Explaining gender differences in caries: a multifactorial approach to a multifactorial disease

A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia

People with intellectual disability have a higher risk of oral health problems. This study assessed the clinical oral health status and behaviors and treatment needs of people living in an institution in Padang, West Sumatra, Indonesia. We quantified oral health status of 65 individuals with intellectual disability using Oral Hygiene Index Simplified (OHIs), Angle’s classification of malocclusion, Community Periodontal Index and Treatment Need (CPITN), and decay index and also recorded their brushing behavior. We found that males had significantly lower OHIs (p < 0.001), more malocclusion (p < 0.001), greater caries number (p < 0.001), greater CPITN (p = 0.001) and higher need of dental treatment (p < 0.01) than females. Additionally, we found that high caries number was associated with poor OHIS, malocclusion, periodontal disease, and dependent brushing behavior (p < 0.001). The findings of this study imply that there is a gap in appropriate oral health care in individuals with intellectual disability. There should be a greater focus on providing appropriate oral health education to people with intellectual disability, improving the health literacy and quality of care of caregivers, and providing more dentists with specialized training in special needs dentistry.

Enamel and Dentin Caries Risk Factors of Adolescents in the Context of the International Caries Detection and Assessment System (ICDAS): A Longitudinal Study

Objective: The objective of this study was to identify risk factors for enamel and dentin caries in adolescents. Method: This 1-year longitudinal study was conducted in 2018 and 2019; 13- to 14-year-old adolescents were recruited. The merged International Caries Detection and Assessment System (ICDAS) was used to identify caries. The relationships between the caries increment and variables were analyzed with a zero-inflated negative binomial (ZINB) regression model. Results: A total of 1,016 participants completed the assessment. The ZINB analysis found that individuals with caries at baseline were more likely to develop new dentin caries. Females, or individuals who had a high cariostat score had an increased likelihood of having a high ΔD4-6MFT score. Among the caries-free adolescents at baseline, females, or individuals who consumed snacks once or more than once a day were more likely to develop caries. Individuals from one-child families, who used fluoride toothpaste, and who had a high saliva buffering capability (pH≥4.25) had an increased likelihood of a low ΔD1-6MFT score. Conclusion: The results suggest that there are some specific risk factors of initiating of enamel caries in adolescents, including the frequency of snack consumption, sex, saliva buffering capability, fluoride toothpaste usage and belonging to a one-child family. In all adolescents, most of whom have enamel caries, the dentin caries risk factors were past caries experience, cariostat score and sex.

Oral and Dental Status of Lebanese and Syrian Refugees Living in Proximity to Deir Kanoun Ras El Ain Dump in Lebanon

Aims:

In this study, we aimed at investigating the oral and dental health conditions of Lebanese and Syrian refugees living in proximity to Deir Kanoun Ras El Ain dump whereby its leachates influx into a canal used for irrigation and drinking purposes.

Materials and Methods:

This observational study involved oral and dental examinations of 589 Lebanese and Syrian Refugees participants living in the three villages: Deir Kanoun Ras El Ain, Klayleh, and Smaiyeh. Differences in oral and dental examination results were analyzed between different villages, sexes, nationalities, and age groups. Correlation tests were conducted between dental fluorosis, staining, papilla swelling, and several sociodemographic factors.

Results:

Dental fluorosis, staining, and papilla swelling were the most prominent problems among total participants. The highest percentages of individuals with the studied diseases were shown to be in Klayleh village, among females, and individuals aged between 21 and 40 years. Significant associations were observed between dental fluorosis and nationality; between dental staining and gender, nationality, age, and smoking; as well as between papilla swelling and age, smoking, and diabetes.

Conclusions:

Our study investigated and highlighted the prevalence of several oral and dental diseases among Lebanese and Syrian inhabitants that are related to environmental, social, and economic determinants and not just by individual behaviors. It also showed gaps of oral and dental health knowledge that recommend implementing health systems that focus on preventing oral diseases.

Sex-specific differences in the salivary microbiome of caries-active children

Background and Objectives: Dental caries is a chronic disease affecting young children and has multi-factorial risk factors. The purpose of this work was to identify sex-specific differences in the salivary microbiota within caries-active children. Design: Saliva specimens were collected from 85 children (boys: 41; girls: 44) between the ages of 2-12 years. Salivary microbial DNA was subjected to PCR amplification using V3-V4 16S rDNA-specific primers and next-generation sequencing. Results: Significant sex differences in salivary microbiota were found between caries-active boys versus caries-active girls. Neisseria flavescens, Rothia aeria, and Haemophilus pittmaniae were found at significantly higher levels in caries-active boys. In contrast, Lactococcus lactis, Selenomonas species HOT 126, Actinobaculum species HOT 183, Veillonella parvula, and Alloprevotella species HOT 473 were found at significantly higher levels in caries-active girls. Conclusion: We have found the acid-generating, cariogenic Lactococcus lactis to be much more abundant in caries-active girls than caries-active boys, indicating that this microorganism may play a more significant role in shaping the cariogenic microbiome in girls. In addition, in caries-active girls, Alloprevotella species HOT 473 was the only species that exhibited both significant sex differences (4.4-fold difference; p=0.0003) as well as high abundance in numbers (1.85% of the total microbial population).

Effect of socioeconomic status on dental caries during pregnancy

Background and Objective:

It is generally agreed that people with low socioeconomic status have a significantly worse oral and general health compared to people with higher socioeconomic status. The aim of the study was to find out the role of socioeconomic status of pregnant women on their oral health by evaluating the dental caries risk factor, the salivary Streptococcus mutans count and DMFT index.

Materials and Methods:

A total of 50 first time pregnant women were randomly sampled and were divided into different socioeconomic strata following the Kuppuswamy socioeconomic status scale. DMFT index and microbiological assessment of dental caries risk factor parameter, the salivary Streptococcus mutans colony forming units, were carried out during the three trimesters and postpartum period. The observations were compared with 50 non-pregnant women of same age group.

Results:

Of the randomly sampled subjects, majority of the pregnant women (28/50) of the study group were of middle/lower middle class, 11 pregnant women were of upper middle class, and 11 were of the lower/upper lower class. When followed in their three trimesters and postpartum period, statistically significant increase in the salivary Streptococcus mutans colony forming units was noted in 2^nd trimester, 3^rd trimester and postpartum period (P value < 0.05) of all pregnant women. Comparison of the caries risk factor between the pregnant women of three socioeconomic strata, however, revealed that no particular class was at a higher risk for dental caries.

Conclusion:

This study gives an insight into the possible changing trends towards awareness for oral hygiene in various socioeconomic strata of pregnant women.

The Bioarchaeology of Health Crisis: Infectious Disease in the Past

Beginning some 10,000 years ago, humans began a dramatic alteration in living conditions relating especially to the shift in lifeway from foraging to farming. In addition to the initiation of and increasing focus on the production and consumption of domesticated plant carbohydrates, this revolutionary transformation in diet occasioned a decline in mobility and an increased size and agglomeration of populations in semipermanent or permanent settlements. These changes in life conditions presented an opportunity for increased transmission of pathogenic microbes from host to host, such as those that cause major health threats affecting most of the 7.5 billion members of our species today. This article discusses the bioarchaeology of infectious disease, focusing on tuberculosis, treponematosis, dental caries, and periodontitis, all of which continue to contribute to high levels of morbidity and mortality among the world's populations today.

Dental genetics in Brazil: Where we are

Dentistry constitutes the basic nucleus of professionals of higher level of health in Brazil with one of the largest concentrations of dentists per capita in the world. However, the genetic in dentistry in Brazil is explored, basically, in research field. Future actions need to be performed in order to deep the whole knowledge about diagnosis and treatment of diseases with genetic basis in dentistry, in Brazil.

General anxiety, dental anxiety, digit sucking, caries and oral hygiene status of children resident in a semi-urban population in Nigeria

BACKGROUND

Digit sucking can represent untreated anxiety or other emotional problems. The aim of this study was to determine if digit sucking is a predictor of general anxiety and dental anxiety; and if general and dental anxiety are associated with caries and oral hygiene status of children resident in sub-urban Nigeria.

METHODS

This was a secondary data analysis of a household survey conducted in Ile-Ife, Nigeria. The level of general anxiety and dental anxiety of 450 6 to12 year old children were measured using the Revised Child Manifest Anxiety Scale and Dental Subscale of the Child Fear Survey Schedule respectively. Presence of digit sucking habit, caries and oral hygiene status were determined. General anxiety and dental anxiety scores were dichotomized into low and high levels respectively. Logistic regression was conducted to determine if digit sucking was a predictor of general anxiety and dental anxiety; and if general anxiety and dental anxiety were predictors caries and good oral hygiene status. Adjustments were made for age and sex.

RESULTS

Digit sucking is not a significant predictor of dental anxiety (p = 0.99) and general anxiety (p = 0.79). Children with high general anxiety (AOR: 5.02; 95% CI: 2.9-9.74; p <  0.001) and high dental anxiety (AOR: 1.74; 95% CI: 1.15-2.65; p = 0.009) had higher odds of having caries and good oral hygiene respectively.

CONCLUSION

Digit sucking was not a significant predictor of general anxiety and dental anxiety. General and dental anxiety however, had effects on the likelihood of having caries and good oral hygiene.

Dental caries experience and treatment needs of an adult female population in Nigeria

Background

Experience and awareness of adult females concerning dental caries is important in its prevention particularly in children because of their natural role as care givers.

Objectives

To determine the prevalence of dental caries and treatment needs in an adult female Nigerian population.

Methods

In this cross-sectional study, adult females attending outreach programmes were examined for dental caries using the Decayed Missing and Filled Teeth caries index (DMFT). Socio-demographic variables were also recorded and statistical analysis done with SPSS software.

Results

A total of 430 females aged 16 to 59 years participated in the outreach programme out of which 109 (25.3%) had a DMFT score > 0. Mean DMFT was 0.7 ± 1.6. Fifty-five (12.8%) participants had decayed teeth, 78 (18.1 %) had missing teeth and 10(2.3%) had filled teeth. The treatment need was 34.3%, restorative index was 13.3% and significant caries index was 2.0. There were significant differences in caries experience based on age, marital status and educational qualifications of participants p < 0.05.

Conclusion

The prevalence of dental caries among the study group was low but the treatment need was high. Younger females, singles and those with lower educational qualifications had a higher dental caries experience.

Estimation of DMFT, Salivary Streptococcus Mutans Count, Flow Rate, Ph, and Salivary Total Calcium Content in Pregnant and Non-Pregnant Women: A Prospective Study

INTRODUCTION

Pregnancy, a period from conception till birth, causes changes in the functioning of the human body as a whole and specifically in the oral cavity that may favour the emergence of dental caries. Many studies have shown pregnant women at increased risk for dental caries, however, specific salivary caries risk factors and the particular period of pregnancy at heightened risk for dental caries are yet to be explored and give a scope of further research in this area.

AIM

The aim of the present study was to assess the severity of dental caries in pregnant women compared to non-pregnant women by evaluating parameters like Decayed, Missing, Filled Teeth (DMFT) index, salivary Streptococcus mutans count, flow rate, pH and total calcium content.

MATERIALS AND METHODS

A total of 50 first time pregnant women in the first trimester were followed during their second trimester, third trimester and postpartum period for the evaluation of DMFT by World Health Organization (WHO) scoring criteria, salivary flow rate by drooling method, salivary pH by pH meter, salivary total calcium content by bioassay test kit and salivary Streptococcus mutans count by semiautomatic counting of colonies grown on Mitis Salivarius (MS) agar supplemented by 0.2U/ml of bacitracin and 10% sucrose. The observations of pregnant women were then compared with same parameters evaluated in the 50 non-pregnant women. Paired t-test and Wilcoxon sign rank test were performed to assess the association between the study parameters.

RESULTS

Evaluation of different caries risk factors between pregnant and non-pregnant women clearly showed that pregnant women were at a higher risk for dental caries. Comparison of caries risk parameters during the three trimesters and postpartum period showed that the salivary Streptococcus mutans count had significantly increased in the second trimester, third trimester and postpartum period while the mean pH and mean salivary total calcium content decreased in the third trimester and postpartum period. These changes reflected on the DMFT score which increased in the third trimester and postpartum period.

CONCLUSION

The results of this study suggest that there is a definite correlation between pregnancy and dental caries. We conclude that the third trimester and postpartum period of pregnancy are the periods during which the pregnant women are at a higher risk for development of dental caries.

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

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

Gender differences in oral health status and behavior of Greek dental students: A meta-analysis of 1981, 2000, and 2010 data

BACKGROUND

The aim of this study was to investigate the oral health status and behavior of Greek dental students over time, and to meta-analyze these findings to test the widely documented hypothesis that women have better oral health behavior, oral hygiene, and periodontal status but higher dental caries rates than men.

MATERIALS AND METHODS

A total sample of 385 students was examined using identical indices to assess oral health and behavioral data initially in 1981 while the years 2000 and 2010 were selected due to significant changes that took place in the dental curriculum in the 1990s and 2000s. Data by gender concerning the outcome variables recorded in every one of the three surveys were analyzed using Mantel-Haenszel and continuous outcomes methods.

RESULTS

A significant improvement in the oral health status and behavior of students was observed over time. The meta-analysis of data by gender showed that females brushed their teeth significantly more often than males [summary odds ratio (OR): 1.95 and 95% confidence interval (CI): 1.08-3.54]. Males and females were found to have a similar risk of developing dental caries.

CONCLUSION

The hypothesis that young women have better oral hygiene habits compared to men was confirmed. However, the hypothesis that women have better oral hygiene and periodontal status but exhibit higher dental caries experience than men was not supported by the findings of the study.

ACE Insertion/Deletion Polymorphism Associated with Caries in Permanent but Not Primary Dentition in Czech Children

OBJECTIVE

Dental caries is a multifactorial, infectious disease where genetic predisposition plays an important role. Insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) has very recently been associated with caries in Polish children. The aim of this study was to analyze ACE I/D polymorphism in a group of caries-free children versus subjects affected by dental caries in the Czech population.

MATERIALS AND METHODS

In this case-control study, 182 caries-free children (with decayed/missing/filled teeth, DMFT = 0), 561 subjects with dental caries (DMFT ≥1) aged 13-15 years and 220 children aged 2-6 years with early childhood caries (ECC, dmft ≥1) were included. Genotype determination of ACE I/D polymorphism in intron 16 was based on the TaqMan method.

RESULTS

Although no significant differences in the allele or genotype frequencies between the caries-free children and those affected by dental caries were observed, statistically significant differences between the children with DMFT = 0 and the subgroup of 179 patients with high caries experience (DMFT ≥4; p < 0.01 and p < 0.05, respectively) were detected. The comparison of DD versus II+ID genotype frequencies between the patients with DMFT ≥1 or DMFT ≥4 and healthy children also showed significant differences (31.5% or 35.6% vs. 23.6%, p < 0.05 or p < 0.01, respectively). A gender-based analysis identified a significant difference in the DD versus II+ID genotype frequencies only in girls (p < 0.05). In contrast, no significant association of ACE I/D polymorphism with ECC in young children was found (p > 0.05).

CONCLUSIONS

ACE I/D polymorphism may be associated with caries in permanent but not primary dentition, especially in girls in the Czech population.

Digit Sucking Habit and Association with Dental Caries and Oral Hygiene Status of Children Aged 6 Months to 12 Years Resident in Semi-Urban Nigeria

Objectives

Non-nutritive sucking (NNS) is a common behavior in childhood. The association between digit sucking, dental caries and oral health has been studied with inconclusive results. The objectives of this study were to determine the prevalence of, and the association between digit sucking, caries and oral hygiene status of children age six months to 12 years, resident in Ile-Ife, Osun State, Nigeria.

Methods

A cross-sectional study was conducted in Ife Central Local Government Area of Osun State. Data were collected through a household survey using a multi-stage sampling procedure from children between six months and 12 years. Details of each child’s socio-demographic characteristics, digit sucking habits, caries status and oral health status were collected. The association between digit sucking, caries status and oral hygiene status was determined using Chi square and Logistic regression.

Results

The mean age of the 992 study participants was 5.8 ± (3.2) years. The prevalence of digit sucking, caries and poor oral hygiene were 7.2%, 10.5% and 2.4% respectively. The mean dmft score was 0.22 ± (0.80), mean DMFT score was 0.04 ± (0.30) while mean Oral Hygiene Index score was 1.27 ± (0.73). Digit sucking increased the odds of having caries (OR: 1.28; CI: 0.58–2.81) but decreased the odds of having poor oral hygiene (OR: 0.58; CI: 0.34–1.01) insignificantly.

Conclusions

Digit sucking was not a significant predictor of caries and oral hygiene status, although the odds of having caries increased while the odds of having poor oral hygiene decreased with digit sucking.

Demographic factors and dental health of Swedish children and adolescents

OBJECTIVE

To investigate the dental health of Swedish children and adolescents with reference to age, gender and residence.

MATERIAL AND METHODS

Electronic dental records from 300,988 3-19-year-olds in one Swedish region were derived in a cross-sectional study in years 2007-2009. The DMFT system was used. Age was categorized into 3-6/7-9/10-12/13-15/16-17/18-19-year-olds and residence into 'metropolitan', 'urban' and 'rural' areas. ANOVA, generalized linear regression models and Fisher's exact test were used.

RESULTS

Among 7-9-year-old children, nine out of 10 were free from fillings and manifest caries, while for 18-19-year-olds; this proportion was one third. Girls (18-19-year-olds) had a significantly lower risk of caries compared to boys of the same age, RR for the DT index = 0.83 (95% CI = 0.81-0.85). This pattern was reversed in 7-12-year-old children. Children and adolescents in metropolitan and urban areas had significantly more caries than subjects in rural areas, for instance the RR for the DT index in metropolitan 7-9-year-olds was 2.26 (95% CI = 2.11-2.42) compared to their rural counterparts.

CONCLUSIONS

In the permanent dentition, the overall pattern revealed that girls ≤ 12 years had a higher risk of caries, while adolescent girls had a lower risk of caries, both compared with boys of corresponding ages. Living in an urban or metropolitan area entailed a higher risk of caries than living in a rural area. A greater occurrence of dental caries in adolescents than in children was confirmed. The findings should have implications for planning and evaluation of oral health promotion and disease prevention activities.

Caries Experience Differs between Females and Males across Age Groups in Northern Appalachia

Sex disparities in dental caries have been observed across many populations, with females typically exhibiting higher prevalence and more affected teeth. In this study we assessed the sex disparities in two Northern Appalachian populations from West Virginia (WV, N = 1997) and Pennsylvania (PA, N = 1080) by comparing caries indices between males and females across four phases of dental development: primary dentition in children aged 1–5 years, mixed dentition in children aged 6–11 years, permanent dentition in adolescents aged 12–17 years, and permanent dentition in adults aged 18–59 years. No significant sex differences were observed for children aged 1–5 years. Contrary to national and international trends, WV girls aged 6–11 years had 1.5 fewer affected teeth than boys (p < 0.001). However, by ages 12–17, caries indices in the WV girls matched those in boys. In both WV and PA adults, women and men had similar total counts of affected teeth (i.e., DMFT), although women had more dental restorations (p < 0.001) and men had more current decay (p < 0.001). These results suggest that in some Appalachian populations, young girls benefit from protection against caries that is lost during adolescence and that adult women utilize dental health care to a greater degree than men.

The Predisposing Factors between Dental Caries and Deviations from Normal Weight

Background:

Dental caries and deviations from normal weight are two conditions which share several broadly predisposing factors. So it's important to understand any relationship between dental state and body weight if either is to be managed appropriately.

Aims:

The study was done to find out the correlation between body mass index (BMI), diet, and dental caries among 12-15-year-old schoolgoing children in Panchkula District.

Materials and Methods:

A multistage sample of 12-15-year-old school children (n = 810) in Panchkula district, Haryana was considered. Child demographic details and diet history for 5 days was recorded. Data regarding dental caries status was collected using World Health Organization (1997) format. BMI was calculated and categorized according to the World Health Organization classification system for BMI. The data were subjected to statistical analysis using chi-square test and binomial regression developed using the Statistical Package for Social Sciences (SPSS) 20.0.

Results:

The mean Decayed Missing Filled Teeth (DMFT) score was found to be 1.72 with decayed, missing, and filled teeth to be 1.22, 0.04, and 0.44, respectively. When the sample was assessed based on type of diet, it was found that vegetarians had higher mean DMFT (1.72) as compared to children having mixed diet. Overweight children had highest DMFT (3.21) which was followed by underweight (2.31) and obese children (2.23). Binomial regression revealed that females were 1.293 times at risk of developing caries as compared to males. Fair and poor Simplified-Oral Hygiene Index (OHI-S) showed 3.920 and 4.297 times risk of developing caries as compared to good oral hygiene, respectively. Upper high socioeconomic status (SES) is at most risk of developing caries. Underweight, overweight, and obese are at 2.7, 2.5, and 3 times risk of developing caries as compared to children with normal BMI, respectively.

Conclusion:

Dental caries and deviations from normal weight are two conditions which share several broadly predisposing factors such as diet, SES, lifestyle and other environmental factors.

Genetic susceptibility to dental caries differs between the sexes: a family-based study

Many of the factors affecting susceptibility to dental caries are likely influenced by genetics. In fact, genetics accounts for up to 65% of inter-individual variation in dental caries experience. Sex differences in dental caries experience have been widely reported, with females usually exhibiting a higher prevalence and severity of disease across all ages. The cause for this sex bias is currently uncertain, although it may be partly due to the differential effects of genetic factors between the sexes: gene-by-sex interactions. In this family based study (N = 2,663; 740 families; ages 1-93 years), we assessed dental caries via intra-oral examination and generated six indices of caries experience (DMFS, dfs, and indices of both pit-and-fissure surface caries and smooth surface caries in both primary and permanent dentitions). We used likelihood-based methods to model the variance in caries experience conditional on the expected genetic sharing among relatives in our sample. This modeling framework allowed us to test two lines of evidence for gene-by-sex interactions: (1) whether the magnitude of the cumulative effect of genes differs between the sexes, and (2) whether different genes are involved. We observed significant evidence of gene-by-sex interactions for caries experience in both the primary and permanent dentitions. In the primary dentition, the magnitude of the effect of genes was greater in males than females. In the permanent dentition, different genes may play important roles in each of the sexes. Overall, this study provides the first direct evidence that sex differences in dental caries experiences may be explained, in part, by gene-by-sex interactions.

A comparison of female and male oral health in skeletal populations from late Roman Britain: implications for diet

OBJECTIVES

Textual sources from the Roman period point to the existence of dietary differences between the sexes. The aim of this study was to assess the palaeopathological evidence for such gender differences in dietary habits in Roman Britain by comparing the oral health of sexed individuals from two late Romano-British sites (Ancaster, Lincolnshire, and Winchester, Hampshire, England).

MATERIALS AND METHODS

Eighty-seven females (1243 teeth and 1950 sockets) and 112 males (1984 teeth and 2903 sockets) were examined for the presence of five dento-alveolar conditions, namely caries, calculus, periapical lesions, periodontal disease, and antemortem tooth loss. The frequency of each condition was calculated at the per individual and per tooth/socket level, and the results were compared between the sexes using Fisher's exact tests.

RESULTS

Caries and antemortem tooth loss were slightly more common among women, but differences between the sexes were generally not significant. Males experienced higher rates of calculus and periodontal disease. There were no sex differences in the frequency of periapical lesions.

CONCLUSIONS

Comparable rates of caries, periapical lesions and antemortem tooth loss in females and males indicate broad similarity in the diets of men and women. The greater levels of calculus and periodontal disease in males might point to some dietary differences, but could also be explained by non-dietary factors. Overall, the findings suggest that significant gender differences in diet, described in some contemporaneous textual sources, were not widely observed in Roman Britain.

Gender differences in autoimmune disease

Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.

Fine mapping of locus Xq25.1-27-2 for a low caries experience phenotype

OBJECTIVE

The purpose of this study was to fine map the locus Xq25.1-27-2 in order to identify genetic contributors involved in low caries experience.

DESIGN

Seventy-two families from the Philippines were studied. Caries experience was recorded and genomic DNA extracted from peripheral blood was obtained from all subjects. One hundred and twenty-eight polymorphisms in the locus Xq25.1-27-2, a region that contains 24 genes, were genotyped. Association between caries experience and alleles was tested using the transmission disequilibrium test (TDT). This initial analysis was followed by experiments with DNA samples from 1481 subjects from Pittsburgh, 918 children from Brazil, and 275 children from Turkey in order to follow up the results found in the Filipino families. Chi-square or Fisher's exact tests were used. Sequencing of the coding regions and exon-intron boundaries of MST4 and FGF13 were also performed on 91 women from Pittsburgh.

RESULTS

Statistically significant association with low caries experience was found for 11 markers in Xq25.1-27-2 in the Filipino families. One marker was in MST4, another marker was in FGF13, and the remaining markers were in intergenic regions. Haplotype analysis also confirmed these results, but the follow up studies with DNA samples from Pittsburgh, Brazil, and Turkey showed associations for a subset of the 11 markers. No coding mutations were identified by sequencing.

CONCLUSIONS

Our study failed to conclusively demonstrate that genetic factors in Xq25.1-27-2 contribute to caries experience in multiple populations.

Genome-wide association study of primary dentition pit-and-fissure and smooth surface caries

Dental caries continues to be the most common chronic disease in children today. Despite the substantial involvement of genetics in the process of caries development, the specific genes contributing to dental caries remain largely unknown. We performed separate genome-wide association studies of smooth and pit-and-fissure tooth surface caries experience in the primary dentitions of self-reported white children in two samples from Iowa and rural Appalachia. In total, 1,006 children (ages 3-12 years) were included for smooth surface analysis, and 979 children (ages 4-14 years) for pit-and-fissure surface analysis. Associations were tested for more than 1.2 million single nucleotide polymorphisms, either genotyped or imputed. We detected genome-wide significant signals in KPNA4 (p value = 2.0E-9), and suggestive signals in ITGAL (p value = 2.1E-7) and PLUNC family genes (p value = 2.0E-6), thus nominating these novel loci as putative caries susceptibility genes. We also replicated associations observed in previous studies for MPPED2 (p value = 6.9E-6), AJAP1 (p value = 1.6E-6) and RPS6KA2 (p value = 7.3E-6). Replication of these associations in additional samples, as well as experimental studies to determine the biological functions of associated genetic variants, are warranted. Ultimately, efforts such as this may lead to a better understanding of caries etiology, and could eventually facilitate the development of new interventions and preventive measures.

Association between parity and dentition status among Japanese women: Japan public health center-based oral health study

BACKGROUND

Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men.

METHODS

A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model.

RESULTS

Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects.

CONCLUSION

Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.

Caries experience in schoolchildren in Bucharest, Romania: the PAROGIM study

OBJECTIVE

This cross-sectional study aimed to investigate the prevalence and experience of dental caries among children from public middle schools in Bucharest in relation to socioeconomic status and access to school-based dental care.

METHODS

Clinical data were collected from 1,595 schoolchildren aged 10-17 years, randomly allocated by clusters into a stratified sample population. The dental caries were scored according to the World Health Organization (WHO) clinical criteria and expressed based on tooth and surface levels [Decayed-Missing-Filled Teeth/Surfaces indices (DMFT/DMFS)]. A questionnaire was administered to the children to determine the education level of their parents and their living standard.

RESULTS

The caries prevalence was 75 percent, and 64 percent had untreated caries. The mean DMFT value for the entire sample was 2.8, and its highest component was decayed teeth (mean DT 2). Parental education level had the strongest influence on the caries scores; 70 percent of children whose parents had not completed a university degree had untreated caries (%DT) compared to only 49 percent of children whose parents had a higher level of education (P < 0.05). Children with access to school-based dental care had significantly better dental health (P < 0.05).

CONCLUSION

Compared to previous national surveys, the caries rates among schoolchildren in Bucharest are slowly declining. However, there was still a high proportion of untreated caries with a clear socioeconomic gradient, and a change in the school-based oral preventive strategy is needed to meet the needs of the children.

The neolithic demographic transition and oral health: The Southeast Asian experience

The purpose of this article is to present new oral health data from Neolithic An Son, southern Vietnam, in the context of (1) a reassessment of published data on other Neolithic, Bronze, and Iron Age Southeast Asian dental series, and (2) predictions of the Neolithic Demographic Transition (NDT). To this end, frequencies for three oral conditions (caries, antemortem tooth loss, and alveolar lesions) were investigated for seven Southeast Asian adult dental series from Thailand and Vietnam with respect to time period, age-at-death and sex. A clear pattern of elevated rates for oral disease in the Neolithic followed by a marked improvement in oral health during the Bronze and Iron Ages was observed. Moreover, rates of caries and antemortem tooth loss for females were almost without exception higher than that for males in all samples. The consensus view among Southeast Asian bioarchaeologists that oral health did not decline with the adoption/intensification of agriculture in Southeast Asia, can no longer be supported. In light of evidence for (1) the low cariogenicity of rice; (2) the physiological predisposition of females (particularly when pregnant) to poorer oral health; and (3) health predictions of the NDT model with respect to elevated levels of fertility, the most plausible chief explanation for the observed patterns in oral health in Southeast Asia is increased levels of fertility during the Neolithic, followed by a decline in fertility during the subsequent Bronze and Iron Ages.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

The impact of gender on caries prevalence and risk assessment

Dental caries remains a common disease worldwide. There is evidence indicating that many caries risk factors provide a gender bias, placing women at a higher caries risk. Generally, dental caries disproportionally affects the poor and racial or ethnic minorities worldwide, with women suffering more from the disease. Differences in access to care as reflected by untreated caries rates also reflect gender disparities. There is a lack of evidence in regard to gender differences and dental caries. Therefore, there is an urgent need to develop the evidence necessary to meet the oral health needs of both women and men worldwide.

Dental crowding as a caries risk factor: a systematic review

INTRODUCTION

The association between dental crowding and dental caries has long been accepted because of increased food accumulation and plaque retention in areas of crowding. The aim of this review was to evaluate this potential causal relationship systematically.

METHODS

Six electronic databases were accessed, supplemented by manual searching of the references of the relevant retrieved articles, peer-reviewed orthodontic journals, and gray literature. Search terms included caries, decay, crowding, and irregularity. Non-English articles were excluded from the review in the study-selection stage. Data extraction and evaluation of primary studies were performed independently by 2 reviewers.

RESULTS

The initial search retrieved 6914 citations. However, only 18 articles met the inclusion criteria. The qualitative systematic review included 8 studies, with articles of low or moderate quality. No association between crowding and caries was reported in 4 studies, a significant negative correlation was found in 2 studies, 1 study showed a direct and significant relationship, and another study showed a positive association in the mandibular anterior region but an inverse correlation in the maxillary posterior region.

CONCLUSIONS

To date, there are no high-quality studies to resolve the possible association between dental crowding and caries; further high-quality longitudinal studies are needed to clarify this relationship.

The role of school-based dental programme on dental caries experience in Yogyakarta Province, Indonesia

OBJECTIVES

To assess the effectiveness of a school-based dental programme (SBDP) in controlling caries by measuring the relationship between the SBDP performance and caries experience in children aged 12 in Yogyakarta Province, Indonesia, by taking into account influencing factors.

METHODS

A cross-sectional survey was undertaken of 1906 children participating in SBDPs. Four SBDPs were chosen by good and poor performances in urban and rural areas. Caries was assessed using WHO criteria whereas behaviour and socio-demographic factors were collected using a questionnaire administered to the children.

RESULTS

The decayed, missed, and filled teeth (DMFT) of children in good SBDPs (2.8 ± 2.4) was lower than that of the counterparts (3.8 ± 3.4). From path analysis using a structural equation model (SEM), place of residence (OR = 4.0) was shown to have a strongest direct relationship to caries experience, whereas SBDP performance showed no direct relationship. At the same time, SBDP performance was significantly related to frequencies of dental visits (OR = 0.3), sugar consumption (OR = 0.8), and tooth brushing (OR = 3.2), which in turn are interrelated with place of residence, gender, and mother's education.

CONCLUSIONS

The study suggests that the differences in DMFT of children in good and poor performance SBDPs were caused by relation to social factors rather than by relation to oral health service activities.

Genetic and environmental factors associated with dental caries in children: the Iowa Fluoride Study

Dental caries remains the most common chronic childhood disease. Despite strong evidence of genetic components, there have been few studies of candidate genes and caries. In this analysis we tried to assess genetic and environmental factors contributing to childhood caries in the Iowa Fluoride Study. Environmental factors (age, sex, race, tooth-brushing frequencies and water fluoride level) and three dental caries scores (d(2)fs-total, d(2)fs-pit/fissure, and d(2)fs-smooth surface) were assessed in 575 unrelated children (mean age 5.2 years). Regression analyses were applied to assess environmental correlates. The Family-Based Association Test was used to test genetic associations for 23 single nucleotide polymorphism (SNP) markers in 7 caries candidate genes on 333 Caucasian parent-child trios. We evaluated the associations between caries status and the level of both single and multiple SNPs (haplotype) respectively. Permutation procedure was performed for correction of inflated type I errors due to multiple testing. Age, tooth-brushing frequency and water fluoride level were significantly correlated to at least one carious score. Caries on pit and fissure surfaces was substantially higher than on smooth surfaces (61 vs. 39%). SNPs in three genes (DSPP, KLK4 and AQP5) showed consistent associations with protection against caries. Of note, KLK4 and AQP5 were also highlighted by subsequent haplotype analysis. Our results support the concept that genes can modify the susceptibility of caries in children. Replication analysis in independent cohorts is highly needed in order to verify the validity of our findings.

Gender differences in oral health in South Asia: metadata imply multifactorial biological and cultural causes

OBJECTS

This study was designed to examine the magnitude and etiology of gender differences in oral health. South Asia was selected for study because sex differences in caries rates exist in prehistory here, great cultural diversity provides context, and clinical reports document caries by gender.

METHODS

A literature survey yielded extensive data on caries rates in India, Nepal, Bangladesh, and Sri Lanka. The percentage of individuals with caries (prevalence) and the mean number of decayed, missing, and filled teeth (experience) comprise the data. Statistical tests for gender differences come from published sources or were independently computed.

RESULTS

Higher caries rates were found more often among females than males. The data show that: (a) in male children caries rates are greater than, or equal to, female rates, (b) the gender bias reverses (F > M caries rates) from adolescence through the reproductive years, (c) mature adults typically exhibit significant differences, with higher caries rates in females, (d) a male gender bias in adults is rare, and (e) though some studies find no significant gender difference in caries, a female bias dominates. Tooth loss is also greater in women than men and often results from caries (vs. periodontal disease).

CONCLUSIONS

The gender gap in oral health exists in South Asia and results from genetic, hormonal, and cultural influences. Three cultural factors contribute to this gender gap South Asia: (a) the relative value of sons and daughters, (b) frequent fasting among Hindu women, and (c) the belief that dietary restrictions result in easier childbirth.