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

Oral Health in the State of Kuwait: An Appraisal

BACKGROUND

Oral health issues have received significant attention from most global health agencies, which have integrated these issues into their noncommunicable disease, sustainable development, and universal health coverage objectives.

METHODS

This paper provides an update on the progress made in the last 2 decades and aims to highlight some of the challenges faced by the oral health care system in Kuwait.

RESULTS

Despite the nation's rising expenditure on oral health care, the prevalence of oral diseases remains high in Kuwait. The lack of reliable data on periodontitis and edentulism limits the ability of researchers to comment on the trends of these conditions. This emphasises the critical need for a nationwide household-level oral health survey in both pediatric and adult populations that would provide valuable information on the oral health status of these populations.

CONCLUSION

In the future, Kuwait must invest more in oral disease prevention programs, especially among children and the high-risk communities of the population.

The Evolving Microbiome of Dental Caries

Dental caries is a significant oral and public health problem worldwide, especially in low-income populations. The risk of dental caries increases with frequent intake of dietary carbohydrates, including sugars, leading to increased acidity and disruption of the symbiotic diverse and complex microbial community of health. Excess acid production leads to a dysbiotic shift in the bacterial biofilm composition, demineralization of tooth structure, and cavities. Highly acidic and acid-tolerant species associated with caries include Streptococcus mutans, Lactobacillus, Actinomyces, Bifidobacterium, and Scardovia species. The differences in microbiotas depend on tooth site, extent of carious lesions, and rate of disease progression. Metagenomics and metatranscriptomics not only reveal the structure and genetic potential of the caries-associated microbiome, but, more importantly, capture the genetic makeup of the metabolically active microbiome in lesion sites. Due to its multifactorial nature, caries has been difficult to prevent. The use of topical fluoride has had a significant impact on reducing caries in clinical settings, but the approach is costly; the results are less sustainable for high-caries-risk individuals, especially children. Developing treatment regimens that specifically target S. mutans and other acidogenic bacteria, such as using nanoparticles, show promise in altering the cariogenic microbiome, thereby combatting the disease.

Trends and age-period-cohort effect on dental caries prevalence from 2008 to 2019 among Brazilian preschoolers

This study aimed to evaluate trends in the prevalence of dental caries in preschool children and associated factors considering different time variations. This is a time series study performed using data from three cross-sectional studies with pre-school children from southern Brazil in 2008, 2013 and 2019. This children group was born between the years of 2003 to 2018. Dental caries was evaluated by decayed, missing and filled deciduous teeth (dmft index). Demographic, socioeconomic, behavioural and psychosocial variables were also collected. Chi-square test for trends and a hierarchical age-period-cohort (HAPC) analysis using multilevel Poisson regression model for testing the associations between predictor variables and dental caries experience were used. A total of 1,644 pre-school children participated in all surveys. There was a significant difference in caries experience considering all APC effects. The prevalence of dental caries was 25.0% in 2008, 16.3% in 2013, and 19.4% in 2019 (p < 0.01) and no statistical difference was observed. An age effect showed that older children were more likely to experience dental caries. Considering the cohort effect, there is a significant difference between the generations, mainly between 2003 and 2018. Household income, use of dental services, and parent's perception of child oral health were associated with dental caries experience no matter the time variation. Despite recent declines in dental caries prevalence among preschool children, caries levels increased with age and social inequalities persisted through the years, indicating a need of reviewing the policies to reduce the burden of this oral disease.

Cost-effectiveness of dental caries prevention strategies in South African schools

BACKGROUND

In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children.

METHODS

The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective.

RESULTS

The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively.

CONCLUSION

Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

Oral Health Survey in Burundi; Evaluation of the Caries Experience in Schoolchildren Using the DMFT Index

Background and objectives: There are no data on oral health in the population of Burundi. This study aimed to describe the oral health status of schoolchildren in Burundi using the dmft/DMFT index for the first time. Materials and methods: The study was designed as a cross-sectional population-based epidemiological survey. The survey was designed according to the WHO methodology for oral health surveys. Oral examinations were conducted in school rooms using a dental mirror, probe, and headlight. The following characteristics of primary dentition status were recorded: decayed (d/D), missing (m/M), and filled (f/F) teeth, and the dmft/DMFT (d + m + f t/D + M + F T) index was calculated for each subject. Quantitative and qualitative variables were represented by measures of position and variability. One-way ANOVA was used to assess differences between parametric variables. Logistic regression was performed for total caries experience and gender, age groups, living area, and geographical provinces. Results: A total of 1902 children were examined, 1007 (52.94%) six-year-olds and 895 (47.06%) in the older group. The dmft/DMFT and subgroups were statistically significantly different in terms of age groups, living areas, and geographical regions (dmft/DMFT d-subgroup and D-subgroup p < 0.01), but only for DMFT for sex. The ORs estimated by logistic regression by total caries experience showed a protective effect for 12 year old subjects and those living in southern provinces, an OR of 0.52 (95%CI 0.43-0.64) and an OR of 0.26 (95%CI 0.21-0.32), respectively. Conclusions: Dental caries in African countries, including Burundi, remains a major problem affecting the general health and wellbeing of the population. Tackling untreated caries requires a multifaceted approach, including strengthening oral health infrastructure, promoting oral health education, providing affordable dental services, and encouraging healthier eating habits.

Oral findings in patients with cartilage-hair hypoplasia - cross-sectional observational study

BACKGROUND AND OBJECTIVES

Cartilage-hair hypoplasia (CHH) is a rare chondrodysplasia with associated primary immunodeficiency. The aim of this cross-sectional study was to examine oral health indicators in individuals with CHH.

METHODS

In total, 23 individuals with CHH, aged between 4.5 and 70 years, and 46 controls aged between 5 and 76 years were clinically examined for periodontal disease, presence of oral mucosal lesions, tooth decay, masticatory system function, and malocclusions. A chairside lateral flow immunoassay test of active-matrix metalloproteinase was obtained from all the adult participants with a permanent dentition. Laboratory signs of immunodeficiency were recorded for individuals with CHH.

RESULTS

Individuals with CHH and controls had similar prevalence of gingival bleeding on probing (median 6% vs. 4%). Oral fluid active-matrix metalloproteinase concentration was greater than 20 ng/ml in 45% of study subjects in both groups. However, deep periodontal pockets, 4 mm or deeper, were more common in individuals with CHH as compared to the controls (U = 282.5, p = 0.002). Similarly mucosal lesions were significantly more common in individuals with CHH (30% vs. 9%, OR = 0.223, 95%CI 0.057-0.867). The median sum of the number of decayed, missing due to caries, and filled teeth was nine for the individuals with CHH and four for controls. In the CHH cohort, 70% displayed an ideal sagittal occlusal relationship. Malocclusion and temporomandibular joint dysfunction prevalence were similar in both study groups.

CONCLUSIONS

Individuals with CHH have more frequently deep periodontal pockets and oral mucosal lesions than general population controls. Routine intraoral examination by a dentist at regular intervals should be recommended to all individuals with CHH.

Dental pattern diversity in a military population and its usefulness for assessing the degree of certainty in dental identification

In forensic dentistry, the analysis of dental diversity forms the basis of probability calculations in dental identification. The present study aimed to contribute to the knowledge of dental diversity in a Spanish military population (considering isolated teeth, sets of different numbers of teeth, and combinations of teeth of forensic interest) and its implications for dental identification. A further aim was to compare the performance of three coding systems (detailed, generic, and binary) to assess dental pattern diversity. Dental diversity of a representative sample of the Spanish military population (3920 individuals aged between 18 and 55 years) was calculated according to a genetic (mitochondrial DNA) model in which diversity was defined as the likelihood that two randomly selected individuals in a sample would exhibit different patterns. By performing all pairwise comparisons of dental patterns in the dataset, the total number of matches was generated, and the diversity of dental patterns was then derived. First and third molars were the teeth that showed the highest levels of diversity, and a high diversity value (>0.99) was obtained with only 5 teeth (16, 36, 38, 46, and 48) when detailed coding was used. In addition, dental diversity in the full dentition and posterior teeth exceeded the threshold of 0.99 in all three coding systems. Although a very high diversity value (≥0.999) was only achieved with detailed coding, it should be noted that the generic coding system requires less time and skill to use, and can also provide high diversity values. Our findings show that further efforts should be made to establish large, periodically updated dental datasets of different populations in order to assess dental pattern diversity (without excluding third molars) based on empirical comparison, and to substantiate the certainty of dental identification.

Tooth Loss and Caries Experience of Elderly Chileans in the Context of the COVID-19 Pandemic in Five Regions of Chile

Risk factors associated with tooth loss have been studied; however, the current status of the epidemiological profiles and the impact of the pandemic on the oral health of the elderly is still unknown. This study aims to determine the experience of caries and tooth loss among elderly Chilean citizens in five regions and to identify the risk factors associated with tooth loss. The sample includes 135 participants over 60 years old assessed during COVID-19 lockdown. Sociodemographic variables such as education and RSH (Social Registry of Households) were obtained through a teledentistry platform called TEGO. The history of chronic diseases such as diabetes, obesity, depression and dental caries reported by DMFT index scores were incorporated. The statistical analysis included Adjusted Odds Ratios (ORs) to assess risk factors associated with the lack of functional dentition. Multivariate hypothesis testing was used to compare the mean equality of DMFT and its components between regions (p-value < 0.05). Individuals with RSH ≤ 40% were at higher risk of having no functional dentition with OR 4.56 (95% CI: 1.71, 12.17). The only mean difference between regions was the filled tooth component. Tooth loss was associated with multidimensional lower income, where the elderly belonging to the 40% most vulnerable population had a higher prevalence of non-functional dentition. This study highlights the importance of implementing a National Oral Health Policy that focuses on oral health promotion and minimally invasive dentistry for the most vulnerable population.

Epidemiological and sociodemographic transitions of severe periodontitis incidence, prevalence, and disability-adjusted life years for 21 world regions and globally from 1990 to 2019: An age-period-cohort analysis

BACKGROUND

Severe periodontitis is one of the most prevalent diseases and a global public health problem due to its high incidence and prevalence. However, there are few studies on the burden of periodontitis in different regions of the world.

METHODS

We extracted data on the incidence, prevalence, and disability-adjusted life years (DALYs) from the Global Burden of Disease study as severe periodontitis burden measures. We also explored the global burden of severe periodontitis according to 21 world regions and Socio-Demographic Index (SDI) quintiles. The joinpoint model was used to analyze temporal trends of major regions from 1990 to 2019, and the age-period-cohort model was used to estimate age, period, and cohort trends in severe periodontitis.

RESULTS

Globally, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and disability-adjusted life years (DALYs) rate increased from 1990 to 2019 (percentage change: 5.77%, 7.78%, and 8.01%, respectively), with average annual percent changes of 0.2%, 0.3%, and 0.3%, respectively. The region with the highest DALY rate was western sub-Saharan Africa with a value of 142.5 (95% uncertainty interval: 56.3, 303.7) per 100,000 in 2019. For the ASIR, ASPR, and DALY, the age effect of severe periodontitis showed an increase followed by a decrease, the period effect showed an upward trend, the cohort effect showed an overall decreasing trend, and the cohort relative risk for incidence for some SDI quintiles showed a slight increase in recent years.

CONCLUSIONS

Oral health varies significantly across regions, and it is essential to address inequalities in oral health between countries. Effective measures to prevent severe periodontitis risk factors should also be taken in regions with low SDI.

Selective versus stepwise removal of deep carious lesions: A meta-analysis of randomized controlled trials

Background/purpose

Stepwise removal (SWR) and selective removal (SCR) are proposed techniques to treat deep carious lesions, but it is currently uncertain which technique is better. This meta-analysis aimed to compare the therapeutic effects of SCR and SWR for deep carious lesions in both primary and permanent teeth.

Materials and methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched until June 9, 2021. Success was the primary outcome. Secondary outcomes included pulp exposure, tooth extraction, pulp necrosis, pulpitis, and endodontic treatment. The effect size of each outcome was tested for heterogeneity. The source of heterogeneity was explored by meta regression analysis. Subgroup analysis and sensitivity analysis were conducted for the outcomes.

Results

Nine studies of 1550 patients with 1929 deep carious teeth were included. SCR had a significantly higher success rate than SWR (pooled relative risk [RR] = 1.123, 95% confidence interval [CI] = 1.056-1.194, I² = 52.3%, P < 0.001). The incidence of pulp exposure was significantly lower in the SCR group than that in the SWR group (pooled RR = 0.266, 95%CI = 0.096-0.740, I² = 0.0%, P = 0.011). The incidence of pulp necrosis in the SCR group was approximately 14.2% of that in the SWR group (pooled RR = 0.142, 95%CI = 0.026-0.789, I² = 0.0%, P = 0.026). Compared with SWR, SCR reduced the incidence of pulpitis by about 76.3% (pooled RR = 0.237, 95%CI = 0.090-0.623, I² = 0.0%, P = 0.003).

Conclusion

SCR may be a better treatment for deep caries to achieve better outcomes than SWR. Future research on comparing SCR and SWR for different outcomes in deep carious lesions is warranted to confirm our findings.

Dietary Factors Influencing the Caries Status of Adults in Karachi, Pakistan: Initial Findings

Objective: The objective was to identify the relationship between the dietary factors related to increases in the number of dental caries among an adult population group. Methods: A cross-sectional study was conducted involving adult patients and their accompanying person, aged 18 years and above (n = 1730) visiting the dental outpatient department (OPD) of a public sector tertiary healthcare institute in Karachi, Pakistan. A 39-item Food Frequency Questionnaire (FFQ) was administered to the patients, followed by a dental caries assessment using Radke’s WHO criteria. Caries assessment data were transformed into the DMFT Index (D = decayed, M = missing, F = filled teeth). Factor analysis (FA) was performed using Stata v. 11.0, followed by assessing the internal consistency of the FFQ. Multilogistic analysis was performed to explore the association between dental caries (cut-off = 5) and other independent variables, considering a p-value < 0.05 as significant. Results: The mean age of participants in the group was 32.65 ± 10.49 years. The number of female participants (934; 54%) was higher than male participants (796; 46%). Of the total, 951 (52%) participants were married. The internal consistency value for the FFQ, as measured by Cronbach’s alpha, was 0.80. In addition to age and gender, out of four dietary patterns, only “cereals” were found to be significantly (p < 0.05) associated with increased DMFT. Conclusion: This study established that the high intake of cereals is a contributory factor to the high prevalence of dental caries among adults.

Primary Tooth Decay Prevention Program in Children: Application of Intervention Mapping Approach

Background. As the most common diseases globally, oral and dental diseases are closely related to people’s behavior. The present study is aimed at developing a program to prevent primary teeth decay in children using the intervention mapping approach. Methods. This study protocol is aimed at using the intervention mapping approach as the planning framework. The study consists of six steps of intervention mapping, including needs assessment based on the relevant literature review, development of an objectives matrix for changing people’s behaviors and environmental factors, program preparation, program implementation, and program evaluation to develop a family-centered program. Results. The use of the intervention mapping approach helped us identify the outcomes and functional objectives, develop an appropriate intervention program, and evaluate the program. Conclusions. The intervention mapping approach is an appropriate guide to developing a systematic and evidence-based program.

Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP): a feasibility study

BACKGROUND

Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice.

METHOD

This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis.

DISCUSSION

The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021.

Mother’s Characteristics and Socioeconomic Status as Possible Risk Factors for Children’s Caries in Jordan

Background. Clinical oral health status of children affects their health-related quality of life. A major determinant of oral health is early childhood caries, which possesses a negative effect. Objective. The primary objective of the study was to examine the association between socioeconomic status and different mother’s characteristics and the risk of dental caries in children using the decay missing filled (DMF) score as an indicator. Methods. This was a cross-sectional descriptive study that was in the pediatric dental clinic in Hashem Ibn Al-Hussein medical military hospital in Jordan. Pearson correlation was used to examine associations between two continuous variables. Linear regression was used to detect variables that might predict the decayed missing filled teeth (dmft) score of the child. Results. A total of 264 children were enrolled in the study. Average age of children was 4.80 ± 1.99 years, and average mothers’ age was 32.74 ± 5.68. Mothers had an average DMFT score of 8.84 ± 5.39, while children had an average dmft score of 6.17 ± 4.82. There was no association between the mother’s age and the dmft score of the child (Pearson correlation = 0.08, and $P$ value = 0.215). However, a moderate, statistically significant correlation was found between the mother’s and the child’s DMFT scores (Pearson correlation = 0.418, and $P$ value = 0.001). Children who belonged to low and middle-income families had a higher dmft score compared to those that belonged to families with high income. Conclusion. Socioeconomic status of the family, mother’s habits, dental hygiene, and education level are important factors that influence the child’s oral health. Strategies that focus on children with these characteristics can help them achieve better oral health.

Caries Experience and Its Relationship with Mother\'s Educational Level and Occupational Status: A Cross-sectional Survey

Aim

Most studies have investigated established risk factors contributing to dental caries in children, however, with the growing incidence of caries in children more risk factors are being included in literature. Thus, this cross-sectional study was conducted to assess the relationship between mother's educational level and occupational status with the caries experience of the child.

Materials and method

About 120 mother–child pairs participated in the study. Children below 12 years were screened for their dental caries status using DMFT index. The pairs were equally divided into three groups according to the mother's education and occupational status as: Group I–Mothers who did not receive any formal education, Group II–Educated mothers but unemployed, and Group III–Educated employed mothers. Mother's knowledge and attitude regarding the child's oral health was recorded analyzed using Chi-square test with statistical significance set at p < 0.05.

Results

In the present study, the lower DMFT score has been significantly related to higher levels of education and occupation of the mother. It was also observed that the knowledge and attitude of the mother related to the child's oral health is directly proportional to the education and occupational status.

Conclusion

The findings of our study suggest that mother's level of education increases the awareness of the child's oral health. Therefore, it is utmost important to educate a mother to help the child maintain his oral health and reduce the caries prevalence.

Clinical significance

The results of the present study conducted will help the clinician to keep in sight the relationship of mother's education and occupational level and its impact on their child's teeth, which will in turn help them for creating further dental awareness in the society.

How to cite this article

Nembhwani HV, Varkey I. Caries Experience and Its Relationship with Mother's Educational Level and Occupational Status: A Cross-sectional Survey. Int J Clin Pediatr Dent 2022;15(S-2):S226–S229.

Significance of sugar intake in young adults: a review

BACKGROUND

Foodborne diseases non-communicable diseases (NCDs) are the main reason of death, accounting for 38 million (68%) of the 56 million premature deaths worldwide in 2012. Lower-middle and middle-income countries accounted for nearly three-quarters of all NCD fatalities (28 million), as well as the bulk of illness and premature death (82%). An excessive consumption of added sugar is source of worry for its link to unhealthy nutrition quality, overweight, and the risk of NCDs among adolescents. A further source of worry is the link among free sugar consumption and tooth cavities in young adults. Dental infections are the most common NCDs worldwide in young adults, and despite significant advances in management and cure in recent decades, issues remain, resulting in pain, anxiety, functional limitations (which include failing school grades and attendance in children), and social severe disability due to missing teeth.

OBJECTIVES

The purpose of this report is to give suggestions on how to consume added sugar in order to mitigate the possibility of NCDs in children and young adults, with an emphasis on the care and mitigation of obesity and metabolic syndrome and tooth decay among young adults.

METHODS AND MATERIALS

The Keywords like adolescent, Health, Dental Caries, Obesity, Sugar Intake, Recommendation have been used to evaluate the standard of evidence discovered via current systematic reviews of the scientific literature relating to significance of sugar intake consumption and its effect in young adults.

RESULTS

The relevant data from prospective studies was judged to be of good quality, but data from nationwide population-based studies was judged to be of extremely low quality. Free sweeteners should be used in moderation during one's life, according to the World Health Organization (strong recommendation 1). WHO advises limiting natural sugar consumption to very little about 10% of total calorie intake among both grownups and children 2 (strong recommendation).

CONCLUSIONS

There is a significant association of prevalence of tooth decay, obesity due to sugar consumption at an alarming rate hence regulators as well as curriculum developers can utilize the recommendation reviewed by us to compare current free sugar intake levels in their nations to a benchmark. They may also be used to design ways to reduce free sugar consumption through a wide variety of social health initiatives, if required.

DMF Index among Amelogenesis Imperfecta Patients: Systematic Review of the Literature

Objectives

The aim of this study was to explore the literature in order to assess systematically the association between amelogenesis imperfecta (AI) and caries development and to evaluate the DMF index among AI patients. Basic Research Design. PubMed was used to explore the database Medline. The key words used were “Amelogenesis Imperfecta” [Mesh], “Dental Caries” [Mesh], “Tooth Loss” [Mesh], “DMF Index” [Mesh], and “Dental Restoration, Permanent” [Mesh]. Moreover, an ad hoc search was performed in order to make the study as exhaustive as possible.

Results

Fifty-five articles were retained. The total number of patients gathered was 499. A percentage of 68.8% of the articles dealt with cases with a relatively low dental caries process, 20.8% dealt with cases in which the dental caries process was relatively moderate, and 10.4% dealt with cases in which the dental caries process was severe. Teeth extraction due to dental caries was mentioned in 10 articles. Eleven articles, concerning 53 patients, mentioned dental fillings. Four patients did not have dental filling due to dental caries. DMF index was very low in 2 articles and low-to-high in 3 articles.

Conclusion

Low dental caries susceptibility with AI patients was noticed in this study. A possible factor could be the lack of proximal contacts and elimination of fissures through enamel loss. The lack of dental caries susceptibility was also explained by the microbacterial specificity of hypoplastic AI patients. Moreover, it was also noted that the prevalence of dental caries among AI patients depends on sociodemographic change.

Age period cohort analysis of chewing ability in Korea from 2007 to 2018

There have been marked improvements in oral health in Korea during the past 10 years, including chewing ability. We sought to disentangle age, period, and cohort effects in chewing ability between 2007 and 2018. We analyzed data from the Korea National Health and Nutrition Examination Survey. The main variable was chewing difficulty, which was assessed among participants aged 20 years and older. APC analysis revealed three trends in chewing difficulty: (1) there was an increase in chewing difficulty starting at around 60 years of age (age effect), (2) there was a steady decrease in chewing difficulty during the observation period (period effect), and (3) chewing ability improved with each successive generation born after 1951 (cohort effect). Regarding recent improvements in chewing ability, cohort effects were somewhat more important than period effects.

Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care

BACKGROUND

Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth.

METHOD

This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes.

DISCUSSION

SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN.

TRIAL REGISTRATION NUMBER

ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search .

Ten-year trends in DMF-S and DMF-T in a northeast German adult population

OBJECTIVE

The aim of this study was to assess 10-year trends in coronal caries in adults aged 20-83 years using data from the two-representative population-based Studies of Health in Pomerania (SHIP-0/SHIP-Trend-0).

METHODS

Repeated cross-sectional data from 4,286 SHIP-0 and 3,913 SHIP-Trend-0 participants were analysed. Carious, filled and missing teeth/surfaces were recorded in a half-mouth design and the DMF-T/S scores and sound surfaces/teeth were calculated according to WHO criteria. Trends in DMF-T/S scores and its single components were presented stratified by age group and sex.

RESULTS

A statistically significant decline in coronal caries experience (DMF-T and DMF-S) in adults aged 20 to 83 years as well as for D-T/S components was observed. The proportion of edentulous participants was almost halved from 8.7% (SHIP-0) to 5.1% (SHIP-Trend-0), while the number of M-T declined from 4.4 to 3.5 revealing an overall clear shift to a higher retention rate of teeth. In younger adults (25-34 years) 3.8 more sound teeth (17.2 sound surfaces) were found in average in the mouth and in elderly (65-74 years) a clear shift from extracted to filled teeth was observed (M-T reduced by 5.4, while F-T increased by 4). Regarding sex differences, females had consistently on average higher MF-T/S values, but lower D-T/S values than males.

CONCLUSION

A clinically relevant drop in the severity of coronal caries experience in all adult age groups in Northeast Germany shows that not only reductions in caries experience in adolescence translated into adulthood but also later improvements led to long-term oral health.

Oral health and caries/gingivitis-associated factors of adolescents aged 12-15 in Shandong province, China: a cross-sectional Oral Health Survey

Background

We aimed to analyse the oral health status of adolescents in Shandong province, including dental caries and gingivitis, and their associated factors.

Methods

Adolescents aged 12–15-years in Shandong province were recruited. Caries and gingival status were assessed following the World Health Organisation diagnostic criteria. Information including the sociodemographic, oral hygiene knowledge, attitudes and practices were collected through the questionnaire. Chi-square test and multivariate logistic regression analysis were used to investigate the oral diseases associated factors.

Results

In total, 3868 students (50.2% males) were enrolled. Of these, 39.9% of the participants experienced caries, and 81.7% and 31.3% had calculus and bleeding gingival, respectively. Multivariate logistic regression analysis revealed that there was an association between dental caries and toothaches, dental visits and sleeping troubles caused by oral problems (P < 0.024). A low-frequency of brushing, high sugar consumption and no flossing were more associated with calculus formation and gingival bleeding (P < 0.008).

Conclusion

Compared to caries, worse gingival condition was more prevalent among adolescents in Shandong province. Brushing behaviour is associated with gingivitis, while dental visits and toothaches are associated with caries. Hence, prevention-oriented dental visits and oral hygiene training are strongly recommended to improve oral health status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01640-x.

Risk factors for dental caries in Latin American and Caribbean countries

Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

Associations Between Diet Quality and Dental Caries in Low-Income Women

BACKGROUND

The Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes.

OBJECTIVE

The objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women.

DESIGN

In this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module.

PARTICIPANTS/SETTINGS

Participants in this study were part of a larger research project-Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data.

MAIN OUTCOME MEASURES

The exposure was diet quality and the main outcome measure was DMFT score.

STATISTICAL ANALYSIS

Dental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality-as assessed by HEI-2015 total and component scores-and dental caries experience, adjusting for the covariates.

RESULTS

Caries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores.

CONCLUSIONS

This research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.

Determinants of dental caries in children in the Middle East and North Africa region: a systematic review based on literature published from 2000 to 2019

Background

Dental caries risk factors have been expanded to not only emphasize biology, dietary and oral habits but also broader social determinants such as socioeconomic factors and the utilization of health services. The aim was to review sociobehavioural/cultural and socioeconomic determinants of dental caries in children residing in the Middle East and North Africa (MENA) region.

Methods

A search was conducted in the PubMed/Medline database and Google Scholar to identify studies published from 2000 to 2019 covering children using key search terms. In the initial stages, titles, abstracts and, if needed, full articles were screened for eligibility. In the final stage, all included articles were reassessed and read, and relevant data were extracted.

Results

Out of 600 initial articles, a total of 77 were included in this review, of which 74 were cross-sectional, 2 were longitudinal and one was a case–control study. The studies included a total of 94,491 participants in 14 countries across the MENA region. A majority used the World Health Organization scoring system to assess dental caries. The caries prevalence ranged between 17.2% and 88.8%, early childhood caries between 3% and 57% and decayed missing filled teeth (dmft) varied between 0.6 and 8.5 across the various age groups. Increased age, low maternal education, low overall socioeconomic status, decreased frequency of tooth brushing, low parental involvement, poor oral habits, infant feeding practices and sugar consumption were among the most prevalent determinants for increased risk of caries in the reviewed studies.

Conclusions

Dental caries was found to be high among children in many of the studies published from MENA. The key determinants of dental caries were found to include factors related to child characteristics, family background, oral hygiene and infant feeding and eating habits. The high dental caries prevalence emphasises the need to address the prevailing modifiable sociobehavioural and socioeconomic determinants by translating them into effective oral health prevention policies and programmes.

The Influence of Age on the Development of Dental Caries in Children. A Radiographic Study

Dental caries is a chronic disease that can be influenced by a multitude of factors. Poor oral hygiene and unhealthy eating habits are the most incriminating factors in the onset of dental caries, but age has been proven to impact the disease. The aim of this study was to find correlations between age and the evolution of dental caries in the first permanent molars in children. The retrospective study was conducted based on 400 panoramic radiographs, belonging to Romanian children between the ages of 6 and 14 years. All first permanent molars were investigated, and the carious lesions were classified according to their depth. The chronological age was calculated by subtracting the patient's date of birth from the date when the radiograph was performed, while for the assessment of dental age, the Demirjian method was used. The gender of the patients did not significantly influence the number of superficial, medium, and deep carious lesions. Most of the identified carious lesions were superficial. Regarding correlations between age and dental caries, there was an association between the decrease in the chronological age and the increase in the number of superficial carious lesions on the first permanent molars and also an association between the increase in the chronological age or dental age and the increase in the number of medium and deep carious lesions on the first permanent molars. Age can impact the development of dental caries in first permanent molars.

Taxes to Unhealthy Food and Beverages and Oral Health in Mexico: An Observational Study

In January 2014, taxes on sugar-sweetened beverages and nonessential energy-dense food were implemented in Mexico to discourage the consumption of these products. Published evaluations have shown reductions in purchases of taxed food and beverages associated with the implementation of this fiscal policy. Although there are some studies on the impact on health based on simulation studies, no evaluations with empirical data on changes in oral health have been published. We used administrative records and data from an epidemiological surveillance system to estimate changes in (1) outpatient visits related to dental caries; (2) having experienced dental caries: Decayed, Missing and Filled Teeth (DMFT) >0 for permanent dentition or dmft >0 for primary dentition (dmft); (3) number of teeth with caries experience (DMFT and dmft), (4) cases with DMFT >0 or dmft >0, and (5) the series of mean DMFT or dmft, associated with the taxes. We estimated probit and negative binomial models for outcomes at individual level, and interrupted time series analysis for population-level outcomes. The implementation of the taxes was associated with negative changes in the trends of outpatient visits, as well as for cases with DMFT >0, dmft >0 and mean DMFT. Taxes were also associated with a lower probability of having experienced dental caries and with a lower number of teeth with caries experience in the samples studied. Our results suggest positive impacts of the implementation of taxes on unhealthy food and beverages in the oral health of Mexicans, which are the first health benefits observed, and add to the health benefits predicted by modeling studies.

Individual and familial factors associated with caries and gingivitis among adolescents resident in a semi-urban community in South-Western Nigeria

Objectives

We describe the prevalence, and individual and familial risk indicators for dental caries and gingivitis among 10–19-year-old adolescents in Ile-Ife, South-West Nigeria.

Methods

This cross-sectional study collected data through household surveys conducted between December 2018 and January 2019. Adolescents were recruited through multistage sampling. Oral health outcomes were caries, measured by the ‘Decayed, Missing due to caries, and Filled Teeth’ (DMFT) index, and gingivitis, measured by the Loe and Silness gingival index. Explanatory variables were individual (sex, age, oral health perception) and familial (socioeconomic status, birth rank, family size and parental living status) factors. Oral health behaviors (daily tooth-brushing, use of fluoridated toothpaste, consuming refined carbohydrates in-between meals, use of dental floss, dental service utilization in past 12 months, and smoking habits) were treated as confounders. Poisson regression models with robust estimation were constructed to determine associations between explanatory factors and oral health outcomes.

Results

A total of 1472 adolescents were surveyed. Caries prevalence was 3.4%, with mean (standard deviation) DMFT of 0.06 (0.36) and plaque index of 0.84 (0.56). Only 128 (8.7%) adolescents brushed their teeth twice daily, 192 (16.1%) used dental floss daily, 14 (1.1%) utilized dental services in the last 12 months, and 508 (36.1%) consumed refined carbohydrates in-between meals less than once daily. The proportion of respondents who currently smoked cigarettes was 1.6%, and 91.7% of respondents used fluoridated toothpaste daily. The adjusted prevalence ratio of having caries increased by 18% for every additional age-year (APR: 1.18; 95% CI 1.004, 1.34). Additionally, participants with high socioeconomic status had significantly lower prevalence of caries compared to those with lower status (APR: 0.40; 95% CI 0.17, 0.91). Moderate/severe gingivitis was significantly associated with higher frequency of consuming refined carbohydrates in-between meals (APR: 2.33; 95% CI 1.36, 3.99) and higher plaque index scores (APR: 16.24; 95% CI 9.83, 26.82).

Conclusion

Caries prevalence increased with increasing age and was higher among Nigerian adolescents with low socioeconomic status, while moderate/severe gingivitis was associated with frequent consumption of refined carbohydrates and higher plaque index score. While behavioral interventions may reduce the risk of gingivitis, structural interventions may be needed to reduce the risk for caries in this population.

Association between root/coronal caries and individual factors in institutionalised elderly using ICDAS severity and activity

Background

Caries in the elderly has been associated with dependence, oral-health status and -care practices. This cross-sectional study aimed to investigate the association between root/coronal caries and individual factors among institutionalised elderly people in Bogotá, Colombia, using the International Caries Detection and Assessment System severity and activity criteria (ICDAS).

Methods

A total of 226 institutionalised elderly were clinically examined for root and coronal caries in 40 institutions. Caries risk was assessed with Cariogram, and demographics, oral health knowledge and practices, oral health-related quality of life and denture-use habits using a questionnaire.

Results

Participants (mean age: 80.1 ± 9.3 years; 63.7% female) presented a mean number of 10.8 ± 7.3 teeth and 19.4 ± 18.8 exposed root surfaces. Prevalence of Coronal-ICDAS caries experience (C-ICDAS DF) was of 100% and of 54.4% for C-ICDAS D; mean number of C-ICDAS DFS was 16.76 ± 27.36, with 50.9% of subjects having ≥ one active C-ICDAS DS. Prevalence of Root Caries Index was of 49.1% and of R-ICDAS DF of 46%; mean number of R-ICDAS DFS was 2.03 ± 2.78, with 40.3% of subjects having ≥ one active R-ICDAS DS. Most individuals had a systemic condition (94.2%) and required oral-hygiene assistance (58%). Logistic regression analyses showed significant associations (p < 0.05): for coronal active caries when having over six teeth (OR: 2.7), and for root caries, when having coronal caries (OR: 2.41), being a man (OR: 1.95), and having over 14 teeth (OR: 0.30). Those presenting with > eight exposed root surfaces were 4.04 more likely to have root caries and 2.4 times more likely to have active root caries.

Conclusion

In the institutionalised elderly population in Bogotá significant associations were found, both for the presence as for the activity status of root and coronal caries, with individual clinical factors including coronal caries, exposed root surfaces and number of teeth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01520-4.

Dental caries thresholds among adolescents in England, Wales, and Northern Ireland, 2013 at 12, and 15 years: implications for epidemiology and clinical care

BACKGROUND

Dental caries is the most prevalent condition globally. Despite improvements over the past few decades, there remains a significant disease burden in childhood. Epidemiological surveys provide insight to disease patterns and trends, and have traditionally focused on obvious decay which are inconsistent with contemporary clinical criteria. This study examined the distribution of dental caries in 12- and 15-year-olds in England, Wales and Northern Ireland, by severity threshold, at surface, tooth and child level and explored its association with socioeconomic, psychological and behavioural factors.

METHODS

Data from 12- and 15-year-olds in the 2013 Children's Dental Health Survey (CDHS 2013) were analysed at three levels, taking account of dental caries thresholds which involved recording both clinical decay [visual enamel caries (AV) and above] and obvious decay [non-cavitated dentine lesions (2V) and above]. Negative binomial regression was used to identify factors associated with dental caries experience at both thresholds.

RESULTS

The prevalence and severity of dental caries experience was higher among 15-year-olds at all levels. Visual change in enamel (AV) was by far the most common stage of caries recorded in both ages. The average number of surfaces with obvious decay experience, which has been the traditional epidemiological threshold, in 12- and 15-year-olds was 2.3 and 3.9 respectively. The corresponding values under the clinical decay threshold were higher, at 3.9 and 5.9 respectively. Visualisation of the distribution of dental caries at surface/tooth-level exhibited horizontal symmetry and to a lesser extent vertical symetry. In the adjusted models for both ages, country/region, school type, area deprivation, high frequency sugar consumption and irregular dental attendance were associated with greater caries experience in both groups. Dental anxiety was inversely associated with caries experience among 15-year-olds.

CONCLUSION

This research highlights the importance of recognising dental caries patterns by surface, tooth and child-level amongst adolescents and the value of reporting dental caries distribution by threshold in epidemiological surveys, including its relevance for clinical care. Inclusion of enamel caries reveals the extent of caries management required at a point when non-invasive care is possible, emphasising the importance of prevention through contemporary primary care, which includes supporting self-care.

Reasons for Permanent Teeth Extractions and Related Factors among Adult Patients in the Eastern Province of Saudi Arabia

Objective

To evaluate the reasons for permanent teeth extractions and related factors among adult patients visiting dental clinics in the Eastern Province of Saudi Arabia.

Materials and Methods

This retrospective cross-sectional study included data of patients who underwent teeth extractions. Data were collected from public and private dental clinics in different cities of the Eastern Province of Saudi Arabia (January-March 2020). The demographic information of patients and their reasons for teeth extractions were obtained from participating dentists.

Results

The study included data of 696 patients with 55.9% of males and 44.1% of females. The mean number of teeth extractions in the sample was 1.86 ± 1.8, and it increased significantly with advancing age (P ≤ 0.001). Saudi (1.97 ± 1.98) versus non-Saudi patients (1.55 ± 1.11) (P=0.02) and patients in public practice (2.03 ± 1.95) versus patients in private practice (1.50 ± 1.38) (P ≤ 0.001) showed significantly higher teeth extractions. Dental caries was the most common reason for teeth extractions (49.1%), followed by remaining roots (18.5%), periodontal disease (18.4%), and impactions (7.2%). Most commonly extracted teeth included tooth # 30 (9.8%), followed by tooth #16 (9.6%), tooth # 1 (8.8%), tooth # 19 (8.3%), and tooth # 4 (8.3%). On the other hand, upper incisors were the least commonly extracted teeth.

Conclusions

Dental caries, remaining roots, periodontal disease, and impactions were the most common reasons for teeth extractions in our sample of patients. The extractions increased significantly with increasing age. Saudis and patients in public clinics underwent significantly higher teeth extractions. Measures aimed at the prevention and treatment of oral conditions can help reduce teeth extractions and improve the quality of life of patients.

Association of Dietary Fluoride Intake and Diet Variables with Dental Caries in Adolescents from the ELEMENT Cohort Study

To examine the association of dietary fluoride intake, total carbohydrate consumption and other key dietary variables with dental caries experience among adolescents, a cross-sectional analysis was conducted in a sample of 402 participants from the Early Life Exposures in Mexico to Environmental Toxicants cohort. The presence and severity of dental caries were assessed using the International Caries Detection and Assessment System (ICDAS) to calculate the number of decayed, missing, and filled teeth or surfaces (D1MFT/D4MFT). The dietary intake of fluoride, energy, carbohydrates, and food groups was estimated using a validated food frequency questionnaire (FFQ). Multivariate zero-inflated negative binomial regression models and negative binomial regression models were run to estimate the association of fluoride intake (mg/day) and total carbohydrate intake (g/day) with the D1MFT/D4MFT index. We found that 80% of the adolescents experienced dental caries (D1MFT >0), with 30% presenting cavitated lesions (D4MFT >0). The mean scores for D1MFT and D4MFT were 6.2 (SD 5.3) and 0.67 (SD 1.3), respectively. The median intake of fluoride estimated by the FFQ was 0.015 mg/kg/day. This intake was statistically higher in participants with a D4MFT = 0 compared to those with a D4MFT >0 (0.90 vs. 0.82 mg/day; 0.016 vs. 0.014 mg/kg/day; p < 0.05). For D1MFT, D1MFS, D4MFT, and D4MFS scores, a higher fluoride consumption (mg/day) from foods and beverages was associated with a statistically significant reduction in the number of lesions. The reported frequency of consumption of sugary foods in a whole day was statistically higher in those with D1MFT >0 than in those with D1MFT = 0 (p < 0.05). The total carbohydrate intake (g/day) was positively associated with dental caries experience. We conclude that a higher fluoride intake through foods and beverages is associated with a lower dental caries experience among adolescents; this effect was seen even when the dietary intake of fluoride was 0.015 mg/kg/day, which is lower than the average intake recommendation. In contrast, a higher total carbohydrate intake and the frequency of intake of sugary foods were associated with a higher dental caries experience, with no apparent threshold for the effects.

Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults

The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.

Estimating the prevalence of untreated caries in permanent teeth from the DMF index and lifetime caries prevalence

AIM

To derive formulas to estimate the prevalence of untreated dental caries in permanent teeth based on the DMF index and lifetime caries prevalence.

METHODS

Data from participants, aged 5 years or older, in the National Health and Nutrition Examination Survey 2011-2016 were analyzed. Dental caries was assessed at surface level with the Radike criteria, which matches the case definition of the Global Burden of Disease study. Participants' data were aggregated into 438 groups, based on survey strata and 5-year age brackets, to produce population estimates for the prevalence of untreated caries (DT > 0), DMFT, DMFS, DT, DS, and lifetime caries prevalence (DMFT>0). Conversion formulas were derived using fractional polynomials to characterize the association of each caries indicator with the prevalence of untreated caries.

RESULTS

The mean prevalence of untreated caries was 23.5 percent (SD: 12.9 percent, range: 1.0-72.3 percent). After adjustment for age, the prevalence of untreated caries was correlated with DMFT (r = 0.23), DMFS (r = 0.25), DT (r = 0.74), DS (r = 0.65) and lifetime caries prevalence (r = 0.18). Using fractional polynomial models adjusted for categorical age, the prevalence of untreated caries at population level could be estimated from DMFT with power 1 (linear form), DMFS with power 0.5, DT with power 0.5, DS with powers (0.5; 1) and lifetime caries prevalence with power 1.

CONCLUSION

The prevalence of untreated caries in permanent teeth can be estimated from the DMF index and lifetime caries prevalence. These conversion formulas can facilitate the inclusion of more studies in estimation of the global burden of untreated caries in permanent teeth.

Age, period and cohort trends in oral health status in South Korean adults

OBJECTIVES

The purpose of this study was to identify the age, period and cohort effects on the changes in oral health status in South Koreans.

METHODS

The age, period and cohort analysis (APC analysis) of the oral health status was conducted using an aggregated age-by-time period table. The age-by-time period table was formulated using data from the Korea National Oral Health Survey (KNOHS) 2000 and 2006, and the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 and 2015. Two oral health outcomes were measured: the number of teeth and Decayed-Missing-Filled Teeth (DMFT) index. Descriptive analysis by graphical representation and partial least square (PLS) regression was used for APC analysis.

RESULTS

Both graphical description and PLS regression showed age and cohort effects in oral health status with the number of teeth decreasing and the DMFT index increasing with age. No period effects were found in either index. The number of teeth increased in the recent birth cohorts. However, the DMFT index showed a reverse J-shaped trend, which worsened in recent birth cohorts. The DMFT index increase in the recent cohort was mainly attributed by an increase in the FT index.

CONCLUSIONS

The effects of age on the number of teeth and caries highlight the importance of oral health in adulthood. The increased caries experience in recent cohorts may indicate the limitations of the current oral health policy. It would be relevant to explore what determinants cause the changes in oral health status. Future oral health policies should address the new directions to reduce the burden of oral diseases.

Frightened of the pulp? A qualitative analysis of undergraduate student confidence and stress during the management of deep caries and the exposed pulp

AIM

To evaluate sources of student confidence and stress during the management of deep carious lesions and the exposed pulp during undergraduate clinics. Further aims were to identify barriers and facilitators, which could result in educational or practical improvements in the delivery of teaching and provision of treatment in this area.

METHODOLOGY

A exploratory qualitative study design was used, based on recorded focus group interviews, guided by 12 predetermined questions. The discussions were transcribed verbatim and analysed by inductive qualitative content analysis. Common categories were identified to aid understanding. Forty undergraduate dental students from 4th and 5th years in Dublin Dental University Hospital participated in the study.

RESULTS

Student stress and confidence were multifactorial and broadly linked to specific domains: clinical procedure, academic education, clinical training, evaluation/grading, organization and equipment, vital pulp biomaterial and the patient. Most students expressed a preference for one-stage selective carious removal to soft dentine rather than potential pulp exposure in deep carious lesions, noting that although it helped to decrease their immediate stress, it also caused longer-term concern by leaving caries close to the pulp. Nevertheless, their confidence was affected by limited clinical experience of carrying out selective removal procedures in deep caries. A recurrent finding was students citing high levels of stress after pulp exposure. Feelings including anger, fear, embarrassment and denial were associated with pulp exposure during deep caries management. Generally, the students felt able to manage pulp capping procedures, but were less certain about partial pulpotomy, suggesting that although they are aware of its advantages, they were unsure about the appropriate volume of pulp tissue to remove. To reduce stress, students suggested that laboratory teaching should employ new 3-D printed solutions and clinics should establish clear consensus amongst supervising teachers about the best way to manage the exposed pulp.

CONCLUSIONS

Students lacked confidence as they neared the pulp and prefer selective caries removal techniques, which reduce the likelihood of pulp exposure. Students identified stressors and suggested improvements in several domains that would improve confidence. These ameliorations could lead to enhancements in student ability to perform these conservative techniques, and improve the provision of treatment in this area.

Correlation of Caries Prevalence, Oral Health Behavior and Sweets Nutritional Habits among 10 to 19-Year-Old Cluj-Napoca Romanian Adolescents

Background and objectives: The primary oral disease during adolescence is dental caries. Less is known about the caries prevalence, oral health behavior, and sweets nutritional habits in Romanian adolescents. The objective of this study was to assess the actual caries prevalence among Romanian adolescents in a representative area of Romania, Cluj, and to correlate with oral hygiene behaviors and dietary sugary foods intake. Materials and methods: We have done a cross-sectional study of 650 adolescents aged 10 to 19-years-old (average age 15.3 ± 2.8). We performed the oral dental examination according to the WHO methodology, calculated the number of decayed, missing (due to caries), and filled teeth (DMFT index), assessed the oral hygiene and dietary behaviors using a two-section valid questionnaire and statistically analyzed the interrelation between DMFT, oral hygiene and eating behaviors by multivariate statistical analysis. Results: (a) The caries prevalence in the adolescent population enrolled in the study was 95.5%; (b) the mean DMFT was 3.13 ± 2.0, without significant differences between the urban and rural adolescents (p = 0.253); lower in females than males (p < 0.050), (c) more than one third (33.7%, n = 219) of teenagers are seldom or never brush their teeth in the evening; (c) 40.6% of adolescents are missing the regular annual dental check-ups leading to an increased DMFT as shown in the multivariate analysis (p = 0.038); and (d) there is an increased prevalence of caries with age (p = 0.020), and with sugary sweetened beverages consumption (p = 0.028). Conclusions: Our study evidenced a persistent high caries prevalence in Romanian teenagers. Their dietary habits and irregular dental check-up were associated with the occurrence of dental conditions.

Reliability of Caries Assessment Spectrum and Treatment Tool in the Indian Subcontinent

BACKGROUND

Accurate diagnosis, reporting of caries and its consequences, is absolute mandate for planning an efficient, effective community health-care program. Literature reports indicate shortcomings of existing caries assessment tools. Caries assessment spectrum and treatment (CAST) is novice caries quantification tool, which quantifies the entire spectrum of carious lesions. This tool records give an insight into the status of restorations along with various progressive developmental stages of dental caries. This instrument has been validated for face, content, and construct by an expert group, and currently, its usage is on the rise.

AIM

The aim of this study was to report the reliability of this assessment tool with regard to the primary and permanent dentition of school children and adults belonging to a south Indian district.

MATERIALS AND METHODS

A cross-sectional study was carried out by two trained and calibrated examiners by examining 192 school children in the age-group between 4 and 6 years and 262 adults between 19 and 69 years. The study sample was reexamined by the same examiners after a gap of 4 weeks. The κ coefficient values and percent of agreement were calculated for the data recorded from the study subjects.

RESULTS

The analyzed data showed moderate intra-examiner and inter-examiner reproducibility for either of the dentition as revealed by κ coefficient values (0.80-0.89). Inter- or intra-examiner agreement was found to be substantial to almost perfect (percent agreement above 90%) with respect to both the age-groups.

CONCLUSION

The CAST tool seems quite promising to be the future for quantifying caries spectrum for a community or an individual.

A longitudinal study of the impact of change in socioeconomic status on dental caries in the permanent dentition of Swedish children and adolescents

OBJECTIVES

The overall aim was to analyse longitudinally the development of dental caries in the permanent dentition of children and adolescents in a Swedish region, in relation to possible change in socioeconomic status (SES).

METHODS

A total of 259 448 individuals in western Sweden were followed over a 3-year period, through dental journal records at baseline (3-19-year-olds) and 1-3 dental check-ups during the follow-up period. Official socioeconomic register information (ethnicity, wealth, parental education and employment) was available at both baseline and follow-up. Data were used both as independent single variables and combined in an index. Gender, age and caries status at baseline and the examination years were included as covariates in the regression models.

RESULTS

Associations over time were found between SES and dental caries in young people. A persistently low SES was associated with the greatest risk of both new and accumulated (decayed plus filled teeth/approximal surfaces) caries; however, any change in SES, whether improved or worsened, led to a greater risk. An increased risk of new caries events was identified for those who were older at baseline and by examination year. On average, the increase per year in decayed and/or filled teeth and in approximal surfaces was 0.23 and 0.12, respectively.

CONCLUSION

SES was shown to be an important risk factor for dental caries over time in young Swedish people. Prevention programmes should pay particular attention to the needs of socioeconomically vulnerable individuals and groups.

Oral health among student veterans: Effects on mental and physical health

Objective: The purpose of this study was to explore differences in oral health among students by military service status in postsecondary settings. Participants: Secondary data were obtained from the American College Health Association's 2011-2014 National College Health Assessment II. Method: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with maximum likelihood multiple logistic regression. Results: Service member and veteran students are at greater risk for neglecting health behaviors associated with positive oral health, including that they were less likely to get dental exams and that those who deployed in the past were the least likely to be practicing good oral health. Conclusions: The results suggest that improving oral health will contribute to improving health and mental health outcomes in this population, and provide important information for health specialists working with service members and veterans on college campuses.

Estimation of Caries Treatment Needs in First Permanent Molars of Lithuanian 5-6-Year-Old Children, Based on Caries Lesion Activity Assessment

Background and Objectives: Early detection of dental caries lesions at active stages of development can facilitate their monitoring and reduce needs for restorative dental care. This study aimed to describe the prevalence and caries treatment needs in first permanent molars of pre-school children, based on a caries lesion activity assessment, and in relation to participants’ ages, dental plaque levels and toothbrushing habits. Materials and Methods: Large cross-sectional dental caries survey using multistage cluster sampling was conducted among Lithuanian 4–6-year-old children attending kindergartens. For the present study purpose, all individuals presenting erupted permanent molars were selected. Thus, only 5–6-year-olds (n = 453) took part in this study. They were examined for caries by one calibrated examiner using Nyvad clinical diagnostic criteria that differentiate between active and inactive caries lesions. Dental plaque was assessed by the Silness-Löe index, and parents’ reports about toothbrushing frequency were collected. Results: Overall, 41% of permanent molars were affected by caries; 6-year-olds had more caries lesions than 5-year-olds (p < 0.05). Mean number of decayed and filled surfaces (DF-S) of all participants was 1.79 (SD 2.93), half of lesions were noncavitated, more than one-third were cavitated and fillings comprised less than one surface per child. Majority of lesions were active; prevalence of inactive lesions (all noncavitated) was 1% and 6% in 5- and 6-year-olds, respectively. Prevalence of active lesions increased with age; it correlated with plaque levels and with toothbrushing frequency (<0.001). Likelihood to detect active lesions was up to nine times higher in teeth with abundant plaque (odds ratio (OR) 8.73; confidence interval (CI) 5.35–14.25), and up to seven times higher in individuals brushing teeth irregularly (OR 6.88; CI 2.21–21.41). Conclusions: The obtained data indicate high treatment needs in the erupted permanent molars of the Lithuanian pre-school population and imply that caries management should primarily focus on improved biofilm removal, accompanied with regular use of fluoridated toothpaste.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.

Oral disorders in patients with newly diagnosed haematological diseases

OBJECTIVE

This study aimed to examine saliva flow rates and prevalence of dental and periodontal diseases of patients with newly diagnosed severe haematological diseases and compare these findings with age-matched controls of normal population.

METHODS

A total of 149 patients diagnosed with haematological diseases aimed to be treated with haematological stem cell transplantation between 2008 and 2018 and 154 controls were included in the study. A dental examination was performed for patients within a maximum of 6 months after diagnosis. Differences were compared in terms of the stimulated salivary flow rate (SSFR); decayed, missing and filled teeth (DMFT) index; number of teeth; caries prevalence; presence of periodontitis and acute infections.

RESULTS

The mean SSFR of the patient group was significantly lower (1.1 ml/min ± 0.7 ml/min) than the mean SSFR of the controls (1.3 ml/min ± 0.5 ml/min; p = 0.004). The number of caries lesions was significantly higher in the patient group (mean ± SD, 1.1 ± 1.9) than in the control group (mean ± SD, 0.4 ± 1.2; p < 0.001). There were fewer teeth and a higher DMFT index in the patient group compared to the control group, but the differences were not significant. Acute symptomatic infections were observed in eight (5.4%) patients and in none of the controls (p < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Oral examinations in patients with newly diagnosed severe haematological disease demonstrated a higher prevalence of caries, acute infections and lower mean SSFR compared with the controls. These findings support the recommendations for early dental examination at the time of diagnosis.

A rapid chair-side method for the estimation of oral bacterial colonization density

AIMS

Caries and periodontal disease are associated with inadequate control of oral bacteria. Since conventional microbiological evaluations are impractical in dental clinics or public engagement activities, a rapid test for the quantification of oral bacteria represents a useful tool. We describe the development of a colour change test to rapidly estimate bacterial colonisation density in the mouth.

METHODS AND RESULTS

Volunteers rinsed with milk or milkshake. Viability indicators were added and colour changes quantified during incubation. Using milkshake and the resazurin-based solution PrestoBlue (9% v/v), the method distinguished between samples before and after brushing within 5 min. Colour changes were quantified and viable counts were obtained using oral rinses. Measured colour changes strongly correlated with total counts of both anaerobes and streptococci (Spearman's correlation coefficient of 0·782 and 0·769, respectively, P ≤ 0·001) and with perceived changes, as determined by volunteers (n = 10) visually ranking images.

CONCLUSIONS

The resazurin milkshake test can rapidly and visually quantify viable bacteria in oral samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

The resazurin milkshake test could serve as a sensitive semi-quantitative method for measuring oral bacteria in human oral rinse samples.

The association between periodontal disease and root/coronal caries

OBJECTIVES

To examine whether there is an association between periodontal disease and each of root caries and coronal caries among adults (aged 35 and over), using a nationally representative sample of adults in England, Northern Ireland and Wales.

MATERIAL AND METHODS

In this cross-sectional study, data from the Adult Dental Health Survey 2009 were used. Adults aged 35 years or older who had periodontal and caries assessment were included. Two sets of negative binomial regression were conducted for each of coronal caries and root caries adjusting for periodontal diseases, dental visits, country, sex, age, education, job classification, oral hygiene and smoking.

RESULTS

Overall, 4738 were included in the analysis. Periodontal disease was significantly associated with each of coronal and root caries. In the fully adjusted model, those with PD/ LoA ≥ 4 mm had 1.03 rate ratio (RR) for coronal caries (95% CI: 1.01-1.05). In the model pertaining to root caries, the RR for those with periodontitis was 1.23 (95% CI: 1.16-1.30). Smoking, sex, age and oral hygiene were the variables that showed a consistent and significant association with coronal and root caries.

CONCLUSION

Individuals with periodontal diseases appeared to be at higher risk of coronal and root caries. While root exposure could be a plausible explanation for the relationship between periodontitis and root caries, the association with coronal caries could be attributed to the irritation of carious cavities, or common risk factors such as poor oral hygiene, or co-occurrence of different health risk behaviours related to both caries and periodontitis and socioeconomic conditions.

Ending the neglect of global oral health: time for radical action

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

Trends in use of dental services by Brazilian pre-school children considering Age-Period-Cohort Effect

BACKGROUND

Besides the growth in Brazilian public oral health investments, no pre-school children preventive policies were done, and surveys demonstrated lower prevalences of use of dental service.

AIM

To verify trends in the use, type, and reason for seeking dental services among pre-school children considering time variations.

METHODS

This study used data of clinical examinations and structured interviews of three cross-sectional surveys of southern pre-school children in Brazil, from 2008, 2010, and 2013. Chi-square test for trends and hierarchical age-period-cohort (HAPC) analysis using the multilevel Poisson regression model assessing the influence of social and clinical variables in the use, type, and reason for seeking dental services were performed.

RESULTS

A total of 1765 pre-school children participated in all surveys. At least, one time-related variation affected one of three assessed outcomes. There was no significant change in prevalence of the use of dental services (75.8%, 77.4%, and 74.9%, respectively, for each year; P = 0.750). In the HAPC analysis, younger children and from low socio-economic backgrounds were less likely to have visited the dentist.

CONCLUSION

The prevalence of use of oral health services did not change and socio-economic inequalities persisted through the years, indicating a need of reviewing the policies to promote public health.

"Setting the scene in early childhood" - an MID approach for life

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

Management of deep caries and the exposed pulp

Caries prevalence remains high throughout the world, with the burden of disease increasingly affecting older and socially disadvantaged groups in Western cultures. If left untreated, caries will advance through dentine stimulating pulpitis and eventually pulp infection and necrosis; however, if conservatively managed, pulpal recovery occurs even in deep carious lesions. Traditionally, deep caries management was destructive with nonselective (complete) removal of all carious dentine; however, the promotion of minimally invasive biologically based treatment strategies has been advocated for selective (partial) caries removal and a reduced risk of pulp exposure. Selective caries removal strategies can be one-visit as indirect pulp treatment or two-visit using a stepwise approach. Management strategies for the treatment of the cariously exposed pulp are also shifting with avoidance of pulpectomy and the re-emergence of vital pulp treatment (VPT) techniques such as partial and complete pulpotomy. These changes stem from an improved understanding of the pulp-dentine complex's defensive and reparative response to irritation, with harnessing the release of bioactive dentine matrix components and careful handling of the damaged tissue considered critical. Notably, the development of new pulp capping materials such as mineral trioxide aggregate, which although not an ideal material, has resulted in more predictable treatments from both a histological and a clinical perspective. Unfortunately, the changes in management are only supported by relatively weak evidence with case series, cohort studies and preliminary studies containing low patient numbers forming the bulk of the evidence. As a result, critical questions related to the superiority of one caries removal technique over another, the best pulp capping biomaterial or whether pulp exposure is a negative prognostic factor remain unanswered. There is an urgent need to promote minimally invasive treatment strategies in Operative Dentistry and Endodontology; however, the development of accurate diagnostic tools, evidence-based management strategies and education in management of the exposed pulp are critical in the future.