Community dentistry and oral epidemiology最新文献

Objectives: Oral health is an important part of general health and well-being and shares risk factors, such as poor diet, with obesity. The published literature assessing the association between obesity and oral health in early childhood is sparse and inconsistent. The objective of this study was to investigate associations between overweight/obesity (measured by body mass index) and dental outcomes (caries, plaque index and gingival index) both cross-sectionally and longitudinally, taking account of potential confounding factors, based on data collected at age 2 and age 5 within the Australian Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE) birth cohort study.

Methods: This study used data from 1174 SMILE participants. Associations between overweight/obesity and dental outcomes were assessed using generalized linear regression models for the modified Poisson family with log link to estimate prevalence ratios. Cross-sectional and longitudinal models were fitted, after minimal and full adjustment for potential confounders.

Results: Approximately 12% of the participants were overweight/obese at 2 years and 9% at 5 years. Between 2 and 5 years, the prevalence of caries increased from approximately 4% to 24%, at least mild plaque accumulation increased from 37% to 90% and at least mild inflammation from 27% to 68%. There were no associations between overweight/obesity and the prevalence of dental caries; prevalence ratios (PR) [95% confidence interval (CI)] after adjustment for age and sex were 0.9 (0.3, 2.4) cross-sectionally at 2 years, 1.0 (0.6, 1.5) cross-sectionally at 5 years, and 1.0 (0.6, 1.5) for overweight/obesity at 2 years and caries at 5 years. Prevalence ratios were all around the value of 1 for the other dental outcomes and also after adjustment for additional confounders.

Conclusions: There were no associations between overweight/obesity and dental caries, plaque index or gingival index in this cohort of preschool children. However, associations may emerge as the children become older, and it will be possible to extend analyses to include data collected at age 7 in the near future.

Background: The target trial framework was developed as a strategy to design and analyze observational epidemiologic studies with the aim of reducing bias due to analytic decisions. It involves designing a hypothetical randomized trial to answer a question of interest and systematically considering how to use observational data to emulate each trial component.

Aims: The primary aim of this paper is to provide a detailed example of the application of the target trial framework to a research question in oral epidemiology.

Materials and methods: We describe the development of a hypothetical target trial and emulation protocol to evaluate the effect of preconception periodontitis treatment on time-to-pregnancy. We leverage data from Pregnancy Study Online (PRESTO), a preconception cohort, to ground our example in existing observational data. We discuss the decision-making process for each trial component, as well as limitations encountered.

Results: Our target trial application revealed data limitations that precluded us from carrying out the proposed emulation. Implications for data quality are discussed and we provide recommendations for researchers interested in conducting trial emulations in the field of oral epidemiology.

Discussion: The target trial framework has the potential to improve the validity of observational research in oral health, when properly applied.

Conclusion: We encourage the broad adoption of the target trial framework to the field of observational oral health research and demonstrate its value as a tool to identify directions for future research.

Objective: Dental caries is one of the most prevalent chronic non-communicable diseases worldwide. There is a lack of evidence, especially in adult populations, documenting caries disease progression considering lesion severity, activity and tooth surface-level characteristics. The study aimed to investigate the extent to which primary active caries lesions in adults affect caries lesions progression compared with inactive caries lesions over a 2-year follow-up period, considering their severity, surface and tooth type.

Methods: A prospective study data set from a cohort of workers in a factory in Belarus were used. Participants aged 18-64 years with 20 or more natural teeth were included in the study. The participants were clinically examined twice within an interval of 2 years and completed a self-reported questionnaire. One calibrated examiner evaluated caries lesions using the International Caries Detection and Assessment System (ICDAS) and the Nyvad system. The primary outcome was caries lesions' progression. The lesion was classified as 'progressed' if it turned to a more advanced severity stage, was restored or missing/extracted due to caries. A multilevel Poisson regression was used to estimate the association between baseline caries lesions' characteristics and caries lesion progression.

Results: Out of 495 participants, 322 people completed clinical examinations at baseline and 2 years later, with an attrition rate of 35%. The prevalence of active DS1-6 and DS5-6 lesions at the baseline was 83.8% and 64.8%, respectively. In 2 years, 24% of active non-cavitated and 31% of active micro-cavitated/shadowed caries lesions progressed, while 15% of inactive caries lesions, non- or micro-cavitated/shadowed, progressed. The adjusted rate ratio (RR) for ICDAS_3 + 4 caries lesions progression was 1.41 (CI 95% 1.16, 1.70) than ICDAS_1 + 2 lesions. The RR for ICDAS_1 + 2, active and ICDAS_3 + 4, active lesions was 1.78 (CI 95%, 1.40, 2.27) and 1.97 (CI 95%, 1.53, 2.55), respectively than ICDAS_1 + 2, inactive lesions. The RR for caries lesions progression on proximal surfaces and on pits and fissures was 1.57 (CI 95%, 1.30, 1.89) and 1.37 (CI 95%, 1.11, 1.67), respectively than smooth surface lesions.

Conclusion: In caries active adults over 2 years, most non- and micro-cavitated/shadowed active and inactive caries lesions did not progress. Among caries lesions that showed progression, more severe lesions were more likely to progress than less severe lesions; active lesions were more likely to progress than inactive lesions. Pit and fissure caries lesions and proximal lesions were more likely to progress than smooth surface lesions.

Objective: Oral health is often overlooked in ageing health issues, despite its impact on overall health and quality of life. Older Australians, especially those in rural and remote areas, face difficulties accessing oral health services. The aim of the study was to investigate the factors that contribute to financial barriers to accessing dental services among the ageing population in Australia in relation to their residential location.

Method: The study included a weighted sample of Australian adults aged 65 years and over from a population-based survey called the National Study of Adult Oral Health (NSAOH) conducted in 2017-18. Descriptive analysis was conducted and generated cross-tabulation tables to investigate the distributions of the outcome, exposure and covariates, including Sex, Education level (the highest level of education), Equivalised household income, Dental insurance, Concession card ownership, Difficulty paying a dental bill and last dental visit. Blinder-Oaxaca decomposition counterfactual analysis was used to explore the potential impact of a person's residence on their financial difficulty accessing dental services.

Results: The findings showed that 26.2% (95% CI: 24.3-29.3) of major city residents and 30.1% (95% CI: 26.9-33.3) of rural residents avoided or delayed dental visits due to cost. The decomposition analysis indicated that 53.8% of the disparities in the prevalence of avoided or delayed dental visits due to cost were explained by the selected variables, while 46.2% remained unexplained. The explanatory variable with the largest contribution was difficulty paying a $200 dental bill, accounting for 62.4% of the differences, followed by dental insurance, last dental visit and equivalised household income, which explained 42.1%, 20.8% and 14.9% of the differences, respectively.

Conclusion: Regional/remote populations experience more financial barriers to accessing dental care than major city populations and the identified factors explain a significant proportion of these disparities. Based on the study findings, recommendations include expanding public dental service coverage, evaluating concession card mechanisms and advocating for regular dental visits to mitigate disparities in dental care access.

Background: To assess the efficiency of periodontal treatment (PT) in improving diabetes-related outcomes in adults with type 2 diabetes mellitus (T2DM) and periodontitis, providing an updated and comprehensive synthesis from economic evaluations (EE).

Methods: Seven databases and one register were independently searched by two reviewers for articles published up to 8 May 2024. Studies that assessed the efficiency of PT versus no treatment or other dental treatments were included. Risk of bias was assessed using the Cochrane RoB 2, ROBINS-I and ECOBIAS tools for the first stage of EE and the CHEERS checklist and NICE quality appraisal tool for overall EE. Qualitative and quantitative syntheses of the articles were conducted and assessed using the GRADE approach.

Results: Eleven studies were included. PT reduces total healthcare costs, including inpatient and outpatient, diabetes-related costs and other drug costs (low to moderate certainty). A total incremental net benefit of USD 12 348 (2022 currency, 95% CI 12 195-12 500) was estimated from three high-quality model-based cost-utility analyses (high certainty).

Discussion: The inclusion of PT in the comprehensive treatment of patients with T2DM and periodontitis is cost-effective. Future research is required to ensure the transferability of these findings and inform decision makers from different countries.

Registration: PROSPERO CRD42023443146.

Background: In the early 2020s, nearly half of New Zealand adults reported that cost of treatment had prevented them from accessing dental care, with higher rates among Māori, Pasifika and individuals living in the most deprived areas. Unaffordable dental care may be explained by a rise in dental service fees over time relative to personal income, as documented in New Zealand between 1978 and 1993. However, there have been no contemporary estimates in New Zealand of how the affordability of dental care has changed. The aims of this study were to analyse the change in dental treatment fees and the personal income of New Zealanders from 1978 to 2023 and to explore differences in affordability of dental care by ethnicity.

Methods: Average fees for dental treatments were sourced from surveys completed by practising New Zealand dentists. Earnings (from 1978) and personal income data (full population from 2000 and by ethnicity from 2008) were sourced from Statistics NZ and NZ Official Yearbooks. Inflation-adjusted changes in average fees, weekly personal earnings and income were calculated as a percentage change from 1978 levels for fees and earnings and from 2000 for personal income.

Results: For the five dental treatments with data available from 1978 to 2023, fees increased in the range of 75%-236%, while earnings increased by 46% over the same period. Fees for other treatments (with data available from 1981 to 2009) similarly increased and mostly surpassed changes in earnings. From 2008 to 2023 the overall increase in personal income (about 21% across all ethnic groups) kept pace with the rising cost of most treatments. However, due to persistent income inequalities, in 2023, Māori and Pasifika would need to spend a higher proportion of their weekly income (approximately 16% and 23% respectively) to receive the same dental treatments as NZ Europeans.

Conclusions: Fees for dental treatments have risen markedly in recent decades, more sharply than the price of other goods and services.

Clinical practice guidelines aim to enhance the quality, equality and consistency of care but often demand more time than is available, rendering adherence impractical and exceeding feasible resources. The 2017 introduction of a new periodontal classification system by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) sought to refine clinical and epidemiological practices by serving as the basis for clinical practice guidelines and epidemiological investigations around the world. Following this classification, the EFP recommends supportive periodontal care visits every 3-12 months for all periodontitis cases. Given that in Norway, approximately 72% of the adult population are identified as periodontitis cases under the current AAP/EFP case definition, this poses a significant demand on healthcare resources. We calculated that between 60% and 70% of all estimated available working hours available for adult dental care provided by dentists and dental hygienists in Norway in 2017 would be spent on supportive periodontal care visits alone if the recommendations were to be met. This situation calls for a reevaluation of disease definitions and clinical practice guidelines to ensure they are practical, financially feasible and patient-outcome relevant.

Objectives: To determine the effect of social mobility on self-perceived oral health (SPOH) by: (i)characterizing patterns of social mobility from birth to adulthood and (ii)assessing their influence on SPOH among British adults.

Methods: A secondary data analysis of the 1970 British Cohort Study. Data were collected at birth and at 5, 10, 16, 26, 30, 34, 38, 42 and 46 years of age. Social class (SC) was indicated by parental SC from birth to age 16 and own SC from ages 26 to 42. At age 46, SPOH was measured using a single question. Sex, ethnicity, country and residence area were included as potential confounders. Latent class growth analysis (LCGA) was used to identify trajectories of exposure to non-manual SC over time, instead of predetermined categories.

Results: LCGA identified four social mobility patterns: stable high, stable low, upwardly mobile and downwardly mobile; the time for the change in SC happening between 16 and 26 years. A total of 9657 participants were included. In the crude model, stable high had lower odds (OR: 0.67, 95% CI: 0.59-0.76), while downward mobility and stable low had higher odds (OR: 1.36, 95% CI: 1.15-1.61 and OR: 1.57, 95% CI: 1.40-1.77) of poor SPOH than upward mobility. These results were corroborated in the fully adjusted model; being female and living in rural areas was also associated with lower odds (OR: 0.64, 95% CI: 0.59-0.71 and OR: 0.90, 95%CI: 0.80-1.00) of poor SPOH.

Conclusion: Social mobility significantly affects SPOH in British adults. Those in non-manual SC have better SPOH than those in manual SC. When compared to upward mobility, downwardly mobile individuals report bad SPOH more frequently, evidencing that current SC influences oral health in a slightly greater measure than early years SC.

Objectives: The aim of the study was to assess patterns of longitudinal changes in caries status among school-going children in Singapore.

Methods: Dental records for a single cohort of students who received dental examinations in six standard examination years between 2009 and 2017 were analysed (n = 24 699). Group-based trajectory modelling with a zero-inflated Poisson distribution was carried out to determine dental caries trajectories in the permanent dentition. Associations between sociodemographic factors and trajectory group membership were assessed using multinomial logistic regression.

Results: The predicted population distribution across the four caries trajectory groups identified was 65.0% ('none'), 16.8% ('low'), 14.8% ('medium') and 3.4% ('high'). The 'none' trajectory group had a decayed, missing and filled teeth (DMFT) score of 0 throughout the 8 years. Higher baseline DMFT counts and nonlinear increases in DMFT scores were noted for the 'low', 'medium' and 'high' trajectory groups. The correlation coefficient between DMFT counts in years 6 and 8 was 0.91, as compared to 0.77 between baseline and year 1. Factors associated with the 'high' caries trajectory include lower socio-economic status, female gender, Chinese race (compared to the Indian race), enrolment in primary schools in the Eastern and Western regions of Singapore, and enrolment in public secondary schools.

Conclusions: Under a nationwide school dental service, four trajectory patterns of caries counts in the permanent dentition were identified over 8 years. Among students in the 'low', 'medium' and 'high' trajectory groups, greater caries increment was noted during the transition from primary to secondary school. The correlation between DMFT counts in successive examinations was stronger in older than younger ages.

Objectives: Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old.

Methods: Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts.

Results: Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R² = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation.

Conclusions: Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.