Oral Health of Older Adults in Washington State.

Purpose: An aging population, combined with increasing tooth retention, could significantly impact the dental care delivery system. The purpose of this study was to assess self-reported oral health and the factors associated with oral health outcomes among a random sample of older adults in Washington State.Methods: A telephone survey of adults 55+ years was used to collect information on factors associated with oral health, plus four outcome variables; substantial tooth loss (6+ teeth lost), oral problems, oral pain, and poor health of teeth. Data were weighted to reflect the state's age and gender statistics.Results: A total of 2,988 older adults completed the survey during 2017. Substantial tooth loss (18%), oral problems (17%) and oral pain (13%) were the most frequently reported issues. Of the adults with teeth, 17% reported fair/poor health of teeth. Compared to adults with an income of $75,000 or more, adults with an income less than $25,000 were twice as likely to have substantial tooth loss and oral problems (OR=2.1 and 2.2, respectively) and were three times more likely to report oral pain and poor health of teeth (OR=3.1 and 3.3, respectively). The oldest old (adults 75+ years), as compared to those 55-64 years, were significantly more likely to have substantial tooth loss (OR=2.6) but were less likely to report oral problems (OR=0.6), pain (OR=0.3), or poor health of teeth (OR=0.5).Conclusions: Although the majority of Washington's older adults report having good oral health, a small subgroup has oral problems which may have a negative impact on quality of life.

A novel staging system for caries severity in the primary dentition.

OBJECTIVES: Caries in the primary dentition (CIPD) has a high prevalence in U.S. children compared to other diseases, with substantial disparities among different population groups. Few reports correlate CIPD prevalence with clinical impairment of children's quality of life, such as tooth pain, speech delay or trauma to the child from operative restorations, which we collectively term morbidity. Likewise, current case definitions (ECC, S-ECC) and disease metrics (mean dmfs/dmft) are not helpful in assessing morbidity for individual or groups of children. We describe a construct to stage caries severity for children ages 0 -5, called "CIPD Levels." This metric is based on small interval age-group dmft scores, and has a direct link to current and predicted morbidity for the child. It is modeled after staging systems for medical diseases in which the various stages or levels are correlated with the probability of morbidity or mortality. METHODS: We created a matrix in which CIPD Levels 0-4 are assigned for dmft scores 0-7 depending on a child's age. CIPD Level-4 is the highest level, and frequently results in clinical adverse outcomes, including pain and extensive restorations. We next tested this matrix with data from a high-risk population. RESULTS: Among children with any cavitated caries at age <24 months, 82.8% reached the adverse outcomes threshold (CIPD Level-4) at age 36 months. For children with dmft = 0 at 24 months, 71.4% did not reach CIPD Level-4 at age 36 months. CONCLUSION: Our new metric is useful for quantifying disease burden from caries for high-risk children.

Timing of primary tooth emergence among U.S. racial and ethnic groups.

OBJECTIVES: To compare timing of tooth emergence among groups of American Indian (AI), Black and White children in the United States at 12 months of age. METHODS: Data were from two sources - a longitudinal study of a Northern Plains tribal community and a study with sites in Indiana, Iowa and North Carolina. For the Northern Plains study, all children (n = 223) were American Indian, while for the multisite study, children (n = 320) were from diverse racial groups. Analyses were limited to data from examinations conducted within 30 days of the child's first birthday. RESULTS: AI children had significantly more teeth present (Mean: 7.8, Median: 8.0) than did Whites (4.4, 4.0, P < 0.001) or Blacks (4.5, 4.0, P < 0.001). No significant differences were detected between Black and White children (P = 0.58). There was no significant sex difference overall or within any of the racial groups. CONCLUSIONS: Tooth emergence occurs at a younger age for AI children than it does for contemporary White or Black children in the United States.

Factors associated with dental caries in a group of American Indian children at age 36 months.

OBJECTIVES: Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This article reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study. METHODS: Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children, and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28, and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary, and behavioral factors. Nonparametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts). RESULTS: Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only noncavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added-sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (P < 0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts. CONCLUSIONS: By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size, and maternal factors, but further analyses are needed to better understand caries in this population.

The Indian Health Service Early Childhood Caries Collaborative: A Five-year Summary.

PURPOSE: The purpose of this study was to assess a national initiative's effect on prevalence of early childhood caries and untreated decay in zero- to five-year-old Indian/Alaska Native preschool children. METHODS: The Indian Health Service (IHS) conducted a five-year Early Childhood Caries Collaborative from October 1, 2009 to September 30, 2014. The program used educational materials and routine communication with the 322 IHS and United States tribal dental programs, with an emphasis on early access to care, dental sealanth, fluoride varnish, and interim therapeutic restorations (ITRs). Prevalence and untreated decay data were obtained through the nationwide oral health survey (2010 and 2014). Data were also collected on access to care, sealants, fluoride, and ITRs. RESULTS: The number of zero- to five-year-olds with a dental visit increased seven percent: dental sealants placed increased 65 percent; and fluoride varnish applications increased 161.2 percent. Between 2010 and 2014, the percentage of one- to two-year-olds with decay experience and untreated decay declined, but the difference was not statistically significant. CONCLUSIONS: Early childhood caries prevention strategies, such as early access to dental care, sealants, fluoride varnish, and interim therapeutic restorations, demonstrated some initial improvement in the oral health status of zero- to five-year-old Indian/Alaska Native children.

Genotypic characterization of initial acquisition of Streptococcus mutans in American Indian children.

BACKGROUND: Severe-early childhood caries (S-ECC) is one of the most common infectious diseases in children and is prevalent in lower socio-economic populations. American Indian children suffer from the highest levels of S-ECC in the United States. Members of the mutans streptococci, Streptococcus mutans, in particular, are key etiologic agents in the development of caries. Children typically acquire S. mutans from their mothers and early acquisition is often associated with higher levels of tooth decay. METHODS: We have conducted a 5-year birth cohort study with a Northern Plains Tribe to determine the temporality and fidelity of S. mutans transmission from mother to child in addition to the genotypic diversity of S. mutans in this community. Plaque samples were collected from 239 mother/child dyads at regular intervals from birth to 36 months and S. mutans were isolated and genotyped by arbitrarily primed-polymerase chain reaction (AP-PCR). RESULTS: Here we present preliminary findings from a subset of the cohort. The focus for this paper is on initial acquisition events in the children. We identified 17 unique genotypes in 711 S. mutans isolates in our subset of 40 children, 40 mothers and 14 primary caregivers. Twelve of these genotypes were identified in more than one individual. S. mutans colonization occurred by 16 months in 57.5% of the children and early colonization was associated with higher decayed, missing and filled surface (DMFS) scores (p=0.0007). Children colonized by S. mutans shared a common genotype with their mothers 47.8% of the time. While multiple genotypes were common in adults, only 10% of children harbored multiple genotypes. CONCLUSION: These children acquire S. mutans at an earlier age than the originally described 'window of infectivity' and often, but not exclusively, from their mothers. Early acquisition is associated with both the caries status of the children and the mothers.

Permanent first molar eruption and caries patterns in American Indian and Alaska Native children: challenging the concept of targeting second grade for school-based sealant programs.

OBJECTIVE: To describe first permanent molar eruption and caries patterns among American Indian and Alaska Native (AI/AN) children in order to identify the appropriate target grade for school-based sealant programs. METHODS: We used data from the 2011-2012 Indian Health Service oral health surveillance survey of AI/AN children in kindergarten through third grade. Children were screened by trained examiners. Cavitated lesions were classified as decayed, and teeth with any portion of the crown exposed were considered erupted. RESULTS: We screened 15,611 AI/AN children in 186 schools. The percentage with four erupted first molars was 27 percent of kindergarten, 76 percent of first, 96 percent of second, and 99 percent of third-grade children. About 7 percent of kindergarteners had decayed, missing, or filled molars compared with 20 percent, 30 percent, and 38 percent of first, second, and third graders, respectively. CONCLUSION: School-based sealant programs for AI/AN children should target kindergarten and first grade with follow-up programs for second-grade children.

Using chlorhexidine varnish to prevent early childhood caries in American Indian children.

OBJECTIVES: To test the efficacy of 10% chlorhexidine (CHX) dental varnish applied to the mothers' dentition in preventing caries in American Indian children. METHODS: This was a placebo-controlled, double-blind, randomized clinical trial. Mother-child pairs were enrolled when the child was 4.5-6.0 months. Mothers received 4 weekly applications of the study treatment (CHX or placebo) followed by single applications when her child was age 12 and 18 months. Children received caries examinations at enrollment, 12, 18 and 24 months. Analyses were limited to the intent-to-treat (ITT) group: children whose mothers received the first study treatment and who received at least one post-baseline exam. The outcome variable was the number of new carious surfaces (NNCS) at the child's last visit. Wilcoxon nonparametric and Fisher's exact tests were used to test differences between the active and placebo groups. RESULTS: We randomized 414 mother-child pairs, with 367 (88.6%) included in the ITT group (active = 188, placebo = 179). The proportion of children caries-free at their final exam was 51.1% and 50.8% for the active and placebo groups (P > 0.99). The mean NNCS for the active and placebo groups was 3.82 (standard deviation [SD] = 8.18) and 3.80 (SD = 6.08), respectively (P = 0.54). The proportion with NNCS > 6 was 18.1% for active children versus 27.9% for placebo (relative risk [RR] = 0.65, P = 0.03). The number needed to treat to shift one child from NNCS > 6 to a lower severity was 10.2. CONCLUSIONS: In this population CHX varnish did not reduce the mean NNCS or proportion of children with caries, but did reduce the proportion with severe caries.

No evidence to support the claim that amoxicillin causes molar-incisor hypomineralization.

SUBJECTS: All children (n = 217) attending the second to fifth years of comprehensive schools in the nonfluoridated town of Lammi, Finland, were invited to participate in the study. Of those invited, 147 (67.7%) agreed to participate and study data were obtained for 141. The children ranged in age from 7.8 to 12.7 years with a mean of 10.7 years. Slightly more than half (53.9%) of the children were male. No other information was presented. KEY RISK/STUDY FACTOR: The key study factor was antibiotic use during the first, second, third, and fourth years of life. Information on amoxicillin, penicillin V, cephalosporin, macrolides (erythromycin), sulfonamide, and trimethoprim use was obtained from the local health center medical records. MAIN OUTCOME MEASURE: The outcome measure was hypomineralization of the permanent first molars. A tooth was considered to be hypomineralized if it had a demarcated opacity, broken-down hypomineralized enamel, or an atypical restoration. Lesions smaller than 2 mm in diameter were excluded. The potential issue of missing first molars and how they should be classified was not addressed. MAIN RESULTS: Eighty-five percent of the children had received at least one course of antibiotics. During the first year of life, 34.8% had taken either penicillin or amoxicillin or both, whereas 5.0% received erythromycin. Twenty-three children (16.3%) had one or more permanent first molars with hypo-mineralization. Of the children with molar hypomineralization (MH), 12 (52.2%) had taken antibiotics during the first year of life compared with 33.9% of the children without MH (P > .05). The unadjusted odds ratio (OR) for MH among children who received amoxicillin during the first year was 2.06 (95% confidence interval [CI] 1.01-4.17), whereas the unadjusted OR for MH was 4.14 (95% CI, 1.05-16.4) among children who received erythromycin during the first year. CONCLUSIONS: The authors concluded that the early use of amoxicillin is among the causative factors of molar hypomineralization. STUDY 2 SUMMARY SUBJECTS: Mandibular molar explants from 27 mouse embryos in an organ culture. KEY RISK/STUDY FACTOR: Exposure to amoxicillin at 100 mg/mL, 1 mg/mL, and 4 mg/mL. MAIN OUTCOME MEASURE: Enamel and dentin thickness after 10 days of culture. MAIN RESULTS: In first molars with enamel, the enamel-dentin layer was thicker in explants exposed to amoxicillin at concentrations of 1 mg/mL or more compared with controls and those exposed to 100 mg/mL (P < .001). The enamel/dentin ratio also differed significantly (P < .007). The actual thickness data were not presented. CONCLUSIONS: The authors concluded that the early use of amoxicillin is among the causative factors of molar hypomineralization.

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.

State oral health infrastructure and capacity: lessons learned from other states.

This paper discusses some preliminary findings from the Infrastructure Enhancement Project conducted by the Association of State and Territorial Dental Directors (ASTDD), which focuses on state oral health programs and their roles in addressing core public health functions and essential public health services. Findings from analysis of state data since 2000, surveys, reports, and key informant interviews substantiate the value of the following: a) state oral health surveillance; b) oral health improvement plans; c) collaborations and coalitions; d) evidence-based practices and evaluation; e) diversified funding; f) placement and authority of the programs and directors; and g) competencies versus staffing formulas. No single program model fits all the unique populations and political and economic variations among states. Each state is encouraged to use the many tools, resources, and best practices/lessons learned available through ASTDD, federal agencies, and national organizations to design effective and sustainable programs.

California's state oral health infrastructure: opportunities for improvement and funding.

California has virtually no statewide dental public health infrastructure leaving the state without leadership, a surveillance program, an oral health plan, oral health promotion and disease prevention programs, and federal funding. Based on a literature review and interviews with 15 oral health officials nationally, the paper recommends hiring a state dental director with public health experience, developing a state oral health plan, and seeking federal and private funding to support an office of oral health.

Language and literacy relate to lack of children's dental sealant use.

OBJECTIVES: This study aimed to determine the percent of California's third grade public school children lacking sealants by child and family factors and to measure social disparities for lacking sealants. METHODS: The study analyzed data from the California Oral Health Needs Assessment (COHNA) 2004-2005, a complex stratified cluster sample of children (n = 10,450) from 182 randomly selected public elementary schools in California. The dependent variable was absence of sealants in first permanent molars. The independent variables included child race/ethnicity; socio-economic position (SEP) measured as child's participation in the free or reduced-price lunch program at the individual and school level; acculturation measured as language spoken at home and school level percent of English language learners; and parent functional health literacy measured as correctly following questionnaire instructions. Absolute differences and health disparity indices (i.e. Slope Index of Inequality, Relative Index of Inequality-mean, Absolute Concentration Index) were used to measure absolute and relative disparities. RESULTS: The percent of children lacking sealants was high in all racial/ethnic groups; no child or school level SEP differences in lacking sealants were seen, but significant differences existed by acculturation (child and school level) and parental functional health literacy. CONCLUSIONS: NonEnglish language and poor parental functional health literacy are potential barriers that need to be addressed to overcome disparities in sealant utilization.

Periodontal conditions in elderly men with and without osteoporosis or osteopenia.

BACKGROUND: The purpose of this case-control study is to investigate the periodontal conditions in elderly men with and without osteoporosis or osteopenia and to determine their possible association with periodontal destruction. METHODS: A total of 200 community-dwelling Chinese males (age range: 69 to 78 years; mean ± SD age: 71.9 ± 3.3 years) were recruited from the Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, including 67 subjects with osteoporosis, 66 subjects with osteopenia, and 67 age-matched normal control subjects based on bone mineral density at the hip, spine, and whole body measured by dual-energy x-ray densitometry. All subjects were interviewed using questionnaires and received a full-mouth periodontal examination. RESULTS: Subjects with osteoporosis exhibited a significantly higher percentage of sites with clinical attachment loss (AL) > or= 6 mm compared to subjects with osteopenia (P <0.05); subjects with osteoporosis also showed a greater percentage of sites with interproximal gingival recession (GR) > or = 5 mm than did control subjects (P <0.05) after excluding smokers. Subjects with osteoporosis were more likely (odds ratio = 3.3; P <0.05) to exhibit interproximal GR > or = 5 mm than were control subjects. Osteoporosis remained significantly associated with severe clinical AL and interproximal GR after adjusting for age, supragingival plaque, and number of teeth lost. CONCLUSION: This study suggests that osteoporosis is associated with severe clinical AL and interproximal GR in elderly Chinese men.

No evidence to support the claim that amoxicillin causes molar-incisor hypomineralization.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Amoxicillin may cause molar incisor hypomineralization. Laisi S, Ess A, Sahlberg C, Arvio P, Lukinmaa PL, Alaluusua S. J Dent Res 2009;88(2):132-6. REVIEWER: Kathy R. Phipps, MPH, DrPH PURPOSE/QUESTION: Does exposure to antibiotics, specifically amoxicillin, increase a child's risk of having hypomineralized permanent first molars? SOURCE OF FUNDING: The Academy of Finland (government) and the Finnish Dental Society Apollonia (nonprofit) TYPE OF STUDY/DESIGN: Two studies were presented, one was laboratory the other was a retrospective cohort LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

Periodontal health of older men: the MrOS dental study.

OBJECTIVE: The purpose of this study was to evaluate the prevalence and severity of periodontitis in men of 65+ years and identify demographic and lifestyle factors associated with its presence. METHODS: Participants were recruited from the Osteoporotic Fractures in Men Study, a longitudinal study of risk factors for fractures in older men. Dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque and bleeding on a random half-mouth, plus a questionnaire regarding access to care, symptoms and previous diagnosis. RESULTS: 1210 dentate men completed the dental visit. Average age was 75 years, 39% reported some graduate school education, 32% smoked 20 + pack years and 88% reported their overall health as excellent/good. In terms of periodontal health, 38% had sub-gingival calculus, 53% gingival bleeding, 82% CAL > or =5 mm and 34% PD > or =6 mm. The prevalence of severe periodontitis was 38%. Significant demographic and lifestyle factors associated with severe periodontitis in multivariate analyses included age > or =75 (OR 1.4, 95% CI 1.1-1.7) non-white race (OR 1.9, 95% CI 1.3-2.8), less than an annual dental visit (OR 1.5, 95% CI 1.1-2.0), and 20 + pack years (OR 2.1, 95% CI 1.6-2.7). CONCLUSION: A high proportion of healthy older men have evidence of periodontal destruction which could, given the growing ageing population, have a significant impact on the dental profession's ability to provide preventive and therapeutic care. The population at highest risk of periodontitis in MrOS is older minority men who smoke and do not have annual dental visits.

Development and status of the National Oral Health Surveillance System.

During the last 2 decades of the 20th century, few national, state, or local oral health programs were able to conduct public health surveillance in a timely fashion. Under the leadership of the Association of State and Territorial Dental Directors and with substantial support from the Division of Oral Health at the Centers for Disease Control and Prevention, the National Oral Health Surveillance System was established as a first step in helping oral health programs routinely document population needs and program impact with standard, feasible methods. In 1999, the Council of State and Territorial Epidemiologists approved 7 oral health indicators for public health surveillance: 3 for adults (most recent dental visit, most recent dental cleaning, total tooth loss) using data from the Behavioral Risk Factor Surveillance System; 3 for third-grade students (presence of treated or untreated dental caries, untreated tooth decay, dental sealants) collected by states using a standard screening protocol; and the percentage of the population served by public water systems that receives optimally fluoridated water, tracked through the Water Fluoridation Reporting System. The Web site that describes the National Oral Health Surveillance System (http://www.cdc.gov/nohss/) and provides access to current indicators was launched in 2001 with adult and water fluoridation data for all states; child indicators were added later. Data are now available electronically for 35 to 51 states (including the District of Columbia), depending on the indicator, indicating progress toward state-specific monitoring of these oral health indicators.