Oral health and multimorbidity: Is diet the chicken or the egg?

Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition, oral, and systemic diseases that contribute to multi-morbidity. Diet and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables, and nutrient poor diets which are similar to diet and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility, and swallowing. Oral dysfunction makes it difficult to eat nutrient dense whole grains, fruits, and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our 'canary in the coal mine' for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy dense, nutrient poor foods - typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence, and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multi-morbidities. Disruption of this pathway will reduce risk of multi-morbidities and enable individuals to fully engage in society throughout the lifespan.

Food insecurity is associated with lower diet quality among dental students.

PURPOSE: Food insecurity is associated with lower diet quality, adverse health outcomes, and academic difficulty among undergraduate students. The objective was to identify the relationship between food security status and diet quality in dental students. METHODS: All dental students attending Howard University (n = 286) or the University of Iowa (n = 326) during the fall 2021 semester were invited to complete a cross-sectional survey designed to query demographics, food security status (i.e., United States Department of Agriculture's ten item Adult Food Security Module), and diet quality (i.e., short Healthy Eating Index). The survey was administered using the Qualtrics platform. RESULTS: Response rates were similar for Howard (32.5%) and Iowa (29.4%). Students with food insecurity (46.0%) were slightly older and more likely to be Black or other, first generation professional/graduate students, and receive financial aid than peers with food security (p < 0.050). Food insecurity was associated with lower intakes of fruits and vegetables (p ≤ 0.005), higher intakes of added sugars (p < 0.001), and lower diet quality (p = 0.003). In linear regression analyses that controlled for other variables, food insecurity (p = 0.012), school site (p = 0.027), and gender (p = 0.039) were predictive of lower diet quality. CONCLUSIONS: The inability to procure adequate and appropriate foods was associated with marginal dietary habits (i.e., less than ideal food choices and eating behaviors) and lower diet quality in dental students. Both marginal dietary habits and lower diet quality increase chronic disease risk and may present a barrier to academic success. Addressing food insecurity among dental students is necessary to ensure equitable opportunities for a healthy workforce in the future.

Food insecurity and consumption of cariogenic foods in mothers and their two-year-old children in Appalachia.

OBJECTIVES: To describe the association between household food insecurity and intake of cariogenic foods that increase risk of dental caries. METHODS: Cross-sectional analysis of 842 mothers in Appalachia and their children participating in the Center for Oral Health Research Cohort 2 between 2011 and 2017 when their children were ~ 24 months of age. Mothers completed a telephone interview regarding cariogenic food consumption and food insecurity. Associations between food insecurity and daily food intake were adjusted for education, income, state residence, and daily snacking. RESULTS: After adjustment for household income, state residence, daily snacking, and maternal education, mothers from moderately/severely food insecure households drank on average ½ more sugar-sweetened beverage servings per day (p = 0.005) and children drank almost 1/3 servings more (p = 0.006). Further, mothers and children from moderately/severely food insecure households had lower, but not statistically significant, daily average consumption of vegetables (mothers: 1/5 less of a vegetable serving per day, children: ~1/10 less) and fruits (mothers: 1/5 less of a fruit serving per day, children: ~ 1/10 les) and elevated consumption of sweets (mothers: ~ 1/25 more sweet servings per day, children: ~ 2/25 more); differences based on state residence were noted. CONCLUSIONS: Food insecurity is associated with higher consumption of foods that increase risk of dental caries, but this association is modified by maternal education, income, and state residence. Food insecurity, and its socioeconomic determinants, should be considered when designing and implementing interventions to prevent dental caries.

Early Childhood Diet in Relation to Toddler Nighttime Sleep Duration Trajectories.

The objective of this study was to evaluate whether dietary habits at age 2 associate with sleep duration trajectories through age 5 in children from north and central Appalachia. A total of 559 children from the Center for Oral Health Research in Appalachia (COHRA) cohort 2 were followed via caregiver phone interviews up to six times between ages 2 and 5. Exposures included data from the year 2 interview: sleep habits, household and demographic characteristics, meal patterns and consumption frequencies of fruits, vegetables, water, juice, milk, and soda. Sleep duration trajectories were identified using group-based trajectory models from ages 2 to 5. Three distinct nightly sleep duration trajectories were identified: short, increasing duration (4.5% of the study population); steady, 9 h of sleep (37.3%); and longer, slightly decreasing sleep duration (58.2%). Using multinomial logistic models that accounted for confounders, children with consistent meal patterns (i.e., meals and snacks at same time every day) and with higher fruit and vegetable consumption were more likely to follow the longer duration sleep trajectory compared to the steady sleep trajectory. In contrast, children who drank milk more frequently at age 2 were less likely to be in the longer duration sleep trajectory than the steady sleep trajectory.

Associations between body mass index and body composition measures in a birth cohort.

BACKGROUND: Associations among body composition measures have been limited to cross-sectional analyses of different subjects. We identified cross-sectional relationships between body mass index (BMI) and other body composition measures and predicted body composition measures from BMI throughout childhood and adolescence. METHODS: BMI was calculated and % body fat (%BF), fat mass index (FMI), and fat-free mass index (FFMI) were measured using dual-energy x-ray absorptiometry at ages 5, 9, 11, 13, 15, and 17 years in a birth cohort (n = 629). Sex-specific body composition measures were calculated for BMI-for-age percentiles; associations between BMI and body composition measures were characterized; and body composition measures were predicted from BMI. RESULTS: %BF, FMI, and FFMI generally increased with BMI-for-age percentiles at each age. Correlations between BMI and %BF or FMI were generally higher at BMI-for-age percentiles ≥95% than for lower BMI-for-age percentiles. Correlations between BMI and FFMI were generally higher for participants at very low and very high BMI-for-age percentiles than at moderate BMI-for-age percentiles. Age- and sex-specific predictions from BMI are provided for %BF, FM, and FFMI. CONCLUSIONS: Sex-specific body composition measures throughout childhood and adolescence are presented. BMI is a better indicator of adiposity at higher than at lower BMI values. IMPACT: Sex-specific body composition measures throughout childhood and adolescence are described. % BF, FMI, and FFMI generally increased with BMI-for-age percentiles for both sexes throughout childhood and adolescence. BMI is a better indicator of adiposity at higher BMI levels than at lower BMI values throughout childhood and adolescence.

Weak Evidence Suggests Vegetarian Diets May Be Associated With an Increased Risk of Dental Erosion.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Vegetarian diet and its possible influence on dental health: A systematic literature review. Community Dent Oral Epidemiol. Smits KPJ, Listl S, Jevdjevic M. 2020; 48(1):7-13. SOURCE OF FUNDING: No financial support. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Is food insecurity a barrier to dental student success?

PURPOSE: The prevalence of food insecurity among undergraduate students is higher than the national average and associated with adverse academic outcomes. Our objective was to describe the prevalence of food insecurity, food access behaviors, and associations between food security status and well-being in a dental student population. METHODS: All dental students (N = 328) enrolled in the College of Dentistry at the University of Iowa in the fall 2019 semester were invited to participate. The survey was designed to query demographic variables, food security status (i.e., the United States Department of Agriculture's 10-item Adult Food Security Module), and food- or hunger-related well-being (i.e., sleep, academic performance, and stress). The survey was administered using the Qualtrics survey platform. Following the initial invitation, students were sent two reminders and allowed 3 weeks for completion. RESULTS: The survey response rate was 24.7%. Forty-seven percent of respondents were food insecure. Food insecure students were more likely to attend collegiate programming (e.g., lunch and learns) for the primary purpose of obtaining free food than their food secure peers (p <0.001). In addition, food insecure students were more likely to report experiencing food- or hunger-related sleep (p = 0.001), study or academic performance (p <0.001), or stress difficulties than their food secure peers (p <0.001). CONCLUSION: The prevalence of food insecurity in dental students was relatively high and associated with adverse food- and/or hunger-related well-being outcomes. Food insecurity might be a barrier to dental student success, compromising their immediate health and ability to learn.

Beverage Intakes and Toothbrushing During Childhood Are Associated With Caries at Age 17 Years.

BACKGROUND: Sugar-sweetened beverages (SSBs) have been associated with childhood caries; however, associations among lifelong beverage intakes and adolescent caries have received less attention. OBJECTIVE: To investigate associations between beverage intakes during childhood and adolescence and caries experience at 17 years of age, while adjusting for fluoride intakes and toothbrushing. DESIGN: Descriptive model analyses were conducted on data collected from a longitudinal birth cohort study. PARTICIPANTS/SETTING: Participants included Iowa Fluoride Study members (n = 318) recruited at birth between 1992 and 1995 with at least 6 beverage questionnaires completed from ages 1 to 17 years and a caries examination at age 17. EXPOSURE: Predictors included mean daily milk, juice (100% juice and juice drinks before age 9), SSB (including juice drinks after age 9), and water/sugar-free beverage (SFB) intakes; daily fluoride intakes; and daily toothbrushing frequencies for ages 1 to 17. MAIN OUTCOME MEASURES: The outcome was dental caries count at age 17, adjusted for the number of scored tooth surfaces (decayed and filled surfaces attack rate [DFSAR]). STATISTICAL ANALYSES PERFORMED: Univariable generalized linear models were fit for each predictor and the outcome DFSAR. Multivariable models assessed combined effects of beverage types, fluoride variables, toothbrushing, sex, and baseline socioeconomic status. RESULTS: Based on multivariable models, each 8 oz of additional daily juice and water/SFB decreased expected DFSAR by 53% (95% confidence interval [CI]: 17%-73%) and 29% (95% CI: 7%-46%), respectively, and 8 additional oz SSBs increased expected DFSAR by 42% (95% CI: 5%-92%), after adjustment for other beverage intakes, toothbrushing, total fluoride intake excluding SSB fluoride (non-SSB total fluoride), sex, and baseline socioeconomic status. Each additional daily toothbrushing event decreased expected DFSAR by 43% (95% CI: 14%-62%) after adjustment for beverage intakes, non-SSB total fluoride intake, sex, and baseline SES. CONCLUSIONS: Higher juice and water/SFB intakes and more toothbrushing were associated with lower caries at age 17, while higher SSB intakes were associated with higher caries.

Identification of and Associations among Low, Middle, and High Body Composition Trajectories from Age 5- to 17-Years.

Our objective was to identify sex-specific age 5- to 17-year body composition (body mass index (BMI), % body fat, fat mass index, fat-free mass index) trajectories, compare trajectories assigned using age 5 (AGE5) data to those assigned using all available (ALL) data, and compare BMI assignments to other body composition assignments. Cluster analysis was used to identify low, medium, and high trajectories from body composition measures obtained from dual energy x-ray absorptiometry (DXA) scans at 5, 9, 11, 13, 15, and 17 years in a birth cohort followed longitudinally (n = 469). Moderate agreement was observed for comparisons between AGE5 data and ALL data cluster assignments for each body composition measure. Agreement between cluster assignments for BMI and other body composition measures was stronger using ALL data than using AGE5 data. Our results suggest that BMI, % body fat, fat mass index, and fat free mass index trajectories are established during early childhood, and that BMI is a reasonable predictor of body composition appropriate to track obesity in public health and clinical settings.

Dietary patterns associated with dental caries in adults in the United States.

OBJECTIVES: Dental caries experience, which affects 91% of US adults, is a consequence of a carious process influenced by diet. Although individual foods have been implicated, we hypothesized that dietary patterns might be important predictors of caries presence. METHODS: We analysed data from 4467 people ≥18 years old participating in the 2013-2014 National Health and Nutrition Examination Survey, a nationally representative sample of the US population. Data from 24-hour dietary recalls were classified into standard food categories and reduced to three dietary patterns using principal components (PCs) analysis. We used regression to model the log-transformed decayed, missing and filled teeth (DMFT) score and the prevalence of any caries experience by quartiles of PC scores, controlling for potential confounders. Dietary patterns differed by age with respect to dental caries so 18-30-year-olds (n = 1074) and >30-year-olds (n = 3393) were analysed separately. RESULTS: Similar dietary patterns existed among individuals aged 18-30 and >30 years, but the prevalence of DMFT score >0 and the median of DMFT was greater in those >30:78.7% (95% CI: 76.1, 81.3) vs 92.6% (95% CI: 91.4, 93.7) and 4 (95% CI: 4, 5) vs 12 DMFT (95% CI: 11, 13), respectively. In those 18-30, no dietary pattern was associated with greater prevalence or severity of dental caries experience. Among those >30, the prevalence of DMFT>0 was higher by 2% for those in each subsequent quartile of a diet high in sugar-sweetened beverages and sandwiches (adjusted PR: 1.02, 95% CI: 1.001, 1.03)-thus, the prevalence of dental caries experience was 6% higher among those in the uppermost quartile than in the lowest quartile. For every subsequent quartile in the same pattern, there was a 1.98% higher (95% CI: 0.15, 3.85) DMFT score. However, analysis using the two strongest loading food groups from any of the PCs did not identify any predictors of caries experience. CONCLUSIONS: Dietary patterns were associated with the prevalence of dental caries experience, with differing findings by age. Although effect sizes were small, the population impact may be substantial. While food groups high in sugar were associated with caries prevalence and severity, associations were more apparent in the context of overall diet. Prospective studies are needed to confirm whether particular dietary patterns are causally related to the development of dental caries.

Dietary Implications for Dental Caries: A Practical Approach on Dietary Counseling.

Acid produced during bacterial fermentation of carbohydrates dissolves tooth structure, leading to dental caries. Carbohydrates are a nutrient within foods, individual foods contain multitudinous differing nutrients in varying concentrations, and, ultimately, food choices and eating behaviors are associated with the caries process. Consideration of food choices and eating behaviors is necessary for effective caries prevention. This article (1) defines a healthy diet and eating behaviors as a foundation for caries prevention, (2) identifies food choices and eating behaviors associated with caries, (3) identifies diet-related screening and assessment tools for caries risk, and (4) provides counseling strategies to manage dental caries.

Child and Adolescent Sugar-Sweetened Beverage Intakes Are Longitudinally Associated with Higher Body Mass Index z Scores in a Birth Cohort Followed 17 Years.

BACKGROUND: Sugar-sweetened beverages (SSB) are considered a risk factor for obesity. OBJECTIVE: The objective of the current study was to investigate associations between the predictors of beverage and energy intakes and mean adequacy ratios (MARs), and the outcome of body mass index (BMI) z scores, in a birth cohort using longitudinal models. DESIGN: This was a longitudinal analysis of secondary data. PARTICIPANTS/SETTING: Participants in the Iowa Fluoride and Iowa Bone Development Studies with two beverage intake questionnaires completed between ages 2 and 4.7 years or 5 and 8.5 years or one questionnaire between ages 9 and 10.5, 11 and 12.5, 13 and 14.5, or 15 and 17 years (n=720); two food and beverage diaries completed between ages 2 and 4.7 years or 5 and 8.5 years or completion of the Block's Kids' Food Frequency Questionnaires at age 11, 13, 15, or 17 years (n=623); and anthropometric measures at the corresponding age 5-, 9-, 11-, 13-, 15-, or 17-year examination(s). PREDICTORS: Mean daily 100% juice, milk, SSB, water/sugar-free beverage, and energy intakes and MARs averaged over ages 2 to 4.7, 5 to 8.5, 9 to 10.5, 11 to 12.5, 13 to 14.5, or 15 to 17 years were predictors. OUTCOME: BMI z score was the outcome. STATISTICAL ANALYSES: Linear mixed models were fit for each beverage, energy, and MAR variable, with the beverage, energy, or MAR variable as the predictor and BMI z score as the outcome. Beverage models were adjusted for energy and MAR and baseline socioeconomic status. RESULTS: SSB intake adjusted for energy intake, MAR, and baseline socioeconomic status was associated with BMI z score; each additional 8 oz SSB consumed/day throughout childhood and adolescence increased the BMI z score an average 0.050 units (95% CI 0.022 to 0.079; P=0.001). Adjusted water/sugar-free beverage intake (0.026 units; 95% CI 0.006 to 0.046; P=0.013) was modestly associated with BMI z score, while 100% juice (-0.001 units; 95% CI -0.059 to 0.057; P=0.97) and milk (0.022 units; 95% CI -0.007 to 0.052; P=0.13) intakes were not associated with BMI z scores. CONCLUSIONS: Higher SSB intakes were associated with increased BMI z scores throughout childhood and adolescence in Iowa Fluoride Study participants. Public health initiatives targeting SSB consumption during childhood and adolescence remain relevant.

Dental Educators' Perceptions of Educational Learning Domains.

The aim of this study was to seek the views of a national sample of dental educators regarding the importance of learning domains in dental education, their defined outcomes of those domains, and their perceived effectiveness of their schools in guiding learning in those domains. The study defined the educational domains important for training future dentists as knowledge, technical skills, critical thinking, ethics, social responsibility, and interprofessional education/practice (IPE/IPP). A survey of members of the American Dental Education Association (ADEA) Special Interest Group on the Scholarship of Teaching and Learning was conducted in 2017. In addition to reporting their demographics, participants were asked to rate and rank the importance of each learning domain as well as answer open-ended questions. Of the 89 respondents (response rate 12.5%), 31% were course directors, and 48% had been dental faculty members for more than ten years. Knowledge was ranked as the most important domain, followed by critical thinking, technical skills, clinical decision making, ethics, problem-solving, social responsibility, and finally IPE/IPP. When rating the absolute importance of these domains in the training of dental students, the respondents gave all but IPE/IPP and social responsibility the highest rating. Knowledge and technical skills were rated highest for respondents' confidence in defining student outcomes with similar high ratings for their confidence in guiding this learning. There was little consensus concerning a definition of critical thinking, and a third of the respondents were uncertain of specific learning outcomes for it. Participants expressed even less confidence in defining outcomes for ethics, IPE/IPP, and social responsibility. This baseline information will be used for a future in-depth study to aid in the development of strategies for articulating outcomes, guiding learning, and assessing performance in U.S. dental schools.

Associations of fluoride intake with children's cortical bone mineral and strength measures at age 11.

OBJECTIVES: There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424). METHODS: Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height. RESULTS: The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant. CONCLUSIONS: In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.

Description of Child and Adolescent Beverage and Anthropometric Measures According to Adolescent Beverage Patterns.

Our objective is to retrospectively describe longitudinal beverage intakes and anthropometric measures according to adolescent beverage patterns. Data were collected from Iowa Fluoride Study participants (n = 369) using beverage questionnaires at ages 2⁻17 years. Weight and height were measured at ages 5, 9, 13 and 17 years. Cluster analyses were used to identify age 13- to 17-year beverage patterns. Treating age and beverage cluster as explanatory factors, sex-specific generalized linear mixed models were used to identify when differences in beverage intakes and anthropometric measures began. Predominant beverage intakes were higher in each of the corresponding clusters by 9⁻12.5 years; females with high milk intakes during adolescence and males with high 100% juice or sugar-sweetened beverage intakes during adolescence reported higher intakes of that beverage beginning at 2⁻4.7 years. Females and males in the 100% juice cluster had lower weights than other clusters beginning at 13 years, while females and males in the neutral cluster were shorter beginning at 13 years. Females in the water/sugar-free beverage cluster had higher body mass indices (BMIs) beginning at 9 years. Females and males in the 100% juice cluster had lower BMIs beginning at 5 and 9 years, respectively. Childhood beverage intakes and growth patterns differ according to adolescent beverage patterns.

Higher Longitudinal Milk Intakes Are Associated with Increased Height in a Birth Cohort Followed for 17 Years.

Background: Height is an indicator of nutritional status; linear growth faltering has recognized consequences for cognitive, emotional, and chronic disease risk. Although height is routinely studied in developing countries, less attention is given to height in the United States. Objective: The objective of this study was to identify longitudinal associations between childhood and adolescent beverage intakes, nutrient adequacy, or energy intake and height in a birth cohort. Methods: Data for participants through ages 2-17 y (n = 717; 353 males, 364 females) recruited at birth for the longitudinal Iowa Fluoride Study (IFS) were used in the current cohort analyses. Beverage intakes (n = 708) were collected by beverage-frequency questionnaires at 3- to 6-mo intervals, whereas nutrient data (n = 652) were obtained from 3-d food diaries completed at 3- to 6-mo intervals through age 8.5 y and from Block Kids' food-frequency questionnaires at 2-y intervals after age 8.5 y. Nutrient adequacy ratios were calculated with the use of age- and sex-specific Estimated Average Requirements. Height was measured at clinic visits when the participants were approximately ages 5, 9, 11, 13, 15, and 17 y. Linear mixed models were used to identify longitudinal associations between dietary variables and height. A baseline model that adjusted for changing growth patterns during adolescence was established. Dietary and potential confounding variables were added to this baseline model. Results: Milk intake adjusted for mean adequacy ratio, energy intake, and baseline socioeconomic status was associated with height; for each additional 8 ounces (236 mL) of milk consumed per day throughout childhood and adolescence, height increased, on average, by 0.39 cm (95% CI: 0.18, 0.60 cm; P < 0.001). Conclusions: IFS participants' height increased by 0.39 cm for each additional 8 ounces (236 mL) of milk consumed throughout childhood and adolescence. The clinical implications of the mild linear growth faltering observed in healthy youth are unknown. This trial was registered at www.clinicaltrials.gov as 199112665.

Longitudinal associations between dental caries increment and risk factors in late childhood and adolescence.

OBJECTIVES: To assess longitudinal associations between permanent tooth caries increment and both modifiable and non-modifiable risk factors, using best subsets model selection. METHODS: The Iowa Fluoride Study has followed a birth cohort with standardized caries exams without radiographs of the permanent dentition conducted at about ages 9, 13, and 17 years. Questionnaires were sent semi-annually to assess fluoride exposures and intakes, select food and beverage intakes, and tooth brushing frequency. Exposure variables were averaged over ages 7-9, 11-13, and 15-17, reflecting exposure 2 years prior to the caries exam. Longitudinal models were used to relate period-specific averaged exposures and demographic variables to adjusted decayed and filled surface increments (ADJCI) (n = 392). The Akaike Information Criterion (AIC) was used to assess optimal explanatory variable combinations. RESULTS: From birth to age 9, 9-13, and 13-17 years, 24, 30, and 55 percent of subjects had positive permanent ADJCI, respectively. Ten models had AIC values within two units of the lowest AIC model and were deemed optimal based on AIC. Younger age, being male, higher mother's education, and higher brushing frequency were associated with lower caries increment in all 10 models, while milk intake was included in 3 of 10 models. Higher milk intakes were slightly associated with lower ADJCI. CONCLUSIONS: With the exception of brushing frequency, modifiable risk factors under study were not significantly associated with ADJCI. When possible, researchers should consider presenting multiple models if fit criteria cannot discern among a group of optimal models.

Dietary assessment and counseling for dental erosion.

BACKGROUND AND OVERVIEW: Dental erosion occurs after exposure to intrinsic or extrinsic acids. Exposure to intrinsic gastrointestinal acids is associated with anorexia nervosa, bulimia nervosa, rumination syndrome, or gastroesophageal reflux. Extrinsic dietary acids from foods or beverages also can cause erosion, particularly when exposure is prolonged by holding or swishing behaviors. CONCLUSIONS: Clinicians should screen patients exhibiting dental erosion for anorexia nervosa, bulimia nervosa, rumination syndrome, and gastroesophageal reflux disease. Clinicians should screen patients without a medical explanation for their erosion for exposure to acidic foods and beverages, particularly for habits that prolong exposure. PRACTICAL IMPLICATIONS: Identification of intrinsic and extrinsic acid exposures and recommendations to minimize exposures are important to prevent erosion and maintain oral health.

Critical Thinking Theory to Practice: Using the Expert's Thought Process as Guide for Learning and Assessment.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.