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Janusz CB, Doan T, Gebremariam A, Rose A, Keels MA, Quinonez RB, Eckert G, Yanca E, Fontana M, Prosser LA. A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children. Acad Pediatr 2024; 24:765-775. [PMID: 38548263 PMCID: PMC11193632 DOI: 10.1016/j.acap.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. METHODS Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1-18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one. RESULTS For RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs. CONCLUSION Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.
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Affiliation(s)
- Cara B. Janusz
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Tran Doan
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor MI
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh PA (current)
| | - Acham Gebremariam
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Angela Rose
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
| | - Martha Ann Keels
- Department of Pediatrics, Duke University, Durham NC
- Division of Pediatric Dentistry and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill NC
| | - Rocio B. Quinonez
- Division of Pediatric Dentistry and Public Health, University of North Carolina Adams School of Dentistry, Chapel Hill NC
| | - George Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington IN
| | - Emily Yanca
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Bloomington IN
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences & Endodontics, School of Dentistry, University of Michigan, Ann Arbor MI
| | - Lisa A. Prosser
- Susan B. Meister Child Health and Evaluation Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor MI
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor MI
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Khan SY, Schroth RJ, Cruz de Jesus V, Lee VHK, Rothney J, Dong CS, Javed F, Yerex K, Bertone M, El Azrak M, Menon A. A systematic review of caries risk in children <6 years of age. Int J Paediatr Dent 2024; 34:410-431. [PMID: 38071403 DOI: 10.1111/ipd.13140] [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: 06/01/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 06/14/2024]
Abstract
BACKGROUND For caries risk assessment (CRA) tools for young children to be evidence-based, it is important to systematically review the literature to identify factors associated with the onset of early childhood caries (ECC). AIM This updated systematic review aimed to identify current evidence on caries risk in young children. DESIGN A comprehensive and systematic literature search of relevant databases was conducted to update a previous systematic review and identify risk factors associated with ECC. Potential risk factors were identified based on strength of association using odds ratios, hazard ratios, relative risk, etc. GRADE was used for rating quality evidence through consensus. RESULTS Twenty-two studies met inclusion criteria for the search from mid-2017 to 2021. Twenty-five publications from the prior systematic review, from 1997 to mid-2017, were also included. Several socioeconomic, behavioral, and clinical variables were identified as ECC risk factors. Factors included the following: age, socioeconomic status, frequency of and supervised toothbrushing, fluoride exposure, breast- and bottle-feeding, feeding habits, absence of a dental home, past caries experience, active non-cavitated lesions, visible plaque, enamel defects, and microbiome. CONCLUSION This study provides updated evidence of risk factors for ECC that could be included in CRA tools.
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Affiliation(s)
- Saima Yunus Khan
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Robert J Schroth
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Shared Health Inc., Winnipeg, Manitoba, Canada
| | - Vivianne Cruz de Jesus
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Victor H K Lee
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Janet Rothney
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cecilia S Dong
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Faraha Javed
- Dr. Ziauddin Ahmed Dental College, Aligarh Muslim University, Aligarh, India
| | - Katherine Yerex
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary Bertone
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed El Azrak
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anil Menon
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Fontana M, Eckert G, Katz B, Keels M, Levy B, Levy S, Kemper A, Yanca E, Jackson R, Warren J, Kolker J, Daly J, Kelly S, Talbert J, McKnight P. Predicting Dental Caries in Young Children in Primary Health Care Settings. J Dent Res 2023; 102:988-998. [PMID: 37329133 PMCID: PMC10477774 DOI: 10.1177/00220345231173585] [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] [Indexed: 06/18/2023] Open
Abstract
Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80-1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1-2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83-2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.
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Affiliation(s)
- M. Fontana
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - B.T. Levy
- University of Iowa, Iowa City, IA, USA
| | - S.M. Levy
- University of Iowa, Iowa City, IA, USA
| | - A.R. Kemper
- Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - E. Yanca
- University of Michigan, Ann Arbor, MI, USA
| | - R. Jackson
- Indiana University, Indianapolis, IN, USA
| | - J. Warren
- University of Iowa, Iowa City, IA, USA
| | | | - J.M. Daly
- University of Iowa, Iowa City, IA, USA
| | - S. Kelly
- Duke University, Durham, NC, USA
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Rodriguez GA, Cabello RA, Borroni CP, Palacio RA. Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children. J Public Health Dent 2022; 82:280-288. [PMID: 35567374 DOI: 10.1111/jphd.12526] [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: 09/05/2020] [Revised: 01/11/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the cost-effectiveness of two preventive interventions aimed at increasing the proportion of caries-free preschool children of low socioeconomic status using a decision analytic model. METHODS Two scenarios were tested, one with a school milk program (SMP) and one without (non-SMP). Fluoride varnish (FV) and a probiotic (PB) were compared to a do-nothing alternative among children in public nurseries/schools over a 4-year period. FV was applied biannually and a PB (Lactobacillus rhamnosus) added to milk powder prepared daily. A Markov decision tree model was utilized. Several sources of data were used to populate the model. Probabilistic and deterministic sensitivity analyses were performed, and a public provider perspective was used. RESULTS In the SMP scenario, PB was more effective and less costly than FV and, compared with do-nothing, increased the proportion of caries-free children by 14.5%, with a cost of USD 12.5 per child (June 2018). PB presented an incremental cost-effectiveness ratio (ICER) or cost per extra caries-free child of USD 86.2. In the non-SMP scenario, both interventions were cost-effective. FV (compared with do-nothing) increased the percentage of caries-free children by 8.3% with an ICER of USD 338.3 and PB (compared with FV) increased the effect by 6.2% with an ICER of USD 1400.2. CONCLUSIONS The findings showed that PB was most effective and less costly than FV in the SMP scenario only. This type of analysis and its results provide essential information for decision-makers to improve the oral health of preschool children.
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Affiliation(s)
| | | | - Catalina P Borroni
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Raul A Palacio
- School of Dentistry, Pontificia Universidad Catolica de Chile, Santiago, Chile
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5
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Burgette JM, Divaris K, Fontana M. Reducing Inequities in Early Childhood Dental Caries in Primary Health Care Settings. JAMA HEALTH FORUM 2021; 2:e214115. [DOI: 10.1001/jamahealthforum.2021.4115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacqueline M. Burgette
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatric Dentistry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor
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Graif C, Meurer J, Fontana M. An Ecological Model to Frame the Delivery of Pediatric Preventive Care. Pediatrics 2021; 148:s13-s20. [PMID: 34210842 PMCID: PMC8312252 DOI: 10.1542/peds.2021-050693d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, identify social determinants of health, and identify protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary based on features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery.
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Affiliation(s)
- Corina Graif
- Department of Sociology and Criminology, College of the Liberal Arts and Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
| | - John Meurer
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
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Selvaraj D, Curtan S, Copeland T, McNamee E, Debelnogich J, Kula T, Momotaz H, Nelson S. Caries disparities among Medicaid-enrolled young children from pediatric primary care settings. J Public Health Dent 2021; 81:131-142. [PMID: 33135213 PMCID: PMC8756375 DOI: 10.1111/jphd.12423] [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: 07/07/2020] [Revised: 09/09/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this study are to determine the overall and racial differences in the extent of caries experience and to examine the association between child and parent/caregiver characteristics and caries among 3-6-year-old Medicaid-enrolled children. METHODS This study reports baseline cross-sectional data from a larger pragmatic clinical trial in pediatric primary care practices. Child-level clinical dental exams included decayed and filled teeth (dft) using ICDAS criteria and parent/caregiver questionnaire collected information on socio-demographics, child oral health behaviors, oral health related quality of life (OHQoL), and food environment. RESULTS A total of 1,024 parent/caregiver-child dyads participated in the study. The overall caries experience (dft) was 49 percent and untreated decay was 42 percent. Children who were Black had 1.3 and 1.2 times significantly higher frequency of untreated primary decay and caries experience compared to non-Black children. An overall logistic regression model predicted that race, increased age, receiving dental care in the past 12 months for a cavity/toothache, and lower caregiver OHQoL was significantly associated with increased odds of the child having caries. Non-Black caregivers with less education, whose child was older, and lower child OHQoL had increased odds of having a child with caries, but these same variables were not predictive for the Black children. CONCLUSIONS Racial disparities exist with respect to caries experience and untreated decay within a Medicaid-enrolled population of young children attending well-child visits. Pediatric primary care offices are well-positioned to provide dental surveillance and preventive care and could play an important role in decreasing oral health inequities.
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Affiliation(s)
- David Selvaraj
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Shelley Curtan
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Tashyana Copeland
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Erin McNamee
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Jelena Debelnogich
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Taylor Kula
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
| | - Hasina Momotaz
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Suchitra Nelson
- Community Dentistry, Case Western Reserve University, Cleveland, OH, USA
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8
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Saengtipbovorn S. Testing the efficacy of a brief-caries risk assessment form to evaluate the dental health status among preschool children, Bangkok, Thailand. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-07-2019-0161] [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
PurposeThe study aims to test the efficacy of brief-caries risk assessment form with standard caries risk assessment form and to evaluate the application of caries risk assessment following American Academy of Pediatric Dentistry (AAPD) between brief and standard caries risk assessment on dental health status among preschool children.Design/methodology/approachBrief-caries risk assessment form was developed. Then, experimental study was conducted in public health center 54 among 70 patients (35 test and 35 control) from January to July 2019. Test group used brief-caries assessment form, and control group used standard form. Both groups received the same caries risk assessment criteria and management protocol from AAPD. At baseline, 3-month and 6-month follow-up, caries risk and dental health status (plaque index, cavitated caries lesion and non-cavitated caries lesion) were assessed. Data were analyzed by descriptive statistic, t-test, chi-square test, Fisher's exact test and repeated measures ANOVA.FindingsPercentage of high caries risk decreased from baseline (93.9%: test and 96.9%: control) to 6-month follow-up (66.7%: test and 65.6%: control) in both groups, with no statistically significant differences between groups. Plaque index, cavitated caries lesion and non-cavitated caries lesion were not statistically significant differences between groups. Brief-caries assessment decreased times/visit from 10-15 minutes to 5 minutes.Originality/valueBrief-caries assessment form decreased caries risk and prevented dental caries as the standard form. Using brief-caries assessment form could save time, is cost-effective and is appropriate for use in public health centers. However, a short follow-up time might have insufficient power to detect the differences between groups.
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9
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Zhou Y, Yoo P, Feng Y, Sankar A, Sadr A, Seibel EJ. Towards AR-assisted visualisation and guidance for imaging of dental decay. Healthc Technol Lett 2019; 6:243-248. [PMID: 32038865 PMCID: PMC6952244 DOI: 10.1049/htl.2019.0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 12/27/2022] Open
Abstract
Untreated dental decay is the most prevalent dental problem in the world, affecting up to 2.4 billion people and leading to a significant economic and social burden. Early detection can greatly mitigate irreversible effects of dental decay, avoiding the need for expensive restorative treatment that forever disrupts the enamel protective layer of teeth. However, two key challenges exist that make early decay management difficult: unreliable detection and lack of quantitative monitoring during treatment. New optically based imaging through the enamel provides the dentist a safe means to detect, locate, and monitor the healing process. This work explores the use of an augmented reality (AR) headset to improve the workflow of early decay therapy and monitoring. The proposed workflow includes two novel AR-enabled features: (i) in situ visualisation of pre-operative optically based dental images and (ii) augmented guidance for repetitive imaging during therapy monitoring. The workflow is designed to minimise distraction, mitigate hand-eye coordination problems, and help guide monitoring of early decay during therapy in both clinical and mobile environments. The results from quantitative evaluations as well as a formative qualitative user study uncover the potentials of the proposed system and indicate that AR can serve as a promising tool in tooth decay management.
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Affiliation(s)
- Yaxuan Zhou
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA 98195, USA
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Paul Yoo
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Yingru Feng
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Aditya Sankar
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA 98195, USA
| | - Alireza Sadr
- School of Dentistry, University of Washington, Seattle, WA 98195, USA
| | - Eric J. Seibel
- Human Photonics Lab, Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
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10
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Kahharova D, Brandt BW, Buijs MJ, Peters M, Jackson R, Eckert G, Katz B, Keels MA, Levy SM, Fontana M, Zaura E. Maturation of the Oral Microbiome in Caries-Free Toddlers: A Longitudinal Study. J Dent Res 2019; 99:159-167. [PMID: 31771395 PMCID: PMC6977153 DOI: 10.1177/0022034519889015] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Understanding the development of the oral microbiota in healthy children is of
great importance to oral and general health. However, limited data exist on a
healthy maturation of the oral microbial ecosystem in children. Moreover, the
data are biased by mislabeling “caries-free” populations. Therefore, we aimed to
characterize the healthy salivary and dental plaque microbiome in young
children. Caries-free (ICDAS [International Caries Detection and Assessment
System] score 0) children (n = 119) and their primary
caregivers were followed from 1 until 4 y of child age. Salivary and dental
plaque samples were collected from the children at 3 time points (T1, ~1 y old;
T2, ~2.5 y old; and T3, ~4 y old). Only saliva samples were collected from the
caregivers. Bacterial V4 16S ribosomal DNA amplicons were sequenced using
Illumina MiSeq. The reads were denoised and mapped to the zero-radius
operational taxonomic units (zOTUs). Taxonomy was assigned using HOMD. The
microbial profiles of children showed significant differences
(P = 0.0001) over time. Various taxa increased, including
Fusobacterium, Actinomyces, and
Corynebacterium, while others showed significant decreases
(e.g., Alloprevotella and Capnocytophaga) in
their relative abundances over time. Microbial diversity and child-caregiver
similarity increased most between 1 and 2.5 y of age while still not reaching
the complexity of the caregivers at 4 y of age. The microbiome at 1 y of age
differed the most from those at later time points. A single zOTU
(Streptococcus) was present in all samples
(n = 925) of the study. A large variation in the proportion
of shared zOTUs was observed within an individual child over time (2% to 42% of
zOTUs in saliva; 2.5% to 38% in dental plaque). These findings indicate that the
oral ecosystem of caries-free toddlers is highly heterogeneous and dynamic with
substantial changes in microbial composition over time and only few taxa
persisting across the 3 y of the study. The salivary microbiome of 4-y-old
children is still distinct from that of their caregivers.
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Affiliation(s)
- D Kahharova
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, the Netherlands
| | - B W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, the Netherlands
| | - M J Buijs
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, the Netherlands
| | - M Peters
- University of Michigan, Ann Arbor, MI, USA
| | - R Jackson
- Indiana University, Indianapolis, IN, USA
| | - G Eckert
- Indiana University, Indianapolis, IN, USA
| | - B Katz
- Indiana University, Indianapolis, IN, USA
| | | | - S M Levy
- University of Iowa, Iowa City, IA, USA
| | - M Fontana
- University of Michigan, Ann Arbor, MI, USA
| | - E Zaura
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, the Netherlands
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11
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Featherstone JD, Fontana M, Wolff M. Novel Anticaries and Remineralization Agents: Future Research Needs. J Dent Res 2019; 97:125-127. [PMID: 29355470 DOI: 10.1177/0022034517746371] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- J D Featherstone
- 1 Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - M Fontana
- 2 Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M Wolff
- 3 Cariology and Comprehensive Care, College of Dentistry, New York University, New York, NY, USA
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12
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Abstract
Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.
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