Modelling time-varying risk factors of tooth loss: Results from joint model compared with extended Cox regression model.

AIM: To illustrate the use of joint models (JMs) for longitudinal and survival data in estimating risk factors of tooth loss as a function of time-varying endogenous periodontal biomarkers (probing pocket depth [PPD], alveolar bone loss [ABL] and mobility [MOB]). MATERIALS AND METHODS: We used data from the Veterans Affairs Dental Longitudinal Study, a longitudinal cohort study of over 30 years of follow-up. We compared the results from the JM with those from the extended Cox regression model which assumes that the time-varying covariates are exogenous. RESULTS: Our results showed that PPD is an important risk factor of tooth loss, but each model produced different estimates of the hazard. In the tooth-level analysis, based on the JM, the hazard of tooth loss increased by 4.57 (95% confidence interval [CI]: 2.13-8.50) times for a 1-mm increase in maximum PPD, whereas based on the extended Cox model, the hazard of tooth loss increased by 1.60 (95% CI: 1.37-1.87) times. CONCLUSIONS: JMs can incorporate time-varying periodontal biomarkers to estimate the hazard of tooth loss. As JMs are not commonly used in oral health research, we provide a comprehensive set of R codes and an example dataset to implement the method.

Depression and Differential Oral Health Status Among U.S. Adults With and Without Prior Active Duty Service in the U.S. Military, National Health and Nutrition Examination Survey 2011-2018.

INTRODUCTION: Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations. MATERIALS AND METHODS: Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health-related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis. RESULTS: Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression. CONCLUSIONS: This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.

Effect of being overweight and obese on periodontal treatment costs.

BACKGROUND: Obesity can increase a person's risk of developing periodontal disease, and patients with obesity have greater health care costs. However, the effect of obesity on periodontal treatment costs has not been examined. METHODS: This retrospective cohort study used data from the electronic dental records of adult patients examined from July 1, 2010, through July 31, 2019 at a US dental school. Primary exposure was body mass index, which was categorized as obese, overweight, or normal. Periodontal disease was categorized using clinical probing measures. Fee schedules and procedure codes were used to compute the primary outcome, which was total periodontal treatment costs. A generalized linear model with gamma distribution was used to examine the relationship between body mass index and periodontal costs after controlling for initial periodontal disease severity and other confounding variables. Parameter coefficients and mean ratios with 95% CIs were estimated. RESULTS: The study sample included 3,443 adults, of whom 39% were normal weight, 37% were overweight, and 24% were obese. Mean (SD) total periodontal treatment costs for patients who were obese were considerably higher ($420 [$719]) than those for patients who were overweight ($402 [$761]) and patients who were normal weight ($268 [$601]). After controlling for covariates and disease severity, patients who were obese had 27% higher periodontal treatment costs than patients who were normal weight. The additional periodontal treatment costs attributable to obesity were greater than those attributable to either diabetes or smoking. CONCLUSIONS: The study results suggest that among patients at a dental school, those who were obese incurred substantially higher periodontal treatment costs than patients who were normal weight, independent of initial periodontal disease severity. PRACTICAL IMPLICATIONS: The study findings have important implications for clinical guidelines and dental benefit design and coverage policies.

Response to commentary: See Original Article here.

This letter is a response to commentary by Dr. Smith on 'Examining the association between cancer history in early life and dental care utilization'. We provided additional information and clarification regarding our analysis and results in response to Dr. Smith's questions and comments. Despite the limitations and weaknesses of our study, we still believe that it provides important information and further research questions.

Periodontitis is associated with an increased hazard of mortality in a longitudinal cohort study over 50 years.

AIM: To evaluate the association between periodontal disease and all-cause mortality in a longitudinal cohort study over 50 years. MATERIALS AND METHODS: Participants (N = 1156) in the Veterans Affairs Dental Longitudinal Study, aged 25-85 years at enrollment in 1968, received comprehensive medical and oral exams approximately every 3 years through 2007. Periodontal status was defined using person-level, mean whole-mouth radiographic alveolar bone loss (ABL) scores using a five-point Schei ruler, each unit representing 20% increments of ABL. Time-varying Cox regression models estimated hazard ratios (HRs) for the association between continuous and categorical ABL and mortality, adjusting for covariates. RESULTS: Each one-unit increase in mean ABL score was associated with a 14% increase in the hazard of mortality (adjusted HR = 1.14, 95% confidence interval [CI] 1.02, 1.27). When assessed categorically, HRs for average scores of 2 to <3 and 3 to ≤5 showed increasing associations with hazard of mortality, relative to 0 to <1 (adjusted HR = 1.17, 95% CI 0.94, 1.46; and HR = 1.65, 95% CI 0.94, 2.85, respectively). By contrast, we observed null associations for average scores of 1 to <2 relative to 0 to <1 (adjusted HR = 1.00, 95% CI 0.86, 1.17). CONCLUSIONS: Time-varying periodontal status assessed using radiographic ABL was positively associated with all-cause mortality even after confounder adjustment.

The association of sedentary behaviour and physical activity with periodontal disease in NHANES 2011-2012.

AIM: Periodontal disease is one of the most prevalent oral pathologies and a major chronic disease worldwide. Lifestyle habits such as poor nutrition and smoking have been established to contribute to the development of periodontal disease, but limited research has investigated whether physical activity and sedentary lifestyle play a role. The purpose of this study is to evaluate the association between physical activity, sedentary behaviour, and periodontal disease. MATERIALS AND METHODS: We used a nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. We examined the association between physical activity and sedentary behaviour and periodontal disease using multivariable logistic regression models and reported odds ratios (ORs). RESULTS: Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence. Adjusted multivariable regression models showed that higher sedentary behaviour (more than 7.5 h/day) was associated with higher odds of periodontal disease (OR = 1.17; 95% confidence interval = 1.00-1.36; p = .045). CONCLUSIONS: The findings showed that higher sedentary behaviour is associated with higher odds of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease.

Edentulism is associated with increased risk of all-cause mortality in adult men.

BACKGROUND: Prior reports of positive associations between edentulism and all-cause mortality have been limited by onetime assessments of edentulism and inadequate control of known confounding variables. The authors aimed to assess the association between edentulism and mortality using a longitudinal clinical oral health cohort. METHODS: The authors used data from the Department of Veterans Affairs Dental Longitudinal Study, an ongoing, closed-panel cohort study from 1968 through 2019 (N = 1,229). Dentition status was evaluated through triennial clinical examinations. Mortality was assessed via the National Death Registry. The authors used Cox regression models to estimate the association between edentulism and all-cause mortality after covariate adjustment. Furthermore, the authors calculated propensity scores and assessed hazard ratios (HRs) in a trimmed, matched, and inverse probability weighted sample. RESULTS: Participants who were edentulous (N = 112) had 1.24 (95% CI, 1.00 to 1.55) times the hazard of all-cause mortality compared with those who were nonedentulous, after adjustment with time-varying covariates. Use of propensity scores in the model resulted in slightly elevated HRs compared with the standard Cox model, regardless of propensity score method; adjusted HRs were 1.35 (95% CI, 1.01 to 1.80) after matching, 1.26 (95% CI, 1.00 to 1.59) after trimming, and 1.29 (95% CI, 1.18 to 1.42) after inverse probability weighting. CONCLUSIONS: Edentulism was associated with an increased risk of all-cause mortality in a cohort that captured incident edentulism. This association was consistent after multiple methods to account for confounding. PRACTICAL IMPLICATIONS: The findings of this study suggest that edentulism is associated with an increase in risk of mortality, after accounting for salient confounding variables using multiple approaches. Efforts to improve equitable access to tooth-preserving treatments are critical.

Examining the association between cancer history in early life and dental care utilization.

OBJECTIVES: This study aims to examine associations between cancer history in early life (diagnosed at 20 years of age or younger) and utilization of dental care. METHODS: We analysed data of 10,185 participants, aged ≥20 years, from the National Health and Nutrition Examination Survey cycles 2015-2018. The main predictor was self-reported past history of any type of cancer diagnosed at 20 years of age or younger (yes/no). The outcome variables were having a dental visit within the past year, treatment or preventative visit, urgent need for care, and unmet dental need. Covariates included gender, age, race, marital status, education, and income. Bivariate and multiple logistic regression were conducted, accounting for the complex sampling design. RESULTS: There was no difference between early life cancer survivors in regards to dental visit within the past year (OR: 0.7; 95% CI: 0.3-1.6), visit for dental treatment (OR: 0.6; 95% CI: 0.3-1.6), urgent need for care (OR: 0.8; 95% CI: 0.3-2.0), or unmet dental need (OR: 0.6; 95% CI: 0.2-1.6) compared to cancer-free participants. CONCLUSIONS: Cancer history in early life doesn't impact dental care visits, type of last dental visit, dental care recommendation, or unmet dental need. Future cohort studies are needed to confirm this association.

Association between Parity and Dental Caries Experience among US Women: Findings from the National Health and Nutrition Examination Survey.

AIM AND OBJECTIVE: This study aims to investigate the association between parity and dental caries among US women. MATERIALS AND METHODS: National Health and Nutrition Examination Survey (NHANES 2001-2004) data for parous women aged 20-45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. RESULTS: The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). CONCLUSION: Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. CLINICAL SIGNIFICANCE: Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

The association between the supplemental nutrition assistance programme participation and dental caries among U.S. adults.

INTRODUCTION: The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. METHODS: We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. RESULTS: Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio: 1.6; 95% CI: 1.2-2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries. CONCLUSIONS: Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

Breastfeeding and Early Childhood Caries: Findings from the National Health and Nutrition Examination Survey, 2011 to 2018.

Purpose: Childhood caries is a highly prevalent disease that is intricately connected to diet and other social and behavioral factors. While it has been established that breastfeeding confers many health benefits for children, previous research found no consensus on the relationship between breastfeeding and caries. The purpose of this study was to examine the relationship between early childhood caries (ECC) and the length of time breastfeeding using the National Health and Nutrition Examination Survey (NHANES). Methods: Four cycles of NHANES (2011 to 2018) were analyzed, including 3,234 children ages two to five years. The association between breastfeeding duration and incidence of ECC and severe earlychildhood caries (S-ECC) was evaluated using logistic regression, adjusting for age, ethnicity, education, income, last dental visit, and sugar-sweetened beverages. Results: In the study population, 16.9 percent had ECC and 12.2 percent had S-ECC. Breastfeeding six months to one year, one to two years, or over two years was not associated with higher odds of ECC or S-ECC than breastfeeding for zero to six months after adjusting for covariates. Conclusions: There was no statistically significant relationship between breastfeeding and early childhood caries, and breastfeeding duration was not associated with increased caries risk. More research from well-controlled analytical studies is needed to establish or refute a relationship between breastfeeding and ECC.

The association between food insecurity, diet quality, and untreated caries among US children.

BACKGROUND: The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship. METHODS: The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach. RESULTS: Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries. CONCLUSIONS: Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries. PRACTICAL IMPLICATIONS: Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

The association between food insecurity and dental caries among U.S. adults: Data from the National Health and Nutrition Examination survey.

OBJECTIVES: The purpose of this study was to examine the association between food insecurity and untreated dental caries using a nationally representative sample of US adults. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014 on adults aged 18 years and older were analysed (n = 10 723). Primary predictors were overall food security (food-secure/ food-insecure) and household food security (full, marginal, low and very low). The main outcome was any untreated dental caries (none/ ≥ one). Multiple logistic regression analyses were done to estimate the adjusted odds ratio after controlling for confounders. RESULTS: Food-insecure adults were more likely to have untreated dental caries than food-secure adults after adjusting for potential confounders (OR: 1.2; 95% CI: 0.9-1.5). Adults from households with marginal (OR:1.4; 95% CI:1.5-2.2), low (OR:1.3, 95% CI:1.3-2.0) and very low food security (OR:1.3; 95% CI:0.9-1.5) had higher odds of untreated caries than adults from households with full food security. Following age stratification, marginal, low and very low food-secure adults had higher prevalence of untreated dental caries than full food-secure adults across all age groups. CONCLUSIONS: Our findings suggest that food-insecure adults had higher odds of untreated dental caries than food-secure adults. These findings highlight the importance of assessing food insecurity as a risk factor for dental caries. Longitudinal cohort studies are recommended to determine causal mechanisms.

A quantitative bias analysis to assess the impact of unmeasured confounding on associations between diabetes and periodontitis.

AIM: To investigate unmeasured confounding in bidirectional associations between periodontitis and diabetes using quantitative bias analysis. METHODS: Subsamples from the Veterans Affairs Dental Longitudinal Study were selected. Adjusted for known confounders, we used Cox proportional hazards models to estimate associations between pre-existing clinical periodontitis and incident Type II Diabetes (n = 672), and between pre-existing diabetes and incident severe periodontitis (n = 521), respectively. Hypothetical confounders were simulated into the dataset using Bernoulli trials based on pre-specified distributions of confounders within categories of each exposure and outcome. We calculated corrected hazard ratios (HR) over 10,000 bootstrapped samples. RESULTS: In models using periodontitis as the exposure and incident diabetes as the outcome, adjusted HR = 1.21 (95% CI: 0.64-2.30). Further adjustment for simulated confounders positively associated with periodontitis and diabetes greatly attenuated the association or explained it away entirely (HR = 1). In models using diabetes as the exposure and incident periodontitis as the outcome, adjusted HR = 1.35 (95% CI: 0.79-2.32). After further adjustment for simulated confounders, the lower bound of the simulation interval never reached the null value (HR ≥ 1.03). CONCLUSIONS: Presence of unmeasured confounding does not explain observed associations between pre-existing diabetes and incident periodontitis. However, presence of weak unmeasured confounding eliminated observed associations between pre-existing periodontitis and incident diabetes. These results clarify the bidirectional periodontitis-diabetes association.

The impact of periodontitis exposure misclassification bias from partial-mouth measurements on association with diabetes and cardiovascular disease.

AIM: To quantify exposure misclassification bias arising from use of partial-mouth protocols in studies of periodontitis-systemic disease associations. MATERIALS AND METHODS: Using data from 10,134 adults participating in the National Health and Nutrition Examination Survey, we classified periodontal status based on full-mouth clinical examinations and three commonly used partial-mouth protocols. Associations between periodontitis and self-reported diabetes and cardiovascular disease were evaluated under each protocol using adjusted logistic regression. Percent relative bias was calculated to evaluate magnitude and direction of bias. RESULTS: Misclassification primarily resulted in underestimation of associations, the extent of which depended on both the outcome under study and exposure severity. Bias due to misclassification of severe periodontitis was negligible for cardiovascular disease (0%-4.1%) compared to diabetes (177.7%-234.1%). In contrast, bias in moderate periodontitis associations was comparable across each outcome-diabetes (28.4%-39.5%) and cardiovascular disease (8.9%-46.7%). Results did not meaningfully change based on the partial-mouth protocol implemented. Stratified analyses showed increased bias among those with ≤15 teeth. Use of mean attachment loss as a continuous exposure resulted in minimal-to-no bias. CONCLUSIONS: Exposure misclassification bias due to use of partial-mouth protocols can yield inaccurate conclusions about periodontitis-systemic disease associations, the extent of which may depend on periodontitis classification and the association under study.

Patients With Metabolic Syndrome May Experience More Tooth Loss and Poorer Functional Dentition Than Those Without Metabolic Syndrome.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis. Souza ML, Massignan C, Glazer Peres K, Aurélio Peres M. J Am Dent Assoc 2019;150(12):1027-1039.e7. SOURCE OF FUNDING: Government. Foundation for Research and Innovation Support of Santa Catarina State (Brazil), Coordination of Improvement of Higher Level Personnel (Brazil). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

The effect of diet drinks on caries among US children: Cluster analysis.

BACKGROUND: The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. METHODS: In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. RESULTS: Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). CONCLUSIONS: The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. PRACTICAL IMPLICATIONS: Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.

Predicting professional school performance with a unique lens: are there other cognitive predictors?

BACKGROUND: We investigated the associations between admissions criteria and performance in four cohorts of pre-dental MS in Oral Health Sciences (OHS) program at Boston University Schools of Medicine and Dental Medicine. Previously we have reported that OHS serves as a successful pre-dental pipeline program for students from underrepresented groups. METHODS: We evaluated academic variables that further affect overall graduate GPA and grades in the first year dental school courses taken by OHS students at Boston University between 2012 and 2016 as part of the MS curriculum. Demographic data, region of residency, undergraduate grade point average, number of science and math credits, major of study, dental admissions test scores and undergraduate institution were collected. The competitiveness of the undergraduate institution was scored based on Barron's Profiles of American Colleges. OHS-GPA was assessed and individual grades in two first year dental school courses taken as part of the OHS curriculum were collected. Analysis of variance, the Chi-square test and Fisher's Exact test were utilized to assess associations between academic performance parameters, successful program completion and matriculation to dental school. RESULTS: Results indicate that undergraduate major, age and number of science course credits taken had no impact on MS performance in the Boston University MS in Oral Health Sciences program; however, students who took an undergraduate course in Physiology performed better than those who did not (p = 0.034). This was not the case with courses in Cell Biology and Biochemistry. Students with DAT scores over 20 academic average (p = 0.001), 18 total science average (p = 0.001) and 22 reading comprehension (p = 0.004) performed better in dental school courses taken in OHS. CONCLUSION: We report that strong test scores, attending a mid or highly rigorous undergraduate institution and completion of an undergraduate Physiology course are positive predictors. We hope these findings will guide admission's decisions and improve recruitment to, and future success of, graduate student's pursuit of professional school. Understanding alternative predictors of success may help to reduce the intrinsic bias among applicants from underrepresented groups and continue to look beyond the DATs (or MCATs) to decrease the gap between professionals from underrepresented groups and those they serve.

The Healthy Eating Index and coronal dental caries in US adults: National Health and Nutrition Examination Survey 2011-2014.

BACKGROUND: The purpose of this cross-sectional study was to determine if Healthy Eating Index (HEI-2015) scores are associated with coronal caries and the odds of untreated coronal caries in adults 20 years and older. METHODS: Data on decayed, missing, and filled teeth (DMFT), untreated coronal caries, and HEI-2015 scores were obtained from 7,751 adults who completed a dental examination and two 24-hour dietary recalls in National Health and Nutrition Examination Survey cycles 2011-2012 and 2013-2014. HEI-2015 scores were categorized into quintiles, with HEI-2015 quintile 1 scores indicating the least compliance with 2015-2020 Dietary Guidelines for Americans. The authors used multivariable linear regression to assess associations of HEI-2015 with DMFT and logistic regression for associations with untreated coronal caries. All regression models were controlled for age, sex, race or ethnicity, current cigarette use, family income to poverty threshold ratio, last dental visit, education, and whether participants were ever told they had a heart attack. RESULTS: Relative to HEI-2015 quintile 1, the adjusted odds of any untreated coronal caries were quintile 5 (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.46 to 0.80), quintile 4 (OR, 0.66; 95% CI, 0.53 to 0.84), quintile 3 (OR, 0.76; 95% CI, 0.56 to 1.04), and quintile 2 (OR, 0.93; 95% CI, 0.66 to 1.31). Participants who met the recommendations for the total fruits, whole fruits, greens and beans, and added sugars components of the HEI-2015 score were less likely to have untreated coronal caries than those who did not meet the recommendations. Overall, mean coronal DMFT also decreased as HEI-2015 scores increased, but trends were not consistent in all racial or ethnic groups. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Greater compliance with the Dietary Guidelines for Americans is associated with lower prevalence and the odds of untreated caries in adults. Dietary counseling for caries prevention by dental professionals should incorporate comprehensive dietary guidelines that are consistent with those intended for enhancing overall health and reducing the risk of developing common systemic diseases.

Dental Sealant Prevalence Among Children with Special Health Care Needs: National Health and Nutrition Examination Survey (NHANES) 2013 to 2014.

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower odds of having a sealant versus older age groups. Sealant use prevalence was lowest among African American children (39 percent) versus Hispanic (47 percent) and Caucasian (54 percent; P=0.01) children. Conclusions: The findings indicate disparities in dental sealants use among those with physical disabilities and younger age groups. Further studies and strategies are needed to intervene at an early age and increase utilization of sealants among children with special health care needs. (Pediatr Dent 2019;41(3):186-90) Received September 15, 2018 | Last Revision February 24, 2019 | Accepted March 4, 2019.