The impact of oral health on the academic performance of disadvantaged children

Clinical consequences of untreated dental caries in German 5- and 8-year-olds

Background

About half of all carious lesions in primary teeth of German 6- to 7-year-old children remain untreated, but no data regarding the clinical consequences of untreated dental caries are available. Therefore, this cross-sectional observational study aimed to assess the prevalence and experience of caries and odontogenic infections in the primary dentition of 5- and 8-year-old German children.

Methods

Dental examinations were performed in 5-year-old pre-school children (n = 496) and in 8-year-old primary school children (n = 608) living in the Westphalian Ennepe-Ruhr district. Schools and preschools were selected by sociodemographic criteria including size, area, ownership, socio-economic status. Caries was recorded according to WHO criteria (1997). The Lorenz curves were used to display the polarisation of dental caries. Caries pattern in 5-year-olds was categorized by Wyne’s (1997) definition of early childhood caries (ECC). Odontogenic infections as clinical consequence of untreated dental caries were assessed by the pufa index. The ‘untreated caries-pufa ratio’ was calculated, and the Spearman’s rank correlation coefficient (ρ) was used for evaluating the correlation between dmft and pufa scores. Categorical data were compared between groups using the chi-square test and continuous data were analysed by t-test.

Results

Caries prevalence and experience in the primary dentition was 26.2 %/0.9 ± 2.0 dmft in 5-year-olds and 48.8 %/2.1 ± 2.8 dmft in 8-year-olds. ECC type I (22 %) was the prevalent caries pattern in 5-year-olds. About 30 % of the tooth decay was treated (5y: 29.7 %/8y: 39.3 %). The Lorenz curves showed a strong caries polarisation on 20 % of the children. Pufa prevalence and experience was 4.4 %/0.1 ± 0.5 pufa in 5-year-olds and 16.6 %/0.3 ± 0.9 pufa in 8-year-olds. In 5-year-olds 14.2 % and in 8-year-olds 34.2 % of the d-component had progressed mainly to the pulp. A significant correlation between dmft and pufa scores exists in both age groups (5y: ρ = 0.399; 8y: ρ = 0.499). First deciduous molars were most frequently affected by odontogenic infections, presenting virtually all pufa scores (>95 %).

Conclusions

Prevalence and experience of odontogenic infections and the untreated caries-pufa ratio were increasing from the younger to the elder children. Dmft and pufa scores in primary teeth predict a higher caries risk in permanent teeth. The pufa index highlights relevant information for decision makers to develop effective oral health care programs for children at high risk for caries.

Safety Net Care and Midlevel Dental Practitioners: A Case Study of the Portion of Care That Might Be Performed Under Various Setting and Scope-of-Practice Assumptions

OBJECTIVES

We sought to determine the proportion of dental care provided at safety net-type clinics that might be performed by midlevel practitioners.

METHODS

Data were obtained on 157,328 procedures performed in 2012 at the clinics associated with a Midwestern dental school. Based on procedure codes, we determined the overall proportion, as well as the proportion of visits and patients' care, that could have been performed by 3 types of practitioners.

RESULTS

Overall, 48% to 66% of all procedures could have been performed by a midlevel dental practitioner. Nearly half of all visits, and roughly a third of all patients, could have been entirely cared for by a practitioner trained in prophylaxis and with evaluation capabilities. Such practitioners could handle roughly 80% of the visits at the community-based clinic and more than half of the visits at the hospital-based clinic.

CONCLUSIONS

A midlevel practitioner with training in prophylaxis has the potential to alleviate much of the burden on the dental safety net because much of the need among vulnerable populations falls well within their scope of practice.

Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new interdisciplinary partnership

OBJECTIVES

We provided oral health care services at 2 sites using a nurse practitioner-dietitian team to increase dental workforce capacity and improve access to care for low-income preschool children.

METHODS

Our team provided oral health assessments and education, fluoride varnish application, and dentist referrals. The primary endpoint was participants' access to oral health care. Secondary endpoints included increasing the practice scope of registered dietitians through training programs for oral health assessment and the application of fluoride varnishes for children. The oral health and hygiene and dietary habits of the participants were also determined.

RESULTS

From 2010 to 2013, 4360 children received fluoride varnishes in 7195 total visits. Although the proportion of children with dental caries at the first visit was greater at the urban site, both sites were similar by visits 2 and 3. The number of caries declined with increased program visits, which coincided with an increase in the proportion of participants visiting a dentist.

CONCLUSIONS

Progress toward eliminating dental health disparities requires addressing barriers to dental care access. We showed that expanding access to oral health services through nurse practitioner-dietitian cooperation improved access to preventive fluoride varnishing use in low-income children.

Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children

BACKGROUND

Severe-early childhood caries (S-ECC) is one of the most common infectious diseases in children and is prevalent in lower socio-economic populations. American Indian children suffer from the highest levels of S-ECC in the United States. Members of the mutans streptococci, Streptococcus mutans, in particular, are key etiologic agents in the development of caries. Children typically acquire S. mutans from their mothers and early acquisition is often associated with higher levels of tooth decay.

METHODS

We have conducted a 5-year birth cohort study with a Northern Plains Tribe to determine the temporality and fidelity of S. mutans transmission from mother to child in addition to the genotypic diversity of S. mutans in this community. Plaque samples were collected from 239 mother/child dyads at regular intervals from birth to 36 months and S. mutans were isolated and genotyped by arbitrarily primed-polymerase chain reaction (AP-PCR).

RESULTS

Here we present preliminary findings from a subset of the cohort. The focus for this paper is on initial acquisition events in the children. We identified 17 unique genotypes in 711 S. mutans isolates in our subset of 40 children, 40 mothers and 14 primary caregivers. Twelve of these genotypes were identified in more than one individual. S. mutans colonization occurred by 16 months in 57.5% of the children and early colonization was associated with higher decayed, missing and filled surface (DMFS) scores (p=0.0007). Children colonized by S. mutans shared a common genotype with their mothers 47.8% of the time. While multiple genotypes were common in adults, only 10% of children harbored multiple genotypes.

CONCLUSION

These children acquire S. mutans at an earlier age than the originally described 'window of infectivity' and often, but not exclusively, from their mothers. Early acquisition is associated with both the caries status of the children and the mothers.

Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6-17 years, 2011-2012

BACKGROUND

We assessed the prevalence of dental disease among U.S. children and adolescents aged 6-17 years, as well as the impact of unmet dental needs on school absenteeism because of illness/injury within the past 12 months.

METHODS

Data were from the 2011/2012 National Survey of Children's Health (n=65,680). Unmet dental need was defined as lack of access to appropriate and timely preventive or therapeutic dental healthcare when needed within the past 12 months. The impact of unmet dental needs on school absenteeism was measured using a multivariate generalized linear model with Poisson probability distribution (p<0.05).

RESULTS

Within the past 12 months, 21.8% (10.8 million) of all U.S. children and adolescents aged 6-17 years had "a toothache, decayed teeth, or unfilled cavities." Of all U.S. children and adolescents aged 6-17 years, 15.8% (7.8 million) reported any unmet dental need (i.e., preventive and/or therapeutic dental need) within the past 12 months. The mean number of days of school absence because of illness/injury was higher among students with an unmet therapeutic dental need in the presence of a dental condition compared to those reporting no unmet dental need (β=0.25; p<0.001).

CONCLUSIONS

Enhanced and sustained efforts are needed to increase access to dental services among underserved U.S. children and adolescents.

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents

BACKGROUND

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents.

METHODS

Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male.

RESULTS

Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care.

CONCLUSIONS

Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed.

Frequency of daily tooth brushing: predictors of change in 9- to 11-year old US children

OBJECTIVE

To investigate whether an increase in daily tooth brushing frequency in children was predicted by either a) having a strong intention to brush twice a day or b) their parents receiving information about their new caries experience.

BASIC RESEARCH DESIGN

Secondary data analyses were conducted on two waves of data from the Aban Aya Youth Project and the Iowa Fluoride Study.

PARTICIPANTS

The Aban Aya study included 576 10- and 11-year olds from Chicago, Illinois. The Iowa Fluoride Study included a convenience sample of 709 babies born in Iowa. The present study includes those children at age 9.

MAIN OUTCOME MEASURES

In both studies, reported daily tooth brushing frequency was assessed twice six months apart.

RESULTS

In the Aban Aya data, compared with children with a weak intention at wave 1 to brush twice a day, children with a strong intention to brush twice a day were more likely to increase their brushing frequency by wave 2, OR 7.0, 95%CI 1.5,32.9. In the Iowa Fluoride Study, compared with children who did not have new caries at wave 1, children who had new caries experience were less likely to increase their brushing frequency by wave 2, OR 0.4, 95%CI 0.2,0.9.

CONCLUSIONS

Strengthening intention to brush twice a day might increase children's brushing frequency. However, simply providing parents with information about new caries probably will not. Future studies should assess tooth brushing frequency, habit strength, intention, and situational cues at closely-spaced waves.

Self-reported racism and experience of toothache among pregnant Aboriginal Australians: the role of perceived stress, sense of control, and social support

OBJECTIVES

We hypothesized that the psychosocial factors perceived stress and sense of personal control mediated the relationship between self-reported racism and experience of toothache. We hypothesized that social support moderated this relationship.

METHODS

Data from 365 pregnant Aboriginal Australian women were used to evaluate experience of toothache, socio-demographic factors, psychosocial factors, general health, risk behaviors, and self-reported racism exposure. Hierarchical logistic regression models estimated odds ratios (ORs) and 95 percent confidence intervals (CIs) for experience of toothache. Perceived stress and sense of personal control were examined as mediators of the association between self-reported racism and experience of toothache. Social support was examined as a moderator.

RESULTS

Self-reported racism persisted as a risk indicator for experience of toothache (OR 1.99, 95 percent CI 1.07-3.72) after controlling for age, level of education, and difficulty paying a $100 dental bill. The relationship between self-reported racism and experience of toothache was mediated by sense of control. The direct effect of self-reported racism on experience of toothache became only marginally significant, and the indirect effect was significant (β coefficient=0.04, bias-corrected 95 percent CI 0.004-0.105, 21.2 percent of effect mediated). Stress was insignificant as a mediator. Social support was insignificant as a moderator.

CONCLUSIONS

The findings indicate that high levels of self-reported racism were associated with experience of toothache and that sense of control, but not perceived stress, mediated the association between self-reported racism and experience of toothache among this sample of pregnant Aboriginal Australian women. Social support did not moderate the association between self-reported racism and experience of toothache.

Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.