ORCA-EFCD consensus report on clinical recommendations for caries diagnosis. Paper II: caries lesion activity and progression assessment.

INTRODUCTION: This consensus paper provides recommendations for oral health professionals on why and how to assess caries activity and progression with special respect to the site of a lesion. METHODS: An expert panel was nominated by the executive councils of the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD). The steering committee built three working groups that were asked to provide recommendations on 1) caries detection and diagnostic methods, 2) caries activity and progression assessment and 3) obtain individualized caries diagnoses. The experts of work group 2 phrased and agreed on provisional general and specific recommendations on caries lesion activity and progression, based on a review of the current literature. These recommendations were then discussed and refined in a consensus workshop followed by an anonymous Delphi survey to determine the agreement on each recommendation. RESULTS: The expert panel agreed on general (n=7) and specific recommendations (n=6). The specific recommendations cover coronal caries on pits and fissures, smooth surfaces, proximal surfaces, as well as root caries and secondary caries/ caries adjacent to restorations and sealants (CARS). 3/13 recommendations yielded perfect agreement. CONCLUSION: The most suitable method for lesion activity assessment is the visual-tactile method. No single clinical characteristic is indicative of lesion activity; instead, lesion activity assessment is based on assessing and weighing several clinical signs. The recall intervals for visual and radiographic examination need to be adjusted to the presence of active caries lesions and recent caries progression rates. Modifications should be based on individual patient characteristics.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment.

OBJECTIVES: The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS: The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS: Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION: Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE: The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

Impact of Socioeconomic Inequalities on Dental Caries Status in Sardinian Children.

BACKGROUND: The association between oral health of schoolchildren living in the North Sardinia area and socioeconomic deprivation was assessed to evaluate a potential spatial correlation. METHODS: A total of 10,947 subjects were examined (5281 aged 3-5-years, and 5666 aged 6-11-years). The WHO dmft index score was calculated following clinical examination by calibrated examiners. The Sardinian Deprivation Index (IDMS) of the children's municipalities was also considered. Descriptive, bivariate and multinomial data analysis was conducted to assess the association between clinical data and socioeconomic deprivation. The presence of systematic spatial variation regarding caries experience (dmft) and deprivation status was investigated using a spatial autoregressive analysis. RESULTS: Caries figures were statistically different in the two age groups (dmf > 0, 13.79% in the younger group vs. dmf > 0, 34.20% in the older one, p < 0.01). In a multinomial logistic regression model for caries experience, all the covariates were statistically significantly associated (p < 0.01) in comparison with the base outcome "caries-free". Linear regression analysis showed a dependence of dmft on IDMS (p < 0.01). Based on this equation, the dmft of the 39 municipalities that did not participate in the survey was estimated. IDMS was statistically significantly associated (p < 0.01) with caries prevalence in the spatial regression model. CONCLUSIONS: The deprivation index significantly increased the risk of caries for all categories of caries experience and prevalence compared to caries-free. The relationship between IDMS and caries data was also confirmed by spatial analysis.

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review.

Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case-control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.

Caries Severity, Decayed First Permanent Molars and Associated Factors in 6-7 Years Old Schoolchildren Living in Palermo (Southern Italy).

To date, there are very few epidemiologic studies on caries disease in 6-7 year old children living in Sicily (Southern Italy). The first permanent molar (FPM) is the most commonly affected tooth in this target population, and a one-unit increase in the number of decayed FPMs is predictive of caries in other teeth and in adulthood. The primary aim of this research is to estimate the prevalence of caries in 6-7 year old schoolchildren living in Palermo and, as a secondary aim, to estimate the prevalence of affected FPMs. It was designed as a cluster cross-sectional survey on 995 children from 16 schools, selected based on their geographical location, in one of the eight city districts. Caries data were recorded using the International Caries Detection and Assessment System for each tooth surface. The relation between socio-economic status, behavioural determinants, and clinical information and the number of teeth with initial caries (IC), moderate caries (MC), or extensive caries (SC) was analysed through the ordinal logistic regression. Among the 995 schoolchildren, 662 (66.5%) had at least one lesion and 742 (74.6%) had FPMs. Of the latter, 238 (32.0%) were affected by IC, 86 (11.6%) were affected by MC, and only 3 (0.4%) were affected by SC. During multivariable analysis, there was evidence of an increased risk of MC and SC related to the deprivation of the district in which the children lived and went to school, as well as to the protective role of parental education and employment. The same significant determinants were found for IC and MC FPMs. The study showed the important role of socio-economic determinants, unhealthy behaviours, and social deprivation related to the increased risk of moderate and extensive caries in 6-7 year old schoolchildren. Investigating this target population is very important, as early development of caries in FPMs may have serious consequences in the prognostics of oral health in an adult.

Inequalities in caries among pre-school Italian children with different background.

BACKGROUND: The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient. METHODS: The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.8% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) was estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated, children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic and logistic regression) were used to elucidate the associations between all explanatory variables and caries prevalence. RESULTS: Overall, 54.4% (95%CI 46.7-58.3%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.6% vs 41.6% p < 0.01) and to the area of living (p = 0.03). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z = 5.24, p < 0.01). Children in the highest household income group had lower levels of caries. In multivariate analysis, Immigrant status, the highest parents' occupational and educational level, only one kid in the family, living in the North-Western Italian area and a high household income, were statistically significant associated (p = 0.01) to caries prevalence. The social gradient was statistically significant associated (p < 0.01) to the different caries levels and experience in children with European background. CONCLUSIONS: Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background.

Economic Impact of COVID-19 Pandemic on Dental Practices in Germany: A Cross-Sectional Survey.

An observational cross-sectional survey was planned and carried out to evaluate the economic impact of the SARS-CoV-2/COVID-19 pandemic on dental practices in Germany. An online-questionnaire was developed and previously calibrated by a group consisting of experts from dentists, lawyers, and business economists (n = 21; Intra-Class-Coefficient > 0.8). It consisted of four main categories: vital statistics, professional activity and practice structure, economic impact of the COVID-19 pandemic and validation and contextualization to avoid automated filling in. The questionnaire was administered anonymously to 9732 dentists in Germany, 4434 of whom opened it and 1496 of whom fully completed it. These results were evaluated and summarized. Respondents were divided into seven German economic macro areas. Difference in proportion among questionnaire items was evaluated with χ2 test or Fisher exact test appropriately. Linear trend analysis was performed among German macro areas. Ordinal multinomial linear regression analysis was run to evaluate the association with questionnaire items with respect to a collapse and/or quarantine measures due to a positive test/infection/disease of dental personnel or an increase in average monthly costs due to the pandemic. One-third experienced a collapse or quarantine measures of the predominantly self-employed participating dentists (92%). Small practices were less affected than larger ones. Average monthly costs increased sharply in all practice structures. The findings shall help to better manage future pandemics and provide information to policy makers. As the pandemic situation is still ongoing, the medium- and long-term economic impact should be further evaluated.

Caries risk assessment using different Cariogram models. A comparative study about concordance in different populations-Adults and children.

This methodological survey aimed to verify whether there is concordance among several Cariogram different risk models at different thresholds, comparing both children and adult populations and how each risk/protective factor weight on the overall caries risk profile. Three groups' data (two in children and one in adults) were obtained from previous studies, while a fourth, in young adults, was ad hoc enrolled. Different caries risk levels were assessed: a) three risk categories with two different thresholds as: "low risk" = 61-100% or 81-100% chance to avoid caries, "moderate risk" = 41-60% or 21-80% and "high risk" = 0-40% or 0-20%, named model 1 and 2; b) four risk categories with two different thresholds as: "low risk" = 61-100% or 76-100%, "moderate/low risk" = 41-60% or 51-75%; "moderate/high risk" = 21-40% or 26-50% and "high risk" = 0-20% or 0-25%, model 3 and 4; c) five risk categories as: "very low risk" = 81-100%; "low risk" = 61-80% "moderate risk" = 41-60%; "high risk" = 21-40% and "very high risk" = 0-20%, model 5. Concordance of the different Cariogram risk categories among the four groups was calculated using Cohen's kappa. The weight of the association between all Cariogram models toward the Cariogram risk variables was evaluated by ordinal logistic regression models. Considering Cariogram model 1 and 2, Cohen's Kappa values ranged from 0.40 (SE = 0.07) for the young adult group to 0.71 (SE = 0.05) for the adult one. Cohen's Kappa values ranged from 0.14 (SE = 0.03 p<0.01) for the adult group to 0.62 (SE = 0.02) for the two groups of children in models 3 and 4. Statistically significant associations were found for all Cariogram risk variables excepting Fluoride program in models 4 and 5 and the overall risk on children's samples. Caries experience showed a quite variable weight in the different models in both adult groups. In the regression analyses, adult groups' convergence was not always achievable since variations in associations between caries risk and different risk variables were narrower compared to other samples. Significant differences in caries risk stratification using different thresholds stands out from data analysis; consequently, risk assessments need to be carefully considered due to the risk of misleadingly choosing preventive and research actions.

The Decision Tree for Clinical Management of Dentin Hypersensitivity. A Consensus Report.

PURPOSE: To reach a consensus on a consistent strategy to adopt when screening patients for the clinical management of dentin hypersensitivity. MATERIALS AND METHODS: A panel consisting of members of the Advanced Technology in Oral Hygiene Sciences Academy (ATASIO) was formed to start a review process on dentin hypersensitivity (DH) and subsequently elaborate a decision tree to manage DH, from diagnosis to prognosis. The panel employed the RAND in their deliberations. After an initial systematic literature review, it became evident that a consensually validated protocol for the management of patients affected by dentin hypersensitivity has to be considered mandatory by all dental professionals. However, the outcome of the systematic review made it evident that the treatment options to be provided, as well as their prognosis and timing, had never been defined. The panel produced documents that addressed the topic and were subsequently used to generate a questionnaire. A workshop of expert dental professionals was organised to reach consensus on the main steps of the decision tree. Each member completed the questionnaire independently, and then a panel discussion was held to reach a consensus. RESULTS: A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated was answered. A clinical decision threshold was created. CONCLUSIONS: The dissemination of the information to a wide dental audience should commence upon publication of this consensus document. The authors hope that this consensus will become a model for the development of a dedicated protocol to manage DH.

COVID-19 in Switzerland and Liechtenstein: A Cross-Sectional Survey among Dentists' Awareness, Protective Measures and Economic Effects.

The aim of this observational cross-sectional study was to gain information on the awareness; protective measures and economic effects of dentists in Switzerland during the global COVID-19 pandemic. All dentist were members of the Swiss Dental Association SSO from all over Switzerland-including all Swiss cantons and Liechtenstein-and received a previously calibrated questionnaire as an ad hoc online version. The questionnaire was divided into four parts: personal data; precautionary measures; awareness; perception. In total, 1324 questionnaires were analyzed; the response rate was 30.59% (ntotal = 4328). Participants stated in less than 2% common symptoms/signs of COVID-19; of which only fatigue was statistically significant (p < 0.01). A small number of dentists reported a positive test (0.91%; n = 12) or having one or more symptoms (2.65%; n = 35) of COVID-19 during the pandemic; whereas only 6.71% (n = 87) of the participants reported having treated SARS-CoV-2 infected patients. High prevalence areas were only medium-large and large Swiss cantons (p < 0.01). Face filter (FFP2/FFP3) masks were used by about half of the dentists, while disposable visor was rarely used. The majority of dentists had to reduce the dental practice activity to a minimum of 0-10% (n = 923; 69.98%) due to the lockdown. This economic impact forced 1.4% (n = 18) to close their practice permanently or by the end of 2020 due to the economic situation. These results can be helpful to better prepare dental practices for future outbreaks of infection (e.g., prophylactic storage of additional protective measures), define the best strategy and organize the dental workforce. Political decision-makers should consider drastic economic effects when deciding on drastic measures such as "lockdown", which can lead to practice closures and unemployment of dental staff after only a few weeks. This should be taken into account, especially with regard to possible financial assistance to severely impaired dental practices to maintain a high level of dental care.

Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children.

This study presents the result of the second National pathfinder conducted in Italy on children's oral health, reporting the prevalence and severity of caries in 12-year old children and describing the caries figure related to the socioeconomic inequalities, both at individual level and macroeconomic level. The two-digit codes related to ICDAS (International Caries Detection and Assessment System) for each tooth and the gingival bleeding score were recorded at school on 7,064 children (48.97% males and 51.03% females). The Gross National Product (GNP) per capita, the Gini Index and Unemployment rate in each Italian section, parents' educational levels, working status, smoking habit and their ethnic background were recorded. Zero-inflated-negative-binomial (ZINB) models were run, using caries-free teeth, teeth with enamel lesions, cavitated lesions and restorations as functions of socioeconomic explanatory variables, to evaluate the effects of justifiable economic factors of geographical distribution. The mean number of enamel lesions, cavitated lesions and filled per teeth were statistically significant (p < 0.01) dissimilar among the Italian section. GNP per capita, Gini Index and Unemployment rate were significantly correlated to ICDAS scores and filled teeth. Important differences in ICDAS score values remain among children from different socioeconomic backgrounds. Efforts should be made to improve awareness and knowledge regarding oral health practice and to implement preventive programs and access to dental services in Southern Italy where the disease is still unresolved.

Assessing the Predictive Performance of Probabilistic Caries Risk Assessment Models: The Importance of Calibration.

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities <0.5 and underestimates the risk for forecast probabilities >0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required.

How Much Country Economy Influences ECC Profile in Serbian Children-A Macro-Level Factor Analysis.

Introduction: Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants. However, a high prevalence of early childhood caries (ECC) with wide variation across the country was observed in previous studies. This paper aimed to analyze the association between economic and healthcare country macro-level factors with ECC prevalence and treatment. Method: The outcome variables were ECC prevalence and frequency of untreated ECC in 36- to 71-month-olds. Cross-sectional pathfinder survey on a nationally representative sample of children was conducted in order to obtain data. Independent variables included the following: gross domestic product (GDP), social and health care budget beneficiaries' expenditures, local self-government budget, unemployment rate, population density and density of physicians and dentists. Guided by the WHO's Basic Methods for Oral Health Surveys stratified cluster sample, 17 sites were randomly chosen to obtain adequate distribution of data regarding urban, peri-urban and rural areas in each analyzed statistical territorial unit. The variables were analyzed using the independent t-test or Mann-Whitney U test. A probability value of <0.05 was considered significant. Results: The final sample included 864 children aged 36 to 71 months. Observed prevalence of ECC was 41.1%. Although no statistically significant difference was found, children with ECC compared to healthy children were living in parts of the country with averages of ≈122€ lower GDP per capita, ≈4€ lower social and health care expenditures per capita, 9 inhabitants per km2 lower population density, almost 7€ per capita lower local self-government budget and a 0.6% higher unemployment rate. Furthermore, although without a statistically significant difference, untreated ECC was associated with ≈302€ lower GDP per capita, ≈12€ lower social and health care expenditures per capita, 34 inhabitants per km2 lower population density, almost 20€ per capita lower local self-government budget and a 1.7% higher unemployment rate. Conclusions: This study, performed in a nationally representative sample of preschool children, revealed the association of economic macro-level factors with ECC prevalence and its (non-) treatment. Further research on a larger sample is necessary to confirm the results. These findings suggest that most of the public-health efforts regarding prevention and early treatment of ECC should be directed at regions with lower economic performance.

Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management.

A large number of disorders may affect the oral cavity, including genetic diseases, infections, cancers, blood diseases, skin diseases, endocrine and metabolic disorders, autoimmune and rheumatologic diseases, local lesions, to name a few. Oral mucosa shows a considerable variation in its normal structure and a wide range of conditions may affect it. Such conditions are often harmless or minor and could be primary or secondary to systemic disease. Several of them are quite rare and, hence, the diagnosis is not easy. Clinically, lesions may appear as ulcers, discoloration of the oral mucosa and alterations in size and configuration of oral anatomy. Genetic disorders have specific manifestations and can be caused by a derangement of one or more components of the tissue. Many of them follow the skin or systemic signs of the underlying genetic disease, but in a few cases oral signs could be the first manifestation of the disorder. Among them genodermatoses are prominent. They are inherited disorders characterized by a multisystem involvement. This review describes chondro-ectodermal dysplasia, dyskeratosis congenita, Ehlers-Danlos syndrome, hereditary benign intraepithelial dyskeratosis, keratosis follicularis, lipoid proteinosis, multiple hamartoma syndrome, pachyonychia congenita, Peutz-Jeghers syndrome, tuberous sclerosis and white sponge nevus. Other genetic disorders not included in the genodermatosis group and reported in the present review are: acanthosis nigricans, angio-osteo-hypertrophic syndrome, encephalotrigeminal angiomatosis, familial adenomatous polyposis, focal dermal hypoplasia, focal palmoplantar and oral mucosa hyperkeratosis syndrome, gingival fibromatosis, Maffucci's syndrome, neurofibromatosis (type 1) and oro-facial-digital syndrome (type 1). Disorders during embryonic development might lead to a wide range of abnormalities in the oral cavity; some of them are quite common but of negligible concern, whereas others are rare but serious, affecting not only the oral mucosa, but also other structures of the oral cavity (ie palate, tongue and gingiva). Fordyce's granules, leukoedema, cysts of the oral mucosa in newborns, retrocuspid papilla, geographic tongue, fissured tongue, median rhomboid glossitis, hairy tongue, lingual varices and lingual thyroid nodule are described. This review may help dentists, dental hygienists, but also general internists and pediatricians to diagnose different disorders of the oral mucosa, to understand the pathogenesis and to schedule a treatment plan.

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review.

BACKGROUND: Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment. METHODS: Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment. RESULTS: One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels. CONCLUSIONS: The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

The burden of tooth loss in Italian elderly population living in nursing homes.

BACKGROUND: This survey aims to evaluate the prevalence and severity of tooth loss in the Italian elderly population living in nursing homes and to associate the oral data with demographic, socioeconomic factors, the Mini-Mental State Examination (MMSE), the Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) scores. METHODS: A cluster sample method was performed using each nursing home as a cluster. Twenty-three nursing homes located in the five areas of the Italy (North-West, North-East, Centre, South and Islands) were selected. An informed consent to participate was distributed by the personnel of the selected nursing homes and signed directly by subjects/caregivers; 2114 forms were distributed, 1998 forms signed and finally 1976 subjects were examined. Chewing ability was scored as good (≥10 functional units (FUs)), sufficient (7-10 FUs), and insufficient (< 7 FUs). The presence of prosthetic dental restorations was summarized as: absent of prosthesis, fixed prosthesis, removable prosthesis, combined prosthesis. Age, gender, socioeconomic status, MMSE, BMI and MNA were obtained from medical charts. RESULTS: Almost three quarters of the subjects were ≥ 80 years old (74.37%) and women (74.04%). The prevalence of edentulism was 42.10% with a large variation among the five areas of Italy (from 34.43% in Centre to 53.46% in North-West). Insufficient presence of FUs was preeminent in each age group (prevalence 42.10%) and statistically associated to age and to female gender (p <  0.01). Overweight/obese (7.47%) subjects showed the highest FUs. Area of living, MMSE (both < 0.01), BMI (p = 0.01) were statistically significant associated to the type of prosthetic dental restorations in the oldest group. Subjects with no mental impairment showed the highest percentage of prosthetic dental restorations (32.36%). CONCLUSIONS: More than half of the sample has an insufficient number of functional units for chewing and this is more pronounced in females. The presence and the type of prosthetic dental restorations are linked to cognitive impairment: the higher is the mental impairment the higher is the number of subjects with absence of prosthetic restorations. The findings of this national survey highlight the need for public health policy, aiming to increase awareness regarding oral health though health education.

Are distinctive risk indicators associated with different stages of caries in children? A cross-sectional study.

BACKGROUND: Actual caries figures emphasize the need to identify the risk indicators involved in the disease's development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children. METHODS: A total of 390 subjects aged 6-8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours. RESULTS: Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated. CONCLUSIONS: Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

Caries-risk profiles in Italian adults using computer caries assessment system and ICDAS.

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83-3.03 and OR = 1.43, 95%CI = 1.13-1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.

Political priority of oral health in Italy: an analysis of reasons for national neglect.

PURPOSE: Oral health remains a neglected area and its political priority on most national agendas is low. This analysis aimed to identify the political priority of oral health in Italy. BACKGROUND: Italian public health services are decentralised at the regional level and are financed by both central and local authorities. Despite certain legally guaranteed public oral health services, access to oral health care seems to be inhomogeneous. METHODS: Appraisal of the political priority of oral health in Italy uses the Political Power Framework as proposed by Shiffman and Smith. RESULTS AND DISCUSSION: There is no clear mandate for leadership or coordination within the oral health sector, resulting in fragmentation and in dominance of the private sector. As a consequence, oral diseases are mainly addressed through a curative rather than a preventive public health approach. Current, systematic and representative data are lacking. Therefore, the real burden of oral diseases is unknown and thus cannot be addressed adequately. Evidence-based, cost-effective and sustainable population-wide public dental health interventions are not implemented on a large scale, and growing inequities in terms of access to care are not seen as a concern. CONCLUSION: Lack of relevant policies with a public health focus, absence of systematic oral health surveillance and limited access to care for large population groups are strong indicators that oral health is not a political priority. However, opportunities in the wider political environment could be used to facilitate analysis, discussion and change in order to improve political priority of oral health in Italy.

Caries-risk profiles in Italian adults using computer caries assessment system and ICDAS

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83–3.03 and OR = 1.43, 95%CI = 1.13–1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.