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Examination of dental utilization of newly resettled adult refugees in Washington state enrolled in dental medicaid program. 对华盛顿州新安置的参加牙科医疗补助计划的成年难民的牙科使用情况进行调查。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-11-04 DOI: 10.1111/cdoe.13007
Ana Lucia Seminario, Sogole Tabatabaiepur, Yan Wang, Christopher Okunseri, Darien J Weatherspoon, Frank Roberts

Objective: To assess dental utilization of resettled adult refugees in Washington (WA) state and the demographic factors associated with dental utilization.

Methods: Data were collected between January 1, 2015, and December 31, 2015 for newly arrived adult refugees (>21 years) enrolled in Washington State dental Medicaid program. Three state agencies provided enrollment and claims data that included demographic information as well as number and types of dental claims, and time to first dental claim for the newly resettled adult refugee population.

Results: A total of 1294 adult refugees resettled in WA State in 2015. Approximately, 67% were aged 21-39 years and 32.4% White race and 93.9% without any disability. Over half (57%) of adult refugees had at least one dental claim within 12 months, and the median time to first dental utilization was 4.1 months [IQR:2.4-6.8]. Black refugees had a 74% greater chance of a first dental claim within 12 months of resettlement compared to White refugees (p < .001), and people from countries with high volume of refugees also had a 31% greater chance than those from countries with low volume of refugees (p = .005).

Conclusions: Over half of all the adult refugees resettled in WA utilized dental services within 12 months of arrival. Understanding the mosaic of demographic backgrounds of newly resettled refugees in any given state will improve early utilization of dental care needs and therefore improve their oral health.

目的评估在华盛顿州(Washington,WA)重新安置的成年难民的牙科使用情况以及与牙科使用相关的人口因素:数据收集时间为 2015 年 1 月 1 日至 2015 年 12 月 31 日,对象为加入华盛顿州牙科医疗补助计划的新到成年难民(21 岁以上)。三个州政府机构提供了注册和索赔数据,其中包括人口统计信息、牙科索赔的数量和类型,以及新安置成年难民首次牙科索赔的时间:2015年,共有1294名成年难民在西澳大利亚州重新定居。约67%的难民年龄在21-39岁之间,32.4%为白人,93.9%无任何残疾。超过一半(57%)的成年难民在12个月内至少有过一次牙科索赔,首次使用牙科服务的中位时间为4.1个月[IQR:2.4-6.8]。与白人难民相比,黑人难民在重新安置后的 12 个月内首次申请牙科治疗的几率要高出 74%(p 结论):在西澳大利亚州定居的所有成年难民中,有一半以上在抵达后的12个月内使用过牙科服务。了解任何一个州新安置难民的人口背景,都将提高他们对牙科保健需求的早期利用率,从而改善他们的口腔健康。
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引用次数: 0
The Role of Nationality in Childhood Caries in Qatar. 国籍在卡塔尔儿童龋齿中的作用。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-30 DOI: 10.1111/cdoe.13010
Andrew John Spencer, Asmaa Othman AlKhtib, Mohamed Sultan Al Darwish, Hasaan Gassim Saad Mohame, Tintu Mathew, Ghanim Ali Al Mannai, Mohammed Al Thani, Mariam Abdulmalik, Johann de Vries, Loc Giang Do, Sergio Chrisopoulos

Childhood primary dentition caries prevalence and experience is higher among Qatari than non-Qatari nationality children in Qatar but only this bivariate association has been described.

Objectives: There were two objectives. First, to understand the variation of primary dentition caries among 4- to 8-year-old children in Qatar across nationality classified into four groups, and second, to explore whether the association persisted in the presence of socio-demographic and behavioural indicators.

Methods: The study used data from the Qatar Child Oral Health Survey 2017 (QCOHS 2017). Detailed information was collected through a parental dual-language questionnaire and an oral epidemiological examination conducted by calibrated dentist examiners. Children in 20 kindergartens and 40 schools across Qatar were recruited. Data were weighted to represent the Qatar child population.

Results: Overall, 1154 children aged 4-8 years old (48.9% female, 51.1% male) participated. Qatari children made up 26.3%, Non-Qatari (N-Q) Arabic children 44.2% N-Q Indian sub-continent 16.4% and N-Q Other 13.1%. There were no significant differences by nationality for age or sex, but differences existed for kindergarten/school type and parents' highest level of education. Among behavioural indicators, Qatari and N-Q Arabic children began toothbrushing later, and more N-Q Other children brushed 2+ times a day and had made a check-up visit in the last 12 months. More Qatari children were in the highest tertial for sugar intake and drank bottled water with no fluoride. All N-Q children had a significantly lower prevalence and experience of caries. The means ratio (95% CI) for N-Q Arabic (0.78; 0.65-0.94), Indian (0.58; 0.46-0.72) and other children (0.61; 0.42-0.88) were all significant against Qatari nationality children. Multivariable models showed an attenuation of the association with caries with the means ratio for N-Q Arabic (0.92; 0.73-1.16), Indian (0.79; 0.57-1.11) and other children (0.94; 0.61-1.44) being non-significant compared to Qatari nationality children. The variables which were significantly associated with caries were parental education, toothbrushing frequency, sugar intake and check-up visiting in the last 12 months in the multivariable models.

Conclusions: Primary dentition caries in children resident in Qatar differed by nationality. The association of primary dentition caries with nationality was markedly attenuated and non-significant in the presence of socio-demographic and behavioural variables, pointing towards the importance of these variables as the pathways to improving primary dentition caries prevalence and experience of children in Qatar.

在卡塔尔,卡塔尔籍儿童比非卡塔尔籍儿童的初级龋齿患病率和患病经历更高,但仅描述了这种二元关联:有两个目标。首先,了解卡塔尔 4 至 8 岁儿童在不同国籍(分为四组)之间的初级龋齿差异;其次,探讨在存在社会人口和行为指标的情况下,这种关联是否持续存在:研究使用了 2017 年卡塔尔儿童口腔健康调查(QCOHS 2017)的数据。详细资料是通过家长双语问卷和经校准的牙医检查员进行的口腔流行病学检查收集的。招募了卡塔尔全国 20 所幼儿园和 40 所学校的儿童。数据经过加权处理,以代表卡塔尔儿童人口:共有 1154 名 4-8 岁的儿童(48.9% 为女性,51.1% 为男性)参加了此次调查。卡塔尔儿童占 26.3%,非卡塔尔(N-Q)阿拉伯儿童占 44.2%,非卡塔尔(N-Q)印度次大陆儿童占 16.4%,非卡塔尔(N-Q)其他儿童占 13.1%。不同国籍的儿童在年龄和性别方面没有明显差异,但在幼儿园/学校类型和父母的最高教育水平方面存在差异。在行为指标方面,卡塔尔儿童和N-Q阿拉伯儿童开始刷牙的时间较晚,而更多的N-Q其他儿童每天刷牙2次以上,并在过去12个月中进行过检查。更多的卡塔尔儿童糖摄入量处于最高三分位,并饮用不含氟的瓶装水。所有北卡塔尔儿童的患龋率和患龋经历都明显较低。与卡塔尔籍儿童相比,N-Q 阿拉伯儿童(0.78;0.65-0.94)、印度儿童(0.58;0.46-0.72)和其他儿童(0.61;0.42-0.88)的均值比(95% CI)均显著降低。多变量模型显示,与卡塔尔籍儿童相比,N-Q 阿拉伯语(0.92;0.73-1.16)、印度语(0.79;0.57-1.11)和其他儿童(0.94;0.61-1.44)的均值比与龋齿的相关性减弱。在多变量模型中,与龋齿明显相关的变量是父母教育程度、刷牙频率、糖摄入量和过去 12 个月中的就诊情况:结论:居住在卡塔尔的儿童的初级牙齿龋齿情况因国籍而异。在存在社会人口和行为变量的情况下,初级牙齿龋齿与国籍的关系明显减弱且不显著,这表明这些变量作为改善卡塔尔儿童初级牙齿龋齿患病率和经历的途径非常重要。
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引用次数: 0
Navigating Disparities in Dental Health-A Transit-Based Investigation of Access to Dental Care in Virginia. 牙科保健中的差异导航--基于弗吉尼亚州牙科保健的公交调查。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-30 DOI: 10.1111/cdoe.13015
Junghwan Kim, Shashank Karki, Tegwyn Brickhouse, Marko Vujicic, Kamyar Nasseh, Changzhen Wang, Mengxi Zhang

Objective: To identify vulnerable areas and populations with limited access to dental care in Virginia, the study aimed (1) to calculate travel time and accessibility scores to dental care in Virginia using a transit-based accessibility model for all dental clinics and dental clinics participating in the Medicaid dental program and (2) to estimate factors associated with accessibility to dental clinics participating in the Medicaid dental program in Virginia.

Methods: The study used building footprints as origins of transit trips to dental care services (or destinations). The study then computed transit-based origin-destination travel time matrices based on the detailed trip information, including in-vehicle and out-of-vehicle travel time. Accessibility scores were calculated by counting the number of dental clinics that can be reached within 60 min. Regression analysis was used to measure factors associated with accessibility scores to dental clinics participating in Medicaid.

Results: Residents in smaller regions spent longer travel time to dental clinics by public transit compared with those who resided in larger regions. Medicaid participants also faced longer travel time compared with the general population. Residents spent more than three-fourths of the time waiting for public transit and walking to clinics regardless of where they live and what type of insurance they have. Associations between sociodemographic factors and accessibility scores to dental clinics participating in the Medicaid dental program varied across regions.

Conclusions: Disparities in dental care accessibility exist depending on the size of regions and Medicaid participation in Virginia. The disparities in transit-based access to dental clinics and a disproportionate amount of time spent waiting for public transit and walking to dental clinics could be improved through tailored interventions taking into account the sociodemographic and geographic characteristics of each region.

目标:为确定弗吉尼亚州牙科保健服务有限的脆弱地区和人群,该研究旨在:(1)使用基于交通的可达性模型,计算弗吉尼亚州所有牙科诊所和参与医疗补助牙科项目的牙科诊所的旅行时间和牙科保健服务可达性得分;(2)估计与弗吉尼亚州参与医疗补助牙科项目的牙科诊所可达性相关的因素:方法:该研究使用建筑物足迹作为前往牙科保健服务(或目的地)的公交出行的起点。然后,研究根据详细的行程信息,包括车内和车外的旅行时间,计算出基于交通的起点-终点旅行时间矩阵。通过计算 60 分钟内可到达的牙科诊所数量,计算出了可达性得分。回归分析用于衡量与参与医疗补助计划的牙科诊所可及性得分相关的因素:结果:与居住在较大地区的居民相比,居住在较小地区的居民乘坐公共交通前往牙科诊所所花费的时间更长。与普通居民相比,医疗补助计划的参与者也需要花费更长的旅行时间。无论居民居住在哪里,也无论他们拥有哪种保险,他们都要花费四分之三以上的时间等待公共交通或步行前往诊所。不同地区的社会人口因素与参与医疗补助牙科项目的牙科诊所可及性得分之间的关系各不相同:在弗吉尼亚州,牙科保健可及性方面存在着差异,这取决于地区的大小和医疗补助计划的参与情况。考虑到各地区的社会人口和地理特征,可以通过量身定制的干预措施来改善牙科诊所交通可达性方面的差异,以及花在等待公共交通和步行前往牙科诊所上的过多时间。
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引用次数: 0
Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis. 60 岁及以上成年人的社会关系与牙齿脱落:系统回顾与元分析》。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-22 DOI: 10.1111/cdoe.13011
Eiko Yoshida-Kohno, Kenji Fueki, Amal A Wanigatunga, Thomas K M Cudjoe, Jun Aida

Objective: To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older.

Methods: A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation.

Results: Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low.

Conclusions: Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur.

Trial registration: Protocol Registration: PROSPERO (CRD42023417845).

目的系统评估当前关于社会关系与 60 岁及以上成年人牙齿脱落相关程度的证据:在 PubMed、Embase、Web of Science、CINAHL 和 Cochrane Library 数据库中进行系统性文献检索,以确定从 1966 年至 2024 年 3 月期间发表的相关研究。研究对象包括调查社会关系的结构性、功能性和/或组合性(结构性和功能性)成分与社区居住或机构养老的老年人剩余牙齿数量或牙齿缺失之间关系的横断面或队列研究。研究人员提取了有关参与者和研究特征的数据,包括研究设计、用于评估社会关系的测量类型(结构性、功能性和组合性)、结果测量和关联估计值。对队列研究采用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对横断面研究采用改编的 NOS 对研究质量进行评估。采用荟萃分析法和稳健方差估计法总结了所报告的社会关系与剩余牙齿数量或缺牙之间的关系:20 项研究被纳入综述,12 项研究(125 553 名参与者)被纳入荟萃分析。在这 12 项研究中,平均几率比(95% 置信区间)为 1.15 (1.01-1.32),这表明社会关系较弱的人拥有较少牙齿或牙齿缺损的可能性要高出 15%。证据体的 GRADE 确定性较低:社会关系薄弱与老年人牙齿数量较少或牙齿缺损有关。我们的研究结果可能会为针对和改变社会关系的潜在公共卫生方法提供信息,以预防和解决老年人的口腔疾病。尽管如此,社会关系与牙齿脱落之间的方向性和内在机制仍需通过纵向研究进一步探讨,随访时间要足够长,以便出现口腔健康结果或社会关系的变化:协议注册:prospero(CRD42023417845)。
{"title":"Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.","authors":"Eiko Yoshida-Kohno, Kenji Fueki, Amal A Wanigatunga, Thomas K M Cudjoe, Jun Aida","doi":"10.1111/cdoe.13011","DOIUrl":"10.1111/cdoe.13011","url":null,"abstract":"<p><strong>Objective: </strong>To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older.</p><p><strong>Methods: </strong>A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation.</p><p><strong>Results: </strong>Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low.</p><p><strong>Conclusions: </strong>Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur.</p><p><strong>Trial registration: </strong>Protocol Registration: PROSPERO (CRD42023417845).</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Data-Driven Approach Identifies Subtypes of Caries From Dental Charting. 从牙科图表中识别龋齿亚型的数据驱动方法
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-22 DOI: 10.1111/cdoe.13014
Simon Haworth, Lisa Kastenbom, Peter Persson, Niklas Fries, Anders Esberg, Daniel Jönsson, Ingegerd Johansson

Objectives: The objectives were to: (i) assess the accuracy of dental data for adults obtained from the Swedish Quality Register on Caries and Periodontitis (SKaPa); (ii) explore whether Latent Class Analysis (LCA) can identify groups of people based on caries data; and (iii) characterise the dental, medical and behavioural characteristics of people in the LCA-derived classes.

Methods: Caries data from the SKaPa register were compared with clinical data collected by five experienced dentists in a nested subgroup of the Malmö Offspring Study (MOS), namely the Malmö Offspring Dental Study (MODS) (n = 724) for validation. Dental data from SKaPa were then used to classify 61 984 adult participants of the Västerbotten Intervention Programme (VIP) into five classes using LCA and DMFS-based quintile ranking, respectively. Dental status (including caries progression over 5 years), medical, anthropometric and behavioural characteristics were compared between the groups. Analyses were replicated in 2767 adults in the MOS.

Results: DMFS-scores and number of teeth recorded within -2 to +2 years showed excellent agreement between the SKaPa and reference data with intra-class correlations > 0.90. The five LCA classes differed in mean DMFS from 10.0 to 94.4. There were strong associations between LCA class and health, and health and behavioural measures respectively, including some associations that were not detected using DMFS-ranked quintile groups. LCA class was associated with incremental change in DMFS, DFS, and number of teeth. The results in the MOS cohort were consistent with the results in the VIP cohort.

Conclusions: Dental data for adults from the SKaPa registry were considered accurate within 2 years of recording. The LCA approach can classify participants into caries subtypes based on dental charting. These groups differ in health and behavioural characteristics and future caries increment. The LCA approach may capture some information that is missing from DMFS-ranked quintile groups, but is also heavily influenced by total DMFS, meaning that applying LCA in cumulative, highly age-determined diseases, such as caries, is a challenge.

目标:目的是(i)评估从瑞典龋病和牙周炎质量登记册(SKaPa)中获得的成人牙科数据的准确性;(ii)探讨潜在类别分析(LCA)是否能根据龋病数据确定人群;(iii)描述 LCA 衍生类别中人群的牙科、医疗和行为特征:将 SKaPa 登记册中的龋齿数据与马尔默后代研究(MOS)嵌套子组,即马尔默后代牙科研究(MODS)(n = 724)中由五位经验丰富的牙医收集的临床数据进行比较,以进行验证。然后,利用SKaPa的牙科数据,采用LCA和基于DMFS的五分法排名,将韦斯特博滕干预计划(VIP)的61 984名成年参与者分为五个等级。比较了各组之间的牙齿状况(包括 5 年的龋病进展)、医疗、人体测量和行为特征。分析结果在 2767 名 MOS 成人中进行了重复:DMFS分数和-2至+2年内记录的牙齿数量显示,SKaPa和参考数据之间的一致性非常好,类内相关性大于0.90。五个 LCA 等级的平均 DMFS 差异从 10.0 到 94.4 不等。LCA 等级分别与健康状况、健康状况和行为指标之间存在很强的相关性,其中一些相关性在使用 DMFS 五分位数分组时无法检测到。LCA等级与DMFS、DFS和牙齿数量的增量变化相关。MOS队列的结果与VIP队列的结果一致:SKaPa登记册中的成人牙科数据在记录后两年内被认为是准确的。LCA方法可根据牙科图表将参与者分为龋齿亚型。这些群体在健康和行为特征以及未来龋齿增量方面存在差异。LCA方法可以捕捉到DMFS五分位组别中缺失的一些信息,但也深受DMFS总量的影响,这意味着将LCA应用于累积性、高度年龄决定性疾病(如龋齿)是一项挑战。
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引用次数: 0
A Systematic Review of Dental Antibiotic Stewardship Interventions. 牙科抗生素管理干预的系统回顾。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-14 DOI: 10.1111/cdoe.13009
Leanne Teoh, Christin Löffler, Michelle Mun, Anirudha Agnihotry, Harpinder Kaur, Karen Born, Wendy Thompson

Background: Antimicrobial resistance is a significant threat to global health. Antimicrobial stewardship is reducing inappropriate antimicrobial prescribing to counter it. Dentists prescribe ~10% of all antibiotics worldwide, yet up to 90% of antibiotic prescriptions by dentists are inappropriate. The aim of this systematic review was to update a 2017 review evaluating the effects of antibiotic stewardship interventions in dental settings, using the international consensus on core outcomes for dental antibiotic stewardship.

Methods: Systematic database searches were undertaken in April 2023, of the: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE via OVID, EMBASE via OVID, Dentistry and Oral Sciences Source, the US National Institutes of Health Trials Register, the World Health Organisation International Clinical Trials Registry Platform and the ISRCTN registry databases. Randomised controlled trials (or non-randomised studies with clearly reported mechanism of group formation and inclusion criteria) of interventions to optimise and/or reduce dental antibiotic prescribing were eligible for inclusion. Two authors independently screened for eligible studies. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, certainty of evidence assessed using GRADE. Meta-analysis was planned whether the results of studies reported similar outcomes, otherwise narrative synthesis was undertaken.

Results: Three eligible studies randomising 2148 participants were included. The interventions were combinations of education, audit and feedback and written behaviour change messages, guideline summary, practice visits and patient leaflets. None of the control groups received an intervention. All three included studies measured the quantity of antibiotics prescribed and two measured the appropriateness of prescribing. None measured patient-reported or adverse outcomes. Two included studies were assessed as 'high risk' and one with 'low risk' of bias. There was high-certainty evidence that audit and personalised feedback with individualised behaviour change messages can be effective. Evidence for in-person education was low-certainty. Guideline dissemination alone was ineffective at improving antibiotic prescribing. Due to different outcomes reported, meta-analysis was inappropriate.

Conclusion: Although various dental antibiotic stewardship interventions have been reported in the literature, none provided high-certainty evidence of effectiveness and only three have been evaluated using a randomised design. To strengthen the body of evidence, well-powered, robust, randomised controlled trials are required, with adequate follow-up, reporting the internationally-agreed core outcomes and including a parallel process evaluation is recommended.

Trial registration: PROSPERO (CRD42023411476).

背景:抗菌药耐药性是对全球健康的重大威胁。抗菌药物管理就是通过减少不适当的抗菌药物处方来应对这一问题。牙医开具的抗生素处方约占全球抗生素处方总量的 10%,但高达 90% 的牙医抗生素处方是不恰当的。本系统性综述旨在更新 2017 年的一篇综述,利用牙科抗生素管理核心成果的国际共识,评估牙科抗生素管理干预措施的效果:方法:于 2023 年 4 月对以下数据库进行了系统检索:方法:2023 年 4 月,对以下数据库进行了系统检索:Cochrane 口腔健康组试验登记、Cochrane 对照试验中央登记、MEDLINE(通过 OVID)、EMBASE(通过 OVID)、Dentistry and Oral Sciences Source、美国国立卫生研究院试验登记、世界卫生组织国际临床试验登记平台和 ISRCTN 登记数据库。关于优化和/或减少牙科抗生素处方的干预措施的随机对照试验(或明确报告了分组机制和纳入标准的非随机研究)均符合纳入条件。两名作者独立筛选符合条件的研究。使用 Cochrane Risk of Bias 2 工具评估偏倚风险,使用 GRADE 评估证据的确定性。如果研究结果报告相似,则计划进行荟萃分析,否则进行叙述性综合分析:共纳入三项符合条件的研究,随机抽取了 2148 名参与者。干预措施包括教育、审核和反馈以及书面行为改变信息、指南摘要、实践访问和患者宣传单。对照组均未接受干预。所纳入的三项研究都对处方抗生素的数量进行了测量,其中两项研究对处方的适当性进行了测量。没有一项研究测量了患者报告的结果或不良后果。两项纳入研究被评估为 "高风险 "偏倚,一项为 "低风险 "偏倚。有高度确定性的证据表明,审计和个性化反馈以及个性化行为改变信息是有效的。现场教育的证据确定性较低。仅靠指南传播无法有效改善抗生素处方。由于报告的结果不同,因此不适合进行荟萃分析:尽管文献中报道了各种牙科抗生素监管干预措施,但没有一项提供了高确定性的有效性证据,仅有三项采用随机设计进行了评估。为了加强证据库,建议进行有充分证据支持的、可靠的随机对照试验,并进行充分的随访,报告国际公认的核心结果,包括平行的过程评估:试验注册:prospero (CRD42023411476)。
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引用次数: 0
The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study. 家庭居住者和养老院居民的认知功能与口腔健康之间的关系:HUNT 研究
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-14 DOI: 10.1111/cdoe.13013
Ernest Obeng Asante, Rannveig Sakshaug Eldholm, Marit Kolberg, Håvard Kjesbu Skjellegrind, Geir Selbæk, Xiao-Mei Mai, Yue Chen, Yi-Qian Sun

Objectives: To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population.

Methods: This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results: The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function.

Conclusions: NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

目的:评估挪威老年人群的认知功能和护理依赖与口腔健康之间的关系:评估挪威老年人口中认知功能和护理依赖与口腔健康的关系:这项横断面研究包括来自特伦德拉格健康研究第四波(HUNT4 70+)和特隆赫姆市(特隆赫姆 70+)的 2623 名 70 岁及以上的参与者。神经认知障碍(NCD)由临床专家根据 DSM-5 框架进行诊断。护理依赖性指的是疗养院居住情况。口腔健康采用《修订口腔评估指南-延雪平》(ROAG-J)进行评估。如果在 ROAG-J 九个项目中至少有一个项目的得分达到 2 分或 3 分,则被视为 "有口腔问题"。采用泊松回归法估算患病率比(PRs)和 95% 置信区间(CIs):结果:在调整了潜在的混杂因素后,患有非传染性疾病的参与者出现口腔问题的比例比认知功能正常的参与者高 19%(PR 1.19,95% 置信区间:1.09-1.29)。进一步分析表明,与认知功能正常的居家者相比,患有非传染性疾病的居家者(PR 1.23,95% CI:1.13-1.33)和疗养院居民(PR 1.32,95% CI:1.20-1.45)的口腔问题发生率更高:非传染性疾病与挪威老年人口腔问题患病率的增加有关。这项研究表明,有必要加强对患有非传染性疾病的居家老年人和养老院居民的口腔护理。
{"title":"The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study.","authors":"Ernest Obeng Asante, Rannveig Sakshaug Eldholm, Marit Kolberg, Håvard Kjesbu Skjellegrind, Geir Selbæk, Xiao-Mei Mai, Yue Chen, Yi-Qian Sun","doi":"10.1111/cdoe.13013","DOIUrl":"https://doi.org/10.1111/cdoe.13013","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population.</p><p><strong>Methods: </strong>This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function.</p><p><strong>Conclusions: </strong>NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Do Persons With Disabilities and/or Complex Health Conditions Perceive Oral Health? A Qualitative Study. 残疾人和/或有复杂健康问题的人如何看待口腔健康?定性研究。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-10 DOI: 10.1111/cdoe.13008
Marie-Sophie Bogner, Sasha Scambler, Caroline Eschevins, Denise Faulks

Objectives: This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions.

Methods: Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi-structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken.

Results: Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter-relationships between the mouth, oral health and the socio-medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions.

Conclusion: This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population.

Trial registration: This study was registered into ClinicalTrials.gov (NCT04815434).

研究目的这项定性研究旨在探讨患有残疾且健康状况复杂的成年人对口腔、口腔健康、口腔功能和社会环境的体验和感知:方法: 采用最大变异策略进行有目的的抽样,以选择在人口统计学、残疾和健康状况方面具有广泛经验的参与者。在征得同意后,进行了半结构化访谈,并逐字记录和转录。根据解释学传统,我们采用了现象学方法来描述参与者所描述的与口腔有关的生活和背景经验。研究进行了主题分析:对 18 名患有残疾和复杂健康状况的参与者进行了访谈。其中 12 人有智力障碍。确定了三大主题:对口腔和口腔健康的认识;对口腔健康问题的症状认识和反应;以及口腔、口腔健康和社会医疗环境之间的相互关系。口腔在参与者的生活中占据中心位置,但只有当口腔健康问题影响到日常生活、功能、社会关系、家庭生活或自主性时,口腔的重要性才会被认识到。某些健康的社会决定因素已被确认:社会排斥、经济无保障、缺乏自主性、营养和服务谈判。口腔问题被认为是残疾或健康状况复杂者的额外负担:这项研究有助于深入了解患有残疾或健康状况复杂的成年人的日常生活。它有助于填补现有文献在口腔和口腔健康认知方面的空白,将口腔功能、总体健康和社会环境联系起来:本研究已在 ClinicalTrials.gov (NCT04815434) 上注册。
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引用次数: 0
Poverty Dynamics and Caries Status in Young Adolescents. 贫困动态与青少年龋齿状况。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-10-10 DOI: 10.1111/cdoe.13012
Gisselle Carbajal Rodriguez, Agatha W van Meijeren-van Lunteren, Eppo B Wolvius, Lea Kragt

Objectives: To investigate whether timing, accumulation and trajectories of poverty are associated with dental caries in young adolescents.

Methods: The study was conducted within the Generation R Study, which is an ongoing population-based prospective cohort study conducted in Rotterdam, the Netherlands. This study included 2653 children. Information about household income and number of children and adults living in a household at six time points from pregnancy to 13 years old was retrieved from parental questionnaires to construct the poverty variable. Dental caries was assessed with the decayed, missing and filled teeth index through intraoral photographs at the age of 13 years. Sociodemographic and oral health-related characteristics were included as possible confounders. The association between poverty and dental caries was analysed on the basis of the three lifecourse theories, that is, critical period, cumulative risk and social mobility model. For the latter, we used latent class growth analysis (LCGA) to identify poverty trajectories over time. Next, the associations were studied with Hurdle Negative Binomial Models.

Results: Poverty at birth and intermittent poverty up to the age of 13 were significantly associated with dental caries at 13 years of age (OR 1.41, 95% CI 1.01-1.99; OR 1.36, 95% CI 1.01-1.83 respectively) and with an increased mean number of decayed teeth by 34% (95% CI 1.02-1.76; 95% CI 1.05-1.71, respectively). LCGA showed four trajectories for the probabilities of poverty. All trajectories were significantly associated with dental caries at 13 years of age, with the 'downward mobility' trajectory showing the strongest association with dental caries (OR 1.55, 95% CI 1.05-2.29) and an increasing mean number of decayed teeth by 58% (95% CI 1.18-2.12) than the 'stable absent' trajectory.

Conclusion: Poverty at birth, intermittent poverty and downward poverty trajectory were associated with higher odds and higher mean number of decayed teeth at 13 years of age. The three lifecourse models influenced dental caries status during adolescence, hence strategies and policies targeted to improve socioeconomic conditions on deprived children should be implemented.

目的:研究贫困的时间、积累和轨迹是否与青少年龋齿有关:调查贫困的时间、积累和轨迹是否与青少年龋齿有关:该研究是在荷兰鹿特丹进行的一项基于人口的前瞻性队列研究。这项研究包括 2653 名儿童。研究人员从家长问卷中获取了从怀孕到 13 岁这六个时间点的家庭收入、儿童和成人数量等信息,从而构建了贫困变量。通过 13 岁时的口内照片,用蛀牙、缺牙和补牙指数来评估龋齿情况。社会人口学和口腔健康相关特征被列为可能的混杂因素。贫困与龋齿之间的关系根据三种生命历程理论进行分析,即关键期、累积风险和社会流动模型。对于后者,我们使用了潜类增长分析法(LCGA)来识别随时间变化的贫困轨迹。接下来,我们使用飓风负二项模型研究了两者之间的关联:结果:出生时的贫困和 13 岁前的间歇性贫困与 13 岁时的龋齿显著相关(OR 分别为 1.41,95% CI 为 1.01-1.99;OR 为 1.36,95% CI 为 1.01-1.83),并与蛀牙的平均数量增加 34%显著相关(95% CI 分别为 1.02-1.76;95% CI 为 1.05-1.71)。LCGA 显示了贫困概率的四个轨迹。与 "稳定缺失 "轨迹相比,"向下流动 "轨迹与龋齿的关系最为密切(OR 1.55,95% CI 1.05-2.29),龋齿的平均数量增加了 58%(95% CI 1.18-2.12):结论:出生时贫困、间歇性贫困和贫困下降轨迹与 13 岁时蛀牙的几率和平均蛀牙数较高有关。这三种生命历程模式都会影响青少年时期的龋齿状况,因此应实施有针对性的战略和政策,改善贫困儿童的社会经济条件。
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引用次数: 0
Causal analyses in longitudinal observational studies in oral health: A scoping review. 口腔健康纵向观察研究中的因果分析:范围综述。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-09 DOI: 10.1111/cdoe.13002
An T M Dao, Loc G Do, Nicole Stormon, Manori Dhanapriyanka, Diep H Ha

Objective: Causal analysis including causal inference and causal mediation is pivotal to inform effective interventions. In modern epidemilogy, causal analysis involves four key steps: formulating causal questions, employing directed acyclic graphs (DAGs), conducting data management and selecting statistical strategies. Our objective was to conduct a scoping review to assess how longitudinal observational studies (LOSs) in dental field have integrated these four steps to contribute leverage evidence that inform oral public health interventions.

Methods: LOSs focusing on determinants of dental caries published from 2012 to 2024 were systematically retrieved from five major databases. The Joanna Briggs Institute-scoping review guidance and the Covidence application were employed to identify eligible LOSs for being reviewed.

Results: Out of the 85 eligible LOSs, none formulated causal hypothesis by applying 'what if' question or investigated mediation across three levels of the determinants of oral health. A minority (18 studies, ~21.2%) employed DAGs to visualise relationships among study variables, while only one third (33 studies, ~39%) clearly defined confounders. The majority (64 studies, ~75%) incorporated a time-varying feature of their data, yet only a few (11 studies) fully leveraged this advanced aspect. Among these studies that fully utilised time-varying data, more than half encountered challenges in employing robust statistics to address confounders arising from such data dynamics.

Conclusions: Dental LOSs have, to date, mostly focused on investigating associations over causality, often neglecting the four-step causal analysis and not fully utilising time-varying data. Researchers necessitate to shift their focus to causal inference and prioritise building capacity in causal analysis with a consistent four-step approach to advance the field. Studies exploring mechanisms linking determinants of dental caries across levels and leveraging time-varying data are strongly encouraged.

目的:因果分析(包括因果推断和因果中介)对于提供有效的干预措施至关重要。在现代流行病学中,因果分析包括四个关键步骤:提出因果问题、使用有向无环图(DAG)、进行数据管理和选择统计策略。我们的目标是进行一次范围综述,以评估牙科领域的纵向观察研究(LOSs)如何整合这四个步骤,从而为口腔公共卫生干预提供有利证据:从五个主要数据库中系统地检索了 2012 年至 2024 年间发表的关注龋齿决定因素的纵向观察研究。采用乔安娜-布里格斯研究所(Joanna Briggs Institute)范围审查指南和 Covidence 应用程序来确定符合审查条件的 LOS:结果:在 85 项符合条件的 LOSs 中,没有一项通过 "如果 "问题提出因果假设,也没有一项调查了口腔健康决定因素三个层面的中介作用。少数研究(18 项研究,约占 21.2%)采用 DAG 来直观显示研究变量之间的关系,只有三分之一的研究(33 项研究,约占 39%)明确定义了混杂因素。大多数研究(64 项研究,约占 75%)在数据中加入了时变特征,但只有少数研究(11 项研究)充分利用了这一先进特征。在这些充分利用了时变数据的研究中,有一半以上的研究在采用稳健的统计方法来处理此类数据动态所产生的混杂因素方面遇到了挑战:结论:迄今为止,牙科 LOS 大多侧重于研究关联性而非因果性,往往忽视了四步因果分析法,也没有充分利用时变数据。研究人员有必要将重点转移到因果推断上,并优先建设因果分析能力,采用一致的四步方法来推动该领域的发展。强烈鼓励开展研究,探索龋齿决定因素在不同层面的关联机制,并充分利用时变数据。
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引用次数: 0
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