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The aims of this study were to investigate the relationship between self-reported preventive and curative orientations of general dental practitioners (GDPs) and the oral healthcare services (OHS) they provided to patients under 18-years-old. And in addition, to determine which patient, GDP, and dental practice characteristics predicted the provision of preventive and curative care. GDPs in the Netherlands using dental software program Exquise (>2,000) were invited to participate in this study voluntarily. Participants completed a web-based questionnaire on characteristics of themselves, their dental practices, and on 20 hypothetical clinical situations concerning caries management. Based on their responses GDPS were classified for their preventive orientation, and their curative orientation. Data on the OHS provided to their young patients over the period 2013-2017 were automatically extracted from the patient files. Based on the annual frequency of provided care to regular patients over a period of 4 or 5 years, this was converted into 3 longitudinal care patterns regarding prevention and 3 longitudinal care patterns regarding curative care. Multinomial logistic regression analyses were conducted with a multilevel approach to correct for dental practices. The 37 participating GDPs provided data for 16,229 young patients. There was not a significant relationship between self-reported preventive orientations and preventive care patterns. The self-reported middle curative orientation was a predictor of the care pattern 'curative treatment(s) in 1 year' (OR 1.23 compared to nu curative treatments; 95% CI 1.02-1.48). The self-reported high curative orientation was a predictor of 'curative treatments in several years' (OR 1.90; 95% CI 1.27-2.85). Common characteristics predicting (p<0.05) both regular preventive care and curative treatments in several years were patient related: age 4-9 and 10-12, low-income neighborhood, 5 years included in study. GDP and dental practice related predictors were: the GDP could fulfill the care demand by working overtime, small dental practice (≤2,000 patients), and practice policy on the provision of care to young patients. This showed that the variation in provided care was partly supplier-driven instead of patient-centered.
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Autorrelato , Humanos , Países Baixos , Feminino , Masculino , Adolescente , Odontólogos , Criança , Inquéritos e Questionários , Padrões de Prática Odontológica/estatística & dados numéricos , Pré-Escolar , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Serviços de Saúde Bucal/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Odontologia PreventivaRESUMO
OBJECTIVES: The study aimed to assess whether psychological distress mediates the association between financial strain and oral health and dental attendance in the Dutch adult population. METHODS: The study followed a cross-sectional design based on 2812 participants from the 2014 wave of the Dutch population-based GLOBE study. Financial strain was considered the exposure, while psychological distress measured with the Mental Health Inventory-5 (MHI-5) was the mediator. The outcomes included self-reported number of teeth, self-rated oral health, and self-reported dental attendance. Generalized regression analyses were used for the mediation analysis adjusted for several covariables. RESULTS: Greater financial strain was significantly associated with poorer self-rated oral health (total effect: 0.09, 95%CI: 0.05; 0.14) and restorative or no dental attendance (i.e. participants never visiting a dentist or only visiting a dentist for regular treatments or when they have complaints with their mouth, teeth, or prosthesis) (total effect: 0.05, 95%CI: 0.02; 0.09). Greater financial strain was not significantly associated with self-reported number of teeth (total effect: -0.14, 95%CI: -0.91; 0.64). Psychological distress significantly mediated the association of financial strain with self-rated oral health (average causal mediation effect [ACME]: 0.02, 95%CI: 0.01; 0.03) and self-reported dental attendance (ACME: 0.01, 95%CI: 0.00; 0.02), respectively. However, it did not significantly mediate the association of financial strain with self-reported number of teeth (ACME: -0.11, 95%CI: -0.25; 0.02). The estimated proportion of the total effect of financial strain on self-rated oral health and self-reported dental attendance that could be explained by psychological distress was respectively 24% (95%CI: 14%; 48%) and 19% (95%CI: 6%; 62%). CONCLUSIONS: Psychological distress partly explains the association of financial strain with self-rated oral health and dental attendance, but not with self-reported number of teeth. Future studies using longitudinal data are necessary to confirm the results.
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General dental practitioners (GDPs) differ in the preventive and curative care they provide to their young patients. This may be related to variation in the caries risk of patients, but also to differing opinions among GDPs about 'proper care'. Longitudinal data offers the possibility to make care patterns of GDPs comparable and to reveal possible treatment variation between GDPs. GDPs who participated in this study delivered data on the oral healthcare services (OHS) they provided to young patients during the period 2013-2017. Subsequently, data from patients who received regular OHS for 4 to 5 years were used in the analyses. Based on this, longitudinal preventive and curative care patterns were distinguished. Patients were divided into 3 preventive care patterns: no prevention, occasional prevention, and regular prevention. Furthermore, 3 curative care patterns were distinguished: no curation, curation in 1 year, and curation in several years. These care patterns were then combined. In addition, patients were classified into caries risk categories based on the caries-related treatments they received over a 2-year period: low (no procedures), elevated (1 procedure), and high (2 or more procedures). The caries risk based on the first 2 years and the last 2 years in the dataset were combined into a longitudinal caries risk profile. The most frequent combined care pattern (35.8%) was no curation and occasional or regular prevention. The most common longitudinal caries risk profile was low at beginning and end (45.2%). Dental practices varied considerably in the distribution of curative and preventive care patterns. Thereby, no relationship was shown between curative care patterns and provided preventive care. There was also a large spread in the provided OHS within the various caries risk profiles. These diversities indicated treatment variation between GDPs, which is unwarranted if less or more care is provided than necessary.
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Cárie Dentária , Odontólogos , Humanos , Papel Profissional , Atenção à Saúde , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controleRESUMO
The aim of this study was to assess the oral health status, oral health behaviours and oral healthcare utilization among Indian migrants living in the Netherlands and how they compare with the host population. Based on a random sample from Dutch municipalities, cross-sectional data were obtained for the Indian migrants living in the Netherlands (n = 148) and the host population (n = 244). A questionnaire was used to collect information on socio-demographic, self-reported oral health status, oral health behaviours and oral healthcare utilization. The distribution of self-reported oral health variables for both groups were tabulated and compared using logistic, ordinal and multinomial regression analysis. When adjusted for covariates such as age, gender, marital status, education, income, occupation and dental insurance, regression analysis for oral health status showed that the odds of reporting oral impact on daily performances (OIDP) was 5.87 times higher for Indians compared to the host population (95%CI:3.45;9.65). In contrast, the odds of Indians reporting bleeding gums [OR = 0.44 (95%CI:0.27;0.73)] and diagnosed with gum diseases [OR = 0.23(95%CI:0.13;0.39)] were lower than the host population. Also, the odds of consuming alcohol and cakes or chocolates was significantly lower among Indian migrants compared to the host population [(OR = 0.15(95%CI:0.09;0.25)] and [OR = 0.33(95%CI:0.21;0.52)], respectively. But the odds of consuming sugar in hot beverages were significantly higher among Indians [OR = 10.44(95%CI:5.99;18.19)]. The odds of Indians visiting a dental professional were 9.22 times (95%CI:4.62;18.40) lower compared to the host population. We found that oral health status and behaviours among Indian migrants were different in certain aspects compared to the host population. However, their oral healthcare utilization remained overall lower. The underlying determinants for such observations merit further research. Migrant friendly approach from both the dental professionals and policy makers can encourage dental visits and improve the utilization patterns among Indians migrants in the future.
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Migrantes , Humanos , Estudos Transversais , Saúde Bucal , Países Baixos , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
AIM: To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. MATERIALS AND METHODS: A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. RESULTS: Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). CONCLUSIONS: This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.
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Multimorbidade , Transtornos Relacionados ao Uso de Substâncias , Adulto , Feminino , Humanos , Masculino , Faculdades de Odontologia , Comorbidade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , PrevalênciaRESUMO
The study aimed to assess the prevalence of spin in the titles and abstracts of RCTs in dental caries with statistically nonsignificant primary outcomes and to assess the risk indicators which may be associated with spin. Any original publication reporting a two-arm RCT in dental caries with clearly identified statistically nonsignificant primary outcomes published from January 1, 2015 until October 28, 2022 were included. PubMed was searched electronically to identify the eligible publications. The prevalence of spin in titles and abstracts were assessed and categorized into spin patterns based on a pre-determined classification scheme. The association between spin and the potential risk indicators at study, author, journal, institutional, and national level was assessed. A total of 234 eligible RCT publications were included. The prevalence of spin in the titles and abstracts was 3% (95%CI: 2% to 6%) and 79% (95%CI: 74% to 84%), respectively. The most common spin patterns in the results and conclusion sections, respectively, were results focusing on statistically significant within-group comparisons (23%), and conclusions focusing only on statistically significant results without acknowledgment of statistically nonsignificant results for the primary outcomes (26%). The spin was significantly associated with number of study centers (single-center vs. multicenter) (OR=2.131; 95%CI: 1.092 to 4.158; P=0.03), trial designs (non-parallel designs vs. parallel designs) (OR=0.395; 95%CI: 0.193 to 0.810; P=0.01), and overall H index of institutions for last authors (OR=0.998; 95%CI: 0.996 to 0.999; P<0.01), while it was not significantly associated with the other indicators. In the RCT publications with statistically nonsignificant results for primary outcomes in dental caries, the prevalence of spin may be low in the titles but high in the abstracts. Single-center studies with parallel designs and a lower overall H index of institutions for last authors may be more likely to have spin in the abstracts.
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OBJECTIVES: Although many studies have reported a higher risk of atherosclerotic cardiovascular diseases (ACVD) in people with periodontitis (PD), this has been tested in a few large-scale population-based studies with a longitudinal design. The aim of this study was to investigate whether people with PD status have an increased risk of a nonfatal ACVD event compared to people without PD status. METHODS: A cohort of 1.2 million participants from a healthcare insurance claims database was studied longitudinally for a period of 8 years. PD status was derived from PD-related insurance claims and ACVD status from ACVD-related insurance claims. Person-time at risk (PTAR) was calculated from the start of follow-up (01 January 2007) for participants with and without PD status until ACVD or event-free censoring (31 December 2014). Time-dependent Cox proportional hazard models were used to calculate the hazard ratio (HR) and to adjust for shared risk factors (age, sex, socioeconomic position and diabetes mellitus). RESULTS: The prevalence of PD was 20.1%, and the cumulative incidence of nonfatal ACVD events was 7.5%. The univariable and multivariable analyses revealed a limited risk of ACVD for participants with PD status (HR: 1.12; 95% CI 1.10-1.14, HR: 1.06; 95% CI 1.04-1.08, respectively). A subgroup analysis of participants ≤35 and > 35 years of age showed that those ≤35 years of age with PD status had a higher ACVD risk (univariable HR: 1.20; 95% CI 1.05-1.37, multivariable HR: 1.21; 95% CI 1.05-1.39). ACVD risk was not increased in participants >35 years of age with PD status (univariable HR: 0.92; 95% CI 0.91-0.94, multivariable HR: 0.96; 95% CI 0.94-0.98). CONCLUSIONS: This study based on a healthcare insurance cohort shows that PD can hardly be regarded as a risk factor for nonfatal ACVD. The increased risk is of minor size, and therefore, the proposed role of PD in the development of ACVD events should be reconsidered. Possibly PD plays a role as a risk factor in younger people due to overlapping genetic risk factors of ACVD and a more aggressive course of PD.
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Aterosclerose , Doenças Cardiovasculares , Seguro , Periodontite , Humanos , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Periodontite/complicações , Periodontite/epidemiologia , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Fatores de Risco , Estudos RetrospectivosRESUMO
OBJECTIVE: This scoping review aims to identify complex health interventions (CHI's) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI's, and explore the details of their development, evaluation, and implementation. INTRODUCTION: Many interventions to prevent ECC have multiple interacting components and can be seen as CHI's. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI's. INCLUSION CRITERIA: This scoping review will consider clinical trials reporting CHI's to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context. METHODS: This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and review full-text studies, and extract data. The reference lists of all included sources will be screened for additional CHI's or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI's development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions. DISCUSSION: The proposed review will generate evidence which may provide a direction for the future design of studies on CHI's to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.
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Atenção à Saúde , Suscetibilidade à Cárie Dentária , Pré-Escolar , Feminino , Humanos , Programas de Rastreamento , Gravidez , Literatura de Revisão como AssuntoRESUMO
BACKGROUND: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. OBJECTIVE: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. METHODS: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. RESULTS: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. CONCLUSIONS: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication. TRIAL REGISTRATION: Netherlands Trial Register NL8737; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8737. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39683.
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The mission of academic excellence has resulted in a science system that incentivises publications within high impact, often basic science journals, and less in application-oriented journals. For the dental research field this so-called academic drift can result in a research portfolio that moves away from research that serves dental healthcare. Therefore, we examined if and how academic drift has changed the dental research field. Web of Science data were used to develop a network map for dental research containing journal clusters that show similar citation behavior. From the year 2000 up to 2015, we explored the intensity of knowledge exchange between the different clusters through citation relations. Next, we analyzed changes in research focus of dental research institutes in seven countries, in dental research, clinical medicine research, basic science, public health research and other fields. Within the citation network, 85.5% of all references in dental journals concern references to other dental journals. The knowledge contribution of non-dental research fields to dental research was limited during the studied period. At the same time, the share of output of dental research institutes in dental research has declined. The research activity of the dental research institutes increased mainly in basic science while the knowledge input from basic science into dental research did not increase. Our findings suggest that the dental research portfolio is influenced by academic drift. This academic drift has increased the disbalance towards basic science, and presents a challenge for the scientific progress in dental healthcare services.
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Engagement of patients in the composition of a research agenda is essential to reduce the gap between research and practice and thereby generate more impact. The aim of this study was to develop a research agenda for oral health. Experienced challenges and needs with oral health(care) of practitioners and patients formed the input for the research agenda. We describe the identification of research priorities of patients and the integration of these with previously identified research priorities of practitioners, using a participatory multi-phase approach for research agenda setting (Dialogue Model). Via focus group discussions, 32 research topics were generated. Next, 1495 patients prioritized these topics in an online survey. In a dialogue meeting, a joint research agenda of eight research topics was agreed upon. Many topics were contributed by patients, but were prioritized by both stakeholder groups. The most important topics concerned behavior change and the relation between general and oral health. Other topics that were prioritized covered affordability and accessibility as well as health system research and organizational issues. By considering different perspectives, this research agenda has uncovered directions for future research that go beyond evident research topics, as many topics are currently underrepresented in oral healthcare research.
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Pesquisa sobre Serviços de Saúde , Participação do Paciente , Humanos , Inquéritos e QuestionáriosRESUMO
Various models are available to assess caries risk in individuals. In general past caries experience is considered as the best single predictor for future caries development in populations. Likewise, recent restorations have been used to predict future restorations. We aimed to evaluate a classification model for risk categories for dental caries in children based on claims data from Dutch healthcare insurance company Zilveren Kruis. The baseline caries risk categories were derived from the number of claimed restorations in two baseline years (2010 through 2011). These categories were defined as low (no new restorations), moderate (1 new restoration), and high (2 or more new restorations). First, we analyzed the relationship between baseline caries risk categories and the number of new restorations during 3 years of follow-up (2012 through 2014). Secondly, we used negative binominal two-level analyses to determine the accuracy of our classification model in predicting new restorations during follow-up. Thirdly, we reclassified the participants after 3 years and determined the changes in the categorization. We included insurance claims data for the oral healthcare services in 28,305 children and adolescents from 334 dental practices for the period 2010-2014. At baseline, 68% of the participants were in risk category low, 13% in moderate and 19% in high. The mean number of new restorations during follow-up was 0.81 (SD 1.72) in baseline risk category low, 1.61 (SD 2.35) in moderate, and 2.65 (SD 3.32) in high. The accuracy of the multivariate model for predicting 0/>0 restorations was 50%. After 3 years, 60% of the study participants were in the same risk category, 20% were in a lower, and 21% in a higher risk category. Risk categories based on claimed restorations were related to the number of new restorations in groups. As such, they could support planning and evaluation of oral healthcare services.
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Cárie Dentária , Criança , Pré-Escolar , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Seguro/organização & administração , Masculino , Países Baixos/epidemiologiaRESUMO
There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents' willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents' demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child's teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child's teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention's importance in maintaining healthy teeth and reducing possibly oral health inequalities.
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Cárie Dentária , Saúde Bucal , Pré-Escolar , Estudos Transversais , Cárie Dentária/prevenção & controle , Humanos , Prevenção Primária , Escovação DentáriaRESUMO
CONTEXT: A research agenda for oral health care was established in the Netherlands using the Dialogue Model. This project served as a case study in which we applied boundary-work theory as a framework to understand boundaries (ie demarcations) between and within groups, and how these boundaries can be overcome. OBJECTIVE: To gain insights into the boundaries encountered when setting a research agenda, we analysed how this agenda served as a boundary object (ie circumstances, situations or material that connect actor groups and allow boundary crossing) that facilitated crossing boundaries and uniting the perspectives of patients and practitioners. METHODS: We used a thematic approach to analyse researchers' observations, meeting materials, emails, interviews with patients (n = 11) and a survey among patients and practitioners (n = 18). RESULTS: Setting the research agenda helped to cross boundaries in oral health care, which demonstrates its role as a boundary object. First, this made it possible to integrate research topics representing the perspectives and priorities of all patients and also to unite those perspectives. It was essential to involve practitioners at an early stage of the project so that they could better accept the patients' perspectives. This resulted in support for an integrated research agenda, which facilitated the crossing of boundaries. CONCLUSIONS: The research agenda-setting project was found to serve as a boundary object in uniting the perspectives and priorities of patients and practitioners. PATIENT CONTRIBUTION: Patient involvement in this case study was structured in the process of research agenda setting using the Dialogue Model.
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Participação do Paciente , Pesquisadores , Humanos , Países Baixos , Inquéritos e QuestionáriosRESUMO
Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.
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OBJECTIVES: To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses. DATA/SOURCES: We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). STUDY SELECTION: A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00. CONCLUSION: The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies. CLINICAL SIGNIFICANCE: Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.
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Suscetibilidade à Cárie Dentária , Cárie Dentária , Viés , Cárie Dentária/epidemiologia , Humanos , Curva ROC , Medição de RiscoRESUMO
OBJECTIVES: The aim of this study was to develop a research agenda based on the most important information needs concerning the effects and outcomes of oral healthcare provided by oral healthcare professionals (OHPs). METHODS: A two-stage survey study was used to identify and prioritise topics for future research. The first survey generated topics based on information needs by OHPs. Topics were clustered thematically and overlapping topics were merged in 84 research themes. In the second survey, respondents selected their top 5 from the 84 research themes. Themes were sorted by the rank number based on rank sum. RESULTS: In the first survey, 937 topics were suggested. Almost half (n = 430, 46%) were identified as topics related to endodontology, cariology, oral medicine/surgery or tooth restoration. Topics were grouped in 84 research themes, covering 10 research domains. These were prioritised by 235 OHPs. Behaviour change for oral health and oral healthcare for geriatric patients ranked as most important. CONCLUSIONS: Consultation of OHPs has resulted in a research agenda, which can be used to inform programming future oral health research. The highest prioritised research themes have an interdisciplinary nature, mainly concern oral disease prevention and are under-represented in the current oral healthcare research portfolio.
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Atenção à Saúde , Prioridades em Saúde , Idoso , Pessoal de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Inquéritos e QuestionáriosRESUMO
As the reported data on oral health status among the migrants in Europe is fragmented, we systematically reviewed the published literature on the oral health status, behaviours and care utilisation among migrants residing in Europe. For this, we retrieved publications from PubMed and EMBASE, supplemented by manual citation screening and grey literature search on Google scholars. Two independent reviewers screened the studies, extracted data and critically appraised the publications. A total of 69 studies included showed higher dental caries among migrant children. But some studies on adolescents and adults reported similar or even better oral health among migrants compared to the host population, while other reported the opposite. Poor oral health behaviours were generally reported among the migrants and they frequently made use of emergency service utilisation compared to the host population. We shed light on the gaps in dental literature and make some recommendations for the future.
Assuntos
Cárie Dentária , Migrantes , Adolescente , Adulto , Criança , Cárie Dentária/epidemiologia , Europa (Continente) , Humanos , Saúde Bucal , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
OBJECTIVE: Undocumented migrants in Europe face multiple barriers in access to oral health care. This study aimed to explore the accessibility of a voluntary dental network providing dental treatments to undocumented migrants in the Netherlands, from the perspectives of patients, dentists and staff members of nongovernmental organizations involved. METHODS: This qualitative study used semi-structured interviews (n = 21) with undocumented migrants (n = 12), dentists (n = 7) and staff members of nongovernmental organizations (n = 2) during the implementation of a voluntary dental network. Interviews were analysed using a framework analysis method. RESULTS: As a temporary answer to problems in access to oral health for undocumented migrants, the voluntary dental network targeted initial barriers to dental care. Main challenges within the network were conflicting expectations and perceived treatment outcomes by patients, dentist and NGO staff members, limited financial resources, logistic and communication barriers and an increasing administrative burden. Furthermore, feelings of compassion for and trust of the patient affected the ethics of the professional relationship and influenced treatment decisions of dentists. CONCLUSION: Through the implementation of a voluntary dental network, treatments could be provided to undocumented migrants as a temporary solution. However, the voluntary nature of dental care in the network resulted in a fragmented provision of oral health care among undocumented migrants. To reduce inequalities in oral health on the long term, systemic barriers in access to oral health care need to be addressed.
Assuntos
Migrantes , Europa (Continente) , Acessibilidade aos Serviços de Saúde , Humanos , Países Baixos , Saúde BucalRESUMO
OBJECTIVES: To identify predictors in patient profiles, and to develop, internally validate, and calibrate prediction models for the persistence of self-reported orofacial pain at the 6-month and 12-month follow-up in patients with myofascial pain. MATERIALS AND METHODS: A cohort of 63 adult patients with moderate to severe chronic myofascial pain was included. Patient and disease characteristics at baseline were recorded as potential predictors. Patients` presence or absence of improvement of orofacial pain at follow-up was considered the outcome. Binary logistic regression analyses were used to develop the models. The performance and clinical values of the models were determined. RESULTS: Forty-three percent and 30% of the patients had persistence of orofacial pain at 6-month and 12-month follow-up, respectively. Pain elsewhere, depression, parafunctional activities, and mandibular function impairment (MFI) were significantly associated with persistence of the pain at 6-month follow-up, whereas depression, parafunctional activities, and MFI were significantly associated with persistence of the pain at 12-month follow-up. Both of the models showed good calibration and discrimination, with shrunken area under the curve (AUC) values of 0.73 and 0.76, respectively. The clinical added predictive values for ruling in the risk of the persistence were 0.30 and 0.31, respectively, and those for ruling it out were 0.25 and 0.20, respectively. CONCLUSIONS: Potential predictors for prediction of the persistence of self-reported orofacial pain at follow-up were identified. The calibration, discrimination, and clinical values of the models were acceptable. CLINICAL RELEVANCE: The models may assist clinicians in decision-making regarding the improvement of orofacial pain of individual patients during follow-up in clinical settings.