Progression of dental caries and tooth loss between the third and fourth decades of life: a birth cohort study

Association between Age at First Birth and Long-Term Dental Caries Experience among Women in the United States

Background: Pregnant women are at a higher risk of caries compared to nonpregnant women, and higher parity is a risk factor for untreated caries and tooth loss. However, it is unknown whether the timing of birth is associated with dental caries experience over time. Materials and Methods: This study is a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES), 2011-2018. The study population included nonpregnant women 20 years of age or older, who had available data on the oral health examination and age at first birth (AFB). Dental caries experience was defined as the DMFT score (sum of the number of decayed, missing due to caries, and filled permanent teeth). The associations between AFB and DMFT scores were assessed using Poisson regression to compute incidence rate ratios (IRRs) and the associated 95% confidence intervals (CIs). Results: This study included 6,553 women (mean age 53.4 years, SD 15.7). The mean DMFT index score was 13.1 ± 7.4, with younger AFB groups generally having higher mean scores. After adjusting for sociodemographic variables, time since last dental visit, and reproductive health factors, women with an AFB of <18 years (IRR, 1.10; 95% CI, 1.01-1.21) or 18-20 years (IRR, 1.11; 95% CI, 1.01-1.21) had significantly higher DMFT index scores compared to those with an AFB of 30-32 years. Conclusions: This study suggests that younger maternal AFB may be associated with greater dental caries experience. More rigorous studies are necessary to determine how to improve oral health outcomes during pregnancy and postpartum.

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation

Background

Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults.

Objective

To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design.

Design

Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data.

Setting

National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services.

Participants

Dental patients aged 12 years and over living in England (n = 6,370,280).

Intervention and comparison

Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores.

Outcome measures

Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment.

Data sources

National Health Service Business Services Authority dental claims data. Water quality monitoring data.

Primary outcome

Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful.

Secondary outcomes

Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices).

Limitations

Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes.

Conclusions

Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.

Future work

National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted.

Trial registrations

This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

Caries Experience and Risk Indicators in a Portuguese Population: A Cross-Sectional Study

Oral health surveys are essential for assessing the dental caries experience and to influence national policies. This retrospective cross-sectional study aims to analyze dental caries experience for which dental treatment was sought in a reference university dental hospital at the Lisbon Metropolitan Area between January 2016 and March 2020. Full-mouth examination, and sociodemographic, behavior, and medical information were included. Descriptive analyses and logistic regression analysis were applied to ascertain risk indicators associated with dental caries experience. A final sample of 9349 participants (5592 females/3757 males) were included, aged 18 to 99 years old. In this population, caries experience was 91.1%, higher in female participants. Age (OR = 1.01, 95% CI [1.00-1.02], occupation (OR = 2.94, 95% CI [2.37-3.65], OR = 3.35, 95% CI [2.40-4.67], OR = 2.55, 95% CI [1.66-3.91], for employed, unemployed, and retired, respectively), overweight (OR = 1.52, 95% CI [1.18-1.96]), reporting to have never visited a dentist (OR = 0.38, 95% CI [0.23-0.64], and self-reported week teeth status (OR = 2.14, 95% CI [1.40-3.28]) were identified as risk indicators for the presence of dental caries, according to adjusted multivariable logistic analyses. These results highlight a substantial rate of dental experience in a Portuguese cohort and will pave the way for future tailored oral public health programs in Portugal.

Association Between Oral Health and Frailty in Older Korean Population: A Cross-Sectional Study

Purpose

Frailty is closely associated with biological age, concurrent medical conditions, morbidity, and decreased survival. Poor oral health is common in older individuals and is associated with frailty. Considering its potential importance, a study on the association between oral health and frailty is meaningful. Therefore, we aimed to analyze the association between major oral health factors and frailty using nationally representative samples of older adults.

Patients and Methods

This cross-sectional study included 3018 older adults (age ≥ 65 years) from the seventh Korea National Health and Nutrition Examination Survey. Oral examination results, laboratory data, handgrip strength, life style factors derived from questionnaires, and food intake survey results were analyzed. This study used the deficit accumulation model among the main operational definitions of frailty. We constructed a frailty index based on 36 items and classified participants as non-frail, pre-frail, or frail. Oral health factors included chewing difficulty, number of teeth, periodontal disease, and number of carious teeth. Logistic regression analysis was performed to determine significant factors.

Results

A total of 1222 (40.5%), 1014 (33.6%), and 782 (25.9%) individuals were classified as non-frail, pre-frail, and frail, respectively. Chewing difficulty was associated with increased risk of frailty after adjusting for age, sex, socioeconomic factors, and comorbidities (odds ratio 2.68, 95% confidence interval 2.08-3.44). Periodontal disease was positively associated with chewing difficulty (odds ratio 1.29, 95% confidence interval 1.07-1.56), and chewing difficulty decreased as the number of teeth increased (odds ratio 0.97, 95% confidence interval 0.96-0.99).

Conclusion

Chewing difficulty was significantly associated with frailty in the older population. Considering the negative effect of chewing difficulty on frailty, more attention should be focused on oral health.

Caries detection with tooth surface segmentation on intraoral photographic images using deep learning

BACKGROUND

Intraoral photographic images are helpful in the clinical diagnosis of caries. Moreover, the application of artificial intelligence to these images has been attempted consistently. This study aimed to evaluate a deep learning algorithm for caries detection through the segmentation of the tooth surface using these images.

METHODS

In this prospective study, 2348 in-house intraoral photographic images were collected from 445 participants using a professional intraoral camera at a dental clinic in a university medical centre from October 2020 to December 2021. Images were randomly assigned to training (1638), validation (410), and test (300) datasets. For image segmentation of the tooth surface, classification, and localisation of caries, convolutional neural networks (CNN), namely U-Net, ResNet-18, and Faster R-CNN, were applied.

RESULTS

For the classification algorithm for caries images, the accuracy and area under the receiver operating characteristic curve were improved to 0.813 and 0.837 from 0.758 to 0.731, respectively, through segmentation of the tooth surface using CNN. Localisation algorithm for carious lesions after segmentation of the tooth area also showed improved performance. For example, sensitivity and average precision improved from 0.890 to 0.889 to 0.865 and 0.868, respectively.

CONCLUSION

The deep learning model with segmentation of the tooth surface is promising for caries detection on photographic images from an intraoral camera. This may be an aided diagnostic method for caries with the advantages of being time and cost-saving.

Real-world evidence of the impact of obesity on residual teeth in the Japanese population: A cross-sectional study

BACKGROUND

Tooth loss is associated with nutritional status and significantly affects quality of life, particularly in older individuals. To date, several studies reveal that a high BMI is associated with tooth loss. However, there is a lack of large-scale studies that examined the impact of obesity on residual teeth with respect to age and tooth positions.

OBJECTIVE

We assessed the impact of obesity on the number and position of residual teeth by age groups using large scale of Japanese database.

METHODS

This was a cross-sectional study of 706150 subjects that were included in the database that combined the data from health insurance claims and health check-up, those lacking information about BMI, HbA1c level, smoking status, and the number of residual teeth were excluded. Thus, a total of 233517 aged 20-74 years were included. Subjects were classified into 4 categories based on BMI, and the number of teeth was compared between age-groups. The percentage of subjects with residual teeth in each position was compared between groups with obesity (BMI ≥25.0 kg/m2) and non-obesity. Logistic regression analysis was performed to clarify whether obesity predicts having <24 teeth.

RESULTS

Higher BMI was associated with fewer teeth over 40s (P for trend <0.0001 when <70s). Obesity was associated with the reduction of residual teeth in the maxillary; specifically, the molars were affected over the age 30. Smoking status further affected tooth loss at positions that were not affected by obesity alone. After adjusting for age, sex, smoking status, and HbA1c ≥6.5%, obesity remained an independent predictive factor for having <24 teeth (ORs: 1.35, 95% CIs: 1.30-1.40).

CONCLUSIONS

We found that an increase in BMI was associated with a decrease in the number of residual teeth from younger ages independently of smoking status and diabetes in the large scale of Japanese database.

Profiles of sugar fermenting bacteria of the oral cavity among children with dental caries attending stomatology services at Ruhengeri referral hospital in Musanze District, Northern Rwanda

BACKGROUND

Dental caries remains a public health threat of concern among children. About 2.3 billion people are affected by dental caries, of which 530 million are children globally.

OBJECTIVE

This study was carried out to identify sugar fermenting bacteria in the oral cavity and their antibiotic susceptibility pattern, assess the association with sugar fermenter bacteria and dental caries and evaluate dental caries outcomes among children.

MATERIALS AND METHODS

This was a cross-sectional study conducted between October 2021 and February 2022 at Ruhengeri Referral Hospital. About 136 oral swab samples were collected from children with and without dental caries at 1:1 ratio. The samples were put in Stuart sterile container and transported to INES-clinical microbiology laboratory for microbial identification. Logistic regression analysis of demographic characteristics was performed to study the relationship between demographic variables and dental caries. Chi-square test was performed for the association between variables.

RESULTS

About 67.6% were male, while children of age 7-9 years (64.7%) dominated the age groups. Lactobacilli spp (15.29%) and Streptococcus mutans (12.94%) were the most predominant microorganisms observed in the oral cavity among children with dental caries. The S. mutans (x² = 27.03, P < 0.00001, 95% confidence interval [CI]=0.2901-0.5785), S. aureus (x² = 34.59, P < 0.00001, 95% CI = 0.3541-0.6292), Enterobacter aerogenes (x² = 13.5, P = 0.000239, 95% CI = 0.151-0.4622), Serratia marcescens (x² = 11.64, P = 0.00645, 95% CI = 0.1275-0.4418) and Klebsiella pneumonia (x² = 13.51, P = 0.000237, 95% CI = 0.1511-0.4623) were significantly associated with dental caries. Teeth loss (x² = 51.04, P < 0.00001, 95% CI = 0.4757-0.7205), teeth pain (x² = 5.05, P = 0.0246, 95% CI = 0.0249-0.33499), and infection (x² = 4.73, P = 0.02964, 95% CI = 0.0186-0.3441) were dental outcomes associated with tooth decay. Ciprofloxacin, clindamycin, and amoxicillin were the most sensitive antibiotics, while vancomycin and chloramphenicol were the most resistant.

CONCLUSION

Sugar consumption favours the growth of sugar fermenter bacteria that cause dental caries among children. Dental caries is associated with adverse oral health outcomes among children. Oral health education is recommended for children. Parents are advised to reduce the consumption of sugary food for their children for oral health safety.

Association between type 2 diabetes (T2D) and tooth loss: a systematic review and meta-analysis

BACKGROUND

Several studies have assessed the relationship between type 2 diabetes (T2D) and tooth loss; however, results have been inconsistent. Therefore, the present systematic review and meta-analysis of observational studies was designed to examine the association between T2D and tooth loss.

METHODS

This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline. We searched all the relevant studies in international databases of Scopus, PubMed, ProQuest, Web of Science, Cochrane Library, and Google scholar search engine until February 2022. The heterogeneity of the studies was calculated using the I² index. Measure of effect and 95% confidence interval (CI) were extracted from each study. The results of the study were analyzed using the random effects model.

RESULTS

In the present study, 22 eligible studies were included. Meta-analysis of unadjusted and adjusted results showed that T2D significantly increased the risk of tooth loss, and Odds Ratio (OR) unadjusted was 1.87 (95% CI: 1.62-2.13, p < 0.001), and OR adjusted was 1.20 (95% CI: 1.10-1.30, p < 0.001), respectively. Subgroup analysis based on study design for adjusted OR indicated that in the cohort study (OR: 1.29, 95% CI: 1.07-1.51), in the cross-sectional study (OR: 1.15, 95% CI: 1.06-1.23), and in the case-control study (OR: 5.10, 95% CI: 1.01-9.18) there was a significant association between T2D and tooth loss. Other subgroups analyses showed consistent results and no publication bias existed.

CONCLUSIONS

The findings suggest that T2D is associated with increased risk of tooth loss. This conclusion may provide useful evidence for correlated clinical researches.

Predictors of tooth loss: A machine learning approach

Introduction

Little is understood about the socioeconomic predictors of tooth loss, a condition that can negatively impact individual’s quality of life. The goal of this study is to develop a machine-learning algorithm to predict complete and incremental tooth loss among adults and to compare the predictive performance of these models.

Methods

We used data from the National Health and Nutrition Examination Survey from 2011 to 2014. We developed multiple machine-learning algorithms and assessed their predictive performances by examining the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive values.

Results

The extreme gradient boosting trees presented the highest performance in the prediction of edentulism (AUC = 88.7%; 95%CI: 87.1, 90.2), the absence of a functional dentition (AUC = 88.3% 95%CI: 87.3,89.3) and for predicting missing any tooth (AUC = 83.2%; 95%CI, 82.0, 84.4). Although, as expected, age and routine dental care emerged as strong predictors of tooth loss, the machine learning approach identified additional predictors, including socioeconomic conditions. Indeed, the performance of models incorporating socioeconomic characteristics was better at predicting tooth loss than those relying on clinical dental indicators alone.

Conclusions

Future application of machine-learning algorithm, with longitudinal cohorts, for identification of individuals at risk for tooth loss could assist clinicians to prioritize interventions directed toward the prevention of tooth loss.

What factors are associated with early childhood dental caries? A longitudinal study of the Growing Up in New Zealand cohort

BACKGROUND

The relative importance of different strategies to prevent dental caries is not known.

AIM

We explored the relationship between oral health behaviours, diet, and the incidence of dental caries.

DESIGN

We conducted a study of children participating in the 'Growing Up in New Zealand' cohort. Exposures were oral health behaviours, a food frequency questionnaire, and sociodemographic characteristics that were recorded when the child was nine months and two years old. Outcomes were records of dental caries at ages four to seven years.

RESULTS

4111 children had dental examination records from between the ages of four and seven years. High levels of dental caries were reported in children of Pacific, Asian, and Māori ethnicity. Food frequency questionnaire information was summarised into two principal components. The major axis of variation was in the intake of food and drinks with high concentrations of sugar and refined starch, with this component strongly associated with caries (multivariable incidence rate ratio of caries 0.48; 95% confidence interval: 0.38-0.61, comparing the extreme quintiles of the first principal component).

CONCLUSIONS

A diet high in sugar or refined starch was strongly linked to caries. Policies to reduce sugar and refined starch intake should be considered.

How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

BACKGROUND

Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12.

METHODS/DESIGN

Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation.

DISCUSSIONS

There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.

Determinants of dental prosthetic treatment need: A birth cohort study

OBJECTIVES

To estimate the incidence of the need for a dental prosthesis during early adulthood and its association with socioeconomic and oral disorder trajectories.

METHODS

In 1982, in the city of Pelotas, all live births (n = 5914) and their mothers were assessed. A representative sample of this cohort study was examined for oral health conditions at 15, 24 and 31 years (Oral Health Study-OHS). The need for a dental prosthesis was assessed at 24 and 31 years of age, and variables of interest (gender, skin colour, socioeconomic status (SES), use of dental services, caries and periodontal disease) were collected from different waves of this cohort. Longitudinal association between outcome and variables of interest was assessed using multilevel mixed models.

RESULTS

A total of 539 individuals were assessed in 2013 (60.7% response rate). The need for a dental prosthesis was 28.9% at 24 years. (95% CI 24.9-33.2) and 49.0% at 31 years (95% CI 44.7-53.3). Risk of presenting with a need for a dental prosthesis was higher in users of public services. Downwardly mobile and lower SES trajectory groups presented a higher risk of the need for a dental prosthesis. High-risk caries trajectory group showed a higher risk of presenting with the need for a dental prosthesis from 24 to 31 years.

CONCLUSIONS

Our findings demonstrate that the need for dental prosthesis from 24 to 31 years old was determined by trajectories of exposure during the life cycle, reinforcing that tackling socioeconomic inequalities at any stage of life can have an effect on an individual's oral health.

Sugar-sweetened beverage consumption and caries experience: An examination of children and adults in the United States, National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

The authors' aim was to examine the association between sugar-sweetened beverage (SSB) consumption and the prevalence and severity of the caries experience in children and adults in the United States.

METHODS

The authors analyzed data obtained from 14,192 people aged 2 through 74 years, who participated in the National Health and Nutrition Examination Survey from 2011 through 2014. Using descriptive analyses, the authors assessed the distributions of sociodemographic characteristics overall and via SSB intake. The authors used multivariable logistic regression to estimate the association of untreated and severe untreated caries with SSB consumption in all age groups.

RESULTS

Across all ages, male participants were more likely than female participants to consume SSBs, and consumption was higher in non-Hispanic black and Hispanic populations. Relative to those who did not consume SSBs, people aged 20 through 44 years who consumed SSBs had significantly higher odds of having untreated caries (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04 to 1.55) and severe untreated caries (AOR, 1.36; 95% CI, 1.15 to 1.60). Adolescents aged 9 through 19 years had significantly higher odds of having untreated caries (AOR, 1.37; 95% CI, 1.05 to 1.80), and middle-aged adults (45-64 years) had significantly higher odds of severe untreated caries (AOR, 1.46; 95% CI, 1.10 to 1.92) relative to those who did not consume SSBs.

CONCLUSIONS

Consumption of SSBs was associated with increased caries experience among young children and increased risk of developing untreated caries in all age groups of children and adults. Continued efforts by policy makers, public health leaders, and clinicians to reduce consumption of SSBs across the life span are paramount.

Microbial biogeography and ecology of the mouth and implications for periodontal diseases

In humans, the composition of microbial communities differs among body sites and between habitats within a single site. Patterns of variation in the distribution of organisms across time and space are referred to as "biogeography." The human oral cavity is a critical observatory for exploring microbial biogeography because it is spatially structured, easily accessible, and its microbiota has been linked to the promotion of both health and disease. The biogeographic features of microbial communities residing in spatially distinct, but ecologically similar, environments on the human body, including the subgingival crevice, have not yet been adequately explored. The purpose of this paper is twofold. First, we seek to provide the dental community with a primer on biogeographic theory, highlighting its relevance to the study of the human oral cavity. We summarize what is known about the biogeographic variation of dental caries and periodontitis and postulate that disease occurrence reflects spatial patterning in the composition and structure of oral microbial communities. Second, we present a number of methods that investigators can use to test specific hypotheses using biogeographic theory. To anchor our discussion, we apply each method to a case study and examine the spatial variation of the human subgingival microbiota in 2 individuals. Our case study suggests that the composition of subgingival communities may conform to an anterior-to-posterior gradient within the oral cavity. The gradient appears to be structured by both deterministic and nondeterministic processes, although additional work is needed to confirm these findings. A better understanding of biogeographic patterns and processes will lead to improved efficacy of dental interventions targeting the oral microbiota.

Tooth loss is a complex measure of oral disease: Determinants and methodological considerations

OBJECTIVES

Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.

METHODS

An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.

RESULTS

In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).

CONCLUSIONS

Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.

Dento-alveolar measurements and histomorphometric parameters of maxillary and mandibular first molars, using micro-CT

BACKGROUND

Micro-CT is a high-resolution, non-invasive, and non-destructive imaging technique, currently acknowledged as a gold standard modality for assessing quantitatively and objectively dental morphology and bone microarchitecture parameters.

PURPOSE

The aim of this study was to analyze critical dental and periodontal measurements characterizing the mandibular (MandFM) and maxillary (MaxFM) first molar architecture, as well as the corresponding bony socket, using micro-CT.

MATERIALS AND METHODS

Thirty-eight human dried skulls (22-76 years) were scanned to enable the virtual analysis of 61 first molars. Depending on the type of measurement, the parameters were recorded on two-dimensional sections or directly on three-dimensional models. Tooth morphology was described by four aspects (e.g., tooth width, trunk length, root length, and root span), while the socket architecture was assessed by buccal plate thicknesses and bone density measurements.

RESULTS

Minimum, maximum, and mean distances as well as cortical and trabecular bone densities were recorded in MandFM and MaxFM. It is noteworthy that the buccal plate thickness was found to be less than 1 mm in more than 55% of cases in MaxFM, whereas only in 20.8% of cases in MandFM (and even 0% at two sites). A wide range of bone densities was observed and the comparison between MandFM and MaxFM did not show a significant difference. Furthermore, cortical densities were negatively correlated with aging, while trabecular densities were not influenced.

CONCLUSIONS

Using micro-CT, three-dimensional aspects of the human first molar morphology and microstructural parameters of the surrounding bone were evaluated in the mandible and in the maxilla. These comprehensive measurements and their correlation with aging may be of great importance for the use of immediate implant placement in molar extraction sockets and thus the potential long-term success of this treatment modality.

[Needs for dental prostheses and their use in elderly Brazilians according to the National Oral Health Survey (SBBrazil 2010): prevalence rates and associated factors]

The objectives of this study were to evaluate the use of and need for dental prostheses among elderly Brazilians (65-74 years of age) and to verify associated factors. Data were analyzed from 7,496 elderly participants in the National Oral Health Survey in 2010 (SBBrazil 2010). Use of and need for dental prosthesis were the outcomes. The exposure variables included demographic and socioeconomic characteristics, dental services use, and self-rated oral health. Descriptive, bivariate, and multivariate analyses were performed. Prevalence rates for use of and need for dental prostheses were 78.2% and 68.7%, respectively. The Southeast Region had the highest prevalence of use (71.3%) and the greatest need for dental prostheses (82.9%). Multivariate Poisson regression analyses showed greater use of dental prostheses by women, individuals with 5 to 7 years of schooling, and users of private dental services, and lower use by black individuals and those with self-reported need for dental prostheses. Less need for dental prostheses was seen in women and in users of private services, and greater need in those with self-reported need for dental prostheses. Regional differences were seen in the distribution of use and need for dental prostheses. Still, the findings showed high prevalence rates for both outcomes in all regions of Brazil. Socioeconomic and demographic variables and use of dental services influenced the use of and need for dental prostheses.

Tooth loss among the elders in an inner city area of Ibadan, Nigeria

OBJECTIVE

To determine the prevalence and factors associated with tooth loss among elders in an inner city area of Ibadan, Nigeria.

BACKGROUND

Tooth loss is an indication of the oral health of a population, and the possible effects of oral health on general health of the elders has been reported.

MATERIAL AND METHODS

A cross-sectional study was undertaken among 392 consenting elders in Idikan, Ibadan, Nigeria. Information on socio-demographic characteristics, causes and effects of tooth loss was obtained using a pretested semistructured questionnaire. After the interview, the elders were examined for the presence of tooth loss by a trained examiner.

RESULT

Mean (SD) age of the elders was 73.0 (9.2) years. One hundred and eighty-seven (47.7%) participants had ≥1 missing tooth, and 20 (5.1%) participants had complete edentulousness. The mean SD number of missing teeth was 5.9 (4.7) teeth. Age, level of education, monthly income and physical impairment were associated with mean (SD) number of missing teeth (P˂.05). Speech difficulty, appearance problems, chewing difficulty, feeling bereaved, mobility of adjacent teeth, halitosis and premature ageing were reported more by participants who had ˃16 missing teeth compared to those who had ≤16 teeth (P˂.05).

CONCLUSION

The mouth prevalence of tooth loss was 47.7%, and mean (SD) number of missing teeth was 5.9 (4.7) teeth. Age, level of education, monthly income and physical impairment were associated with number of missing teeth (P˂.05). Speech difficulty, appearance problem, chewing difficulty, feeling of bereavement, mobility of adjacent teeth, halitosis and premature ageing were associated with increasing number of missing teeth (P˂.05).

Factors related to the dental caries incidence in youth: a cohort study in Brazilian Northeastern

Abstract The conceptual model of the life course considers that health-disease is a dynamic process that is also affected by previous and current lifelong experiences. The aim of the study was to investigate the incidence of caries and its determinants in young people in Sobral-Ceará, Brazil. This was a cohort study of oral health started in 2000, with waves in 2006 and 2012. 482 young people aged 17-21 years were examined and interviewed. The incidence of caries between 2006 and 2012 was the outcome analyzed and the independent variables were socioeconomic conditions and use of oral health actions and services. The average incidence of caries was 2.95 teeth from the adolescence to the youth. It was found that social deprivation throughout life and deny access to the dentist during infancy implies a greater incidence of caries in youth, therefore, the use of services and oral health actions during the adolescence and youth have not been sufficient to reduce inequities in oral health.

Caries and Innate Immunity: DEFB1 Gene Polymorphisms and Caries Susceptibility in Genetic Isolates from North-Eastern Italy

Background: The DEFB1 gene, encoding for the constitutively expressed human β-defensin 1 (hBD1) antimicrobial peptide is a potential candidate when studying genetic susceptibility to caries. DEFB1 genetic variations have been reported as contributing to hBD1 production impairment, leading to a greater susceptibility to be infected by oral pathogens, also leading to periodontitis. Methods: We analysed 5 DEFB1 polymorphisms, namely 3 functional single-nucleotide polymorphisms (SNPs) at the 5′-untranslated region (UTR), -52G>A (rs1799946), -44C>G (rs1800972), and -20G>A (rs11362), 2 SNPs at the 3′-UTR, c*5G>A (rs1047031) and c*87A>G (rs1800971) SNP located in potential miRNA binding sites, looking for possible correlations with the risk to develop caries in 654 adult subjects from isolated populations of north-eastern Italy. Dental caries prevalence was evaluated with the DMFT (decayed, missing, filled teeth) index, calculated after an accurate oral examination. DEFB1 SNP genotyping was performed with an Illumina 370k high-density SNP array. Results: Two DEFB1 SNPs were significantly associated with the DMFT index: the strongest association emerged from rs11362 SNP (p = 0.008). In particular G/G homozygous individuals showed a higher DMFT index compared to both G/A heterozygous and A/A homozygous individuals; rs1799946 SNP was also significantly associated with DMFT (p = 0.030), and individuals homozygous for the T allele had a higher DMFT value compared to heterozygous C/T and homozygous C/C individuals. Conclusions: Our study replicated, on a larger number of individuals, previous findings showing the association between two 5′-UTR SNPs in the DEFB1 gene and DMFT, suggesting that these polymorphisms could be considered as potential markers for assessing the risk to develop caries.

Contextual socioeconomic determinants of tooth loss in adults and elderly: a systematic review

OBJECTIVE

To perform a systematic review regarding studies that investigated the association between contextual socioeconomic factors and tooth loss.

METHODS

MEDLINE, Embase, and LILACS databases were searched and no language or date restrictions were applied for this research. The search was also carried out at the Brazilian Library of Theses and Dissertations (BDTD), with the objective of seeking unpublished studies. We evaluated the bibliographical and methodological characteristics of the studies, as well as the findings.

RESULTS

We found 348 articles, out of which only 6 were included in this study after revision by 2 independent researchers. We also identified an unpublished thesis. In general, these results show that the socioeconomic context interferes in tooth loss. We found an association between the highest number of missing teeth with less favorable contextual variables, despite the weak evidence, due to the fact that all selected studies had a cross-sectional design.

CONCLUSION

We suggest the standardization of outcome formats and exposures in order to favor the comparison between studies and their quantitative analysis.

Caries-risk profiles in Italian adults using computer caries assessment system and ICDAS

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83-3.03 and OR = 1.43, 95%CI = 1.13-1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.

Permanent dentition caries through the first half of life

AIM

To describe the occurrence of dental caries at the person, tooth and tooth surface level from childhood to early mid-life.

BACKGROUND

No studies have reported on age and caries experience in a population-based sample through the first half of life.

METHODS

Prospective cohort study of a complete birth cohort (n = 1,037) born in 1972/73 in Dunedin, New Zealand. Dental examinations were conducted at ages 5, 9, 15, 18, 26, 32 and 38, and participation rates remained high. Surface-level caries data were collected at each age (WHO basic methods). Statistical analyses and graphing of data were undertaken using Intercooled Stata Version 10.

RESULTS

Data are presented on dental caries experience in the permanent dentition at ages 9, 15, 18, 26, 32 and 38. Percentile curves are charted and reported for person-level caries experience. Data are also presented on the number of decayed teeth and tooth surfaces, (including root surfaces at age 38), as a function of the number of teeth and surfaces present, respectively. Across the cohort, the number of tooth surfaces affected by dental caries increased by approximately 0.8 surfaces per year (on average), while the percentage of at-risk tooth surfaces affected by caries increased by approximately 0.5% per year, with negligible variation in that rate throughout the observation period.

CONCLUSION

These unique data show clearly that dental caries continues as a disease of adulthood, remaining important beyond childhood and adolescence and that rates of dental caries over time remain relatively constant.

Polymorphisms in sweet taste genes (TAS1R2 and GLUT2), sweet liking, and dental caries prevalence in an adult Italian population

The aim of the study was to assess the relationship between sweet taste genes and dental caries prevalence in a large sample of adults. In addition, the association between sweet liking and sugar intake with dental caries was investigated. Caries was measured by the decayed, missing, filled teeth (DMFT) index in 647 Caucasian subjects (285 males and 362 females, aged 18-65 years), coming from six villages in northeastern Italy. Sweet liking was assessed using a 9-point scale, and the mean of the liking given by each individual to specific sweet food and beverages was used to create a sweet liking score. Simple sugar consumption was estimated by a dietary history interview, considering both added sugars and sugar present naturally in foods. Our study confirmed that polymorphisms in TAS1R2 and GLUT2 genes are related to DMFT index. In particular, GG homozygous individuals for rs3935570 in TAS1R2 gene (p value = 0.0117) and GG homozygous individuals for rs1499821 in GLUT2 gene (p value = 0.0273) showed higher DMFT levels compared to both heterozygous and homozygous for the alternative allele. Furthermore, while the relationship sugar intake-DMFT did not achieve statistical significance (p value = 0.075), a significant association was identified between sweet liking and DMFT (p value = 0.004), independent of other variables. Our study showed that sweet taste genetic factors contribute to caries prevalence and highlighted the role of sweet liking as a predictor of caries risk. Therefore, these results may open new perspectives for individual risk identification and implementation of target preventive strategies, such as identifying high-risk patients before caries development.

Cost-effectiveness of caries excavations in different risk groups - a micro-simulation study

BACKGROUND

Whilst being the most prevalent disease worldwide, dental caries is increasingly concentrated in high-risk populations. New caries treatments should therefore be evaluated not only in terms of their cost-effectiveness in individuals, but also their effects on the distribution of costs and benefits across different populations. To treat deep caries, there are currently three strategies: selective (one-step incomplete), stepwise (two-step incomplete) and complete excavation. Building on prior research that found selective excavation generally cost-effective, we compared the costs-effectiveness of different excavations in low- and high-risk patients, hypothesizing that selective excavation had greater cost-effectiveness-advantages in patients with high compared with low risk.

METHODS

An average tooth-level Markov-model was constructed following the posterior teeth in an initially 18-year old male individual, either with low or high risk, over his lifetime. Risk was assumed to be predicted by several parameters (oral hygiene, social position, dental service utilization), with evidence-based transition probabilities or hazard functions being adjusted for different risk status where applicable. Total lifetime treatment costs were estimated for German healthcare, with both mixed public-private and only private out-of-pocket costs being calculated. For cost-effectiveness-analysis, micro-simulations were performed and joint parameter uncertainty introduced by random sampling of probabilities. Cohort analyses were used for assessing the underlying reasons for potential differences between strategies and populations.

RESULTS

Selective excavation was more effective and less costly than both alternatives regardless of an individual's risk. All three strategies were less effective and more costly in patients with high compared with low risk, whilst the differences between risk groups were smallest for selective excavation. Thus, the cost-effectiveness-advantages of selective excavation were more pronounced in high-risk groups, who also benefitted the most from reduced private out-of-pocket treatment costs.

CONCLUSIONS

Whilst caries excavation does not tackle the underlying sources for both the development of caries lesions and the potential differences of individuals' risk status, selective excavation seems most suitable to treat deep lesions, especially in patients with high risk, who over-proportionally benefit from the resulting health-gains and cost-savings.

What is the risk of future extraction of asymptomatic third molars? A systematic review

PURPOSE

The purpose of our report was to determine clinically whether young adults who elect to retain their asymptomatic third molars (M3s) have a risk of undergoing 1 or more M3 extractions in the future.

MATERIALS AND METHODS

To address our clinical question, we designed and implemented a systematic review. The studies included in the present review were prospective, had a sample size of 50 subjects or more with at least 1 asymptomatic M3, and had at least 12 months of follow-up data available. The primary study variables were the follow-up duration (in years) and the number of M3s extracted by the end of the follow-up period or the number of subjects who required at least one M3 extraction. The annual and cumulative incidence rates of M3 removal were estimated.

RESULTS

Seven studies met the inclusion criteria. The samples sizes ranged from 70 to 821 subjects, and the follow-up period ranged from 1 to 18 years. The mean incidence rate for M3 extraction of previously asymptomatic M3s was 3.0% annually (range 1 to 9%). The cumulative incidence rate for M3 removal ranged from 5% at 1 year to 64% at 18 years. The reasons for extraction were caries, periodontal disease, and other inflammatory conditions.

CONCLUSIONS

The cumulative risk of M3 extraction for young adults with asymptomatic M3s is sufficiently high to warrant its consideration when reviewing the risks and benefits of M3 retention as a management strategy.

A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption

OBJECTIVE

To examine the quantitative relationship between sugar intake and the progressive development of dental caries.

DESIGN

A critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose-response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.

SETTING

Global, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.

SUBJECTS

Children aged 6 years or more and adults.

RESULTS

Caries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2-3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.

CONCLUSIONS

Previous analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2-3 % of energy intake, whether or not fluoride intake is optimum.

Age, period and cohort trends in caries of permanent teeth in four developed countries

OBJECTIVES

We assessed the relative influences of age, period, and cohort effects on trends in caries experience of permanent teeth in 4 different populations.

METHODS

We used data from England and Wales, United States, Japan, and Sweden in which numerous cross-sectional, nationally representative surveys have been conducted periodically since the early 1960s. For each country, trends in caries experience (measured by DMFT index-the number of decayed, missing, and filled permanent teeth) were analyzed in an age, period, and cohort (APC) analysis using partial least square regression.

RESULTS

A strong effect of age manifested in caries experience, period and cohort effects aside. Caries levels increased through to adolescence; thereafter, there was a larger increase in DMFT in adulthood. Compared with the aging effect, period and cohort effects on caries experience were small. Population DMFT scores decreased over time in all countries except Japan. Cohort effects on caries experience displayed a nonlinear pattern in all 4 countries, with slightly lower caries levels among the oldest and most recent generations.

CONCLUSIONS

Despite marked recent declines in caries among children, caries levels increase with age and remain problematic in adults.

Extent of differences in dental caries in permanent teeth between childhood and adulthood in 26 countries

OBJECTIVE

To compare levels of caries in permanent teeth between children and adults and specifically, the extent to which the decayed, missing, filled teeth (DMFT) index was greater in adults than in children.

METHODS

The analysis was based on published reports from 26 countries with comparable summary data on dental caries for different World Health Organisation index ages. Reports were obtained from two large electronic databases, the World Health Organisation Oral Health Country/Area Profile Programme and the Global Burden of Disease 2010 Study.

RESULTS

Very much higher levels of caries occurred in adults than in children in all 26 countries. For most countries, irrespective of the DMFT levels in 12-year-olds, the percentage difference in levels of DMFT between 12-year-olds and 35- to 44-year-olds was above 500% and the relative difference was 5 or more.

CONCLUSION

Large differences in experience of dental caries in permanent teeth were found between childhood and adulthood.

Prevalence of Dentulism, Partial Edentulism and Complete Edentulism in Rural and Urban Population of Malwa Region of India: A Population-based Study

Background

The objective of this study was to evaluate the prevalence of dentulism, partial edentulism and complete edentulism in rural and urban population of Malwa region of India, who visited at department of prosthodontics for the first time.

Materials and methods

An institution-based, cross-sectional study using the random sampling method was used to select the study sample of 1000 males and females. Data were collected using questionnaires and oral examination. Data were statistically analyzed using Chi-square test.

Results

Nearly, 38.5 and 63.1% of the rural and urban females were dentulous in the age of below 53 and 43 years. 61.4 and 36% of rural and urban males were dentulous in the age of below 53 and 43 years. Nearly, 41.9 and 48.2% of the rural and urban females were partial edentulous in the age of above 53 and 43 years. Fifty-eight and 51.7% of rural and urban males were dentulous in the age of above 53 and 43 years. Nearly, 22.4 and 55.8% of the rural and urban females were completing edentulous in the age of above 43 years in both population. 77.5 and 44.1% of rural and urban males were completing edentulous in the age of above 33 and 53 years.

Limitation

The study was conducted in an institution-based set-up. Hence, any interpretation of the results of this study must bear this limitation in mind.

Conclusion

It is essential to identify feasible strategies to provide primary dental health education and treatment to all rural and urban elderly in the future. We suggest community dental health services to be included in general health of the elderly rather than a special health need of the community.

How to cite this article

Sonkesariya S, Jain D, Shakya P, Agrawal R, Prasad SVS. Prevalence of Dentulism, Partial Edentulism and Complete Edentulism in Rural and Urban Popu- lation of Malwa Region of India: A Population-based Study. Int J Prosthodont Restor Dent 2014;4(4):112-119.

Social determinants of health and dental caries in Brazil: a systematic review of the literature between 1999 and 2010

OBJECTIVE: To review epidemiological studies conducted in Brazil that investigated the distribution of dental caries according to socioeconomic status and demographic characteristics. METHODS: The systematic review included articles published between 1999 and 2010 available in six bibliographic sources, without any other restriction. We analyzed the bibliometric and methodological characteristics of the studies, and the direction and statistical significance of associations tested. RESULTS: Of the 1,128 references identified, 67 were incorporated into this study. There was a higher percentage of publications in the last two years and most of the studies were conducted in the South and Southeast of the country with a young population. The cross-sectional design, using a complex sampling procedure, was the most commonly adopted. The DMFT and dmft indexes were the most commonly used to measure dental caries, while sex/gender, income, education, race/skin color and type of school were the most common socioeconomic exposures. CONCLUSIONS: Most studies identified a high rates of dental caries among the poorest, least educated, black and brown and female individuals. A more detailed methodological and theoretically sound study of the relationship between dental caries and socioeconomic conditions is needed.

Frequency and risk indicators of tooth decay among pregnant women in France: a cross-sectional analysis

INTRODUCTION

Little is known on the prevalence of tooth decay among pregnant women. Better knowledge of tooth decay risk indicators during pregnancy could help to develop follow-up protocols for women at risk, along with better prevention strategies. The aim of this study was to assess the frequency of tooth decay and the number of decayed teeth per woman in a large sample of pregnant women in France, and to study associated risk indicators.

METHODS

A secondary cross-sectional analysis of data from a French multicentre case-control study was performed. The sample was composed of 1094 at-term women of six maternity units. A dental examination was carried out within 2 to 4 days post-partum. Socio-demographic and behavioural characteristics were obtained through a standardised interview with the women. Medical characteristics were obtained from the women's medical records. Risk indicators associated with tooth decay were identified using a negative binomial hurdle model.

RESULTS

51.6% of the women had tooth decay. The mean number of decayed teeth among women having at least one was 3.1 (s.d. = 2.8). Having tooth decay was statistically associated with lower age (aOR = 1.58, 95%CI [1.03,2.45]), lower educational level (aOR = 1.53, 95%CI [1.06,2.23]) and dental plaque (aOR = 1.75, 95%CI [1.27,2.41]). The number of decayed teeth was associated with the same risk indicators and with non-French nationality and inadequate prenatal care.

DISCUSSION

The frequency of tooth decay and the number of decayed teeth among pregnant women were high. Oral health promotion programmes must continue to inform women and care providers about the importance of dental care before, during and after pregnancy. Future research should also assess the effectiveness of public policies related to oral health in target populations of pregnant women facing challenging social or economic situations.

Dental plaque and oral health during the first 32 years of life

BACKGROUND

Studies investigating the role of dental plaque in oral disease have focused primarily on the quantity and quality of plaque at a given point in time. No large-scale epidemiologic research has been conducted regarding the continuity and change in plaque levels across the long term and the association of plaque levels with oral health.

METHODS

The authors used data from the Dunedin Multidisciplinary Health and Development Study. Collection of dental plaque data occurred at ages 5, 9, 15, 18, 26 and 32 years by means of the Simplified Oral Hygiene Index. The authors assessed oral health outcomes when participants were aged 32 years.

RESULTS

The authors identified three plaque trajectory groups (high, n = 357; medium, n = 450; and low; n = 104) and found substantial, statistically significant differences in both caries and periodontal disease experience among those groups. For example, after the authors controlled for sex, socioeconomic status and dental visiting pattern, they found that participants in the high-plaque-trajectory group lost nearly five times more teeth owing to caries than did those in the low-plaque-trajectory group.

CONCLUSIONS

Across the long term, participants in the high-plaque-trajectory group were more likely to experience caries, periodontal disease and subsequent tooth loss than were those in the low- or medium-plaque-trajectory groups, and they experienced all those conditions with greater severity.

CLINICAL IMPLICATIONS

Improving oral health requires emphasizing long-term self-care, as well as providing broad public health and health promotion measures that promote and support oral self-care. This study's findings suggest that poor oral hygiene and smoking have a synergistic effect on periodontal disease experience.

Design of the Prevention of Adult Caries Study (PACS): a randomized clinical trial assessing the effect of a chlorhexidine dental coating for the prevention of adult caries

BACKGROUND

Dental caries is one of the primary causes of tooth loss among adults. It is estimated to affect a majority of Americans aged 55 and older, with a disproportionately higher burden in disadvantaged populations. Although a number of treatments are currently in use for caries prevention in adults, evidence for their efficacy and effectiveness is limited.

METHODS/DESIGN

The Prevention of Adult Caries Study (PACS) is a multicenter, placebo-controlled, double-blind, randomized clinical trial of the efficacy of a chlorhexidine (10% w/v) dental coating in preventing adult caries. Participants (n = 983) were recruited from four different dental delivery systems serving four diverse communities, including one American Indian population, and were randomized to receive either chlorhexidine or a placebo treatment. The primary outcome is the net caries increment (including non-cavitated lesions) from baseline to 13 months of follow-up. A cost-effectiveness analysis also will be considered.

DISCUSSION

This new dental treatment, if efficacious and approved for use by the Food and Drug Administration (FDA), would become a new in-office, anti-microbial agent for the prevention of adult caries in the United States.

TRIAL REGISTRATION NUMBER

NCT00357877.

Dental caries experience in young Australian Army recruits 2008

BACKGROUND

Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008.

METHODS

A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water.

RESULTS

Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87.

CONCLUSIONS

Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

Trajectories of dental anxiety in a birth cohort

OBJECTIVE

To examine predictors of dental anxiety trajectories in a longitudinal study of New Zealanders.

METHODS

Prospective study of a complete birth cohort born in 1972/73 in Dunedin, New Zealand, with dental anxiety scale (DAS) scores and dental utilization determined at ages 15, 18, 26 and 32 years. Personality traits were assessed at a superfactor and (more fine-grained) subscale level via the Multidimensional Personality Questionnaire at age 18 years. Group-based trajectory analysis was used to identify dental anxiety trajectories.

RESULTS

DAS scores from at least three assessments were available for 828 participants. Six dental anxiety trajectories were observed: stable nonanxious low (39.6%); stable nonanxious medium (37.9%); recovery (1.6%); adult-onset anxious (7.7%); stable anxious (7.2%) and adolescent-onset anxious (5.9%). Multivariate analysis showed that males and those with higher DMFS at age 15 years were more likely to be in the stable nonanxious low trajectory group. Membership of the stable nonanxious medium group was predicted by the dental caries experience at age 15 years. Participants who had lost one or more teeth between ages 26 and 32 years had almost twice the relative risk for membership of the adult-onset anxious group. Personality traits predicted group membership. Specifically, high scorers (via median split) on the 'stress reaction' subscale had over twice the risk of being in the stable anxious group; low scorers on the traditionalism subscale were more likely to be members of the recovery trajectory group; and high scorers on the 'social closeness' subscale had half the risk of being in the stable anxious group. Dental caries experience at age 5 years was also a predictor for the stable anxious group. Membership of the late-adolescent-onset anxious group was predicted by higher dental caries experience by age 15 years, but none of the other predictors was significant.

CONCLUSION

Six discrete trajectories of dental anxiety have been observed. Some trajectories (totalling more than 90% of the cohort) had clear associations with external influences, but others were more strongly associated with characteristics such as personality traits. A mix of both influences was observed with only the stable anxious dental anxiety trajectory.

Caries, gender and socio-economic change in the Xavante Indians from Central Brazil

BACKGROUND

The oral health conditions of indigenous peoples in Amazonia are closely associated with ecological and dietary changes related to interaction with non-Indians.

AIM

The study investigated the incidence of caries in an indigenous community from Central Brazil focusing on gender differences.

SUBJECTS AND METHODS

The research was conducted among the Xavante Indians and was based on longitudinal data collected in two surveys (1999 and 2004). The study included 128 individuals, 63 (49.2%) males and 65 (50.8%) females, divided in four age brackets (6-12, 13-19, 20-34, 35-60 years of age). The DMFT (decayed, missing and filled teeth) index and incidences (difference between 1999 and 2004) were calculated for each individual. The proportion of incidence was also calculated. Differences in caries risk between gender and age brackets were compared by parametric and non-parametric tests.

RESULTS

There were statistically significant differences in relation to caries incidence between age brackets and gender. The greatest incidence was observed in the 20-34 age bracket, which presented 3.30 new decayed teeth, twice the risk of the 6-12 age bracket (p<0.01), chosen as reference. While females in most age groups did not show higher risk for caries when compared to males, there was a 4.04-fold risk in the 20-34 age bracket (p<0.01).

CONCLUSION

It is concluded that factors related to the social functions of each sex (gender issues) and differential access to information, health services, and education may help to understand the differences observed in the incidence of caries.

Bionic restorative system: its potential value in caries therapy

Dental defect caused by dental caries is usually restored by fillings, inlays or onlays at the present day. Although the therapeutic effects of these methods have already been confirmed, complications occasionally set in, such as pulp injury, fracture and secondary caries. Bionic dental organic center possesses similar functions of the natural dental organic center. So we put forward a hypothesis that bionic organic center can be transplanted onto the conditioned pulpal walls of the prepared cavity and a specific filling material, which the cavity will be filled with, provides oxygen, nutrition and raw materials for it to regenerate the lost odontal tissue in vivo. The regenerated odontal tissue which has similar properties of the healthy odontal tissue will restore the defect and it will be combined with the residual odontal tissue tightly, not only in physical structure but also in function. Then the teeth suffering from dental caries could live and function like healthy ones.

Female and male antisocial trajectories: from childhood origins to adult outcomes

This article reports on the childhood origins and adult outcomes of female versus male antisocial behavior trajectories in the Dunedin longitudinal study. Four antisocial behavior trajectory groups were identified among females and males using general growth mixture modeling and included life-course persistent (LCP), adolescent-onset, childhood-limited, and low trajectory groups. During childhood, both LCP females and males were characterized by social, familial and neurodevelopmental risk factors, whereas those on the adolescent-onset pathway were not. At age 32, women and men on the LCP pathway were engaging in serious violence and experiencing significant mental health, physical health, and economic problems. Females and males on the adolescent-onset pathway were also experiencing difficulties at age 32, although to a lesser extent. Although more males than females followed the LCP trajectory, findings support similarities across gender with respect to developmental trajectories of antisocial behavior and their associated childhood origins and adult consequences. Implications for theory, research, and practice are discussed.

Trajectory patterns of dental caries experience in the permanent dentition to the fourth decade of life

Dental caries is a chronic, cumulative disease, but no studies have investigated longitudinal patterns of caries experience. The objective of this study was to identify and describe developmental trajectories of caries experience in the permanent dentition to age 32. Longitudinal caries data for 955 participants in a longstanding birth cohort study were analyzed by trajectory analysis. Three caries experience trajectories were identified by the SAS macro PROC TRAJ; these were categorized as "high" (approximately 15%), "medium" (approximately 43%), and "low" (approximately 42%) DMFS (Decayed, Missing, and Filled Surfaces). All were relatively linear, although the higher trajectories were more "S-shaped". This effect disappeared following adjustment for the number of unaffected surfaces remaining at each age, suggesting that, among individuals following a similar caries trajectory, caries rate is relatively constant across time.

Cigarette smoking and tooth loss experience among young adults: a national record linkage study

Background

Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20–39 years using linked data from two national databases in Japan.

Methods

Two databases of the National Nutrition Survey (NNS) and the Survey of Dental Diseases (SDD), which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E.

Results

Smoking rates differed greatly in men (53.3%) and women (15.5%). The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women). Tooth loss occurred more frequently among current smokers (40.6%) than former (23.1%) and non-smokers (27.9%). Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40–3.50], P = 0.0007) and women (1.70 [1.13–2.55], P = 0.0111). A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend < 0.0001 and 0.0004 in men and women, respectively). Current smoking was also associated with the prevalence of decayed teeth (1.67 [1.28–2.20], P = 0.0002).

Conclusion

An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to limitations of the available variables in the present databases, further studies including caries experience and its confounders should be conducted to examine whether smoking is a true risk of premature tooth loss in young adults.