The effect of cessation of drinking water fluoridation on dental restorations and crowns in children aged 3-5 years in Israel - a retrospective study.

BACKGROUND: Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3-5, treated in "Assuta Tel Aviv" dental clinics, under general anesthesia or deep sedation. METHODS: The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014-2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation. RESULTS: A statistically significant increase in the mean number of treatments in the years after fluoridation cessation (P < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages. CONCLUSION: The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.

[Need for prosthodontics of permanent teeth in children aged 8-18 years]. / Nuzhdaemost' v ortopedicheskom lechenii postoyannykh zubov detei 8­18 let.

OBJECTIVE: To reveal need for prosthodontics in permanent teeth in children aged 8-18 years. MATERIALS AND METHODS: The study was performed in Khimki Dental Municipal Clinic. Dental examination and radiological studies were conducted in 97 primary patients aged 8-18 years. Indications for prosthodontics in permanent teeth were occlusal deterioration index more than 40% and crown decay of more than 50% in incisors and canines. Additional features were registered including DMFT index, the presence of extracted teeth and teeth after root canal treatment, as well and teeth with extensive restorations with resins and marginal seal quality. RESULTS: From 97 primary patients (27.8%) children needed prosthodontics in permanent teeth (in average 2.3±2.1 teeth): 1 tooth in 10 children, 2 teeth in 11 children, 3 teeth in 1 child, 4 teeth in 3 children and 4 teeth in 2 children. Mean DMFT was 8.1±4.5 teeth. Six children already had extracted permanent teeth (9 teeth in total). Half of the teeth (49.2%) which needed orthodontic treatment had history of root canal treatment while 46% needed primary or secondary endodontic treatment. Occlusal deterioration index was more than 40% in 41.3% of cases, more than 60% in 49.2% of teeth and more than 80% in 9.52% of teeth. From all the teeth restored with composite resins 41.7% had good marginal seal but 58.3% showed macroscopic signs of marginal leakage. CONCLUSION: Our study shows high percentage of adolescents having need for prosthodontics in permanent teeth and unjustified widening of indications for direct resin restorations in this group of patients.

Restorative and patient factors associated with repeat general anesthesia for dental treatments in young children: A case-control study.

BACKGROUND: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments. METHODS: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients). RESULTS: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2. CONCLUSIONS: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA. PRACTICAL IMPLICATIONS: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2.

Clinical and patient-level predictors of procedure and tooth survival after direct pulp capping.

BACKGROUND: Historical reports of unpredictable outcomes associated with vital pulpal therapies, particularly direct pulp capping (DPC), have contributed to clinicians' skepticism of the procedure. Contemporary reports highlight more predictable outcomes of vital pulpal therapies, inclusive of DPC. There is a dearth of reported patient-centered outcomes of these procedures. METHODS: Insurance claims were used in an observational, retrospective cohort study to evaluate outcomes of DPC performed on permanent teeth. Statistical analyses included Kaplan-Meier survival estimates and Cox proportional hazards regression. Log-rank tests were used to evaluate unadjusted differences in survival. Cox proportional hazard regression was used to evaluate the adjusted hazard of adverse event occurrence. RESULTS: The analytic cohort included 4,136 teeth from 3,716 patients. DPC procedures were identified in public-payer (85.5%) and private-payer (13.4%) insurance claims databases. After DPC, procedure survival rate was 83% and tooth survival rate was 93% during a mean follow-up time of 52 months. Molar tooth type, same-day permanent restoration placement, and amalgam restoration type were significant positive predictors of procedure (DPC) survival. Age was not a statistically significant predictor of procedure survival after controlling for tooth type, gender, time to restoration, and restoration type. Nonmolar tooth type and younger age were significant positive predictors of tooth survival after DPC. Failures were most likely to occur within the first year. CONCLUSIONS: DPC has favorable patient-centered outcomes and contributes to long-term tooth survival. PRACTICAL IMPLICATIONS: The favorable patient-centered outcomes of DPC bolster calls to consider cost-effectiveness and access to care for endodontic procedures.

A 2-Year Randomized Clinical Trial of Three Bonding Techniques in Non-Carious Cervical Lesions.

Background and objective: The aim of this randomized split-mouth study-controlled clinical trial was to compare the 2-year clinical performance of resin composite restorations placed at non-caries cervical lesions (NCCL) with one-step self-etch, total-etch, and selective enamel etch and self-etch adhesive techniques. Materials and methods: Thirty-two patients received three resin composite restorations each at NCCLs (Tetric EvoCeram/Ivoclar/Vivadent), bonded with a total-etch adhesive agent (ExciTE F/Ivoclar/Vivadent) and a self-etch (AdheSE One F/Ivoclar/Vivadent) without and with selective enamel etching. All restorations were evaluated by two examiners at baseline, 6-, 12-, 18-, and 24-months with FDI clinical criteria (post-operation regarding retention, caries occurrence, marginal adaptation, and marginal staining). A logistic regression analysis, a Cohen's kappa statistic, a multifactorial analysis, and X2 were performed with generalized estimating equations. Results: After 2 years, the retention rate was 86.8% for total etch, 92.26% for self-etch, and 93.63% for selective enamel etching and self-etch. No caries was detected on the restorations. Concerning marginal adaptation, the clinically perfect restorations were 26.9% for the total-etch technique, 16% for self-etch, and 25.9% for selective enamel etch and self-etch. The logistic regression model revealed that only time reduced the probability of perfect marginal adaptation. Conclusions: All three adhesive strategies provided restorations with no significant differences in the retention rate or marginal adaptation, whereas the total etch yielded better performance for marginal staining. All restorations were assessed as clinically acceptable after 2 years.

Further Interventions after Root Canal Treatment Are Most Common in Molars and Teeth Restored with Direct Restorations: A 10-11-Year Follow-Up of the Adult Swedish Population.

INTRODUCTION: The aims were to investigate 1) the frequency of nonsurgical retreatment, root-end surgery, extraction, and further restorative treatment during a follow-up of 10-11 years after root filling and compare the frequencies according to tooth group and type of coronal restoration and 2) the timing of nonsurgical retreatment, root-end surgery, and extraction. METHODS: Data were collected from the Swedish Social Insurance Agency's register. A search for treatment codes identified teeth root filled in 2009 and the type of coronal restoration (direct, indirect, and unspecified) registered within 6 months of root filling. The root-filled teeth were followed 10-11 years, and further interventions were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. RESULTS: In 2009, root fillings were registered for 215,611 individuals/teeth. Nonsurgical retreatment, root-end surgery, and extraction were undertaken in 3.5%, 1.4%, and 20% teeth, respectively. The frequency of further interventions varied with respect to tooth group and type of coronal restoration, but only slightly for endodontic retreatments. Further interventions, except for root-end surgery, were registered more often for molars and directly restored teeth (P < .001). The majority of endodontic retreatments were undertaken within 4 years, while extractions were evenly distributed over 10-11 years. CONCLUSIONS: The frequency numbers of nonsurgical retreatment and root-end surgery were low, despite 1 in 5 root-filled teeth registered as extracted. Further interventions were most common in molars and directly restored teeth. Endodontic retreatments were performed more often during the first 4 years.

Exploring Recent Decreases in First Molar Sealants among US Children.

Analyses of National Health and Nutrition Examination Survey (NHANES) data suggested a significant decrease in sealant prevalence among children between 2011 to 2014 and 2015 to 2018. We explore whether this decrease could be associated with possible changes in 1) clinical sealant delivery, 2) dental materials (i.e., increased use of glass ionomer [GI] sealants resulting in an inability to detect sealant fragments that still provide preventive benefits or increased use of composite restorations leading to misclassifying sealants as restorations), and 3) examination sensitivity and specificity. We used NHANES data to estimate the prevalences of sealants, untreated caries, and restorations in ≥1 first permanent molar among children aged 7 to 10 y and used Medical Expenditure Panel Survey data to estimate the annual clinical delivery of sealants and fluoride treatments. We examined changes in outcomes between 2 periods (P < 0.05) controlling for selected sociodemographic characteristics. NHANES sealant examination quality was based on the reference examiner's replicate examinations. The adjusted prevalence of sealants decreased relatively by 27.5% (46.6% vs. 33.8%). Overall, untreated caries decreased. Untreated caries and restoration decreased among children without sealants. Annual clinical sealant delivery did not change, whereas fluoride treatment delivery increased. The decrease in sealant prevalence held when assessed for various age ranges and NHANES cycle combinations. While sealant examination specificity remained similar between the periods, sensitivity (weighted by the proportion of exams by each examiner) decreased relatively by 17.4% (0.92 vs. 0.76). These findings suggest that decreased sealant prevalence was not supported by decreased clinical sealant delivery nor increased use of composite restorations. Decreased examination sensitivity, which could be due to an increased use of GI sealants, could contribute to the decrease in sealant prevalence. The decrease in caries among children without sealants could suggest the increased use of GI sealants. However, we could not rule out that the decrease in caries could be attributable to increased fluoride treatment delivery.

Incidencia de fracturas dentales reportadas en la Ciudad de Chihuahua durante la pandemia por COVID-19 / Incidence of dental fractures reported in Chihuahua city during COVID-19 pandemic

Se presentan los casos de fracturas verticales sintomáticos que ameritaron la extracción de las órganos dentales afectados en un periodo de cinco meses durante la pandemia por COVID-19 en la ciudad de Chihuahua, México. Material y métodos: Se recolectaron 26 muestras para el estudio, proporcionadas por los cirujanos dentistas integrantes del Grupo de Egresados de la Facultad de Odontología de la Universidad Autónoma de Chihuahua. Resultados: Los resultados muestran diferencias a lo reportado previamente respecto al tipo de diente involucrado, sexo de los pacientes, restauraciones coronales y tratamientos endodóncicos previos. Conclusiones: Se puede suponer que las modificaciones en el estilo de vida de la población, sumadas a la angustia permanente, pueden ser factores que contribuyen a las fracturas dentales (AU)

There are cases of symptomatic vertical fractures that warranted the extraction of affected teeth are presented, over a period of five months during the COVID-19 pandemic in Chihuahua City, Mexico. Material and methods: 26 samples were collected for the study, provided by the dentist who were members of the Graduate Group of the Faculty of Dentistry of the Autonomous University of Chihuahua. Results: The results show differences from what was previously reported regarding the type of tooth involved, sex of patients, coronal restorations and previous endodontic treatments. Conclusions: It can be assumed that changes in the lifestyle of the population, added to permanent distress, may be factors to preserve dental fractures (AU)

The Use of Hall's Technique Preformed Metal Crown (HTPMC) by Pediatric Dentists in Malaysia.

INTRODUCTION: Hall's technique preformed metal crown (HTPMC) has been used widely by pediatric dentists in developed countries as a new approach for managing decayed primary molars without local anesthesia, caries removal, and tooth preparation. Currently, inadequate information is available regarding the implementation of this technique (HTPMC) in Malaysia. This study is aimed at evaluating the implementation of HTPMC by Malaysia's pediatric dentists and identify the co-occurrence frequencies of the HTPMC implementation with the respondents' demographic profile. MATERIALS AND METHODS: A cross-sectional questionnaire-based research was conducted among 65 pediatric dentists in Malaysia. Online questionnaires were distributed to the pediatric dentists employed at public hospitals (MOH) and universities in Malaysia. RESULT: It was found that over half of the respondents (65.6%) employed HTPMC. The analysis of the co-occurrence network frequency revealed that a high frequency of female pediatric dentists who were within the age group of 31-40 years old had fulfilled their postgraduation overseas and was employed in the university mainly applied HTPMC. CONCLUSION: The application of HTPMC among respondent pediatric dentists in Malaysia was high. However, most respondents considered HTPMC a treatment option only to manage carious primary molar rather than a treatment of choice.

The Association of Caries Increment Dynamics in Preschool Children with Risk Factors: The 3-Year Prospective Study.

This prospective study monitored the dental status, the presence of plaque, and cariogenic microorganism levels of identical children over three years. The aim was to determine the dynamics of caries increment as well as the relationship between risk factors and caries prevalence. A total number of 125 children (72 boys and 53 girls) was included in the study, with an average age of 3.95 ± 0.06 years at the baseline. During the clinical examination at the nursery schools, the presence of dental plaque was recorded, and saliva samples were collected from the tongue of children for the DentoCult SM test providing easy detection of mutans streptococci from saliva samples. At baseline, 65.6% of the children had no caries, 4% had restored teeth with fillings or crowns or missing teeth due to caries, and 30.4% had at least one untreated caries. The percentages of intact teeth, restored or missing teeth, and untreated caries were 52.8%, 8.8%, 38.4% in the second year and 49.1%, 13.8%, and 31.1% in the third year. The dmft index value was 1.41 ± 0.24 in the first year, 2.29 ± 0.30 in the second year, and 2.33 ± 0.31 in the third year. There was a significant correlation between plaque presence and dt and dmft values (p < 0.05; the statistical analyses were performed using the Kolmogorov-Smirnov test). This 3-year longitudinal study highlighted the importance of examining both the oral hygiene and the level of cariogenic microorganisms when undertaking the evaluation of caries risk evaluation in preschool children.

Development and calibration of biochemical models for testing dental restorations.

Currently, resin composites are the most popular materials for dental restoration in clinical practice. Although the properties of such materials have been improved significantly, together with better clinical techniques used for their placement, early restoration failure still occurs too frequently. As clinical studies take years to complete, and new resin composites are being produced at ever increasing pace, laboratory assessment using accelerated but representative tests is necessary. The main types of failure in resin-composite restoration are tooth/restoration fracture and secondary caries, which are caused by a combination of mechanical and biochemical challenges. In this study, a biofilm model (S. mutans) and a chemical model (lactic-acid buffer) for producing artificial caries in bovine dentin are developed and calibrated against in situ data. Using a power law relationship between the demineralization depth and challenge duration, scale factors that convert the in vitro durations to the equivalent clinical durations are determined for different pH values for each model. The scale factors will allow the synchronization of biochemical and mechanical challenges in terms of their rates of action to potentially test resin-composite restoration in an accelerated but clinically representative manner. STATEMENT OF SIGNIFICANCE: Although the properties of resin composites for dental restoration have been improved significantly, early restoration failure still occurs too frequently. As clinical studies take years to complete, accelerated laboratory testing is necessary. Resin-composite restoration fail mainly through fracture and secondary caries, caused by a combination of mechanical and biochemical challenges. In this study, a biofilm and a chemical model for producing artificial caries in bovine dentin are calibrated against in situ data. Using a power law relationship between demineralization depth and challenge duration, scale factors are determined for different pH for each model. The scale factors will allow the synchronization of biochemical and mechanical challenges in testing resin-composite restoration in an accelerated but clinically representative manner.

Factors associated with the number of filled teeth in adolescents from public schools: a cohort study.

This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.

Threshold values affect predictive accuracy of caries risk assessment.

OBJECTIVE: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. MATERIAL AND METHODS: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists' risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. RESULTS: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. CONCLUSIONS: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

Prosthetic dental restorations in Swedish samples: prevalence and agreement between self-report, clinical findings, and influence on quality of life.

OBJECTIVE: To determine the prevalence of dental prosthetic restorations in an adult population, to study the agreement between self-reports and clinical findings of prosthetic restorations, and to study answers from a questionnaire in relation to the prevalence of prosthetic restorations. MATERIAL AND METHODS: A questionnaire was sent to a sample of 10,000 adults. A further sample of 1000 individuals was invited to answer the questionnaire and also participate in a clinical study. The agreement between self-report and clinical findings was analyzed, as were the associations between prosthetic restorations and questionnaire responses, using the chi2 test. RESULTS: A total of 40% of the sample had fixed dental prostheses (FDP), 2.7% had removable dentures. The agreement between self-report and clinical findings was 93%. 34.7% of the individuals with no prosthetic restorations were university graduates and 4% of individuals with removable complete dentures. Oral health had the greatest impact on the quality of life of younger individuals with FDP, with an OHIP-14 (Oral Health Impact Profile) score of 7.3 for the age group 20-39 years compared to 4.9 for the age group 65-89 years. CONCLUSION: The questionnaire method can be a cost-effective way to determine the prevalence of prosthetic restorations.

Indications for root canal treatment in a Swedish county dental service: patient- and tooth-specific characteristics.

AIM: To study patient- and tooth-specific characteristics of teeth indicated for root canal treatment, in the public dental service of the county of Västra Götaland, Sweden. METHODOLOGY: During a designated 8-week period, general dental practitioners working at 20 different public dental clinics consecutively registered indications for undertaking root canal treatment. The patients' subjective level of pain was also registered (visual analogue scale) at the very first appointment. The following information was retrieved from computerized dental records and radiographs: gender, age, number of remaining teeth, tooth group, previous restoration, number of restored surfaces, dental caries and tooth substance loss. Gender and age were compared using both descriptive and analytical statistics. RESULTS: The material comprised 243 teeth in 243 patients: 128 (52.7%) women and 115 (47.3%) men, mean age 48.3 years. Molar teeth predominated (47.7%). Most of the teeth (83.5%) had previously been restored and exhibited significant loss of tooth substance, more than a third of the crown (71.3%). Dental caries was present in 127 teeth (62.9%). Dental trauma was implicated in only seven cases (2.9%). Initial treatment was frequently undertaken at an emergency visit, for relief of symptoms (64.9%). The most commonly registered indication was pulpal necrosis with apical periodontitis (38.1%), followed by pulpitis (37.7%). Retreatment of a root filled tooth was reported in 18 teeth (7.4%). CONCLUSIONS: In the general Public Dental Service of Sweden, root canal treatment is most frequently undertaken in molars. The primary indication is relief of symptoms. Retreatment of root filled teeth is uncommon.

Factors associated with the number of filled teeth in adolescents from public schools: a cohort study

Abstract This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.

Oral health experiences of individuals with Rett syndrome: a retrospective study.

BACKGROUND: There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. METHODS: Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. RESULTS: The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46-16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94-0.97). CONCLUSIONS: Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.

Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska.

BACKGROUND: The general aim of this research was to determine whether cessation of community water fluoridation (CWF) increased oral health disparities, as measured by dental caries procedures and restoration costs for children and adolescents. METHODS: The analysis was based on all Medicaid dental claims records of 0- to 18-year-old patients residing in zip code 99801 (Juneau, Alaska) during an optimal CWF year (2003, n = 853) compared to all claims for the same age group from 2012 (n = 1052), five years after cessation of CWF. A bivariate analysis (Mann-Whitney U test) of the mean number of caries procedures performed per client was conducted in the study groups under both independent CWF conditions. Furthermore, logistic regression was performed using the dependent variables of caries procedures and the cost of caries-related procedures, with adjustments for CWF group, gender, and race. RESULTS: The statistically significant results included a higher mean number of caries-related procedures among 0- to 18-year-old and < 7-year-old patients in the suboptimal CWF group (2.35 vs. 2.02, p < 0.001; 2.68 vs. 2.01, p = 0.004, respectively). The mean caries-related treatment costs per patient were also significantly higher for all age groups, ranging from a 28 to 111% increase among the suboptimal CWF cohorts after adjusting for inflation. The binary logistic regression analysis results indicated a protective effect of optimal CWF for the 0- to 18-year-old and < 7-year-old age groups (OR = 0.748, 95% CI [0.62, 0.90], p = 0.002; OR = 0.699, 95% CI [0.52, 0.95], p = 0.02, respectively). Additionally, the age group that underwent the most dental caries procedures and incurred the highest caries treatment costs on average were those born after CWF cessation. CONCLUSIONS: These results expand our understanding of caries epidemiology under CWF cessation conditions and reaffirm that optimal CWF exposure prevents dental decay. These findings can offer fiscal estimates of the cost burden associated with CWF cessation policies and help decision-makers advance oral health, prevent dental caries, and promote equity in oral health outcomes.

The ultimate guide to restoration longevity in England and Wales. Part 8: Canine teeth: time to next intervention and to extraction of the restored tooth.

Aim: It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods: A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions: Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.