Prevalence of past-year dental visit among US adults, 1999-2010: comparison of trends and estimates between the Behavioral Risk Factor Surveillance System and three national surveys.

OBJECTIVES: To compare estimated prevalence of past-year dental visit (PPYDV) among US adults aged ≥18 years from the Behavioral Risk Factor Surveillance System (BRFSS) to estimates from the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES). METHODS: We estimated PPYDV adjusted for covariates (age, race/ethnicity, education level, poverty status, edentulism) using BRFSS, MEPS, and NHIS 1999-2010, and NHANES 1999-2004. We tested trend in overall PPYDV for BRFSS, MEPS, and NHIS from 1999-2010. For 2002 and 2010, we calculated absolute differences (AD) and 95% confidence intervals (CI) in PPYDV between BRFSS and each of the other surveys overall and among subpopulations defined by covariates. We pooled NHANES 1999-2004 data for comparison with BRFSS 2002. RESULTS: From 1999 to 2010, BRFSS (68.5% vs. 67.5%), MEPS (43.5% vs. 39.7%), and NHIS (63.3% vs. 59.7%) showed small but significant decreases in overall PPYDV. In 2002, estimates for overall PPYDV were highest for BRFSS (70.0%) and lowest for MEPS (43.9%) with estimates for NHIS (61.5%) and NHANES (1999-2004: 58.1%) in between; the largest AD (26.2%, 95% CI: 25.0%-27.3%) was between BRFSS and MEPS. ADs were consistent in 2002 and 2010, overall and by covariates, except among edentate persons, where PPYDV estimates from BRFSS and NHIS were similar. CONCLUSIONS: Estimates of PPYDV from BRFSS were notably higher than estimates from MEPS, NHIS, or NHANES except among the edentate. Trends in PPYDV over time, however, were consistent across all surveys.

Hyposalivation and dietary nutrient intake among community-based older Japanese.

AIM: Saliva is important for maintaining oral function and regulating oral health. Reduced saliva flow rate, which is common among older adults, has been reported to be associated with perceived chewing and swallowing difficulties; however, its relationship to actual nutrient intake is unclear. The aim of the present cross-sectional study was to evaluate the relationship between hyposalivation and nutrient intake among older Japanese adults. METHODS: The participants were 352 community-based Japanese aged 80 years. A stimulated salivary flow rate <0.5 mL/min was defined as hyposalivation. Multivariable analysis of differences in nutrient and food intake outcome variables, which were collected through a validated food frequency questionnaire, between groups with/without hyposalivation was carried out using general linear models. Models included adjustment for number of teeth, denture use, sex, income, education, body mass index, smoking status, alcohol use, diabetes, medication, activities of daily living, depression and total calorie intake. RESULTS: The hyposalivation group had significantly lower intake of n-3 polyunsaturated fatty acid, potassium, vitamin D, vitamin E, vitamin B6 and folate than the group without hyposalivation (P < 0.05) after adjusting for confounders. Vegetable, fish and shellfish consumption was significantly lower in the hyposalivation group (P < 0.05). CONCLUSIONS: Dietary intake was poorer in those with hyposalivation than among those without. A decrease in stimulated salivary flow rate could have negative effects on geriatric nutrition.

Feasibility study of a salivary occult blood test to correlate with periodontal measures as indicators of periodontal inflammation in a population of pregnant women.

The purpose of this feasibility study was to investigate the correlation of a salivary occult blood test (SOBT) with traditional periodontal measures to assess the feasibility of the SOBT as a measure of periodontal inflammation in a population of women during pregnancy. Considering the limitations of the previous SOBT studies, this study evaluated correlation of the Perioscreen Sunstar SOBT with traditional measures from a full mouth periodontal examination. Data were collected 3 times during pregnancy (12-14, 24-28, and 36 weeks) from women participating in an ongoing study of pregnancy and inflammation. Descriptive statistics and correlations were generated for SOBT scores with periodontal measures. Preliminary data were analyzed from 7 women with 3 visits, 7 with 2, and 9 with 1 visit. For these 44 visits' data, the mean percent of sites with bleeding on probing (BOP) for SOBT scores = 0, 2, and 5 was 58% ± 18%, 68% ± 14%, and 72% ± 19%, respectively. Correlations for percent of sites with BOP and continuous SOBT score was 0.301, P-value = 0.0469 and dichotomous SOBT was 0.32, P-value = 0.0339. Results for feasibility, measured as recruitment of participants, acceptance of protocols, distribution of periodontal inflammation and preliminary correlations, support SOBT as a correlated marker of periodontal inflammation in this population of pregnant women.

Longitudinal relationship between metabolic syndrome and periodontal disease among Japanese adults aged ≥70 years: the Niigata Study.

BACKGROUND: There has been little evaluation in longitudinal epidemiologic studies of the effect of metabolic syndrome (MetS) on periodontal status. The specific aim of this longitudinal study is to investigate whether MetS in the Japanese population could be a risk factor for periodontal disease. METHODS: A total of 125 older adults from Japan for whom data were available for the years 2003 to 2006 were selected for the current study. Full-mouth periodontal status, measured as clinical attachment level (CAL), was recorded at baseline and in follow-up examinations. Development of periodontal disease was considered to be ≥2 teeth demonstrating a longitudinal loss of proximal attachment of ≥3 mm at the follow-up dental examination. A multivariable Poisson regression model with robust error variance was used to evaluate the association of MetS defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria with development of periodontal disease. Adjustments for sex, income, education, smoking status, number of teeth at baseline, mean CAL at baseline, pattern of visits to a dentist, and brushing frequency were considered. RESULTS: The prevalence of MetS was 21.6% (27/125). Study participants with MetS were approximately 2.6 times more likely to develop periodontal disease (adjusted relative risk 2.58, 95% confidence interval 1.17 to 5.67) after simultaneous adjustment for other covariates. CONCLUSIONS: These findings support the hypothesis that MetS may be a risk factor for periodontal disease in older Japanese individuals. Additional studies with larger, more diverse populations and more complete information are needed to substantiate the findings.

Oral health status: relationship to nutrient and food intake among 80-year-old Japanese adults.

OBJECTIVES: The aim of this cross-sectional study was to investigate the relationship of oral health status defined on the basis of presence of posterior occluding pairs (POPs) and adequacy of removable denture fit as determined by self-report to nutrient and food intake among older Japanese. METHODS: The subjects were 353 Japanese aged 80 years in 2008 and were classified into four groups according to the number of POPs, defined as pairs of occluding natural, restored, or fixed prosthetic postcanine teeth (range: 0-8) and removable denture status. The groups were: (i) good dentition (n = 56; 8 POPs and no removable prosthesis), (ii) well-fitting dentures (n = 158; <8 POPs with self-reported good-fitting dentures), (iii) ill-fitting dentures (n = 70; <8 POPs with self-reported ill-fitting dentures), and (iv) compromised dentition (n = 69; <8 POPs and no removable prosthesis). Multivariable analysis of the differences in nutrient and food intake outcome variables which were collected via validated food frequency questionnaire among the four oral health status groups was conducted using general linear models. Results: Intake of multiple nutrients was significantly (P < 0.05) lower in the group with ill-fitting dentures or compromised dentition than in the good dentition group. Vegetable, fish, and shellfish consumption was significantly lower in the ill-fitting dentures or compromised dentition groups. No significant differences were seen in dietary intake between the well-fitting dentures and good dentition groups. Conclusions: Dietary intake was poorer in those with self-perceived ill-fitting dentures or fewer POPs than among those having all POPs. Regular dental care to maintain intact dentition, as well as dental treatment to replace missing teeth and ensure adequate denture fit and function, may be important to the diet intake and subsequent nutritional status of older Japanese.

Dietary antioxidants and periodontal disease in community-based older Japanese: a 2-year follow-up study.

OBJECTIVE: To investigate the longitudinal relationship between the intake of dietary antioxidants and periodontal disease in community-dwelling older Japanese. DESIGN: A retrospective cohort study, with a follow-up of 2 years (2003-2005). Intakes of dietary antioxidants (vitamin C, vitamin E, α-carotene and ß-carotene) were assessed with a validated FFQ. Participants were classified by tertile of antioxidant intake. Full-mouth periodontal status, measured as the clinical attachment level, was recorded at baseline and follow-up examinations. Periodontal disease progression was considered as loss of attachment of 3 mm or greater over the study period at the interproximal site for each tooth. Finally, the number of teeth with periodontal disease progression per person was calculated and was used as the outcome. Poisson regression analysis was conducted, with dietary antioxidants as the main exposure, to estimate their influence on the number of teeth with periodontal disease progression. SETTING: Niigata City (Japan). SUBJECTS: Dentate individuals aged 75 years in 2003, for whom data were available, were included in the analyses (n 264). RESULTS: A higher intake of dietary antioxidants was inversely associated with the number of teeth with periodontal disease progression, controlling for other variables. The multivariate-adjusted incidence rate ratios in the first, second and third tertiles were 1·00, 0·76 (95 % CI 0·60, 0·97) and 0·72 (95 % CI 0·56, 0·93) for vitamin C; 1·00, 0·79 (95 % CI 0·62, 0·99) and 0·55 (95 % CI 0·42, 0·72), for vitamin E; and 1·00, 1·02 (95 % CI 0·81, 1·29) and 0·73 (95 % CI 0·56, 0·95) for ß-carotene. CONCLUSIONS: The study results suggest that higher intake of antioxidants may mitigate periodontal disease in community-dwelling older Japanese.

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children.

OBJECTIVES: To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years. METHODS: A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities. RESULTS: A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children. CONCLUSIONS: The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.

Prevalence of gingival overgrowth in renal transplant recipients on sirolimus immunosuppressive therapy is not clearly established.

PURPOSE/QUESTION: The authors attempted to study the gingival status of renal transplant patients receiving sirolimus immunosuppressive therapy by measuring the presence and severity of gingival overgrowth (GO) and by investigating the association between GO and sociodemographic, medical, and pharmacologic variables. SOURCE OF FUNDING: Grants from the Coordination of Improvement of Upper Level Personnel (CAPES), Brasilia, DF, Brazil, and the Foundation for Support of Research in Minas Gerais (FAPEMIG/#13016). TYPE OF STUDY/DESIGN: Cross-sectional LEVEL OF EVIDENCE: Level 3: Other evidence. STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Oral healthcare access and adequacy in alternative long-term care facilities.

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long-term care facilities (ALTCF). A 24-item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% (n = 508). Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived. Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.

Socioeconomic factors in adolescents' oral health: are they mediated by oral hygiene behaviors or preventive interventions?

OBJECTIVES: To determine whether there is a socioeconomic status (SES) disparity in caries experience (i.e., DMFT) in an adolescent sample from Pennsylvania and to determine whether differences in oral hygiene behaviors and preventive interventions account for this disparity. METHODS: A cross-sectional clinical assessment was conducted on a representative sample of 9th grade and 11th grade students across Pennsylvania. These students also completed a brief questionnaire regarding their oral hygiene behaviors. From this group of students, a random subsample of 530 parents completed a questionnaire assessing SES, fluoride exposure, and recency of receipt of dental services. DMFT was examined at two thresholds of severity: simple prevalence (DMFT > 0) and severe caries (DMFT > 3). RESULTS: Using structural equation modeling, we found that lower SES was associated with higher prevalence of DMFT and higher prevalence of severe caries. Although lower SES was associated with lower rates of brushing, less use of sealants, and less recent receipt of dental services, these oral health behaviors and preventive interventions did not account for the disparities in DMFT defined by SES. CONCLUSIONS: There is an SES gradient in caries experience in adolescents in Pennsylvania. Disparities in caries experience, however, cannot be accounted for by SES-associated differences in brushing, flossing, sealant use, fluoride exposure, or recency of use of dental services. To facilitate the design of preventive interventions, future research should determine the pathways through which SES-associated disparities occur.

Perceptions of oral health adequacy and access in Michigan nursing facilities.

OBJECTIVE: To determine practices and perceived access barriers (facility resources, attitudes and professional dental involvement) related to oral health by surveying directors of nursing (DONs) in Michigan nursing homes (NHs). BACKGROUND: DONs are crucial to NH practice and policy, so understanding their perceptions of oral health care is vital. METHODS: A 27-item questionnaire exploring aspects of oral health was mailed to all 402 Michigan NH. Descriptive statistics were calculated for response items. RESULTS: Facility response rate was 32% (n = 129). Sixty-three per cent of facilities had a written dental care plan primarily co-ordinated by nursing staff and social workers. Stationary dental equipment was available in 3% of facilities. Thirty-eight per cent stated an examination by a dentist was provided to new residents. Seventy-five per cent of residents identified as needing dental treatment were likely to receive it. Of the 28% of residents receiving dental treatment beyond an examination in the past year, 28% received emergent care. Over 50% of responding DONs indicated satisfaction with how oral hygiene needs were met in their facilities. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or their private offices as well as financial concerns of the resident and/or family. Generally, greater resources were available in urban facilities, but substantial barriers to care were uniformly perceived. CONCLUSION: Oral health policies and practices within Michigan NH vary, as measured by resources, attitudes, and the availability of professional care. Dental involvement in policy creation, provision of consultation, and service is limited.

Survey of dental sealants in Maryland third graders.

The Survey of the Oral Health Status of Maryland Schoolchildren, 2000-2001 was used to describe dental sealant prevalence among third-grade public schoolchildren in Maryland. The presence/absence of dental sealants on permanent molars was scored according to visual criteria. Descriptor variables included gender, race/ethnicity, parent/guardian level of education, and dental insurance status. Overall, less than 25% of third-grade Maryland schoolchildren had dental sealants, including 16% of non-Hispanic black children, 11% of children from families with less than 12 years of education, and 17% of those without dental insurance. Controlling for co-variates, non-Hispanic blacks were 2.2 times as likely to lack dental sealants as their peers, compared with children from families with less than 12 years of education (2.7 times as likely) and those without dental insurance (1.9 times as likely).

Dental visits and access to dental care among Maryland schoolchildren.

BACKGROUND: Regular dental visits afford an opportunity for dentists to provide preventive services and to diagnose and treat disease. Not all children, however, have equal access to these services. METHODS: The authors conducted this study to describe access to and utilization of oral health care services for Maryland schoolchildren in kindergarten and third grade. They obtained data from a questionnaire filled out by parents or guardians participating in the Survey of the Oral Health Status of Maryland School Children, 2000-2001 (N = 2,642). Outcome variables included having a dental visit in the last year, prophylaxis in the last year, usual source of medical care and usual source of dental care. Descriptor variables included region, grade, race/ethnicity, eligibility for free or reduced-fee meals, parents' or guardians' education and dental insurance status. RESULTS: Overall, general dental visit and dental prophylaxis visit rates were similar (74.1 and 71.3 percent, respectively). Schoolchildren, however, were more likely to have had a usual source of medical care than of dental care (96.0 and 82.9 percent, respectively). Third graders, those ineligible for free or reduced-fee meals and those with some dental insurance coverage were more likely to have received a prophylaxis in the last year and were more likely to have a usual source of dental care. Non-Hispanic white and non-Hispanic black schoolchildren also were more likely to have had a usual source of dental care than were Hispanics. CONCLUSIONS: Schoolchildren most likely to have received regular preventive dental care were those who had parents or guardians with financial resources. Medicaid and State Children's Health Insurance Program (SCHIP) provide safety nets, but these programs could be improved. PRACTICE IMPLICATIONS: Dentistry's challenge is to determine which characteristics are unique to those who visit the dentist regularly and use this information to help meet the needs of the underserved.

Survey of Oral Health Status of Maryland Schoolchildren, 2000--2001.

PURPOSE: The purpose of this study was to describe dental caries experience in the primary and permanent dentitions of Maryland schoolchildren in kindergarten and third grade, with an emphasis on untreated disease. METHODS: Data came from the Survey of the Oral Health Status of Maryland Schoolchildren, 2000--2001. Outcome variables were measures of dental caries experience for primary and permanent teeth. Dental caries was scored only for lesions that were >0.5 mm, measured with a periodontal probe. Radiographs were not used. Descriptor variables included grade level, gender, race/ethnicity, eligibility for free or reduced meals at school, parent/ guardian education, dental insurance status, and region. The statistical software program SUDAAN was used to produce weighted estimates and account for the complex sampling design. RESULTS: More than 2 in 10 schoolchildren had a history of dental caries. In children with a history of disease, approximately half of the experience was due to untreated decay. Controlling for confounders, disparities in untreated dental caries were significantly associated with region, race/ethnicity, and parent/guardian education. CONCLUSIONS: Success in meeting the dental caries treatment needs in children will require attention to multiple family-level, community-level, and system-level barriers, especially among low socioeconomic status populations. Unless barriers are overcome, dental caries disparities will continue in Maryland.

Self-reported awareness of unrestored dental caries. Survey of the Oral Health Status of Maryland Schoolchildren, 2000--2001.

PURPOSE: The purpose of this study was to assess and compare parental awareness of unrestored dental caries needs in a schoolchildren population according to socioeconomic status. METHODS: Subjective and normative unrestored dental caries data of kindergarten and third-grade children were collected from parental awareness questionnaires and clinical examinations, respectively, used in a 2000--2001 statewide survey of Maryland schoolchildren. Descriptive, bivariate, and multivariate analyses were performed to assess awareness of unrestored dental caries. Parental perceived need also was compared to clinical findings of unrestored dental caries. RESULTS: Actual (clinically assessed) unrestored dental caries (21%) was found to be 2 times the level of self-reported awareness of dental caries (11%). Those most likely to have significantly incorrect awareness of unrestored dental caries were: (1) low-income populations; (2) residents of the Maryland Eastern Shore. Sensitivity was 34% and specificity 96% in comparing self-assessed, unrestored dental caries need with the clinical findings. CONCLUSIONS: An incorrect perceived oral health need is high in poorer populations and may serve as a barrier to their achieving optimal oral health, given that disease prevalence is higher and access to oral health care services is lower in this population group.

Is 75 percent of dental caries really found in 25 percent of the population?

OBJECTIVES: Dental caries prevalence is used to quantify inequalities and to target high-risk populations for interventions. Prevalence can be described via measures of centrality; however, some have used cumulative frequency distribution curves (Lorenz curves). This investigation provides dental caries Lorenz curves for the primary and permanent dentitions at selected ages. Results provide accurate age-specific and dentition-specific X values for the general statement, "75 percent of dental caries is found in X percent of the population." METHODS: Data were derived from the Third National Health and Nutrition Examination Survey, a cross-sectional study conducted between 1988 and 1994. Cumulative frequency distributions for total dfs or DMFS were plotted against cumulative frequency distributions for the total population. RESULTS: X values varied substantially between dentitions and across ages. Total dental caries experience in the permanent dentition was more dispersed than it was in the primary dentition, and the total dental caries experience in older persons was more dispersed than it was in younger persons. For those aged 2-5 years, 75 percent of dental caries (primary dention) was found in 8.1 percent of the population. For those aged 6 years or older, 75 percent of dental caries (permanent dentition) was found in 33.0 percent of the population. CONCLUSIONS: For accuracy and relevancy, the statement, "75 percent of dental caries is found in X percent of the population" must be applied to a particular dentition or age group, and must account for appropriate severity and prevalence reference points.

Diabetes, periodontal diseases, dental caries, and tooth loss: a review of the literature.

Diabetes mellitus, is a common chronic disease, and its prevalence in the United States, particularly type 2 diabetes, is increasing. Complications associated with diabetes impose a heavy burden on many people, especially among certain minority populations. Periodontal diseases, dental caries, and tooth loss also are common conditions in the United States, but their prevalence is generally decreasing. Nevertheless, among important subgroups of the population, particularly certain minority and economically disadvantaged groups, there is a disproportionately higher burden of periodontal diseases, dental caries, and tooth loss. This article reviews the post-1960 English-language literature on the relationship between diabetes and oral health, specifically focusing on periodontal disease, dental caries, and tooth loss. Substantial evidence exists to support the role of diabetes and poorer glycemic control as important risk factors for periodontal disease. Additionally, the evidence provides support for viewing the relationship between diabetes and periodontal diseases as bidirectional. However, additional research is necessary to firmly establish that treating periodontal infections can contribute to glycemic control management and possibly to the reduction of type 2 diabetes complications. The literature does not describe a consistent relationship between type 2 diabetes and dental caries. It reports increased, decreased, and similar caries experiences between those with and without diabetes. This review suggests that currently there is insufficient evidence to determine whether a relationship between diabetes and risk for coronal or root caries exists. Most of the reviewed studies reported greater tooth loss in people with diabetes. However, the differences were slight and not significant in several of the reports. Furthermore, this review of the association between diabetes and tooth loss reveals that valid population-based evidence generalizable to the US population is sparse. Further investigations of the association of diabetes with dental caries and tooth loss are warranted. If adverse effects of diabetes on dental caries and/or tooth loss are substantiated, the results of such studies would help design intervention studies to prevent or reduce the occurrence of dental caries and tooth loss in people with diabetes. These results also may affect existing clinical practice protocols and promote new public policy related to diabetes.