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Whittaker W, Goodwin M, Bashir S, Sutton M, Emsley R, Kelly MP, Tickle M, Walsh T, Pretty IA. Economic evaluation of a water fluoridation scheme in Cumbria, UK. Community Dent Oral Epidemiol 2024; 52:601-612. [PMID: 38525802 DOI: 10.1111/cdoe.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES The addition of fluoride to community drinking water supplies has been a long-standing public health intervention to improve dental health. However, the evidence of cost-effectiveness in the UK currently lacks a contemporary focus, being limited to a period with higher incidence of caries. A water fluoridation scheme in West Cumbria, United Kingdom, provided a unique opportunity to study the contemporary impact of water fluoridation. This study evaluates the cost-effectiveness of water fluoridation over a 5-6 years follow-up period in two distinct cohorts: children exposed to water fluoridation in utero and those exposed from the age of 5. METHODS Cost-effectiveness was summarized employing incremental cost-effectiveness ratios (ICER, cost per quality adjusted life year (QALY) gained). Costs included those from the National Health Service (NHS) and local authority perspective, encompassing capital and running costs of water fluoridation, as well as NHS dental activity. The measure of health benefit was the QALY, with utility determined using the Child Health Utility 9-Dimension questionnaire. To account for uncertainty, estimates of net cost and outcomes were bootstrapped (10 000 bootstraps) to generate cost-effectiveness acceptability curves and sensitivity analysis performed with alternative specifications. RESULTS There were 306 participants in the birth cohort (189 and 117 in the non-fluoridated and fluoridated groups, respectively) and 271 in the older school cohort (159 and 112, respectively). In both cohorts, there was evidence of small gains in QALYs for the fluoridated group compared to the non-fluoridated group and reductions in NHS dental service cost that exceeded the cost of fluoridation. For both cohorts and across all sensitivity analyses, there were high probabilities (>62%) of water fluoridation being cost-effective with a willingness to pay threshold of £20 000 per QALY. CONCLUSIONS This analysis provides current economic evidence that water fluoridation is likely to be cost-effective. The findings contribute valuable contemporary evidence in support of the economic viability of water fluoridation scheme.
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Affiliation(s)
- William Whittaker
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Saima Bashir
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Goodwin M, Walsh T, Whittaker W, Emsley R, Kelly MP, Sutton M, Tickle M, Pretty IA. The CATFISH study: An evaluation of a water fluoridation program in Cumbria, UK. Community Dent Oral Epidemiol 2024; 52:590-600. [PMID: 38757663 DOI: 10.1111/cdoe.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/12/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The objective was to assess the effectiveness of a Water Fluoridation program on a contemporary population of children. METHODS The study used a longitudinal prospective cohort design. In Cumbria, England, two groups of children were recruited and observed over a period of 5-6 years. The Birth Cohort consisted of families recruited from two hospitals in Cumbria where children were conceived after water fluoridation was reintroduced. The systemic and topical effects of community water fluoridation were evaluated in the Birth Cohort. The Older Cohort were approximately 5 years old and recruited from primary schools in Cumbria, shortly after water fluoridation was reintroduced. The predominantly topical effects of fluoridated water were evaluated in the Older Cohort. The primary outcome was the proportion of children with clinical evidence of caries experience in their primary (Birth Cohort) or permanent teeth (Older Cohort). Unadjusted and adjusted regression models were used for analysis. RESULTS The final clinical examinations for the Birth Cohort involved 1444 participants (mean age 4.8 years), where 17.4% of children in the intervention group were found to have caries experience, compared to 21.4% in the control group. A beneficial effect of water fluoridation was observed adjusting for deprivation (a socioeconomic measure), sex, and age, (adjusted odds ratio 0.74 95% CI 0.55 to 0.98). The final Older Cohort clinical examinations involved 1192 participants (mean age 10.8 years) where 19.1% of children in the intervention group were found to have caries experience compared to 21.9% in the control group (adjusted odds ratio 0.80, 95% CI 0.58 to 1.09). For both the Birth Cohort and Older Cohort there was evidence of a beneficial effect on dmft/DMFT count (IRR 0.61, 95% CI 0.44, 0.86) and (IRR 0.69, 95% CI 0.52, 0.93) respectively. No conclusive proof was found to indicate that the effectiveness of water fluoridation differed across area deprivation quintiles. CONCLUSIONS In the contemporary context of lower caries levels and widespread use of fluoride toothpaste, the impact of water fluoridation on the prevalence of caries was smaller than previous studies have reported. It is important to consider the clinical importance of the absolute reduction in caries prevalence against the use of other dental caries preventive measures.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Aykanat B, Elbay M. Effect of photobiomodulation on the efficacy of anesthesia in maxillary permanent molar teeth with molar incisor hypomineralization: A randomized clinical trial. Int J Paediatr Dent 2024; 34:219-228. [PMID: 37688333 DOI: 10.1111/ipd.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Difficulty in anesthetizing teeth that have been diagnosed with molar incisor hypomineralization (MIH) is a frequently reported clinical problem. The effects of low-level laser application (photobiomodulation) on the efficacy of anesthesia during the dental treatment of patients with MIH have not yet been studied. AIM To assess the effects of photobiomodulation therapy (PBMT) on the efficacy of anesthesia in maxillary permanent molar teeth with MIH. DESIGN This prospective, parallel-arm control, randomized, triple-blind clinical trial included children aged 7-12 years. Maxillary permanent first molar teeth with MIH that required pulpotomy treatment were included. Seventy participants were randomly divided into two groups: experimental (with PBMT) and control (placebo). In the experimental group, before the administration of local infiltration anesthesia, PBMT (diode laser: 940 nm; continuous mode; 0.5 W; 78 J/cm2) was applied to the oral mucosa for 60 s each. In the control group, the laser probe was channeled toward the mucosa but was not activated. Pain scores were evaluated during the access cavity preparation of the pulpotomy treatment (when using the dentin cutting handpiece and while entering into the pulp) using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Additional anesthesia requirements were assessed in both groups. The data obtained were analyzed for statistical significance (p < .05). The chi-squared test was used to determine the effect of PBMT on categorical outcomes. RESULTS The no-pain scores of the experimental group were higher than those of the control group (29% vs. 20%). Moderate-to-high pain was more frequent in the control group than in the experimental group (43% vs. 20%). While 31% of the experimental group required supplemental anesthesia, 49% of the control group required supplemental anesthesia during pulpotomy of the tooth with MIH. No statistical difference, however, was found between the two groups in terms of pain scores and the need for supplemental anesthesia (p = .235, p = .143). CONCLUSIONS Anesthesia with and without PBMT caused no difference in pain during the treatment of maxillary molar teeth with MIH.
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Affiliation(s)
- Berkehan Aykanat
- Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Mesut Elbay
- Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Moore D, Nyakutsikwa B, Allen T, Lam E, Birch S, Tickle M, Pretty IA, Walsh T. Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation. PUBLIC HEALTH RESEARCH 2024; 12:1-147. [PMID: 38785327 DOI: 10.3310/rfqa3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults. Objective To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design. Design Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data. Setting National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services. Participants Dental patients aged 12 years and over living in England (n = 6,370,280). Intervention and comparison Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores. Outcome measures Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment. Data sources National Health Service Business Services Authority dental claims data. Water quality monitoring data. Primary outcome Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful. Secondary outcomes Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices). Limitations Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes. Conclusions Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. Future work National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted. Trial registrations This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Deborah Moore
- Division of Dentistry, The University of Manchester, Manchester, UK
| | | | - Thomas Allen
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Emily Lam
- Independent Patient and Public Engagement Representative
| | - Stephen Birch
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, The University of Manchester, Manchester, UK
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Schmoeckel J, Wahl G, Santamaría RM, Basner R, Schankath E, Splieth CH. Influence of School Type and Class Level on Mean Caries Experience in 12-Year-Olds in Serial Cross-Sectional National Oral Health Survey in Germany-Proposal to Adjust for Selection Bias. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:467. [PMID: 38673378 PMCID: PMC11050198 DOI: 10.3390/ijerph21040467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
The objective of this study is to analyse the effects of attended school type and class level on the reported caries experience (DMFT) obtained in the serial cross-sectional National Oral Health Study in Children in Germany (NOHSC) for the WHO reference group of 12-year-olds. METHODS Caries data from the 2016 NOHSC were adjusted for each federal state on the basis of two additional large-scale datasets for school type and class level. RESULTS Twelve-year-olds in all grades in Saxony-Anhalt (n = 96,842) exhibited significantly higher DMFT values than 12-year-olds in 6th grade (n = 76,456; +0.10 DMFT; ~14.2%, p < 0.001). Adjustments for school type had effects on DMFT on the level of federal states but almost balanced out on the national level (-0.01 DMFT; ~2%). Due to putatively similar structures of the federal states, the national mean DMFT for 12-year-olds in the latest NOHSC (2016; n = 55,002) was adjusted from 0.44 to 0.50 DMFT, correcting for selection bias. CONCLUSION Selection bias in this NOHSC leads to an underestimation of caries levels by about 15%. Due to very low caries experience in children in Germany, these precise adjustments (+0.06 DMFT) have only a minor effect on interpretations of the national epidemiologic situation. Consequently, other national caries studies worldwide using the robust marker of DMFT should also adjust for systematic selection bias related to socio-economic background rather than increasing efforts in examination strategy.
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Affiliation(s)
- Julian Schmoeckel
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475 Greifswald, Germany; (R.M.S.); (C.H.S.)
| | - Goetz Wahl
- Landesamt für Verbraucherschutz Sachsen-Anhalt (LAV), Große Steinernetischstr. 4, 39104 Magdeburg, Germany
| | - Ruth M. Santamaría
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475 Greifswald, Germany; (R.M.S.); (C.H.S.)
| | - Roger Basner
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475 Greifswald, Germany; (R.M.S.); (C.H.S.)
| | - Elisabeth Schankath
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475 Greifswald, Germany; (R.M.S.); (C.H.S.)
| | - Christian H. Splieth
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475 Greifswald, Germany; (R.M.S.); (C.H.S.)
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Sharma V, Crowe M, Cassetti O, Winning L, O'Sullivan A, O'Sullivan M. Dental caries in children in Ireland: A systematic review. Community Dent Oral Epidemiol 2024; 52:24-38. [PMID: 37515429 DOI: 10.1111/cdoe.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/22/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Dental caries is the most common childhood disease worldwide. In the mid-1960s, mandatory Community Water Fluoridation (CWF) was introduced in the Republic of Ireland (RoI) aimed at reducing the prevalence and severity of dental caries in the population. In 2017, approximately, 71% of the Irish population was supplied with fluoridated drinking water. OBJECTIVES To review all children's dental health surveys at National, Regional and County-levels conducted in the Republic of Ireland from 1950 to 2021 and describe trends in dental caries prevalence. The secondary objective was to compare dental caries experience in children living in areas with and without CWF. METHODS Seven databases (Embase, Medline Ovid, PubMed, Cochrane, Web of Science, Scopus and Lenus Ireland) were systematically searched followed by lateral searches from reference lists. Studies reporting the caries experience of Irish children were eligible for inclusion. Two authors independently evaluated the quality of included studies using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS Thirty-one studies were included. Over the last 70 years, at National, Regional and County levels, mean dmft/DMFT (decayed, missing and filled teeth) scores have decreased and the percentage of caries-free children has increased in 5, 8, 12, and 15-year-olds. The decline in dental caries indices observed throughout the country was greater in children living in areas with CWF. Between the 1960s and 2002, the mean dmft scores for 5-year-olds living in the RoI were reduced by approximately 82% and 69% for the fluoridated and non-fluoridated groups respectively. Reduction in the mean DMFT scores for the 12-year-olds were 75% and 71%, respectively, for the fluoridated and non-fluoridated groups. Between 1961 and 2014, reductions in the mean dmft/DMFT scores among 5 and 12-years-olds living in County Dublin were approximately 88% and 90% respectively. These results should be interpreted in the context of widespread use of fluoridated toothpaste in the RoI. CONCLUSIONS Large reductions in the prevalence of dental caries in Irish children have been observed over the last seven decades. Greater dental caries reductions have been reported among children living in areas with CWF compared to those without CWF.
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Affiliation(s)
- Vinay Sharma
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Michael Crowe
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Oscar Cassetti
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Lewis Winning
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Aifric O'Sullivan
- Institute of Food and Health, Science Centre, South, UCD, Dublin, Ireland
| | - Michael O'Sullivan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
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Shoaee S, Masinaei M, Saeedi Moghaddam S, Sofi-Mahmudi A, Hessari H, Shamsoddin E, Heydari MH, Larijani B, Fakhrzadeh H, Farzadfar F. National and Subnational Trend of Dental Caries of Permanent Teeth in Iran, 1990-2017. Int Dent J 2024; 74:129-137. [PMID: 37574408 PMCID: PMC10829359 DOI: 10.1016/j.identj.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE There are currently no integrated data on the trend of dental caries amongst distinct age groups in Iran. We aimed to assess the national and subnational trend of dental caries of permanent teeth in Iran from 1990 to 2017. METHODS A literature search about dental caries and the decayed-missing-filled teeth index (DMFT) was performed in PubMed, Web of Science, Scopus, and 3 national databases (in Persian). All eligible national oral health surveys in these 28 years were included. We categorised and aggregated the DMFT values and their components based on age (5-year-based groups from 5 to 9 to 60+ years), sex, year, and province. The data for missing spots were estimated using the spatiotemporal Bayesian hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. RESULTS Nationally, the all-ages mean DMFT increased by nearly 58.0% (6.8 [95% UI, 4.1-10.5] in 1990 to 10.8 [95% UI, 7.5-14.5] in 2017). Decayed teeth (DT) and missing teeth (MT) rose by 84.5% and 31.6% during this period, respectively. Filled teeth (FT) showed almost a 2.6-fold increase in the same period from 0.6 (95% UI, 0.01-1.6) in 1990 to 1.7 (95% UI, 0.6-2.8) in 2017. The proportion of DT and FT continuously increased in both sexes. In 2017, the highest DT, MT, and FT were estimated in the 25-29 (4.9 [95% UI, 2.5-7.2]), 60+ (21.5 [95% UI, 17.5-25.4]), and 35-39 (2.6 [95% UI, 1.3-4.0]) year age groups. CONCLUSIONS Caries of permanent dentition levies a growing burden on the Iranian population. Considering the continuous increase in caries during the 1990-2017 period, Iranian policymakers should pay heed to these findings and react more proactively to mitigate this perpetuating issue. Implementing nationwide interventions such as sugar consumption management should be encouraged to achieve sustainable outcomes in this regards.
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Affiliation(s)
- Shervan Shoaee
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Sofi-Mahmudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Hossein Hessari
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Shamsoddin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Mohammad-Hossein Heydari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Fakhrzadeh
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Mohd Yani AAB, Marcenes W, Stansfeld SA, Bernabé E. The relationship between traumatic dental injuries and adolescents' non-suicidal self-injury behaviour: A cross-sectional analysis of an East London cohort. Dent Traumatol 2023; 39:173-178. [PMID: 36409280 DOI: 10.1111/edt.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIM Recent reviews of case reports have pointed out a potential connection between non-suicidal self-injury (NSSI) and traumatic dental injuries (TDIs). The aim of this study was to investigate the association of a history of NSSI with TDIs in 15- to 16-year-old adolescents. METHODS This study analysed cross-sectional data from the Research with East London Adolescents Community Health Survey, a prospective population survey of adolescents attending state schools in East London, England. The history of NSSI was obtained using two items from the Lifestyle and Coping questionnaire (whether they have ever engaged with self-harm and the last time they engaged in such behaviours). The presence of TDIs, increased overjet and inadequate lip coverage were determined through clinical assessments by two trained dentists. Survey logistic regression was fitted to test the association of NSSI with TDIs. Odds ratios (ORs) were adjusted for socio-demographic and clinical characteristics as potential confounders. RESULTS The lifetime and last-year prevalence of NSSI were 11.9% and 6.7%, respectively, whereas the prevalence of TDIs was 16.5%. Neither the lifetime prevalence of NSSI (OR: 1.02, 95% confidence interval: 0.56-1.85) nor the last-year prevalence of NSSI (OR: 0.76, 95% CI: 0.36-1.61) were associated with TDIs in regression models adjusted for confounders. CONCLUSION This study did not support an association between history of NSSI and TDIs among adolescents aged 15-16 years old in East London.
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Affiliation(s)
- Azri Aliah Binti Mohd Yani
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Faculty of Dentistry, Universiti Teknologi MARA, Malaysia
| | - Wagner Marcenes
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Affordable Health Initiative, London, UK
| | - Stephen A Stansfeld
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Eduardo Bernabé
- Dental Public Health Group, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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9
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Goodwin M, Henshaw M, Borrelli B. Inequities and oral health: A behavioural sciences perspective. Community Dent Oral Epidemiol 2023; 51:108-115. [PMID: 36753398 DOI: 10.1111/cdoe.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The importance of tackling ongoing dental health inequities, observed both within and across countries, cannot be overstated. Alarmingly, health inequities in some areas are widening, resulting in an urgent need to act. The objective of this commentary is to explore oral health inequities through the lens of behavioral science and discuss adapting evidence based interventions for populations experiencing health inequities. METHOD/RESULTS The first section of this paper aims to describe the role of health disparities and inequities within oral health, with a specific focus on behaviours. The determinants, from upstream to downstream, and the interplay between these levels of intervention are discussed. This is followed by an overview of oral health promotion interventions, again with a focus on behaviours, which could potentially improve oral health while also taking into account oral health inequities. It is essential to translate evidence-based interventions (EBIs) to populations that have the greatest burden of disease. The second section of this paper discusses the rationale for cultural adaption of EBIs, criteria to justify EBIs and considers different cultural adaptation strategies necessary for the development and testing of effective, engaging, equitable and culturally relevant interventions. CONCLUSIONS We conclude with future directions for the development of theory-based multi-level interventions, guided by extent evidence-based interventions, and transdisciplinary approaches to science and key stakeholders such as patients, providers and payers.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michelle Henshaw
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Belinda Borrelli
- Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA.,The University of Manchester, Manchester, UK
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10
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Caries-Free Prevalence among Schoolchildren in Malaysia-Time-Series Analysis of Trends and Projections from 1996 to 2030. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020264. [PMID: 36832393 PMCID: PMC9955133 DOI: 10.3390/children10020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Abstract
This study assessed caries-free prevalence trends over two decades from 1996 to 2019 and projected the caries-free prevalence from 2020 to 2030 among schoolchildren in Malaysia. The study consisted of secondary data analysis of caries-free prevalence from 1996 to 2019 in six-, twelve- and sixteen-year-old schoolchildren obtained from Health Information Management System (HIMS) reports. Three time-series models were compared: double exponential smoothing (DES), autoregressive integrated moving average (ARIMA) and the error, trend and seasonal (ETS) model, and the best model with the smallest error was chosen for univariate projection of caries-free prevalence of each age group until 2030. An upward trend of caries-free prevalence was observed for all age groups over the years. Caries-free prevalence was projected to increase with a different increment in each age group for the next decade, with a slightly damped trend noted in 16-year-old schoolchildren. Of all the age groups, the caries-free prevalence trend and projection demonstrated to be highest in 12-year-olds, followed by 16-year-olds, while 6-year-old schoolchildren revealed the lowest caries-free prevalence over three decades. The 16-year-old schoolchildren demonstrated the smallest predicted increment in caries-free prevalence. Future work can explore multivariate projections. Meanwhile, more resources and interventions could prioritise all age groups.
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11
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Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi A, Hessari H, Heydari MH, Shamsoddin E, Parsaeian M, Ghasemian A, Larijani B, Fakhrzadeh H, Farzadfar F. Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017. BMC Oral Health 2022; 22:634. [PMID: 36564764 PMCID: PMC9789600 DOI: 10.1186/s12903-022-02634-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dental caries is the most prevalent child affliction in the world and can be reduced through effective preventive interventions. To plan cost-effective interventions, clear and integrated data are needed. This study has been designed to overcome the lack of national trend in deciduous dental caries in Iran. OBJECTIVE To estimate the dental caries trend in deciduous teeth in the Iranian population at different ages from 1990 to 2017. METHODS From 1990 to 2017 a literature search about dmf and its components (decayed, missed, and filled tooth, abbreviated as dt, mt, and ft) as well as dental caries was done in the Iranian population in three English (PubMed, Web of Science, and Scopus) and three national databases (in Persian). All eligible national oral health surveys in these 28 years were included. National dmft data were categorised based on age (1-4, 5-9, and 10-14), sex, province and year. The final trends were estimated using an age-spatio-temporal hierarchical model. We used the bootstrap method in multilevel models to predict the uncertainty interval (UI) of the modelled results. Finally, the estimations of dmft, dt, mt, and ft with a 95% UI were reported from 1990 to 2017. RESULTS Almost 22% of the Iranian deciduous teeth were involved with dental caries in 1990 [dmft = 4.37; (95% UI 2.23, 6.62)] which more than 83% of it was dt [3.64 (1.53, 5.88)] and less than 7% was ft [0.30 (0.06, 0.65)]. During 1990-2017, dmft increased by more than 15% [in 2017, dmft = 5.03 (2.82, 7.29)]. The highest increase was seen in dt which was more than 17% [in 2017, dt = 4.27 (1.96, 6.57)]. CONCLUSION Increasing dental caries among Iranian children over 28 years shows that oral health policies in Iran need critical evaluation. We need cost-effective nationwide interventions (e.g., supervised tooth brushing and improving dietary habits) and training well-experienced intermediate manpower (e.g., dental hygienists) to reduce dental caries.
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Affiliation(s)
- Shervan Shoaee
- grid.411705.60000 0001 0166 0922Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.412105.30000 0001 2092 9755Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Saeedi Moghaddam
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Masoud Masinaei
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Ahmad Sofi-Mahmudi
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Hossein Hessari
- grid.411705.60000 0001 0166 0922Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Hossein Heydari
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.411600.2School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Shamsoddin
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | - Mahboubeh Parsaeian
- grid.411705.60000 0001 0166 0922Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Anooshe Ghasemian
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran
| | - Bagher Larijani
- grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
| | - Hossein Fakhrzadeh
- grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
| | - Farshad Farzadfar
- grid.411705.60000 0001 0166 0922Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713136 Iran ,grid.411705.60000 0001 0166 0922Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, 10, Al-e-Ahmad and Chamran Highway Intersection, Tehran, 1411713111 Iran
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12
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Babar MG, Andiesta NS, Bilal S, Yusof ZYM, Doss JG, Pau A. A randomized controlled trial of 6-month dental home visits on 24-month caries incidence in preschool children. Community Dent Oral Epidemiol 2022; 50:559-569. [PMID: 35138648 DOI: 10.1111/cdoe.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This paper reports on the effect of 6-month dental home visits compared to no dental home visits on 24-month caries incidence in 5- to 6-year-olds. METHODS 5- to 6-year-olds attending kindergartens were randomized to receive either 6-month dental home visits and education leaflets (Intervention group) or education leaflets alone (Control group) over 24 months. To detect a 15% difference in caries incidence with a significance level of 5% and power of 80%, 88 children were calculated to be needed in the Intervention group and 88 in the Control. Baseline clinical data included oral examinations at the kindergartens. Follow-up visits were made on the 6th, 12th and 18th month. At the end of the 24 months, both the Intervention and Control groups were visited for oral examinations. The primary outcome was caries incidence, measured by the number and proportion of children who developed new caries in the primary molars after 24 months. The secondary outcome was the number of primary molars that developed new caries (d-pms). Frequency distributions of participants by baseline socio-demographic characteristics and caries experience were calculated. The chi-square test was used to test differences between the caries experience in the Intervention and Control groups. The t test was used to compare the mean number of primary molars developing new caries between the Intervention Group and the Control Group. The number of children needed to treat (NNT) was also calculated. RESULTS At the 24-month follow-up, 19 (14.4%) developed new caries in the Intervention Group, compared to 60 (60.0%) in the Control Group (p = .001). On average, 0.2 (95% CI = 0.1-0.3) tooth per child in the Intervention Group was observed to have developed new caries compared to 1.1 (95% CI = 0.8-1.3) tooth per child in the Control Group (p = .001). The number of children needed to treat (NNT) to prevent one child from developing new caries was 2.2. CONCLUSIONS The present study has demonstrated that 6-month home visits to families of 5- to 6-year-olds are effective in caries prevention in 5- to 6-year-olds of low-income families in a middle-income country where access to health services, including oral health promotion services, is limited.
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Affiliation(s)
- Muneer Gohar Babar
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Niekla Survia Andiesta
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Sobia Bilal
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, 57000, Malaysia
| | - Zamros Yuzadi Mohd Yusof
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Jennifer Geraldine Doss
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Allan Pau
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, 57000, Malaysia
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13
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Wise J. Water fluoridation confers modest benefit to children's dental health, study finds. BMJ 2022; 379:o2739. [PMID: 36379519 DOI: 10.1136/bmj.o2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, Whittaker W, Pretty IA. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/shmx1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste.
Objective
The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective?
Design
A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water.
Setting
The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria.
Participants
Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years.
Intervention
The provision of a ‘reintroduced fluoridated water scheme’.
Main outcome measures
The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed.
Results
In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles.
Conclusions
The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations.
Limitations
The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals).
Study registration
This study is registered as Integrated Research Application System 131824 and 149278.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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15
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Kissa J, Albandar JM, El Houari B, Khlil N, Amine K, Chemlali S, Mikou S, Gharibi A, El Ouadnassi I, Tricha L, Himmiche M, Rifki C. National survey of periodontal diseases in adolescents and young adults in Morocco. J Clin Periodontol 2022; 49:439-447. [PMID: 35246871 DOI: 10.1111/jcpe.13613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
AIM National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population. MATERIALS AND METHODS This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed. RESULTS Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco. CONCLUSIONS The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.
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Affiliation(s)
- Jamila Kissa
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
| | - Bouchra El Houari
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Nadia Khlil
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Khadija Amine
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Sihame Chemlali
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Salwa Mikou
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Amina Gharibi
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Imane El Ouadnassi
- Department of Periodontology, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | - Latifa Tricha
- Department of Pedodontics, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
| | | | - Chouaib Rifki
- Department of Oral Surgery, Faculty of Dental Medicine, University of Hassan II, Casablanca, Morocco
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16
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Luo Y, Zhang H, Zeng X, Xu W, Wang X, Zhang Y, Wang Y. Nomogram prediction of caries risk among schoolchildren age 7 years based on a cohort study in Shanghai. J Int Med Res 2021; 49:3000605211060175. [PMID: 34851774 PMCID: PMC8647255 DOI: 10.1177/03000605211060175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Caries risk assessment tools are essential for identifying and providing treatment for individuals at high risk of developing caries. We aimed to develop a nomogram for the assessment and evaluation of caries risk among Chinese children. Methods We enrolled schoolchildren age 7 years from a primary school in Shanghai. Baseline information of participants was collected using a questionnaire completed by children’s caregivers. A nomogram of a novel prediction scoring model was established based on predictors detected in univariate and multivariate analyses. Predictive accuracy and discriminative ability of the nomogram were calculated using the concordance index (C index). The bootstrap method (1000 samples) was used to decrease overfitting. The net benefit of the model was validated using decision curve analysis. Results Overall, 406 children with complete information and two completed dental examinations were included in the final analysis. The nomogram based on logistic regression model coefficients demonstrated a C index of 0.766 (95% confidence interval: 0.761–0.771) for caries risk. The net benefit of the decision curve analysis was 38.6% at 55% threshold probability. Conclusion This nomogram model, derived using dietary habits, oral hygiene status, and caries experience, showed promising predictive ability to assess the caries risk among Chinese children.
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Affiliation(s)
- Yuan Luo
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.,Department of Oral and Maxillofacial Surgery, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.,Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
| | - Xiaoli Zeng
- Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
| | - Wei Xu
- Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
| | - Xun Wang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
| | - Ying Zhang
- Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
| | - Yan Wang
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China.,Department of Preventive Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China *Hao Zhang is the Co-first author of the manuscript
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17
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Moradi S, Sabbagh S, Timms L, Ravaghi V. Teaching Minimally Invasive Interventions in Paediatric Dentistry: A Cross-Sectional Survey of Dental Schools in Iran. BMC Oral Health 2021; 21:368. [PMID: 34301216 PMCID: PMC8298961 DOI: 10.1186/s12903-021-01735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental caries is a significant public health problem in Iran. Teaching minimally invasive interventions in paediatric dentistry may facilitate the provision of treatment for untreated dental caries in children. We evaluated the teaching of such interventions in both undergraduate dental curriculum and Paediatric Dentistry Specialty Training Programme (PDSTP) in Iran. METHODS This was a cross-sectional questionnaire-based survey. Participants in this study were the directors of 40 undergraduate programmes and 15 PDSTPs in all Iranian dental schools (response rate = 100%). Descriptive statistics were reported. RESULTS The most commonly taught methods were preventive fissure sealant and preventive resin restoration (PRR), which were taught 'both didactically and clinically' in all undergraduate dental programmes. The least commonly taught methods were silver diamine fluoride (SDF), the Hall technique and resin infiltration, which were taught 'both didactically and clinically' in less than 5% of dental schools. The same three methods were the least commonly approaches taught in PDSTP, further, they were less often perceived to be 'essential'. CONCLUSIONS There was a notable variation in the teaching of the management of dental caries in Iran's dental education. Some minimally invasive approaches including SDF, the Hall technique and resin infiltration are not being commonly taught in Iranian dental schools despite the evidence base for these techniques.
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Affiliation(s)
- S Moradi
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - S Sabbagh
- Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - L Timms
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - V Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
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18
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A novel non-destructive technique for qualitative and quantitative measurement of dental erosion in its entirety by porosity and bulk tissue-loss. J Dent 2021; 110:103688. [PMID: 33961936 DOI: 10.1016/j.jdent.2021.103688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/11/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the potential of combining non-contact profilometry (NCP) and confocal laser scanning microscopy (CLSM) data to measure the entire erosive process non-destructively and to validate findings using inductively coupled plasma-atomic emission spectroscopy (ICP-AES), scanning electron microscopy (SEM) and surface microhardness (SMH) using the same samples throughout. METHODS Polished bovine enamel samples (n = 35) were divided into groups (7/group) with similar SMH values. Samples underwent individual erosive challenges (1 % citric acid, pH3.8) for 1, 5, 10, 15 or 30 min under stirring and aliquot extracts were analysed for Ca and P by ICP-AES. SMH was used to measure erosive softening. Profilometry was used to assess bulk volume loss (BVL). Images were captured by SEM. Samples were stained with rhodamine-B (0.1 mM, 24 h) and images captured by CLSM. Image processing was used to determine changes in fluorescent volume for the first 10 μm (ΔFV10) for each enamel sample which were combined with BVL to calculate total lesion volume (TLV). ANOVA, linear regression and Pearson correlation analysis were used where applicable. RESULTS Surface softening, [Ca], [P], BVL and ΔFV10μm increased with acid erosion duration which were significant by 10 min (P < .01). The Ca:P ratio increased to 1.57 then decreased after 5 min erosion suggesting a sub/surface phase change, which was observed by SEM and CLSM showing significant changes to the enamel surface and subsurface morphology with time. Combination of BVL and ΔFV10 as TLV strengthened the significant correlations with [Ca], [P], and SMH (P < .01). CONCLUSION This novel combination of CLSM and NCP allows for concurrent non-destructive quantification of the entire erosive process by mineral loss, and qualitatively characterise microstructural changes during dental erosion.
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Wang X, Bernabe E, Pitts N, Zheng S, Gallagher JE. Dental caries thresholds among adolescents in England, Wales, and Northern Ireland, 2013 at 12, and 15 years: implications for epidemiology and clinical care. BMC Oral Health 2021; 21:137. [PMID: 33740952 PMCID: PMC7980596 DOI: 10.1186/s12903-021-01507-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dental caries is the most prevalent condition globally. Despite improvements over the past few decades, there remains a significant disease burden in childhood. Epidemiological surveys provide insight to disease patterns and trends, and have traditionally focused on obvious decay which are inconsistent with contemporary clinical criteria. This study examined the distribution of dental caries in 12- and 15-year-olds in England, Wales and Northern Ireland, by severity threshold, at surface, tooth and child level and explored its association with socioeconomic, psychological and behavioural factors. METHODS Data from 12- and 15-year-olds in the 2013 Children's Dental Health Survey (CDHS 2013) were analysed at three levels, taking account of dental caries thresholds which involved recording both clinical decay [visual enamel caries (AV) and above] and obvious decay [non-cavitated dentine lesions (2V) and above]. Negative binomial regression was used to identify factors associated with dental caries experience at both thresholds. RESULTS The prevalence and severity of dental caries experience was higher among 15-year-olds at all levels. Visual change in enamel (AV) was by far the most common stage of caries recorded in both ages. The average number of surfaces with obvious decay experience, which has been the traditional epidemiological threshold, in 12- and 15-year-olds was 2.3 and 3.9 respectively. The corresponding values under the clinical decay threshold were higher, at 3.9 and 5.9 respectively. Visualisation of the distribution of dental caries at surface/tooth-level exhibited horizontal symmetry and to a lesser extent vertical symetry. In the adjusted models for both ages, country/region, school type, area deprivation, high frequency sugar consumption and irregular dental attendance were associated with greater caries experience in both groups. Dental anxiety was inversely associated with caries experience among 15-year-olds. CONCLUSION This research highlights the importance of recognising dental caries patterns by surface, tooth and child-level amongst adolescents and the value of reporting dental caries distribution by threshold in epidemiological surveys, including its relevance for clinical care. Inclusion of enamel caries reveals the extent of caries management required at a point when non-invasive care is possible, emphasising the importance of prevention through contemporary primary care, which includes supporting self-care.
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Affiliation(s)
- Xiaozhe Wang
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
| | - Eduardo Bernabe
- Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
| | - Nigel Pitts
- Centre for Clinical and Translational Research, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - Shuguo Zheng
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Bessemer Road, London, SE5 9RS, UK.
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Moore D, Allen T, Birch S, Tickle M, Walsh T, Pretty IA. How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study. BDJ Open 2021; 7:3. [PMID: 33479223 PMCID: PMC7820470 DOI: 10.1038/s41405-021-00062-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12. METHODS/DESIGN Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation. DISCUSSIONS There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.
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Affiliation(s)
- Deborah Moore
- grid.5379.80000000121662407Dental Public Health, Division of Dentistry, Dental Health Unit, The University of Manchester, Lloyd Street North Manchester Science Park, Manchester, M15 6SE UK
| | - Thomas Allen
- Director, Centre for the Business and Economics of Health, University of Queensland, St Lucia, Queensland, 4072 UK
| | - Stephen Birch
- Director, Centre for the Business and Economics of Health, University of Queensland, St Lucia, Queensland, 4072 UK ,grid.5379.80000000121662407Health Economics, Manchester Centre for Health Economics, The University of Manchester, Jean McFarlane Building Oxford Road, Manchester, M13 9PL UK
| | - Martin Tickle
- grid.5379.80000000121662407Dental Public Health & Primary Care, Division of Dentistry, The University of Manchester, Coupland 3, Manchester, M13 9PL UK
| | - Tanya Walsh
- grid.5379.80000000121662407Healthcare Evaluation, Division of Dentistry, The University of Manchester, Coupland 3, Manchester, M139PL UK
| | - Iain A. Pretty
- grid.5379.80000000121662407Public Health Dentistry, Division of Dentistry, Dental Health Unit, The University of Manchester, Lloyd Street North Manchester Science Park, Manchester, M15 6SE UK
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21
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Mohindra ASVK, Jie JGH, Lim LY, Mehta S, Davies J, Pettigrew VA, Woodhoo R, Nehete S, Muirhead V. A student and staff collaborative audit exploring the food and drinks available from a dental teaching hospital outlet. Br Dent J 2021; 230:32-38. [PMID: 33420456 DOI: 10.1038/s41415-020-2506-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/10/2020] [Indexed: 11/09/2022]
Abstract
Introduction NHS England's Commissioning for Quality and Innovation (CQUIN) standard 1b sets targets for food and drinks high in fat, sugar or salt (HFSS) that should be sold in hospitals.Aims To assess the products that were available in a dental hospital food outlet and to explore the cost and placement of HFSS products.Design and setting A prospective audit of the food outlet in a dental hospital in London, UK carried out by staff and students in May 2018 benchmarked against CQUIN 1b.Materials and methods Staff and students collected data on food and drinks that were available over a two-week period.Results Only cold and hot drinks met the CQUIN target that 80% of drinks should contain less than five grams of sugar/100 ml. A third of packaged biscuits and 50% of cakes and pastries contained more than 250 kcal per portion. HFSS products were visible in front of customers at the checkout till. Packaged fruits were more expensive than packaged biscuits.Discussion and conclusion This audit showed inconsistencies between the food and drinks available for staff, students and patients at a dental hospital and the healthy eating messages that staff and students relay to support patients' oral health.
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Affiliation(s)
- Amar S V K Mohindra
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Joshua Goh Hua Jie
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Li Ying Lim
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Sanket Mehta
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Janet Davies
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | | | - Roy Woodhoo
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Swati Nehete
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Vanessa Muirhead
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
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22
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Paisi M, Witton R, Radford P, Plessas A. What is the global prevalence of dental healthcare needs and unmet dental needs among adolescents? Evid Based Dent 2021; 22:8-9. [PMID: 33772119 DOI: 10.1038/s41432-020-0146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Data sources Databases searched included Web of Science, PubMed and Scopus.Study selection Cross-sectional studies that estimated dental healthcare needs and unmet dental needs in young people, aged 10-19 years were considered for inclusion. No limitations in terms of year of publication, language, location of the study, gender and race of the participants, or the type of dental health needs and unmet needs were applied. The papers were screened on title and abstract, and then on full text by two reviewers. Any disagreements were resolved through discussion and consultation with a third reviewer.Data extraction and synthesis Data were extracted by three reviewers. Critical appraisal was conducted by two reviewers using the Joanna Briggs Institute critical appraisal checklist. A PRISMA flowchart was used to present the study selection results. Summary measures on the prevalence of dental health needs and unmet needs were calculated. For the meta-analysis, the inverse variance method was used to obtain pooled summary measures.Results Fifty-seven studies were included in the review. The overall prevalence of dental healthcare needs was 49% (95% CI: 42-56) across all types of dental care. The highest prevalence was that for periodontal treatment needs (71%; 95% CI: 46-96 as reported in four studies), followed by that of general treatment needs (59.0%; 95% CI: 42-75 as reported in 12 studies), orthodontic treatment (46%; 95% CI: 38-53 as reported in 32 studies) and lastly that of malocclusion treatment needs (39%; 95% CI: 28-50 as reported in nine studies). The pooled prevalence of unmet dental needs as reported in nine studies was 34% (95% CI: 27-40) with the highest prevalence found in Southeast Asia (72.3%; 95% CI: 70.1-74.5) and the lowest in Europe (11.8%; 95% CI: 3.4-20.3).Conclusions The results of this review showed that the prevalence of dental healthcare needs was higher in America and Europe while unmet needs were more prevalent in Southeast Asia and Africa. The former could partly be explained by the lower number and sample sizes of studies conducted in developing countries.Commentary.
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Affiliation(s)
- Martha Paisi
- Peninsula Dental School, University of Plymouth, Plymouth, UK; Peninsula Dental Social Enterprise, University of Plymouth, Plymouth, UK.
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Plymouth, UK; Peninsula Dental Social Enterprise, University of Plymouth, Plymouth, UK
| | - Philip Radford
- Rotherham NHS Foundation Trust Community Dental Service, Barnsley, UK
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23
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Soares ALFH, Ribeiro CCC, Thomaz EBAF, Queiroz RCS, Alves CMC, Ferraro AA, Silva AAM, Bettiol H, Barbieri MA, Saraiva MCP. Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil. ACTA ACUST UNITED AC 2020; 54:e10161. [PMID: 33263609 PMCID: PMC7695448 DOI: 10.1590/1414-431x202010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022]
Abstract
The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother’s schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.
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Affiliation(s)
- A L F H Soares
- Departamento de Clínica Infantil, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C C C Ribeiro
- Departamento de Odontologia II, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - E B A F Thomaz
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R C S Queiroz
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - C M C Alves
- Departamento de Odontologia II, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A A Ferraro
- Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A A M Silva
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - H Bettiol
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M A Barbieri
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M C P Saraiva
- Departamento de Clínica Infantil, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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24
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Moore D, Keat R. Does dental appearance impact on employability in adults? A scoping review of quantitative and qualitative evidence. Br Dent J 2020:10.1038/s41415-020-2025-5. [PMID: 33082523 DOI: 10.1038/s41415-020-2025-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/14/2020] [Indexed: 11/09/2022]
Abstract
Background The importance of physical appearance in social and professional situations has been well studied. It has been suggested that improving dental appearance may increase employment prospects. This scoping review aims to map the current literature regarding the impact of dental appearance on employability.Methods A scoping review was carried out in accordance with guidance from the Joanna Briggs Institute. Inclusion and exclusion criteria were developed iteratively, databases were searched and decisions on inclusion made in duplicate. Data were charted in Excel and synthesised using a visual map, study summary table and narrative description.Results We identified 16 relevant articles: ten experimental simulation studies, two qualitative studies, one cross-sectional survey, one pre-/post-dental treatment survey, one retrospective cohort study and one narrative systematic review. Experimental simulations support the notion that visible dental conditions can negatively impact appraisals of employment-related personal characteristics. Negative impacts on job-seeking self-efficacy and willingness to apply for jobs have also been documented.Conclusions The applicability of this evidence base to the UK health system context is uncertain and demonstration of real-life impact on employment is lacking. Further research is needed before programmes to improve dental appearance could be justified on the basis of improving employment outcomes.
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Affiliation(s)
- Deborah Moore
- University of Manchester, Division of Dentistry, Dental Health Unit, Williams House, Lloyd Street North, Manchester, M15 6SE, UK.
| | - Ross Keat
- University of Manchester, Division of Dentistry, Dental Health Unit, Williams House, Lloyd Street North, Manchester, M15 6SE, UK
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25
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Hookham MJ, Lynch RJ, Naughton DP. Characterisation of mineral loss as a function of depth using confocal laser scanning microscopy to study erosive lesions in enamel: A novel non-destructive image processing model. J Dent 2020; 99:103402. [DOI: 10.1016/j.jdent.2020.103402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
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Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol 2019; 89 Suppl 1:S46-S73. [PMID: 29926936 DOI: 10.1002/jper.17-0576] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.
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Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Cléverson O Silva
- Department of Dentistry, State University of Maringá, Maringá, Brazil
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH, USA
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27
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Moore D, Goodwin M, Pretty IA. Long-term variability in artificially and naturally fluoridated water supplies in England. Community Dent Oral Epidemiol 2019; 48:49-55. [PMID: 31625207 DOI: 10.1111/cdoe.12502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/11/2019] [Accepted: 09/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand the potential impact of exposure misclassification on water fluoridation studies in England, this paper aims to describe the long-term variation in water fluoride concentrations in both artificially and naturally fluoridated water supplies. METHODS Water fluoridation dose monitoring data were requested from all five English public water suppliers who artificially fluoridate their water, as well as from one water company that supplies naturally fluoridated water. Descriptive statistics were calculated, including annual means, standard deviations, minimum-maximum and absolute and relative frequencies. RESULTS Data were made available by two of the five English water companies who supply artificially fluoridated water and one water company that supplies naturally fluoridated water (40 398 individual samples). The data for fluoridated water spanned 18-35 years, whilst the data on naturally fluoridated water spanned 14 years. The artificially fluoridated samples showed wide variation in fluoride dose control, both between different water treatment works and over time. Mean fluoride concentrations in the artificially fluoridated supplies ranged from 0.53 (SD 0.47) to 0.93 (SD 0.22) mg F/L and were within the optimal range of 0.7-1.0 mg F/L in 27.7%-77.8% of samples. The naturally fluoridated supplies had a higher mean fluoride concentration of 1.06 (SD 0.18) and 1.15 (SD 0.16) mg F/L than the artificially fluoridated supplies, with lower variation over time. The naturally fluoridated supplies were above the optimal range in 75.5% and 53% of samples. CONCLUSIONS Assumptions that populations living in areas with a water fluoridation scheme have received optimally fluoridated water (0.7-1.0 mg F/L) are invalid. To support future research endeavours, as well as to provide 'external control' and facilitation of optimal dosing, it is recommended that a quarterly record of water fluoride concentrations (mean, standard deviation and minimum and maximum) are made available for every water supply in England, in a format that can be mapped against residential postcodes.
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Affiliation(s)
- Deborah Moore
- Division of Dentistry, Dental Health Unit, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michaela Goodwin
- Division of Dentistry, Dental Health Unit, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Dental Health Unit, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Ravaghi V, Hargreaves DS, Morris AJ. Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance. JDR Clin Trans Res 2019; 5:185-194. [PMID: 31487468 DOI: 10.1177/2380084419872136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. METHODS We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. RESULTS We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. CONCLUSIONS The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. KNOWLEDGE TRANSFER STATEMENT While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.
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Affiliation(s)
- V Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - D S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - A J Morris
- School of Dentistry, University of Birmingham, Birmingham, UK
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Splieth C, Santamaria R, Basner R, Schüler E, Schmoeckel J. 40-Year Longitudinal Caries Development in German Adolescents in the Light of New Caries Measures. Caries Res 2019; 53:609-616. [DOI: 10.1159/000501263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/30/2019] [Indexed: 11/19/2022] Open
Abstract
This study assessed the 40-year longitudinal caries development in German adolescents in the light of the sixth National Oral Health Survey in Children (NOHSC, 2016) employing initial DMFT (IDMFT), Significant Caries Index (SiC) and Specific Affected Caries Index (SaC). On the basis of the current NOHSC (randomized cluster selection using school list or regional community school surveys, 55,956 12-year-old sixth-graders examined by 482 calibrated community/study dentists) DMFT, SiC, a novel IDMFT including initial lesions (IT) and the recently introduced SaC were calculated and also recalculated for national and international surveys from the last 4 decades. In 2016, 78.8% of children were caries-free (DMFT = 0), 65.5% including IT lesions. The mean DMFT was 0.44 (single components: DT = 0.14, MT = 0.02, FT = 0.29, IT = 0.52) showing a clear association with the school type as marker for the socio-economic status. The mean number of affected teeth in children with DMFT >0 was 2.07 (SaC) in comparison to almost 9 teeth in the 1970s. The current care index on the tooth level was 66.3%, leaving only 7.7% of children with restorative treatment needs. Longitudinally, a continuous caries decline of more than 80%, including the risk groups (SiC/SaC), to an internationally extremely low level was observed. In conclusion, the National Oral Health Surveys reveal a continuous caries decline to a very low caries level in 12-year-old 6th-graders in Germany even if IT lesions are included (IDMFT). In spite of proportional reductions in the risk groups (SiC/SaC), the polarized caries distribution according to socio-economic parameters reveals the need for targeted preventive programmes.
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30
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Haque M, Sartelli M, Haque SZ. Dental Infection and Resistance-Global Health Consequences. Dent J (Basel) 2019; 7:dj7010022. [PMID: 30823670 PMCID: PMC6473604 DOI: 10.3390/dj7010022] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/03/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20⁻50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia.
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, via Santa Lucia 2, 62100 Macerata, Italy.
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Freire MDCM, Daher A, Costa LR, Corrêa-Faria P, de Brito LC, Bönecker MJS, de Abreu MHNG. Caries severity declined besides persistent untreated primary teeth over a 22-year period: Trends among children in Goiânia, Brazil. Int J Paediatr Dent 2018; 29:129-137. [PMID: 30450741 DOI: 10.1111/ipd.12451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence of time trends in early childhood caries in low- and middle-income countries in the second decade of the year 2000 is scarce. AIM To assess the trends in early childhood caries prevalence and severity in 2- to 5-year-old children over a 22-year period (1993-2015) in Goiânia, Midwest Brazil. Additionally, we aimed to investigate the changes regarding affected dental arches and teeth. DESIGN A time-lag analysis of trends in caries was carried out using data from three cross-sectional studies based on the World Health Organization diagnostic criteria, in 1993 (N = 1362), 2001 (N = 1620), and 2015 (N = 548). RESULTS Caries prevalence declined from 45.1% in 1993 to 29.0% in 2015. Prevalence of severe caries (dmft ≥ 6) in 2015 was nearly one-third of that found in 1993, and the SiC index (mean dmft of the highest tertile) decreased from 4.55 to 3.32. Decline was higher in the 1993-2001 than in the 2001-2015 time-lag. Posterior teeth and second molars had the greatest reductions. High proportions of untreated caries were found in all ages and survey years. CONCLUSION There were significant changes in caries prevalence and severity, marked by a striking decline from 1993 to 2001, followed by a less prominent decrease up to 2015, and high levels of untreated caries.
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Affiliation(s)
- Maria do Carmo Matias Freire
- Department of Oral Health, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
- Dentistry Graduate Program, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Anelise Daher
- Department of Oral Health, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Luciane Rezende Costa
- Department of Oral Health, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
- Dentistry Graduate Program, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Patrícia Corrêa-Faria
- Dentistry Graduate Program, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
| | - Letícia Candine de Brito
- Department of Oral Health, Faculty of Dentistry, Federal University of Goiás, Goiânia, GO, Brazil
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Frencken JE, Sharma P, Stenhouse L, Green D, Laverty D, Dietrich T. Global epidemiology of dental caries and severe periodontitis - a comprehensive review. J Clin Periodontol 2018; 44 Suppl 18:S94-S105. [PMID: 28266116 DOI: 10.1111/jcpe.12677] [Citation(s) in RCA: 495] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dental caries and periodontitis are the most common oral diseases and major causes of tooth loss. AIM To perform a review of global prevalence and incidence of dental caries and periodontitis. METHODOLOGY Inclusion and exclusion criteria were developed. MEDLINE database and EMBASE database were used to search for eligible publications using keywords and MeSH terms. Additionally, WHO databank was used for obtaining dental caries information and PUBMED for a search on trends of dental caries prevalence and severity. RESULTS Over the last four decades, the prevalence and severity of dentine carious lesions among 5- and 12-year-olds have declined; the decay-component is very high, with the lowest prevalence among 12-year-olds in high-income countries, which also had the lowest prevalence among 35- to 44-year-olds; and the number of retained teeth has increased around the globe. The prevalence of periodontitis is high, with approximately 10% of the global population affected by severe periodontitis. Study heterogeneity and methodological issues hamper comparisons across studies and over time. CONCLUSION While the prevalence of dental caries has decreased, the disease is prevalent in all age groups. The prevalence of periodontitis is high. There is insufficient evidence to conclude that the prevalence of periodontitis has changed over time.
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Affiliation(s)
- Jo E Frencken
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Praveen Sharma
- Periodontal Research Group, College of Medical and Dental Sciences, Dental School, University of Birmingham, Birmingham, UK
| | - Laura Stenhouse
- Department of Special Care Dentistry, Birmingham Dental Hospital and School of Dentistry, Birmingham, UK
| | - David Green
- Department of Restorative Dentistry, Birmingham Dental Hospital and School of Dentistry, Birmingham, UK
| | - Dominic Laverty
- Department of Restorative Dentistry, Birmingham Dental Hospital and School of Dentistry, Birmingham, UK
| | - Thomas Dietrich
- Periodontal Research Group, College of Medical and Dental Sciences, Dental School, University of Birmingham, Birmingham, UK
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Harris JC. The mouth and maltreatment: safeguarding issues in child dental health. Arch Dis Child 2018; 103:722-729. [PMID: 29472196 DOI: 10.1136/archdischild-2017-313173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Jenny C Harris
- Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Clin Periodontol 2018; 45 Suppl 20:S44-S67. [DOI: 10.1111/jcpe.12939] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/15/2017] [Accepted: 10/21/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases; University of Ferrara; Ferrara Italy
- Operative Unit of Dentistry; University-Hospital of Ferrara; Ferrara Italy
| | | | - Dimitris N. Tatakis
- Division of Periodontology; College of Dentistry; The Ohio State University; Columbus OH USA
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Rouxel P, Chandola T. Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland. Community Dent Oral Epidemiol 2018; 46:426-434. [PMID: 29888400 PMCID: PMC6849874 DOI: 10.1111/cdoe.12390] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
Objectives Although adolescence is a sensitive developmental period in oral health, the social equalization hypothesis that suggests health inequalities attenuate in adolescence has not been examined. This study analyses whether the socioeconomic gap and ethnic disadvantage in oral health among children aged 5 reduces among adolescents aged 15. Methods Data from the cross‐sectional Children's Dental Health Survey 2013 were analysed, comprising of 8541 children aged 5, 8, 12 and 15 attending schools in England, Wales and Northern Ireland. Oral health indicators included decayed and filled teeth, plaque, gingivitis and periodontal health. Ethnicity was measured using the 2011 UK census ethnic categories. Socioeconomic position was measured by family, school and residential deprivation. Negative binomial and probit regression models estimated the levels of oral health by ethnicity and socioeconomic position, adjusted for demographic and tooth characteristics. Results The predicted rate of decayed teeth for White British/Irish children aged 5 was 1.54 (95%CI 1.30‐1.77). In contrast, the predicted rate for Indian and Pakistani children was about 2‐2.5 times higher. At age 15, ethnic differences had reduced considerably. Family deprivation was associated with higher levels of tooth decay among younger children but not among adolescents aged 15. The influence of residential deprivation on the rate of tooth decay and filled teeth was similar among younger and older children. Moreover, inequalities in poor periodontal health by residential deprivation was significantly greater among 15‐year‐old children compared to younger children. Conclusions This study found some evidence of smaller ethnic and family socioeconomic differences in oral health among British adolescents compared to younger children. However, substantial differences in oral health by residential deprivation remain among adolescents. Community levels of deprivation may be particularly important for the health of adolescents.
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Affiliation(s)
- Patrick Rouxel
- CLOSER, Department of Social Science, University College London Institute of Education, London, UK.,UCL Eastman Dental Institute, London, UK
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36
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Muirhead VE, Quayyum Z, Markey D, Weston-Price S, Kimber A, Rouse W, Pine CM. Children's toothache is becoming everybody's business: where do parents go when their children have oral pain in London, England? A cross-sectional analysis. BMJ Open 2018; 8:e020771. [PMID: 29490969 PMCID: PMC5855301 DOI: 10.1136/bmjopen-2017-020771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the number of parents who visited community pharmacies in London seeking pain medications for their children's pain and specifically for oral pain, to identify which health services parents contacted before their pharmacy visit and to estimate the cost to the National Health Service (NHS) when children with oral pain who visit pharmacies also see health professionals outside dentistry. DESIGN A cross-sectional study. SETTING 1862 pharmacies in London in November 2016-January 2017. PARTICIPANTS Parents, carers and adolescents purchasing over-the-counter pain medications or collecting pain prescriptions for children (0-19 years). BRIEF INTERVENTION A survey administered by pharmacy staff to participants and a guidance pack. MAIN OUTCOME MEASURES The number of parents who visited pharmacies seeking pain medications for their children's pain and oral pain and the number of parents who contacted health professionals outside dentistry before their pharmacy visit. Estimated costs of visits by children with oral pain to health professionals outside dentistry. RESULTS One in two (951) pharmacies participated collecting information from 6915 parents seeking pain medications for their children. The majority (65%) of parents sought pain medications to relieve their children's oral pain. Only 30% of children with oral pain had seen a dentist before the pharmacy visit, while 28% of children had seen between one and four different health professionals. The cost to the NHS of children contacting health professionals outside dentistry was £36 573, extrapolated to an annual cost of £373 288. Replicating these findings across all pharmacies in England could mean that the NHS spends an estimated £2.3 million annually when children with oral pain inappropriately use multiple health services. CONCLUSION Most parents who visited pharmacies for children's pain medications in London sought pain medications for children's oral pain. Children's inappropriate contact with multiple health services when they have oral pain adds significant costs to the NHS.
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Affiliation(s)
- Vanessa Elaine Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Zahidul Quayyum
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Donal Markey
- Dental, Optometry and Pharmacy Commissioning, NHS England London Region, London, UK
- Children & Young People Programme, Healthy London Partnerships, London, UK
| | - Sally Weston-Price
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
| | - Annette Kimber
- Dental, Optometry and Pharmacy Commissioning, NHS England London Region, London, UK
| | - Wayne Rouse
- Dental, Optometry and Pharmacy Commissioning, NHS England London Region, London, UK
| | - Cynthia M Pine
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
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37
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Murphy JM, Burch TE, Dickenson AJ, Wong J, Moore R. An evidence-based oral health promotion programme: Lessons from Leicester. Oral Dis 2018; 24:38-43. [PMID: 29480636 DOI: 10.1111/odi.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To provide an overview and draw lessons from the establishment of a local oral health promotion programme for preschool children in Leicester, England (2013-2017). The article provides information on the strategic approach taken in Leicester, one of the most ethnically diverse cities in England, and also one of the most deprived. Over a third of children aged 3 years, and half of those aged 5 years, have experience of obvious dental decay. METHODS A description of the evolution and development of the programme is provided along with commentary by the authors. This includes the origins, design and evaluation of the programme. RESULTS Progress so far has been promising. There has been a statistically significant 8% decrease in the proportion of 5-year-old children in Leicester with dental decay from 2011/2012 to 2014/2015. This will need to be sustained and further developed to deliver the 10% reduction required within the strategy. CONCLUSIONS The successful implementation of a local oral health improvement programme in Leicester has required leadership to coordinate a multiagency partnership approach to embedding effective concepts and realising opportunities collaboratively. However, longer term sustainability remains a concern.
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Affiliation(s)
- J M Murphy
- Public Health England Midlands and East Region, Nottingham, UK
| | - T E Burch
- Leicester City Council, Leicester, UK
| | - A J Dickenson
- Health Education England and Visiting Fellow in Health & Care, University of Lincoln, Lincoln, UK
| | - J Wong
- NHS England Midlands and East (Central Midlands) and General Dental Practitioner, Grantham, Lincolnshire, UK
| | - R Moore
- Leicester City Council and Honorary Senior Lecturer, University of Leicester, Leicester, UK
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Amadeu de Oliveira F, MacVinish LJ, Amin S, Herath D, Jeggle P, Mela I, Pieri M, Sharma C, Jarvis GE, Levy FM, Santesso MR, Khan ZN, Leite AL, Oliveira RC, Buzalaf MAR, Edwardson JM. The effect of fluoride on the structure, function, and proteome of intestinal epithelia. ENVIRONMENTAL TOXICOLOGY 2018; 33:63-71. [PMID: 29068160 DOI: 10.1002/tox.22495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
Fluoride exposure is widespread, with drinking water commonly containing natural and artificially added sources of the ion. Ingested fluoride undergoes absorption across the gastric and intestinal epithelia. Previous studies have reported adverse gastrointestinal effects with high levels of fluoride exposure. Here, we examined the effects of fluoride on the transepithelial ion transport and resistance of three intestinal epithelia. We used the Caco-2 cell line as a model of human intestinal epithelium, and rat and mouse colonic epithelia for purposes of comparison. Fluoride caused a concentration-dependent decline in forskolin-induced Cl- secretion and transepithelial resistance of Caco-2 cell monolayers, with an IC50 for fluoride of about 3 mM for both parameters. In the presence of 5 mM fluoride, transepithelial resistance fell exponentially with time, with a t1/2 of about 7 hours. Subsequent imaging by immunofluorescence and scanning electron microscopy showed structural abnormalities in Caco-2 cell monolayers exposed to fluoride. The Young's modulus of the epithelium was not affected by fluoride, although proteomic analysis revealed changes in expression of a number of proteins, particularly those involved in cell-cell adhesion. In line with its effects on Caco-2 cell monolayers, fluoride, at 5 mM, also had profound effects on Cl- secretion and transepithelial resistance of both rat and mouse colonic epithelia. Our results show that treatment with fluoride has major effects on the structure, function, and proteome of intestinal epithelia, but only at concentrations considerably higher than those likely to be encountered in vivo, when much lower fluoride doses are normally ingested on a chronic basis.
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Affiliation(s)
- Flávia Amadeu de Oliveira
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Lesley J MacVinish
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Simran Amin
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Duleni Herath
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Pia Jeggle
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Ioanna Mela
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Maria Pieri
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Chetanya Sharma
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | - Gavin E Jarvis
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Flávia M Levy
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Mariana R Santesso
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Zohaib N Khan
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Aline L Leite
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Rodrigo C Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Marília A R Buzalaf
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - J Michael Edwardson
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
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Al-Jobair A, Al-Hammad N, Alsadhan S, Salama F. Retention and caries-preventive effect of glass ionomer and resin-based sealants: An 18-month-randomized clinical trial. Dent Mater J 2017; 36:654-661. [PMID: 28701637 DOI: 10.4012/dmj.2016-225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objective of this study was to compare the retention and caries-preventive effect of glass ionomer (Fuji Triage) and resin-based (Clinpro) sealants among 6-9-year-old children. This split-mouth, randomized clinical trial covered 35 children/140 fully erupted permanent first molars. Evaluation was conducted by two independent examiners after 6, 12, and 18 months and the data were compared in relation to the children's caries risk and age groups. The Kaplan-Meier survival method and chi-square test were used for analysis. There were no statistically significant differences in the survival of partial and fully retained sealants or in the survival of caries-free pits and fissures between glass-ionomer and resin-based sealants. In terms of retention, both sealants performed better in the younger age group at the end of the study, and showed better caries prevention in moderate caries risk children. After 18 months, both sealants had comparable retention and caries-preventive effects in 6-9-year old children.
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Affiliation(s)
- Asma Al-Jobair
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University
| | - Nouf Al-Hammad
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University
| | - Salwa Alsadhan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University
| | - Fouad Salama
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University
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40
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Vernazza CR, Murray JJ. Child dental health: Forty year overview. Br Dent J 2017; 222:406-7. [DOI: 10.1038/sj.bdj.2017.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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