Food insecurity and its relationship to mental health and oral health in older adults.

BACKGROUND AND OBJECTIVES: Poor oral health disproportionately affects low-income older adults, for whom food insecurity and poor mental health may affect dental health. We explored the associations between food insecurity, mental health, and dental health. Furthermore, we examined whether mental health impacted the associations between food insecurity and dental health. MATERIALS AND METHODS: We conducted a cross-sectional study with a convenience sample of 226 older adults (aged 50+), employing survey and dental screening data. Participants were recruited from seven community-based organisations in Washington State, USA. We calculated descriptive statistics and conducted Chi-square tests, t tests, and logistic regression analyses to assess the associations between aspects of dental health (untreated decay, gum disease, and unmet dental needs), mental health (depression and cognitive function), and food insecurity. RESULTS: In our sample, food insecurity was observed in 28.4%, 40.6% had untreated decay, 31.6% gum disease, and 42.5% unmet dental needs. Food insecurity was associated with a higher occurrence of untreated decay and unmet dental needs. Participants experiencing food insecurity had higher odds of gum disease (aOR = 2.3; 95% CI: 1.1, 5.2) and unmet dental needs (aOR = 3.2; 95% CI:1.4, 7.6). Greater gum disease due to food insecurity was observed among individuals with lower levels of cognitive impairment. CONCLUSION: Food insecurity is associated with poorer oral health among older adults and cognitive function may modify this relationship. These findings underscore the importance of addressing both food insecurity and cognitive impairment as integral components of efforts to improve the oral health of older adults.

Dental enamel defects predict adolescent health indicators: A cohort study among the Tsimane' of Bolivia.

OBJECTIVES: Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. METHODS: This cohort study of 349 Amerindian adolescents (10-17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log-binomial regression and receiver operating characteristics (ROCs). RESULTS: Greater extent of defective enamel formation on the tooth surface was associated with shorter height (-1.35 cm, 95% CI: -2.17, -0.53), lower weight (-0.98 kg, 95% CI: -1.70, -0.26), lower hemoglobin (-0.36 g/dL, 95% CI: -0.59, -0.13), lower glycated hemoglobin (-0.04 %A1c , 95% CI: -0.08, -0.00008), and higher white blood cell count (0.74 109 /L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. CONCLUSIONS: Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes.

Malnutrition-related early childhood exposures and enamel defects in the permanent dentition: A longitudinal study from the Bolivian Amazon.

OBJECTIVES: We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. MATERIALS AND METHODS: This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. RESULTS: The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. DISCUSSION: The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects.

Unstimulated Saliva-Related Caries Risk Factors in Individuals with Cystic Fibrosis: A Cross-Sectional Analysis of Unstimulated Salivary Flow, pH, and Buffering Capacity.

Salivary flow rate, pH, and buffering capacity are associated with dental caries, but studies from the cystic fibrosis (CF) literature are inconclusive regarding these salivary factors and caries. The aim of this study was to evaluate these factors and their associations with dental caries in individuals with CF. Unstimulated whole saliva was collected from individuals aged 6-20 years at Seattle Children's Hospital CF Clinic, USA (n = 83). Salivary flow rate was measured in milliliters per minute. Salivary pH was assessed using a laboratory pH meter. Buffering capacity was assessed by titration with HCl. The outcome measure was caries prevalence, defined as the number of decayed, missing, or filled primary and permanent tooth surfaces. Spearman's rank correlation coefficient and the t test were used to test for bivariate associations. Multiple variable linear regression models were used to (1) run confounder-adjusted analyses and (2) assess for potential interactions. There was no significant association between salivary flow rate or buffering capacity and caries prevalence. There was a significant negative association between salivary pH and caries prevalence, but this association was no longer significant after adjusting for age. There was no significant interaction between salivary flow rate and buffering capacity or between antibiotic use and the 3 salivary factors. Our results indicate that unstimulated salivary factors are not associated with dental caries prevalence in individuals with CF. Future studies should investigate other potential saliva-related caries risk factors in individuals with CF such as cariogenic bacteria levels, salivary host defense peptide levels, and medication use.

Prospective cohort clinical study assessing the 5-year survival and success of anterior maxillary zirconia-based crowns with customized zirconia copings.

STATEMENT OF PROBLEM: Studies evaluating anterior zirconia-based crowns are limited. PURPOSE: The purpose of this prospective cohort clinical study was to assess the efficacy of zirconia-based anterior maxillary crowns with 0.3-mm customized copings at the cervical third and anatomical design elsewhere for up to 5 years of service. MATERIAL AND METHODS: Eighteen participants who required an anterior maxillary crown (n=20) and who had signed a consent form approved by the University of Washington Health Sciences Center Human Subjects Division were enrolled. All preparations were standardized and prepared with an occlusal reduction of 1.5 to 2 mm and an axial reduction of 1 to 1.5 mm with 10 degrees of convergence angle. All finish lines were located on the sound tooth structure. Zirconia copings (Lava; 3M ESPE) were custom designed and milled to a 0.3-mm thickness at the cervical third and with selective thickness elsewhere to support the veneering porcelain. All restorations were luted with self-etching self-adhesive composite resin cement. Recall appointments were at 2 weeks, 6 months, and 12 months, and annually thereafter for 5 years. Modified Ryge criteria were used to assess the clinical fracture measurements, esthetics, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses. Descriptive statistics and 95% confidence intervals were used to describe the number and rate of complications and self-reported satisfaction with the crowns. RESULTS: Twenty crowns with a mean follow-up of 58.7 months were evaluated. All crowns were rated as Alfa for fracture measurements (smooth surface, no fracture/chipping). Twelve crowns were rated esthetically as Romeo (no mismatch in color and shade) and 8 as Sierra (mismatch in color and shade within normal range). Twelve crowns were rated as Alfa (no visible evidence of crevice) and 8 as Bravo (visible evidence of crevice, no penetration of explorer) for marginal integrity. Nineteen were rated as Alfa (no discoloration) and 1 as Bravo (superficial discoloration) for marginal discoloration. No proximal caries or periapical pathoses were detected in 5 years. Participants were highly satisfied with their crowns after 5 years (mean ±SD: 9.8 ±0.4 on 0 to 10 scale). CONCLUSIONS: Zirconia-based anterior maxillary crowns with customized copings with 0.3-mm thickness at the cervical third and zirconia margins performed well after 5 years of service.

Influence of aging on flexural strength of translucent zirconia for monolithic restorations.

STATEMENT OF PROBLEM: Concern has been raised with regard to the low-temperature degradation (LTD) of translucent yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) for monolithic zirconia restorations. PURPOSE: The purpose of this in vitro study was to assess the LTD behavior of 4 commercially available translucent Y-TZP materials by accelerated aging specimens in steam at 134°C, 0.2 MPa. MATERIAL AND METHODS: Thin bars (22×3×0.2 mm) of Y-TZP, including Katana ML (Kuraray Noritake Dental Inc), Katana HT13 (Kuraray Noritake Dental Inc), Prettau (Zirkonzahn), and BruxZir (Glidewell Laboratories) (n=30 for each group), were machined from sintered blocks. Control specimens were assessed in the nonaged condition. Artificially ageing (n=5 per group at 5, 50, 100, 150, and 200 hours) was conducted in steam at 134°C at 0.2 MPa. The specimens were characterized, tested in 4-point flexure, and the fracture surfaces were analyzed. The monoclinic-to-tetragonal (m/t) peak intensity ratio measured by x-ray diffraction was used to calculate the monoclinic phase fraction and monitor LTD. Linear regression with heteroscedasticity-consistent robust standard errors was used to test for the effect of LTD (aging time) on (σf) and m/t. The Spearman rank correlation coefficient was used to assess the relationship between σf and monoclinic phase fraction (α=.05). RESULTS: Artificial aging resulted in LTD as shown by an increase in the monoclinic phase fraction for all specimens. After aging for 200 hours, the mean ±SD monoclinic phase fraction increased from 2.90 ±0.34% to 76.1 ±0.64% for Prettau, 2.69 ±0.18% to 76.0 ±0.26% for BruxZir, 4.6 ±0.19% to 35.8 ±0.80% for Katana HT13, and 3.57 ±0.35% to 33.2 ±1.1% for Katana ML (all P<.001). Flexural strength changed from a mean ±SD of 1612 ±197 MPa to all fractured during aging for Prettau (P<.001); 1248 ±73.5 MPa to all fractured during aging for BruxZir (P<.001); 1052 ±84.2 to 1099 ±70 MPa ±130 for Katana HT13 (P=.45); and from 875 ±130 to 909 ±70 MPa (P=.82) for Katana ML. The mean flexural strength values of Prettau and BruxZir decreased with an increase in the monoclinic phase with Spearman rank correlation coefficients of -0.80 (P=.001) for Prettau and -0.63 (P=.022) for BruxZir. No significant changes in flexural strength were measured for Katana ML or Katana HT13 (P>.05). CONCLUSIONS: The LTD of Y-TZP resulted in a significant decrease in flexural strength of Prettau and BruxZir, whereas Katana ML and Katana HT13 exhibited less LTD and no significant decrease in flexural strength.

A comparative evaluation of the translucency of zirconias and lithium disilicate for monolithic restorations.

STATEMENT OF PROBLEM: Studies comparing the translucency of zirconias and lithium disilicates are limited. PURPOSE: The purpose of this in vitro study was to measure the translucency of recently developed translucent zirconias and compare them with lithium disilicate. MATERIAL AND METHODS: Five types of zirconia, Prettau Anterior (Zirkonzahn GmbH), BruxZir (Glidewell Laboratories), Katana HT, Katana ST, and Katana UT (Kurary Noritake Dental Inc), and 1 type of lithium disilicate, e.max CAD LT (Ivoclar Vivadent AG), were assessed. Non-colored zirconia test specimens (n=5) were prepared as rectangles with dimensions of 15×10×0.5 and 15×10×1.0 mm. The shade of lithium disilicate was B1. A spectrophotometer (Evolution 300 UV-Vis) with an integrating sphere was used to evaluate the total transmittance of light as a percentage (Tt%) at a wavelength of 555 nm for comparison among groups. The Welch robust test for equality of means was used to compare group means (α=.025) and post hoc pairwise comparisons among groups were performed with the Dunnett T3 method. RESULTS: For the 0.5 mm thickness groups, the Tt% was 31.90 ±0.49 for Prettau Anterior, 28.82 ±0.22 for BruxZir, 28.49 ±0.14 for Katana HT, 31.67 ±0.24 for Katana ST, 33.73 ±0.13 for Katana UT, and 40.32 ±0.25 for e-max CAD LT. Post hoc tests indicated that all groups were significantly different from each other, except for between BruxZir and Katana HT, and between Prettau Anterior and Katana ST. Katana UT was significantly more translucent than all other zirconias, and e-max CAD LT was significantly more translucent than all zirconias. For the 1.0 mm thickness groups, the Tt% was 22.58 ±0.41 for Prettau Anterior, 20.13 ±0.22 for BruxZir, 20.18 ±0.39 for Katana HT, 21.86 ±0.39 for Katana ST, 23.37 ±0.27 for Katana UT, and 27.05 ±0.56 for e-max CAD LT. Post hoc tests indicated that all materials were significantly different from each other, except for between BruxZir and Katana HT, and among Prettau Anterior, Katana ST and Katana UT which were significantly more translucent than all other zirconias and less translucent than e-max CAD LT. CONCLUSION: At a thickness of 0.5 mm, Katana UT was significantly more translucent than all other zirconias, and e-max CAD LT was significantly more translucent than all zirconias. At a thickness of 1.0 mm, Prettau Anterior, Katana ST, and Katana UT were significantly more translucent than all other zirconias and less than e-max CAD LT.

Proteomic analysis of saliva from patients with oral chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is an immune-mediated disorder and is the major long-term complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). The oral mucosa, including the salivary glands, is affected in the majority of patients with cGVHD; however, at present there is only a limited understanding of disease pathobiology. In this study, we performed a quantitative proteomic analysis of saliva pooled from patients with and without oral cGVHD-cGVHD(+) and cGVHD(-), respectively-using isobaric tags for relative and absolute quantification labeling, followed by tandem mass spectrometry. Among 249 salivary proteins identified by tandem mass spectrometry, 82 exhibited altered expression in the oral cGVHD(+) group compared with the cGVHD(-) group. Many of the identified proteins function in innate or acquired immunity, or are associated with tissue maintenance functions, such as proteolysis or the cytoskeleton. Using ELISA immunoassays, we further confirmed that 2 of these proteins, IL-1 receptor antagonist and cystatin B, showed decreased expression in patients with active oral cGVHD (P < .003). Receiver operating curve characteristic analysis revealed that these 2 markers were able to distinguish oral cGVHD with a sensitivity of 85% and specificity of 60%, and showed slightly better discrimination in newly diagnosed patients evaluated within 12 months of allo-HSCT (sensitivity, 92%; specificity 73%). In addition to identifying novel potential salivary cGVHD biomarkers, our study demonstrates that there is coordinated regulation of protein families involved in inflammation, antimicrobial defense, and tissue protection in oral cGVHD that also may reflect changes in salivary gland function and damage to the oral mucosa.

Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008.

OBJECTIVES: We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes. METHODS: We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship. RESULTS: About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship. CONCLUSIONS: Interventions and policies to ensure food security may help address the US pediatric caries epidemic.

Effect of hydrothermal degradation on three types of zirconias for dental application.

STATEMENT OF PROBLEM: Concern has been expressed with regard to hydrothermal aging of yttria-stabilized tetragonal zirconia polycrystalline. PURPOSE: The purpose of this study was to assess the accelerated aging characteristics of a new yttria-stabilized tetragonal zirconia polycrystalline material and 2 commercially available yttria-stabilized tetragonal zirconia polycrystalline materials by exposing specimens to hydrothermal treatments in steam at 134°C, 0.2 MPa, and at 180°C, 1.0 MPa. MATERIAL AND METHODS: Thin bars of zirconia: Prettau, Zirprime, and a new zirconia, ZirTough, n = 55 for each brand (22 × 3 × 0.2 mm) were cut and ground from blocks sintered according to the manufacturer's specifications. The control specimens for each group were evaluated in the nonaged condition, and their chemical composition was measured with energy dispersive spectroscopy. The experimental specimens were artificially aged under standard autoclave sterilization conditions, 134°C at 0.2 MPa (n = 5 per group at 5, 50, 100, 150, and 200 hours), and under standard industrial ceramic aging conditions, 180°C at 1.0 MPa (n = 5 per group at 8, 16, 24, and 48 hours). The tetragonal to monoclinic transformation was measured by using x-ray diffraction for all groups. Flexural strength was measured with a 4-point bend test (ASTM 1161-B) for all the groups, and the fracture surfaces were examined with scanning electron microscopy. The data were analyzed as a function of aging time. To test for an aging effect on the flexural strength and the monoclinic-tetragonal ratio, a 1-way ANOVA (with heteroscedasticity-consistent standard errors) was used to test for a general time effect. For the analyses of the monoclinic-tetragonal ratio, the same specimens were used at 0 hours and after aging, and the data were analyzed with an ANOVA for an incomplete block design. The relationship between flexural strength and monoclinic-tetragonal ratio was assessed with the Spearman rank correlation coefficient based on the average value at each aging. RESULTS: After 200 hours at 134°C and 0.2 MPa, the flexural strength decreased from a mean (standard deviation) of 1328 ± 89.9 MPa to all fractured during aging for Prettau (P < .001); 1041 ± 130 to 779 ± 137 MPa for Zirprime (P = .<.001) and 1436 ± 136 to 1243 ± 101 MPa for ZirTough (P = .017). After 200 hours at 134°C and 0.2 MPa, a portion of the tetragonal crystals transformed to the monoclinic phase in all specimens. The mean (standard deviation) monoclinic phase fraction increased from 3.08% ± 0.28% to 78.8% ± 2.0% for Prettau, 1.95% ± 0.48% to 74.8% ± 0.52% for Zirprime, and 12.4% ± 0.60% to 31.4% ± 4.4% for ZirTough (all P < .001). After 16 hours at 180°C and 1.0 MPa, all Prettau specimens had spontaneously fractured during aging. The Zirprime and ZirTough specimens were intact after 48 hours at 180°C and 1.0 MPa, and the mean (standard deviation) flexural strength had decreased from 1041 ± 130 MPa to 595 ± 88.4 MPa for Zirprime and 1436 ± 136 MPa to 1068 ± 76.8 MPa for ZirTough (all P < .001). The mean (standard deviation) monoclinic phase fraction increased from 3.08% ± 0.28% to 79.0% ± 0.13% for Prettau, from 1.95% ± 0.48% to 68.1% ± 4.4%, for Zirprime, and from 12.4% ± 0.60% to 39.5% ± 5.56% for ZirTough (all P<.001). The flexural strength decreased with an increase in the monoclinic phase for all the groups (Spearman rank correlation coefficients, -0.71 to -1.0). Scanning electron microscope micrographs revealed a transformed layer on the fracture surfaces. The decrease in flexural strength was related to the increase in monoclinic phase from long-term degradation. CONCLUSION: Hydrothermal aging of zirconia caused a statistically significant decrease in flexural strength of thin bars of zirconia, which was the result of the transformation from tetragonal to monoclinic crystal structure. ZirTough exhibited the least decrease in strength and smallest amount of monoclinic phase after aging.

Treatment fidelity of brief motivational interviewing and health education in a randomized clinical trial to promote dental attendance of low-income mothers and children: Community-Based Intergenerational Oral Health Study "Baby Smiles".

BACKGROUND: Fidelity assessments are integral to intervention research but few published trials report these processes in detail. We included plans for fidelity monitoring in the design of a community-based intervention trial. METHODS: The study design was a randomized clinical trial of an intervention provided to low-income women to increase utilization of dental care during pregnancy (mother) or the postpartum (child) period. Group assignment followed a 2 × 2 factorial design in which participants were randomly assigned to receive either brief Motivational Interviewing (MI) or Health Education (HE) during pregnancy (prenatal) and then randomly reassigned to one of these groups for the postpartum intervention. The study setting was four county health departments in rural Oregon State, USA. Counseling was standardized using a step-by-step manual. Counselors were trained to criteria prior to delivering the intervention and fidelity monitoring continued throughout the implementation period based on audio recordings of counselor-participant sessions. The Yale Adherence and Competence Scale (YACS), modified for this study, was used to code the audio recordings of the counselors' delivery of both the MI and HE interventions. Using Interclass Correlation Coefficients totaling the occurrences of specific MI counseling behaviors, ICC for prenatal was .93, for postpartum the ICC was .75. Participants provided a second source of fidelity data. As a second source of fidelity data, the participants completed the Feedback Questionnaire that included ratings of their satisfaction with the counselors at the completion of the prenatal and post-partum interventions. RESULTS: Coding indicated counselor adherence to MI protocol and variation among counselors in the use of MI skills in the MI condition. Almost no MI behaviors were found in the HE condition. Differences in the length of time to deliver intervention were found; as expected, the HE intervention took less time. There were no differences between the overall participants' satisfaction ratings of the HE and MI sessions by individual counselor or overall (p > .05). CONCLUSIONS: Trial design, protocol specification, training, and continuous supervision led to a high degree of treatment fidelity for the counseling interventions in this randomized clinical trial and will increase confidence in the interpretation of the trial findings.

Association between food insecurity and edentulism for older adults: A pilot study.

OBJECTIVES: This pilot study examined the association between food insecurity and edentulism among older adults in Washington State. METHODS: This study focused on adults aged 50 years and older, who were recruited through seven community-based organizations in Washington State. The exposure variable was food security level (high, marginal, and low/very low food security) assessed using the 10-item U.S. Adult Food Security Survey. The outcome was edentulism, defined as having zero natural teeth. Confounder-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were generated using binary logistic regression models (α = 0.05). RESULTS: Of the 216 participants, 28.7% (n = 62) had low/very low food security and 7.9% (n = 17) had zero teeth. Older adults with low or very low food security had greater odds of being edentulous compared to those with marginal or high food security, although the difference was not statistically significant (OR: 1.39; 95% CI: 0.46, 4.20; p = 0.56). CONCLUSIONS: Future research should explore food insecurity-focused interventions aimed at preventing edentulism in older adults in a broader effort to address oral health inequities.

Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment.

BACKGROUND: Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed. METHODS: The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year. RESULTS: Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0). CONCLUSIONS: Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction. PRACTICAL IMPLICATIONS: Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.

The association between cystic fibrosis-related diabetes and periodontitis in adults: A pilot cross-sectional study.

OBJECTIVES: Periodontitis is a highly prevalent complication of diabetes. However, the association between cystic fibrosis-related diabetes (CFRD) and periodontitis has not yet been evaluated. The objective of this study was to assess if: 1) CFRD is associated with periodontitis among adults with CF, and 2) periodontitis prevalence differs by CF and diabetes status. METHODS: This was a pilot cross-sectional study of the association between CFRD and periodontitis in adults with cystic fibrosis (CF) (N = 32). Historical non-CF controls (N = 57) from the U.S. National Health and Nutrition Examination Survey (NHANES) dataset were frequency matched to participants with CF on age, sex, diabetes status, and insulin use. We defined periodontitis using the U.S. Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) case definition, as the presence of two or more interproximal sites with CAL ≥3 mm and two or more interproximal sites with PD ≥4 mm (not on the same tooth) or one site with PD ≥5 mm. Because NHANES periodontal data were only available for adults ages ≥30 years, our analysis that included non-CF controls focused on this age group (CF N = 19, non-CF N = 57). Based on CF and diabetes status, we formed four groups: CFRD, CF and no diabetes, non-CF with diabetes, and non-CF and no diabetes (healthy). We used the Fisher's exact test for hypotheses testing. RESULTS: There was no association between CFRD and periodontitis for participants with CF ages 22-63 years (CFRD 67% vs. CF no diabetes 53%, P = 0.49), this was also true for those ages ≥30 years (CFRD 78% vs. CF no diabetes 60%, P = 0.63). For the two CF groups, the prevalence of periodontitis was significantly higher than for healthy controls (CFRD 78% vs. healthy 7%, P<0.001; CF no diabetes 60% vs. healthy 7%, P = 0.001) and not significantly different than the prevalence for non-CF controls with diabetes (CFRD 78% vs. non-CF with diabetes 56%, P = 0.43; CF no diabetes 60% vs. non-CF with diabetes 56%, P = 0.99). CONCLUSION: Among participants with CF, CFRD was not associated with periodontitis. However, regardless of diabetes status, participants with CF had increased prevalence of periodontitis compared to healthy controls.

Health professional advice for smoking and weight in adults with and without diabetes: findings from BRFSS.

Health risk behaviors including smoking and weight-gain can cause and exacerbate chronic diseases like diabetes. Brief provider advice is an effective intervention to reduce risk from these behaviors. However, behavioral advice is provided more often to those who already have a chronic illness when compared with those who are at risk. The purpose of this study is to determine whether the frequency of provider advice for smoking cessation and weight loss varies between overweight or obese smokers with and without diabetes. BRFSS data from a subset of overweight and obese smokers with (n = 848) and without (n = 6,279) diabetes were analyzed to determine differences in reported provider advice. Overweight and obese smokers with diabetes reported receiving more advice for both weight (46.4% vs. 23.4%, P < 0.001) and smoking (84.5% vs. 72.8%, P < 0.001) compared to those without diabetes. Advice for smoking cessation was reported two to three times more often than advice for weight. Nearly a quarter of those with diabetes and almost half of those without reported no receipt of advice about weight. Results indicate that providers are not adequately addressing overweight and obesity in patients with and at risk for diabetes.

Selection patterns of dietary foods in edentulous participants rehabilitated with maxillary complete dentures opposed by mandibular implant-supported prostheses: a multicenter longitudinal assessment.

STATEMENT OF PROBLEM: Documentation of long-term changes in food intake is lacking for those treated with a maxillary complete denture opposed by a mandibular, screw-retained, implant-supported fixed prosthesis. PURPOSE: The purpose of this study was to evaluate the selection patterns of dietary foods over 5 years for edentulous participants treated in a multicenter prospective clinical trial that compared cast alloy versus laser-welded titanium frameworks of an implant-supported prostheses opposed by maxillary complete dentures to rehabilitate edentulous participants. MATERIAL AND METHODS: The study assessed data from a multicenter prospective clinical trial that followed edentulous participants from an initial baseline of wearing existing complete dentures to implant placement, restoration with a mandibular implant-supported prosthesis opposed by a maxillary complete denture, to follow-up assessment of these treatments over 5 years. The 32 participants in the cohort were treated at 5 of 9 participating centers. The data collected included 2 dietary forms, a standardized 4-day food diary form, and a dietary habits questionnaire. Each participant completed forms before entering into treatment (control) and at the 1- and 5-year follow-up assessment after being treated with a maxillary complete denture opposing a mandibular complete-arch fixed implant-supported prosthesis. Descriptive statistics were calculated for each measure at each assessment point. Regression analysis and the Sign test were used to calculate change in the participants' nutritional status (α=.05). RESULTS: Among the findings, it was noted that difficulty in masticating hard, raw, and fibrous foods decreased and intake of vegetable portions increased significantly from 2.5 to 3.3 servings. Participant comfort in eating in public places and their enjoyment of eating were significantly improved from 50% of participants being uncomfortable with their prior complete denture treatment to only 4% after 5 years. CONCLUSIONS: Within the limitations of this study, it was concluded that vegetable intake and ability to masticate raw, hard, and fibrous food for these participants improved when they received a mandibular implant-supported prosthesis opposed by a maxillary complete denture. According to the analysis and findings, the overall eating experience was more pleasurable, and eating in public was more comfortable after replacement of complete dentures with a mandibular implant-supported prosthesis.

In vitro assessment of three types of zirconia implant abutments under static load.

STATEMENT OF PROBLEM: Although various zirconia abutments have been introduced, insufficient data exist regarding the maximum load capacity of internal tri-channel connection zirconia implant abutments with various implant-abutment interfaces. PURPOSE: The purpose of this in vitro study was to compare the maximum load capacity of 3 different types of internal tri-channel connection zirconia abutments and to assess their mode of failure. MATERIAL AND METHODS: The study investigated 3 groups (n=20) of zirconia implant abutments with different implant-abutment interfaces. Group AllZr consisted entirely of zirconia (Aadva CAD/CAM Zirconia Abutment), group FrZr of a titanium insert friction-fitted to the zirconia abutment component (NobelProcera Abutment Zirconia), and group BondZr of a titanium insert bonded to the zirconia abutment component (Lava Zirconia abutment). All the abutments were thermal cycled for 20 000 cycles between 5°C and 55°C. Sixty test implants made of titanium (Dummy NobelReplace) were embedded in autopolymerizing acrylic resin, and 60 zirconia copings (Lava Zirconia) with a uniform thickness of 2.0 mm were fabricated and bonded to the abutments. A universal testing machine was used to statically load all the specimens at a crosshead speed of 1 mm/min. The maximum load was recorded and used as the failure load. The fractured specimens were collected and representative specimens were studied with a stereomicroscope and scanning electron microscope (SEM). One-way ANOVA and post hoc comparisons with the Tukey HSD tests were used for statistical analysis (α=.05). RESULTS: The mean (SD) maximum load capacity was 484.6 (56.6) N for NobelProcera, 503.9 (46.3) N for Aadva, and 729.2 (35.9) N for Lava abutments. The maximum load capacity of Lava abutments was significantly higher than that of Aadva or NobelProcera (P< 05). No significant difference between Aadva and NobelProcera abutments was noted. The mode of failure among the Aadva, NobelProcera, and Lava abutments was different. CONCLUSIONS: With standard diameter internal tri-channel connection implants, the maximum load capacity of the Lava abutment was significantly higher than that of the Aadva or NobelProcera abutment. No significant difference in maximum load capacity was noted between Aadva and NobelProcera abutments. However, the fracture behavior of all 3 abutments was different.

County-level characteristics as predictors of dentists' ECC counseling in the USA: a survey study.

BACKGROUND: Transmission of Streptococcus mutans from mother-to-child can lead to Early Childhood Caries. A previous study identified characteristics and beliefs of general dentists about counseling pregnant women to reduce risk of infection and Early Childhood Caries. This study extends those findings with an analysis of county level factors. METHODS: In 2006, we surveyed 732 general dentists in Oregon, USA about dental care for pregnant women. Survey items asked about individual and practice characteristics. In the present study we matched those data to county level factors and used multinomial logistic regression to test the effects of the factors (i.e., dentist to population ratio, percentage of female dentists, percentage of females of childbearing age, and percentage of individuals living in poverty) on counseling behavior. RESULTS: County level factors were unrelated to counseling behavior when the models controlled for dentists' individual attitudes, beliefs, and practice level characteristics. The adjusted odds ratios for no counseling of pregnant patients (versus 100 percent counseling) were 1.1 (95% CI .8-1.7), 1.0 (1.0-1.1), 1.2 (.9-1.5), and 1.1 (1.0-1.2) for dentist/population ratio, percent female dentists, percent females of childbearing age, and percent in poverty, respectively Similar results were obtained when dentists who counseled some patients were compared to those counseling 100 percent of patients. CONCLUSIONS: Community level factors do not appear to impact the individual counseling behavior of general dentists in Oregon, USA regarding the risk of maternal transmission of Early Childhood Caries.

Design of a community-based intergenerational oral health study: "Baby Smiles".

BACKGROUND: Rural, low-income pregnant women and their children are at high risk for poor oral health and have low utilization rates of dental care. The Baby Smiles study was designed to increase low-income pregnant women's utilization of dental care, increase young children's dental care utilization, and improve home oral health care practices. METHODS/DESIGN: Baby Smiles was a five-year, four-site randomized intervention trial with a 2 × 2 factorial design. Four hundred participants were randomly assigned to one of four treatment arms in which they received either brief Motivational Interviewing (MI) or health education (HE) delivered during pregnancy and after the baby was born. In the prenatal study phase, the interventions were designed to encourage dental utilization during pregnancy. After childbirth, the focus was to utilize dental care for the infant by age one. The two primary outcome measures were dental utilization during pregnancy or up to two months postpartum for the mother, and preventive dental utilization by 18 months of age for the child. Medicaid claims data will be used to assess the primary outcomes. Questionnaires were administered at enrollment and 3, 9 and 18 months postpartum (study end) to assess mediating and moderating factors. DISCUSSION: This trial can help define the most effective way to provide one-on-one counseling to pregnant women and new mothers regarding visits to the dentist during pregnancy and after the child is born. It supports previous work demonstrating the potential of reducing mother-to-child transmission of Streptococcus mutans and the initiation of dental caries prevention in early childhood. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01120041.

Preventive dental care utilization and dental caries for Medicaid-enrolled adolescents in Oregon.

OBJECTIVES: This study aimed to evaluate the relationship between preventive dental care utilization and untreated dental caries for Medicaid-enrolled adolescents and to determine if the relationship is moderated by chronic conditions (CC). METHODS: This analysis was based on 2015-2016 Medicaid claims files and survey data collected from adolescents ages 12-18 years enrolled in Oregon Medicaid, who received a dental screening between December 2015 and December 2016 (n = 240). To assess the relationship between preventive dental care utilization and untreated dental caries (defined as decayed tooth surfaces), prevalence ratios (PR) and 95% confidence intervals (CI) were generated using log-linear regression models. We also tested for an interaction between preventive dental care utilization and CC. RESULTS: About 60.4% of adolescents utilized preventive dental care, 21.7% had CC, and 29.6% had ≥1 decayed tooth surfaces. There were no significant differences in untreated dental caries between adolescents who did and did not utilize preventive dental care (PR: 0.73, 95% CI: 0.33-1.60; p = 0.43). There was not a significant interaction between preventive dental care utilization and CC (p = 0.65). Preventive dental care utilization was not significantly associated with untreated dental caries for adolescents with CC (PR: 0.51, 95% CI: 0.10-2.65; p = 0.42) nor among adolescents without CC (PR: 0.79, 95% CI: 0.33-1.91; p = 0.61). CONCLUSIONS: Preventive dental care was not shown to be associated with lower untreated dental caries for Medicaid-enrolled adolescents or those with CC. Future work that is adequately powered should continue to elucidate this relationship in Medicaid enrollees.