JDR Clinical & Translational Research最新文献

Introduction: Canada's national health insurance historically excluded dental care until the introduction of the Interim Canada Dental Benefit (CBD) in October 2022. This represented a paradigm shift toward enhancing dental care accessibility for children younger than 12 y from lower-income families. This study investigated parents' perspectives on access to oral health care and the Interim CDB.

Methods: The Strategic Counsel for Health Canada collected data from participants across Canada using an online survey administered in March 2023. Data were administered to parents of children younger than 12 y with a household income less than $90,000. The survey included 45 questions covering demographics, barriers to accessing dental care, and awareness of the Interim CBD. Paired/overlap t test for means and paired/overlap z test for percentages were performed, with statistical significance set at P ≤ 0.05.

Results: A total of 2,203 participants completed the survey, with a response rate of 65%. Most participants expressed concerns about the costs (90.9%) and accessibility (80.9%) of dental care, indicated that regular dental visits for children are important (97.2%), and would take their children more frequently to dental appointments if they had extra money (79.9%). Some of the barriers preventing regular dental visits for children included the costs of service and transportation and lack of insurance. Most parents supported the Interim CDB (87%), with the greatest support coming from the provinces of Manitoba and Saskatchewan (90.4%).

Conclusion: This research underscores the imperative for ongoing evaluation and policy refinement to ensure the Canadian Dental Care Plan (CDCP) effectively addresses the nuanced needs of Canadian families, fostering a more inclusive and accessible dental care system. Parents' concerns regarding dental care and their support for the Interim CDB signal a clear mandate for improving program outreach and accessibility through the CDCP.Knowledge Transfer Statement:This study showed the significant concerns reported by survey participants about dental care affordability in Canada and the highly positive perception of the Interim Canada Dental Benefit (CDB). This supports the necessity of programs such as the CDB and Canadian Dental Care Plan, which are crucial for the success of a policy intervention. Concern about accessing dental services, despite the availability of insurance, indicates ongoing barriers to dental care, suggesting areas for future policy refinements.

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.

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: 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.

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.

The objective of this study is to estimate the causal effect of tooth loss on the critical outcome of COVID-19, using 3 different propensity score methods. This retrospective study included patients aged >35 y with a diagnosis of COVID-19 between January 2020 and July 2021 at 2 hospitals in the Netherlands. The independent variable was number of teeth, dichotomized into 0 to 20 teeth (treatment) and 21 to 28 teeth (control). The critical outcome of COVID-19 (intensive care unit [ICU] admission and/or death) was the dependent variable. Potential confounders included patients' demographics, lifestyle habits, medical conditions, COVID-19-related parameters, and hospitals. Three different propensity score methods were used to balance the baseline characteristics between the treatment and control groups: including propensity score matching (PSM), inverse propensity score weighting (IPW), and marginal mean weighting through stratification (MMWS). Both univariate and multivariate logistic regression analyses were performed to assess the causal association between tooth loss and the critical outcome of COVID-19 after the propensity methods. A total of 399 patients were included in the analyses. The multivariate logistic regression analysis controlling for the confounders revealed a statistically significant association between tooth loss and the critical outcome of COVID-19 across all the 3 propensity score methods: PSM (causal risk ratio [cRR]: 2.00; 95% confidence interval [CI]: 1.07-3.74; P = 0.03), MMWS (cRR: 1.78; 95% CI: 1.07-2.06; P = 0.03), and IPW (cRR: 1.85; 95% CI: 1.09-3.15; P = 0.02). Tooth loss has a statistically significant causal effect on the critical outcome of COVID-19. Patients with fewer teeth have a higher risk of ICU admission or mortality due to COVID-19.Knowledge Transfer Statement:The findings of this study can help clinicians and policymakers recognize the important role of oral health in COVID-19 prognosis. By encouraging health care professionals to integrate oral health assessments into comprehensive evaluations, the study promotes more accurate risk stratification for COVID-19 prognosis. This enables early interventions and better management of high-risk patients, ultimately leading to improved health outcomes by preventing critical outcomes of COVID-19 and enhancing patient care.

Introduction: Children accessing early childhood intervention due to developmental concerns or disability may be less likely to receive regular dental care compared with the general pediatric population. This qualitative study explores the perspectives of parents and carers regarding their children's experiences with dental services.

Methods: A qualitative descriptive design was used to study families accessing early childhood intervention services at a community health service in Melbourne, Australia. Convenience and purposive sampling was used to recruit families of children aged 0 to 6 y. Semi-structured interviews were conducted, recorded, and analyzed using thematic analysis to explore perspectives on the oral health needs and experiences of families.

Results: Participants included 11 parents of children aged 1.5 to 6.4 y. Parents were primarily mothers, with 1 interview including both parents and another including the father. Three themes were developed regarding child and family experiences, and 3 themes were developed relating to opportunities to improve dental care as part of early childhood intervention.

Discussion: This study highlighted the anxiety and distress faced by children with complex needs and their families in the traditional dental environment setting. Sensory sensitivities led to avoidance of dental visits and compromise of oral health status. A holistic preventative approach emphasizing desensitization coupled with improved practitioner training in disability awareness could mitigate anxiety. Systemic barriers, including fragmented health care and inadequate support networks, further impeded access. Reforms prioritizing person-centered care are essential to address these unmet needs.

Conclusion: This study highlighted the need for tailored resources, integrated care models, accessible services, sensory-friendly environments, and flexible approaches to dental care to improve oral health outcomes for children accessing early childhood intervention. Future research should explore these issues from the perspective of health care providers and investigate co-designed interventions to address the identified barriers.Knowledge Transfer Statement:The results of this study can be used to inform patient-centered approaches to dental care for children with developmental concerns and/or disability who are accessing early childhood intervention services. The perspectives of families suggest that clinicians, health services, and policymakers all play an important role in improving dental experiences for children and their families.

Introduction: The oral microbiome may influence brain health and contribute to cognitive decline. However, little evidence exists on the potential modifying role of the oral microbiome in the relationship between tooth loss and cognitive performance. This study aimed to investigate the interaction effects between tooth loss and oral dysbiotic status on cognitive performance.

Methods: Data were from the 2011-2012 National Health and Nutrition Examination Survey. The sample included 677 adults aged 60 to 69 y. Cognitive performance was assessed by the Consortium to Establish a Registry for Alzheimer's Disease, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test. Significant tooth loss was defined as a loss of ≥10 permanent teeth out of 28. A high dysbiotic index was defined as being in the upper tertile of the ratio of periodontal disease-associated bacteria (Treponema, Porphyromonas, and Tannerella) to healthy bacteria (Rothia and Corynebacterium).

Results: A multivariable linear regression model showed a significant interaction effect between tooth loss and dysbiotic index on the AFT (b = -1.87, P = 0.03), indicating that participants with a higher dysbiosis index and fewer missing teeth scored lower on the AFT.

Conclusions: The effect of tooth loss on verbal fluency depends on oral bacterial imbalances: if there is significant tooth loss, bacterial imbalances may not be important. However, when fewer teeth are lost, high bacterial imbalances may account for lower verbal fluency. These findings suggest that maintaining periodontal health aimed at decreasing oral dysbiosis should be promoted among older adults in the community.Knowledge Transfer Statement:Our findings highlight the importance of preserving the health of the teeth and not just retaining the teeth. Oral health awareness and good oral hygiene practice should be further promoted among older adults in the community.