A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study.

BACKGROUND: Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS: A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS: Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS: Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.

Wnt3a-Loaded Hydroxyapatite Nanowire@Mesoporous Silica Core-Shell Nanocomposite Promotes the Regeneration of Dentin-Pulp Complex via Angiogenesis, Oxidative Stress Resistance, and Odontogenic Induction of Stem Cells.

Pulp exposure often leads to pulp necrosis, root fractures, and ultimate tooth loss. The repair of the exposure site with pulp capping treatment is of great significance to preserving pulp vitality, but its efficacy is impaired by the low bioactivity of capping materials and cell injuries from the local accumulation of oxidative stress. This study develops a Wnt3a-loaded hydroxyapatite nanowire@mesoporous silica (Wnt3a-HANW@MpSi) core-shell nanocomposite for pulp capping treatments. The ultralong and highly flexible hydroxyapatite nanowires provide the framework for the composites, and the mesoporous silica shell endows the composite with the capacity of efficiently loading/releasing Wnt3a and Si ions. Under in vitro investigation, Wnt3a-HANW@MpSi not only promotes the oxidative stress resistance of dental pulp stem cells (DPSCs), enhances their migration and odontogenic differentiation, but also exhibits superior properties of angiogenesis in vitro. Revealed by the transcriptome analysis, the underlying mechanisms of odontogenic enhancement by Wnt3a-HANW@MpSi are closely related to multiple biological processes and signaling pathways toward pulp/dentin regeneration. Furthermore, an animal model of subcutaneous transplantation demonstrates the significant reinforcement of the formation of dentin-pulp complex-like tissues and blood vessels by Wnt3a-HANW@MpSi in vivo. These results indicate the promising potential of Wnt3a-HANW@MpSi in treatments of dental pulp exposure.

Epidemiological and Microbiome Characterization of Black Tooth Stain in Preschool Children.

OBJECTIVE: To assess the epidemiologic attributes and microbial variations associated with extrinsic black tooth stain (BTS) among Chinese preschool children. METHODS: This cross-sectional study included 250 preschool children (3-4 years) from three kindergartens in Shanghai, China. Following clinical examination, and using a case-control design, saliva and dental plaque specimens were collected from caries-free participants with (n = 21, BTS group) and without (n = 48, control group) BTS. The chi-square test and logistic regression model were used to evaluate factors associated with BTS. 16S rRNA sequencing were used to characterize the associated microbial communities. RESULTS: BTS was detected in 12.4% of participants, with a mean of 13.7 black-stained teeth. Participants with BTS had a lower caries burden and better oral hygiene (P = 0.003). Children with less frequent intake of marmalade or honey (P = 0.033) and regular application of fluoride (P = 0.007) had a lower likelihood of having BTS. Microbiota analysis revealed 14 phyla, 35 classes, 63 orders, 113 families, 221 genera, 452 species, and 1,771 operational taxonomic units (OTUs). In terms of microbial diversity, no significant differences were observed in the saliva of the two groups (P > 0.05). Dental plaque from the BTS group exhibited higher OTU richness but lower evenness than that from the control group (Chao P = 0.006, Shannon P = 0.007, respectively) and showed a significant difference in ß diversity (P = 0.002). The microbiome in the two groups was characterized by various microbial biomarkers, such as Pseudomonas fluorescens, Leptotrichia sp._HMT_212, Actinomyces sp._HMT_169, and Aggregatibacter sp._HMT_898 in plaques from the BTS group. Functional analysis of the microbial species suggested the existence of a hyperactive metabolic state on teeth surfaces with BTS plaques and revealed that ferric iron, the iron complex transport system, and the iron (III) transport system were more abundant in BTS plaque samples. CONCLUSIONS: This study provides insights into the epidemiologic and microbial features of BTS in preschool children. The microbiome in BTS is characterized by various microbial biomarkers, which can serve as indicators for BTS diagnosis and prognosis.

Periodontal Status of Chinese Adolescents: Findings from the 4th National Oral Health Survey.

OBJECTIVE: To investigate the periodontal health status and associated factors of adolescents aged 12 to 15 years old in China. METHODS: A cross-sectional national oral health survey was conducted in 2015-2016. The multi-stage stratified cluster sampling was used to select participants in all 31 provinces, autonomous regions and municipalities in the mainland of China. Each participant received a clinical assessment including periodontal bleeding and calculus, and 15-year-old adolescents received additional examinations including for periodontal pocket depth and attachment loss, using the latest criteria from the Oral Health Survey Basic Methods, as recommended by the World Health Organization (WHO). A self-answered structured questionnaire was designed to collect the data of background information and associated risk factors. RESULTS: A total of 118,514 adolescents (14.0 ± 1.09 years old) completed all the oral examinations and the questionnaire. The prevalence of periodontal bleeding and calculus was 61.0% and 67.3% respectively. In the group of 15 year olds, 6.5% adolescents had periodontal pocket and 0.5% had attachment loss. Molars were often involved and, furthermore, calculus also occurred on lower incisors. The periodontal status of adolescents became worse as they grew up. The condition of girls was significantly better than boys. CONCLUSION: This survey illustrated a brief picture of periodontal status of adolescents in China showing that gingival bleeding and calculus were very common and frequent. Further actions on oral health education were necessary, especially for those in lower socio-economic classes.

Factors associated with black tooth stain in Chinese preschool children.

OBJECTIVES: The objective of this study was to investigate the prevalence of black tooth stain and associated factors in primary dentition in Shanghai, China. MATERIALS AND METHODS: Through a cross-sectional design, preschool children were randomly recruited from 12 kindergartens. Children's dental caries were assessed on the number of decayed, missing, and filled teeth (dmft) and surfaces (dmfs). The presence of black tooth stain was examined, and the visible plaque index was calculated. Questionnaires were completed by the children's parents or guardians. Negative binomial regression was used to investigate the associated factors. RESULTS: A total of 2,023 children were invited, and 1,397 examined participants with questionnaire data were included in final analysis. The rate of black tooth stain was 9.9 % with mean age of 4.55 years. Compared to children without black stain, children with black stain had a significant lower prevalence and experience of dental caries (P < 0.01). Factors for black stain were age, born in Shanghai, parents' higher education level, lower visible plaque index and mean dmfs, less use of nursing bottle, food with more soy sauce, and history of pneumonia. CONCLUSIONS: Preschool children with black tooth stain had fewer dental caries. Further studies are warranted to explore the microbiologic risk factors for black tooth stain and to evaluate the causal-effect factors using prospective study design. CLINICAL RELEVANCE: In clinics, dentists should pay more attention to this aesthetic problem for the relative high prevalence of black tooth stain in primary dentition. Also, the related factors can be explained to parents for the prevention of black tooth stain in children.