Sociodemographic, biological, and timing characteristics of dental caries and fluorosis using mixed-type cluster analysis on 12-year-olds in Ho Chi Minh city, 1989-2019.

Objectives: In 1990, Ho Chi Minh City started Community water fluoridation (CWF) at 0.7 ppm F, and in 2000, it was adjusted to 0.5 ppm F. Here, we analyzed dental caries and fluorosis data in Ho Chi Minh City to explore commonalities associated with CWF among 12-year-old children. Methods: Dental caries and fluorosis data were collected in 1989, 2003, 2012, and 2019 (N = 4773). Trained dentists scored dental caries using the WHO detection criteria and fluorosis using Dean's Fluorosis Index. We used these data and the k-prototypes method by the R package to identify clusters of participants with shared clinical and water fluoride levels. Results: We used datasets 1 (4773 participants) and 2 (4194 participants, missing fluorosis data in 1989). K-prototypes analysis identified three clusters in each dataset. Cluster 1, with 80 % of the sample at 0.5 ppm F area characterized by low caries and fluorosis scores. Cluster 2 with 60 % of the sample non-fluoridated area had high caries and low fluorosis scores. Cluster 3, with 75 % of the sample in 0.7 ppm area, had low caries but borderline high fluorosis scores. Conclusion: Identifying three clusters based on clinical and environmental scores supports the decision to fluoridate the water to prevent caries (0-0.7 ppm) and the shift from 0.7 to 0.5 ppm to keep the caries preventive effect while reducing the risk of fluorosis. Clinical significance: Our results support the effectiveness of CWF in preventing dental caries and the appropriateness of changing the F concentration to reduce the risk of fluorosis while maintaining its effectiveness.

Prevalence and mean number of teeth with amalgam and nonamalgam restorations, United States, 2015 through 2018.

BACKGROUND: Amalgam has been used for more than 150 years as a safe and reliable restorative material. The authors described the occurrence of amalgam and nonamalgam restorations in the United States in primary and permanent teeth across age groups and according to sociodemographic characteristics. METHODS: The authors used clinical examination data from the National Health and Nutrition Examination Survey 2015-2018 for participants 2 years and older (n = 17,040). The authors estimated the prevalence and mean number of amalgam and nonamalgam restorations in primary and permanent teeth according to age groups (2-5 years, 6-11 years, 12-15 years, 16-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥ 80 years), race and ethnicity, federal poverty guideline, education, and pregnancy status. RESULTS: The prevalence of amalgam restorations ranged from 4% through 69%. Overall, amalgam restorations were more prevalent in children and adolescents from racial and ethnic minority groups and families at lower poverty levels and with lower education. The mean number of teeth with nonamalgam restorations was higher than those with amalgam restorations in primary teeth of children aged 6 through 11 years, permanent teeth of those 12 through 15 years and 20 through 39 years, and women aged 20 through 49 years, regardless of pregnancy status. The mean number of amalgam restorations was higher than that for nonamalgam restorations in older age groups. CONCLUSIONS: Nonamalgam restorations were the most common in the primary teeth of children older than 5 years and in the permanent teeth of adults younger than 40 years. Amalgam restorations were more common in older adults. Amalgam and nonamalgam restorations were equally common in children younger than 5 years. PRACTICAL IMPLICATIONS: The study findings suggest a shift from amalgam to alternative restorative materials in the United States.

Oral health inequities: Recommended public policies to achieve health equity.

In the United States (US), racial and ethnic minority populations experience poorer oral health than the general population. Social and commercial determinants of health embedded in structural and institutional racism and/or discrimination generate and exacerbate oral health inequities. We provide examples of oral health disparities (including oral health status and workforce issues) among selected racial and ethnic minority groups in the US. In addition, we compiled four priority areas based on research over the last two decades to guide actions to improve oral health equity. These four priority areas aim to improve health care models, interventions, and policies to help close gaps and reduce disparities in oral health and access to dental care.

Surveillance and monitoring of oral health in elderly people.

Continued ageing of the global population is expected to pose significant challenges to maintaining optimum lifelong health in individuals and populations. Oral health is an essential element of general health and quality of life throughout an individual's life course, yet it is often neglected in integrated approaches to general health promotion. Surveillance and monitoring systems are essential for developing oral health policy and strategy at both national and community levels. As major oral diseases, dental caries and periodontal diseases are core indicators for surveillance at every stage of life. In addition, oral mucosal lesions and masticatory function are essential indicators, especially in an ageing population. The assessment of risk factors such as tobacco use, alcohol consumption or dietary habits (e.g., sugar intake) is also important for oral disease prevention. Although surveillance is conducted through clinical examinations (normative assessments), this method is becoming more difficult to use because of high costs and human resource shortages, even in high-income countries. Alternative and less resource-demanding approaches, such as self-reported protocols, are therefore needed at the global level. The World Health Organization's (WHO) oral health surveillance and monitoring activities have evolved into the Oral Health STEPwise approach, which includes questionnaire surveys (Step 1) and clinical examinations (Step 2). Collaboration between international organisations such as the World Dental Federation (FDI), WHO and the International Association for Dental Research (IADR) is now needed to coordinate global oral health surveillance and monitoring systems.

Water Intake by Outdoor Temperature Among Children Aged 1-10 Years: Implications for Community Water Fluoridation in the U.S.

OBJECTIVE: The U.S. water fluoridation recommendations, which have been in place since 1962, were based in part on findings from the 1950s that children's water intake increased with outdoor temperature. We examined whether or not water intake is associated with outdoor temperature. METHODS: Using linked data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 and the National Oceanic and Atmospheric Administration, we examined reported 24-hour total and plain water intake in milliliters per kilogram of body weight per day of children aged 1-10 years by maximum outdoor temperature on the day of reported water intake, unadjusted and adjusted for age, sex, race/ethnicity, and poverty status. We applied linear regression methods that were used in previously reported analyses of data from NHANES 1988-1994 and from the 1950s. RESULTS: We found that total water intake was not associated with temperature. Plain water intake was weakly associated with temperature in unadjusted (coefficient 5 0.2, p=0.015) and adjusted (coefficient 5 0.2, p=0.013) linear regression models. However, these models explained little of the individual variation in plain water intake (unadjusted: R(2)=0.005; adjusted: R(2)=0.023). CONCLUSION: Optimal fluoride concentration in drinking water to prevent caries need not be based on outdoor temperature, given the lack of association between total water intake and outdoor temperature, the weak association between plain water intake and outdoor temperature, and the minimal amount of individual variance in plain water intake explained by outdoor temperature. These findings support the change in the U.S. Public Health Service recommendation for fluoride concentration in drinking water for the prevention of dental caries from temperature-related concentrations to a single concentration that is not related to outdoor temperature.

No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever.

OBJECTIVE: To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). STUDY DESIGN: Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. RESULTS: Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P=.20) or hypoplasia (P=1.0) was found between the 2 groups. CONCLUSIONS: This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label.

The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs.

BACKGROUND: A panel of experts (the 2014 Panel) convened by the American Dental Association Council on Scientific Affairs developed an evidence-based clinical practice guideline (CPG) on the use of prophylactic antibiotics in patients with prosthetic joints who are undergoing dental procedures. This CPG is intended to clarify the "Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Evidence-based Guideline and Evidence Report," which was developed and published by the American Academy of Orthopaedic Surgeons and the American Dental Association (the 2012 Panel). TYPES OF STUDIES REVIEWED: The 2014 Panel based the current CPG on literature search results and direct evidence contained in the comprehensive systematic review published by the 2012 Panel, as well as the results from an updated literature search. The 2014 Panel identified 4 case-control studies. RESULTS: The 2014 Panel judged that the current best evidence failed to demonstrate an association between dental procedures and prosthetic joint infection (PJI). The 2014 Panel also presented information about antibiotic resistance, adverse drug reactions, and costs associated with prescribing antibiotics for PJI prophylaxis. PRACTICAL IMPLICATIONS AND CONCLUSIONS: The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2009-2010.

OBJECTIVE: In 2009-2010, the oral health component for the National Health and Nutrition Examination Survey (NHANES) focused on adult periodontal health and included a full mouth periodontal examination as well as a series of questions adminis during the home interview. During this period, intraoral assessments were conducted by dental hygienists. METHODS: This report provides oral health content information and results of dental examiner reliability for data collected during NHANES 2009-2010 on 7,189 persons aged 3-19 years and 30 years and older representing the US civilian, noninstitutionalized population in these age groups. RESULTS: For caries and dental sealant assessments, Kappa statistics ranged from 0.71 to 1.00. Kappa scores for moderate and severe periodontitis using the Centers for Disease Control and Prevention/American Academy of Periodontology case definition guidelines was 0.70, but were lower for other periodontal status definitions. When defining moderate or severe periodontitis based on the NHANES 2003-2004 study, protocols using data from only three facial periodontal sites, the Kappa scores were 0.64 and 0.55. Interclass correlation coefficients (ICCs) for mean attachment loss were 0.80 or higher for both examiners. Site-specific mean attachment loss ICCs were generally higher for interproximal measurements compared with mid-facial and mid-lingual measurements. CONCLUSION: Overall, the data reliability analyses conducted for 2009-2010 indicate an acceptable level of data quality and that examiner (dental hygienist) performance in this data collection cycle is similar to prior survey periods since the NHANES continuous survey began in 1999.

Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review.

BACKGROUND: A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies. TYPES OF STUDIES REVIEWED: The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents--including mouthrinses, varnishes, gels, foams and pastes--with caries increment outcomes published in English through October 2012. RESULTS: The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research. PRACTICAL IMPLICATIONS: The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from "in favor" to "expert opinion for." As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Selected oral health indicators in the United States, 2005-2008.

Data from the National Health and Nutrition Examination Survey, 2005-2008 More than one in five people had untreated dental caries and 75% had existing dental restorations. Prevalence of untreated dental caries varied significantly by poverty level for all age groups; however, there was little difference in dental restoration prevalence by poverty level for children and adolescents aged 5-19 years. Twenty-seven percent of children and adolescents aged 5-19 years had at least one dental sealant. Nearly 38% of non-Hispanic black adults had not lost a permanent tooth compared with 51% for non-Hispanic white and 52% for Mexican-American persons. Almost 23% of adults aged 65 and over were edentulous.

Recording and surveillance systems for periodontal diseases.

This paper describes tools used to measure periodontal diseases and the integration of these tools into surveillance systems. Tools to measure periodontal diseases at the surveillance level have focussed on current manifestations of disease (e.g. gingival inflammation) or disease sequelae (e.g. periodontal pocket depth or loss of attachment). All tools reviewed in this paper were developed based on the state of the science of the pathophysiology of periodontal disease at the time of their design and the need to provide valid and reliable measurements of the presence and severity of periodontal diseases. Therefore, some of these tools are no longer valid. Others, such as loss of periodontal attachment, are the current de-facto tools but demand many resources to undertake periodical assessment of the periodontal health of populations. Less complex tools such as the Community Periodontal Index, have been used extensively to report periodontal status. Laboratory tests for detecting putative microorganisms or inflammatory agents present in periodontal diseases have been used at the clinical level, and at least one has been tested at the population level. Other approaches, such as self-report measures, are currently under validation. In this paper, we do not review indices designed to measure plaque or residual accumulation around the tooth, indices focussed only on gingival inflammation or radiographic approaches with limited applicability in surveillance systems. Finally, we review current case-definitions proposed for surveillance of periodontal disease severity.

Nonfluoride caries-preventive agents: executive summary of evidence-based clinical recommendations.

BACKGROUND: In this article, the authors present evidence-based clinical recommendations regarding the use of nonfluoride caries preventive agents. The recommendations were developed by an expert panel convened by the American Dental Association (ADA)Council on Scientific Affairs. The panel addressed several questions regarding the efficacy of nonfluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. TYPES OF STUDIES REVIEWED: A panel of experts convened by the ADA Council on Scientific Affairs, in collaboration with ADA Division of Science staff, conducted a MEDLINE search to identify all randomized and nonrandomized clinical studies regarding the use of non fluoride caries-preventive agents. RESULTS: The panel reviewed evidence from 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of various nonfluoride caries-preventive agents. CLINICAL IMPLICATIONS: The panel concluded that certain nonfluoride agents may provide some benefit as adjunctive therapies in children and adults at higher risk of developing caries. These recommendations are presented as a resource for dentists to consider in the clinical decision-making process. As part of the evidence based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2005-08.

The oral health component for the National Health and Nutrition Examination Survey (NHANES) was changed in 2005 from an examination conducted by dentists to an oral health screening conducted by health technologists rather than dental professionals. The oral health screening included a person-based assessment for dental caries, restorations, and sealants. This report provides oral health content information and presents results of data quality analyses that include dental examiner reliability statistics for data collected during NHANES 2005-08. Oral health data are available on 15,342 persons aged 5 years and older representing the civilian, noninstitutionalized population of the United States who participated in NHANES 2005-08. Overall, interrater reliability findings indicate that health technologist performance was excellent with concordance between examination teams and the survey reference examiner being almost perfect for a number of assessments. Concordance for dental caries and sealants (kappa statistics) between health technologists and the survey reference examiner ranged from 0.82 to 0.90 for the combined 4-year period. These findings support the use of health technologists in the assessment of person-based estimators of dental caries and sealant prevalence as part of an oral health surveillance system.

Techniques for assessing tooth surfaces in school-based sealant programs.

BACKGROUND: The authors reviewed the evidence supporting current guidelines for the detection of cavitated carious lesions. Currently, cavitation is the point at which sealants are not placed in school-based programs. TYPES OF STUDIES REVIEWED: The authors did not perform a formal systematic review. However, they examined existing systematic reviews of caries detection and diagnosis, including those presented at the 2001 National Institutes of Health Consensus Conference on Management of Caries, published evidence related to the International Caries Detection and Assessment System criteria and other peer-reviewed publications. Where the authors found ambiguity or uncertainty in the evidence, they consulted with fellow members of an expert work group. RESULTS: Visual examination is appropriate and adequate for caries assessment before placing sealants. The clinician should not use an explorer under force. Radiographs are not indicated solely for the placement of sealants, and the use of magnification and caries detection devices is not necessary to determine cavitation. CLINICAL IMPLICATIONS: This report focuses on tooth assessment, in particular the detection of carious lesion cavitation in school-based sealant programs. These recommendations must be balanced with the dentist's expertise, available treatment options, the patient's preferences and access to care.

Silver diamine fluoride (SDF) may be better than fluoride varnish and no treatment in arresting and preventing cavitated carious lesions.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Silver diamine fluoride: A caries "silver-fluoride bullet." Rosenblatt A, Stamford TCM, Niederman R. J Dent Res 2009;88(2):116-25. REVIEWER: Eugenio D. Beltrán-Aguilar, DMD, MPH, MS, DrPH, Diplomate ABDPH PURPOSE/QUESTION: The authors conducted a systematic review of clinical studies on the effectiveness of silver diamine fluoride to arrest and prevent dental caries at the cavitated level. SOURCE OF FUNDING: NIH Grant (DOI:10.1177/0022034508329406) TYPE OF STUDY/DESIGN: Systematic review LEVEL OF EVIDENCE: Level 2: Limited-quality patient-oriented evidence STRENGTH OF THE RECOMMENDATION GRADE: Grade B: Limited-quality patient-oriented evidence.

Prevalence and severity of dental fluorosis in the United States, 1999-2004.

Dental fluorosis refers to changes in the appearance of tooth enamel that are caused by long-term ingestion of fluoride during the time teeth are forming. Studies conducted in the 1930s showed that the severity of tooth decay was lower and dental fluorosis was higher in areas with more fluoride in the drinking water. In response to these findings, community water fluoridation programs were developed to add fluoride to drinking water to reach an optimal level for preventing tooth decay, while limiting the chance of developing dental fluorosis. By the 1980s, studies in selected U.S. communities reported an increase in dental fluorosis, paralleling the expansion of water fluoridation and the increased availability of other sources of ingested fluoride, such as fluoride toothpaste (if swallowed) and fluoride supplements. This report describes the prevalence of dental fluorosis in the United States and changes in the prevalence and severity of dental fluorosis among adolescents between 1986­1987 and 1999­2004.

Trends in oral health status: United States, 1988-1994 and 1999-2004.

OBJECTIVE: This report presents national estimates and trends for a variety of oral health status measures for persons aged 2 years and older by sociodemographic and smoking status since the late 1980s in the United States. METHODS: Data from the third National Health and Nutrition Examination Survey (NHANES III), 1988-1994 and from the NHANES 1999-2004 were used. These data sources were designed to provide information on the health and nutritional status of the civilian noninstitutionalized population in the United States. Information from oral health examination methods common to both survey periods were used to present prevalence estimates and for trend analyses. Statistical significance of differences between common estimates from each survey period was evaluated using two-sided t-tests. RESULTS: This report provides mean, percentile values, and standard errors for dental caries, dental sealants, incisal trauma, periodontal health, dental visits, perception of oral health status, tooth retention, and edentulism. Additional estimates for monitoring progress toward the Healthy People 2010 oral health objectives using NHANES source data are presented as well. CONCLUSIONS: For most Americans, oral health status has improved between 1988-1994 and 1999-2004. For seniors, edentulism and periodontitis has declined; for adults, improvements were seen in dental caries prevalence, tooth retention, and periodontal health; for adolescents and youths, dental sealant prevalence has increased and dental caries have decreased; however, for youths aged 2-5 years, dental caries in primary teeth has increased.