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Lin YT, Kalhan AC, Lin YTJ, Kalhan TA, Chou CC, Gao XL, Hsu CYS. Risk assessment models to predict caries recurrence after oral rehabilitation under general anaesthesia: a pilot study. Int Dent J 2018; 68:378-385. [PMID: 29740814 DOI: 10.1111/idj.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Oral rehabilitation under general anaesthesia (GA), commonly employed to treat high caries-risk children, has been associated with high economic and individual/family burden, besides high post-GA caries recurrence rates. As there is no caries prediction model available for paediatric GA patients, this study was performed to build caries risk assessment/prediction models using pre-GA data and to explore mid-term prognostic factors for early identification of high-risk children prone to caries relapse post-GA oral rehabilitation. METHODS Ninety-two children were identified and recruited with parental consent before oral rehabilitation under GA. Biopsychosocial data collection at baseline and the 6-month follow-up were conducted using questionnaire (Q), microbiological assessment (M) and clinical examination (C). RESULTS The prediction models constructed using data collected from Q, Q + M and Q + M + C demonstrated an accuracy of 72%, 78% and 82%, respectively. Furthermore, of the 83 (90.2%) patients recalled 6 months after GA intervention, recurrent caries was identified in 54.2%, together with reduced bacterial counts, lower plaque index and increased percentage of children toothbrushing for themselves (all P < 0.05). Additionally, meal-time and toothbrushing duration were shown, through bivariate analyses, to be significant prognostic determinants for caries recurrence (both P < 0.05). CONCLUSIONS Risk assessment/prediction models built using pre-GA data may be promising in identifying high-risk children prone to post-GA caries recurrence, although future internal and external validation of predictive models is warranted.
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Affiliation(s)
- Yai-Tin Lin
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | | | - Tosha Ashish Kalhan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Xiao Li Gao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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52
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Ballantine JL, Carlson JC, Ferreira Zandoná AG, Agler C, Zeldin LP, Rozier RG, Roberts MW, Basta PV, Luo J, Antonio‐Obese ME, McNeil DW, Weyant RJ, Crout RJ, Slayton RL, Levy SM, Shaffer JR, Marazita ML, North KE, Divaris K. Exploring the genomic basis of early childhood caries: a pilot study. Int J Paediatr Dent 2018; 28:217-225. [PMID: 29057527 PMCID: PMC5811369 DOI: 10.1111/ipd.12344] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE A genetic component in early childhood caries (ECC) is theorized, but no genome-wide investigations of ECC have been conducted. This pilot study is part of a long-term research program aimed to: (1) determine the proportion of ECC variance attributable to the human genome and (2) identify ECC-associated genetic loci. METHODS The study's community-based sample comprised 212 children (mean age=39 months; range = 30-52 months; males = 55%; Hispanic/Latino = 35%, African-American = 32%; American Academy of Pediatric Dentistry definition of ECC prevalence = 38%). Approximately 2.4 million single nucleotide polymorphisms (SNPs) were genotyped using DNA purified from saliva. A P < 5 × 10-8 criterion was used for genome-wide significance. SNPs with P < 5 × 10-5 were followed-up in three independent cohorts of 921 preschool-age children with similar ECC prevalence. RESULTS SNPs with minor allele frequency ≥5% explained 52% (standard error = 54%) of ECC variance (one-sided P = 0.03). Unsurprisingly, given the pilot's small sample size, no genome-wide significant associations were found. An intergenic locus on 4q32 (rs4690994) displayed the strongest association with ECC [P = 2.3 × 10-6 ; odds ratio (OR) = 3.5; 95% confidence interval (CI) = 2.1-5.9]. Thirteen loci with suggestive associations were followed-up - none showed evidence of association in the replication samples. CONCLUSION This study's findings support a heritable component of ECC and demonstrate the feasibility of conducting genomics studies among preschool-age children.
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Affiliation(s)
- Jami L. Ballantine
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Jenna C. Carlson
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA
| | - Andrea G. Ferreira Zandoná
- Department of Operative DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Cary Agler
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Leslie P. Zeldin
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Richard Gary Rozier
- Department of Health Policy and ManagementGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Michael W. Roberts
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Patricia V. Basta
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Biospecimen Processing Facility coreUniversity of North CarolinaChapel HillNCUSA
| | - Jason Luo
- Lineberger Comprehensive Cancer CenterSchool of MedicineUniversity of North CarolinaChapel HillNCUSA,Mammalian Genotyping coreUniversity of North CarolinaChapel HillNCUSA
| | - Mikafui E. Antonio‐Obese
- Oral and Craniofacial Health SciencesSchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Daniel W. McNeil
- Departments of Dental Practice & Rural Health and PsychologyWest Virginia UniversityMorgantownWVUSA
| | - Robert J. Weyant
- Department of Dental Public Health and Information ManagementSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Richard J. Crout
- Department of PeriodonticsSchool of DentistryWest Virginia UniversityMorgantownWVUSA
| | - Rebecca L. Slayton
- Department of Pediatric DentistrySchool of DentistryUniversity of WashingtonSeattleWAUSA
| | - Steven M. Levy
- Department of Preventive and Community DentistryUniversity of Iowa College of DentistryIowa CityIAUSA,Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIAUSA
| | - John R. Shaffer
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA
| | - Mary L. Marazita
- Center for Craniofacial and Dental GeneticsSchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of Human GeneticsGraduate School of Public HealthUniversity of PittsburghPittsburghPA USA,Department of Oral BiologySchool of Dental MedicineUniversity of PittsburghPittsburghPAUSA,Department of PsychiatrySchool of MedicineUniversity of PittsburghPittsburghPAUSA,Clinical and Translational Science InstituteSchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Kari E. North
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
| | - Kimon Divaris
- Department of Pediatric DentistrySchool of DentistryUniversity of North Carolina‐Chapel HillChapel HillNCUSA,Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina‐Chapel HillChapel HillNCUSA
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Bowen WH, Burne RA, Wu H, Koo H. Oral Biofilms: Pathogens, Matrix, and Polymicrobial Interactions in Microenvironments. Trends Microbiol 2018; 26:229-242. [PMID: 29097091 PMCID: PMC5834367 DOI: 10.1016/j.tim.2017.09.008] [Citation(s) in RCA: 513] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/26/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
Biofilms are microbial communities embedded within an extracellular matrix, forming a highly organized structure that causes many human infections. Dental caries (tooth decay) is a polymicrobial biofilm disease driven by the diet and microbiota-matrix interactions that occur on a solid surface. Sugars fuel the emergence of pathogens, the assembly of the matrix, and the acidification of the biofilm microenvironment, promoting ecological changes and concerted multispecies efforts that are conducive to acid damage of the mineralized tooth tissue. Here, we discuss recent advances in the role of the biofilm matrix and interactions between opportunistic pathogens and commensals in the pathogenesis of dental caries. In addition, we highlight the importance of matrix-producing organisms in fostering a pathogenic habitat where interspecies competition and synergies occur to drive the disease process, which could have implications to other infections associated with polymicrobial biofilms.
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Affiliation(s)
- William H Bowen
- Center for Oral Biology, Department of Microbiology & Immunology and Environmental Medicine, University of Rochester Medical Center, Rochester, New York, NY, USA; Deceased (15 November 2016)
| | - Robert A Burne
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Hui Wu
- Departments of Microbiology and Pediatric Dentistry, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hyun Koo
- Levy Center for Oral Health, Department of Orthodontics, Divisions of Pediatric Dentistry and Community of Oral Health, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
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Beyond Streptococcus mutans: clinical implications of the evolving dental caries aetiological paradigms and its associated microbiome. Br Dent J 2018; 224:219-225. [PMID: 29449651 DOI: 10.1038/sj.bdj.2018.81] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/09/2022]
Abstract
Aetiological concepts of dental caries have evolved over the years from being considered as a disease initiated by nonspecific microorganisms, to being regarded as an 'infectious' disease caused by specific bacteria, to the current paradigms that emphasise a 'mixed bacterial-ecological approach' as being responsible for lesion initiation and pathogenesis. These aetiological paradigms are not just intellectual concepts but have important implications on how clinicians manage this age-old disease in the twenty-first century. Despite evidence-backed recommendations for adopting more biological measures to counter the disease, a significant proportion of dentists continue following traditional caries management guidelines in their daily clinical practice. This paper will review the evolving dental caries aetiological concepts and highlight the current evidence for adopting a more ecological approach to caries prevention, risk assessment, and treatment.
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55
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Guedes RS, Piovesan C, Ardenghi TM, Emmanuelli B, Braga MM, Mendes FM. Presence of Initial Caries Lesions as a Risk Factor for Caries in Preschool Children: A Cohort Study. Caries Res 2017; 52:32-41. [PMID: 29232677 DOI: 10.1159/000479824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate the influence of initial noncavitated caries lesions on cavitated caries increment in preschool children. A 2-year cohort study was designed to include the participants of a survey on dental caries performed in 2010. Preschool children (12-59 months old) were examined for dental caries and classified as children with no caries lesions, with only initial lesions, with at least 1 moderate caries lesion, and with extensive lesions. Socioeconomic data were also collected. After 2 years, 466 children were re-examined (follow-up rate of 72.9%) only for cavitated lesions. Association between caries incidence at 2 levels of severity and caries experience and other variables was evaluated using hierarchical Poisson regression analysis. The children with moderate and extensive caries lesions at baseline presented a higher risk of presenting both outcomes than the children with no caries lesions. Nevertheless, the children with only initial lesions had a higher risk of developing at least 1 new cavitated carious lesion, but not for a more severe increment in caries. Subgroup analysis stratified by the children's age showed that the influence of the presence of initial caries lesions on cavitated caries increment was only observed in children aged 12-35 months. In conclusion, although the presence of moderate and extensive lesions at baseline is a significant predictor for cavitated caries increment after 2 years in preschool children at all ages, the presence of only initial caries lesions is also associated, but with less severe caries incidence.
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Affiliation(s)
- Renata S Guedes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Peres KG, Chaffee BW, Feldens CA, Flores-Mir C, Moynihan P, Rugg-Gunn A. Breastfeeding and Oral Health: Evidence and Methodological Challenges. J Dent Res 2017; 97:251-258. [PMID: 29108500 DOI: 10.1177/0022034517738925] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breastfeeding is a powerful health-promoting behavior. A 2016 Lancet global collaboration to review the health implications of breastfeeding was among the first to consider oral health outcomes. While a role was suggested for breastfeeding in preventing malocclusion, caries was the only included disease condition unfavorably associated with breastfeeding. The present critical review examines the evidence connecting breastfeeding practices to these outcomes and discusses the methodological challenges inherent in reaching causal conclusions. Published systematic reviews show some evidence of a protective effect of breastfeeding against primary dentition malocclusion but no supportive evidence for mixed dentition and permanent dentition malocclusions. Regarding caries, well-conducted studies report a benefit with breastfeeding up to 12 mo but a positive association between caries and breastfeeding of longer duration, at times that vary between 12 and 24 mo, as well as nocturnal feeding. Future studies would be methodologically stronger if focused on specific malocclusion traits that are plausibly associated with sucking movements rather than using general malocclusion indices. Studies should use detailed and consistent terminology for breastfeeding definition, including frequency, intensity, and timing. Analytical studies should be carried out to distinguish between confounders (e.g., prematurity) and mediators (e.g., use of pacifier). Regarding a link to caries, standard terminology for exposures (e.g., nocturnal feeding) is recommended. Statistical analyses must account for known confounding factors (e.g., socioeconomic conditions) but avoid inappropriate adjustment for variables on a causal path between exposure and outcome or for variables not associated with breastfeeding (e.g., tooth brushing), as can be guided using tools such as direct acyclic graphs. For dental practice, the potential caries risk of long-duration breastfeeding should be part of individual patient counseling that incorporates patient values and circumstances. Given the unquestioned overall health benefits of breastfeeding, the dental community should support World Health Organization guidelines that encourage and promote breastfeeding.
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Affiliation(s)
- K G Peres
- 1 Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Australia
| | - B W Chaffee
- 2 Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
| | - C A Feldens
- 3 Department of Pediatric Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
| | - C Flores-Mir
- 4 Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - P Moynihan
- 5 School of Dental Sciences, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - A Rugg-Gunn
- 6 Newcastle University, Newcastle upon Tyne, UK
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Divaris K. Fundamentals of Precision Medicine. COMPENDIUM OF CONTINUING EDUCATION IN DENTISTRY (JAMESBURG, N.J. : 1995) 2017; 38:30-32. [PMID: 29227115 PMCID: PMC5880533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Precision medicine is no longer a distant vision; it is becoming part of the rapidly evolving present. Insights from studies of the human genome and microbiome, their associated transcriptomes, proteomes, and metabolomes, and epigenomics and exposomics have reached an unprecedented depth and scale. Much more needs to be done, however, particularly in dentistry.
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Affiliation(s)
- Kimon Divaris
- Associate Professor of Pediatric Dentistry and Epidemiology, School of Dentistry and Gillings, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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58
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Chen J, Li T, Zhou X, Cheng L, Huo Y, Zou J, Li Y. Characterization of the clustered regularly interspaced short palindromic repeats sites in Streptococcus mutans isolated from early childhood caries patients. Arch Oral Biol 2017; 83:174-180. [PMID: 28783550 DOI: 10.1016/j.archoralbio.2017.07.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the characteristics of the clustered regularly interspaced short palindromic repeats (CRISPR) sites in 45 clinical Streptococcus mutans strains and their relationship to the clinical manifestations of early childhood caries (ECC). METHODS Forty-five S. mutans strains were isolated from the plaque samples taken from sixty-three children. CRISPR sites were sequenced and BLAST was used to compare these sites to those in the CRISPRTarget database. The association between the distribution of CRISPR sites and the manifestation of caries was analyzed by Chi-Square test. Further, biofilm formation (by crystal violet staining) and the synthesis of polysaccharide (by anthrone-sulfuric method) of all clinical isolated S. mutans strains with both CRISPR sites and no CRISPR site were comapared. Finally, acidogenicity and acidurity of two typical strains were determined using pH drop and acid tolerance assays. Biofilm formation and EPS synthesis by two typical strains were compared by 3D CLSM (Confocal Laser Scanning Microscope) assays and the expression of gtf genes were evaluated using qPCR. RESULTS We found that most of the spacers in the clinical S. mutans strains were derived from Streptococcus phages APCM01 and M102. The number of CRISPR sites in these strains was associated with the clinical manifestations of ECC. Moreover, we found that the biofilm formation and EPS synthesis ability of the S. mutans strains with both CRISPR sites was significant improved. CONCLUSIONS An association was found between the distribution of CRISPR sites and the clinical manifestations of caries. The CRISPR sites might contribute to the cariogenic potential of S. mutans.
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Affiliation(s)
- Jing Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tiancheng Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China; Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Cheng
- Department of Operative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuanyuan Huo
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Zou
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuqing Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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59
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Divaris K, Bhaskar V, McGraw KA. Pediatric obesity-related curricular content and training in dental schools and dental hygiene programs: systematic review and recommendations. J Public Health Dent 2017; 77 Suppl 1:S96-S103. [PMID: 28708273 DOI: 10.1111/jphd.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors conducted a systematic review to determine: a) What dental schools and dental hygiene programs are doing to promote knowledge and skills related to addressing childhood obesity and to reduce consumption of sugar-sweetened beverages (SSBs) and b) What else these schools and programs could do to better equip future oral health professionals to address childhood obesity and reduce consumption of SSBs. METHODS The authors searched PubMed, Scopus, Education Full Text (EBSCOHost), and ERIC (EBSCOHost) to identify peer-reviewed publications reporting on obesity or dietetic-related curricula in dental and dental hygiene education within the last 20 years. Three studies met inclusion and exclusion criteria. Outcomes of the identified studies were abstracted and summarized independently by two investigators. RESULTS The first study describes a 2009 survey of pediatric dentistry residents. Approximately, half had received formal training yet they lacked essential knowledge or skills for managing children who were obese. The second study describes nutrition-related coursework offered in the second year of a predoctoral dental school curriculum in Saudi Arabia, and the third study reports on the development of an "oral health rotation" dietetic internship in a pediatric dentistry clinic, in the context of interprofessional education (IPE). CONCLUSIONS Evidence of dental schools' and dental hygiene programs' efforts to address obesity and SSB consumption in children in their curricula is scant, while Commission on Dental Accreditation standards make sporadic mentions of diet and nutrition. Opportunities exist to leverage existing resources and innovative, experiential approaches, including IPE, to formally, and effectively address this important issue in predoctoral oral health education.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Vaishnavi Bhaskar
- ITDP program, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A McGraw
- User Services & School of Dentistry Liaison, Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Pediatric oral health is determined by the interaction of environmental factors and genetic influences. This is the case for early childhood caries, the most common disease of childhood. The complexity of exogenous-environmental factors interacting with innate biological predispositions results in a continuum of normal variation, as well as oral health and disease outcomes. Optimal oral health and care or precision dentistry warrants comprehensive understanding of these influences and tools enabling intervention on modifiable factors. This article reviews the current knowledge of the genomic basis of pediatric oral health and highlights known and postulated mechanistic pathways of action relevant to early childhood caries.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina at Chapel Hill, 228 Brauer Hall, CB#7450, Chapel Hill, NC 27599, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA.
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61
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Mira A, Artacho A, Camelo-Castillo A, Garcia-Esteban S, Simon-Soro A. Salivary Immune and Metabolic Marker Analysis (SIMMA): A Diagnostic Test to Predict Caries Risk. Diagnostics (Basel) 2017; 7:diagnostics7030038. [PMID: 28654016 PMCID: PMC5617938 DOI: 10.3390/diagnostics7030038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/20/2023] Open
Abstract
By using ELISA and colorimetric tests, we have measured 25 compounds in individuals with and without dental caries at different time points of dental biofilm formation and time of the day. We find that some compounds appear to be affected by circadian rhythms, others by dental plaque maturity, and others show constant values during a 24 h period. Using univariate analysis and cross-validation techniques, we have selected six components measured at specific time points that maximize the diagnostic separation of health and disease conditions. Two out of the six selected compounds are related to immune competence, another two to the adhesion capacity of micro-organisms, and another two to acid production or pH buffering. We conclude that, in order to design a robust caries risk test, the time of saliva sampling must be standardized and biomarkers from different categories must be included. The preliminary data shown in this paper provide a proof of principle of a caries risk test based on risk-associated categories. Thus, the test will provide not only a general caries risk assessment, but also the likely biological origin of that risk, namely: immune imbalance, and/or a tendency to adhesion of cariogenic organisms, and/or a lack of acid buffering. When tested longitudinally and validated in larger cohorts, this could open the possibility to develop preventive and personalized treatments.
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Affiliation(s)
- Alex Mira
- Center for Advanced Research in Public Health, FISABIO Foundation, Valencia 46020, Spain.
| | - Alejandro Artacho
- Center for Advanced Research in Public Health, FISABIO Foundation, Valencia 46020, Spain.
| | - Anny Camelo-Castillo
- Center for Advanced Research in Public Health, FISABIO Foundation, Valencia 46020, Spain.
| | - Sandra Garcia-Esteban
- Center for Advanced Research in Public Health, FISABIO Foundation, Valencia 46020, Spain.
| | - Aurea Simon-Soro
- Center for Advanced Research in Public Health, FISABIO Foundation, Valencia 46020, Spain.
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Chaffee BW, Featherstone JDB, Zhan L. Pediatric Caries Risk Assessment as a Predictor of Caries Outcomes. Pediatr Dent 2017; 39:219-232. [PMID: 28583247 PMCID: PMC5463572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To determine cumulative dental treatment experience in a retrospective clinical cohort, according to baseline caries risk assessment (CRA) information. METHODS Evaluated were electronic records from a university pediatric dental clinic (2009 to 2014) of new, six- to 72- month-old patients who were not treated under sedation or general anesthesia (N equals 750). The mean number of teeth restored or extracted (two-year total and omitting the first 190 days post-baseline to discount initial treatment needs) was compared by baseline CRA category and CRA items (caries risk indicators, protective items, and clinical disease indicators). RESULTS The CRA category was associated with mean treated teeth over two years (low equals 0.53, moderate equals 1.02, high/extreme equals 4.47) and post 190 days (low equals 0.51, moderate equals 0.89, high/extreme equals 2.11). Any treatment probability was greatest for high/extreme-risk children but not statistically significantly different between low- and moderate-risk. Age-standardized means were greater for all individual baseline clinical indicators and most risk indicators, but lower for most protective items (not statistically significantly for all items). Clinical indicators were the strongest outcome correlates. CONCLUSIONS In this population, baseline risk information was associated with clinical outcomes. CRA can help identify patients needing more intensive caries prevention.
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Affiliation(s)
- Benjamin W Chaffee
- Assistant professor, Department of Preventive and Restorative Dental Sciences, at University of California San Francisco, San Francisco, Calif., USA;,
| | - John D B Featherstone
- Professor and Dean, at University of California San Francisco, San Francisco, Calif., USA
| | - Ling Zhan
- Associate professor, Department of Orofacial Sciences, at University of California San Francisco, San Francisco, Calif., USA
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63
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Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety? Br Dent J 2017; 222:299-304. [PMID: 28232699 PMCID: PMC5565940 DOI: 10.1038/sj.bdj.2017.175] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 12/03/2022]
Abstract
Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors.Design Analysis of prospectively obtained data.Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children.Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data.Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale.Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P <0.001]).Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease.
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Gomez A, Nelson KE. The Oral Microbiome of Children: Development, Disease, and Implications Beyond Oral Health. MICROBIAL ECOLOGY 2017; 73:492-503. [PMID: 27628595 PMCID: PMC5274568 DOI: 10.1007/s00248-016-0854-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/01/2016] [Indexed: 05/05/2023]
Abstract
In the era of applied meta-omics and personalized medicine, the oral microbiome is a valuable asset. From biomarker discovery to being a powerful source of therapeutic targets and to presenting an opportunity for developing non-invasive approaches to health care, it has become clear that oral microbes may hold the answer for understanding disease, even beyond the oral cavity. Although our understanding of oral microbiome diversity has come a long way in the past 50 years, there are still many areas that need to be fine-tuned for better risk assessment and diagnosis, especially in early developmental stages of human life. Here, we discuss the factors that impact development of the oral microbiome and explore oral markers of disease, with a focus on the early oral cavity. Our ultimate goal is to put different experimental and methodological views into perspective for better assessment of early oral and systemic disease at an early age and discuss how oral microbiomes-at the community level-could provide improved assessment in individuals and populations at risk.
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Affiliation(s)
- Andres Gomez
- Departments of Human Biology and Genomic Medicine, J. Craig Venter Institute, La Jolla, 92037, CA, USA.
| | - Karen E Nelson
- Departments of Human Biology and Genomic Medicine, J. Craig Venter Institute, La Jolla, 92037, CA, USA
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Morou-Bermudez E, Loza-Herrero MA, Garcia-Rivas V, Suarez-Perez E, Billings RJ. Oral Bacterial Acid-Base Metabolism in Caries Screening: A Proof-Of-Concept Study. JDR Clin Trans Res 2016; 2:132-141. [PMID: 28435894 DOI: 10.1177/2380084416673049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this cross-sectional study was to clinically validate an array of biochemical tests for oral acid/alkali generation as caries screening instruments. 185 adult subjects (mean 33.6±10.6 years) were examined clinically for dental caries using the ICDAS criteria. Bitewing radiographs were used to confirm interproximal surfaces of posterior teeth. For the purposes of this study, subjects were classified as "caries-active" if they had at least one untreated caries lesion with ICDAS 4 or higher. Pooled supragingival plaque and unstimulated saliva samples were collected and assayed for pH changes from sucrose and urea metabolism using colorimetric tests. The validity of each test to discriminate between "caries-inactive" and "caries-active" subjects was assessed and compared to a commercial bacteriological caries-screening test using roc regression and logistic regression models. The AUCs of the plaque-urea (PU: 0.59 (0.51, 0.67)), plaque-urea-glucose (PUG: 0.59 (0.51, 0.67)) and saliva-urea-glucose (SUG: 0.59 (0.51, 0.67)) tests did not differ significantly from the bacteriological tests (CRT-mutans: 0.62 (0.54, 0.70); CRT-lactobacillus: 0.63 (0.56, 0.71) (P>0.05), but the plaque-glucose (SG), saliva-glucose (SG), saliva-urea (SU) and saliva-plaque-glucose (SPG) tests had significantly smaller AUCs (P<0.05). The AUCs for the PU, PUG, SUG, and the CRT-mutans tests were higher in subjects who had no existing dental restorations (PU: 0.90 (0.77, 1.04); PUG: 0.90 (0.79, 1.01); SUG: 0.89 (0.69, 1.08); CRT-mutans: 0.90 (0.73, 1.08)). The incorporation of the biochemical tests into a multidimensional bacteriological/psychosocial caries screening model significantly increased its diagnostic values (Se+Sp: 160.6, AUC: 0.846). In conclusion, as a proof of concept, the results of this study indicate that measuring the ability of dental plaque and saliva to metabolize urea together with the ability to generate acid from sugars may have a promising role in caries screening either independently, or as part of a multidimensional biological test.
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Affiliation(s)
- E Morou-Bermudez
- School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan PR
| | - M A Loza-Herrero
- School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan PR
| | - V Garcia-Rivas
- School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan PR
| | - E Suarez-Perez
- Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan PR
| | - R J Billings
- University of Rochester, School of Medicine and Dentistry, Eastman Institute for Oral Health, Department of Community Dentistry, Rochester NY
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Carvalho JC, Dige I, Machiulskiene V, Qvist V, Bakhshandeh A, Fatturi-Parolo C, Maltz M. Occlusal Caries: Biological Approach for Its Diagnosis and Management. Caries Res 2016; 50:527-542. [DOI: 10.1159/000448662] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/24/2016] [Indexed: 11/19/2022] Open
Abstract
The management of occlusal caries still remains a major challenge for researchers as well as for general practitioners. The present paper reviews and discusses the most up-to-date knowledge and evidence of the biological principles guiding diagnosis, risk assessment, and management of the caries process on occlusal surfaces. In addition, it considers the whole spectrum of the caries process on occlusal surfaces, ranging from the molecular ecology of occlusal biofilms to the management of deep occlusal caries lesions. Studies using molecular methods with focus on biofilms in relation to occlusal caries should explore the relationship between the function and the structural composition of these biofilms to understand the role of occlusal biofilms in caries development. State-of-the-art measures to evaluate risk for occlusal caries lesion activity, caries incidence, and progression should include the assessment of the occlusal biofilm and the stage of tooth eruption. Careful clinical examination of non-cavitated lesions, including assessment of the lesion activity status, remains the major tool to determine the immediate treatment need and to follow on the non-operative treatment outcome. Even medium occlusal caries lesions in the permanent dentition may be treated by non-invasive fissure sealing. By extending the criteria for non-invasive treatments, traditional restoration of occlusal surfaces can be postponed or even avoided, and the dental health in children and adolescents can be improved. Selective removal (incomplete) to soft dentin in deep carious lesions has greater success rates than stepwise excavation. Selective (complete) removal to firm dentin has a lower success rate due to increased pulp exposure.
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Quinteros ME. Bioethical considerations about water fluoridation: a critical review. JOURNAL OF ORAL RESEARCH 2016. [DOI: 10.17126/joralres.2016.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salivary Bacterial Levels and Clinic Attendance Patterns may be Longitudinally Associated with Caries Outcomes in Established Adult Dental Patients. J Evid Based Dent Pract 2016; 16:139-41. [PMID: 27449848 DOI: 10.1016/j.jebdp.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Multicenter study on caries risk assessment in Japanese adult patients. Arino M, Ito A, Fujiki S, Sugiyama S, Mayashi M. J Dent 2015;43(10):1223-8. SOURCE OF FUNDING The Japan Society for the Promotion of Science, an independent administrative institution under the Ministry of Education, Culture, Sports, Science, and Technology, provided a Grant-in-Aid for Scientific Research (25293387) TYPE OF STUDY/DESIGN: Retrospective cohort (chart review).
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Chaffee BW, Featherstone JDB, Gansky SA, Cheng J, Zhan L. Caries Risk Assessment Item Importance: Risk Designation and Caries Status in Children under Age 6. JDR Clin Trans Res 2016; 1:131-142. [PMID: 27403458 DOI: 10.1177/2380084416648932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Caries risk assessment (CRA) is widely recommended for dental caries management. Little is known regarding how practitioners use individual CRA items to determine risk and which individual items independently predict clinical outcomes in children under age 6-years. OBJECTIVES Assess the relative importance of pediatric CRA items in dental providers' decision-making regarding patient risk and in association with clinically evident caries, cross-sectionally and longitudinally. METHODS CRA information was abstracted retrospectively from electronic patient records of children initially ages 6-72 months at a university pediatric dentistry clinic (N=3810 baseline; N=1315 with follow-up). The 17-item CRA form included caries risk indicators, caries protective items, and clinical indicators. Conditional random forests classification trees were implemented to identify and assign variable importance to CRA items independently associated with baseline high-risk designation, baseline evident tooth decay, and follow-up evident decay. RESULTS Thirteen individual CRA items, including all clinical indicators and all but one risk indicator, were independently and statistically significantly associated with student/resident providers' caries-risk designation. Provider-assigned baseline risk category was strongly associated with follow-up decay, which increased from low (20.4%), moderate (30.6%), to high/extreme risk patients (68.7%). Of baseline CRA items, before adjustment 12 were associated with baseline decay and 7 with decay at follow-up; however, in the conditional random forests models, only the clinical indicators (evident decay, dental plaque, and recent restoration placement) and one risk indicator (frequent snacking) were independently and statistically significantly associated with future disease, for which baseline evident decay was the strongest predictor. CONCLUSIONS In this predominantly high-risk population under caries-preventive care, more individual CRA items were independently associated with providers' risk determination than with future caries status. These university dental providers considered many items in decision-making regarding patient risk, suggesting that in turn, these comprehensive CRA forms could also aid individualized care, linking risk assessment to disease management.
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Affiliation(s)
- Benjamin W Chaffee
- University of California San Francisco, Department of Preventive and Restorative Dental Sciences, 3333 California St. Suite 495 Box 1361, San Francisco, CA 94143,
| | | | | | | | - Ling Zhan
- University of California San Francisco,
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Hajishengallis E, Forrest CB, Koo H. Early Childhood Caries: Future Perspectives in Risk Assessment. JDR Clin Trans Res 2016; 1:110-111. [PMID: 28879240 DOI: 10.1177/2380084416637577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- E Hajishengallis
- Division of Pediatric Dentistry, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C B Forrest
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Koo
- Department of Orthodontics and Division of Pediatric Dentistry, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
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