Association between asthma and severe tooth loss in the adult population of the United States.

OBJECTIVE: This study aimed to investigate the association between asthma and severe tooth loss in the U.S. (United States) adult population. METHODS: Data were analyzed from the national health and nutritional examination survey (NHANES), 2009-2014. Study-participants were classified into current, former, and never asthmatics based on their asthma status. Former-asthmatics were excluded. The case definition of severe tooth loss (outcome variable) was having 9 or fewer remaining permanent teeth. Characteristics of our study-sample were identified based on the descriptive statistical analyses. Logistic regression analyses were performed to examine the association between asthma and severe tooth. Multivariable models were constructed to control for the known common clinical, demographic, and lifestyle factors. Each analysis accounted for the examination sample weights and the complex clustered design of the continuous NHANES. RESULTS: Total study-participants were 14,184 representing ≈185.77 million U.S. adults. Prevalence of asthma was 8.99% in our study-sample, and 8.78% had severe tooth loss. Current-asthmatic adults had 34% higher odds of severe tooth loss as compared to their reference group of never-asthmatics adults in the U.S. after controlling for age, race or ethnicity, gender, diabetes, smoking, body mass index, education, and family income-to-poverty ratio. CONCLUSION: In the United States, as compared to never-asthmatic adults, current-asthmatic adults were more likely to have severe tooth-loss. Oral health promotion is therefore recommended through medical-dental integration to ensure overall health for asthmatic adults.

Association between asthma and periodontitis in the US adult population: A population-based observational epidemiological study.

AIM: To examine the association between asthma and periodontitis in a nationally representative sample of adults in the United States. MATERIALS AND METHODS: Data obtained from 10,710 adult men and women who participated in National Health and Nutritional Examination Survey from 2009 to 2014 were analysed. Asthma was measured based on self-reported physician diagnosis. Periodontitis was the outcome of interest. It was classified into mild, moderate, and severe periodontitis according to the updated CDC/AAP case definitions. Multivariable models were developed to examine the association of asthma with periodontitis while controlling for age, race/ethnicity, gender, education, income, body mass index, diabetes, and smoking. Odds ratio (OR) and respective 95% confidence interval (CI) were calculated. Replication was performed by differently classifying the outcome using another system called periodontal profile class (PPC). RESULTS: Current asthmatics, in reference to never asthmatics, had lower odds of severe periodontitis [(adjusted OR = 0.51, 95% CI = 0.30-0.87) and (adjusted OR = 0.58, 95% CI = 0.35-0.97) as classified using CDC/AAP case definitions and PPC system, respectively]. However, there was no statistically significant association between asthma and any other forms of periodontitis (p value >.05). CONCLUSIONS: In the United States, current-asthmatic adults were less likely to have severe periodontitis as compared with never-asthmatic adults. Further research is required to fully understand this association.

Association between asthma and dental caries in US (United States) adult population.

OBJECTIVE: To investigate the associations of asthma with dental-caries-experience (DFT: decayed and filled teeth) and untreated-dental-caries (DT: decayed teeth) in the US adult population. METHODS: Data from the National Health and Nutritional Examination Survey, 2009-2014 were analyzed. Study-participants were classified into current, former and never asthmatics based on their asthma-status. Former-asthmatics were excluded. Both the outcomes, dental-caries-experience and untreated-dental-caries were dichotomized as being either present or absent, and were also categorized into tertiles based on their distributions in our study-sample. Logistic regression analyses were performed to determine the associations of asthma with dichotomized outcomes. The generalized logit model was applied for multilevel categorical outcomes. Multivariable models were developed to control for common demographic, clinical, and lifestyle factors. RESULTS: Total study-participants were 13,135, representing 175.26 million US adults. In the adjusted models, current-asthmatics, when compared to the reference group of never-asthmatics, were more likely to have dental-caries-experience (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.66) and untreated-dental-caries (OR, 1.38; 95% CI, 1.10-1.73) in ≥1 tooth. Asthma was associated with all three categories of dental-caries-experience in our study-sample. We observed a positive gradient in the OR with an increasing extent of untreated-dental-caries. Relative to never-asthmatics, asthma doubled the odds of having untreated dental caries in the subgroup of current-smokers. CONCLUSION: Current-asthmatic adults had higher odds of dental-caries-experience and untreated-dental-caries as compared to never-asthmatic adults in the US. Based on the observations from this study, interprofessional collaboration should be recommended to institute caries control and health promotion in current-asthmatic adult population.

Social capital and periodontal disease in Hispanic/Latino adults in the United States: Results from the Hispanic Community Health Study/Study of Latinos.

AIMS: To examine the association of social capital with periodontal disease severity. MATERIALS AND METHODS: We analysed data obtained from 3,994 men and women aged 18-74 years in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (HCHS/SOL SCAS). From 2008 to 2011, dentists assessed periodontitis status with a full-mouth periodontal examination. Periodontitis was classified using standardized case definitions. Multivariable logistic regression estimated odds of moderate-severe periodontitis associated with two measures of social capital: structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). RESULTS: For US-born participants, for each additional person in their social network, the adjusted odds of moderate-severe periodontitis was reduced 17% (OR = 0.83, 95% CI = 0.71, 0.96). However, no association was found between functional support and periodontal disease severity. CONCLUSIONS: Greater structural social support was associated with a lower prevalence of moderate-severe periodontitis in US-born Hispanics/Latinos. These findings suggest that US-born Hispanics/Latinos with less social support represent a vulnerable segment of the population at high-risk group for periodontal disease.

Oral health risk factors and overall dental treatment needs for incoming air force recruits.

OBJECTIVE: To determine if relationships exist between the total dental treatment needs of incoming Air Force recruits and non-clincal demographic and oral-health related factors. METHODS: Data from the 2018 Air Force Recruit Oral Health Study (ROHS) was used, an anonymized sample of 1330 AF recruits that included a comprehensive oral exam and survey collecting demographic and oral health behavior information. The primary outcome variable was the total number of dental treatment needs for recruits, and independent predictor variables included select socio-demographic factors and wellness behaviors. Along with descriptive statistics, a multivariable negative binomial regression analysis was performed to assess the relationship between variables with a normalized weight making the final results representative of all incoming recruits. RESULTS: The final adjusted analysis showed that an incoming recruit's self-rated oral health, dental coverage prior to enlistment, need for a dental visit within the last 12 months, sugar intake, and tobacco use increased their risk for dental treatment needs. CONCLUSION: This is the first study to assess the relationship between specific risk indicators and increased dental treatment needs while adjusting other related covariates. Factors associated with dental treatment needs were identified that provide Air Force leaders with actionable information to directly improve recruit oral health and military readiness by identifying new airmen at the highest risk for excessive dental care needs while at basic military training.

Social support and dental caries experience: Findings from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

OBJECTIVE: To examine the association of social support with dental caries experience in Hispanics/Latinos living in the United States (US) and to assess whether the relationship is modified by nativity status. METHODS: This cross-sectional study analysed data for 4459 dentate men and women aged 18-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. At baseline (2008-2011), dentists quantified dental caries experience as the number of decayed, missing, and filled permanent tooth surfaces (DMFS) for all teeth excluding third molars. Social support was assessed according to measures of structural support (Social Network Index) and functional support (Interpersonal Support Evaluation List). Covariate-adjusted multiple linear regression estimated the relationship between social support and dental caries experience and tested whether the association was modified by nativity status (born within the 50 US states, foreign-born <10 years in the United States, foreign-born >10 years or more in the United States). RESULTS: In covariate-adjusted models, each additional role in the social network was associated with 1.39 fewer DMF tooth surfaces (95% CI: -2.21, -0.58) among foreign-born Hispanics/Latinos with fewer than 10 years lived in the US. For foreign-born Hispanics/Latinos with 10 years or more in the United States, each additional social network role was associated with 0.57 fewer DMF tooth surfaces (95% CI: -1.19, 0.04). No association was observed between functional social support and dental caries experience regardless of nativity status. CONCLUSIONS: Our findings suggest that structural social support is protective against dental caries experience among recent immigrants of Hispanic/Latino background. This association may reflect the importance of social support to integration into the medical and dental infrastructure and thus receipt of dental care. Future research that examines the behavioural and cultural factors that moderate the relationship between social support and dental caries experience will inform development of culturally sensitive dental caries prevention programs for Hispanics/Latinos in the United States.

Prescribing Analgesics for Postoperative Dental Pain.

It is well-known that there is an opioid crisis in the United States. Prescription opioid analgesics contribute to this crisis; in 2012, dentists ranked second to family care physicians as the top prescribers. The medical and dental literature demonstrates that dental prescribing practices have been excessive, resulting in leftover medication that could then be diverted, misused, or abused. A multimodal analgesic approach is highly valuable in targeting pain along various points on the peripheral and central pain pathways and includes the use of long-acting local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, the last of which are generally reserved for the most severe pain only. The Dental Impaction Pain Model demonstrates that NSAIDs are the frontline drugs for postoperative dental pain. Opioids have their role in postoperative analgesia but should be reserved for severe breakthrough pain or in situations where NSAIDs may be contraindicated.

Trends in non-traumatic dental emergency department use in New York and New Jersey: a look at Medicaid expansion from both sides of the Hudson River.

OBJECTIVE: The aim of this study was to examine the effect of Medicaid expansion on non-traumatic dental condition (NTDC) emergency department visits in New York (NY) and New Jersey (NJ). METHODS: The 2010-2014 State Emergency Department Databases for NY and NJ were analyzed. NTDCs were defined as ICD-9-CM codes 520.0-529.9. Primary payers for ED discharges and patient's race were considered. RESULTS: In NY, from 2010 to 2011, there was a 51 percent decrease in private insurance and a 91 percent increase in Medicaid for NTDCs. In NJ, with the 2014 expansion, NTDCs fell 35 percent for uninsured and rose 57 percent for Medicaid. Black individuals have by far the highest population rates of NTDC ED visits, particularly in NJ. CONCLUSIONS: The experiences in NY and NJ suggest that the timing of expansion had significant effects on payer distribution for NTDCs. Racial disparities continue exist with black individuals disproportionately accessing EDs for NTDCs.

Sugar-sweetened beverage consumption and caries experience: An examination of children and adults in the United States, National Health and Nutrition Examination Survey 2011-2014.

BACKGROUND: The authors' aim was to examine the association between sugar-sweetened beverage (SSB) consumption and the prevalence and severity of the caries experience in children and adults in the United States. METHODS: The authors analyzed data obtained from 14,192 people aged 2 through 74 years, who participated in the National Health and Nutrition Examination Survey from 2011 through 2014. Using descriptive analyses, the authors assessed the distributions of sociodemographic characteristics overall and via SSB intake. The authors used multivariable logistic regression to estimate the association of untreated and severe untreated caries with SSB consumption in all age groups. RESULTS: Across all ages, male participants were more likely than female participants to consume SSBs, and consumption was higher in non-Hispanic black and Hispanic populations. Relative to those who did not consume SSBs, people aged 20 through 44 years who consumed SSBs had significantly higher odds of having untreated caries (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04 to 1.55) and severe untreated caries (AOR, 1.36; 95% CI, 1.15 to 1.60). Adolescents aged 9 through 19 years had significantly higher odds of having untreated caries (AOR, 1.37; 95% CI, 1.05 to 1.80), and middle-aged adults (45-64 years) had significantly higher odds of severe untreated caries (AOR, 1.46; 95% CI, 1.10 to 1.92) relative to those who did not consume SSBs. CONCLUSIONS: Consumption of SSBs was associated with increased caries experience among young children and increased risk of developing untreated caries in all age groups of children and adults. Continued efforts by policy makers, public health leaders, and clinicians to reduce consumption of SSBs across the life span are paramount.

Meth mout.

Methamphetamine (meth) is a drug traditionally sought by groups living on the fringes of society. But now, it has entered the mainstream. Over the last five years, meth has seen a surge in abuse, media coverage and attention from law enforcement officers. Meth mouth is characterized by rampant caries, typically on the smooth surfaces of dentition. This article gives a history of meth use and abuse. It describes the condition of meth mouth and its etiology. Treatment options and other dental considerations are discussed.

Mother's Caries Experience as a Risk Factor for Child's Oral Health: An Analysis of a High-Risk Population in the Bronx, New York.

Purpose: The purposes of this study were to: (1) assess the prevalence of dental caries experience in a sample of 543 low-income children, ages six months to 17 years, in the Bronx, New York; and (2) determine the existence of any association between maternal active decay and child's caries experience. Methods: Caries risk assessment forms completed in the pediatric clinic of an urban safety-net hospital in the Bronx were analyzed. Descriptive statistics and multiple logistic regression models assessed associations between maternal active decay and child's caries experience. Results: Active decay in the past 12 months was seen in 43.8 percent of mothers or primary caregivers. Prevalence of white spots and obvious decay and presence of restorations in their children were 26.5 percent, 23.8 percent, and 16.4 percent, respectively. Children of mothers or primary caregivers who had active decay in the past 12 months had more than double the odds (odds ratio equals 2.18; 95 percent confidence interval equals 1.53 to 3.09) of experiencing dental caries (P<0.0001). Conclusions: This study highlights the significant impact that a mother's oral health has on a child's risk of experiencing dental caries. Incorporating oral health risk assessments in adult and pediatric primary care is strongly recommended.

Meth mouth.

Methamphetamine (meth) is a drug traditionally sought by groups living on the fringes of society. But now, it has entered the mainstream. Over the last five years, meth has seen a surge in abuse, media coverage and attention from law-enforcement officers. Meth mouth is characterized by rampant caries, typically on the smooth surfaces of dentition. This article gives a history of meth use and abuse. It describes the condition of meth mouth and its etiology. Treatment options and other dental considerations are discussed.

Expanded Medicaid dental coverage under the Affordable Care Act: an analysis of Minnesota emergency department visits.

OBJECTIVES: Hospital emergency departments (EDs) function as the safety net for patients with non-traumatic dental conditions (NTDCs). With the implementation of Medicaid expansion under the Affordable Care Act (ACA) many adults became eligible for dental benefits. We examined the impact of "early" Medicaid expansion in Minnesota on ED visits for NTDCs from 2008 (prereform) to 2014 (postreform). METHODS: Data from the State Emergency Department Databases for Minnesota were analyzed for 2 years: 2008 and 2014. All individuals who presented to the ED with a dental problem were identified based on the International Classification of Diseases, Ninth Revision, Clinical Modification with a primary diagnosis of 520.0-529.9. Demographic variables including patient age, gender, and primary payer were examined. RESULTS: Between 2008 and 2014 there was a 18.8 percent increase in the number of all non-dental ED visits and a 9.7 percent decrease in the number of NTDC visits. In that time period, young adults 18-26 years old showed a significant decrease (19.3 percent, P < 0.001) in the number of NTDC visits. CONCLUSIONS: The Minnesota experience suggests that the increase in Medicaid dental benefits through the ACA has significantly decreased NTDC visits, especially among young adults who were eligible for a dependent coverage policy that extends parents' health insurance to age 26. To our knowledge, no previous study has reported on the impact of early Medicaid expansion on the rate of ED use for NTDCs.

Maternal risk indicators for childhood caries in an inner city population.

OBJECTIVES: This study evaluated whether characteristics of mothers, such as high mutans streptococci (MS) level, caries experience, reported sugar consumption and demographic variables, could be important risk indicators of caries for their children. METHODS: Mothers selected on the basis of the caries status of their 3-5-year-old-children were tested for MS, caries, reported sugar consumption and demographic variables. RESULTS: We found strong associations between children's caries and their mothers' MS levels (high/low adj. OR = 11.3), maternal active caries (yes/no adj. OR = 4.0) and maternal sugar consumption (high/low adj. OR = 4.2). In this small study, mothers' demographic variables were not associated with the status of caries in their children. CONCLUSIONS: Our findings suggest that maternal high MS levels, maternal active decay and maternal sugar consumption are strong risk indicators for children's caries. Although further study is needed, these three maternal risk indicators, taken together, may prove useful in predicting children's caries risk.

Early childhood caries-related visits to hospitals for ambulatory surgery in New York State.

OBJECTIVES: The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State. METHODS: Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health-related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age. RESULTS: Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3-year-old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement. CONCLUSIONS: These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.

Tobacco cessation services in dental offices. Are we doing all we can?

Approximately 8,000 people die of oral and pharyngeal cancers every year in the United States. Approximately 70% of these deaths are related to smoking and other forms of tobacco use. Previous studies have shown that tobacco cessation services are underutilized in dental practice. A survey was mailed to 700 dentists in New York State. A total of 364 dentists (58.5%) responded to either the long survey or postcard. Although over 90% of dentists had asked at least one patient in the prior three months about his or her smoking status, only 37% had asked this question of most or nearly all patients. Variables that were associated with the provision of tobacco cessation services included level of preparedness, training and being a periodontist. Perceived barriers included lack of time and reimbursement, and patient resistance. These results suggest that training programs and professional perceptions of responsibilities are related to dentists' provision of tobacco cessation services, findings that could have a significant impact on future policy initiatives and educational endeavors.

The prevalence of caries and tooth loss among participants in the Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The Hispanic and Latino population is projected to increase from 16.7 percent to 30.0 percent by 2050. Previous U.S. national surveys had minimal representation of Hispanic and Latino participants other than Mexicans, despite evidence suggesting that Hispanic or Latino country of origin and degree of acculturation influence health outcomes in this population. In this article, the authors describe the prevalence and mean number of cavitated, decayed and filled surfaces, missing teeth and edentulism among Hispanics and Latinos of different national origins. METHODS: Investigators in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)-a multicenter epidemiologic study funded by the National Heart, Lung, and Blood Institute with funds transferred from six other institutes, including the National Institute of Dental and Craniofacial Research-conducted in-person examinations and interviews with more than 16,000 participants aged 18 to 74 years in four U.S. cities between March 2008 and June 2011. The investigators identified missing, filled and decayed teeth according to a modified version of methods used in the National Health and Nutrition Examination Survey. The authors computed prevalence estimates (weighted percentages), weighted means and standard errors for measures. RESULTS: The prevalence of decayed surfaces ranged from 20.2 percent to 35.5 percent, depending on Hispanic or Latino background, whereas the prevalence of decayed and filled surfaces ranged from 82.7 percent to 87.0 percent, indicating substantial amounts of dental treatment. The prevalence of missing teeth ranged from 49.8 percent to 63.8 percent and differed according to Hispanic or Latino background. Significant differences in the mean number of decayed surfaces, decayed or filled surfaces and missing teeth according to Hispanic and Latino background existed within each of the age groups and between women and men. CONCLUSIONS: Oral health status differs according to Hispanic or Latino background, even with adjustment for age, sex and other characteristics. PRACTICAL IMPLICATIONS: These data indicate that Hispanics and Latinos in the United States receive restorative dental treatment and that practitioners should consider the association between Hispanic or Latino origin and oral health status. This could mean that dental practices in areas dominated by patients from a single Hispanic or Latino background can anticipate a practice based on a specific pattern of treatment needs.

Heterogeneity in periodontitis prevalence in the Hispanic Community Health Study/Study of Latinos.

PURPOSE: The aim of the study was to examine acculturation and established risk factors in explaining variation in periodontitis prevalence among Hispanic/Latino subgroups. METHODS: Participants were 12,730 dentate adults aged 18-74 years recruited into the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) from four U.S. field centers between 2008 and 2011. A standardized periodontal assessment measured probing pocket depth and gingival recession at six sites per tooth for up to 28 teeth. Periodontitis was defined according to the Centers for Disease Control and Prevention and American Academy of Periodontology case classifications developed for population surveillance. Covariates included acculturation indicators and established periodontitis risk factors. Survey estimation procedures took account of the complex sampling design. Adjusted multivariate binomial regression estimated prevalence ratios and 95% confidence limits (CLs). RESULTS: Unadjusted prevalence of moderate and severe periodontitis was 38.5% and ranged from 24.7% among Dominicans to 52.1% among Cubans. Adjusted prevalence ratios for subgroups relative to Dominicans were as follows: (1) 1.34 (95% CL, 1.13-1.58) among South Americans; (2) 1.37 (95% CL, 1.17-1.61) among Puerto Ricans; (3) 1.43 (95% CL, 1.25-1.64) among Mexicans; (4) 1.53 (95% CL, 1.32-1.76) among Cubans; and (5) 1.55 (95% CL, 1.35-1.78) among Central Americans. CONCLUSIONS: Heterogeneity in prevalence of moderate/severe periodontitis among Hispanic/Latino subpopulations was not explained by acculturation or periodontitis risk factors.