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1.
Pediatr Dent ; 43(4): 287-289, 2021 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-34467845

RESUMEN

Purpose: The purpose of this study was to assess the relationship between the number of teeth present at 12 months and decayed, missing, or filled surfaces (dmfs) at 30 and 48 months. Methods: Data are from a longitudinal, multisite study with clinical dental examinations conducted at 12, 30, and 48 months of age. Spearman correlation and chi-square tests assessed relationships between teeth present at 12 months and dmfs at 30 (n equals 1,062) and 48 months (n equals 985). Results: Spearman correlations were weak but significant for both 30- and 48-month time points (R equals 0.066, P=0.032; R equals 0.093, P=0.004, respectively). Mantel-Haenszel chi-square analyses of categories of teeth present at 12 months (zero, one to four, five to eight, and greater than or equal to nine) and categories of dmfs at 30 and 48 months (zero, one to two, three to five, six to 15, and greater than or equal to 16) revealed nonsignificant (P=0.326) relationship with 30-month dmfs but a significant (P=0.013) relationship with 48-month dmfs. Conclusion: Results suggest that early tooth eruption is weakly associated with an occurrence of early childhood caries.


Asunto(s)
Caries Dental , Erupción Dental , Distribución de Chi-Cuadrado , Preescolar , Caries Dental/epidemiología , Susceptibilidad a Caries Dentarias , Humanos , Estudios Longitudinales
2.
J Dent Educ ; 2021 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-34405408

RESUMEN

OBJECTIVE: To assess variability in caries management decision-making by faculty and dental students. Understanding sources of variability during training can aid in implementing evidence-based clinical decision-making in caries management. METHODS: A voluntary, anonymous survey including clinical scenarios was distributed online to dental students in their first (D1) and third-year (D3) of training, and to faculty in the Department of Cariology, Restorative Sciences and Endodontics. RESULTS: The response rate was 100% (108/108) for D1 students, 56% (73/130) for D3 students, and 39% (34/88; 12 full-time and 22 part-time) for faculty. D1 students, who were completing a cariology course, were in general more conservative in restorative thresholds for less severe caries lesions than D3 students and sometimes clinical faculty (e.g., for lesions at the DEJ, a significantly [p < 0.05] higher percentage of D3 students would restore these [53%] compared to D1 students and faculty [19% and 18%, respectively; p > 0.05]). For all groups, the threshold for doing restorative intervention was shifted toward less severe caries lesions as the caries risk increased (e.g., very few respondents would restore an occlusal lesion confined to enamel, with significantly [p < 0.05] less percentage of D1 students [lower risk scenario-LR = 4%; higher risk scenario-HR = 22%] compared to D3 students and faculty [LR = 15% and 18%; HR = 66% and 62%, respectively; p > 0.05]). Class lectures/preclinical instructors were the most important factor influencing decision-making for D1 students, versus clinical experiences/instructors for D3 students. CONCLUSION: Although the majority of respondents used best-evidence deciding caries management, there was variability in how to manage less severe lesions, with caries risk influencing clinical thresholds, and clinical experiences influencing students' decision-making over time.

3.
Cochrane Database Syst Rev ; 7: CD013039, 2021 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-34280957

RESUMEN

BACKGROUND: Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES: To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS: An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies.  SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS: Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS: We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth.  Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing  with sealant materials (2); sealant materials versus no sealing (2).  Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS: Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.


Asunto(s)
Coronas , Tratamiento Restaurativo Atraumático Dental/métodos , Caries Dental/terapia , Selladores de Fosas y Fisuras/uso terapéutico , Adolescente , Adulto , Sesgo , Niño , Preescolar , Caries Dental/patología , Fracaso de la Restauración Dental/estadística & datos numéricos , Dentina , Dentición Permanente , Humanos , Persona de Mediana Edad , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Diente Primario
4.
Pediatrics ; 148(Suppl 1): s13-s20, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34210842
6.
J Dent Hyg ; 95(1): 50-56, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33627453

RESUMEN

Purpose: The Michigan Caries Prevention Program (MCPP) aimed to reduce the burden of childhood dental disease in the state of Michigan by offering training programs to implement preventive oral health services during well-child medical visits. The purpose of this study was to elicit feedback from the participants of the MCPP and determine which oral health services were implemented post-training, identify implementation barriers and assess provider comfort levels in performing oral screenings and fluoride applications.Methods: A descriptive electronic survey was utilized for data collection. A 15-item survey consisting of multiple choice and Likert scale questions was sent to medical providers who had participated in the MCPP from 2015-2017 (n=1115). Descriptive statistics were used to analyze the data.Results: A total of 170 surveys were completed for a 15% response rate. The majority of the participants were physicians (82%, n=134). Nearly all participants reported performing oral screenings and fluoride varnish application post-training (93%, n=153). Participants felt more comfortable applying fluoride varnish than performing oral screenings (80%, n=121 vs 70%, n=112), respectively. Barriers included lack of time, understaffed, staff resistance, feeling that procedures were outside of their scope of practice and disinterest from parents or safety concerns. A majority (70%, n=112) reported that the MCPP training did not help to establish new relationships with community dental providers.Conclusion: Medical providers indicate that the MCPP training was beneficial and that they were willing and able to incorporate oral health screenings and fluoride varnish applications in their practice, but that they face challenges in developing relationships with dental care providers. Opportunities for dental hygienists to work in non-traditional medical-dental integration practice settings may help to increase oral health services offered to patients and improve communication between health care providers.


Asunto(s)
Caries Dental , Fluoruros , Niño , Caries Dental/diagnóstico , Caries Dental/prevención & control , Susceptibilidad a Caries Dentarias , Humanos , Michigan , Percepción
7.
Pediatr Dent ; 42(6): 470-475, 2020 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-33369559

RESUMEN

Purpose: To evaluate the association between temperament and caries. Methods: A total of 408 primary caregiver-child pairs were followed for 36 months; they completed the Early Childhood Behavior Questionnaire Very Short-Form (ECBQ-VSF) at age four years. Demographic, behavioral, and clinical data were obtained at ages one, two-and-a-half, and four years, with caries experience assessed each time using the International Caries Detection and Assessment System (ICDAS). The ECBQ-VSF (36 items) was used to measure three child temperament domains: (1) surgency; (2) negative affect; and (3) effortful control. The associations between cavitated carious lesion experience by age four years (decayed, missing, and filled primary surfaces [dmfs] score greater than zero; d equals ICDAS score greater than or equal to three) and the three ECBQ-VSF temperament domains were analyzed using generalized estimating equation models. Results: Temperament domains predicted the number of carious surfaces (dmfs). After adjusting for covariates, every one-point increase in surgency and one-point increase in negative affect were associated with 77 percent and 31 percent increases in dmfs, respectively (P<0.05), and every one-point increase in effortful control was associated with a 39 percent decrease in dmfs (P<0.05). Conclusions: By age four years, children with higher levels of surgency and negative affect have a higher caries experience, whereas children with greater effortful control have a lower caries experience.


Asunto(s)
Caries Dental , Temperamento , Cuidadores , Niño , Conducta Infantil , Preescolar , Índice CPO , Humanos , Factores de Riesgo
8.
Br Dent J ; 229(7): 474-482, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33037372

RESUMEN

Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.


Asunto(s)
Caries Dental , Dentina , Consenso , Caries Dental/terapia , Susceptibilidad a Caries Dentarias , Estética Dental , Humanos
9.
Br Dent J ; 229(7): 483-486, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33037373

RESUMEN

Despite evidence strongly supporting use of non-invasive or minimally invasive procedures in caries management, there is still a large gap between evidence-based recommendations and application of these concepts in practice, with the practice of dentistry still largely dominated by invasive procedures in the US. This paper describes efforts in education and clinical practice in the US in the last decade to promote evidence-based cariology strategies, which support a minimum intervention dentistry (MID) philosophy. These include, for example: a competency-based core cariology curriculum framework which has been developed and disseminated. National education accreditation standards supporting caries management are likely to soon be changed to support assessment of best evidence in cariology. There are several ongoing efforts by organised dentistry and other groups involving dental educators, researchers and clinical practitioners to promote cariology concepts in practice, such as the development of evidence-based clinical practice guidelines for caries management by the American Dental Association. Within each of these strategies there are challenges, but also opportunities to expand the implementation of MID in the US, which create optimism for future improvements over time.


Asunto(s)
Caries Dental , Educación en Odontología , Curriculum , Caries Dental/prevención & control , Odontología , Humanos , Estados Unidos
10.
J Dent Educ ; 84(12): 1348-1358, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32779200

RESUMEN

OBJECTIVE: Dental hygienists play a key role in dental caries prevention and management. As the evidence of dental caries risk, prevention, and management becomes more complex, it is essential that dental hygiene (DH) programs have a strong cariology curriculum. This project aimed to assess current cariology content in U.S. DH programs, how content is taught, and interest in development/implementation of a common/core cariology curriculum framework. METHODS: Directors of 336 U.S. DH programs were invited to participate in a voluntary online survey using Qualtrics. The survey consisted of 41 items including demographics, details about the program's cariology content, and how it was delivered, and items related to a core cariology curriculum. RESULTS: The overall response rate used for analyses was 27.3%. Some findings include: 61.6% stated their program had a defined cariology curriculum, 35.2% did not have an individual cariology course, 61.5% had preclinical hands-on experiences in cariology, 79.7% are teaching management strategies related to salivary gland hypofunction, 68.3% are teaching use of silver diamine fluoride (SDF), and 64.2% felt cariology was adequately being taught. Only 17.7% are teaching the International Caries Detection and Assessment System (ICDAS) system. 87.3% indicated support for developing a core curriculum framework for teaching cariology in DH programs. CONCLUSIONS: This study indicated that, although DH programs reported that cariology concepts are being taught both didactically and clinically, discrepancies between concepts taught and the literature exist. Therefore, there is a need to create a more standardized curriculum framework for all U.S. DH programs.


Asunto(s)
Caries Dental , Curriculum , Caries Dental/prevención & control , Higienistas Dentales , Humanos , Higiene Bucal , Facultades de Odontología , Encuestas y Cuestionarios
11.
J Dent Hyg ; 94(3): 6-15, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32554411

RESUMEN

Purpose: The state of Oregon developed the expanded practice dental hygienist (EPDH), to address oral health care disparities. The establishment of collaborative practice agreements between dental hygienists (DH) and physician assistants (PA), has created a need for interprofessional education (IPE) for future interprofessional collaboration with EPDHs. The purpose of this study was to assess the impact of an IPE intervention on future interest in collaborative practice agreements.Methods: Current and former DH and PA students from Pacific University Oregon (n=420) were invited to participate in an electronic survey. The 39-item survey included questions related to an annual IPE activity and questions related to collaborative practice agreements between PAs and EPDHs. Descriptive statistics were used to analyze the data.Results: A total of 80 DHs and PAs completed the survey for a response rate of 19%. There were high levels of agreement between DHs and PAs in regards to valuing the expertise of other health care providers, teamworking skills and interprofessional collaboration for a better understanding of a patient's condition. Only 18.9% (n=7) of the DH respondents and 25.6% of the PA respondents (n=11) were aware of the collaborative practice agreements for Oregon EPDHs.Conclusion: Participants from DH and PA disciplines agreed patient care is improved by collaborative practice fostered through interprofessional education activities. Multiple approaches may be needed to increase knowledge on the EPDH collaborative practice agreements with PAs in Oregon.


Asunto(s)
Higienistas Dentales , Asistentes Médicos , Actitud del Personal de Salud , Humanos , Relaciones Interprofesionales , Oregon , Atención al Paciente
12.
J Can Dent Assoc ; 86: k9, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32543369

RESUMEN

OBJECTIVE: To investigate the efficacy of silver diamine fluoride (SDF) with 5% fluoride varnish (FV) in treating cavitated caries in young children and to explore the association between SDF treatment and oral-health-related quality of life (OHRQoL). METHODS: Children with active dentinal caries in primary teeth underwent treatment with 38% SDF and 5% FV at baseline and 4 months later. Treated lesions were assessed 4 and 8 months after baseline. Child-level analysis focused on classifying SDF treatment as completely successful if all of a child's treated lesions were arrested or incompletely successful if at least 1 lesion was not arrested. The Early Childhood Oral Health Impact Scale questionnaire was completed at second and third visits. Statistical analyses included descriptive and bivariate methods. A p value ≤ 0.05 was considered significant. RESULTS: This pilot study enrolled 40 children with 239 caries lesions; mean age 40.2 ± 14.9 months and 45% male. Lesion arrest rates after 1 and 2 applications of SDF were 74.1% and 96.2%, respectively. Children who reportedly brushed twice daily were more likely to be in the completely successful group compared with those who brushed less (p = 0.006). Those in the completely successful group had a significantly lower mean baseline dmft score than those in the incompletely successful group (p = 0.048). No significant difference in OHRQoL was observed between the 2 groups. CONCLUSIONS: SDF with 5% FV is an effective approach to the management of early childhood caries; more than 1 application is recommended, along with regular follow up of patients and twice daily brushing. OHRQoL was not found to be affected by the level of success of SDF treatment.


Asunto(s)
Caries Dental , Fluoruros , Cariostáticos , Niño , Preescolar , Femenino , Fluoruros Tópicos , Humanos , Masculino , Salud Bucal , Proyectos Piloto , Calidad de Vida , Compuestos de Amonio Cuaternario , Compuestos de Plata
14.
Dent Clin North Am ; 63(4): 695-703, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31470923

RESUMEN

The objective of this article is to review evidence-based strategies available for the nonrestorative management of caries lesions, both cavitated and noncavitated. The goal is to help clinicians make appropriate decisions regarding nonrestorative management of caries lesions. In addition, in the decision-making process, clinicians must consider thresholds for restorative and nonrestorative care and strategies for nonrestorative management that are supported by best available evidence. It is important that this information be considered taking into account a provider's clinical expertise and a patient's treatment needs and preferences, in order to maintain health and preserve tooth structure.


Asunto(s)
Caries Dental , Diente , Humanos
16.
Clin Oral Investig ; 23(10): 3691-3703, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31444695

RESUMEN

OBJECTIVES: To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS: Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS: Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE: Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.


Asunto(s)
Caries Dental/terapia , Esmalte Dental/patología , Dentina/patología , Consenso , Técnica Delfos , Estética Dental , Humanos
17.
J Am Geriatr Soc ; 67(11): 2318-2324, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31335967

RESUMEN

BACKGROUND/OBJECTIVE: To determine factors associated with older adults becoming edentulous (complete tooth loss). DESIGN: Longitudinal study over a 6-year period. SETTING: United States, 2006, 2012. PARTICIPANTS: Nationally representative US sample of adults, aged 50 years and older (n = 9982), participating in the Health and Retirement Study in 2006 and 2012. At the outset, they were dentate and not institutionalized. INTERVENTION: None. MEASUREMENTS: Self-report of being dentate or edentulous, demographic variables, dental utilization and other health behaviors, self-rated general health, and incidence between 2006 and 2012 of comorbid medical conditions, functional limitations, and disabilities. RESULTS: From 2006 to 2012, 563 individuals (5%) became edentulous and 9419 (95%) remained dentate. Adults who became edentulous by 2012 were more likely than those who remained dentate to be black/African American compared to white, to be less educated, were current smokers, had diabetes, and reported poorer self-rated general health, more functional limitations and disabilities, and fewer dental visits (all P < .0001), among other factors. Of those with regular dental visits (at least once every 2 years during the 6-year period), 2.3% became edentulous compared to 9.9% among those without regular dental visits. After adjusting for age and other potential confounders, there was a strong association with poor dental attendance and smoking. Nonregular dental attenders were more likely than regular attenders to become edentulous (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 2.12-3.53), and current smokers were more likely than never smokers to become edentulous (OR = 2.46; 95% CI = 1.74-3.46). CONCLUSION: Although more contemporaneous data are needed to determine causality, regular dental utilization and smoking are modifiable factors that could prevent edentulism, even when many other comorbid conditions are present. J Am Geriatr Soc, 1-7, 2019. J Am Geriatr Soc 67:2318-2324, 2019.


Asunto(s)
Actitud Frente a la Salud , Conductas Relacionadas con la Salud , Boca Edéntula/epidemiología , Salud Bucal/estadística & datos numéricos , Jubilación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Renta , Masculino , Persona de Mediana Edad , Boca Edéntula/etiología , Estudios Retrospectivos , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Pérdida de Diente/epidemiología , Estados Unidos/epidemiología
18.
Caries Res ; 53(5): 555-566, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31137026

RESUMEN

PURPOSE: To assess the effect of silver diamine fluoride (SDF) on microbial profiles present in plaque from root/cervical carious lesions, and its association with caries lesion arrest. MATERIALS AND METHODS: Twenty patients with at least one soft cavitated root/cervical carious lesion were included. One lesion/patient was randomly selected and treated with 38% SDF. Supragingival plaque samples were harvested at preintervention and 1 month postintervention. Using an MiSeq platform, 16S rDNA sequencing of the V3-V4 regions was used to determine bacterial profiles. Clinical evaluation of lesion hardness was used to evaluate arrest. t tests, principal component analysis (PCA), multidimensional scaling (MDS), and generalized linear models (GLMs) tests were used for statistical comparisons. RESULTS: From a total of 40 plaque samples, 468 probe targets were observed. Although 60% of lesions became hard postintervention, PCA and MDS tests showed no distinct pre- and postintervention groups. In addition, pre- and postintervention differences in diversity (Shannon index) of microbial profiles between patients with and without lesion arrest were not statistically different. A likelihood ratio test for pre- versus postintervention differences within patients, i.e., adjusting for differences between patients using negative binomial GLMs, showed 17 bacterial taxa with significant differences (FDR <0.05). CONCLUSION: Although 60% of lesions hardened after SDF treatment, this was not directly due to either overall statistically significant differences in microbial profiles or differences in microbial diversity. Nevertheless, there was a trend with some acid-producing species in that their relative abundance was reduced postintervention. The negative binomial GLMs showed 17 bacterial taxa that were significantly different after SDF treatment.


Asunto(s)
Biopelículas/efectos de los fármacos , Cariostáticos/farmacología , Caries Dental/microbiología , Placa Dental/microbiología , Compuestos de Amonio Cuaternario/farmacología , Caries Radicular/microbiología , Compuestos de Plata/farmacología , Bacterias/clasificación , Bacterias/efectos de los fármacos , Femenino , Fluoruros Tópicos/farmacología , Humanos , Masculino , Persona de Mediana Edad
19.
J Prim Care Community Health ; 10: 2150132719836908, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30896325

RESUMEN

INTRODUCTION: In this 3-year longitudinal study, parent/child attended 3 dental visits and in between, parents were called every 4 months and asked if their child had visited the dentist and if fluoride varnish had been applied. METHODS: Objectives were to assess changes in parents' perceptions of how well they do in taking care of their children's teeth and/or gums across these 3 time points (at age 1, 2.5, and 4 years), assess differences in parents' perceptions of how well they do taking care of their children's teeth and/or gums versus taking care of their children's medical health, and determine factors associated with parental perceptions of how well they do in taking care of the children's teeth and/or gums longitudinally. RESULTS: Participant pairs (1325) were enrolled and over time there was a significant improvement in parental perceptions of their job taking care of their children's teeth and/or gums, increasing from 86% perceiving it to be excellent/very good/good at their child's 1 year of age to 92% at child's age 4 years. The estimated odds of parents perceiving they provided excellent/very good/good versus fair/poor care for the children's teeth and/or gums were higher for those who cleaned and checked inside the children's mouth and/or gums daily (odds ratio 4.74) or took their children to the dentist yearly or twice yearly (odds ratio; 2.73). CONCLUSIONS: Parents' perceptions of the care of their children's teeth and/or gums improved over time. Parents consistently perceived that they provided better medical care than dental care for their child.


Asunto(s)
Actitud Frente a la Salud , Salud Bucal , Higiene Bucal/normas , Padres , Adulto , Preescolar , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Encuestas y Cuestionarios , Adulto Joven
20.
J Dent Educ ; 83(2): 144-150, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30709989

RESUMEN

Caries risk assessment (CRA) is an essential component informing clinical decision making for personalized caries management. The aim of this study was to assess the predictive validity of the CRA model used at the University of Michigan School of Dentistry. Data from patients treated in the school's adult integrated clinics between 2011 and 2014 who had a CRA documented were accessed from the electronic health record. Data extracted included caries risk category, date of reassessments, presence of caries risk indicators/factors, and treatments completed. Out of 2,449 patients who had a CRA completed in 2011, 447 had one or more reassessments at least 180 days after the initial CRA. Caries risk status was significantly associated (p<0.0001) with the number of new caries-related treatments during follow-up, with significant increases (p<0.01) in these needs for each caries risk level. For the 11,152 patients with a completed CRA in 2011-14, the prediction model (area under the curve=0.82) included the following risk factors significantly (p<0.001) associated with increased caries experience/needs over time: stagnant plaque (OR 2.6, 95% CI 2.4, 2.9), presence of salivary risk factors (OR 2.6, 95% CI 2.2, 2.9), presence of dietary risk factors (OR 3.2, 95% CI 2.9, 3.6), lack of adequate protective factors (OR 2.1, 95% CI 1.8, 2.4), presence of conditions that affect compliance (OR 2.4, 95% CI 1.9, 3.1), and past/current caries experience (OR 23.7, 95% CI 21.1, 26.7). High risk patients were significantly more likely (p<0.0001) to have restorative, extraction, or endodontic treatments completed due to caries and less likely (p<0.0001) to have diagnostic procedures than low or moderate risk patients. These results suggest that the CRA model used at the dental school can help predict adult patients' future caries experience/needs.


Asunto(s)
Caries Dental/epidemiología , Educación en Odontología , Modelos Estadísticos , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Medición de Riesgo , Facultades de Odontología
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