Background: Orofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels. Objective: We aimed to measure the quality of care index (QCI) for orofacial clefts worldwide. Methods: We used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios aimed at indirectly reflecting the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide, across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications. Results: Globally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI=99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimize gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world. Conclusion: Despite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.
{"title":"Global, Regional, and National Survey on Burden and Quality of Care Index (QCI) of Orofacial Clefts: Global Burden of Disease Systematic Analysis 1990-2019","authors":"Ahmad Sofi-Mahmudi, Erfan Shamsoddin, Sahar Khademioore, Yeganeh Khazaei, Marcos Roberto Tovani-Palone","doi":"10.1101/2024.03.24.24304795","DOIUrl":"https://doi.org/10.1101/2024.03.24.24304795","url":null,"abstract":"Background: Orofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels.\u0000Objective: We aimed to measure the quality of care index (QCI) for orofacial clefts worldwide.\u0000Methods: We used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios aimed at indirectly reflecting the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide, across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications. Results: Globally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI=99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimize gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world. Conclusion: Despite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140298609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1101/2024.03.12.24303742
Poojan Shrestha, Misa Graff, Yu Gu, Yujie Wang, Christy Avery, Jeannie Ginnis, Miguel Simancas Pallares, Andrew Zandona, Hyunseong Ahn, Kevin Nguyen, Danyu Lin, John Preisser, Gary Slade, Mary Marazita, Kari North, Kimon Divaris
Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS ≥3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16.2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=~487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.
{"title":"Multi-ancestry Genome-Wide Association Study of Early Childhood Caries","authors":"Poojan Shrestha, Misa Graff, Yu Gu, Yujie Wang, Christy Avery, Jeannie Ginnis, Miguel Simancas Pallares, Andrew Zandona, Hyunseong Ahn, Kevin Nguyen, Danyu Lin, John Preisser, Gary Slade, Mary Marazita, Kari North, Kimon Divaris","doi":"10.1101/2024.03.12.24303742","DOIUrl":"https://doi.org/10.1101/2024.03.12.24303742","url":null,"abstract":"Early childhood caries (ECC) is the most common non-communicable childhood disease. It is an important health problem with known environmental and social/behavioral influences that lacks evidence for specific associated genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multi-ancestry population of U.S. preschool-age children (n=6,103) participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used ICDAS criteria to measure ECC with the primary trait using the dmfs index with decay classified as macroscopic enamel loss (ICDAS ≥3). We estimated heritability, concordance rates, and conducted genome-wide association analyses to estimate overall genetic effects; the effects stratified by sex, household water fluoride, and dietary sugar; and leveraged the combined gene/gene-environment effects using the 2-degree-of-freedom (2df) joint test. The common genetic variants explained 24% of the phenotypic variance (heritability) of the primary ECC trait and the concordance rate was higher with a higher degree of relatedness. We identified 21 novel non-overlapping genome-wide significant loci for ECC. Two loci, namely RP11-856F16.2 (rs74606067) and SLC41A3 (rs71327750) showed evidence of association with dental caries in external cohorts, namely the GLIDE consortium adult cohort (n=~487,000) and the GLIDE pediatric cohort (n=19,000), respectively. The gene-based tests identified TAAR6 as a genome-wide significant gene. Implicated genes have relevant biological functions including roles in tooth development and taste. These novel associations expand the genomics knowledge base for this common childhood disease and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations of oral health.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140165532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1101/2024.03.18.24304458
Gauthier DOT, Akhilanand Chaurasia, Guillaume Dubois, Charles Savoldelli, Sara Haghighat, Sarina Azimian, Ali Rahbar Taramsari, Gowri Sivaramakrishnan, Julien Issa, Abhishek Dubey, Thomas Schouman, Laurent Gajny
Delineation of anatomical structures on dento-maxillo-facial (DMF) computed tomography (CT) or cone beam computed tomography (CBCT) scans is greatly needed for an increasing number of digital dentistry tasks. Following this process, called segmentation, three-dimensional (3D) patient-specific models can be exported for visualization, treatment planning, intervention, and follow-up purposes. Although several methods based on deep learning (DL) have been proposed for automating this task, there is no thoroughly evaluated publicly available tool offering segmentation of the anatomical structures needed for digital dentistry workflows. In this work, we propose and evaluate DentalSegmentator, a tool based on the nnU-Net deep learning framework, for fully automatic segmentation of 5 anatomic structures on DMF CT and CBCT scans: maxilla and upper skull, mandible, upper teeth, lower teeth and mandibular canal. A retrospective sample of 470 CT and CBCT scans was used as a training/validation set. The performance and generalizability of the tool was evaluated by comparing segmentations provided by experts and automatic segmentations on 2 hold-out test datasets: an internal dataset of 133 CT and CBCT scans acquired before orthognathic surgery and an external dataset of 123 CBCT scans randomly sampled from routine examinations in 5 institutions. In our internal test dataset (n = 133), the mean overall results were a Dice similarity coefficient (DSC) of 92.2 ± 6.3% and a normalized surface distance (NSD) of 98.2 ± 2.2%. In our external test dataset (n = 123), the mean overall results were a DSC of 94.2 ± 7.4% and a NSD of 98.4 ± 3.6%. The results obtained on this highly diversified dataset demonstrate that our tool can provide fully automatic and robust multiclass segmentation for DMF (CB)CT scans. To encourage the clinical deployment of DentalSegmentator, our pretrained nnU-Net model is made publicly available along with an extension for the 3D Slicer software.
{"title":"DentalSegmentator: robust deep learning-based CBCT image segmentation","authors":"Gauthier DOT, Akhilanand Chaurasia, Guillaume Dubois, Charles Savoldelli, Sara Haghighat, Sarina Azimian, Ali Rahbar Taramsari, Gowri Sivaramakrishnan, Julien Issa, Abhishek Dubey, Thomas Schouman, Laurent Gajny","doi":"10.1101/2024.03.18.24304458","DOIUrl":"https://doi.org/10.1101/2024.03.18.24304458","url":null,"abstract":"Delineation of anatomical structures on dento-maxillo-facial (DMF) computed tomography (CT) or cone beam computed tomography (CBCT) scans is greatly needed for an increasing number of digital dentistry tasks. Following this process, called segmentation, three-dimensional (3D) patient-specific models can be exported for visualization, treatment planning, intervention, and follow-up purposes. Although several methods based on deep learning (DL) have been proposed for automating this task, there is no thoroughly evaluated publicly available tool offering segmentation of the anatomical structures needed for digital dentistry workflows. In this work, we propose and evaluate DentalSegmentator, a tool based on the nnU-Net deep learning framework, for fully automatic segmentation of 5 anatomic structures on DMF CT and CBCT scans: maxilla and upper skull, mandible, upper teeth, lower teeth and mandibular canal. A retrospective sample of 470 CT and CBCT scans was used as a training/validation set. The performance and generalizability of the tool was evaluated by comparing segmentations provided by experts and automatic segmentations on 2 hold-out test datasets: an internal dataset of 133 CT and CBCT scans acquired before orthognathic surgery and an external dataset of 123 CBCT scans randomly sampled from routine examinations in 5 institutions. In our internal test dataset (n = 133), the mean overall results were a Dice similarity coefficient (DSC) of 92.2 ± 6.3% and a normalized surface distance (NSD) of 98.2 ± 2.2%. In our external test dataset (n = 123), the mean overall results were a DSC of 94.2 ± 7.4% and a NSD of 98.4 ± 3.6%. The results obtained on this highly diversified dataset demonstrate that our tool can provide fully automatic and robust multiclass segmentation for DMF (CB)CT scans. To encourage the clinical deployment of DentalSegmentator, our pretrained nnU-Net model is made publicly available along with an extension for the 3D Slicer software.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140165457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-15DOI: 10.1101/2024.03.13.24304243
Amanda Almeida Costa, Luís Otávio Miranda Cota, Rafael Paschoal Esteves Lima, Alcione Maria Soares Dutra Oliveira, Sheila Cavalca Cortelli, José Roberto Cortelli, Renata Magalhães Cyrino, Tarcília Aparecida Silva, Victor Silva Mendes, Fernando Costa
Objective To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease’s daily activities compared to the non-psoriatic ones. Materials & Methods 296 individuals with psoriatic disease (PSO n= 210, APS n= 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. Results The prevalence of PE was higher in PsA (57.0%; OR=2.67 95%CI 1.65–4.32; p<0.001) than in PSO (34.3%; OR=1.05 95% CI 0.73–1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). Conclusion Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.
{"title":"The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis","authors":"Amanda Almeida Costa, Luís Otávio Miranda Cota, Rafael Paschoal Esteves Lima, Alcione Maria Soares Dutra Oliveira, Sheila Cavalca Cortelli, José Roberto Cortelli, Renata Magalhães Cyrino, Tarcília Aparecida Silva, Victor Silva Mendes, Fernando Costa","doi":"10.1101/2024.03.13.24304243","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304243","url":null,"abstract":"Objective To evaluate the association between psoriasis (PSO), psoriatic arthritis (PsA) and periodontitis (PE), and the Oral Health-Related Quality of Life (OHRQoL) impacts on individuals with psoriatic disease’s daily activities compared to the non-psoriatic ones. Materials & Methods 296 individuals with psoriatic disease (PSO n= 210, APS n= 86) (cases) and 359 without these diseases (controls) were included. Complete periodontal examinations and collection of variables of interest were performed. The Brazilian version of the Oral Impacts on Daily Performance (OIDP) instrument was applied. Results The prevalence of PE was higher in PsA (57.0%; OR=2.67 95%CI 1.65–4.32; p<0.001) than in PSO (34.3%; OR=1.05 95% CI 0.73–1.51; p<0.001) compared to controls (33.1%). Both PsA and PSO groups showed more sites and teeth with 4-6mm probing depth (PD) and had higher OIDP scores than controls (p<0.001), thus indicating worse self-reported quality of life. PE, PSO+PE and consumption of alcohol/anxiolytics significantly influenced OHRQoL (p<0.05). The influence of periodontal parameters on OHRQoL was observed for the presence of PE; PD >6 mm; clinical attachment level >6 mm; higher plaque index, % sites and teeth with bleeding on probing (p<0.05). Conclusion Negative impacts of PE on the OHRQoL were demonstrated. The ones having PSO and especially PsA and PE presented significantly worse indicators.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140156635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1101/2024.03.11.24304114
Mayura Manerkar, Vivianne Cruz de Jesus, Betty-Anne Mittermuller, Victor H. K. Lee, Sarbjeet Singh, Mary Bertone, Prashen Chelikani, Robert J Schroth
Introduction: Silver diamine fluoride (SDF) is a simple and non-invasive agent used to arrest early childhood caries (ECC). This study aimed to investigate potential changes to the oral microbiome in children with ECC who were treated with SDF at three different frequency regimens. Methods: Forty-five children (n=15 per group) with ECC were recruited into a randomized clinical trial testing three different treatment frequency regimens of SDF. A total of 195 carious lesions were treated with two applications of 38% SDF and 5% sodium fluoride varnish (NaFV) and assessed over three study visits (one month (Regimen 1M), four months (Regimen 4M), or six months (Regimen 6M) apart). Dental plaque samples were collected at each visit. Sequencing of the V4-16S rRNA and ITS1 rRNA genes were used to study the supragingival plaque microbiome. Results: The overall arrest rates for treated carious lesions were 75.9% at Visit 2 and 92.8% at Visit 3. Arrest rates were higher for all lesions after two applications of SDF with NaFV, and applications one month and four months apart had higher arrest rates (95.9% and 98.5%) than six months (81.1%) apart. The microbial diversity analyses showed no significant differences in the overall microbiome after SDF treatment. However, significant changes in the abundance of specific bacteria and fungi, particularly Lactobacillus spp., Bifidobacterium spp., and Candida spp. were observed after treatment. Furthermore, overabundance of Streptococcus mutans and Candida dubliniensis at baseline was observed in children who had at least one caries lesion not arrested after one SDF application, compared to those who had 100% arrest rates. Conclusion: SDF with NaFV applications were an effective modality for arresting ECC, with higher arrest rates after two SDF applications. No loss of diversity but significant changes in the abundance of specific bacteria and fungi were consequences of SDF treatment.
{"title":"Effects of silver diamine fluoride on oral bacteriome and mycobiome: a randomized clinical trial","authors":"Mayura Manerkar, Vivianne Cruz de Jesus, Betty-Anne Mittermuller, Victor H. K. Lee, Sarbjeet Singh, Mary Bertone, Prashen Chelikani, Robert J Schroth","doi":"10.1101/2024.03.11.24304114","DOIUrl":"https://doi.org/10.1101/2024.03.11.24304114","url":null,"abstract":"<strong>Introduction</strong>: Silver diamine fluoride (SDF) is a simple and non-invasive agent used to arrest early childhood caries (ECC). This study aimed to investigate potential changes to the oral microbiome in children with ECC who were treated with SDF at three different frequency regimens.\u0000<strong>Methods</strong>: Forty-five children (n=15 per group) with ECC were recruited into a randomized clinical trial testing three different treatment frequency regimens of SDF. A total of 195 carious lesions were treated with two applications of 38% SDF and 5% sodium fluoride varnish (NaFV) and assessed over three study visits (one month (Regimen 1M), four months (Regimen 4M), or six months (Regimen 6M) apart). Dental plaque samples were collected at each visit. Sequencing of the V4-16S rRNA and ITS1 rRNA genes were used to study the supragingival plaque microbiome. <strong>Results</strong>: The overall arrest rates for treated carious lesions were 75.9% at Visit 2 and 92.8% at Visit 3. Arrest rates were higher for all lesions after two applications of SDF with NaFV, and applications one month and four months apart had higher arrest rates (95.9% and 98.5%) than six months (81.1%) apart. The microbial diversity analyses showed no significant differences in the overall microbiome after SDF treatment. However, significant changes in the abundance of specific bacteria and fungi, particularly <em>Lactobacillus spp.</em>, <em>Bifidobacterium spp.</em>, and <em>Candida spp.</em> were observed after treatment. Furthermore, overabundance of <em>Streptococcus mutans</em> and <em>Candida dubliniensis</em> at baseline was observed in children who had at least one caries lesion not arrested after one SDF application, compared to those who had 100% arrest rates.\u0000<strong>Conclusion</strong>: SDF with NaFV applications were an effective modality for arresting ECC, with higher arrest rates after two SDF applications. No loss of diversity but significant changes in the abundance of specific bacteria and fungi were consequences of SDF treatment.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140115916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303843
Lamis Abuhaloob, David Conway, Alex Blokland, Al Ross
Background The World Health Organisation has set out a clear priority for the implementation of interventions to reduce the burden of Early Childhood Caries (ECC), a global public health problem affecting over 500 million children around the world and having a substantial impact on child well-being and health system expenditure. The aim of this study was to assess and develop international expert consensus on the evidence for fluoride-based interventions in early-year education settings (kindergartens/nursery and primary schools) for reducing ECC and to synthesise clear programme-level recommendations with regard to ECC prevention in this setting. Methods A systematic overview of systematic reviews, trials, and observational studies was performed to identify and critically appraise the available evidence on the effectiveness and cost-effectiveness of fluoride-based interventions in early-years education settings to prevent ECC. This was followed by a three-stage modified Delphi panel study (n= 21) consisting of: round 1, an online survey to gather opinions on safety, effectiveness and feasibility of interventions; round 2, an iterative survey to consider collated group opinion and gather feedback on review findings; and finally, an online workshop with presentations and facilitated in-depth, recorded group discussions. Results There was high-quality evidence and consensus on delivering supervised toothbrushing in kindergartens (nurseries) and primary/elementary schools; this is safe and cost-effective, shows greater benefit to more disadvantaged children, helps child social development, and is feasible in high and low/middle-income countries. There was more moderate support for the effectiveness and cost-effectiveness of fluoride varnish application in this setting (especially where supervised toothbrushing with fluoride is in place). It was agreed that policy makers should prioritise at-risk groups where resources are limited, and that systemic fluoride interventions (Fluoride tablets, drops, milk, and salt) in this setting are no longer a priority. Conclusion Supervised toothbrushing with fluoridated toothpaste is the most effective, cost-effective, feasible and safest mechanism for children in early education settings. Universal coverage is preferred but where resources are limited targeting based on need is indicated. Panel consensus is that it remains appropriate in water fluoridated areas and is largely feasible in low/middle-income countries.
{"title":"International consensus on fluoride programmes for Early Childhood Caries prevention in early education settings","authors":"Lamis Abuhaloob, David Conway, Alex Blokland, Al Ross","doi":"10.1101/2024.03.05.24303843","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303843","url":null,"abstract":"Background\u0000The World Health Organisation has set out a clear priority for the implementation of interventions to reduce the burden of Early Childhood Caries (ECC), a global public health problem affecting over 500 million children around the world and having a substantial impact on child well-being and health system expenditure.\u0000The aim of this study was to assess and develop international expert consensus on the evidence for fluoride-based interventions in early-year education settings (kindergartens/nursery and primary schools) for reducing ECC and to synthesise clear programme-level recommendations with regard to ECC prevention in this setting.\u0000Methods\u0000A systematic overview of systematic reviews, trials, and observational studies was performed to identify and critically appraise the available evidence on the effectiveness and cost-effectiveness of fluoride-based interventions in early-years education settings to prevent ECC.\u0000This was followed by a three-stage modified Delphi panel study (n= 21) consisting of: round 1, an online survey to gather opinions on safety, effectiveness and feasibility of interventions; round 2, an iterative survey to consider collated group opinion and gather feedback on review findings; and finally, an online workshop with presentations and facilitated in-depth, recorded group discussions.\u0000Results\u0000There was high-quality evidence and consensus on delivering supervised toothbrushing in kindergartens (nurseries) and primary/elementary schools; this is safe and cost-effective, shows greater benefit to more disadvantaged children, helps child social development, and is feasible in high and low/middle-income countries. There was more moderate support for the effectiveness and cost-effectiveness of fluoride varnish application in this setting (especially where supervised toothbrushing with fluoride is in place). It was agreed that policy makers should prioritise at-risk groups where resources are limited, and that systemic fluoride interventions (Fluoride tablets, drops, milk, and salt) in this setting are no longer a priority. Conclusion\u0000Supervised toothbrushing with fluoridated toothpaste is the most effective, cost-effective, feasible and safest mechanism for children in early education settings. Universal coverage is preferred but where resources are limited targeting based on need is indicated. Panel consensus is that it remains appropriate in water fluoridated areas and is largely feasible in low/middle-income countries.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140056672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
. Background Dental caries remains the major oral health challenge affecting more than half of adolescents globally. Most of the disease remain untreated, therefore, negatively impacting adolescents’ general health, well-being, and quality of life. Basic Package of Oral Care (BPOC) is a potential solution to the challenge, however, evidence on its effectiveness is scarce. This study primarily assessed the effects of applying modified BPOC on dental caries prevalence and secondarily on knowledge and behaviours related to dental caries among adolescents in Copperbelt Province, Zambia. Methods A parallel arms cluster randomized field trial (Reg-PACTR202210624926299) including 22 public secondary schools in Copperbelt province, Zambia, was carried out between January 2021 and March 2023. A pre-tested questionnaire was used to collect socio-demographics, knowledge and dental caries related behaviours data, while dental caries was assessed clinically using the caries assessment spectrum and treatment (CAST) at baseline and the follow-ups. The 1st and 2nd follow ups were conducted at 18-and 24 months after baseline respectively. The analysis was based on intention-to-treat protocol using generalized estimating equations (GEE) and results are reported as OR (95% CI). Results Out of 1,794 participants at baseline, 1,690 (94.2%) and 1,597 (89.0%) were seen at 1st and 2nd follow ups respectively. A significant interaction (BPOC x time) for dental caries models at 18 months {OR (95%CI) = 1.3 (1.1, 1.6), p=0.003)} and 24 months {OR (95%CI) = 1.3 (1.1, 1.6), p=0.004)} was observed. Secondary outcomes with significant interactions included adequate knowledge models at 18 months {OR (95%CI) =1.5 (1.2,1.8), p<0.001} and 24 months {OR (95%CI) = 1.6 (1.3, 2.0), p<0.001} as well as use of fluoridated toothpaste twice or more per day at 18 months {OR (95%CI) = 1.6 (1.3, 2.1), p<0.001)} and 24 months {OR (95%CI) = 1.4 (1.2, 1.6), p<0.001)}. Subgroup analysis showed that the intervention group had better outcomes than the control group in terms of dental caries prevalence, adequate knowledge, use of fluoridated toothpaste twice or more per day, at 18- and 24 months. Conclusion The modified BPOC was effective in reducing prevalence of dental caries, improving knowledge on dental caries, and the frequency of using fluoridated toothpaste among Zambian adolescents. Further studies need to be conducted in order to address other factors affecting oral health related behaviours such as the school and home environment, social and cultural factors.
{"title":"Effect of modified basic package of oral care on adolescents’ dental caries status in Copperbelt Province, Zambia; A Cluster Randomized Trial","authors":"Severine Nyerembe Anthony, Hawa Shariff Mbawalla, Febronia Kokulengya Kahabuka, Seter Siziya, Anne-Kristine Nordrehaug Åstrøm","doi":"10.1101/2024.03.03.24303674","DOIUrl":"https://doi.org/10.1101/2024.03.03.24303674","url":null,"abstract":".\u0000Background Dental caries remains the major oral health challenge affecting more than half of adolescents globally. Most of the disease remain untreated, therefore, negatively impacting adolescents’ general health, well-being, and quality of life. Basic Package of Oral Care (BPOC) is a potential solution to the challenge, however, evidence on its effectiveness is scarce. This study primarily assessed the effects of applying modified BPOC on dental caries prevalence and secondarily on knowledge and behaviours related to dental caries among adolescents in Copperbelt Province, Zambia.\u0000Methods\u0000A parallel arms cluster randomized field trial (Reg-PACTR202210624926299) including 22 public secondary schools in Copperbelt province, Zambia, was carried out between January 2021 and March 2023. A pre-tested questionnaire was used to collect socio-demographics, knowledge and dental caries related behaviours data, while dental caries was assessed clinically using the caries assessment spectrum and treatment (CAST) at baseline and the follow-ups. The 1st and 2nd follow ups were conducted at 18-and 24 months after baseline respectively. The analysis was based on intention-to-treat protocol using generalized estimating equations (GEE) and results are reported as OR (95% CI).\u0000Results\u0000Out of 1,794 participants at baseline, 1,690 (94.2%) and 1,597 (89.0%) were seen at 1st and 2nd follow ups respectively. A significant interaction (BPOC x time) for dental caries models at 18 months {OR (95%CI) = 1.3 (1.1, 1.6), p=0.003)} and 24 months {OR (95%CI) = 1.3 (1.1, 1.6), p=0.004)} was observed. Secondary outcomes with significant interactions included adequate knowledge models at 18 months {OR (95%CI) =1.5 (1.2,1.8), p<0.001} and 24 months {OR (95%CI) = 1.6 (1.3, 2.0), p<0.001} as well as use of fluoridated toothpaste twice or more per day at 18 months {OR (95%CI) = 1.6 (1.3, 2.1), p<0.001)} and 24 months {OR (95%CI) = 1.4 (1.2, 1.6), p<0.001)}. Subgroup analysis showed that the intervention group had better outcomes than the control group in terms of dental caries prevalence, adequate knowledge, use of fluoridated toothpaste twice or more per day, at 18- and 24 months.\u0000Conclusion The modified BPOC was effective in reducing prevalence of dental caries, improving knowledge on dental caries, and the frequency of using fluoridated toothpaste among Zambian adolescents. Further studies need to be conducted in order to address other factors affecting oral health related behaviours such as the school and home environment, social and cultural factors.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140035566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although preventable, dental caries remain a serious global public health threat. There are a number of risk factors for the development of dental caries in the general population, and in elementary school children in Thailand in particular, especially if they are from suburban areas. Objective: To identify the prevalence of dental caries in the form of decayed-missing- filled teeth for the permanent (DMFT) and primary (dmft) dentition, and their risk factors among children between 6 and 12 years of age attending a public school in Chiang Rai in northern Thailand. Methods: A cross-sectional study was conducted among 6–12-year-old children attending public education at Thesaban 1 School, Chiang Saen District, Chiang Rai Province in Thailand. All school children from grades 1 to 6 were examined by trained dental students from Mae Fah Luang University’s School of Dentistry in December 2023. Children were clinically examined for DMFT/dmft while demographic information about the children was collected from school records. Children also responded to a standardized 17-item survey about their oral health care behaviours. Descriptive and inferential statistics were used. All tests were set at 95% CI and p>0.05. Results: A total of 232 children (100% of eligible participants) were examined and 96 (40%) responded to the survey. Most children were Buddhists (n=186, 80.1%), and had at least one permanent tooth with sealant (n=198, 85.3%); 82.5% of the 232 children exhibited dental caries/extraction/fillings in primary teeth. The average dmft was 4.1 (1.8–8.8) and the average DMFT was 1.6 (0.1–3.3). Fifty children (21.5%) had their grandparents as their main caregiver. Children who brushed their teeth without fluoridated toothpaste were 1.99 times more likely to have at least 1 permanent tooth with dental decay than children who used fluoridated toothpaste (p=0.065). Conclusion: In this study, a high percentage of dental caries was observed among children from suburban areas in the northernmost province of Thailand. Public health intervention and oral health promotion remain an immediate need among these children.
{"title":"School children’s oral health status, behaviours, and dental care utilization: the case of a northern Thailand elementary school","authors":"Komkham Pattanaporn, Warathaya Kawong, Wassana Wongwanichwattana, Kulnan Chomphrom, Natchaphon Chakkathamanukul, Nalinporn Kamsiriphiman, Panithi Prasomphon, Pitchaya Saksurasap, Pansuk Nilniyom, Mario Brondani","doi":"10.1101/2024.02.25.24303350","DOIUrl":"https://doi.org/10.1101/2024.02.25.24303350","url":null,"abstract":"Background: Although preventable, dental caries remain a serious global public health threat. There are a number of risk factors for the development of dental caries in the general population, and in elementary school children in Thailand in particular, especially if they are from suburban areas.\u0000Objective: To identify the prevalence of dental caries in the form of decayed-missing- filled teeth for the permanent (DMFT) and primary (dmft) dentition, and their risk factors among children between 6 and 12 years of age attending a public school in Chiang Rai in northern Thailand.\u0000Methods: A cross-sectional study was conducted among 6–12-year-old children attending public education at Thesaban 1 School, Chiang Saen District, Chiang Rai Province in Thailand. All school children from grades 1 to 6 were examined by trained dental students from Mae Fah Luang University’s School of Dentistry in December 2023. Children were clinically examined for DMFT/dmft while demographic information about the children was collected from school records. Children also responded to a standardized 17-item survey about their oral health care behaviours. Descriptive and inferential statistics were used. All tests were set at 95% CI and p>0.05. Results: A total of 232 children (100% of eligible participants) were examined and 96 (40%) responded to the survey. Most children were Buddhists (n=186, 80.1%), and had at least one permanent tooth with sealant (n=198, 85.3%); 82.5% of the 232 children exhibited dental caries/extraction/fillings in primary teeth. The average dmft was 4.1 (1.8–8.8) and the average DMFT was 1.6 (0.1–3.3). Fifty children (21.5%) had their grandparents as their main caregiver. Children who brushed their teeth without fluoridated toothpaste were 1.99 times more likely to have at least 1 permanent tooth with dental decay than children who used fluoridated toothpaste (p=0.065). Conclusion: In this study, a high percentage of dental caries was observed among children from suburban areas in the northernmost province of Thailand. Public health intervention and oral health promotion remain an immediate need among these children.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139977314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Oral lichen planus (OLP) is a chronic inflammatory condition known to adversely impact patient quality of life and is associated with an increased risk of cancer. The diverse clinical presentation and poor knowledge of clinical factors that determine the course of disease are amongst the main challenges that hinder effective and personalised treatment for OLP patients. Aim This study aimed to systematically identify clinical predictors of disease severity in OLP patients. Methods A cohort of patients with histologically confirmed OLP (n=87) was recruited in a cross-sectional and single site study. A comprehensive assessment of clinical characteristics, medical and social history, haematological parameters, vitamin D levels, and Perceived Stress Scale (PSS-10) was carried out. Hierarchical linear regression identified the predictive value of clinical factors to OLP disease severity measured by the Oral Disease Severity Score (ODSS) and the Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative (REU) scoring system. Results Our results revealed that extraoral lichen planus and insufficient vitamin D levels were significant predictors of both overall and gingival disease severity of OLP. Specifically, patients with lichen planus affecting the skin or other mucosal sites had a 5.9-unit higher OLP severity score (β=5.998, 95% CI=.888-11.107, p=.022) than those without extraoral involvement as measured by ODSS. Interestingly, patients with insufficient vitamin D levels exhibited 5.3-unit increase in OLP severity (β=5.344, 95% CI =.914-9.774, p=.019) compared to those with adequate vitamin D levels. The presence of dental plaque induced gingivitis (β=4.467, 95% CI =.600-8.333, p=.024), was found to be a significant factor affecting gingival disease severity. Conclusion Our study revealed the importance of adequate vitamin D levels in OLP patients and suggests embedding vitamin D pre-treatment screening to optimise management of OLP. Future research should focus on elucidating the biological mechanisms underlying the protective effects of vitamin D in OLP.
背景口腔扁平苔藓（OLP）是一种慢性炎症，已知会对患者的生活质量产生不利影响，并与癌症风险增加有关。临床表现多种多样，对决定疾病进程的临床因素知之甚少，这些都是阻碍对 OLP 患者进行有效和个性化治疗的主要挑战。方法 在一项横断面单点研究中，招募了一批经组织学确诊的OLP患者（87人）。研究人员对患者的临床特征、病史和社会史、血液学参数、维生素D水平以及感知压力量表（PSS-10）进行了全面评估。结果我们的研究结果表明，口外扁平苔藓和维生素D水平不足是预测OLP总体和牙龈疾病严重程度的重要因素。具体来说，与那些没有口外受累的患者相比，口外扁平苔藓影响皮肤或其他粘膜部位的患者的OLP严重程度评分高出5.9个单位（β=5.998，95% CI=.888-11.107，p=.022）。有趣的是，与维生素 D 水平充足的患者相比，维生素 D 水平不足的患者的 OLP 严重程度增加了 5.3 个单位（β=5.344，95% CI=.914-9.774，p=.019）。牙菌斑引起的牙龈炎（β=4.467，95% CI =.600-8.333，p=.024）是影响牙龈疾病严重程度的重要因素。未来的研究应侧重于阐明维生素D对OLP保护作用的生物机制。
{"title":"Vitamin D is a novel biomarker of clinical disease severity in oral lichen planus","authors":"Sreedevi Poovathumkadavil Unnikrishnan, Janice Boggon, Bernice McLaughlin, Maggie E. Cruickshank, Rasha Abu-Eid, Karolin Hijazi","doi":"10.1101/2024.02.21.24303138","DOIUrl":"https://doi.org/10.1101/2024.02.21.24303138","url":null,"abstract":"Background\u0000Oral lichen planus (OLP) is a chronic inflammatory condition known to adversely impact patient quality of life and is associated with an increased risk of cancer. The diverse clinical presentation and poor knowledge of clinical factors that determine the course of disease are amongst the main challenges that hinder effective and personalised treatment for OLP patients.\u0000Aim\u0000This study aimed to systematically identify clinical predictors of disease severity in OLP patients. Methods\u0000A cohort of patients with histologically confirmed OLP (n=87) was recruited in a cross-sectional and single site study. A comprehensive assessment of clinical characteristics, medical and social history, haematological parameters, vitamin D levels, and Perceived Stress Scale (PSS-10) was carried out. Hierarchical linear regression identified the predictive value of clinical factors to OLP disease severity measured by the Oral Disease Severity Score (ODSS) and the Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative (REU) scoring system.\u0000Results\u0000Our results revealed that extraoral lichen planus and insufficient vitamin D levels were significant predictors of both overall and gingival disease severity of OLP. Specifically, patients with lichen planus affecting the skin or other mucosal sites had a 5.9-unit higher OLP severity score (β=5.998, 95% CI=.888-11.107, p=.022) than those without extraoral involvement as measured by ODSS. Interestingly, patients with insufficient vitamin D levels exhibited 5.3-unit increase in OLP severity (β=5.344, 95% CI =.914-9.774, p=.019) compared to those with adequate vitamin D levels. The presence of dental plaque induced gingivitis (β=4.467, 95% CI =.600-8.333, p=.024), was found to be a significant factor affecting gingival disease severity.\u0000Conclusion\u0000Our study revealed the importance of adequate vitamin D levels in OLP patients and suggests embedding vitamin D pre-treatment screening to optimise management of OLP. Future research should focus on elucidating the biological mechanisms underlying the protective effects of vitamin D in OLP.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139953069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-18DOI: 10.1101/2024.02.17.24301683
Laura Misrachi, Emma Covili, Hippolyte Mayard, Christian Alaka, Jérémy Rousseau, Willy Au
In dental implantology, precise delineation of maxillary sinuses and inferior alveolar nerves (IAN) on CBCT scans is essential for implant planning. Addressing the time-consuming manual segmentation, we introduce SISTR (Sinus and IAN Segmentation with Targeted Refinement), a novel deep-learning method for automated, precise segmentation. SISTR employs a two-stage approach: initially, it predicts coarse segmentation and offset maps to anatomical regions, followed by clustering for region centroids identification and targeted cropping for refined segmentation. Developed on the most diverse dataset to date for sinus and IAN segmentation, sourced from 11 dental clinics and 10 manufacturers (358 CBCT volumes for sinus, 499 for IAN), SISTR demonstrates robust generalizability. It achieved strong performance on an external test set, reaching average DICE scores of 96.64% (95.38-97.60) for sinus and 83.43% (80.96-85.63) for IAN, marking a significant 10 percentage point improvement in Dice Score for IAN compared to single-stage methods (p-value < 0.005). Chamfer distances of 0.38 (0.24-0.60) mm for sinus and 0.88 (0.58-1.27) mm for IAN affirm its precision. Efficient in fast and precise segmentation with an inference time of 4 seconds per case, SISTR advances implant planning in digital dentistry.
{"title":"SISTR: Sinus and Inferior alveolar nerve Segmentation with Targeted Refinement on Cone Beam Computed Tomography images","authors":"Laura Misrachi, Emma Covili, Hippolyte Mayard, Christian Alaka, Jérémy Rousseau, Willy Au","doi":"10.1101/2024.02.17.24301683","DOIUrl":"https://doi.org/10.1101/2024.02.17.24301683","url":null,"abstract":"In dental implantology, precise delineation of maxillary sinuses and inferior alveolar nerves (IAN) on CBCT scans is essential for implant planning. Addressing the time-consuming manual segmentation, we introduce SISTR (Sinus and IAN Segmentation with Targeted Refinement), a novel deep-learning method for automated, precise segmentation. SISTR employs a two-stage approach: initially, it predicts coarse segmentation and offset maps to anatomical regions, followed by clustering for region centroids identification and targeted cropping for refined segmentation. Developed on the most diverse dataset to date for sinus and IAN segmentation, sourced from 11 dental clinics and 10 manufacturers (358 CBCT volumes for sinus, 499 for IAN), SISTR demonstrates robust generalizability. It achieved strong performance on an external test set, reaching average DICE scores of 96.64% (95.38-97.60) for sinus and 83.43% (80.96-85.63) for IAN, marking a significant 10 percentage point improvement in Dice Score for IAN compared to single-stage methods (p-value < 0.005). Chamfer distances of 0.38 (0.24-0.60) mm for sinus and 0.88 (0.58-1.27) mm for IAN affirm its precision. Efficient in fast and precise segmentation with an inference time of 4 seconds per case, SISTR advances implant planning in digital dentistry.","PeriodicalId":501363,"journal":{"name":"medRxiv - Dentistry and Oral Medicine","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139902405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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