Findings from the 2019 nationally representative oral health survey for adults in Singapore.

OBJECTIVES: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). METHODS: A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. RESULTS: Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. CONCLUSIONS: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

Classification of presence of missing teeth in each quadrant using deep learning artificial intelligence on panoramic radiographs of pediatric patients.

Early tooth loss in pediatric patients can lead to various complications, making quick and accurate diagnosis essential. This study aimed to develop a novel deep learning model for classification of missing teeth on panoramic radiographs in pediatric patients and to assess the accuracy. The study included patients aged 8-16 years who visited the Pusan National University Dental Hospital and underwent panoramic radiography. A total of 806 panoramic radiographs were retrospectively analyzed to determine the presence or absence of missing teeth for each tooth number. Moreover, each panoramic radiograph was divided into four quadrants, each of a smaller size, containing both primary and permanent teeth, generating 3224 data. Quadrants with missing teeth (n = 1457) were set as the experimental group, and quadrants without missing teeth (n = 1767) were set as the control group. The data were split into training and validation sets in a 4:1 ratio, and a 5-fold cross-validation was conducted. A gradient-weighted class activation map was used to visualize the deep learning model. The average values of sensitivity, specificity, accuracy, precision, recall and F1-score of this deep learning model were 0.635, 0.814, 0.738, 0.730, 0.732 and 0.731, respectively. In the experimental group, the accuracy was the highest for missing canines and premolars, and the lowest for molars. The deep learning model exhibited a moderate to good distinguishing power with a classification performance of 0.730. This deep learning model and the newly defined small sized region of interest proved adequate for classifying the presence of missing teeth.

Validity of claims-based definition of number of remaining teeth in Japan: Results from the Longevity Improvement and Fair Evidence Study.

BACKGROUND: Secondary healthcare data use has been increasing in the dental research field. The validity of the number of remaining teeth assessed from Japanese dental claims data has been reported in several studies, but has not been tested in the general population in Japan. OBJECTIVES: To evaluate the validity of the number of remaining teeth assessed from Japanese dental claims data and assess its predictability against subsequent health deterioration. METHODS: We used the claims data of residents of a municipality that implemented oral health screening programs. Using the number of teeth in the screening records as the reference standard, we assessed the validity of the claims-based number of teeth by calculating the mean differences. In addition, we assessed the association between the claims-based number of teeth and pneumococcal disease (PD) or Alzheimer's disease (AD) in adults aged ≥65 years using Cox proportional hazards analyses. RESULTS: Of the 10,154 participants, the mean number of teeth assessed from the claims data was 20.9, that in the screening records was 20.5, and their mean difference was 0.5. During the 3-year follow-up, PD or AD onset was observed in 10.4% (3,212/30,838) and 5.3% (1,589/30,207) of participants, respectively. Compared with participants with ≥20 teeth, those with 1-9 teeth had a 1.29 (95% confidence interval [CI]: 1.17-1.43) or 1.19 (95% CI: 1.04-1.36) times higher risk of developing PD or AD, respectively. CONCLUSION: High validity of the claims-based number of teeth was observed. In addition, the claims-based number of teeth was associated with the risk of PD and AD.

Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study.

BACKGROUND: Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults. METHODS: An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Swietokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption. RESULTS: The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms. CONCLUSIONS: The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

The protective effect of CALD identity in the presence of low income on missing teeth of Australian adults over time.

BACKGROUND: 'Culturally And Linguistically Diverse (CALD)' populations have diverse languages, ethnic backgrounds, societal structures and religions. CALD populations have not experienced the same oral health benefits as non-CALD groups in Australia. However, the socio-demographic profile of Australian CALD populations is changing. This study examined how household income modifies the oral health of CALD and non-CALD adults in Australia. METHODS: Data were from two National Surveys of Adult Oral Health (NSAOH) conducted in 2004-06 (NSAOH 2004-06) and 2017-18 (NSAOH 2017-18). The outcome was self-reported number of missing teeth. CALD status was identified based on English not the primary language spoken at home and country of birth not being Australia. Social disadvantage was defined by total annual household income. Effect-measure modification was used to verify differences on effect sizes per strata of CALD status and household income. The presence of modification was indicated by Relative Excess Risk due to Interactions (RERIs). RESULTS: A total of 14,123 participants took part in NSAOH 2004-06. The proportion identifying as CALD was 11.7% and 56.7% were in the low-income group, and the mean number of missing teeth was 6.9. A total of 15,731 participants took part in NSAOH 2017-18. The proportion identifying as CALD was 18.5% and 38.0% were in the low-income group, and the mean number of missing teeth was 6.2. In multivariable modelling, the mean ratio (MR) for CALD participants with low household income in 2004-06 was 2% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.23. Non-CALD participants from lower income households had a higher risk of having a higher number of missing teeth than low income CALD individuals (MR = 1.66, 95%CI 1.57-1.74 vs. MR = 1.43 95%CI 1.34-1.52, respectively). In 2017-18, the MR for CALD participants with low household income was 3% lower than the MR among non-CALD participants with high household income, with the RERI being - 0.11. Low income CALD participants had a lower risk of missing teeth compared to their non-CALD counterparts (MR = 1.43, 95% CI 1.34-1.52 vs. MR = 1.57, 95% CI 1.50-1.64). CONCLUSIONS: The negative RERI values indicate that the effect-measure modification operates in a negative direction, that is, there is a protective element to being CALD among low income groups with respect to mean number of missing teeth.

Exploring the association between number of teeth, food intake, and cognitive function: A 9-year longitudinal study.

OBJECTIVES: This study aimed to investigate the association between the number of teeth, food intake, and cognitive function in Japanese community-dwelling older adults. METHODS: This 9-year longitudinal study included a total of 293 analyzable participants who participated in baseline and follow-up surveys. Dental status (number of teeth and periodontal pocket depth), dietary assessment using the brief-type self-administered diet history questionnaire, cognitive function, and the following confounding factors were evaluated: educational level, financial satisfaction, living situation, smoking and drinking habits, history of chronic diseases, apolipoprotein E-ε4 carrier, body mass index, handgrip strength, instrumental activities of daily living, and depressive symptomatology. The Japanese version of the Montreal Cognitive Assessment was used to evaluate cognitive function. A multinomial logistic regression analysis for the intake level of each food categorized into three groups (low, moderate, high), and a generalized estimating equation (GEE) for cognitive function over nine years were performed. RESULTS: After controlling for confounding factors, the number of teeth was shown to be associated with the intake of green-yellow vegetables and meat. Furthermore, the GEE indicated that the lowest quartile of intake of green-yellow vegetables significantly associated with lower cognitive function (unstandardized regression coefficient [B] = -0.96, 95 % confidence interval [CI]: -1.72 to -0.20), and the lowest quartile of intake of meat significantly associated with lower cognitive function (B = -1.42, 95 % CI: -2.27 to -0.58). CONCLUSIONS: The intake of green and yellow vegetables and meat, which is influenced by the number of teeth, was associated with cognitive function in Japanese community-dwelling older adults. CLINICAL SIGNIFICANCE: There are few studies that have examined the association between oral health, food intake, and cognitive function. This 9-year longitudinal study suggests that it is important to maintain natural teeth to enable the functional means to consume green-yellow vegetables and meat, and thereby help maintain cognitive function.

'It's like being in a tunnel': Understanding the patient journey from tooth loss to life with removable dentures.

INTRODUCTION: The aim of this study was to conceptualise the key stages of the patient journey in the provision of a new denture and examine the factors leading to successful patient-related outcomes. METHODS: Two partially dentate patient samples were included: (i) Denture wearers - patients who had a denture fitted within the previous five years and (ii) New dentures - patients receiving treatment for a new or replacement denture. The methods involved direct targeted participant observations of the denture fitting process, debriefing interviews and a follow-up focus group exploring the patient journey. Data were analysed through the use of phenomenology and grounded theory. RESULTS: Interviews were completed with twenty participants of the denture-wearing sample (11 males and nine females, age range 22 to 86 years). Thirteen participants were included in the treatment journey sample in two primary care settings (six males and seven females, age range 55 to 101 years). Tooth loss and recovery was described as being in an 'emotional tunnel' resulting from 'bodyphonic processes' associated with tooth loss. 'Bodyphonia' subsequently became the context for 'taking control' and 'managing disclosure' when living with a removable denture. Different courses through this process can be readily observed, moderated by different variables (i.e., previous experience, working knowledge, a good fit, the treatment alliance, negotiated compromises and bounded responsibility). CONCLUSIONS: An'integrating framework' that seeks to describe the patient journey from the experience of tooth loss to recovery with a denture is proposed. This framework could be used to aid development of a clinical pathway to guide treatment options. CLINICAL SIGNIFICANCE: This paper conceptualises the patient journey. It stresses the importance of understanding the stages patients go through and highlights that for the dental team, the try-in stage is perhaps the best stage to give information about the denture and plans for continued care.

Impact of tobacco habits on poor oral health status among bone-factory workers in a low literacy city in India: A cross-sectional study.

Oral health is a vital indicator of well-being that is influenced by various habits and lifestyles of individuals. Oral diseases are the bottleneck in the effective control of non-communicable diseases (NCDs) due to chronic in nature and reciprocal relationship as sharing the common risk factors and habits such as sugar, tobacco, and alcohol consumption that increase the risk of developing various inevitable diseases. However, there is a lack of literature highlighting the relationship between risk factors for oral diseases and general health among individuals. This cross-sectional study was carried out among 500 study participants aged 20 to 64 years who gave written informed consent and were recruited by Multistage Stratified Cluster Sampling technique among workers in five bone factories, working for at least one year since January 2001 to March 2022 in Sambhal city, Uttar Pradesh. WHO-Basic Oral Health Survey-1997 was used to record the data regarding sociodemographic and oral health status variables. We used the modified WHO-STEPWISE pre-structured questionnaire to record tobacco consumption habits and oral health-seeking behavior. We scheduled a clinical intra-oral examination to record the Decayed Missing Filled Teeth (DMFT) index and the interview on the premises of five bone factories. Among the 500 bone-factory workers, the total number of males was 342 (68.40%) and 158 (31.60%) were females. The mean age (Standard Deviation) was 33.18 (10), and the mean DMFT score of factory workers was 2.84 (3.12). Production workers had the highest mean DMFT score of 4.60 (3.25). More than half of the factory workers (53.2%) were tobacco users. Tobacco users were 3.52 times more likely to have a severe DMFT index. Most common pre-cancerous lesions were oral submucous fibrosis and leukoplakia. Compared to non-tobacco users, mild tobacco users have 6.80 folds higher odds of oral lesions. Tobacco consumption is not only harmful for oral health but also leads to several non-communicable and systemic diseases. NCDs and dental caries are chronic and preventable conditions with a bidirectional relationship implicated by modifiable major risk factors such as tobacco consumption. Decreasing the consumption of tobacco use may improve oral health and reduce the risk of the development of NCDs. Also, regular dental visits should be scheduled to monitor the oral health status of factory workers. Additionally, tailored intervention for tobacco cessation should be implicated to maintain the general and oral health of industrial workers.

Association of rotating night shift work with tooth loss and severe periodontitis among permanent employees in Japan: a cross-sectional study.

Background: The modern 24/7 society demands night shift work, which is a possible risk factor for chronic diseases. This study aimed to examine the associations of rotating night shift work duration with tooth loss and severe periodontitis. Methods: This cross-sectional study used data from a self-administered questionnaire survey conducted among 3,044 permanent employees aged 20-64 years through a Japanese web research company in 2023. The duration of rotating night shift work was assessed using a question from the Nurses' Health Study. Tooth loss was assessed based on self-reported remaining natural teeth count. Severe periodontitis was assessed using a validated screening questionnaire comprising four questions related to gum disease, loose tooth, bone loss, and bleeding gums. We employed linear regression models for tooth loss and Poisson regression models for severe periodontitis, adjusting for demographic, health and work-related variables and socioeconomic status. Results: Among participants included, 10.9% worked in rotating night shifts for 1-5 years, while 11.0% worked in such shifts for ≥6 years. In fully adjusted models, rotating night shift work duration of 1-5 years was associated with tooth loss (beta -0.74, 95% confidence interval (CI) [-1.55 to 0.08]) and severe periodontitis (prevalence ratio 1.80, 95% CI [1.33-2.43]); however, the association with tooth loss was not statistically significant. Conclusions: This study supports that employees who work short-term rotating night shifts may experience poor oral conditions. Further research is needed to determine whether long-term rotating night shift work is associated with deteriorated oral health.

Chairside digital design and manufacturing method for children's band and loop space maintainers.

OBJECTIVES: This study proposes a chairside digital design and manufacturing method for band and loop space maintainers and preliminarily validates its clinical feasibility. METHODS: Clinical cases of 10 children requiring space maintenance caused by premature loss of primary teeth were collected. Intraoral scan data of the affected children were also collected to establish digital models of the missing teeth. Using a pediatric band and loop space maintainer design software developed by our research team, a rapid personalized design of band and loop structures was achieved, and a digital model of an integrated band and loop space maintainer was ultimately generated. A chairside space maintainer was manufactured through metal computer numerical control machining for the experimental group, whereas metal 3D printing in the dental laboratory was used for the control group. A model fitting assessment was conducted for the space maintainers of both groups, and senior pediatric dental experts were invited to evaluate the clinical feasibility of the space maintainers with regard to fit and stability using the visual analogue scale scoring system. Statistical analysis was also performed. RESULTS: The time spent in designing and manufacturing the 10 space maintainers of the experimental group was all less than 1 h. Statistical analysis of expert ratings showed that the experimental group outperformed the control group with regard to fit and stability. Both types of space maintainers met clinical requirements. CONCLUSIONS: The chairside digital design and manufacturing method for pediatric band and loop space maintainers proposed in this study can achieve same-day fitting of space maintainers at the first appointment, demonstrating good clinical feasibility and significant potential for clinical application.

Células tronco e endodontia regenerativa / Stem cells and regenerative endodontics

Desde o incremento das pesquisas das células-tronco em 1961, por cientistas canadenses, os avanços em estudos, pesquisas e o desenvolvimento de novos tratamentos com esse tipo de recurso se mostram promissores. O uso de células-tronco é uma grande aposta tanto para a medicina quanto para a odontologia regenerativa. Os tratamentos com essa terapia podem oferecer mais qualidade de vida para as pessoas. O potencial dessas células tão especiais se encontra em duas características peculiares: elas são capazes de se multiplicarem e de se diferenciarem em outros tipos de células, como de tecidos, cartilagens e neurônios. É dessa maneira que elas têm um papel fundamental para estudos e tratamentos relacionados à regeneração. O uso de células-tronco na Odontologia torna possível diferentes processos odontológicos que oferecem mais qualidade de vida ao paciente. Isso porque fatores como defeitos genéticos, hábitos nocivos, cáries dentárias e perdas precoces dos dentes contribuem com a perda de dentes ao longo da vida. No início do século XXI, por volta dos anos de 2005, 2006, pesquisadores começaram a publicar em revistas internacionais da área uma nova técnica baseada no uso de célulastronco existentes no osso de sustentação dos dentes e na articulação dento alveolar. Esta técnica, chamada de Revascularização, promove o aparecimento de um novo tecido pulpar sadio, devolvendo ao dente sua vitalidade e higidez(AU)

Since the increase in stem cell research in 1961 by Canadian scientists, advances in studies, research and the development of new treatments with this type of resource have shown promise. The use of stem cells is a big bet for both medicine and regenerative dentistry. Treatments with this therapy can offer more quality of life for people. The potential of these very special cells lies in two peculiar characteristics: they are able to multiply and differentiate into other types of cells, such as tissues, cartilage and neurons. It is in this way that they play a key role for studies and treatments related to regeneration. The use of stem cells in dentistry makes possible different dental processes that offer more quality of life to the patient. That's because factors such as genetic defects, harmful habits, tooth decay, and early tooth loss all contribute to lifelong tooth loss. At the beginning of the twenty-first century, around the years 2005, 2006, researchers began to publish in international journals of the area a new technique based on the use of existing stem cells in the supporting bone of the teeth and in the alveolar tooth joint. This technique, called Revascularization, promotes the appearance of a new healthy pulp tissue, returning to the tooth its vitality and hygiene(AU)

Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014-2018.

PURPOSE: Missing teeth is one of the most important indicators of oral health behavior and the result of dental caries, periodontal disease, and injuries. This study examined a trend in the incidence of severe partial edentulism (SPE) using the Korean National Health Insurance Service (KNHIS) data. MATERIALS AND METHODS: Data of adults aged ≥20 years were obtained from the KNHIS for the 2014-2018 period. SPE was defined in dental information within a population with a treatment history of dental scaling as having 1 to 8 natural teeth. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence interval were calculated per 100000 persons. The Cochran Armitage trend (CAT) test and average annual percentage change were used to analyze SPE trends. RESULTS: The CIRs among Korean adults were from 346.29 to 391.11 in 2014-2016 and from 391.11 to 354.09 in 2016-2018. The AIRs trend statistically increased by 4.31% from 346.29 to 376.80 and decreased by 4.72% from 376.80 to 342.10. The AIRs in men increased by 4.00% and decreased by 3.01%. The AIRs in women decreased by 2.18% and increased by 2.11% (CAT; p<0.01). The AIRs by region and income also showed trends of increase and decrease. CONCLUSION: The study showed that the incidence trend of SPE increased and decreased from 2014 to 2018. This result would be able to aid in the planning of public oral health, and may also serve as fundamental data for verifying the impact of the public oral health policies implemented.

Charting the Future of Oral Health: A Bibliometric Exploration of Quality-of-Life Research in Dentistry.

In recent decades, the focus of health research has shifted to the impact of disease or impairment on how people proceed, behave, and experience quality of life. People's lives are affected by oral diseases in various ways. Oral health-related quality of life (OHRQoL) is inextricably linked to general health and well-being, and it has far-reaching consequences for clinical practice and dentistry research. Particularly in Indonesia, increasing attention to OHRQoL is related to several concerning oral conditions, such as the extremely high number of cases of tooth decay and inflammation of dental supportive tissue that inexplicably lowers the population's OHRQoL. To date, there has yet to be a bibliometric study of OHRQoL research in Indonesia. We intend to map the existing scientific literature on OHRQoL research in Indonesia during the last five years and investigate its research gaps. Scopus and the Sinta Database (a national database through Google Scholar) were used to retrieve Indonesian OHRQoL research publications from 2018 to 2023. Bibliographic data were analyzed using SPSS Statistics 25.0 and VOS Viewer 1.6.19. The data demonstrate that the number of OHRQoL-related publications in Indonesia and the number of local writers have increased over time. More of these publications were published in prestigious national journals than foreign ones. The study found that local researchers tended to conduct OHRQoL research on children and older populations, raising the issue of tooth decay or tooth loss. Exploring other subjects, such as dental anxiety, patient satisfaction, chewing performance, aesthetics, and appearance, and other populations (people with oral cancer and other systemic conditions) could broaden the environment of OHRQoL research in Indonesia.

Blocking endogenous retinoic acid degradation induces oral tooth formation in zebrafish.

According to Dollo's Law of irreversibility in evolution, a lost structure is usually considered to be unable to reappear in evolution due to the accumulation over time of mutations in the genes required for its formation. Cypriniform fish are a classic model of evolutionary loss because, while they form fully operational teeth in the ventral posterior pharynx, unlike other teleosts, they do not possess oral teeth. Paleontological data show that Cypriniforms, a clade of teleost fish that includes the zebrafish, lost their oral teeth 50 to 100 Mya. In order to attempt to reverse oral tooth loss in zebrafish, we block the degradation of endogenous levels of retinoic acid (RA) using a specific inhibitor of the Cyp26 RA degrading enzymes. We demonstrate the inhibition of endogenous RA degradation is sufficient to restore oral tooth induction as marked by the re-appearance of expression of early dental mesenchyme and epithelium genes such as dlx2b and sp7 in the oral cavity. Furthermore, we show that these exogenously induced oral tooth germs are able to be at least partly calcified. Taken together, our data show that modifications of signaling pathways can have a significant effect on the reemergence of once-lost structures leading to experimentally induced reversibility of evolutionary tooth loss in cypriniforms.

Association of dietary inflammation with tooth loss and cognitive decline in older adults from cross-sectional data: The moderated role of albumin.

OBJECTIVE: Growing evidence suggests a potential connection between tooth loss and cognitive function in recent years. Increasing studies have focused on their inter-relationship, however, the underlying mechanism has yet to be fully elucidated. Few studies have considered the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive function. Therefore, the aim of this study was to explore the role of dietary inflammation and serum albumin in the association between tooth loss and cognitive impairment. METHODS: A sample of 1,009 US adults from the National Health and Nutrition Examination Survey (NHANES) provided data on oral condition, cognitive function, dietary intake, and serum tests. The association between tooth loss (exposure variable) and cognitive function (outcome variable) was assessed by linear regression. Furthermore, a moderated mediation model was established to examine the influence of dietary inflammation on the association between tooth loss and cognitive tests, and the visualization of the moderating effect of serum albumin concentration was displayed through the Johnson-Neyman curve. RESULTS: Participants with impaired dentition had worse cognitive function and a higher Dietary Inflammation Index (DII). DII was highly correlated with Immediate Recall Test (IR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST), which mediated 16.46 %, 14.41 % and 11.28 % of the effect between tooth loss and cognitive functions. Additionally, the relationship between DII and DSST was moderated by serum albumin concentration. CONCLUSION: Tooth loss was associated with cognitive function which was affected by pro-inflammatory dietary patterns and serum albumin level. CLINICAL SIGNIFICANCE: This study presents evidence for dentists that dietary pattern change due to tooth loss plays a role in cognitive deterioration, which can also be moderated by serum albumin level. Therefore, the preservation of natural teeth is important for cognitive function, especially in an immunocompromised population with decreased serum albumin concentrations.

Identifying predictors of the tooth loss phenotype in a large periodontitis patient cohort using a machine learning approach.

OBJECTIVES: This study aimed to identify predictors associated with the tooth loss phenotype in a large periodontitis patient cohort in the university setting. METHODS: Information on periodontitis patients and nineteen factors identified at the initial visit was extracted from electronic health records. The primary outcome is tooth loss phenotype (presence or absence of tooth loss). Prediction models were built on significant factors (single or combinatory) selected by the RuleFit algorithm, and these factors were further adopted by regression models. Model performance was evaluated by Area Under the Receiver Operating Characteristic Curve (AUROC) and Area Under the Precision-Recall Curve (AUPRC). Associations between predictors and the tooth loss phenotype were also evaluated by classical statistical approaches to validate the performance of machine learning models. RESULTS: In total, 7840 patients were included. The machine learning model predicting the tooth loss phenotype achieved AUROC of 0.71 and AUPRC of 0.66. Age, periodontal diagnosis, number of missing teeth at baseline, furcation involvement, and tooth mobility were associated with the tooth loss phenotype in both machine learning and classical statistical models. CONCLUSIONS: The rule-based machine learning approach improves model explainability compared to classical statistical methods. However, the model's generalizability needs to be further validated by external datasets. CLINICAL SIGNIFICANCE: Predictors identified by the current machine learning approach using the RuleFit algorithm had clinically relevant thresholds in predicting the tooth loss phenotype in a large and diverse periodontitis patient cohort. The results of this study will assist clinicians in performing risk assessment for periodontitis at the initial visit.

[Dental caries - the most common noncommunicable disease and its impact on general health and disease]. / Karies ­ världens vanligaste icke smittsamma sjukdom.

More than 2.8 billion individuals worldwide suffer from untreated caries. Over ninety-five percent of all 50-year-olds in Sweden have caries experience. Caries is the most common cause of dental restorations and tooth loss. Tooth loss is associated with cardiovascular diseases, dementia, and death. Periapical tooth infections caused by caries can spread and cause severe infection, however rarely with lethal outcome. Sugars are a common risk factor for caries and other noncommunicable diseases such as cardiovascular diseases, diabetes, and obesity.  Caries is a consequence of sugar-provoked acid production and dysbiosis in the tooth biofilm (dental plaque). There are several conditions which may increase the risk for dental caries, such as different medical conditions and medications which may cause dry mouth. Treatment costs for caries are high.

Heterogeneous Association of Tooth Loss with Functional Limitations.

Tooth loss is prevalent in older adults and associated with functional capacity decline. Studies on the susceptibility of some individuals to the effects of tooth loss are lacking. This study aimed to investigate the heterogeneity of the association between tooth loss and higher-level functional capacity in older Japanese individuals employing a machine learning approach. This is a prospective cohort study using the data of adults aged ≥65 y in Japan (N = 16,553). Higher-level functional capacity, comprising instrumental independence, intellectual activity, and social role, was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The scale ranged from 0 (lowest function) to 13 (highest function). Doubly robust targeted maximum likelihood estimation was used to estimate the population-average association between tooth loss (having <20 natural teeth) and TMIG-IC total score after 6 y. The heterogeneity of the association was evaluated by estimating conditional average treatment effects (CATEs) using the causal forest algorithm. The result showed that tooth loss was statistically significantly associated with lower TMIG-IC total scores (population-average effect: -0.14; 95% confidence interval, -0.18 to -0.09). The causal forest analysis revealed the heterogeneous associations between tooth loss and lower TMIG-IC total score after 6 y (median of estimated CATEs = -0.13; interquartile range = 0.12). The high-impact subgroup (i.e., individuals with estimated CATEs of the bottom 10%) were significantly more likely to be older and male, had a lower socioeconomic status, did not have a partner, and had poor health conditions compared with the low-impact subgroup (i.e., individuals with estimated CATEs of the top 10%). This study found that heterogeneity exists in the association between tooth loss and lower scores on functional capacity. Implementing tooth loss prevention policy and clinical measures, especially among vulnerable subpopulations significantly affected by tooth loss, may reduce its burden more effectively.

Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults.

BACKGROUND: Although tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function. METHODS: This study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS. RESULTS: Tooth loss was significantly related to functional limitations. There was a direct (ß = - 0.0308; 95% CI, - 0.0131 to - 0.0036) and indirect (ß = - 0.0068; 95% CI, - 0.0096 to - 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (ß = - 0.0188; 95% CI, - 0.0259 to - 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations. CONCLUSION: The association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.