Prevalence of oral health problems in U.S. adults, NHANES 1999-2004: exploring differences by age, education, and race/ethnicity

Age related impairments in ingestion from a large population based-sample

OBJECTIVES

Epidemiological data regarding the evolution of problems related to mastication and swallowing with age are lacking. This study aims to (i) describe changes in oral function with age, using data from a large French population, (ii) validate online, self-report uses of an ICF questionnaire in older persons, and (iii) assess whether impairment is related to avoidance of certain foods, xerostomia, body mass index (BMI) and oral health related quality of life (OHRQoL).

METHODS

Volunteers aged ≥18 years with internet access completed a series of questionnaires on sociodemographic, anthropometric and oral health characteristics (oral function, Xerostomia Index (XI), OHRQoL, reasons for avoidance of certain food). Oral function was assessed using items derived from the International Classification of Functioning (ICF). Five ICF items related to ingestion function and six items related to activities and participation were used. A validation study was undertaken to identify those with poor chewing ability and low salivary flow amongst older participants reporting impairment.

FINDINGS

39 597 individuals were included. The prevalence of individuals with impairment for ICF items related to ingestion function and oral activity (eating, drinking and speaking), and the percentage of participants with poor OHRQoL increased significantly with age (p < 0.001). Each ICF item was significantly associated with OHRQoL (p < 0.001), XI (p < 0.001), BMI (p < 0.001) and avoidance of certain food due to chewing or swallowing difficulties.

CONCLUSION

Overall, 21.5% and 13.5% of the study population had chewing and/or biting impairments respectively, which might affect food selection and consumption. These findings raise individual and population-based issues. Further studies are needed to assess whether impairment in oral function might increase frailty in older individuals, and also to compare data with those from other countries.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries

OBJECTIVE

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries.

METHODS

We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables.

RESULTS

For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth.

CONCLUSIONS

Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

Mapping Oral health and Local Area Resources (MOLAR): protocol for a randomised controlled trial connecting emergency department patients with social and dental resources

INTRODUCTION

There are substantial inequities in oral health access and outcomes in the USA, including by income and racial and ethnic identity. People with adverse social determinants of health (aSDoH), such as housing or food insecurity, are also more likely to have unmet dental needs. Many patients with dental problems present to the emergency department (ED), where minimal dental care or referral is usually available. Nonetheless, the ED represents an important point of contact to facilitate screening and referral for unmet oral health needs and aSDoH, particularly for patients who may not otherwise have access to care.

METHODS AND ANALYSIS

Mapping Oral health and Local Area Resources is a randomised controlled trial enrolling 2049 adult and paediatric ED patients with unmet oral health needs into one of three trial arms: (a) a standard handout of nearby dental and aSDoH resources; (b) a geographically matched listing of aSDoH resources and a search link for identification of geographically matched dental resources; or (c) geographically matched resources along with personalised care navigation. Follow-up at 3, 6, 9 and 12 months will evaluate oral health-related quality of life, linkage to resources and dental treatment, ED visits for dental problems and the association between linkage and neighbourhood resource density.

ETHICS AND DISSEMINATION

All sites share a single human subjects review board protocol which has been fully approved by the Mass General Brigham Human Subjects Review Board. Informed consent will be obtained from all adults and adult caregivers, and assent will be obtained from age-appropriate child participants. Results will demonstrate the impact of addressing aSDoH on oral health access and the efficacy of various forms of resource navigation compared with enhanced standard care. Our findings will facilitate sustainable, scalable interventions to identify and address aSDoH in the ED to improve oral health and reduce oral health inequities.

TRIAL REGISTRATION NUMBER

NCT05688982.

Association of Interdental Cleaning and Untreated Root Caries in Adults in the United States of America

PURPOSE

This study aimed to evaluate the association between interdental cleaning and untreated root caries amongst middle-aged and older adults in the US.

MATERIALS AND METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) (2015-2016 and 2017-2018). Adults aged ≥40 years who underwent full mouth examination and root caries assessment were included. Participants were classified based on their interdental cleaning frequency as none, 1-3 d/wk, and 4-7 d/wk. Associations between interdental cleaning and untreated root caries were assessed using a weighted multivariable logistic regression model adjusted for sociodemographics, general behaviour, general health condition, oral conditions, oral health behavior, and dietary factors. Subgroup analyses stratified by age and sex were performed after adjusting for covariates in the logistic regression models.

RESULTS

The prevalence of untreated root caries was 15.3% amongst 6217 participants. Interdental cleaning for 4-7 d/wk was a significant risk factor (odds ratio, 0.67; 95% confidence interval, 0.52-0.85). It was associated with a 40% reduction in the risk of untreated root caries in participants aged 40 to 64 years and a 37% reduction in women. Untreated root caries was also significantly associated with age, family income, smoking status, root restoration, number of teeth, untreated coronal caries, and recent dental visit.

CONCLUSIONS

Interdental cleaning for 4-7 d/wk was associated with fewer untreated root caries amongst middle-aged adults and women in the US. The risk of root caries increases with age. Low family income was a risk indicator for root caries amongst middle-aged adults. Additionally, smoking, root restoration, number of teeth, untreated coronal caries, and recent dental visits were common risk factors for root caries in middle-aged and older people in the US.

Perceived racism associated with declines in self-rated oral health among U.S. Black women

PURPOSE

Racial disparities in oral health are well-documented. Stress has been associated with both perceived racism and oral health, yet little research has directly investigated the association between perceived racism and oral health.

METHODS

We used data from the Black Women's Health Study, a longitudinal cohort study that includes a geographically diverse sample of Black women across the United States. Perceived exposure to racism was assessed via two scales, one assessing lifetime exposure and one everyday exposure. Self-rated oral health was subsequently assessed over multiple time points. We used Cox proportional hazard models to calculate adjusted incidence rate ratios estimating the association between higher levels of perceived racism and incident "fair" or "poor" oral health, and explored potential effect measure modification using stratified models.

RESULTS

The adjusted incidence rate ratios (n = 27,008) relating perceived racism to incident fair or poor oral health were 1.50 (95% confidence interval 1.35, 1.66) comparing the highest quartile of everyday racism to the lowest and 1.45 (95% confidence interval 1.31, 1.61) for the highest score of lifetime racism compared to the lowest. We did not see evidence of effect modification.

CONCLUSIONS

Higher levels of perceived racism documented in 2009 were associated with declines in self-rated oral health from 2011 to 2019.

Oral Health Problems among Canadians Aged 45 to 85: Data from the Canadian Longitudinal Study on Aging Baseline Survey (2011-2015)

Oral health is a critical component of overall health. The objective of this study was to describe oral health problems among 47,581 adults aged 45 to 85 in the Canadian Longitudinal Study on Aging (CLSA) among those who have at least one natural tooth (92%) and those without natural teeth across various demographic categories. Among the 47,581 participants in the study, 92% reported having at least one natural tooth (dentate). Among those without teeth, 63% reported an income less than CAD 50,000 versus 39% among those with teeth. Whether they had teeth or not, over 30% of people reported two or more oral health problems. Older adults appear to be retaining their natural teeth (28.9%), but still report experiencing oral health problems. As the population ages, loss of all teeth may not be the most useful proxy for poor oral health, and a population-level understanding of oral health problems may help to better define poor oral health.

Dental implants in dentate primary and secondary Sjögren's syndrome patients: A multicenter prospective cohort study

OBJECTIVES

To prospectively assess the clinical performance and patient-reported outcomes of dental implants in dentate patients with primary and secondary Sjögren's syndrome (pSS and sSS, respectively) compared to patients without SS.

MATERIALS AND METHODS

Thirty-seven implants were placed in 17 patients with pSS/sSS and 26 implants in 17 non-SS patients to replace missing (pre)molars. Clinical performance, marginal bone-level changes, patient satisfaction, and oral health-related quality of life (OHRQoL) were assessed at 1 (T1), 6 (T6), 12 (T12), and 18 (T18) months after placement of the superstructure. Marginal bone-level changes were measured on standardized dental radiographs. Clinical parameters included implant and crown survival, plaque, bleeding and gingival indices, and probing depth. Patient satisfaction and OHRQoL were assessed with validated questionnaires.

RESULTS

Implant survival at T18 was 100% in the patients with pSS/sSS and 96.2% in the non-SS group. Mean marginal bone loss at T18 did not differ between patients with pSS/sSS and non-SS patients, 1.10 ± 1.04 and 1.04 ± 0.75 mm, respectively (p = .87). Clinical performance was good with no differences between the groups for all outcome measures (p > .05). OHRQoL in patients with pSS/sSS had improved significantly after placement of implant supported crowns at all measuring moments compared to baseline (p < .05). Nevertheless, patient satisfaction and OHRQoL remained significantly higher for patients without SS at all measuring moments (p < .05).

CONCLUSION

Dental implants can be successfully applied in dentate patients with pSS/sSS and have a positive effect on OHRQoL.

Apical status and prevalence of endodontic treated teeth among Saudi adults in Eastern province: A prospective radiographic evaluation

Introduction

The main cause for developing periapical lesions (PA) is the root canal infection. The mentioned causes may play a role in not controlling it but are not a “true” cause.

Objective

To determine apical status and prevalence of endodontic treated tooth using radiograph assessment in relation to quality of root canal treatment and clinical factors among Saudi adults in the Eastern province.

Patients and methods

This prospective case series study included 2161 patients who received root canal treatment (RCT) at Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia, between October 21, 2019 and April 22, 2020, after getting ethical approval from the Institutional Research Board (IRB). Saudi natives of either gender, age ≥ 18, with at least one fixed bridge or single dental crown evaluated on a clear, high-quality radiography image were recruited for the study. To determine the periapical state of root canal-filled teeth, the 'periapical index' (PAI) was used. All pertinent patient information was analyzed in SPSS verion-20 (IBM product, Chicago).

Results

Out of 2161 cases, a PA lesion was present in 756 (35.0%). The prevalence of periapical lesions in endodontically treated teeth was 31.2%. PA lesion was associated with molar involvement (50.8% vs. 36.6%, p = 0.001), poor RCT quality (85.2% vs. 51.0%, p = 0.001), and smoking (13.6% vs. 10.5%, p = 0.028). According to logistic regression model, female gender, molar tooth, and poor RCT quality were more likely to expose PA lesion 1.5 times, 1.8 times, and 5 times, respectively.

Conclusion

It is concluded that approximately 1/3rd of endodontically treated teeth are susceptible to the occurrence of periapical lesions in radiographic assessment, which are significantly associated with females, molars, and poor RCT quality, indicating a challenge for endodontists to improve their root canal assessment accuracy.

Perceived racial discrimination partially mediates racial-ethnic disparities in dental utilization and oral health

Objectives

Perceived racial discrimination has been associated with poor health outcomes, yet its impact on oral health disparities is not understood. We examine the role of perceived racial discrimination in healthcare settings in explaining racial‐ethnic disparities in dental visits and tooth loss.

Methods

We used behavioral risk factor surveillance system (BRFSS) data for 2014 from four diverse states (AZ, MN, MS and NM) that included “reactions to race” module. Using Poisson regression to estimate risk ratios, we employed inverse odds ratio(IOR)‐weighted estimation for mediation analyses to estimate the role of perceived discrimination, after equalizing other confounders and risk factors.

Results

We found that among those with similar risk factors, those who experienced racial discrimination were 15% less likely to visit a dentist, and 12% more likely to have tooth loss than those who were treated same as other races. Both Hispanics and non‐Hispanic Blacks were 26% less likely to visit a dentist (for Hispanics, RR = 0.74, 95%CI: 0.69–0.78; for non‐Hispanic Blacks, RR = 0.74, 95%CI: 0.70–0.79), and non‐Hispanic Blacks were 36% more likely to have tooth loss relative to non‐Hispanic Whites with similar risk factors (RR = 1.36, 95%CI: 1.28–1.45). Perceived discrimination appears to contribute to racial‐ethnic disparities in dental utilization among Hispanics, and disparities in tooth loss among non‐Hispanic Blacks, relative to non‐Hispanic Whites.

Conclusions

Perceived racial discrimination partially explains the racial‐ethnic disparities in dental utilization and tooth loss among those who otherwise share the same risk factors for these outcomes. Addressing discrimination and systemic racism can reduce the racial‐ethnic disparities in oral health.

Characteristics Associated With Opioid and Antibiotic Prescribing by Dentists

INTRODUCTION

The objective of this study is to identify county-level characteristics that may be high-impact targets for opioid and antibiotic interventions to improve dental prescribing.

METHODS

Prescriptions during 2012-2017 were extracted from the IQVIA Longitudinal Prescription database. Primary outcomes were yearly county-level antibiotic and opioid prescribing rates. Multivariable negative binomial regression identified associations between prescribing rates and county-level characteristics. All analyses occurred in 2020.

RESULTS

Over time, dental opioid prescribing rates decreased by 20% (from 4.02 to 3.22 per 100 people), whereas antibiotic rates increased by 5% (from 6.85 to 7.19 per 100 people). Higher number of dentists per capita, higher proportion of female residents, and higher proportion of residents aged <65 years were associated with increased opioid rates. Relative to location in the West, location in the Northeast (59%, 95% CI=52, 65) and Midwest (64%, 95% CI=60, 70) was associated with lower opioid prescribing rates. Higher clinician density, median household income, proportion female, and proportion White were all independently associated with higher antibiotic rates. Location in the Northeast (149%, 95% CI=137, 162) and Midwest (118%, 95% CI=111, 125) was associated with higher antibiotic rates. Opioid and antibiotic prescribing rates were positively associated.

CONCLUSIONS

Dental prescribing of opioids is decreasing, whereas dental antibiotic prescribing is increasing. High prescribing of antibiotics is associated with high prescribing of opioids. Strategies focused on optimizing dental antibiotics and opioids are needed given their impact on population health.

Oral side effects of immune checkpoint inhibitor therapy (ICIT): An analysis of 4683 patients receiving ICIT for malignancies at Massachusetts General Hospital, Brigham & Women's Hospital, and the Dana-Farber Cancer Institute, 2011 to 2019

BACKGROUND

Immune checkpoint inhibitors (ICIs) are increasingly accepted as a treatment option for several cancers. Although various systemic immune-related adverse events (irAEs) have been characterized, the effect of ICIs on the oral cavity and contiguous structures is still poorly understood.

METHODS

Electronic medical records of 4683 patients in the Mass General Brigham Registered Patient Data Registry who received ICI therapy (ICIT) between December 2011 and September 2019 were reviewed. Reports of oral conditions were categorized into oral mucosal disorders, xerostomia, and dysgeusia. After applying exclusion criteria, demographic characteristics and clinical features were summarized for the patients who had oral irAEs.

RESULTS

In total, 317 patients developed oral conditions that were associated with ICIT (incidence, 6.8%; 317 of 4683 patients). These conditions included xerostomia (68.5%), oral mucosal disorders (33.4%), and dysgeusia (24.0%). In patients with oral irAEs, respiratory cancer (28.4%) was the most common primary cancer, followed by melanoma (26.2%), and head and neck cancer (14.8%). Oral mucosal disorders developed after the initiation of ICIT between 2 and 851 days (between 1 and 1332 days in patients with xerostomia and between 1 and 1455 days in patients with dysgeusia). Of all oral irAEs, 50.9% developed within 3 months, and 85.5% developed within 12 months.

CONCLUSIONS

Oral side effects appear to be more common among patients who receive ICIT than has been previously reported. Concomitant cytotoxic regimens may exacerbate the risk of oral adverse events, perhaps representing the sum of the effects of different, but simultaneous or sequential, pathogenic mechanisms. Additional studies are warranted to better characterize oral irAEs and their biologic basis.

Inequalities in Untreated Root Caries and Affordability of Dental Services among Older American Adults

The growing geriatric population is facing numerous economic challenges and oral health changes. This study explores the relationship between affordability of dental care and untreated root caries among older American adults, and whether that relationship is independent of ethnicity and socioeconomic factors. Data from 1776 adults (65 years or older) who participated in the National Health and Nutrition Examination Survey (NHANES) were analyzed. The association between affordability of dental care and untreated root caries was assessed using logistic regression models. Findings indicated that untreated root caries occurred in 42.5% of those who could not afford dental care, and 14% of those who could afford dental care. Inability to afford dental care remained a statistically significant predictor of untreated root caries in the fully adjusted regression model (odds ratio 2.79, 95% confidence interval: 1.78, 4.39). Other statistically significant predictors were gender (male), infrequent dental visits, and current smoking. The study concludes that the inability to afford dental care was the strongest predictor of untreated root caries among older Americans. The findings highlight the problems with access to and use of much needed dental services by older adults. Policy reform should facilitate access to oral healthcare by providing an alternative coverage for dental care, or by alleviating the financial barrier imposed on older adults.

Periodontal Disease Status and Associated Risk Factors in Patients Attending a Tertiary Hospital in Northwest Ethiopia

PURPOSE

Information on periodontal disease and its predictors in sub-Saharan Africa is sparse. This study aimed to determine the prevalence of periodontal disease and assess the relationship with associated factors in patients who attended the University of Gondar comprehensive hospital.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted from October 1, 2019, to March 10, 2020, at the University of Gondar comprehensive Hospital. Participants were recruited with a systematic random sampling technique, and interviewed for sociodemographic and medical information through a structured questionnaire. Two examiners evaluated the periodontal status of the study participants using the community periodontal index (CPI).

RESULTS

Four hundred twenty participants were involved in the study. The mean age of the study participants was 29.87 (±7. 76). The majority of the study participants had a habit of tooth brushing (72.1%) and almost half of them did not have a fixed time to brush their teeth. Periodontal change (CPI>0) was noted in 42.4% of the participants and among that 21.7% had shallow pocket (pocket depth of 4-5 mm) and 5.95% had a deep periodontal pocket (≥6 mm). The prevalence was higher in 20-34 years (57.3%), females (58.98%), monthly income of <2500 ETB (82.02%), and frequent carbohydrate intakes (65.17%). Age (AOR=9.61, 95% CI: 6.42, 13.04), gender (AOR=2.00, 95% CI: 136, 2.97), educational status (AOR=3.25), residency (AOR= 1.66), monthly income (AOR=2.13), oral hygiene habit (AOR=4.85) and systemic disease (AOR=1.96) were significantly associated with periodontitis.

CONCLUSION

In the present study, 42.4% of the study participants encountered periodontal disease. The study confirmed that various sociodemographic risk factors/indicators are associated with an increased risk of periodontitis.

Biocompatible Nanocomposite Enhanced Osteogenic and Cementogenic Differentiation of Periodontal Ligament Stem Cells In Vitro for Periodontal Regeneration

Decays in the roots of teeth is prevalent in seniors as people live longer and retain more of their teeth to an old age, especially in patients with periodontal disease and gingival recession. The objectives of this study were to develop a biocompatible nanocomposite with nano-sized calcium fluoride particles (Nano-CaF₂), and to investigate for the first time the effects on osteogenic and cementogenic induction of periodontal ligament stem cells (hPDLSCs) from human donors.Nano-CaF₂ particles with a mean particle size of 53 nm were produced via a spray-drying machine.Nano-CaF₂ was mingled into the composite at 0%, 10%, 15% and 20% by mass. Flexural strength (160 ± 10) MPa, elastic modulus (11.0 ± 0.5) GPa, and hardness (0.58 ± 0.03) GPa for Nano-CaF₂ composite exceeded those of a commercial dental composite (p < 0.05). Calcium (Ca) and fluoride (F) ions were released steadily from the composite. Osteogenic genes were elevated for hPDLSCs growing on 20% Nano-CaF₂. Alkaline phosphatase (ALP) peaked at 14 days. Collagen type 1 (COL1), runt-related transcription factor 2 (RUNX2) and osteopontin (OPN) peaked at 21 days. Cementogenic genes were also enhanced on 20% Nano-CaF₂ composite, promoting cementum adherence protein (CAP), cementum protein 1 (CEMP1) and bone sialoprotein (BSP) expressions (p < 0.05). At 7, 14 and 21 days, the ALP activity of hPDLSCs on 20% Nano-CaF₂ composite was 57-fold, 78-fold, and 55-fold greater than those of control, respectively (p < 0.05). Bone mineral secretion by hPDLSCs on 20% Nano-CaF₂ composite was 2-fold that of control (p < 0.05). In conclusion, the novel Nano-CaF₂ composite was biocompatible and supported hPDLSCs. Nano-CaF₂ composite is promising to fill tooth root cavities and release Ca and F ions to enhance osteogenic and cementogenic induction of hPDLSCs and promote periodontium regeneration.

National Study of Adult Oral Health 2017-18: root caries

BACKGROUND

The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18.

METHODS

A stratified random sample of 15 731 Australians aged ≥15 years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1 mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries.

RESULTS

Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2).

CONCLUSIONS

Root caries was associated with older age, living outside a major city and lower income.

History of Inflammatory Bowel Disease and Self-Reported Oral Health: Women's Health Initiative Observational Study

Background and Objective: Both periodontal disease and inflammatory bowel disease (IBD), are chronic inflammatory conditions, which are mediated by a complex interplay among a dysbiotic microbiota, dysregulated host immune-inflammatory responses, and lifestyle factors. Despite substantial differences in physical and chemical environments, rather strong correlations have been detected between microbial compositions of the oral cavity and stool. In this study, we tested the hypothesis that oral health conditions are affected by the presence of IBD. Materials and Methods: We analyzed the data from 73,621 women who were enrolled in the Women's Health Initiative observational cohort study and completed a follow-up questionnaire that surveyed oral health status specifically at year 5. Among these, 880 reported IBD at the baseline, including 47% who were symptomatic cases and 27% who were on immunosuppressive treatment. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association of IBD and medication status for self-reported oral health outcomes, using logistic regression models, adjusted for selected covariates. Results: IBD was not associated with periodontal disease history itself in a multivariable model; however, poorer self-rated oral health was modestly associated with the presence of IBD (OR = 1.15, 95% CI: 1.01-1.30). Likewise, more frequent eating limitations due to teeth were associated with the presence of IBD history (OR = 1.22, 95% CI: 1.07-1.39). When IBD cases were limited to those who were symptomatic, the associations with these two self-rated oral health outcomes were more pronounced with ORs of 1.28 (95% CI: 1.07-1.54) and 1.36 (95% CI: 1.07-1.54), respectively. Immunosuppressive treatment had little effect on these risk estimates. Conclusions: Among this nation-wide cohort of women 50-79 years of age, history of IBD was associated with poorer perceived oral health status.

High microbicidal effect of peroxynitric acid on biofilm-infected dentin in a root carious tooth model and verification of tissue safety

OBJECTIVES

Root-caries, which frequently occurs in elderly people, is more difficult to treat than caries in a tooth crown, especially in filling restorations. To overcome this difficulty, it is essential to find a strategy for sufficiently sterilizing the infected dentin; however, techniques for sterilizing carious pathogens inside the biofilm, called dental plaque, have not yet been established. Recently, dental applications of plasma sterilization technology have attracted attention. The mechanism of plasma sterilization became clear, and revealed that peroxynitric acid (PNA) is an effective sterilization substance. Highly concentrated PNA solutions can be chemically synthesized in large quantities without using plasma technology. We thought that the application of PNA solution could be a novel treatment for root caries, and examined the microbicidal effect and safety of PNA.

METHODS

A sterilization experiment was performed using an extracted tooth model infected with Streptococcus mutans. Subsequently, a biofilm of S. mutans and Candida albicans was formed on a plate or a dentin slice, and sterilization experiments were performed in comparison with chlorhexidine. Furthermore, a toxicity test of PNA was performed using an epithelial tissue model.

RESULTS

In the infection model, sterilization was achieved with a 22 mM PNA solution in only 10 s. In the biofilm model, a 22 mM PNA solution showed a higher microbicidal effect than 2.0% chlorhexidine. In the toxicity test, 2.0% chlorhexidine was toxic, but a 220 mM PNA solution showed no toxicity.

CONCLUSIONS

PNA is an unprecedented disinfectant that has high microbicidal activity on biofilm and is safe for tissues.

Self-Reported Oral Health Status Among Adults Aged 40+ Years With and Without Vision Impairment: National Health Interview Study, 2008

PURPOSE

To examine self-reported oral health among adults aged 40 years and older with and without vision impairment.

DESIGN

Cross-sectional, with a nationally representative sample.

METHODS

We used publicly available data from the Oral Health Module, last administered in 2008, of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath, and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked, or stained teeth; and/or bleeding gums), and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (P < .05) between vision impairment and oral health outcomes by age group, sociodemographics, and other explanatory variables.

RESULTS

Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged ≥65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status and 57.3% reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90%-150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment.

CONCLUSIONS

Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population.

Predictors of self-reported oral health in the Black Women's Health Study

OBJECTIVES

To describe the self-reported oral health of participants in the Black Women's Health Study (BWHS), a national cohort of 59,000 Black women, and to assess factors associated with this self-report.

METHODS

Annual follow-up of the BWHS cohort occurs via surveys. The 2011 questionnaire included oral health self-report items, on which 38,573 respondents had complete data. Sample characteristics were summarized using descriptive statistics. We assessed correlations with several covariates by estimating odds ratios using multivariable-adjusted logistic regression models.

RESULTS

Those who reported fair or poor oral health were more likely to report current smoking, recent tooth loss, diabetes or hypertension diagnoses, lower education levels, obesity, and higher parity. Few factors were related to self-reported gum disease with bone loss.

CONCLUSIONS

The oral health of US Black women is poorly understood. Correlates of oral health in the BWHS are largely consistent with what has been observed in other populations.

The Healthy Eating Index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older.

METHODS

Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack.

RESULTS

Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

Periodontal Health and Use of Oral Health Services: A Comparison of Germans and Two Migrant Groups

A cross-sectional study was performed with 251 individuals, consisting of 127 Germans, 68 migrants from Turkey, and 56 resettlers (migrants from the former Soviet Union with German ancestors) to compare periodontal health status, with a special focus on associations with lifestyle and anthropometric factors, and use of dental health services. Maximal pocket depth was used as a clinical surrogate marker for periodontitis. Other variables were obtained by questionnaires administered by a Turkish or Russian interpreter. The age- and sex-adjusted prevalence of periodontitis was significantly higher in Turks (odds ratio (OR) 2.84, 95% CI = 1.53–5.26) and slightly higher in resettlers (OR = 1.33, 95% CI = 0.71–2.49). These differences are partly explained by a differential distribution of known risk factors for periodontitis. A full model showed a higher prevalence of maximal pocket depth above 5 mm in Turks (OR = 1.97, 95% CI = 0.99–3.92). Use of oral health services was significantly lower in the two migrant groups. Individuals who reported regular visits to a dentist had significantly less periodontitis, independent of migrant status. A reasonable conclusion is that, since oral health causes major chronic diseases and has a major effect on total health system expenditures, public health efforts both generally and specifically focused on migrant groups are warranted.

Oral Health Training in Osteopathic Medical Schools: Results of a National Survey

Context

Oral health is a critical aspect of overall health, yet many vulnerable communities struggle to access regular dental care and instead seek urgent treatment from physicians. In addition to addressing the consequences of untreated dental disease, physicians are in an ideal position to provide preventive and referral dental services to patients. Osteopathic physicians make up a substantial portion of the physician workforce and can play a central role in increasing oral health care provision in medical settings.

Objective

To assess the extent of oral health curricula in osteopathic medical schools in the United States, including content taught, evaluation practices, and influences and barriers to providing oral health training perceived by educators at these institutions.

Methods

An invitation to participate in the survey was sent electronically to deans of education at all osteopathic medical schools in the United States. Four email reminders followed the initial invitation. In addition to descriptive statistics, the associations between the number of curriculum hours, affiliation with a dental school, and curricular content were evaluated.

Results

Of the 42 institutions contacted, 22 responded (response rate, 52%). The majority of respondents (20 of 22 [91%]) reported the presence of some oral health education at their institutions. Eighteen of 20 respondents (90%) reported that their institution offered at least 1 hour of oral health curriculum over the course of students' education. Greater numbers of curriculum hours were not significantly associated with dental school affiliation or a formalized relationship with oral health educators. Institutions affiliated with dental schools were significantly more likely to include oral health in interprofessional education exercises (P=.023) but were not significantly more likely to cover any specific oral health topics. Seven of 17 respondents (41%) were satisfied with the level of oral health competence their graduates possessed.

Conclusion

Oral health education is present at many osteopathic medical schools, but the content covered and the extent of training varies considerably.

Effect of Silver Diamine Fluoride Treatment on Microbial Profiles of Plaque Biofilms from Root/Cervical Caries Lesions

Purpose: To assess the effect of silver diamine fluoride (SDF) on microbial profiles present in plaque from root/cervical carious lesions, and its association with caries lesion arrest. Materials and Methods: Twenty patients with at least one soft cavitated root/cervical carious lesion were included. One lesion/patient was randomly selected and treated with 38% SDF. Supragingival plaque samples were harvested at preintervention and 1 month postintervention. Using an MiSeq platform, 16S rDNA sequencing of the V3-V4 regions was used to determine bacterial profiles. Clinical evaluation of lesion hardness was used to evaluate arrest. t tests, principal component analysis (PCA), multidimensional scaling (MDS), and generalized linear models (GLMs) tests were used for statistical comparisons. Results: From a total of 40 plaque samples, 468 probe targets were observed. Although 60% of lesions became hard postintervention, PCA and MDS tests showed no distinct pre- and postintervention groups. In addition, pre- and postintervention differences in diversity (Shannon index) of microbial profiles between patients with and without lesion arrest were not statistically different. A likelihood ratio test for pre- versus postintervention differences within patients, i.e., adjusting for differences between patients using negative binomial GLMs, showed 17 bacterial taxa with significant differences (FDR <0.05). Conclusion: Although 60% of lesions hardened after SDF treatment, this was not directly due to either overall statistically significant differences in microbial profiles or differences in microbial diversity. Nevertheless, there was a trend with some acid-producing species in that their relative abundance was reduced postintervention. The negative binomial GLMs showed 17 bacterial taxa that were significantly different after SDF treatment.

Oral Health in Relation to Pancreatic Cancer Risk in African American Women

BACKGROUND

Incidence of pancreatic cancer is higher in African Americans than in U.S. whites. We hypothesized that poor oral health, disproportionately common in African Americans and associated with increased risk of pancreatic cancer in several studies of predominantly white populations, may play a role in this disparity.

METHODS

We examined the relation of self-reported measures of oral health (periodontal disease and adult tooth loss) in relation to pancreatic cancer incidence in the prospective Black Women's Health Study (BWHS). Cox proportional hazard analyses were used to calculate HRs of pancreatic cancer for women with periodontal disease, tooth loss, or both, relative to women who reported neither. Multivariable models adjusted for age, cigarette smoking, body mass index (BMI), type 2 diabetes, and alcohol consumption.

RESULTS

Participants aged 33 to 81 were followed for an average of 9.85 years from 2007 through 2016, with occurrence of 78 incidence cases of pancreatic cancer. Multivariable HRs for pancreatic cancer incidence were 1.77 [95% confidence interval (CI) 0.57-5.49] for periodontal disease with no tooth loss, 2.05 (95% CI, 1.08-3.88) for tooth loss without report of periodontal disease, and 1.58 (95% CI, 0.70-3.57) for both tooth loss and periodontal disease. The HR for loss of at least five teeth, regardless of whether periodontal disease was reported, was 2.20 (95% CI, 1.11-4.33).

CONCLUSIONS

The poor oral health experienced by many African Americans may contribute to their higher incidence of pancreatic cancer.

IMPACT

Future research will assess associations between the oral microbiome and pancreatic cancer risk in this population.

Ethnic background and children's oral health-related quality of life

Purpose

Ethnic background is known to be related to oral health and socioeconomic position (SEP). In the context of patient-centered oral health care, and the growing number of migrant children, it is important to understand the influence of ethnic background on oral health-related quality of life (OHRQoL). Therefore, we aimed to identify the differences in children’s OHRQoL between ethnic groups, and the contribution of oral health status, SEP, and immigration characteristics.

Methods

This study was part of the Generation R Study, a prospective cohort study conducted in Rotterdam, the Netherlands. In total, 3121 9-year-old children with a native Dutch (n = 2510), Indonesian (n = 143), Moroccan (n = 104), Surinamese (n = 195), or Turkish (n = 169) background participated in the present study. These ethnicities comprise the most common ethnic groups in the Netherlands. OHRQoL was assessed using a validated short form of the child oral health impact profile. Several regression models were used to study an association between ethnic background and OHRQoL, and to identify potential mediating factors.

Results

Turkish and Surinamese ethnic background were significantly associated with lower OHRQoL. After adjusting for mediating factors, only Surinamese children had a significantly lower OHRQoL than Dutch children (β:− 0.61; 95% CI− 1.18 to –0.04).

Conclusions

Our results show that Turkish and Surinamese children have a significantly lower OHRQoL than native Dutch children. The association was partly explained by oral health status and SEP, and future studies are needed to understand (cultural) the determinants of ethnic disparities in OHRQoL, in order to develop effective oral health programs targeting children of different ethnic groups.

Electronic supplementary material

The online version of this article (10.1007/s11136-019-02159-z) contains supplementary material, which is available to authorized users.

Ethnic prevalence of anemia and predictors of anemia among chronic kidney disease patients at a tertiary hospital in Johannesburg, South Africa

INTRODUCTION

Anemia is a complication of chronic kidney disease (CKD) that can greatly impact on its prognosis. However, the risk factors for anemia, including the influence of ethnicity, are not well established among the CKD population in Johannesburg.

METHODS

This was a cross-sectional study of 353 adult CKD patients attending the renal outpatient clinic of the Charlotte Maxeke Johannesburg Academic Hospital (Johannesburg, South Africa) from June 1, 2016 to December 30, 2016. Sociodemographic and clinical characteristics were obtained using a proforma. Blood samples were collected for serum electrolytes and hematological parameters. Predictors of low hemoglobin and iron deficiency anemia (IDA) were evaluated using multivariable binary logistic regression.

RESULTS

The mean age and prevalence of anemia among the CKD participants were 55.3±15.0 years and 43.18% (95% CI: 38.1%-48.4%), respectively. Blacks had the highest prevalence of anemia (46.9%), while Indians/Asians had the lowest (18.2%). Although the odds of anemia was 3.8-fold higher (odds ratio =3.8, P-value =0.059) among CKD stage V participants as compared to CKD stage I, the relationship between anemia and stages of CKD was non-linear. Diabetes mellitus (odds ratio =2.31, P-value =0.005) had a strong association with anemia among the CKD participants.

CONCLUSION

Almost half of the CKD participants were anemic, and the odds of anemia did not increase linearly with increasing severity of CKD. There was a marked ethnic disparity in anemia prevalence. Our study highlights the need for risk-based management of anemia among CKD patients.

Novel multifunctional nanocomposite for root caries restorations to inhibit periodontitis-related pathogens

OBJECTIVES

The objectives of this study were to: (1) develop a novel multifunctional composite with nanoparticles of silver (NAg), 2-methacryloyloxyethyl phosphorylcholine (MPC), dimethylaminohexadecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP); and (2) investigate biofilm-inhibition via the multifunctional nanocomposite against three species of periodontal pathogens for the first time.

METHODS

The multifunctional nanocomposite was fabricated by incorporating NAg, MPC, DMAHDM and NACP into the resin consisting of pyromellitic glycerol dimethacrylate (PMDGDM) and ethoxylated bisphenol A dimethacrylate (EBPADMA). Three species (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum) were tested for metabolic activity (MTT), live/dead staining, polysaccharide production and colony-forming units (CFU) of biofilms grown on resins.

RESULTS

Incorporation of 0.08% to 0.12% NAg, 3% MPC, 3% DMAHDM and 30% NACP did not compromise the mechanical properties of the composite (p > 0.1). The multifunctional nanocomposite reduced protein adsorption to nearly 1/10 of that of a commercial control (p < 0.05). For all three species, the biofilm CFU was reduced by about 5 and 1 orders of magnitude via the nanocomposite containing NAg + MPC + DMAHDM, compared to commercial control and the composite with MPC + DMAHDM, respectively.

CONCLUSIONS

The novel multifunctional nanocomposite achieved the greatest reduction in metabolic activity, polysaccharide and biofilm growth of three periodontal pathogens.

CLINICAL SIGNIFICANCE

The strongly-antibacterial, multifunctional composite is promising for treating root lesions, alleviating periodontitis and protecting the periodontal tissues.

Global and regional estimates of the prevalence of root caries - Systematic review and meta-analysis

Aim

To evaluate the pooled prevalence of root caries through a systematic review and meta-analysis.

Methods

A keyword search was done in Scopus, Pubmed and CINAHL databases using all the synonyms of root caries in the published literature (till January 1st, 2018). The search was supplemented with standard Boolean operators and other keywords like prevalence, epidemiology in the title, abstract and MeSH terms. Data was extracted and exported to Covidence software for screening and removal of duplicates.

Results

The search revealed a total of 492 documents from Scopus (n = 95), Pubmed (n = 220) and CINAHL (n = 177). Random effects model was used as there was a high degree of heterogeneity was seen among the studies published (I² = 99.62%). A total of 74 publications were included in the analysis of the pooled prevalence of root caries which yielded a prevalence of 41.5 (36.9–46.1).

Conclusion

Root caries is a significant problem, and four out of ten adults might be affected.

Association between alcohol dependence and both periodontal disease and tooth loss: a cross-sectional study

The impact of alcohol consumption on periodontal disease and tooth loss is still under debate. The aim of this cross-sectional study was to evaluate the association between alcohol dependence and both periodontal diseases and tooth loss in Brazilian native Indians. Full mouth periodontal examination was performed and tooth loss was clinically evaluated in a representative sample of 225 Indians (≥ 19 years). Sociodemographic, oral health-related data, and alcohol dependence were evaluated using structured questionnaires. The subjects were categorized as either alcohol-dependent or non-dependent according to the Alcohol Use Disorders Identification Test results. Severe periodontal disease was defined in individuals with ≥ 2 proximal sites with a clinical attachment level ≥ 6 mm, not on the same tooth, and ≥ 1 proximal site with a probing depth ≥ 5 mm. Tooth loss was categorized as one or more missing teeth, or no missing teeth. Bivariate models followed by logistic regression were used to assess the association between alcohol dependence and both periodontal disease and tooth loss. Prevalence ratio (PR) was calculated using Mantel-Haenszel analysis. Alcohol dependence increased 2.5 times the risk for tooth loss (prevalence ratio [PR] =2.49, 95% confidence interval [CI] = 1.01-9.04, p = 0.05). Severe periodontal disease was not associated with alcohol dependence (OR = 0.54, 95% CI = 0.22-1.31, p = 0.23). In conclusion, alcohol dependence was associated with tooth loss in the present population, but severe periodontal disease was not. Questions on alcohol dependence should be included in dental anamnesis questionnaires, and patients diagnosed with alcohol dependence should be referred for dental evaluation.

Methamphetamine use and oral health-related quality of life

PURPOSE

Methamphetamine (MA) is associated with adverse health effects, including the rampant tooth decay condition called "Meth Mouth." However, the impact of MA use on oral health-related quality of life (OHRQOL) is unknown. This study assessed the relationship between MA use and self-reported OHRQOL.

METHODS

This cross-sectional study uses information from 545 MA-using participants recruited from Los Angeles County, California. Dental examinations were performed by three calibrated dentists using National Health and Nutrition Examination Survey (NHANES) protocols. Data on socio-demographic, behavioral, and drug-use history were recorded using questionnaires. Participants were categorized as 'light' or 'moderate/heavy' users based on reported frequency of MA use in the past 30 days. Route of MA administration was categorized as 'smoking' or 'other.' Self-reported OHRQOL was based on the Oral Health Impact Profile scale.

RESULTS

Majority of the participants were male (80.9%). Median age was 45.0 years (IQR-13.0). Median number of days of MA use was 10.0 (IQR-12.0). Smoking was the preferred route of MA use (70.2%). Root caries in ≥ 3 teeth were reported in 78% of MA users. More than half of the participants reported having painful aching in mouth, avoidance of particular food items, feeling embarrassed, and discomfort while eating in the last 12 months. In unadjusted logistic models, moderate/heavy MA users were more likely to report an affected sense of taste [OR = 1.58, 95% CI (1.10-2.27)] and avoidance of particular foods [OR = 1.45, 95% CI (1.02-2.01)] than light users. Among individuals preferring other MA administration routes, moderate/heavy MA users were 3.09 times as likely to report an affected sense of taste than light users [OR = 3.09, 95% CI (1.52-6.27)].

CONCLUSION

Oral health and OHRQOL appear to be worse among Methamphetamine users than in the US general population.

Root caries incidence and increment in the population - A systematic review, meta-analysis and meta-regression of longitudinal studies

OBJECTIVES

Previous meta-analyses of root caries incidence and increment studies reported different estimates due to the limited number of studies, heterogeneity and variations in studies included. Currently, new publications and approaches to handle heterogeneity are available. This research aims to systematically review and meta-analyse root caries incidence and increment, and use meta-regression to analyse heterogeneity.

SOURCES

PUBMED and EMBASE databases were searched systematically.

STUDY SELECTION

Longitudinal studies on root caries incidence and increment, published in English language prior to 2017, were independently checked by two authors. A pooled incidence and increment of decayed/filled root surfaces (DFS) was estimated and meta-regression analysis was performed by length of follow-up (<2 years; 2years; 3-4years and ≥5years) and study type (observational population-based and clinical trial).

DATA

Of 737 articles, 20 were included for meta-analysis. The annualised root caries incidence and increment were 18.25%[CI = 13.22%-23.28%] and 0.45[CI = 0.37-0.53] root DFS respectively. Length of follow-up influenced the estimates, but not the study type. The annual root DFS incidence and increment from studies <2years were 32.95%[CI = 29.13%-36.77%] and 0.64[CI = 0.38-0.89] root surfaces respectively. Studies with 5+years follow-up, the annualised root caries incidence and increment were 9.4%[CI = 3.32%-15.48%] and 0.43[CI = 0.21-0.64] root surfaces respectively.

CONCLUSIONS

Length of follow-up influenced root caries estimates due to a bias towards relatively healthier older adults retained in the study. Root caries increased over time even among the healthier older adults.

CLINICAL SIGNIFICANCE

The increase in root caries, even among the healthier older adults, should be considered by both clinicians and healthcare planners/policy makers in their provision of services.

Does providing dental services reduce overall health care costs?: A systematic review of the literature

BACKGROUND

The authors conducted a systematic review of the literature to assess the impact of dental treatment on overall health care costs for patients with chronic health conditions and patients who were pregnant.

TYPES OF STUDIES REVIEWED

The authors searched multiple databases including MEDLINE, Embase, Web of Science, and Dentistry & Oral Sciences Source from the earliest date available through May 2017. Two reviewers conducted the initial screening of all retrieved titles and abstracts, read the full text of the eligible studies, and conducted data extraction and quality assessment of included studies.

RESULTS

The authors found only 3 published studies that examined the effect of periodontal treatment on health care costs using medical and dental claims data from different insurance databases. Findings from the qualitative synthesis of those studies were inconclusive as 1 of the 3 studies showed a cost increase, whereas 2 studies showed a decrease.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The small number of studies and their mixed outcomes demonstrate the need for high-quality studies to evaluate the effect of periodontal intervention on overall health care costs.

Nanostructured Polymeric Materials with Protein-Repellent and Anti-Caries Properties for Dental Applications

Dental caries is prevalent worldwide. Tooth cavity restorations cost more than $46 billion annually in the United States alone. The current generation of esthetic polymeric restorations have unsatisfactory failure rates. Replacing the failed restorations accounts for 50–70% of all the restorations. This article reviewed developments in producing a new generation of bioactive and therapeutic restorations. This includes: Protein-repellent and anti-caries polymeric dental composites, especially the use of 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminododecyl methacrylate (DMAHDM); protein-repellent adhesives to greatly reduce biofilm acids; bioactive cements to inhibit tooth lesions; combining protein-repellency with antibacterial nanoparticles of silver; tooth surface coatings containing calcium phosphate nanoparticles for remineralization; therapeutic restorations to suppress periodontal pathogens; and long-term durability of bioactive and therapeutic dental polymers. MPC was chosen due to its strong ability to repel proteins. DMAHDM was selected because it had the most potent antibacterial activity when compared to a series of antibacterial monomers. The new generation of materials possessed potent antibacterial functions against cariogenic and periodontal pathogens, and reduced biofilm colony-forming units by up to 4 logs, provided calcium phosphate ions for remineralization and strengthening of tooth structures, and raised biofilm pH from a cariogenic pH 4.5 to a safe pH 6.5. The new materials achieved a long-term durability that was significantly beyond current commercial control materials. This new generation of bioactive and nanostructured polymers is promising for wide applications to provide therapeutic healing effects and greater longevity for dental restorations.

Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland

Objectives

Hospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care.

Methods

2010–2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data.

Results

Blacks, especially females aged 25–34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland’s population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care.

Conclusion

There are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.

Novel multifunctional dental bonding agent for Class-V restorations to inhibit periodontal biofilms

We recently developed a dental bonding agent to bond restorations to teeth using nanoparticles of amorphous calcium phosphate (NACP) for remineralization with rechargeable calcium and phosphate ion release. The objectives of this study were to: (1) incorporate an antibacterial monomer dimethylaminohexadecyl methacrylate (DMAHDM) and a protein-repellent agent 2-methacryloyloxyethyl phosphorylcholine (MPC); and (2) investigate protein adsorption and periodontitis-related biofilms for the first time. A primer, used to prime tooth structures for bonding, was made with pyromellitic glycerol dimethacrylate (PMGDM) and 2-hydroxyethyl methacrylate (HEMA). An adhesive was made with PMGDM, ethoxylated bisphenol A dimethacrylate and HEMA. NACP, MPC and DMAHDM were incorporated. Streptococcus gordonii, Actinomyces naeslundii, Porphyromonas gingivalis, Fusobacterium nucleatum were cultured to form single and multi-species biofilms. Colony-forming units (CFU), live/dead, metabolic activity, and polysaccharide were measured. Adding DMAHDM, MPC and NACP into the bonding agent did not compromise the dentin bond strength (p > 0.1). Bonding agents with 5% MPC reduced protein adsorption to 1/15 that of the control (p < 0.05). Bonding agents with 5% DMAHDM + 5% MPC had much greater reduction in biofilms than DMAHDM or MPC alone (p < 0.05). Biofilm CFU was reduced by 3 to 4 log via DMAHDM + MPC. Metabolic activities and polysaccharide of biofilms were also substantially reduced (p < 0.05). In conclusion, a novel bonding agent was developed for dental restorations with inhibition of biofilms, reducing CFU by 3 to 4 log. Besides remineralizartion and acid-neutralization via NACP to inhibit caries as shown previously, the multifunctional adhesive is promising for root restorations with subgingival margins to suppress periodontal pathogens and protect the periodontium.

A Clinical Validation of Self-Reported Periodontitis Among Participants in the Black Women's Health Study

BACKGROUND

There is a paucity of data on the validity of self-report of periodontal disease in African Americans. The Black Women's Health Study (BWHS), a United States national cohort study of 59,000 black women followed via mailed questionnaires since 1995, offered the opportunity to clinically validate self-reported periodontitis among a sample of participants.

METHODS

Oral health questionnaires were sent to study participants residing in Massachusetts. Respondents living in the Boston metro area were invited for clinical examination. Self-reports were compared with clinical data obtained from the 77 women (mean age: 59 years) who were examined. The authors examined the predictive ability of individual and combined questionnaire items with respect to clinical periodontal disease severity. Validation parameters were calculated for each question, and receiver operating characteristic statistics were generated to compare questionnaire items.

RESULTS

Periodontitis prevalence in the validation sample was 24% for severe periodontitis and 61% for moderate disease. Performance of individual questionnaire items with respect to predicting periodontitis was better for severe compared with moderate disease. Combinations of questionnaire items improved the predictive ability with respect to severe disease beyond that of individual questionnaire items.

CONCLUSIONS

Prevalence of severe periodontitis was similar to other age-comparable populations, without regard for race or sex, whereas prevalence of total periodontitis (moderate and severe) among women of similar age and/or race was much higher. Predictive ability of questionnaire items assessed in the BWHS was similar to that in other studies.

Effect of bioactive dental adhesive on periodontal and endodontic pathogens

The objectives of this study were to: (1) develop a new bioactive dental bonding agent with nanoparticles of amorphous calcium phosphate and dimethylaminohexadecyl methacrylate for tooth root caries restorations and endodontic applications, and (2) investigate biofilm inhibition by the bioactive bonding agent against eight species of periodontal and endodontic pathogens for the first time. Bonding agent was formulated with 5 % of dimethylaminohexadecyl methacrylate. Nanoparticles of amorphous calcium phosphate at 30 wt% was mixed into adhesive. Eight species of biofilms were grown on resins: Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Parvimonas micra, Enterococcus faecalis, Enterococcus faecium. Colony-forming units, live/dead assay, biomass, metabolic activity and polysaccharide of biofilms were determined. The results showed that adding dimethylaminohexadecyl methacrylate and nanoparticles of amorphous calcium phosphate into bonding agent did not decrease dentin bond strength (P > 0.1). Adding dimethylaminohexadecyl methacrylate reduced the colony-forming units of all eight species of biofilms by nearly three orders of magnitude. The killing efficacy of dimethylaminohexadecyl methacrylate resin was: P. gingivalis > A. actinomycetemcomitans > P. intermedia > P. nigrescens > F. nucleatum > P. micra > E. faecalis > E. faecium. Dimethylaminohexadecyl methacrylate resin had much less biomass, metabolic activity and polysaccharide of biofilms than those without dimethylaminohexadecyl methacrylate (P < 0.05). In conclusion, a novel dental adhesive was developed for root caries and endodontic applications, showing potent inhibition of biofilms of eight species of periodontal and endodontic pathogens, and reducing colony-forming units by three orders of magnitude. The bioactive adhesive is promising for tooth root restorations to provide subgingival margins with anti-periodontal pathogen capabilities, and for endodontic sealer applications to combat endodontic biofilms.

Factors affecting dental diseases presenting at the University of Ghana Hospital

Dental diseases are common in man and range from a toothache to cancers of the head and neck. Dental conditions can affect our capacity to function effectively in areas such as smiling, chewing and speaking. The objective of this study was to describe the main types of dental conditions presenting at the University Hospital between January 2006 and December 2011 and to determine factors associated with the top five diagnosed conditions as well as the acute and chronic conditions. A retrospective review of all 5012 clinical records of dental patients visiting the dental unit within the period stated was carried out. A total of 4196 records which passed the inclusion/exclusion criteria were analysed. Most of the patients who presented were adults. The top 5 dental conditions were apical periodontitis (50.4 %), reversible pulpitis (23.3 %), Gingivitis (11.4 %), Periodontitis (6.2 %) and Halitosis/bad breadth (8.8 %). The top 5 conditions constituted over 75 % of the cases seen. About 84 % of the presentation was acute whilst 16 % was chronic. For the entire dataset and also the top five conditions, approximately 53.0 % were males and 47.0 %. Males outnumbered females on all occasions except for halitosis and most patients presented within 1 month of experiencing symptoms of dental disease. Some significant association was found between the presence of multiple chronic conditions and reversible/irreversible pulpitis. The main dental conditions presenting at the University Hospital during the stated period (i.e. between January 2006 and December 2011) were: apical periodontitis (50.4 %), reversible pulpitis (23.3 %), gingivitis (11.4 %), periodontitis (6.2 %) and halitosis/bad breadth (8.8 %).

Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis

BACKGROUND

The association between rheumatoid arthritis (RA) and periodontitis is well established. Some children with juvenile idiopathic arthritis (JIA) phenotypically resemble adults with RA, characterized by the presence of anti-cyclic citrullinated peptide (CCP) antibodies. We sought to investigate an association between CCP-positive JIA and symptoms of periodontitis and antibodies to oral microbiota.

METHODS

Antibodies to oral pathogens Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum were measured using ELISA in 71 children with CCP-positive JIA and 74 children with CCP-negative JIA. Oral health history was collected from 37 children with CCP-positive JIA and 121 children with CCP-negative JIA. T-tests, Chi-square tests, Mann-Whitney U tests, and multivariable regression were used to compare the groups.

RESULTS

Compared to those with CCP-negative JIA, children with CCP-positive JIA were more likely to be female, older and non-Caucasian. Anti-P. gingivalis (p <0.003) and anti-P. intermedia (p <0.008) IgG antibody titers were higher in the CCP-positive cohort. Differences in P. gingivalis antibody titers remained significant after adjusting for age (p = 0.007). Children with CCP-positive JIA more likely reported tender/bleeding gums (43 % vs. 24 %, p < 0.02) compared to children with CCP-negative JIA. After controlling for age at collection, the odds of having tender/bleeding gums were 2.2 times higher in the CCP-positive group compared (95 % CI 0.98 - 4.83; p = 0.056).

CONCLUSIONS

Children with CCP-positive JIA have higher antibody titers to P. gingivalis and more symptoms of poor oral health, supporting a possible role for periodontitis in the etiology of CCP-positive JIA.

Risk indicators for tooth loss in Kiriri Adult Indians: a cross-sectional study

BACKGROUND

The aim of this cross-sectional study was to evaluate the risk indicators of tooth loss in adult Kiriri Indians from Brazil.

METHODS

A representative sample of 225 Indians (≥ 19 years of age) was assessed. Interviews using a structured written questionnaire were performed to collect data on demographics and socio-economic status, and health-related data. Probing depth, the distance between the cement-enamel junction and the free gingival margin, and decayed, missing or filled teeth were evaluated. Bivariate and logistic models were used to assess associations between tooth loss and age, sex, income, education, diabetic status, smoking habits, dental caries, severe periodontitis, plaque index and previous dental visit.

RESULTS

Eighty per cent of subjects had lost one tooth or more, and 20% had lost eight teeth or more. Mean (± standard deviation) tooth loss was 5.09 (± 5.83) teeth. After adjustment for covariates, loss of one tooth or more was associated with older age [≥ 35 years; odds ratio (OR) = 4.06, 95% confidence interval (95% CI): 1.38-11.94, P = 0.01], severe periodontitis (OR = 3.35, 95% CI: 0.99-11.24, P = 0.05), higher dental caries (OR = 3.24, 95% CI: 1.35-7.78, P = 0.01) and previous dental visit (OR = 23.32, 95% CI: 5.75-94.63, P < 0.001).

CONCLUSION

Tooth loss is highly prevalent in Kiriri Indians. Older age, severe periodontitis, higher caries index and previous dental visit were associated with tooth loss. Prevention and treatment programmes, targeting high-risk groups, are required to promote the oral health of the population.