Pandemic Considerations on Essential Oral Health Care.

The coronavirus disease 2019 (COVID-19) pandemic revealed a lack of consensus on the concept of essential oral health care. We propose a definition of essential oral health care that includes urgent and basic oral health care to initiate a broader debate and stakeholder alignment. We argue that oral health care must be part of essential health care provided by any health system. Essential oral health care covers the most prevalent oral health problems through an agreed-on set of safe, quality, and cost-effective interventions at the individual and community level to promote and protect oral health, as well as prevent and treat common oral diseases, including appropriate rehabilitative services, thereby maintaining health, productivity, and quality of life. By default, essential oral health care does not include the full spectrum of possible interventions that contemporary dentistry can provide. On the basis of this definition, we conceptualize a layered model of essential oral health care that integrates urgent and basic oral health care, as well as advanced/specialist oral health care. Finally, we present 3 key reflections on the essentiality of oral health care. First, oral health care must be an integral component of a health care system's essential services, and by implication, oral health care personnel are part of the essential health care workforce. Second, not all dental care is essential oral health care, and not all essential care is also urgent, particularly under the specific risk conditions of the pandemic. Third, there is a need for criteria, evidence, and consensus-building processes to define which dental interventions are to be included in which category of essential oral health care. All stakeholders, including the research, academic, and clinical communities, as well as professional organizations and civil society, need to tackle this aspect in a concerted effort. Such consensus will be crucial for dentistry in view of the Sustainable Development Goal's push for universal health coverage, which must cover essential oral health care.

Guía básica para el diseño de estudios epidemiológicos destinados a la toma de decisiones sanitarias en el campo de la salud bucal / Basic guide for the design of epidemiological studies aimed to sanitary decision making in the oral health field

El objeto de esta guía es resumir los requisitos básicos para elaborar un diseño epidemiológico destinado a latoma de decisiones en el campo de la salud bucal. Se incluyen los siguientes puntos: • Conceptos básicos que posicionan la perspectiva metodológica de la guía. • Requisitos a considerar para encarar un estudio epidemiológico sobre caries dental, en términos de:a) condiciones de los instrumentos a seleccionar, b) secuencia de las etapas para la organización del estudio epidemiológico, c) enunciado de los recursos a considerar previamente a iniciar del estudio, d) criterios generales acerca del muestreo. • Información sobre las encuestas “Pathfinder” (OMS).Incorpora dos anexos: 1. Enunciado de los diseños destinados a evaluarintervenciones sanitarias. 2. Ejemplo de un muestreo proporcional al tamaño.Esta guía constituye un instrumento básico destinado a colaborar con los interesados en iniciarse en estudios epidemiológicos y evitar los sesgos más comunes

Enamel fluorosis in 12- and 15-year-old school children in Costa Rica. Results of a national survey, 1999.

UNLABELLED: In 1987, Costa Rica implemented a national salt fluoridation programme using sodium fluoride (225-275 mg F/kg). OBJECTIVE: To evaluate the prevalence and severity of enamel fluorosis (EF) in Costa Rican schoolchildren as part of the biological monitoring of the salt fluoridation programme. BASIC RESEARCH DESIGN: In 1999, eight calibrated examiners (interexaminer Kappa = 0.73) recorded EF in the maxillary anterior teeth and first bicuspids (FDI's teeth 14 to 24) using Dean's Index and artificial light without drying. The multistrata probability sample included 12 and 15-year-old schoolchildren (n = 2,499), representing seven regions of the country. Data were analyzed in SAS and SUDAAN to account for sampling design. SETTING: Costa Rican schoolchildren. The 12-year-old cohort was born when salt fluoridation started. PARTICIPANTS: 3,758 children in selected age groups. MAIN OUTCOME MEASURES: Dean's index was calculated for cuspid to cuspid (teeth 13 to 23) and premolar to premolar (teeth 14 to 24). RESULTS: Prevalence of EF (very mild or higher) at age 12 years was 17% for teeth 13 to 23 and 32% when teeth 14 and 24 were included. At age 15 years, the prevalence was 12% for teeth 13 to 23 and 25% when teeth 14 and 24 were included. Large regional differences were observed: from 10% to 76% among 12-year-old children and from 6% to 50% among 15-year-old children. CONCLUSIONS: In the aggregate, EF prevalence is within the range expected for a salt fluoridation programme, but regions with higher severity need further investigation on additional sources of fluoride including environmental sources. Prevalence figures were higher in the cohort born at time of fluoridation.

Overview and quality assurance for the oral health component of the National Health and Nutrition Examination Survey (NHANES), 2003-04.

The 2003-04 National Health and Nutrition Examination Survey (NHANES) was a collaborative effort involving 28 federal funding partners with the National Center for Health Statistics. The collaborators for the 2003-04 NHANES oral health component included the National Institute of Dental and Craniofacial Research and the National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health. Oral health data are available on 8272 persons aged 2 years or older. This report provides an overview of the 2003-04 oral health component including content descriptions and procedures for oral health assessments conducted for the first time in a national survey in the United States. These assessments include posterior functional contacts, tooth wear, and oral health-related quality of life. This report also provides evaluations of data quality in terms of examiner reliability statistics (percent agreements, kappas, and correlation coefficients) for various NHANES 2003-04 oral health examination components and analytical recommendations for producing 6-year estimates using the previous two NHANES data collection components (1999-2000 and 2001-02).

Prevalence and severity of dental caries in Costa Rican schoolchildren: results of the 1999 national survey.

UNLABELLED: In 1987, Costa Rica implemented a comprehensive national salt fluoridation programme using sodium fluoride (225-275mg F/kg salt). AIM: To describe dental caries prevalence and severity in Costa Rican children in 1999. METHODS: Eight calibrated examiners (inter-examiner Kappa = 0.70 or higher) recorded information on dental caries, treatment needs, enamel fluorosis, and dentofacial anomalies for schoolchildren aged 6-8,12, and 15-years (N=3758). The survey utilised a multistrata probability sample with fixed allocation to represent seven regions of the country. RESULTS: The overall mean dmft for age 6-8 years was 3.32. The DMFT for age 12 was 2.46 and for age 15 was 4.37. Regional differences were observed; for example, the DMFT at age 12 years ranged from 1.93 to 3.86. Compared with pre-fluoridation data collected in 1984, schoolchildren aged 12 years, experienced a 28 per cent decrease in caries prevalence (100 per cent to 72 per cent) and a 73 per cent decrease in severity (DMFT from 9.13 to 2.46, representing an 8.3 per cent compound annual per cent reduction). CONCLUSIONS: Between 1984 and 1999, Costa Rican schoolchildren experienced substantial reductions in caries prevalence and severity. Many factors may be involved in this decline, but the most important appears to be exposure to fluoridated salt.

Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995.

OBJECTIVE: To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalence and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries. METHODS: In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 15-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84% reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clinical procedures, but the 1984 survey included a higher proportion of rural residents than did the 1995 one. RESULTS: The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population. CONCLUSIONS: Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt fluoridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of fluoride toothpaste and dietary fluoride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed.

Fluoride varnishes. A review of their clinical use, cariostatic mechanism, efficacy and safety.

BACKGROUND: This is a review of the clinical use, cariostatic mechanism, efficacy, safety and toxicity of fluoride varnishes. TYPES OF STUDIES REVIEWED: The authors reviewed and summarized in vitro, in vivo and in situ studies; clinical trials; demonstration programs; position papers; and editorials published in English in the biomedical literature since 1966. RESULTS: Extensive laboratory research and clinical trials conducted in Europe and elsewhere show that fluoride varnishes are as efficacious as other caries-preventive agents. Fluoride varnishes are widely used in European caries-preventive programs. The U.S. Food and Drug Administration has cleared these products only as medical devices to be used as cavity liners and for the treatment of hypersensitive teeth. These products have not yet been cleared for marketing in the United States as caries-preventive agents. CLINICAL IMPLICATIONS: Three fluoride varnishes are currently available in the United States. Semiannual applications are the most proven treatment regimen. Varnishes are safe and easy to apply and set in contact with intraoral moisture.

Analysis of prevalence and trends of dental caries in the Americas between the 1970s and 1990s.

Data on the prevalence and severity of dental caries collected by country members of the Pan American Health Organisation (PAHO) were summarised to analyse current status and trends since the 1970s. The mean number of decayed, missing, and filled teeth (DMF-T) among 12-year-old children and the relative contribution of each DMF-T component were collected from official reports and publications in the scientific literature. Overall, a secular trend toward lower caries prevalence was observed in most countries, more notably among those with large prevention programmes using fluorides. Many countries have reached the World Health Organization (WHO) year 2000 goal of a mean DMF-T of < or = 3 but others are still far from reaching that goal. Few countries have reached the status of having large proportions of disease prevalence localised in a small percentage of the population, a pattern observed as prevalence decreases. Since 1994, PAHO's Regional Oral Health Program has developed two strategies to address these issues: the introduction and reinforcement of national preventive programmes using fluorides and the introduction of the atraumatic restorative treatment (ART).