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Association between overweight/obesity and dental outcomes in early childhood: Findings from an Australian cohort study. 幼儿期超重/肥胖与牙病之间的关系:澳大利亚队列研究的结果。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-09-04 DOI: 10.1111/cdoe.13006
S D Leary, D H Ha, T Dudding, L G Do

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.

目标:口腔健康是整体健康和幸福的重要组成部分,与肥胖有着共同的风险因素,如不良饮食。已发表的评估幼儿期肥胖与口腔健康之间关系的文献很少,而且不一致。本研究的目的是根据澳大利亚影响口腔健康的母婴生活事件研究(SMILE)出生队列研究中收集的 2 岁和 5 岁儿童的数据,调查超重/肥胖(以体重指数衡量)与牙科结果(龋齿、牙菌斑指数和牙龈指数)之间的横向和纵向关联,同时考虑潜在的混杂因素:本研究使用了 1174 名 SMILE 参与者的数据。使用修正泊松族的广义线性回归模型评估了超重/肥胖与牙科结果之间的关系,并使用对数链接估算了患病率比率。在对潜在混杂因素进行最小调整和完全调整后,对横截面和纵向模型进行了拟合:大约 12% 的参与者在 2 年时超重/肥胖,9% 的参与者在 5 年时超重/肥胖。2至5年间,龋齿患病率从约4%上升至24%,至少轻度牙菌斑堆积从37%上升至90%,至少轻度炎症从27%上升至68%。超重/肥胖与龋齿患病率之间没有关联;对年龄和性别进行调整后,2 年的横截面患病率比 (PR) [95% 置信区间 (CI)]为 0.9 (0.3, 2.4),5 年的横截面患病率比为 1.0 (0.6, 1.5),2 年的超重/肥胖和 5 年的龋齿患病率比为 1.0 (0.6, 1.5)。其他牙科结果的患病率比值都在 1 左右,在对其他混杂因素进行调整后也是如此:结论:在这批学龄前儿童中,超重/肥胖与龋齿、牙菌斑指数或牙龈指数之间没有关联。然而,随着儿童年龄的增长,两者之间可能会出现关联,因此有可能在不久的将来将分析范围扩大到7岁时收集的数据。
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引用次数: 0
Specifying a target trial protocol to estimate the effect of preconception treatment of periodontitis on time-to-pregnancy: A commentary and applied example. 明确目标试验方案,估算孕前治疗牙周炎对怀孕时间的影响:评论与应用实例。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-21 DOI: 10.1111/cdoe.13000
Julia C Bond, Brenda Heaton, Raul I Garcia, Kenneth J Rothman, Lauren A Wise, Matthew P Fox, Eleanor J Murray

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.

背景:目标试验框架是作为一种设计和分析观察性流行病学研究的策略而开发的,目的是减少分析决策造成的偏差。它包括设计一个假设的随机试验来回答一个感兴趣的问题,并系统地考虑如何使用观察数据来模拟试验的每个组成部分:我们描述了假定目标试验和仿真方案的开发过程,以评估孕前牙周炎治疗对怀孕时间的影响。我们利用孕前队列在线研究(PRESTO)的数据,将我们的例子建立在现有观察数据的基础上。我们讨论了每个试验组成部分的决策过程以及遇到的局限性:结果:我们的目标试验应用揭示了数据的局限性,这使我们无法进行提议的模拟。我们讨论了数据质量的影响,并为有兴趣在口腔流行病学领域进行试验仿真的研究人员提供了建议:讨论:目标试验框架如果应用得当,有可能提高口腔健康观察研究的有效性:我们鼓励在口腔健康观察研究领域广泛采用目标试验框架,并证明其作为确定未来研究方向的工具的价值。
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引用次数: 0
Caries lesions progression in adults: A prospective 2-year cohort study. 成人龋齿病变进展:一项为期两年的前瞻性队列研究。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-19 DOI: 10.1111/cdoe.13005
Hoda Abdalla, Paul J Allison, Sreenath A Madathil, Jacques E Veronneau, Natallia Pustavoitava, Svetlana Tikhonova

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 ICDAS3 + 4 caries lesions progression was 1.41 (CI 95% 1.16, 1.70) than ICDAS1 + 2 lesions. The RR for ICDAS1 + 2, active and ICDAS3 + 4, active lesions was 1.78 (CI 95%, 1.40, 2.27) and 1.97 (CI 95%, 1.53, 2.55), respectively than ICDAS1 + 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.

目的:龋齿是全球最普遍的慢性非传染性疾病之一。考虑到病变的严重程度、活动性和牙齿表面特征,目前还缺乏有关龋病进展的证据,尤其是在成年人群中。本研究旨在调查与非活动性龋损相比,成人原发性活动性龋损在两年随访期内对龋病进展的影响程度,同时考虑到龋病的严重程度、牙齿表面和牙齿类型:方法:采用白俄罗斯一家工厂工人队列的前瞻性研究数据集。研究对象年龄在 18-64 岁之间,拥有 20 颗或 20 颗以上天然牙齿。参与者在两年内接受了两次临床检查,并填写了一份自我报告问卷。一名经过校准的检查员使用国际龋病检测和评估系统(ICDAS)和 Nyvad 系统对龋损进行评估。主要结果是龋病的进展情况。如果龋损的严重程度达到更高的阶段、修复或因龋坏而缺失/脱落,则被归类为 "进展"。研究采用多层次泊松回归法估算龋齿基线特征与龋病进展之间的关系:在 495 名参与者中,有 322 人完成了基线和 2 年后的临床检查,自然减员率为 35%。基线时DS1-6和DS5-6活动性病变的发生率分别为83.8%和64.8%。两年后,24%的活动性非凹陷龋和31%的活动性微凹陷/阴影龋病变进展,而15%的非活动性龋病变(非凹陷或微凹陷/阴影)进展。与 ICDAS1 + 2 相比,ICDAS3 + 4 龋损进展的调整率比(RR)为 1.41(CI 95% 1.16,1.70)。与 ICDAS1 + 2 非活动性病变相比,ICDAS1 + 2 活动性病变和 ICDAS3 + 4 活动性病变的 RR 分别为 1.78(CI 95%,1.40,2.27)和 1.97(CI 95%,1.53,2.55)。与光滑表面的病变相比,近端表面以及凹陷和裂隙的龋病进展的RR分别为1.57(CI 95%,1.30,1.89)和1.37(CI 95%,1.11,1.67):在龋病活跃期超过 2 年的成年人中,大多数非龋和微凹/阴影活跃期和非活跃期龋损没有发展。在出现进展的龋损中,较严重的龋损比不太严重的龋损更容易出现进展;活跃的龋损比不活跃的龋损更容易出现进展。窝沟龋和近端龋比表面光滑的龋病更容易发展。
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引用次数: 0
Remoteness-attributable financial inequality in dental service utilization in Australian older adults: A Blinder-Oaxaca decomposition. 澳大利亚老年人牙科服务使用中可归因于远程的经济不平等:布林德-瓦哈卡分解法。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-18 DOI: 10.1111/cdoe.13004
Arash Ghanbarzadegan, Xiangqun Ju, Woosung Sohn, Lisa Jamieson

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.

目的:尽管口腔健康对整体健康和生活质量有影响,但在老龄健康问题中却经常被忽视。澳大利亚老年人,尤其是农村和偏远地区的老年人,在获得口腔保健服务方面面临困难。这项研究的目的是调查造成澳大利亚老年人口获得牙科服务的经济障碍的因素,这些因素与他们的居住地点有关:研究对象包括澳大利亚65岁及以上成年人的加权样本,这些样本来自2017-18年开展的一项名为 "全国成年人口腔健康研究"(NSAOH)的人口调查。研究人员进行了描述性分析,并生成了交叉表,以调查结果、暴露和协变量的分布情况,包括性别、教育水平(最高教育水平)、等值家庭收入、牙科保险、优惠卡拥有量、支付牙科账单的困难程度和上次牙科就诊情况。使用布林德-瓦哈卡分解反事实分析法探讨了居住地对人们获得牙科服务的经济困难的潜在影响:研究结果表明,26.2%(95% CI:24.3-29.3)的大城市居民和 30.1%(95% CI:26.9-33.3)的农村居民因费用问题而避免或推迟看牙医。分解分析表明,53.8%的因费用而避免或推迟牙科就诊流行率的差异可由所选变量解释,46.2%的差异仍无法解释。贡献最大的解释变量是支付 200 美元牙科账单的困难,占差异的 62.4%,其次是牙科保险、最后一次牙科就诊和等值家庭收入,分别解释了差异的 42.1%、20.8% 和 14.9%:结论:与大城市人口相比,地区/偏远地区人口在获得牙科保健服务方面面临更多的经济障碍,已确定的因素在这些差异中占了很大比例。根据研究结果,建议包括扩大公共牙科服务的覆盖面、评估优惠卡机制和倡导定期看牙,以减少牙科保健机会的差异。
{"title":"Remoteness-attributable financial inequality in dental service utilization in Australian older adults: A Blinder-Oaxaca decomposition.","authors":"Arash Ghanbarzadegan, Xiangqun Ju, Woosung Sohn, Lisa Jamieson","doi":"10.1111/cdoe.13004","DOIUrl":"https://doi.org/10.1111/cdoe.13004","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999553","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
Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: A systematic review and meta-analysis of economic evaluations. 牙周治疗改善 2 型糖尿病疗效的效率:经济评估的系统回顾和荟萃分析。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-16 DOI: 10.1111/cdoe.12999
Gustavo Sáenz-Ravello, Marianela Castillo-Riquelme, Cristóbal Cuadrado, Jorge Gamonal, Mauricio Baeza

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.

背景:评估牙周治疗(PT)在改善患有2型糖尿病(T2DM)和牙周炎的成人的糖尿病相关预后方面的效率,提供经济评估(EE)的最新综合结果:方法:两位审稿人独立检索了七个数据库和一个登记册,以查找截至 2024 年 5 月 8 日发表的文章。纳入了评估牙周治疗与不治疗或其他牙科治疗效果的研究。使用Cochrane RoB 2、ROBINS-I和ECOBIAS工具对EE第一阶段进行偏倚风险评估,使用CHEERS检查表和NICE质量评估工具对整体EE进行偏倚风险评估。对文章进行了定性和定量综合,并采用 GRADE 方法进行评估:结果:共纳入 11 项研究。PT 可降低总医疗费用,包括住院和门诊费用、糖尿病相关费用及其他药物费用(低度至中度确定性)。根据三项高质量的基于模型的成本效用分析(高度确定性),估计总增量净效益为12 348美元(2022年货币,95% CI 12 195-12 500):讨论:将牙周治疗纳入 T2DM 和牙周炎患者的综合治疗具有成本效益。讨论:将牙周治疗纳入 T2DM 和牙周炎患者的综合治疗具有成本效益。未来需要开展研究,以确保这些研究结果的可移植性,并为不同国家的决策者提供信息:PROPERCO CRD42023443146.
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引用次数: 0
The declining affordability of dental care in New Zealand from 1978 to 2023. 从 1978 年到 2023 年新西兰牙科保健费用的下降。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-16 DOI: 10.1111/cdoe.12998
Ryan Gage, Jonathan Broadbent, William Leung, Martin Lee, Trudy Sullivan

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.

背景:2020 年代初,近一半的新西兰成年人表示,治疗费用使他们无法获得牙科护理,毛利人、太平洋岛民和生活在最贫困地区的人中这一比例更高。无法负担牙科保健费用的原因可能是牙科服务费用相对于个人收入而言随着时间的推移而增加,新西兰在1978年至1993年期间就有这方面的记录。然而,新西兰并没有对牙科保健的可负担性如何变化进行当代估算。本研究的目的是分析1978年至2023年期间新西兰人牙科治疗费用和个人收入的变化情况,并探讨不同种族在牙科保健负担能力方面的差异:牙科治疗的平均费用来自新西兰执业牙医完成的调查。收入(从1978年开始)和个人收入数据(从2000年开始的全人口数据和从2008年开始的不同种族数据)来自新西兰统计局和《新西兰官方年鉴》。经通货膨胀调整后的平均收费、每周个人收入和收入的变化是按与1978年收费和收入水平相比的百分比变化以及与2000年个人收入相比的百分比变化计算的:结果:对于从 1978 年到 2023 年有数据可查的五种牙科治疗,费用增长幅度在 75%-236% 之间,而同期收入增长了 46%。其他治疗费用(1981 年至 2009 年的数据)也有类似增长,且大部分超过了收入的变化。从 2008 年到 2023 年,个人收入的总体增长(在所有种族群体中约为 21%)与大多数治疗费用的增长保持同步。然而,由于持续存在的收入不平等,到2023年,毛利人和太平洋岛民将需要花费更高比例的周收入(分别约为16%和23%),才能接受与新西兰欧洲人相同的牙科治疗:近几十年来,牙科治疗费用明显上涨,涨幅超过了其他商品和服务的价格。
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引用次数: 0
Applying current European periodontitis clinical practice guidelines is not feasible even for the richest countries in the world. 即使对于世界上最富裕的国家来说,采用现行的欧洲牙周炎临床实践指南也是不可行的。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-15 DOI: 10.1111/cdoe.13003
Eero Raittio, Jostein Grytten, Rodrigo Lopez, Carl Christian Blich, Mario Vianna Vettore, Vibeke Baelum

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.

临床实践指南旨在提高护理的质量、平等性和一致性,但往往需要花费更多的时间,使遵守指南变得不切实际,也超出了可行的资源范围。2017 年,美国牙周病学会(AAP)和欧洲牙周病学联合会(EFP)推出了新的牙周分类系统,旨在通过作为全球临床实践指南和流行病学调查的基础,完善临床和流行病学实践。根据这一分类,欧洲牙周病学联合会建议对所有牙周炎病例每3-12个月进行一次支持性牙周治疗。在挪威,根据美国牙科协会/欧洲牙周病治疗方案目前的病例定义,约有72%的成年人被确定为牙周炎病例,这对医疗资源提出了巨大的需求。根据我们的计算,如果要达到建议的要求,2017年挪威牙医和牙科保健师为成人提供牙科保健服务的所有预计可用工时中,将有60%至70%用于支持性牙周保健就诊。这种情况要求对疾病定义和临床实践指南进行重新评估,以确保它们切实可行、经济上可行且与患者的结果相关。
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引用次数: 0
Trajectories of social class and adult self-perceived oral health. 社会阶层与成人自我感觉口腔健康的轨迹。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-08-15 DOI: 10.1111/cdoe.13001
Reem Aljubair, Elsa Karina Delgado-Angulo

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.

目的通过以下方法确定社会流动性对自我感觉口腔健康(SPOH)的影响:(i)描述英国成年人从出生到成年期间的社会流动模式,(ii)评估其对自我感觉口腔健康的影响:方法:对 1970 年英国队列研究进行二次数据分析。收集了出生时和 5、10、16、26、30、34、38、42 和 46 岁时的数据。社会阶层(SC)由出生至 16 岁期间父母的社会阶层和 26 至 42 岁期间自己的社会阶层来表示。在 46 岁时,SPOH 用一个问题进行测量。性别、种族、国家和居住地区被列为潜在的混杂因素。采用潜类增长分析(LCGA)来确定随时间推移接触非体力劳动者的轨迹,而不是预先确定的类别:LCGA确定了四种社会流动模式:稳定的高流动性、稳定的低流动性、向上流动性和向下流动性;SC发生变化的时间在16至26年之间。共纳入了 9657 名参与者。在粗略模型中,与向上流动相比,稳定度高的人发生 SPOH 不良的几率较低(OR:0.67,95% CI:0.59-0.76),而向下流动和稳定度低的人发生 SPOH 不良的几率较高(OR:1.36,95% CI:1.15-1.61 和 OR:1.57,95% CI:1.40-1.77)。这些结果在完全调整模型中得到了证实;女性和生活在农村地区也与较低的 SPOH 不良几率相关(OR:0.64,95% CI:0.59-0.71 和 OR:0.90,95%CI:0.80-1.00):结论:社会流动性对英国成年人的 SPOH 有重大影响。结论:社会流动性对英国成年人的SPOH有很大影响,非体力劳动者的SPOH优于体力劳动者。与向上流动的人相比,向下流动的人报告口腔卫生不良的频率更高,这证明目前的在职者对口腔健康的影响比早年的在职者略大。
{"title":"Trajectories of social class and adult self-perceived oral health.","authors":"Reem Aljubair, Elsa Karina Delgado-Angulo","doi":"10.1111/cdoe.13001","DOIUrl":"https://doi.org/10.1111/cdoe.13001","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981893","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
Caries trajectories from childhood to adolescence: Analysis of data from a nationwide school dental service. 从儿童到青少年的龋病轨迹:全国学校牙科服务数据分析。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-07-23 DOI: 10.1111/cdoe.12996
Sharon Hui Xuan Tan, Yik-Ying Teo, Melissa Hui Xian Tan, Wong Yim Heng, Wenjia Chen, Xiaoli Gao

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.

研究目的研究旨在评估新加坡学龄儿童龋齿状况的纵向变化模式:分析了2009年至2017年期间六个标准考试年接受牙科检查的单一学生群体的牙科记录(n = 24 699)。采用零膨胀泊松分布进行基于群体的轨迹建模,以确定恒牙区的龋齿轨迹。使用多项式逻辑回归评估了社会人口因素与轨迹组别成员之间的关联:在已确定的四个龋齿轨迹组中,预测的人口分布为 65.0%("无")、16.8%("低")、14.8%("中")和 3.4%("高")。无 "轨迹组在整个 8 年中的蛀牙、缺失牙和补牙(DMFT)得分均为 0。低"、"中 "和 "高 "轨迹组的基线 DMFT 计数较高,DMFT 分数呈非线性增长。第 6 年和第 8 年的 DMFT 计数之间的相关系数为 0.91,而基线和第 1 年之间的相关系数为 0.77。与 "高 "龋齿轨迹相关的因素包括较低的社会经济地位、女性性别、华裔(与印度裔相比)、就读于新加坡东部和西部地区的小学以及就读于公立中学:在全国范围内开展的学校牙科服务中,发现了 8 年中恒牙龋齿数量的四种轨迹模式。在 "低"、"中 "和 "高 "轨迹组的学生中,从小学升入中学的龋齿增量更大。连续检查的 DMFT 计数之间的相关性在高年级比低年级更强。
{"title":"Caries trajectories from childhood to adolescence: Analysis of data from a nationwide school dental service.","authors":"Sharon Hui Xuan Tan, Yik-Ying Teo, Melissa Hui Xian Tan, Wong Yim Heng, Wenjia Chen, Xiaoli Gao","doi":"10.1111/cdoe.12996","DOIUrl":"https://doi.org/10.1111/cdoe.12996","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to assess patterns of longitudinal changes in caries status among school-going children in Singapore.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751246","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
Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study. 人口普查区地理空间分析比较加利福尼亚老年人牙齿脱落与健康的社会决定因素:生态研究。
IF 1.8 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2024-07-19 DOI: 10.1111/cdoe.12995
Gabriel Tse Feng Chong, Stuart A Gansky

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.

目的:单凭个人层面的健康社会决定因素(SDOH)衡量标准可能不足以解释老年人中存在的镶牙差异。因此,作者研究了加州年龄≥65 岁的成年人中人口普查区级 SDOH 和居住地种族隔离措施与拔牙的相关性:解释变量来自健康场所指数(HPI)、国家癌症研究所和多样性数据儿童网站。拔牙症结果变量来自美国疾病预防控制中心(CDC)的PLACES小地区估计值,该估计值来自2018年行为风险因素监测系统数据。估计了皮尔逊和斯皮尔曼等级相关性。进行了多元线性回归和多重共线性评估。全球莫兰 I 统计评估了普查区内的部分自相关性:结果:皮尔逊相关性和斯皮尔曼相关性相似,支持稳健性。HPI 是衡量地区优势的指标,与牙齿缺失率呈强烈负相关[相关系数:-0.87;95% 置信区间 (CI):-0.87, -0.86]。HPI 每变化 1.0,龋齿患病率估计就会下降 5.9%(线性模型调整 R2 = 0.78)。仅有西班牙裔或黑人的种族隔离人口普查区与蛀牙患病率呈正相关[分别为 0.60,95% CI:0.58,0.62;0.33,95% CI:0.31,0.35]。在仅有非西班牙裔白人的人口普查区,情况则相反[-0.57,95% CI:-0.58,-0.55]。关于缺牙症(0.13)和 HPI 分数(0.19)的全球 Moran's I 统计显著(均为 p 结论):人口普查区内较高的不利条件和少数民族种族隔离与蛀牙流行率呈正相关。未来的研究和政策应考虑改善 SDOH 的可能干预措施,以减少口腔健康不平等。
{"title":"Census tract geospatial analysis comparing social determinants of health with tooth loss in California seniors: An ecologic study.","authors":"Gabriel Tse Feng Chong, Stuart A Gansky","doi":"10.1111/cdoe.12995","DOIUrl":"https://doi.org/10.1111/cdoe.12995","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 R<sup>2</sup> = 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731076","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
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Community dentistry and oral epidemiology
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