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Badr F, Sabbah W. Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8523. [PMID: 33212971 PMCID: PMC7698597 DOI: 10.3390/ijerph17228523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Fatma Badr
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia;
- Faculty of Dentistry, Oral & Craniofacial Sciences, Dental Public Health, King’s College London, Denmark Hill Campus, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London SE5 9RS, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, Dental Public Health, King’s College London, Denmark Hill Campus, 2nd Floor Dental Extension, Bessemer Road, Denmark Hill, London SE5 9RS, UK
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Vallim AC, Gaio EJ, Oppermann RV, Rösing CK, Albandar JM, Susin C, Haas AN. Obesity as a risk factor for tooth loss over 5 years: A population-based cohort study. J Clin Periodontol 2020; 48:14-23. [PMID: 33010056 DOI: 10.1111/jcpe.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
AIM To assess obesity as a risk factor for tooth loss over 5 years in an urban sample of Brazilian adults. MATERIALS AND METHODS A total of 1586 individuals were surveyed using a multistage probabilistic approach. Five years later, 635 individuals 14-64 years old were re-examined. An incident case of tooth loss was determined for a participant that had lost at least one tooth over time. Obesity was evaluated by calculating body mass index at baseline and by the change in obesity status over time. RESULTS Incident cases of tooth loss were significantly more frequent among obese (47.1%) than normal-weight individuals (32.4%) (p = .004). Obese individuals had 31% higher risk [relative risk (RR) =1.31; 95% confidence interval (95%CI) 1.04-1.65] for tooth loss than normal-weight individuals adjusting for age, socio-economic status, smoking, dental care and periodontitis. This association was significant for females (RR=1.47, 95%CI 1.08-2.01), but not for males. The risk for tooth loss was also modified by presence of periodontitis at baseline and lifetime smoking exposure. There was an increased risk for tooth loss for those that remained obese than those that remained normal weight. CONCLUSION Obesity is associated with higher risk for tooth loss. This association was modified by sex, periodontal status and smoking.
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Affiliation(s)
- Ana Carolina Vallim
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo José Gaio
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rui Vicente Oppermann
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Jasim M Albandar
- Periodontal Diagnostics Research Laboratory, Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | - Cristiano Susin
- Department of Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Nogueira Haas
- Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Masticatory rhythm 3 months after treatment with unilateral implant-supported fixed partial prosthesis: A clinical study. J Prosthet Dent 2020; 126:553-559. [PMID: 32962837 DOI: 10.1016/j.prosdent.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM Whether treatment with an implant-supported fixed partial prosthesis (ISFPP) affects the masticatory rhythm in patients with unilateral posterior missing teeth is unclear. PURPOSE The purpose of this prospective clinical study was to determine the change in masticatory rhythm in participants with unilateral posterior missing teeth 3 months after treatment with an ISFPP and to assess whether treatment influenced the stability of the masticatory rhythm. MATERIAL AND METHODS Thirty participants (mean age 59 years; 17 women) with unilateral posterior missing teeth were treated with 1-, 2-, or 3-unit ISFPPs. Ten healthy individuals (mean age 36 years; 8 women) with a complete natural dentition were included in a control group. In this prospective study, each participant performed 3 masticatory assays (freestyle, unilateral right, and unilateral left) at baseline and at the 3-month follow-up. Each assay comprised 5 trials of 20 cycles masticating pieces of silicone placed in a latex bag. The time needed to complete the 20 masticatory cycles per trial was measured, and the mean masticatory frequency was calculated for each assay. Coefficients of variation were then calculated from the 5 mean values of the masticatory trials. Differences in the data at 3 months and baseline were analyzed by using the Wilcoxon or paired t tests. The control and treated groups were compared by analysis of variance or Mann-Whitney U tests (α=.05). RESULTS After 3 months, participants treated with ISFPPs showed an increase of 8.7% in masticatory frequency during freestyle mastication (P<.001) and an 8.0% increase during unilateral mastication on the treated side (P<.01). At baseline, the coefficient of variation of masticatory frequency on the treated side was higher in the ISFPP group than in the control group during unilateral mastication (P=.033). Three months after treatment, there was a significant reduction in the coefficient of variation during unilateral mastication on the treated side of the ISFPP group (P<.001). The treatment group also reached a masticatory frequency similar to that of the control group (75 and 78 cycles per minute, respectively). CONCLUSIONS Treatment with ISFPPs accelerated the masticatory rhythm of individuals with unilateral posterior missing teeth, who achieve similar rhythms to those with complete natural dentitions. The stability of the masticatory rhythm was also restored, indicating an improvement in masticatory function.
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Craig T, Johnsen DC, Hartshorn JE, Cowen H, Ashida S, Thompson L, Pendleton C, Xie XJ, Marchini L. Teaching rapid oral health deterioration risk assessment: A 5-year report. J Dent Educ 2020; 84:1159-1165. [PMID: 32700333 DOI: 10.1002/jdd.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this study was to present a 5-year report about the outcomes of using a teaching tool that guides dental students through the thought process of the expert about how to assess the risk of rapid oral health deterioration (ROHD) among older adults and provide viable treatment alternatives. METHODS A teaching tool was previously developed using ROHD risk factors identified in the literature and the steps that experts apply in their treatment decision making, summarized in 10 questions. During 5 years, 188 senior dental students were introduced to the teaching tool and asked to use the 10-question set to present a case they have treated during their Geriatric and Special Needs Program. Two evaluators were asked to grade the students on each question. Students were graded "G" if they answered the question and grasped the principles behind it, "A" if they only answered the question, or "M" if they missed the question. Additionally, the students were given a form to grade the importance of and comment on the exercise. RESULTS More than 75% of the students had an A or G for most questions, agreement between the 2 evaluators was above 85%, and students' performances improved during the 5-year period. Additionally, 94.4% of the students considered the teaching tool as important or very important for the general dentist. CONCLUSION The vast majority of the students had an A or G grade, examiner agreement was high, and the students appreciated the importance of this teaching tool for the general dentist.
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Affiliation(s)
- Trevor Craig
- College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, USA
| | - David C Johnsen
- College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, USA
| | - Jennifer E Hartshorn
- Preventive and Community Dentistry, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, USA
| | - Howard Cowen
- Preventive and Community Dentistry, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, USA
| | - Sato Ashida
- Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, USA
| | - Lena Thompson
- Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, USA
| | | | - Xian Jin Xie
- Iowa Institute for Oral Health Research & Department of Preventive & Community Dentistry, The University of Iowa, Iowa City, USA
| | - Leonardo Marchini
- Preventive and Community Dentistry, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, USA
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Luo H, Wu Q, Bell RA, Wright W, Quandt SA, Basu R, Moss ME. Rural-Urban Differences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results From the 2016 Medical Expenditure Panel Survey. J Rural Health 2020; 37:655-666. [PMID: 32697007 DOI: 10.1111/jrh.12500] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess rural-urban differences in dental service use and procedures and to explore the interaction effects of individual- and county-level factors on having dental service use and procedures. METHODS Data were from the 2016 Medical Expenditure Panel Survey (MEPS). We assessed rural-urban differences in 3 outcome variables: number of dental visits (1, 2, or 3+ visits), preventive care procedures (Yes/No), and treatment procedures (Yes/No). The study sample included 8,199 adults ≥ 18 years of age who reported at least 1 dental visit in the past year. Sampling weights embedded in MEPS were incorporated into all the analyses. FINDINGS A significant interaction between residential location and race/ethnicity (P = .030) suggested limited access to dental visits for minority groups, especially for blacks in the more rural areas. Adults from a more rural area were less likely to have received a preventive procedure (AOR = 0.55, 95% CI: 0.35-0.87) than those from an urban area. Adults of racial/ethnic minority groups, with lower SES, and without dental insurance were less likely to have received a preventive procedure (all P < .01) but were more likely to have received a treatment procedure (all P < .05). CONCLUSIONS The study showed rural adults were less likely to have received preventive dental procedures than their urban counterparts. Racial/ethnic minority groups living in a more rural area had even more limited access to dental services. Innovative service delivery models that integrate telehealth and community-based case management may contribute to addressing these gaps in rural communities.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health, East Carolina University, Greenville, North Carolina
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Wanda Wright
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rashmita Basu
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Mark E Moss
- Department of Foundational Sciences, School of Dental Medicine, East Carolina University, Greenville, North Carolina
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Tellez M, Myers Virtue S, Neckritz S, Lim S, Bhoopathi V, Hernandez M, Shearer B, Ismail A. Randomised clinical trial of a motivational interviewing intervention to improve oral health education amongst older adults in Philadelphia: 12-month evaluation of non-clinical outcomes. Gerodontology 2020; 37:279-287. [PMID: 32643211 DOI: 10.1111/ger.12488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/14/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We conducted a trial to assess the treatment fidelity of an individual-based oral health education intervention utilising motivational interviewing (MI) techniques and its efficacy when compared to a group-based traditional oral health education intervention (TOHE) and a standard of care group (SC) in a sample from Philadelphia during a 12-month follow-up. BACKGROUND There is lack of information on how different types of oral health educational interventions affect older adults on non-clinical outcomes including changes in oral health-related quality of life (OHRQoL), oral health self-efficacy (SE) and oral health knowledge (OHK). MATERIALS AND METHODS One hundred and eighty patients were randomly allocated to TOHE, MI and SC groups. Treatment fidelity was measured in 16 non-study patients. The MI intervention was administered by a public health dental hygienist (PHDH). All interviews were audio-recorded and coded by an expert using the Motivational Interviewing Treatment Integrity (MITI) Code. Multivariable longitudinal regression analyses accounting for baseline demographics and correlated errors due to repeated measures via generalised estimating equation were conducted following an intention to treat approach. RESULTS Over the 1-year follow-up, SE and OHRQoL scores significantly improved amongst the MI group whereas both outcomes worsened amongst the SC group. During the same period, SE and OHRQoL did not change in the TOHE group. CONCLUSION Findings from the study support the fidelity of this intervention and the improvement of all non-clinical outcomes after 12 months amongst the MI group.
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Affiliation(s)
- Marisol Tellez
- Maurice H Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Shanon Myers Virtue
- Helen F. Graham Cancer Center & Research Institute Christiana Care Health System, Newark, Delaware, USA
| | - Sheryl Neckritz
- Maurice H Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Sungwoo Lim
- Maurice H Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Vinodh Bhoopathi
- Maurice H Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
| | | | | | - Amid Ismail
- Maurice H Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
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Smith BJ, Helgeson M, Prosa B, Finlayson TL, Orozco M, Asgari P, Pierce I, Norman G, Aronoff-Spencer E. Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota. PLoS One 2020; 15:e0232898. [PMID: 32407370 PMCID: PMC7224465 DOI: 10.1371/journal.pone.0232898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. METHODS Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. RESULTS Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. CONCLUSION Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.
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Affiliation(s)
- Barbara J. Smith
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Michael Helgeson
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Brenda Prosa
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Tracy L. Finlayson
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Mario Orozco
- West Health Institute, San Diego, California, United States of America
| | - Padideh Asgari
- West Health Institute, San Diego, California, United States of America
| | - Ian Pierce
- West Health Institute, San Diego, California, United States of America
| | - Gregory Norman
- West Health Institute, San Diego, California, United States of America
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Reply to Kenyon, "Are Differences in the Oral Microbiome Due to Ancestry or Socioeconomics?". mSystems 2020; 5:5/2/e00891-19. [PMID: 32156801 PMCID: PMC7065519 DOI: 10.1128/msystems.00891-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE OF REVIEW This article provides an overview of current literature focused on oral health and cognitive impairment in older adulthood, focusing in particular on whether oral inflammation, tooth loss and masticatory dysfunction might increase the risk of cognitive impairment in this age group. RECENT FINDINGS There is now general acceptance that cognitive impairment contributes to poor oral health, largely through detrimental changes in behaviours related to maintaining good oral hygiene. There is more limited evidence for the reverse causal direction, but at least some studies now suggest that inflammatory mechanisms, tooth loss and masticatory dysfunction each have the potential to contribute to cognitive decline. SUMMARY Poorer oral health significantly correlates with cognitive dysfunction, and at least some studies suggest that there may be a bi-directional causal relationship. Randomized controlled trials assessing cognitive abilities in relation to oral hygiene or oral health interventions, or provision of removable or fixed (implant-supported) dentures, are encouraged.
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Alania Y, Trevelin LT, Hussain M, Zamperini CA, Mustafa G, Bedran-Russo AK. On the bulk biomechanical behavior of densely cross-linked dentin matrix: The role of induced-glycation, regional dentin sites and chemical inhibitor. J Mech Behav Biomed Mater 2020; 103:103589. [PMID: 32090918 PMCID: PMC7042333 DOI: 10.1016/j.jmbbm.2019.103589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/17/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
Collagen glycation takes place under physiological conditions during chronological aging, leading to the formation of advanced glycation end-products (AGEs). AGEs accumulation induces non-enzymatic collagen cross-links increasing tissue stiffness and impairing function. Here, we focused on determining the cumulative effect of induced glycation on the mechanical behavior of highly collagen cross-linked dentin matrices and assess the topical inhibition potential of aminoguanidine. Bulk mechanical characterization suggests that early glycation cross-links significantly increase the tensile strength and stiffness of the dentin matrix and promote a brittle failure response. Histologically, glycation yielded a more mature type I collagen in a densely packed collagen matrix. The time-dependent effect of glycation indicates cumulative damage of dentin matrices that is partially inhibited by aminoguanidine. The regional dentin sites were differently affected by induced-glycation, revealing the crown dentin to be mechanically more affected by the glycation protocol. These findings in human dentin set the foundation for the proposed in vitro ribose-induced glycation model, which produces an early matrix stiffening mechanism by reducing tissue viscoelasticity and can be partially inhibited by topical aminoguanidine.
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Affiliation(s)
- Yvette Alania
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA
| | - Livia T Trevelin
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA; Department of Restorative Dentistry, School of Dentistry, University of São Caetano Do Sul, Rua Santo Antônio 50, São Caetano Do Sul, São Paulo, 09521-160, Brazil
| | - Mohammad Hussain
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA
| | - Camila A Zamperini
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA
| | - Gresa Mustafa
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA
| | - Ana K Bedran-Russo
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, 801 South Paulina St, Chicago, IL, 60612, USA.
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Marchini L, Reynolds JC, Caplan DJ, Sasser S, Russell C. Predictors of having a dentist among older adults in Iowa. Community Dent Oral Epidemiol 2020; 48:240-247. [DOI: 10.1111/cdoe.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Leonardo Marchini
- Department of Preventive and Community Dentistry University of Iowa College of Dentistry and Dental Clinics Iowa City Iowa
| | - Julie C. Reynolds
- Department of Preventive and Community Dentistry University of Iowa College of Dentistry and Dental Clinics University of Iowa Public Policy Center Iowa City Iowa
| | - Daniel J. Caplan
- Department of Preventive and Community Dentistry University of Iowa College of Dentistry and Dental Clinics Iowa City Iowa
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Abstract
In this review we critically summarize the evidence base and the progress to date regarding the genomic basis of periodontal disease and tooth morbidity (ie, dental caries and tooth loss), and discuss future applications and research directions in the context of precision oral health and care. Evidence for these oral/dental traits from genome-wide association studies first emerged less than a decade ago. Basic and translational research activities in this domain are now under way by multiple groups around the world. Key departure points in the oral health genomics discourse are: (a) some heritable variation exists for periodontal and dental diseases; (b) the environmental component (eg, social determinants of health and behavioral risk factors) has a major influence on the population distribution but probably interacts with factors of innate susceptibility at the person-level; (c) sizeable, multi-ethnic, well-characterized samples or cohorts with high-quality measures on oral health outcomes and genomics information are required to make decisive discoveries; (d) challenges remain in the measurement of oral health and disease, with current periodontitis and dental caries traits capturing only a part of the health-disease continuum, and are little or not informed by the underlying biology; (e) the substantial individual heterogeneity that exists in the clinical presentation and lifetime trajectory of oral disease can be identified and leveraged in a precision medicine framework or, if unappreciated, can hamper translational efforts. In this review we discuss how composite or biologically informed traits may offer improvements over clinically defined ones for the genomic interrogation of oral diseases. We demonstrate the utility of the results of genome-wide association studies for the development and testing of a genetic risk score for severe periodontitis. We conclude that exciting opportunities lie ahead for improvements in the oral health of individual patients and populations via advances in our understanding of the genomic basis of oral health and disease. The pace of new discoveries and their equitable translation to practice will largely depend on investments in the education and training of the oral health care workforce, basic and population research, and sustained collaborative efforts..
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Affiliation(s)
- Thiago Morelli
- Department of PeriodontologySchool of DentistryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina, USA
| | - Cary S. Agler
- Department of Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina, USA
| | - Kimon Divaris
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina, USA
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth Carolina, USA
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Abstract
Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long-term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri-implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow-up protocols are implemented and that treatment planning is ethically responsible and evidence based.
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Clark D, Levin L. In the dental implant era, why do we still bother saving teeth? Dent Traumatol 2019; 35:368-375. [DOI: 10.1111/edt.12492] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Danielle Clark
- Division of Periodontology Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
| | - Liran Levin
- Division of Periodontology Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
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Shiga Y, Nezu T, Hosomi N, Aoki S, Nishi H, Naito H, Kinoshita N, Ueno H, Maruyama H. Effect of tooth loss and nutritional status on outcomes after ischemic stroke. Nutrition 2019; 71:110606. [PMID: 31811999 DOI: 10.1016/j.nut.2019.110606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Tooth loss, closely associated with malnutrition, increases the risk for cardiovascular disease. The aim of this study was to examine the link between tooth loss, nutritional status, and stroke outcomes. METHODS We retrospectively analyzed 195 consecutive patients with acute ischemic stroke who were evaluated for tooth loss. Tooth loss was classified as mild or severe. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score. A poor neurologic outcome was defined as a score of 3 to 6 on the modified Rankin Scale at 3 mo post-stroke onset; a score of 0 to 2 was defined as a good outcome. RESULTS A significant correlation was observed between tooth loss and the CONUT score at admission (ρ = 0.156; P = 0.034). Patients with poor outcomes had higher CONUT scores (P < 0.001) and a greater frequency of severe tooth loss (P = 0.025). On multivariate analysis, severe tooth loss (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.31-11.8) and the CONUT score (OR, 1.33; 95% CI, 1.02-1.74) were independently associated with poor stroke outcomes. CONCLUSIONS Nutritional status was associated with tooth loss among patients with acute ischemic stroke. Severe tooth loss and a higher CONUT score were independently associated with poor stroke outcomes.
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Affiliation(s)
- Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Kinoshita
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Inglehart MR. Motivational Communication in Dental Practices: Prevention and Management of Caries over the Life Course. Dent Clin North Am 2019; 63:607-620. [PMID: 31470916 DOI: 10.1016/j.cden.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dental caries and periodontal diseases are preventable. Nevertheless, they remain prevalent. Dental practices offer an ideal setting for educating patients about oral health-related behavior change. This article describes the motivational communication approach to changing behavior and applies it to a discussion of behavior change communication over the course of life. CONTENT considerations focus on on identifying high-priority behaviors for change; patient affect, behavior, and cognition related to these behaviors, and understanding in which stage of change the patient is. Process the four principles of the Motivational Interviewing approach by Miller & Rollnick to analyze oral health-related behavior change over the life course.
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Affiliation(s)
- Marita R Inglehart
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, 1011 North University, Ann Arbor, MI 48109-1078, USA; Department of Psychology, College of Literature, Science and Arts (LS&A), University of Michigan, Ann Arbor, MI, USA.
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68
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Weintraub JA, Orleans B, Fontana M, Phillips C, Jones JA. Factors Associated With Becoming Edentulous in the US Health and Retirement Study. J Am Geriatr Soc 2019; 67:2318-2324. [PMID: 31335967 DOI: 10.1111/jgs.16079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVE To determine factors associated with older adults becoming edentulous (complete tooth loss). DESIGN Longitudinal study over a 6-year period. SETTING United States, 2006, 2012. PARTICIPANTS Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized. INTERVENTION None. MEASUREMENTS Self-report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self-rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities. RESULTS From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self-rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6-year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12-3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74-3.46). CONCLUSION Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1-7, 2019. J Am Geriatr Soc 67:2318-2324, 2019.
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Affiliation(s)
- Jane A Weintraub
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian Orleans
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Ceib Phillips
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Jones
- School of Dentistry, University of Detroit Mercy, Detroit, Michigan
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Ortíz-Barrios LB, Granados-García V, Cruz-Hervert P, Moreno-Tamayo K, Heredia-Ponce E, Sánchez-García S. The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis. BMC Oral Health 2019; 19:141. [PMID: 31291933 PMCID: PMC6622000 DOI: 10.1186/s12903-019-0840-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Determine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults. Methods Cross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months. Results The mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p < .001). Using Class 3 an as a reference, the strength of association between the GOHAI scores and low OHRQoL (GOHAI 25th percentile = 24.0) was OR = 0.7, 95% CI = 0.2–3.3 for totally edentulous; OR = 3.0, 95% CI = 1.2–7.6 for Class 2 and OR = 5.0, 95% CI = 2.1–12.1 for Class 1. Conclusion Poor oral health was associated with a negative impact on the OHRQoL of community-dwelling older adults. Clinical relevance It is essential to design and implement oral health care policies specifically targeted at improving the quality of life in this older adult population.
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Affiliation(s)
- Lyzbeth Beatriz Ortíz-Barrios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc No. 330, Edificio CORCE, 3er piso, Col. Doctores, Delegación Cuauhtémoc, CP 06720, Mexico City, Mexico
| | - Víctor Granados-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc No. 330, Edificio CORCE, 3er piso, Col. Doctores, Delegación Cuauhtémoc, CP 06720, Mexico City, Mexico
| | - Pablo Cruz-Hervert
- División de Estudios de Posgrado e Investigación en Odontología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Karla Moreno-Tamayo
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc No. 330, Edificio CORCE, 3er piso, Col. Doctores, Delegación Cuauhtémoc, CP 06720, Mexico City, Mexico
| | - Erika Heredia-Ponce
- Departamento de Salud Pública y Epidemiología Bucal, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sergio Sánchez-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Área Envejecimiento, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc No. 330, Edificio CORCE, 3er piso, Col. Doctores, Delegación Cuauhtémoc, CP 06720, Mexico City, Mexico. .,Departamento de Salud Pública y Epidemiología Bucal, Facultad de Odontología, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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