JDR Clinical & Translational Research最新文献

Fluoridation of community water supplies constitutes one of the most effective public health interventions for preventing dental caries. In recent years, questions have been raised about its effectiveness and safety. This study aims to systematically review and summarize the existing evidence on community water fluoridation (CWF) and dental caries in permanent and deciduous teeth. Five databases and 3 gray databases were searched for relevant studies. Paired reviewers independently screened the studies, extracted data, and assessed their methodological quality. Standard mean differences (SMDs) for dmf(s)/DMFT(S) (decayed, missing, and filled teeth/surface) and odds ratios (ORs) for caries prevalence were measured between exposure or not to CFW for deciduous and permanent teeth. Subgroup analysis was performed to explore whether the study design, continent, or decade of publication changed the point estimates. Seventy-four studies were included in the qualitative analysis: 57 cross-sectional, 13 before-and-after, and 4 cohort studies. Thirty-two studies provided sufficient data for meta-analyses. The overall SMD of DMFT and dmf in those exposed to CWF compared with unexposed were -0.32 (95% confidence interval [CI]: -0.48 to -0.17, I² = 96%, P < 0.01) and -0.30 (95% CI: -0.39 to -0.21, I² = 88%, P < 0.01), respectively. The prevalence of caries was smaller in those exposed to CWF for both the permanent (OR = 0.52, 95% CI: 0.43 to 0.63) and deciduous (OR = 0.60, 95% CI: 0.48 to 0.76) dentitions. Study design, continent, or decade of publication satisfactorily explained the heterogeneity between studies. Communities where water was fluoridated experienced less caries and differences expressed in terms of SMD and prevalence (OR) where of high magnitude, both in children and in adults. The results of the meta-analyses revealed significant differences in caries experience and prevalence in favor of CWF, which represents an effective and comprehensive public health intervention for caries prevention, especially in the primary dentition.Knowledge Transfer Statement:Based on the published literature, the results of this study show that fluoridation of community water supplies is still an effective public health intervention to prevent dental caries, both in children and adults, despite the widespread availability of fluoride-containing dental products, especially toothpaste. This result adds to the existing evidence to support its incorporation into public oral health policies.

Introduction: Dental caries is a significant public health problem in the United States. The evidence on the association between lead exposure and dental caries is conflicting because the impact of childhood lead exposure on the prevalence of caries in young adults has not been evaluated in prospective cohort studies.

Objective: To assess the association of prenatal and postnatal childhood lead exposure with dental caries in young adults living in Cincinnati, Ohio, United States.

Methods: We examined 206 predominately African American participants aged 16 to 22 y in the Cincinnati Lead Study, a prospective cohort study measuring prenatal and postnatal blood lead levels from the maternal, neonatal, and postnatal periods (from 3-78 mo of age) for dental caries. Caries experience was quantified as the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS) in permanent teeth. The impact of average childhood blood lead levels on stimulated and unstimulated salivary flow rate was also assessed.

Results: A significant positive association between average childhood blood lead levels and DMFS and DMFT was observed in young adults. A 2-fold increase in DMFS between 6 and 15 µg/dL, followed by a downturn at the highest blood lead quintile (P < 0.05), was observed. Statistically significant covariates were the number of sealants present, lactobacilli count in saliva, and maternal high school education. When adjusted for mutans streptococci, ever smoking, flossing, and the number of adults and children living in the household, the average childhood blood lead levels were associated with reduced salivary flow rate.

Conclusions: Childhood blood lead levels were associated with an increased DMFS/DMFT in young adulthood.Knowledge Transfer Statement:The results of this study support the need for continued reduction in lead exposure-especially in low- and middle-income countries-to further reduce the risk of dental caries in permanent teeth.

Introduction: Implicit bias is a form of unconscious bias that can affect judgment, decisions, and behaviors.

Objectives: This scoping review examined what scientific literature exists about implicit bias demonstrated by dental/dental hygiene students and providers and, when possible, how these implicit biases are associated with patients' oral health outcomes.

Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). This review included English-language PubMed peer-reviewed studies meeting inclusion criteria, published through October 2023, measuring the implicit bias of dental/dental hygiene students or professionals and how such bias can affect patient oral health outcomes.

Results: A total of 363 records were found. After removing duplicates (n = 114) and title screening (n = 60), 54 abstracts were screened, 24 reports were assessed, and 10 were included in the final review. Implicit bias was assessed using the Implicit Association Test (IAT), Brief IAT (BIAT), and Color-Blind Racial Attitudes Scale (CoBRAS). BIAT scores revealed a pro-White unconscious racial bias in clinical decision-making among dental professionals, and additional IAT results suggested implicit racial preferences for European Americans over African Americans; non-White participants showed more positive implicit preferences toward African Americans in comparison with White participants. Studies using CoBRAS suggest moderate levels of color-blind racial attitudes among students and professionals, indicating an unawareness of racism and a need to further understand the implications of bias on patient outcomes.

Conclusion: Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.Knowledge Transfer Statement:Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.

Objectives: Common reference values for defining healthy salivary flow rates were established decades ago. However, these parameters may no longer accurately reflect normal conditions in contemporary populations. This study aimed to establish average unstimulated (USF) and stimulated (SSF) salivary flow rates in adults as reference values for normality and to compare healthy individuals with those presenting hyposalivation-associated conditions (HACs).

Methods: Searches were conducted across 8 databases and the gray literature. Included studies were those with a group of healthy adult individuals (>18 and <60 y old) who underwent a quantitative salivary profile assessment presented in milliliters per minute (mL/min). Studies were excluded if they lacked a healthy group or included children, adolescents, or elderly, among other criteria. The methodological quality of the included studies was assessed using a JBI instrument. An effect size meta-analysis was performed to estimate the average salivary flow in healthy individuals using the restricted maximum likelihood method. Pairwise meta-analyses comparing salivary flow between individuals with HACs and healthy controls were performed using a random effects model. Subgroup analyses and meta-regression were conducted to examine the influences of latitude, study year, and quality. Prospero: CRD42024449389.

Results: A total of 63 studies, including 3,167 healthy individuals and 2,470 individuals with HAC (ages 18 to 60 y, 60% female), were included. The average USF in healthy individuals was 0.82 mL/min (95% confidence interval [CI] = 0.63-1.01), and the average SSF was 1.48 mL/min (95% CI = 1.31-1.65). The mean difference in salivary flow between individuals with HAC and healthy controls was 0.43 mL/min for SSF (95% CI = 0.04-0.76, P = 0.03) and 0.42 mL/min for USF (95% CI = 0.14-0.71, P = 0.004). Meta-regression and subgroup analysis revealed that latitude, study year, and methodological quality did not explain the heterogeneity.

Conclusions: The average salivary flow in healthy individuals may be substantially higher than the current threshold values for USF but not for SSF. These values may represent the actual global salivary flow rates.Knowledge Transfer Statement:The limit of the confidence intervals could be adopted as the threshold for normality. Nearly 0.4 mL/min might be the clinically relevant salivary flow difference between healthy individuals and those with HAC.

Introduction: Maintaining oral health during pregnancy is essential for women's health, yet awareness of and access to dental care among pregnant women in China remain limited.

Objectives: We aim to assess the knowledge, attitudes, and dental care-seeking behaviors of pregnant women in 2 regions of China and identify the key factors predicting prenatal dental care utilization.

Methods: Data were collected via an online survey from pregnant women recruited through convenience sampling at 2 hospitals in Beijing municipality and Haikou city, Hainan province. The survey included knowledge, attitudes, and sociopsychological factors that may influence dental care utilization. Principal component analysis and multivariate logistic regression were applied to assess the roles of knowledge and attitudes in prenatal dental care utilization.

Results: A total of 248 participants completed the survey. Among them, 39.92% consulted a dentist when experiencing dental issues, while 63.31% consulted any health care professional, including dentists and obstetricians. Participants from Hainan were significantly less likely to consult a dentist as compared with those from Beijing (odds ratio [OR], 0.01; 95% CI, 0.00 to 0.40). Regular dental care before pregnancy (principal component 1) was associated with lower odds of consulting a dentist (OR, 0.58; 95% CI, 0.37 to 0.92) and any health care professional (OR, 0.56; 95% CI, 0.35 to 0.92). Perceived severity of untreated dental issues (principal component 6) increased the odds of consulting a dentist (OR, 1.69; 95% CI, 1.22 to 2.33) and a health care professional (OR, 1.66; 95% CI, 1.21 to 2.30).

Conclusion: Geographic location and perceptions regarding dental care during pregnancy significantly influenced dental care-seeking behaviors among pregnant women. Women in less developed regions such as Hainan sought less dental care, while those aware of untreated dental risks were more likely to seek treatment. These findings highlight the importance of targeted interventions to address regional disparities and gaps in knowledge.Knowledge Transfer Statement:This study highlights key factors influencing prenatal dental care utilization among pregnant women in China, emphasizing regional disparities and the impact of knowledge and perceptions on care-seeking behaviors. Women in less developed regions, such as Hainan, were significantly less likely to consult a dentist or other health care professional as compared with women in Beijing. In addition, prior regular dental care was associated with lower odds of seeking treatment during pregnancy, and awareness of the severity of untreated dental issues increased the likelihood of seeking care. These findings underscore the need for targeted interventions to improve oral health education and access to prenatal dental care, particularly in underserved areas.

Objectives: Analyze the benefit-cost analysis of noninvasive early childhood caries (ECC) management in Latvian preschoolers versus placebo, from a health care perspective, over 12 mo.

Methods: Randomized, blinded, placebo-controlled trial (September 2020-August 2022) at Riga Stradins University, Latvia. A factorial trial was conducted with 3 interventions (placebo, silver diamine fluoride [SDF], Tiefenfluorid) and 2 recall intervals (none: 1 and 6 mo: 2), all including behavioral modification. The 6 strategies were placebo (P1, P2), SDF (SDF1, SDF2), and Tiefenfluorid (TF1, TF2). Probabilistic sensitivity analysis was calculated from the health care perspective. Costs associated with each ECC management program and associated treatments were identified and measured. Incremental benefit-cost ratios (IBCRs) were calculated to determine the margin by which each program was more beneficial than P1 (comparator). The primary outcome measure used for economic evaluation was health care complications averted, defined as teeth with pulp involvement due to dental caries. The economic costs associated with health care complications averted were quantified in monetary terms as benefits.

Results: All alternative strategies were more effective than the comparator in averting health care complications and dental caries lesions. Over 12 mo, SDF2, TF2, and P2 were dominant interventions, yielding an IBCR of -0.98, -0.80, and -0.70, respectively. SDF1 and TF1 had an IBCR of 2.95 and 10.67, respectively, rending these interventions economically beneficial but with lower return on investment.

Conclusion: Biannual SDF applications (SDF2) were the most cost-effective for ECC, significantly outperforming Tiefenfluorid^® (TF2) and placebo (P2). TF2 and P2 slightly improved over placebo (P1) due to additional behavioral modification and counseling. Implementing SDF2 in Latvia would likely reduce health care complications and costs.Knowledge Transfer Statement:This study compared 5 noninvasive early childhood caries management strategies with a placebo "no treatment" group over a 12-mo period. The primary outcome measure was health care complications averted, quantified in monetary terms. The results showed that the 6-monthly applications of SDF and fluoride varnish demonstrated cost savings compared with the placebo group. The study recommends implementing SDF and fluoride varnish into routine clinical practice to reduce health care complications and associated costs.

Background: DELIVER (DELiberative ImproVEment of oRal care quality) is a multinational project funded under the EU's Horizon Europe program that aims to improve the quality of oral health care at the practice, community, national, and international levels. It is important to understand the current situation of oral health care quality to make improvements possible. This study aimed to map oral health care priorities among stakeholders in Amsterdam, the Netherlands, and to describe how these stakeholders interacted to improve the quality of oral health care at the community level.

Methods: A situational analysis approach was used to collate data from desk research and semi-structured interviews with key informants. Interview transcripts were analyzed and grouped into main themes and subthemes using inductive coding. A situational map, a social worlds/arenas map, and a positional map were constructed to represent the community-level situation of quality improvement of oral health care.

Results: Interviews were conducted with 10 professional stakeholders (5 social/welfare workers, 3 health care professionals, 1 public health professional, and 1 municipality policy maker). Stakeholders described prioritizing at least basic oral health care and stated that it should be accessible for everyone. Other priorities included a need for simplified access to oral health care and strengthened social support. While stakeholders agreed that people should not rely on emergency funds and volunteers, they felt that it was unclear which organizations or individuals were responsible for determining access to oral health care. This led social/welfare organizations to feel a sense of responsibility and offer informal care solutions.

Conclusion: There was consensus among stakeholders about the need for social support and simplified access to oral health care for citizens. Stakeholders also emphasized the lack of clarity about who was responsible for oral health care and quality improvement at the community level, which highlighted the urgent need for improved governance, allocating responsibilities for oral health care quality improvement to all parties operating at the community level.Knowledge Transfer Statement:This study mapped the current practice of oral health care quality in Amsterdam, the Netherlands, through a situational analysis as a crucial starting point for enhancing quality improvement of oral health care at the community level. It underscored the need for clarity about responsibilities and provided insights for oral health care providers, social and welfare workers, policy makers, and researchers that could support research and policy formulation targeted at underserved populations, involving multiple stakeholders.

Introduction: Concentrated growth factor (CGF), a novel autologous platelet concentrate, has gained substantial interest for its potential role in managing oral diseases. The objective of this study is to evaluate the effectiveness of CGF in regenerative dentistry.

Methods: A systematic search was performed across MEDLINE, OVID, Scopus, Cochrane Library, Google Scholar, Web of Science, and Elsevier for publications between July 1, 2013, and July 1, 2023. Only randomized clinical trials were included. The quality of the methodology was assessed using the Cochrane Risk of Bias Tool. Data were analyzed using RevMan 5.4 software.

Results: In 3 trials treating periodontal intrabony defects, CGF combined with bone grafts showed significant superiority over bone grafts alone (P < .00001), with a mean reduction of 1.41 mm in intrabony defect depth and a mean gain of 0.55 mm in clinical attachment level (P = 0.002). For gingival recession in 5 trials, CGF combined with coronally advanced flap (CAF) was more effective than CAF alone, resulting in a mean increase in keratinized tissue width of 0.41 mm and a mean increase in gingival thickness of 0.26 mm (P < 0.00001). However, CGF combined with CAF was less effective than connective tissue graft (CTG) combined with CAF, showing a mean difference in root coverage of -15.09% and a mean difference in gingival thickness of -0.50 mm (P < 0.0001). In alveolar ridge preservation, sinus elevation, guided bone regeneration, dental implant procedures, and postextraction healing, CGF gave better values in clinical practice.

Conclusions: CGF enhances regenerative surgery outcomes for periodontal intrabony defects. Combined with CAF, CGF improves therapeutic efficacy for gingival recession, although less so than CTG with CAF. CGF shows promise in various regenerative dentistry areas. However, the absence of meta-analysis and low-quality assessments in many studies necessitates further high-quality research.Knowledge Transfer Statement:The use of concentrated growth factors (CGFs) in regenerative dentistry, within the limitation of low-quality studies, shows promising benefits in treating periodontitis infrabony defects, gingival recession, guided bone regeneration, dental implant alveolar ridge preservation, sinus elevation, and third molar extraction. Future research should focus on high-quality studies and explore combining CGF with grafting materials to enhance therapeutic outcomes in oral surgery.

Background: Understanding the predictors of toothbrushing at the 2 distinct preschool age time points will help develop and implement effective strategies specific to children's age.

Aim: To examine the effect of a family's sociodemographic status and mothers' oral health behavior on children's toothbrushing frequency at 2 different time points: 2 and 5 y of age.

Design: Secondary analysis (cross-sectional) of longitudinal data collected through a cohort study.

Results: In children aged 2 y, the likelihood of toothbrushing twice or more per day was higher than their comparative counterparts if their mother's toothbrushing frequency was twice or more per day (odds ratio [OR]: 5.63; 95% confidence interval [CI]: 4.01-7.90), if they were girls (OR: 1.36; 95% CI: 1.04-1.79), if the mother had completed tertiary education (OR: 1.48; 95% CI: 1.01-2.19) or vocational training (OR: 1.54; 95% CI: 1.01-2.33), if the household had 2 adults (OR: 2.48; 95% CI: 1.12-5.50) or 3 or more adults (OR: 2.52; 95% CI: 1.06-5.97), if the total household income was >A$120,000/year (OR: 1.62; 95% CI: 1.03-2.56), if the household had both parents (OR: 2.11; 95 % CI: 1.11-4.02). At the age of 5 y, girls whose mothers brushed their teeth twice or more per day were 1.43 (95 % CI: 1.02-2.02) and 10.53 (95% CI: 7.01-15.80) times more likely to brush their teeth more than twice or more per day than boys whose mothers brushed less than twice per day, respectively.

Conclusions: Child sex and mother's toothbrushing were the 2 main factors associated with children's toothbrushing frequency at both ages. In addition, several sociodemographic factors were associated with toothbrushing frequency at 2 y of age.Knowledge Transfer Statement:The results of this study can be used by parents, especially mothers and policy makers, as they can help promote consistent toothbrushing habits in children. This is crucial as it is a preventive measure against oral health issues and cavities. In addition, the research can play a vital role in shaping policies to improve toothbrushing practices among children between the ages of 2 and 5 y.

Objective: Chronic pain associated with temporomandibular disorders (TMDs) may reflect dynamic autonomic nervous system (ANS) effects. This pilot observational study tested the hypotheses that Characteristic Pain Intensity (CPI) scores correlated with 1) amplitude, 2) duration, and 3) power densities (amplitude/duration) of nocturnal ultradian cycling of the sympathetic and parasympathetic arms of the ANS.

Materials and methods: In accordance with institutional review board oversight and Strengthening the Reporting of Observational Studies in Epidemiology guidelines, adult subjects gave informed consent, completed Axis I and II components of Diagnostic Criteria for TMD (DC-TMD), and were trained in research protocols to record nocturnal heart rate data. Subjects were assigned to ± pain groups based on CPI scores (0 = no pain, >0 = pain). Nocturnal ultradian cycling of sympathetic and parasympathetic activities was characterized using heart rate variability measures of the percentage of the absolute value of the low-frequency power component (ms²) and normal-to-normal sinus node depolarizations >50 ms compared to total number (pNN50, %), respectively. Peaks and valleys of ultradian cycling were identified, where cycle amplitudes and durations were quantified, and sympathetic/parasympathetic power densities were calculated. The hypotheses were tested by nonparametric correlations and regression analyses, where significance was defined by P < 0.05.

Results: Of 32 individuals screened and enrolled, 18 females and 11 males completed all study protocols. Subjects produced 87 nighttime electrocardiogram recordings with an average duration of 7.7 ± 1.0 h. CPI scores ranged from 0 to 70 and were significantly higher (P = 0.032) in females (30 ± 25) than in males (10 ± 17). Nocturnal ultradian sympathetic cycling in females compared to males showed significantly higher amplitudes (P = 0.011) and lower durations (P = 0.048). CPI scores were correlated with nocturnal cycling amplitude and duration (all |R| ≥ 0.80) and the log of sympathetic/parasympathetic power densities (R² = 0.89).

Conclusion: Characteristic Pain Intensity scores were correlated with amplitudes, durations, and power densities of nocturnal ANS ultradian cycling.Knowledge Transfer Statement:Chronic myofascial pain may reflect autonomic nervous system (ANS) activity. Characteristic Pain Intensity scores of subjects were correlated with power densities of ANS ultradian cycling during sleep. Future research is needed to detect sex differences in ANS power densities in subjects with chronically painful temporomandibular disorders.