Evaluation of oral health status in the population above 50: evidence from the ardakan cohort study on aging (ACSA)

BACKGROUND

The global population is undergoing rapid aging, and older individuals are more susceptible to various health issues, including oral health problems. Despite the increasing attention given to healthy aging, oral health has often been overlooked in discussions related to health problems. This study aims to assess the oral health status of middle-aged and older adults in Iran.

METHODS

This cross-sectional study analyzed data from 4970 men and women aged 50 years and above, who participated in the Ardakan Cohort Study on Aging (ACSA) between 2020 and 2022. Trained personnel administered a questionnaire and conducted oral health examinations to determine the oral health status and oral hygiene behaviors of the participants.

RESULTS

The mean value (SD) of the total Decayed, Missing, and Filled Teeth (DMFT) index was 21.3 (10.7). Approximately 46% of all participants were completely edentulous (without natural teeth). Moreover, 58.5% of the total sample wore dentures, and the mean age (SD) when they started using dentures was 48.5 (20.7) years. About 71% of participants with natural teeth reported brushing their teeth at least once a day, while about 63% of denture wearers cleaned their dentures daily. In the sample, 28% of individuals had visited a dentist in the last year. The prevalence of difficulty in biting and chewing food among the participants was 48.2% and 44.6%, respectively. Additionally, nearly 68% of all samples reported experiencing at least one difficulty in daily functioning due to oral/dental conditions. The study identified cutoff points of seven (sensitivity = 56.8 and specificity = 77.5) and 10 (sensitivity = 72.1 and specificity = 71.1) missing teeth, indicating the presence of at least one problem in daily functioning due to oral/dental conditions in middle-aged and older adults, respectively.

CONCLUSION

The study reveals a high prevalence of edentulism and denture use among participants aged 50 years and above. The majority of samples reported difficulties in daily functioning due to oral and dental conditions, especially in biting and chewing food. These findings highlight the importance of proactive measures to address oral health issues in middle-aged and older adults, thereby enhancing their overall health and well-being.

Salivary Nitric Oxide Levels in Adults with Different DMFT Scores in a Selected Iranian Population: A Cross-Sectional Study

Objectives

Due to the emphasis on the protective and antimicrobial role of Nitric Oxide against gastrointestinal diseases, investigating its relationship with dental caries is a right topic. Therefore, this research has investigated the amount of saliva Nitric Oxide in different volumes of DMFT indicator in adults.

Material and Methods

In this descriptive- analytical cross-sectional study, 80 participants (20-35 years old), without a history of systemic disease and drug use participated as research samples, (53.8% of the participants in the study were women). Participants were selected from patients who had visited dental Department. The participants were divided in four groups based on DMFT (DMFT=0, 1≤DMFT≤3, 3<DMFT<10, DMFT≥10). Non-stimulating saliva was collected from all participants between 9-11 am in a calibrated tube. Saliva Nitric Oxide was measured using a Nitrous Oxide test, based on the Griess reaction. We used a correlation test to analyze quantitative variables, and t-test or ANOVA for qualitative and quantitative variables.

Results

A significant relationship between DMFT and age was identified. At different levels of DMFT, significant relationship between DMFT and sex was not found. In different groups of DMFT, no significant relationship between Nitric Oxide and DMFT exist.

Conclusion

The level of Nitric Oxide saliva was not affected by the amount of DMFT.

Dental Caries Experience in Children in Public Kindergartens of Sarajevo, Bosnia and Herzegovina

OBJECTIVES

Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day's busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well.

AIMS

To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers.

METHODS

The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits.

RESULTS

ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children's parents (CI=10.55%, RI=10.80%, TI=12.98%).

CONCLUSION

Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.

Dental Caries Experience and its Relationship to Demographic Factors in 2-6 Year Old Children in Fars - Iran in 2018

PURPOSE

Among oral conditions, tooth decay is the most common chronic childhood disease. Children's dental caries are influenced by several factors, among which diet is one of the most highlighted ones. The present study was conducted to examine the Decayed, Missing, and Filled Teeth in primary dentition (dmft) and caries-free (CF) indexes as well as the impact of nutrition and demographic factors on oral health of 2-6 year-old children in Fars Province.

METHODS

A cross-sectional study was conducted on children aged 2-6 years old to evaluate dmft and CF indices according to the latest WHO standards as well as their demographic characteristics in 2018. A questionnaire was used for data collection.

RESULTS

A total of 2220 children were recruited. The mean dmft was 1.37 ± 2.69. The components of the dmft score included decay (1.23 ± 2.6), missing (0.03 ± 0.11), filling (0.11 ± 0.7) in primary dentition, and the prevalence of caries-free children was 66.5%. The results showed that dmft had a significant positive relationship with breastfeeding termination time, maternal education level, and maternal age. Birth weight, consumption of iron, vitamin A and D supplements, age at onset of complementary feeding, and maternal occupation had no significant relationship with dmft.

CONCLUSIONS

The tooth decay index of 2-6 year-old children in Fars Province is very different from WHO global standards. Therefore, educating mothers about the duration of breastfeeding is important to achieve standard values for the dental caries index.

Oral Health Status in the Pars Cohort Study

BACKGROUND

Poor oral health is common in the world, especially in low-income and developing countries. We evaluated oral health status and its association with sociodemographic and economic variables in one of the largest cohort studies in Iran.

METHODS

This cross-sectional study was conducted using data from the Pars Cohort Study which is conducted in a rural area in southern Iran. A total of 9264 individuals were enrolled in the initial registry. Data on sociodemographic and clinical characteristics were collected. Oral assessment was completed by trained physicians. Generalized negative binomial regression modeling was applied.

RESULTS

Overall, data from 9264 participants entered the final analysis. The participants' mean age was 52.6 ± 9.7 years. In total, 8975 participants (96.8%) had at least one tooth loss and 1790 participants (19.3%) were edentulous. Female gender (incidence rate ratio [IRR]: 1.05, 95% CI: 1.02, 1.08) (IRR: 1.12, 95% CI: 1.07, 1.16), opium consumption (IRR: 1.17, 95% CI: 1.12, 1.22) (IRR: 1.23, 95% CI: 1.16 1.30), lower socioeconomic status (SES) (IRR: 1.07, 95% CI: 1.03, 1.10) (IRR: 1.10, 95% CI: 1.06, 1.15) and being illiterate (IRR: 1.23, 95% CI: 1.20, 1.26) (IRR: 1.36, 95% CI: 1.32, 1.41) were associated with higher decayed, missing and filled teeth (DMFT) and more tooth loss.

CONCLUSION

Oral health was poor in our study sample, especially among older individuals, people with lower SES, illiterate participants, smokers and opiate consumers, which shows the need for improvement in oral health care.

Association between demarcated enamel hypomineralization on second primary molars and dental caries in childhood

Hypomineralized Second Primary Molars (HSPM) is the name used to describe the presence of demarcated enamel hypomineralization in second primary molars. HSPM has been compared with Molar Incisor Hypomineralization (MIH) as regards its clinical appearance and consequences. The aim of this study was to investigate associations between HSPM and dental caries in childhood. It was a cross-sectional populationbased study that included 216 children aged 4-6 years from public schools in Botelhos, Brazil. Children with all second primary molars erupted were eligible for participation. Clinical examination was performed by one calibrated examiner. HSPM was recorded according to modified European Academy of Paediatric Dentistry criteria. The main outcome was dental caries experience as indicated by the dmft index (%dmft>0) according to WHO criteria. Chi-square test and Logistic Regression Model were used to adjust the results for effects of covariates Among the 216 children examined, 22.2% presented HSPM. After adjustment for logistic regression, children with HSPM were found to have a 2.28 times greater chance of presenting dental caries. Our results reinforce the importance of HSPM in caries development in children, which should be considered by public health dentists in the process of planning actions aimed at this population.

Greater child dental health inequality in England compared to Wales and Northern Ireland, despite lower average disease levels

INTRODUCTION

Dental caries and inequalities in dental health are major public health concerns.

AIM

To report variation in dental caries experience across deprivation quintiles and the magnitude of inequalities between countries.

DESIGN

Secondary analyses of cross-sectional data from the 2013 Child Dental Health Survey (CDHS) in England, Wales, and Northern Ireland.

MATERIALS AND METHODS

Distribution of dental caries across deprivation quintiles were estimated using as proportions and means. The magnitude of inequalities was calculated using the Relative Index of Inequality (RII).

MAIN OUTCOMES

Dental caries experience as indicated by the prevalence (%dmft/DMFT>0) and severity (dmft/DMFT) of 'obvious' and 'clinical' decay experience in both primary and permanent dentitions.

RESULTS

Children from more deprived quintiles showed higher prevalence and severity of dental caries. RIIs for dental caries were greater in England than Wales or Northern Ireland, indicating greater relative inequalities despite lower average dental caries experience. The prevalence and severity of dental caries among the most deprived children in England were 1.7 to 3.7 times greater than those of the least deprived.

CONCLUSION

There is a deprivation gradient in child dental caries in all three countries, with England showing the greatest inequalities.

Exponential tooth decay curve

OBJECTIVE

A review of the distribution of d₃mft scores for Wales was undertaken to inform decisions on future reporting of decay experience. Visual examination of data from one survey suggested that caries in Wales is distributed along an exponential decay curve.

BASIC RESEARCH DESIGN

Weighted d₃mft data from 2007/8, 2011/12 and 2014/15 was utilised. The data was compared with a pragmatically chosen exponential decay model. Distribution curves for d₃mft were plotted for each data set, correlation coefficients calculated and residuals plotted.

RESULTS

The three surveys demonstrate similar exponential decay distributions across the range of d₃mft scores. Plots of each curve against the exponential decay model demonstrated close correlation (0.9826 - 0.9871). The progressive shift of these similarly shaped curves suggest similar levels of caries reduction across the spectrum of caries experience and thus improved oral health without widening of health inequality. The close fit with this simple mathematical model suggests that caries prevalence could be used to generate a theoretical distribution and thereby and estimate of mean d₃mft score. Such an approach could facilitate simplified oral health surveillance in areas where caries distributions are known from previous surveys.

CONCLUSIONS

Within Wales caries does seem to be distributed in line with an exponential decay curve. As a result decay prevalence and mean d₃mft are mathematically related. This finding may have potential to support simplified local oral health surveillance. The data provides evidence suggesting improvements in caries experience in Wales are not at the expense of increased inequality.

Fluoride And Caring for Children's Teeth (FACCT): Clinical Fieldwork Protocol

Background: The reduction in dental caries seen between Irish national surveys of children’s oral health in 1984 and 2002 was accompanied by an increase in the prevalence of enamel fluorosis.  To minimise the risk of enamel fluorosis in Irish children, in 2007, the level of fluoride in drinking water was reduced from 0.8-1.0 ppm to 0.6-0.8 ppm fluoride. Recommendations on the use of fluoride toothpastes in young children were issued in 2002. Fluoride and Caring for Children’s Teeth (FACCT) is a collaborative project between the Oral Health Services Research Centre, University College Cork and the Health Service Executive dental service, with funding from the Health Research Board.

Aim: FACCT aims to evaluate the impact and the outcome of the change in community water fluoridation (CWF) policy (2007) on dental caries and enamel fluorosis in Irish schoolchildren, while also considering the change in policy on the use of fluoride toothpastes (2002).

Methods/Design: A cross-sectional study with nested longitudinal study will be conducted in school year (SY) 2013-2014 by trained and calibrated dental examiners in primary schools in counties Dublin, Cork and Kerry for a representative sample of children born either prior to or post policy changes; age 12 (born 2001) and age 5, (born 2008). Five-year-olds will be followed-up when they are 8-year-olds (SY 2016-2017). The main explanatory variable will be fluoridation status of the children (lifetime exposure to CWF yes/no). Information about other explanatory variables will be collected via parent (of 5-, 8- and 12-year-olds) and child completed (8- and 12-year-olds only) questionnaires.  The main outcomes will be dental caries (dmf/DMF Index), enamel fluorosis (Dean’s Index) and oral health-related quality of life (OHRQoL). Multivariate regression analyses will be used to determine the impact and outcome of the change in CWF policy on oral health outcomes controlling for other explanatory variables.

Evaluation of Periodontal Parameters in Patients with Early Stage Chronic Lymphocytic Leukemia

OBJECTIVE

To assess periodontal conditions in patients with early stage CLL and to compare it with the periodontal status of age matched healthy controls and to analyze the relationship between periodontal and hematological parameters in CLL patients.

MATERIALS AND METHODS

60 subjects were examined: 30 patients with CLL Rai 0 (test group) and 30 age-matching healthy individuals (control group). The exclusion criteria were: presence of other systemic disease or condition (e.g. diabetes), history of treatment for periodontitis, use of antibiotics during the last 3 months, use of medications. Socio-demographic data were obtained by means of a questionnaire. Participants with at least 8 teeth underwent a full mouth examination assessing API, PBI, PPD, REC and CAL. Medical data for CLL patients were collected from the patients' records, while hematological data were obtained from the hemogram.

RESULTS

Difference between groups was statistically significant for age, number of teeth and frequency of dental checkups (p<0.05). Patients with CLL had significantly higher average values of periodontal indices (API 0.81±0.18; PBI 2.72±0.68; PPD 3.40±0.53; REC 1.95±0.87, CAL 4.37±0.80) compared to the control group (API 0.69±0.15; PBI 1.91±0.45; PPD 2.51±0.40; REC 0.99±0.54; CAL 3.00±0.58). The correlation coefficients between age and periodontal indices showed statistically significance between age and REC (r=0.357; p<0.01), and age and CAL (r=0.295; p<0.05). Age was not statistically significant covariate for CAL (F=2.205; p>0.05), only for REC (F=4.601; p<0.05). After the removal of the statistical effect of age, the difference in REC between CLL and control group remained statistically significant (F=19.732; p<0.01; eta(2)=0.287). Statistically significant association between periodontal and hematological parameters in CLL patients was not found (p>0.05).

CONCLUSION

The results of this study showed that patients with CLL had worse periodontal status compared to healthy subjects. Causal relationship between periodontal and hematological parameters was not proved.

The amount of care delivered: challenges of indices in oral health studies

OBJECTIVES

Untreated dental caries is the most prevalent medical condition worldwide, with considerable variations in prevalence between regions and countries. The care index (CI) and the restorative index (RI) are generally used to make comparisons between and within countries of levels of care delivered. However, several methodological challenges can be identified that limit the interpretation and comparison of these indices. The objective of this manuscript was to evaluate these challenges and to provide solutions.

METHODS

Five challenges were identified: (i) the comparability of CI and RI, (ii) the use of multiple definitions of CI and RI, (iii) CI and RI measured for surfaces or teeth, (iv) the skewness of F/D(M)F (restored teeth or surfaces as a fraction of the total number of decayed, (missing), and filled teeth or surfaces), and (v) the relationship between CI, RI and D(M)F. Time-series data were obtained - for people aged 25-44 years with low socioeconomic status - from four cross-sectional studies performed in 1995, 2002, 2007 and 2013 in the Netherlands, and those data were subjected to descriptive analyses.

RESULTS

The analyses showed that the choice of index and definition had a major impact on the results, which varied in terms of absolute size and trends. Moreover, CI and RI are expressed as mean scores, but the distributions of F/DMF and F/DF were highly skewed. CI and RI may therefore mask groups of individuals who still need care. The proportion of individuals receiving most restorative care was much higher in the group with low levels of caries than in the groups with more caries. This implies that, when the need for care decreases over time, the restorative care indices can be expected to increase, even though there may be no improvement in the amount of care delivered.

CONCLUSIONS

We argue that epidemiological studies of oral health in the future should clarify the definitions used to describe the care delivered and investigate subgroups of F/DMF or F/DF in categories based on the extent of caries. These figures could be used to monitor changes in treatment provision and to highlight inequalities in the provision of care.

Examination criteria and calibration procedures for prevention trials of the Early Childhood Caries Collaborating Centers

OBJECTIVES

To summarize diagnostic criteria and examiner training and calibration of the National Institute of Dental and Craniofacial Research-funded Early Childhood Caries Collaborating Centers (EC4) and report examiner calibration results from 2010 to 2014. The EC4 at Boston University, University of Colorado, and University of California San Francisco are performing randomized controlled early childhood caries (ECC) prevention trials with caries as the main outcome measure.

METHODS

The EC4 with University of Iowa consultants developed standardized tooth and tooth surface status examination criteria for use in field conditions, examiner training materials, and examiner calibration and re-calibration methodologies. Calibration and re-calibration were performed with 1- to 5-year-old children in the San Francisco Mission District in which assessments from each examiner to be calibrated were compared with those from a single gold standard examiner from 2010 to 2014. Cohen's kappa statistic was used to determine inter-examiner agreement.

RESULTS

A total of seven examiners were successfully (re)calibrated during that period, examining a total of 231 children. Overall unweighted Cohen's kappas for 10 surface conditions exceeded the criterion of 0.70. However, separate agreement for assessment of noncavitated lesions, as in other studies, was lower.

CONCLUSIONS

An experienced multidisciplinary and multi-institutional team was able to develop criteria and training materials to anticipate situations and field conditions the main trials would encounter. Examiners were successfully trained and (re)calibrated.