice increased from 31.4% in 2001 to 51.8% in 2016 (Trend P < 0.001). No significant increasing trend was found for having a dental visit among those being given dental checkup advice (Trend P > 0.05). Children being given dental checkup advice were more likely to have a dental visit (AOR = 1.54, P < 0.001).

CONCLUSIONS

Although there was an increase in the proportion of children being given advice to have dental checkups by PCPs from 2001 to 2016, there was no significant increase in having a dental visit among children being given the advice. More research is needed to better understand how dental care advice from a PCP can effectively motivate and facilitate dental care for children.

Teeth: Small but Mighty and Mighty Important. A Comprehensive Review of Children's Dental Health for Primary Care Clinicians

Healthy teeth allow us to eat and stay well-nourished. Although primary care clinicians receive limited training about teeth, given the common nature of dental problems, it is important that they understand and recognize normal and abnormal dental conditions and can implement primary and secondary prevention of dental conditions in their practice. PubMed has been used to search the scientific literature for evidence on the following topics: normal dental development, dental abnormalities, malocclusion, teething, dental caries and related epidemiology and prevention, fluoride, dental injury and its management and prevention; and identification, prevention and treatment of gingivitis and periodontal disease. Literature review relied on randomized controlled trials, meta-analyses, systematic reviews, and Cochrane reviews when relevant and available. Other sources of evidence included cohort and case-control studies. Consensus statements and expert opinion were used when there was a paucity of high-quality research studies. The literature has been synthesized on these topics to make them relevant to pediatric primary care clinicians, and as available, the strength of evidence has been characterized when making clinical recommendations.

An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial

Background

Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children.

Objective

This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes.

Methods

Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models.

Results

A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively).

Conclusions

The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy.

Disparities in Caregivers' Experiences at the Dentist With Their Young Child

OBJECTIVE

To understand the experiences of diverse families when taking their young children to the dentist and to document their prevalence.

METHODS

An exploratory sequential design was used. First, 4 focus groups (N = 33) comprised of low-income female caregivers of children under 6 years of age were conducted in English and Spanish. Discussions centered around facilitators and barriers to taking children to the dentist. Themes derived from the groups were then used to create a survey that was given to 1184 caregivers in English, Spanish, or Vietnamese.

RESULTS

Thematic coding of focus groups found little support for typically reported barriers to pediatric oral health care utilization (eg, transportation, cost, knowledge); instead, caregivers reported negative experiences (eg, restraint, separation) as barriers. In the surveys, 66% of caregivers reported being separated from their children, 25% reported that their children were restrained (53.7% for cleanings), 26% of children were given sedating medication for cleanings, and 22% of the caregivers reported experiences that made them not want to return to the dentist. The prevalence of these experiences differed significantly among Latino, Asian, and Caucasian families and for annual incomes under or above $50,000.

CONCLUSIONS

Families with lower incomes and/or from ethnic and linguistic minority groups were more likely to report negative experiences at the dentist than higher income and Caucasian families. These data document the high prevalence of negative experiences and suggest ethnic, financial, and linguistic disparities in the quality of experiences. More research is needed on the role of dentists in facilitating or hindering oral health care utilization among diverse families.

A survey of caregiver acculturation and acceptance of silver diamine fluoride treatment for childhood caries

Background

Interest in aqueous silver diamine fluoride (SDF) has been growing as a treatment for caries arrest. A cross-sectional study was conducted to identify factors associated with caregiver acceptance of SDF treatment for children presenting with caries at 8 Federally Qualified Health Centers. The study purpose was to examine associations between caregiver acceptance of SDF treatment for children with caries and (1) sociodemographic and acculturation characteristics of caregivers and (2) clinical assessments of the children by dentists.

Methods

A caregiver survey collected information on: sociodemographic characteristics; acculturation characteristics, measured using the validated Short Acculturation Scale for Hispanics (SASH); perceived benefits and barriers of SDF treatment, including caregiver comfort; and perceived health-related knowledge. Chart reviews were conducted to assess: the medical / dental insurance of pediatric patients; cumulative caries experience, measured using decayed, missing, filled teeth total scores (dmft / DMFT); whether operating room treatment was needed; and a record of caregiver acceptance of SDF treatment (the outcome measure). Standard logistic regression models were developed for caregiver acceptance of SDF treatment for their children as the binary outcome of interest (yes / no) to calculate unadjusted odds ratios (OR) and adjusted ORs for covariates of interest.

Results

Overall, 434 of 546 caregivers (79.5%) accepted SDF treatment for their children. A U-shaped relationship between caregiver odds of accepting SDF treatment and age group of pediatric patients was present, where caregivers were most likely to accept SDF treatment for their children who were either < 6 years or 9–14 years, and least likely to accept SDF treatment for children 6 to < 9 years. The relationship between acculturation and caregiver acceptance of SDF treatment depended upon whether or not caregivers were born in the United States: greater acculturation was associated with caregiver acceptance of SDF treatment among caregivers born in this country, and lower acculturation was associated with caregiver acceptance of SDF treatment among caregivers born elsewhere.

Conclusions

Caregiver acceptance of SDF treatment is high; child’s age and caregiver comfort are associated with acceptance. Providers need to communicate the risks and benefits of evidence-based dental treatments to increasingly diverse caregiver and patient populations.

Development and validation of the Dental Nutrition Knowledge Competency Scale for low-income women

OBJECTIVE

To develop and validate a Dental Nutrition Knowledge Competency Scale to assess dental health-related nutrition knowledge of low-income women.

DESIGN

This is a cross-sectional study. A literature search for foods/dietary practices related to dental caries was conducted and the items were incorporated into an initial questionnaire. A panel of ten nutrition experts evaluated it for its content, readability and relevance, and a focus group of six low-income women determined its readability and comprehension. Then the questionnaire was administered to 150 low-income women. Construct validity was evaluated by item difficulty, item discrimination and factor analysis. Internal consistency reliability was tested via Cronbach's α. In a sub-sample of forty women, test-retest reliability was established. Paired-sample t tests were conducted to examine differences between test scores at the two time points, 2 weeks apart.

SETTINGS

Community centres in low-income housing in Central Texas, USA.

PARTICIPANTS

A total of 150 low-income women, aged 18-50 years; annual household income <250 % of the federal poverty level.

RESULTS

Item difficulty and discrimination analysis resulted in elimination of eight questions. Factor analysis identified twenty-four items that loaded on three factors related to knowledge. These included foods/dietary practices that affect dental caries, added sugars in foods and on food labels, and recommended frequency of oral hygiene practices. The subscales and the completed scale exhibited good internal consistency (mean 0·7 (sd 0·97)) and test-retest reliability (mean 0·8 (sd 0·013)).

CONCLUSIONS

The Dental Nutrition Knowledge Competency Scale is a validated and reliable instrument to assess nutrition knowledge related to dental health in low-income women.

Development of toolkits for detecting dental caries and caries experience among children using self-report and parent report

OBJECTIVES

To develop child- and parent-reported toolkits for active caries and caries experience in children and adolescents, ages 8-17.

METHODS

A sample of 398 child/parent dyads recruited from 12 dental practices in Los Angeles County completed a computer-assisted survey that assessed oral health perceptions. In addition, children received a dental examination that identified the presence or absence of active caries and caries experience. A Multiple Adaptive Regression Splines model was used to identify a subset of survey items associated with active caries and caries experience. The splines and coefficients were refined by generalized cross-validation. Sensitivity and specificity for both dependent variables were evaluated.

RESULTS

Eleven child self-reported items were identified that had sensitivity of 0.82 and specificity of 0.45 relative to active caries. Twelve parent-reported items had a sensitivity of 0.86 and specificity of 0.50. Seven child self-reported items had a sensitivity of 0.86 and specificity of 0.34, and 11 parent-reported items had a sensitivity of 0.86 and specificity of 0.47 for caries experience.

CONCLUSIONS

The survey items identified here are useful in distinguishing children with and without active caries and with and without caries experience. This research presents a path towards using children's and their parents' reports about oral health to screen for clinically determined caries and caries exposure. The items identified in this study can be useful when clinical information is unavailable.

Motivational Communication in Dental Practices: Prevention and Management of Caries over the Life Course

Dental caries and periodontal diseases are preventable. Nevertheless, they remain prevalent. Dental practices offer an ideal setting for educating patients about oral health-related behavior change. This article describes the motivational communication approach to changing behavior and applies it to a discussion of behavior change communication over the course of life. CONTENT considerations focus on on identifying high-priority behaviors for change; patient affect, behavior, and cognition related to these behaviors, and understanding in which stage of change the patient is. Process the four principles of the Motivational Interviewing approach by Miller & Rollnick to analyze oral health-related behavior change over the life course.

Oral Diseases Associated with Nonalcoholic Fatty Liver Disease in the United States

The US prevalence of nonalcoholic fatty liver disease (NAFLD) is 30.6% and increasing. NAFLD shares some risk factors with periodontitis and dental caries. We explored the association between NAFLD and several oral conditions among US adults, using data from the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES), 1988 to 1994. NAFLD was assessed with ultrasonography (USON), the screening gold standard not available in the more recent NHANES, and the noninvasive Fibrosis Score (FS), Fatty Liver Index (FLI), and US Fatty Liver Index (US-FLI) as other screening alternatives. There were 5,421 eligible dentate adults aged 21 to 74 y with complete relevant data, with transferrin levels ≤50%, without hepatitis B or C, who were not heavy drinkers. Multivariable models were developed to examine the independent effects of moderate-severe periodontitis, untreated dental caries, caries experience, and tooth loss (<20 teeth) on NAFLD while controlling for clinical, biological, and sociodemographic factors. Weighted estimates for odds ratios (ORs) and 95% CIs were calculated with logistic regression. Between 17% and 24% of adults had NAFLD depending on the classification criteria. In adjusted models, as compared with those with better oral health, adults with <20 teeth were more likely to have NAFLD depending on the measure (USON: OR = 1.50, 95% CI = 1.11 to 2.02; FS: OR = 4.36, 95% CI = 3.47 to 5.49; FLI: OR = 1.99, 95% CI = 1.52 to 2.59; US-FLI: OR = 2.32, 95% CI = 1.79 to 3.01). People with moderate-severe periodontitis were more likely to have NAFLD (USON: OR = 1.54, 95% CI = 1.06 to 2.24; FS: OR = 3.10, 95% CI = 2.31 to 4.17; FLI: OR = 1.61, 95% CI = 1.13 to 2.28; US-FLI: OR = 2.21, 95% CI = 1.64 to 2.98). People with any untreated caries were more likely to have NAFLD (USON: OR = 1.51, 95% CI = 1.20 to 1.90; FLI: OR = 1.80, 95% CI = 1.33 to 2.44). NAFLD was associated with tooth loss, periodontitis, and, for some NAFLD measures, untreated dental caries but not overall caries experience after controlling for several key sociodemographic and behavioral factors. Results suggest that further evaluation is needed to better understand this health-oral health interrelationship and potential opportunities for medical-dental integration.

School-based fluoride varnish programs: a national survey

PURPOSE

To identify and describe school-based fluoride varnish (FV) programs in K-12 grades children in the United States.

METHODS

This cross-sectional study utilized an online, self-administered survey to identify and describe school-based FV programs in 2016. Several public health directories, mainly The Association of States and Territorial Dental Directors directory, were contacted to identify FV programs. The survey's questionnaire included 23 closed-ended questions regarding program description, assessment, and process.

RESULTS

Of 85 identified programs, 52 responded (response rate = 61 percent) with 40 school-based FV programs in operation in 27 states. About 85 percent of responding programs apply FV as part of an existing school-based program. Dental sealants on permanent teeth are the most common procedure provided in addition to FV (92 percent). One-third of programs apply FV once a year versus 28 percent that apply FV twice a year.

CONCLUSIONS

Evidence-based guidelines for FV in school-based programs are needed to ensure cost-effectiveness and continuity.

Cost-Savings of Fluoride Varnish Application in Primary Care for Medicaid-Enrolled Children in Virginia

OBJECTIVES

To determine the cost-benefit of fluoride varnish application during pediatric well-visits for the Medicaid/Children's Health Insurance Program population in Virginia (VA) from a Medicaid payer perspective. To provide initial cost estimates from the primary care provider (PCP) perspective.

STUDY DESIGN

A systematic search of recent literature was completed to obtain input data for a Monte Carlo cost-benefit simulation and for the fluoride varnish application time, labor, and materials costs for PCPs. The analysis was conducted from a Medicaid perspective; costs and savings related to fluoride varnish application in primary dentition through 7.5 years were calculated for all Medicaid-eligible children up to 3 years of age in VA. Sensitivity analysis was performed to mitigate the effects of parameter uncertainty.

RESULTS

Delivering fluoride varnish to all children <3 years old in VA who annually receive well-visits through Medicaid but did not receive fluoride varnish at those visits would reduce the percent of 7.5 year olds with decay from 63.2% to 39.8%. Accounting for averted restoration cost, PCP fluoride varnish application would save $75.32 per child, or a total population savings of almost $2 million/year for VA Medicaid. From the PCP perspective, the Medicaid reimbursement rate for fluoride varnish is 3.8-12.0 times the direct fluoride varnish application cost (labor and materials).

CONCLUSIONS

Application of fluoride varnish by a PCP to children under 3 years of age is cost-saving in this study population. Costs to provide fluoride varnish from the PCP perspective are favorable compared with the Medicaid reimbursement, but additional studies on optimizing fluoride varnish application into the well-visit workflow are needed.

A storytelling intervention reduces childhood caries risk behaviors among American Indian and Alaska Native mothers in Northern California

OBJECTIVES

To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers.

METHODS

Fifty-three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self-reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest-posttest design, with an additional six-month follow-up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors.

RESULTS

Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six-months was also observed.

CONCLUSIONS

The results of this intervention study suggest promise for traditional storytelling to increase oral health-related knowledge, beliefs, and behaviors among self-identified AIAN pregnant women and mothers.

Filled dietary fluoride supplement prescriptions for Medicaid-enrolled children living in states with high and low water fluoridation coverage

BACKGROUND

Although dietary fluoride (F) supplements (DFS) are recommended for children who use F-deficient drinking water, no studies have examined filled DFS prescriptions across multiple states to examine the dosage consistency with current recommendations or prescription length.

METHODS

This sequential cross-sectional analysis used Medicaid claims data for children aged 0.5 through 16 years who in 2011 lived in the 6 states with the lowest and the highest fluoridation coverage (≤ 34% and ≥ 95% of the public water system population fluoridated, respectively). For 2011, the authors calculated the mean percentage of children with filled DFS prescriptions and the change since 2000 across states with high and low fluoridation coverage, the percentage of children with filled DFS prescriptions containing F dosage consistent with current recommendations, and filled DFS prescription length and cost across states.

RESULTS

In states with high fluoridation coverage, the mean percentage of children with a filled prescription was < 1% in both years; in states with low fluoridation coverage, this value increased from 0.9% to 10.3%, the highest increase (16.4 percentage points) since 2000 among children aged 0.5 through 2 years. The average prescription length was 72 days. Across states, the mean costs per child prescribed supplements and per enrollee were $17.60 and $1.05, respectively.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Filled prescriptions largely followed current recommendations but reached only a small percentage of children in low-coverage states. The short prescription length indicated limited exposure for caries prevention. Results from these states suggest more children could have longer exposure to the caries-preventive benefits of F at a similar cost with water fluoridation as with DFS.

The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

BACKGROUND

Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures.

METHODS

We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure.

RESULTS

Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits.

CONCLUSIONS

POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia.

KNOWLEDGE TRANSFER STATEMENT

The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

A Comparison of Dental Caries in Urban and Rural Children of the Riyadh Region of Saudi Arabia

Background and Aim: The data presented in this study aimed to document caries prevalence and severity among a representative sample of 6, 12, and 15 years old Saudi Children.

Methodology: The study examined a total of 1,986 school children from 75 schools in urban and rural areas of Riyadh region, Saudi Arabia. Children having one or more dental caries lesion were used to determine prevalence of dental caries. Total number of decayed filled teeth (dft) was used to assess caries severity in the 6 years group while the DMFT was used to assess severity of dental caries at the 12 and 15 years age group.

Results: The caries prevalence was 85.77% in the 6 years group, 64.98% in the 12 years group, and 71.35% in the 15 years group. Mean dft was 1.4 (SD ± 1.1). The mean DMFT was 1.72 (SD ± 0.49) at 12 years and 2.66 (SD ± 0.55) at 15 years. Both caries rate and severity were higher in rural areas than urban areas although the differences were not statistically significant.

Conclusion: The results of this study suggest that the prevalence and severity of dental caries in Saudi Arabia remain high, when compared to global averages.

Advancement Of Teledentistry At The University Of Rochester's Eastman Institute For Oral Health

Dental caries is the most prevalent infectious disease among US children. National surveys have shown that poor and minority-group children are not only disproportionately affected by dental caries but also have limited access to oral health care. Following successful exploratory applications of both synchronous and asynchronous models at the Eastman Institute for Oral Health, teledentistry has been demonstrated to be a practical and cost-effective way to improve oral health care for rural and disadvantaged children. These models support the role of teledentistry in reducing the costs of and barriers to accessing oral health care, improving oral health outcomes, increasing use of oral health care resources, and leading to the establishment of a dental home for underserved children. The advancement of teledentistry underscores the need for its integration with local, regional, and national telehealth programs and the role of policy makers in establishing a balanced framework for teledentistry within the overarching health care system.

Children's Oral Health and Academic Performance: Evidence of a Persisting Relationship Over the Last Decade in the United States

OBJECTIVE

To assess the association between children's oral health and academic performance using the most recent US national data, a decade after the last assessment using similar previous data.

STUDY DESIGN

Data from the 2016-2017 National Survey of Children's Health for 45 711 children aged 6-17 years were analyzed. Children's oral health measures were indicators of specific oral health problems and parent-rated oral health. Academic performance measures included problems at school and missing school days. Regression models were employed adjusting for relevant demographic, socioeconomic, and health characteristics and state effects. Analyses also were conducted stratifying by child's age, sex, household income, and type of health insurance.

RESULTS

We found significant associations across all the evaluated academic outcomes and oral health measures. Children with oral health problems were more likely to have problems at school (OR 1.56, 95% CI 1.32-1.85), miss at least 1 school day (OR 1.54, 95% CI 1.28-1.85), and miss more than 3 or 6 school days (OR 1.39, 95% CI 1.20-1.61 and OR 1.39, 95% CI 1.14-1.69; respectively). These associations were generally larger when using the child's oral health rating. Poor oral health was consistently related to worse academic performance across age, sex, household income, and health insurance type subgroups.

CONCLUSIONS

Children's oral health status continues to be strongly linked to their academic outcomes. This evidence highlights the need for broad population-wide policies and integrated approaches to reduce academic deficits and promote children's health and development, of which oral health is an important component.

Changes in Older Adults' Oral Health and Disparities: 1999 to 2004 and 2011 to 2016

OBJECTIVES

To examine changes in tooth loss and untreated tooth decay among older low-income and higher-income US adults and whether disparities have persisted.

DESIGN

Sequential cross-sectional study using nationally representative data.

SETTING

The 1999 to 2004 and 2011 to 2016 National Health and Nutrition Examination Survey.

PARTICIPANTS

Noninstitutionalized US adults, aged 65 years and older (N = 3539 for 1999-2004, and N = 3514 for 2011-2016).

MEASUREMENTS

Differences in prevalence of tooth loss (having 19 teeth or fewer, 8 teeth or fewer, and no teeth) and untreated decay and mean number of decayed and missing teeth (DMT) between low- and high-income adults 65 years and older in each survey and changes between surveys. Adjusted prevalence and count outcomes were estimated with logistic and negative binomial regression models, respectively. Models controlled for sociodemographic characteristics and smoking status. Reported findings are significant at P < .05.

RESULTS

In 2011 to 2016, unadjusted prevalence of having 19 teeth or fewer, 8 teeth or fewer, no teeth, and untreated decay among low-income adults 65 years and older was 50.6%, 42.0%, 28.6%, and 28.6%, respectively. Multivariate analyses indicated that although most tooth loss measures improved between surveys for both income groups, tooth loss among low-income adults remained at almost twice that among higher-income adults. The disparity in untreated decay prevalence in 2011 to 2016, 15.2 percentage points (26.1% vs 10.9% for low vs high income) was twice that in 1999 to 2004, 8.5 percentage points (22.9% vs 14.4% for low vs high income). DMT decreased for both groups, with lower-income adults having about five more affected teeth in both surveys.

CONCLUSION

Tooth loss is decreasing, but differential access to restorative care by income appears to have increased.

Use of the consolidated framework for implementation research to assess determinants of silver diamine fluoride implementation in safety net dental clinics

OBJECTIVES

In the United States, silver diamine fluoride (SDF) is a relatively new, quick, and low-cost method for arresting dental caries. This study's purpose was to identify determinants of the implementation of an SDF protocol for pediatric patients in three safety net clinics to inform future efforts to implement the protocol.

METHODS

We familiarized dental personnel with the SDF protocol through on-site education and feedback sessions. Two months after the educational sessions, we conducted focus groups with a total of eight dentists and 21 staff across three North Carolina safety net dental clinics: a private nonprofit healthcare network, a community health center, and a county health department. We used the Consolidated Framework for Implementation Research (CFIR) to understand determinants of implementation of the protocol.

RESULTS

Determinants of SDF protocol implementation included SDF protocol characteristics (e.g., source of protocol and its ease of use and adaptability, relative advantage compared to alternatives, low cost), characteristics of the outer setting or the dental clinic's environment (e.g., patient needs), inner setting or dental clinics' characteristics (e.g., culture of safety net clinic, leadership engagement), characteristics of dental personnel (e.g., concerns were alleviated by the training and having the protocol), and process characteristics (e.g., training and technical assistance from a reliable source). Overall, implementation was less successful in clinics with less leadership engagement and turnover of dental personnel who did not receive the training.

CONCLUSIONS

The determinants of SDF protocol implementation identified in this study will be useful to guide future efforts to implement the SDF protocol.

Health insurance and education: major contributors to oral health inequalities in Colombia

BACKGROUND

Health inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict.

METHODS

Using data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively).

RESULTS

A general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas.

CONCLUSION

Health insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage.

Awareness Among US Adults of Dental Sealants for Caries Prevention

INTRODUCTION

Dental sealants applied in childhood can help prevent caries, but knowledge of the availability of sealants and their function is not widespread. We assessed knowledge of dental sealants among US adults and adult parents of children younger than 18 and the differences in knowledge among demographic and socioeconomic groups.

METHODS

We used data on 3,550 respondents to the 2015 FallStyles B survey of noninstitutionalized US adults aged 18 or older. Authors constructed estimates by using weights provided to reflect the distribution of the US population. Knowledge of dental sealants was assessed by sex, age, race/ethnicity, education, household income, and parental status. Multivariate analysis was conducted by using a main effects logistic regression model.

RESULTS

Overall, 46.3% of adults and 55.1% of parents of children younger than 18 had knowledge of dental sealants. Sealant knowledge was highest among parents, women, respondents aged 45 to 59, and respondents with incomes greater than 200% of the federal poverty level and more than a high school education. Non-Hispanic blacks had less than half the odds of non-Hispanic whites of having knowledge of sealants (adjusted odds ratio [OR] = 0.4), and nonparents had half the odds as parents (OR = 0.5) of knowing. The strongest predictors of parental sealant knowledge were race/ethnicity, sex, and income.

CONCLUSION

Disparities in sealant knowledge correspond to disparities in sealant prevalence. Increasing knowledge among low-income and racial/ethnic minority parents could reduce disparities in sealant prevalence and untreated caries.

Increased Dental Use May Affect Changes in Treated and Untreated Dental Caries in Young Children

INTRODUCTION

From 1999-2004 to 2011-2014, untreated dental caries prevalence decreased among US children aged 2 to 5 y, regardless of family income. Policies were concurrently initiated for children to increase access to preventive dental services in dental, primary, and community settings and to restorative care in dental settings.

OBJECTIVES

We aimed to examine 1) whether changes in prevalence and severity of untreated and treated caries between the periods varied by family income and 2) to what degree increased past-year dental visit (PYDV) contributed to the changes.

METHODS

We used data for 3,822 children in the National Health and Nutrition Examination Survey 1999 to 2004 and 2011 to 2014. Caries prevalence included prevalence of untreated caries with ≥1 decayed teeth (dt) and prevalence of treated caries with ≥1 filled teeth (ft). Caries severity included number of dt and ft among those with ≥1 dt or ft. We estimated changes in caries outcomes among low- and higher-income children with models-one controlling for sociodemographics and another controlling for sociodemographics and PYDV. Significant changes ( P < 0.05) becoming insignificant after controlling for PYDV provide insight on the contribution of PYDV to changes in outcomes.

RESULTS

Prevalence of untreated caries decreased for low- and higher-income children, with a slightly larger decrease for low-income children; dt decreased only for low-income children; and estimated decreases did not vary by model. An increase in prevalence of treated caries was observed only among low-income children but became minimized and insignificant after controlling for PYDV. Similarly, after controlling for PYDV, the increase in ft among low-income children lost significance, whereas the increase among higher-income children remained.

CONCLUSION

Untreated caries among children aged 2 to 5 y declined from 1999-2004 to 2011-2014, with larger declines among low-income children. While changes in PYDV contributed to increases in treated caries, particularly for low-income children, additional factors appear to have contributed to decreased untreated caries.

KNOWLEDGE TRANSFER STATEMENT

For young children, the degree and direction of changes in caries over the last decade varied by outcome measure (e.g., untreated or treated) and family poverty status. Examining the effect of increased dental utilization on changes in untreated and treated caries outcomes can help identify those policies that contribute to changes in these outcomes and highlight the potential role of the different caries assessment criteria used in dental offices versus those in a population-based survey.

Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis

Aim

The objective of the present systematic review was to assess the outcomes of Hall technique (HT) on primary carious molars and compared it with the conventional dental restorations.

Materials and methods

The systematic review was registered with Prospero registry (CRD42015020445) to answer the following research question: Is HT a better restorative option compared to other techniques for restoration of carious primary molars? In addition to exploring various health sciences databases, hand search was also done using following key terms in different permutations: (Hall technique OR Hall's technique OR preformed metal crown OR stainless steel crown) AND (caries OR carious molar OR deciduous tooth OR baby tooth OR milk tooth OR primary tooth). The outcome of interest was success of the restoration achieved with either method.

Results

Five studies were included (two RCTs, one quasi-experimental trial, and two retrospective). A total of 1775 teeth were assessed, of which 1325 teeth were restored using HT. The retrospective studies showed no difference between HT and other methods whereas the RCTs and quasi-experimental favored HT over other treatment modalities. Meta-analysis significantly favored HT over conventional restorations [risk ratio 5.55 (3.31–9.30)] (p value ≤ 0.001).

Conclusion

HT appeared demonstrated higher success and significantly outperformed the conventional restorations.

How to cite this article

Badar SB, Tabassum S, Khan FR, et al. Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2019;12(5):445–452.

Implementation of Oral Health Screening and Referral Guidelines in Primary Health Care

Objectives:

To determine the oral health screening and referral practices of pediatric providers, their adherence to American Academy of Pediatrics oral health guidelines, and barriers to adherence.

Methods:

Providers in 10 pediatric practices participating in the North Carolina Quality Improvement Initiative, funded by the Child Health Insurance Program Reauthorization Act of 2009, were asked to complete a 91-item questionnaire. Questions on risk assessment and referral practices were based on those recommended by the American Academy of Pediatrics. Adherence to oral health guidelines was assessed by practitioners’ evaluation of 4 vignettes presenting screening results for an 18-mo-old child with different levels of risk and caries status. Respondents chose referral recommendations assuming adequate and inadequate dentist workforces. Logit models determined the association between barriers specified in Cabana’s framework and adherence (count of 6 to 8 adherent vignettes vs. 0 to 5).

Results:

Of 72 eligible providers, 53 (74%) responded. Almost everyone (98.1%) screened for dental problems; 45.2% referred in at least half of well-child visits. Respondents were aware of oral health guidelines, expressed strong agreement with them, and reported confidence in providing preventive oral health services. Yet they underreferred by an average of 42% per vignette for the 7 clinical vignette-workforce scenarios requiring an immediate referral. Frequently cited barriers were providers’ beliefs that 1) parents are poorly motivated to seek dental care, 2) oral health counseling has a small effect on parent behaviors, 3) there is a shortage of dentists in their community who will see infants and toddlers, and 4) information systems to support referrals are insufficient.

Conclusion:

Pediatric clinicians’ beliefs lead to a conscious decision not to refer many patients, even when children should be referred.

Knowledge Transfer Statement:

Evidence suggests that the primary care–dental referral process needs improvement. This study identifies barriers to delivering recommended preventive oral health services in pediatrics. The information can be used to improve the screening and referral process and, thus, the quality of preventive oral health services provided in primary care. Results also can guide researchers on the selection of interventions that need testing and might close gaps in the referral process and improve access to dental care.

Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in Public Housing

INTRODUCTION

Caries experience among preschool-age children has remained relatively unchanged for the past 2 decades, despite recently documented decreases in untreated decay.

OBJECTIVES

In a community-based cluster-randomized controlled trial, a motivational interviewing (MI) intervention administered to primary caregivers was hypothesized to reduce caries increment over 2 y as compared with controls, among children aged 0 to 5 y at baseline living in public housing.

METHODS

Public housing residents, who served as interventionists, were trained in MI with a focus on early childhood caries prevention. All 26 eligible public housing developments were randomized to either control (quarterly clinical examinations, fluoride varnish applications, toothbrush/toothpaste, and educational brochures) or intervention (same procedures as control plus MI counseling). Quarterly MI sessions were delivered in English or Spanish over 2 y, audio recorded, and assessed for treatment fidelity. The primary outcome was the increment in dmfs (decayed, missing, and filled tooth surfaces) as assessed by clinical examination at baseline, 12 mo, and 24 mo. Secondary outcomes included caregiver oral health knowledge and child oral health behaviors (child toothbrushing and sugar-sweetened beverage intake). Baseline characteristics were compared between groups and adjusted for housing-site clusters. Longitudinal outcomes were analyzed with mixed models.

RESULTS

A total of 1,065 children (49% female, 55% non-White, 61% Hispanic, 89% below poverty level, n = 686 control) and their caregivers were enrolled. During 2 y of follow-up, the mean dmfs increment increased in both groups; however, there were no statistically significant group differences at 24 mo or group × time interactions. The mean increase in intervention caregivers' knowledge was significantly greater than that of control, F(2, 1,593) = 3.48, P = 0.0310, but there were no significant intervention effects on caregiver-reported child sugar-sweetened beverage intake or child toothbrushing.

CONCLUSION

MI counseling plus intensive caries prevention activities resulted in knowledge increases but did not improve oral health behaviors or caries increment (ClinicalTrials.gov NCT01205971).

KNOWLEDGE TRANSFER STATEMENT

When viewed in light of the findings from the companion Pine Ridge study and other recent MI studies, the results of this study suggest that when the complex disease of early childhood caries is addressed in high-risk populations, MI is not effective, and alternative approaches are warranted.

The Burden and Management of Dental Caries in Older Children

Dental caries is endemic in children and adolescents and has significant morbidity. This complex and chronic disease has both genetic and environmental etiologic factors. In children the preponderance of caries affects tooth surfaces with pits and fissures despite these representing only a small portion of the tooth surfaces that are at risk. Pit and fissure sealants are effective in preventing and managing noncavitated caries lesions in these surfaces. A variety of materials are clinically effective, and health care guidelines recommend the use of pit and fissure sealants as part of a comprehensive dental caries prevention program.

Infant Oral Health

It may be easy to discount oral health in infancy because most infants are not born with teeth and only a few teeth erupt during the first year of life. Infancy, however, is a critical time for formation of habits. Positive habits, such as twice-daily brushing with fluoride toothpaste starting at first teeth eruption, provides topical fluoride, which is important for remineralization of the tooth and helps establish a lifelong healthy practice. Negative habits, such as bottle propping and frequent juice consumption, reinforce behaviors that promote caries and obesity. This article reviews normal dental development and eruption. Congenital anomalies affecting the mouth as well as acquired conditions, primarily dental caries, are reviewed. Oral health preventive modalities, including professionally applied products and home-based strategies, are discussed.

Oral Health Disparities in Children: A Canary in the Coalmine?

Despite being largely preventable, oral diseases are still a major public health problem in child populations in many parts of the world. Increasingly, however, oral diseases disproportionately affect socially disadvantaged groups in society. It is unjust and unfair that children and families from disadvantaged backgrounds experience high levels of oral diseases. This article analyzes oral diseases through a health disparities lens. Action to combat oral health disparities requires a radical multifaceted strategy that addresses the shared underlying root causes of oral diseases, the social determinants of health inequality.

Disparities in Receipt of Preventive Dental Services in Children From Low-Income Families

INTRODUCTION

Healthy People 2020 includes a goal of increasing use of preventive dental care among children from low-income families. The services used to define preventive care are evidence-based services (i.e., dental sealants and professionally applied topical fluoride) and professional dental cleaning, which lacks evidence of effectiveness in preventing caries. This study examined how increasing preventive dental care use and reducing disparities by race/ethnicity among children from low-income families varied by the services included in case definitions of preventive dental care use.

METHODS

Three case definitions of past-year preventive dental care use were considered: (1) the Healthy People 2020 definition; (2) receipt of an evidence-based caries prevention service; and (3) dental cleaning only. Using pooled data from the 2001-2002 and 2013-2014 Medical Expenditure Panel Survey for each definition, this study conducted in 2017 used multivariate logistic regression to estimate changes in preventive dental care use among children from low-income families by race/ethnicity.

RESULTS

Use increased for all racial/ethnic groups for all definitions. Use of preventive dental care (Healthy People 2020 definition), however, was at least two times higher than evidence-based preventive dental use for all racial/ethnic groups in both survey periods. After controlling for insurance status and parental education, the disparity between non-Hispanic black and non-Hispanic white children in use of preventive dental care that was present in 2001-2002 was not detected in 2013-2014 whereas the disparity for evidence-based preventive dental care use persisted.

CONCLUSIONS

Case definitions of preventive dental care that include non-evidence-based services may overstate receipt of effective preventive dental care and reductions in certain racial/ethnic disparities.

Association between type of health insurance and children's oral health, NHANES 2011-2014

OBJECTIVES

To examine the association between type of health insurance (public, uninsured, private, or other) and oral health outcomes for children in the United States using nationally representative surveillance data.

METHODS

Using the National Health and Nutrition Examination Survey (2011/12-2013/14), logistic regression models were used to estimate the odds of any dental caries and any untreated caries by type of health insurance (public, uninsured, private, and other) for children aged 2-19 years, with adjustment for relevant individual and socioeconomic characteristics.

RESULTS

Among 6,057 children, the odds of having any dental caries or untreated caries was not significantly different for publicly insured and uninsured children compared to privately insured children, when adjusting for family income and education. Children in families with income to poverty ratios <200 percent had greater odds of caries and untreated caries relative to children in families with income to poverty ratios ≥400 percent. Children with less educated parents also experienced greater odds of caries and untreated caries.

CONCLUSIONS

Oral health outcomes, after adjusting for covariates, were similar for children with public and private health insurance. However, children in low-income families and with less educated parents had greater odds of untreated caries and dental caries, suggesting that initiatives focused on publicly insured populations may miss other vulnerable children of low socioeconomic status.

Oral Health Knowledge and Practices of Pediatric and Family Nurse Practitioners

INTRODUCTION

The purpose of the study was to assess the relationship between oral health educational activities of NPs and their current oral health knowledge and practices.

METHOD

An online survey was distributed to practicing NPs and members of the NAPNAP organization.

RESULTS

The study results from n = 147 NPs indicated an association between oral health CE attendance and knowledge on the age to initiate fluoride toothpaste, age for an initial dental visit, as well as NPs comfort in educating about oral hygiene, diets to reduce caries, bacterial transmission and caries development, in addition to the NPs comfort in performing a risk assessment, oral exam, and identifying decay and other oral pathology compared to NPs that had not attended a CE course.

DISCUSSION

The study findings demonstrate the importance of CE courses for NPs on the latest oral health guidelines and practices beyond their traditional academic education, in order to improve oral health outcomes among children.

Water Fluoridation and Dental Caries in U.S. Children and Adolescents

Fluoridation of America's drinking water was among the great public health achievements of the 20th century. Yet there is a paucity of studies from the past 3 decades investigating its dental health benefits in the U.S.

POPULATION

This cross-sectional study sought to evaluate associations between availability of community water fluoridation (CWF) and dental caries experience in the U.S. child and adolescent population. County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention's Water Fluoridation Reporting System were merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014). Dental caries experience in the primary dentition (decayed and filled tooth surfaces [dfs]) was calculated for 7,000 children aged 2 to 8 y and in the permanent dentition (decayed, missing, and filled tooth surfaces [DMFS]) for 12,604 children and adolescents aged 6 to 17 y. Linear regression models estimated associations between % CWF and dental caries experience with adjustment for sociodemographic characteristics: age, sex, race/ethnicity, rural-urban location, head-of-household education, and period since last dental visit. Sensitivity analysis excluded counties fluoridated after 1998. In unadjusted analysis, caries experience in the primary dentition was lower in counties with ≥75% CWF (mean dfs = 3.3; 95% confidence limit [CL] = 2.8, 3.7) than in counties with <75% CWF (mean dfs = 4.6; 95% CL = 3.9, 5.4), a prevented fraction of 30% (95% CL = 11, 48). The difference was also statistically significant, although less pronounced, in the permanent dentition: mean DMFS (95% CL) was 2.2 (2.0, 2.4) and 1.9 (1.8, 2.1), respectively, representing a prevented fraction of 12% (95% CL = 1, 23). Statistically significant associations likewise were seen when % CWF was modeled as a continuum, and differences tended to increase in covariate-adjusted analysis and in sensitivity analysis. These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.

Oral Health Disparities Across the Life Span

Despite improvements in the oral health status of the US population as a whole, a disproportionately higher burden of oral diseases and disorders are borne by those individuals from low-income and racial and ethnic minority groups. These differences in health status, health outcomes, or health care use between distinct socially disadvantaged and advantaged groups are well documented and known as health disparities. It is vital that members of the dental profession understand the distribution of oral health and disease across different populations and the life span and participate in developing innovative and sustainable approaches to eliminate oral health disparities.

Disparities in untreated caries among children and adults in the U.S., 2011-2014

Background

The Affordable Care Act of 2010 increased dental coverage for children in the United States, (U.S.) but not for adults. Few studies in current scholarship make use of up-to-date, nationally representative data to examine oral health disparities in the U.S. population. The purpose of this study is to use nationally representative data to determine the prevalence of untreated caries among children and adults of different socioeconomic and racial/ethnic groups and to examine the factors associated with untreated caries among children and adults.

Methods

This study used the 2011–2014 National Health and Nutrition Examination Survey (NHANES) demographic, oral health questionnaire, and oral health dentition examination data (n = 7008 for children; n = 9673 for adults). Participants that had a standardized oral health examination and at least one natural primary or permanent tooth considering 28 tooth spaces were included in this study. Our main outcome measure was untreated coronal caries defined as decay on the crown or enamel surface of a tooth that had not been treated or filled. Population estimates were calculated to determine the prevalence of untreated caries among children and adults in the United States. Frequencies and Pearson’s chi-square tests were used to compare those with and without untreated caries. Multivariate logistic regression models were used to evaluate the factors associated with untreated caries. We conducted analyses among children and adults separately.

Results

From 2011 to 2014, 12.4 million children and 57.6 million adults in the United States had untreated caries. Age, family income level, recent dental visit, and financial and non-financial barriers were significantly associated with untreated caries in both children and adults. Race/ethnicity, gender and education level were also significantly associated with untreated caries among adults. The odds of untreated caries associated with financial barriers were 2.06 for children and 2.84 for adults while the odds of untreated caries associated with non-financial barriers were 2.86 for children and 1.67 for adults.

Conclusions

Demographic and socio-economic disparities in untreated caries exist among children and adults.

Correlation with Caries Lesion Depth of The Canary System, DIAGNOdent and ICDAS II

Introduction:

The aim of this study was to correlate lesion depth of natural caries, measured with Polarized Light Microscopy (PLM), to Canary Numbers (CN) derived from The Canary System™ (CS), numerical readings from DIAGNOdent (DD), and lesion scores from ICDAS II.

Methods:

A total of 20 examination sites on extracted human molars and premolars were selected. The selected examination sites consisted of healthy and enamel caries on smooth and occlusal surfaces of each tooth. Two blinded dentists ranked each examination site using ICDAS II and the consensus score for each examined site was recorded. The same examination sites were scanned with CS and DD, and the CN and DD readings were recorded. After all the measurements were completed, the readings of the three caries detection methods were validated with a histological method, Polarized Light Microscopy (PLM). PLM performed by blinded examiners was used as the ‘gold standard’ to confirm the presence or absence of a caries lesion within each examined site and to determine caries lesion depth.

Results:

Pearson’s coefficients of correlation with caries lesion depth of CNs, DD readings and ICDAS scores were 0.84, 0.21 and 0.77, respectively. Mean ± SD CN for sound sites (n=3), caries lesion depths <800 µm (n=11), and caries lesion depths >800 µm (n=6) were 11±1, 55±15, and 75±22, respectively. Mean ± SD DD readings for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 1±1, 7±11, and 8±9, respectively. Mean ± SD ICDAS II scores for sound sites, caries lesion depths <800 µm, and caries lesion depths >800 µm were 0±0, 2±1, and 2±1, respectively. The intra-operator repeatability for the Canary System was .953 (0.913, 0.978).

Conclusion:

This study demonstrated that the CS exhibits much higher correlation with caries lesion depth compared to ICDAS II and DD. CS may provide the clinician with more information about the size and position of the lesion which might help in monitoring or treating the lesion.

The present extracted tooth study found that The Canary System correlates with caries lesion depth more accurately that ICDAS II and DIAGNOdent.

Two decades of persisting income-disparities in dental caries among U.S. children and adolescents

OBJECTIVE

To describe trends in income disparities in dental caries among U.S. children and adolescents during two decades of fluctuating economic growth.

METHODS

Data were from National Health and Nutrition Examination Surveys conducted in 1988-1994, 1999-2004, and 2011-2014. The number of tooth surfaces with dental caries experience per child was computed for three age groups: 2-5, 6-11, and 12-17 years. Absolute and relative measures of inequality compared caries experience in families below the poverty level with families where income was at least three times the poverty threshold.

RESULTS

Conspicuous, inverse income gradients in dental caries were observed at each time period and in each age group. However, there was no consistent trend or statistically significant change in the degree of inequality between survey periods.

CONCLUSIONS

Persisting income disparities in dental caries among U.S. children and adolescents challenge public health dentistry to redouble efforts to redress the inequity.

Two decades of persisting income-disparities in dental caries among U.S. children and adolescents

OBJECTIVE

To describe trends in income disparities in dental caries among U.S. children and adolescents during two decades of fluctuating economic growth.

METHODS

Data were from National Health and Nutrition Examination Surveys conducted in 1988-1994, 1999-2004, and 2011-2014. The number of tooth surfaces with dental caries experience per child was computed for three age groups: 2-5, 6-11, and 12-17 years. Absolute and relative measures of inequality compared caries experience in families below the poverty level with families where income was at least three times the poverty threshold.

RESULTS

Conspicuous, inverse income gradients in dental caries were observed at each time period and in each age group. However, there was no consistent trend or statistically significant change in the degree of inequality between survey periods.

CONCLUSIONS

Persisting income disparities in dental caries among U.S. children and adolescents challenge public health dentistry to redouble efforts to redress the inequity.