Caries clusters at lesion-severity thresholds: A Sierra Leone case study.

OBJECTIVES: Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors. METHODS: This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance. RESULTS: A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay. CONCLUSION: This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

Ethnicity, Social Support and Oral Health Among English Individuals.

OBJECTIVE: To determine whether social support explains ethnic inequalities in oral health among English individuals. METHODS: Data from 42704 individuals across seven ethnic groups in the Health Survey for England (1999-2002 and 2005) were analysed. Oral health was indicated by self-reports of edentulousness and toothache. Social support was indicated by marital status and a 7-item scale on perceived social support. Confounder-adjusted regression models were fitted to evaluate ethnic inequalities in measures of social support and oral health (before and after adjustment for social support). RESULTS: Overall, 10.4% of individuals were edentulous and 21.7% of dentate individuals had toothache in the past 6 months. Indian (Odd Ratio: 0.50, 95% Confidence Interval: 0.32-0.78), Pakistani (0.50, 95%CI: 0.30-0.84), Bangladeshi (0.29, 95%CI: 0.17-0.47) and Chinese (0.42, 95%CI: 0.25-0.71) individuals were less likely to be edentulous than white British individuals. Among dentate participants, Irish (1.21, 95%CI: 1.06-1.38) and black Caribbean individuals (1.37, 95%CI: 1.18-1.58) were more likely whereas Chinese individuals (0.78, 95%CI: 0.63-0.97) were less likely to experience toothache than white British individuals. These inequalities were marginally attenuated after adjustment for marital status and perceived social support. Lack of social support was associated with being edentulousness and having toothache whereas marital status was associated with edentulousness only. CONCLUSION: The findings did not support the mediating role of social support in the association between ethnicity and oral health. However, perceived lack of social support was inversely associated with worse oral health independent of participants' sociodemographic factors.

The Role of Area Deprivation in Explaining Ethnic Inequalities in Adult Oral Health in England.

BACKGROUND: The circumstances of the area where people live may affect their health and ethnic minority groups are often overrepresented in deprived areas. This study explored ethnic inequalities in adult oral health and the contribution of area deprivation to explain such inequalities. METHODS: Data from 15667 adults across 8 ethnicities (White British, Irish, Black Caribbean, Black African, Indian, Pakistani, Bangladeshi, Chinese) in the Health Survey for England 2010/2011 were analysed. Oral health was indicated by having a non-functional dentition, poor self-rated oral health and oral impacts on daily activities. Survey logistic regression and the Blinder-Oaxaca decomposition method were used. RESULTS: There were ethnic inequalities in the non-functional dentition, but not in self-rated oral health or oral impacts. Compared to White British adults (19.7%, 95% CI: 18.9, 20.6), a non-functional dentition was more common in Irish (33.1%, 95% CI: 25.9, 41.2) and less common in Black Caribbean (14.9%, 95% CI: 9.9, 21.7), Black African (6.9%, 95% CI: 3.9, 11.9), Indian (10.5%, 95% CI: 6.3, 17.2), Pakistani (7.2%, 95% CI: 4.5, 11.5), Bangladeshi (12.7%, 95% CI: 4.3, 32.3) and Chinese (2.2%, 95% CI: 0.6, 7.9) adults. In decomposition analysis, observed population characteristics explained over half of the ethnic inequalities in the non-functional dentition. Age, area deprivation and SEP were the main contributors, although results varied by ethnicity. CONCLUSION: Ethnic inequalities in adult oral health varied according to oral health measure and ethnicity. Area deprivation and SEP contributed to, but did not fully, explain such inequalities.

Family Functioning and Dental Behaviours of Pre-school Children.

OBJECTIVES: To examine the association of family functioning with child dental behaviours and to identify family functioning domains associated with those behaviours. METHODS: Cross-sectional data from the East London Oral Health Inequalities (ELOHI) study were analysed in a subsample of 733 parent-child (3-4-years-olds) dyads. Family functioning was measured with the 60-item Family Assessment Device that yielded a general functioning score and six domain scores (roles, communication, problem solving, affective involvement, affective responsiveness, and behaviour control). Child dental behaviours were sugar intake, dental attendance and toothbrushing frequency. The association of family functioning with each dental behaviour was assessed in logistic regression models adjusted for confounders (parental sociodemographic and child demographic factors). RESULTS: Unhealthy general functioning was associated with greater odds of reporting high child intake of sugars (OR: 1.78, 95%CI: 1.01-3.13) as well as lower odds of reporting frequent child brushing (OR: 0.76, 95%CI: 0.50-1.18) and a child visit for dental check-up in the past year (OR: 0.98; 95%CI: 0.62-1.53), after adjustment for confounders. Unhealthy functioning in roles, affective involvement and behaviour control were associated with high child sugar intake whereas unhealthy functioning in roles was inversely associated with frequent child toothbrushing. No family functioning domain was associated with child dental attendance pattern. CONCLUSIONS: Healthy family functioning was associated with more favourable child dental behaviours. How a family functions, particularly in terms of how they define roles and support each other emotionally, is likely to be relevant to child oral health.

Role of Dentistry in Global Health: Challenges and Research Priorities.

Despite some improvements in the oral health of populations globally, major problems remain all over the planet, most notably among underprivileged communities of low- and middle-income countries but also in high-income countries. Furthermore, essential oral health care has been a privilege, instead of a right, for most individuals. The release of the Lancet issue on oral health in July 2019 built up some momentum and put oral conditions and dental services in the limelight. Yet, much work is still needed to bridge the gap between dental research and global health and get oral health recognized as a population health priority worldwide. Using the framework proposed by Shiffman, we argue that a global health network for oral health must be harnessed to influence global health policy and drive health system reform. We have identified challenges around 4 key areas (problem definition, positioning, coalition building, and governance) from our experience working in the global health arena and with collaborators in multidisciplinary teams. These challenges are outlined here to validate them externally but also to call the attention of interested players inside and outside dentistry. How well our profession addresses these challenges will shape our performance during the Sustainable Development Goals era and beyond. This analysis is followed by a discussion of fundamental gaps in knowledge, particularly in 3 areas of oral health action: 1) epidemiology and health information systems; 2) collection, harmonization, and rigorous assessment of evidence for prevention, equity, and treatment; and 3) optimal strategies for delivering essential quality care to all who need it without financial hardship.

Is the Performance of a Periodontal Prediction Model for Identification of Diabetes affected by Participants' Characteristics?

OBJECTIVE: To evaluate whether the diagnostic accuracy of a novel periodontal prediction model (PPM) for identification of adults with diabetes varies according to participants' characteristics. BASIC RESEARCH DESIGN: The study was carried out among 250 adults attending primary care clinics in Riyadh (Saudi Arabia). The study adopted a case-control approach, where diabetes status was first ascertained, and data collection carried out afterwards using questionnaires and periodontal examinations. Variations in the performance of the PPM by demographic (sex and age), socioeconomic (education) and behavioural factors (smoking status and last dental visit) were evaluated using receiver-operating characteristic (ROC) regression. RESULTS: The PPM including 3 periodontal parameters (missing teeth, percentage of sites with pocket depth ≥6mm and mean pocket depth) had an area under the ROC curve (AUC) of 0.69 (95% Confidence Interval: 0.61-0.78), which dropped to 0.64 (95% CI: 0.53-0.75) after adjustment for covariates. Larger variations in performance were found by participants' sex, age and education, but not by smoking status or last dental visit. The PPM performed better among male (adjusted AUC: 0.76; 95% CI: 0.53 to 0.99), younger (0.67; 95% CI: 0.50 to 0.84) and less educated participants (0.76; 95% CI: 0.60, 0.92). CONCLUSIONS: The diagnostic accuracy of a novel periodontal prediction model to identify individuals with diabetes varied according to participants' characteristics. This study highlights the importance of adjusting for covariates on studies of diagnostic accuracy.

Association between Oral Health and Frailty among Older Adults in Madinah, Saudi Arabia: A Cross-Sectional Study.

OBJECTIVES: This study aimed to examine the association between normative and subjective oral health indicators and frailty assessed by Frailty Phenotype (FP) and frailty index (FI) among older Saudi adults. DESIGN: cross-sectional study. SETTING: community and hospital-based. PARTICIPANTS: participants were 356 community-dwelling older adults attending dental clinics and social centres at Madinah, Saudi Arabia. METHODS: Frailty was measured with the frailty phenotype and a 34-item FI. Oral health included the following measures: self-rated oral health, number of teeth, and functional dentition. Covariates included sociodemographic factors and nutritional status. Logistic regression and negative binomial regression models were constructed to test the association between oral health indicators, FP, and FI, respectively. The first model was adjusted for demographic and socioeconomic factors, the second model was additionally adjusted for nutritional status. RESULTS: The number of teeth, functional dentition and self-rated oral health showed significant associations with frailty after adjusting for demographic and socioeconomic variables for both FP and FI. Adjusting for nutritional status attenuated the associations. CONCLUSION: This study has shown significant associations between oral health indicators namely number of teeth, functional dentition and self-rated oral health, and both FP and FI among Saudi older adults. Nutritional status appeared to mediate the association between oral health and frailty implicating inability to eat in this relationship.

Early Introduction of Sugar-Sweetened Beverages and Caries Trajectories from Age 12 to 48 Months.

Early exposure to sweet tastes predicts similar food preferences and eating behavior in later life and is associated with childhood obesity. The aim of this study was to explore the associations of early (during the first year of life) and subsequent intake of sugar-sweetened beverages (SSBs) with 4-y caries trajectories among Scottish young children. We used data from 1,111 Scottish children who were followed annually from age 12 to 48 mo (4 sweeps in total). SSB intake was reported by parents in every sweep. SSB intake was broken down into 2 components, the initial SSB intake and the deviation over time from that initial value. Childhood dental caries was clinically determined (including noncavitated and cavitated lesions) every year. The association of SSB intake with baseline decayed, missing, and filled tooth surfaces (dmfs) (intercept) and rate of change in dmfs over time (slope) was examined in 2-level linear mixed-effects models, with repeated observations nested within children. Both the initial SSB intake and the deviation from the initial SSB intake were positively associated with steeper caries trajectories. By sweep 4, the predicted mean dmfs difference was 1.73 between children with low and high initial SSB intake (1 standard deviation below and above the mean) and 1.17 between children with low and high deviation from their initial SSB intake (1 SD below and above the mean). The findings of this prospective study among Scottish young children provide evidence that the introduction of SSBs during the first year of life can put children in a trajectory of high levels of dental caries. They support current recommendations to avoid sugars for very young children and interventions targeting early feeding practices for caries prevention.

Maternal Oral Health and Early Childhood Caries amongst Low-Income Families.

OBJECTIVE: To determine the association between maternal oral health and Early Childhood Caries (ECC) and discover the role of maternal and child behaviours in explaining this association. BASIC RESEARCH DESIGN: A cross-sectional analytic study. CLINICAL SETTING: Public Healthcare Services in Pasto, Colombia. PARTICIPANTS: 384 mothers and their 2-5-year-old children. METHODS: Mothers completed a questionnaire to provide information on sociodemographic and behavioural factors and were examined for caries experience (DMFS index) and periodontal status (Community Periodontal Index, CPI). Children were examined for dental caries (dmfs index). The association between maternal dental indicators and child dmfs was assessed in negative binomial regression adjusting for confounders. RESULTS: About 96% and 33% of mothers had caries experience and periodontal disease, respectively. The mean dmfs was 7.4 (SD: 9.5, range: 0-71). Maternal DMFS, but not CPI, was positively associated with children's dmfs (Rate Ratio: 2.51, 95%CI: 1.59-3.97) after adjustments for sociodemographic and behavioural factors. CONCLUSIONS: Maternal caries experience, but not periodontal status, was positively associated with ECC in their children. Maternal and child behaviours explained little of this association.

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

Is there a healthy migrant effect in relation to oral health among adults in England?

OBJECTIVE: The aim of the study was to assess the healthy migrant effect in relation to oral health among adults in England. STUDY DESIGN: This is a secondary data analysis of a nationally representative survey. METHODS: Data from 13,373 adults of Irish, black Caribbean, Indian, Pakistani, Bangladeshi and Chinese ethnicity, who participated in the Health Survey for England, were analysed. The proportions of edentate and dentate adults with toothache in the last 6 months in first- and second-generation migrants within each ethnic group were compared with those in the white British (reference group) ethnic group in logistic regression models after adjusting for demographic factors and socio-economic position. Among first-generation migrants, the associations of age at arrival and length of residence with each oral health outcome were assessed in logistic regression models after adjusting for sociodemographic factors. RESULTS: Compared with white British migrants, first-generation black Caribbean (odds ratio [OR]: 1.42) and second-generation Pakistani (OR: 3.16) migrants had higher odds of being edentulous, whereas first-generation Indian (OR: 0.62), Pakistani (OR: 0.62), Bangladeshi (OR: 0.41) and Chinese (OR: 0.49) migrants had lower odds. Among dentate adults, second-generation Irish (OR: 1.51) migrants, first- and second-generation black Caribbean (OR: 1.61 and 1.54, respectively) migrants, first-generation Indian (OR: 1.24) migrants and second-generation Pakistani (OR: 1.34) migrants had higher odds of having toothache in the past 6 months, whereas second-generation Bangladeshi (OR: 0.51) migrants had lower odds than white British. Age at arrival and length of residence were positively associated with being edentulous among first-generation black Caribbean, Pakistani and Bangladeshi migrants. CONCLUSION: Evidence on the healthy migrant effect was mixed, with more consistent findings seen for edentulousness among Asian groups. Black Caribbean migrants were generally the ethnic group with the worst oral health when compared with white British.

Factors associated with use of general anaesthesia for dental procedures among British children.

Objectives To assess the demographic, socioeconomic, behavioural and clinical factors associated with use of dental general anaesthesia (DGA) among British children.Methods This study used data from 3053 children who participated in the 2013 Children's Dental Health Survey in England, Wales and Northern Ireland. Data were collected through parental questionnaires and clinical examinations. The crude and adjusted association of demographic (sex, age, ethnicity and country of residence), socioeconomic (socioeconomic classification and area deprivation), behavioural (age toothbrushing started, age when first went to the dentist, usual reason for dental visit and dental anxiety) and clinical factors (numbers of decayed and filled teeth) with DGA was assessed in logistic regression models.Results The lifetime prevalence of DGA use was 9.1%. Older children and those living in Wales, with higher levels of dental anxiety and more dental fillings, who visited the dentist only when in trouble, and who had parents in routine/manual occupations and parents who never worked have greater odds of reporting having ever used DGA.Conclusion This study shows that family socioeconomic background, usual reason for dental visit and country of residence were associated with DGA use among British children, over and above the effect of child age, dental anxiety and dental status.

Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors.

The Global Burden of Disease 2015 study aims to use all available data of sufficient quality to generate reliable and valid prevalence, incidence, and disability-adjusted life year (DALY) estimates of oral conditions for the period of 1990 to 2015. Since death as a direct result of oral diseases is rare, DALY estimates were based on years lived with disability, which are estimated only on those persons with unmet need for dental care. We used our data to assess progress toward the Federation Dental International, World Health Organization, and International Association for Dental Research's oral health goals of reducing the level of oral diseases and minimizing their impact by 2020. Oral health has not improved in the last 25 y, and oral conditions remained a major public health challenge all over the world in 2015. Due to demographic changes, including population growth and aging, the cumulative burden of oral conditions dramatically increased between 1990 and 2015. The number of people with untreated oral conditions rose from 2.5 billion in 1990 to 3.5 billion in 2015, with a 64% increase in DALYs due to oral conditions throughout the world. Clearly, oral diseases are highly prevalent in the globe, posing a very serious public health challenge to policy makers. Greater efforts and potentially different approaches are needed if the oral health goal of reducing the level of oral diseases and minimizing their impact is to be achieved by 2020. Despite some challenges with current measurement methodologies for oral diseases, measurable specific oral health goals should be developed to advance global public health.

Ethnic Disparities in Oral Health Related Quality of Life among Adults in London, England.

OBJECTIVE: To explore ethnic disparities in oral health related quality of life (OHQoL) among adults, and the role that socioeconomic factors play in that association. RESEARCH DESIGN: Data from 705 adults from a socially deprived, ethnically diverse metropolitan area of London (England) were analysed for this study. Ethnicity was self-assigned based on the 2001 UK Census categories. OHQoL was measured using the Oral Health Impact Profile (OHIP-14), which provides information on the prevalence, extent and intensity of oral impacts on quality of life in the previous 12 months. Ethnic disparities were assessed in logistic regression models for prevalence of oral impacts and negative binomial regression models for extent and intensity of oral impacts. RESULTS: The prevalence of oral impacts was 12.7% (95% CI: 10.2-15.1) and the mean OHIP-14 extent and severity scores were 0.27 (95% CI: 0.20-0.34) and 4.19 (95% CI: 3.74-4.64), respectively. Black adults showed greater and Asian adults lower prevalence, extent and severity of oral impacts than White adults. However, significant differences were only found for the extent of oral impacts; Black adults reporting more and Asian adults fewer OHIP-14 items affected than their White counterparts. After adjustments for socioeconomic factors, Asian adults had significantly fewer OHIP-14 items affected than White adults (rate ratio: 0.28; 95%CI: 0.08-0.94). CONCLUSION: This study found disparities in OHQoL between the three main ethnic groups in South East London. Asian adults had better and Black adults had similar OHQoL than White adults after accounting for demographic and social factors.

Comparing the profile of child patients attending dental general anaesthesia and conscious sedation services.

Aims To compare the profile of paediatric patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). A second aim was to explore whether there is an overlap between the two patient groups.Design This service evaluation study was based on sociodemographic and clinical data extracted from clinical records of patients attending dental appointments for GA or CS services at King's College Hospital. Sociodemographic and clinical differences between GA and CS groups were explored using logistic regression models.Results Data from 113 children (58 GA and 55 CS) were analysed. There were differences between groups in terms of age and numbers of quadrants and teeth treated, but not in terms of sex, ethnicity or deprivation scores. In the adjusted model, older children and those having more teeth treated were more likely to be in the GA than in the CS group. An overlap between the GA and CS groups was found, with 50% of children aged four to nine years having two to four teeth treated in both groups.Conclusion Age and number of teeth treated were the main characteristics associated with receiving care under GA or CS. Some overlap between children receiving dental treatment under GA or CS existed despite demographic and clinical differences between both groups.

Perceived learned skills and professional development of graduates from a master in dental public health programme.

INTRODUCTION: Assessing the impact of a training programme is important for quality assurance and further development. It also can helps with accountability and marketing purposes. This study evaluated the impact of King's College London (KCL) Master of Science programme in Dental Public Health in terms of graduates' perceived learned skills and professional development. METHODS: An online questionnaire was sent to individuals who completed successfully the KCL Master of Science programme in Dental Public Health and had a valid email address. Participants provided information on demographic characteristics, perceived learned skills (intellectual, practical and generic) and professional development (type of organisation, position in the organisation and functions performed at work before and after the programme). Learned skills' scores were compared by demographic factors in multiple linear regression models, and the distribution of responses on career development was compared using nonparametric tests for paired groups. RESULTS: Although all scores on learned skills were on the favourable side of the Likert scale, graduates reported higher scores for practical skills, followed by intellectual and generic skills. No differences in scores were found by sex, age, nationality or time since graduation. In terms of career development, there were significantly higher proportions of graduates working in higher education institutions and taking leadership/managerial roles in organisations as well as greater number and variety of functions at work after than before the programme. CONCLUSION: This online survey shows that the programme has had a positive impact on graduates in terms of perceived learned skills and professional development.

Role of Employment in 11-Year Changes of Clinical Oral Health: A Multilevel Longitudinal Analysis.

The objective was to investigate the role of employment in the 11-y changes of clinically determined oral health. We used data from the longitudinal Health 2011 Survey, including reinvited subjects from the Health 2000 Survey. Data were gathered by clinical oral examinations, interviews, and questionnaires of those aged 30 to 63 y ( n = 1,031) in 2000. Exposures were change in employment from baseline to follow-up and length of unemployment. Outcomes measures were the numbers of missing teeth, sound teeth, filled teeth, decayed teeth, and teeth with periodontal pockets (≥4 mm and ≥6 mm). Separate mixed-effects and conventional negative binomial regression models were fitted for each oral health outcome. Demographic, socioeconomic, and oral health-related behaviors were added as covariates to the analyses. The findings showed that unemployment was inconsistently associated with poorer clinically determined oral health over 11 y. These effects were attributed to income and education and, to a lesser extent, to oral health-related behaviors. The length of unemployment was also inconsistently associated with oral health. The study concluded that one socioeconomic factor, unemployment, had a partial impact on oral health. Knowledge Transfer Statement: The findings of this study can help clinicians and oral health policy makers to reorient oral health services toward those who are unemployed as a risk group for poor oral health. The research highlights the role of employment in the longitudinal changes of clinically determined oral health, taking into consideration other socioeconomic factors. The study concluded that unemployment seemed to have a role in social inequalities of oral health.

Birth Weight, Breastfeeding, Maternal Smoking and Caries Trajectories.

Evidence for the effects of low birth weight, breastfeeding and maternal smoking on childhood caries is mainly cross-sectional. We examined the association of these 3 putative early life factors with caries increment over a 4-y period among young children. We used data from a 4-y longitudinal caries-risk assessment study carried out among Scottish children. Early life factors were measured when children were aged 1 y (baseline). Caries assessment was repeated annually from ages 1 to 4, and the number of decayed, missing and filled primary tooth surfaces (dmfs) were used as a repeated outcome measure. The associations of low birth weight, breastfeeding and maternal smoking with dmfs at baseline and over time (trajectories) were assessed in linear mixed models. A total of 1,102 children were included in this analysis. Birth weight, breastfeeding and maternal smoking were not associated with dmfs at baseline. However, low birth weight and maternal smoking were associated with the rate of change in dmfs. By wave 4, the predicted mean difference in dmfs was 1.86 between children with low and normal birth weight, and 1.66 between children of smoking and non-smoking mothers. Children with low birth weight and smoking mothers had greater caries increments than those with normal weight and non-smoking mothers, respectively. There was no association between breastfeeding duration and childhood caries, either at baseline or over time.

The Shape of the Dose-Response Relationship between Sugars and Caries in Adults.

Dental caries is considered a diet-mediated disease, as sugars are essential in the caries process. However, some gaps in knowledge about the sugars-caries relationship still need addressing. This longitudinal study aimed to explore 1) the shape of the dose-response association between sugars intake and caries in adults, 2) the relative contribution of frequency and amount of sugars intake to caries levels, and 3) whether the association between sugars intake and caries varies by exposure to fluoride toothpaste. We used data from 1,702 dentate adults who participated in at least 2 of 3 surveys in Finland (Health 2000, 2004/05 Follow-up Study of Adults' Oral Health, and Health 2011). Frequency and amount of sugars intake were measured with a validated food frequency questionnaire. The DMFT index was the repeated outcome measure. Data were analyzed with fractional polynomials and linear mixed effects models. None of the 43 fractional polynomials tested provided a better fit to the data than the simpler linear model. In a mutually adjusted linear mixed effects model, the amount of, but not the frequency of, sugars intake was significantly associated with DMFT throughout the follow-up period. Furthermore, the longitudinal association between amount of sugars intake and DMFT was weaker in adults who used fluoride toothpaste daily than in those using it less often than daily. The findings of this longitudinal study among Finnish adults suggest a linear dose-response relationship between sugars and caries, with amount of intake being more important than frequency of ingestion. Also, daily use of fluoride toothpaste reduced but did not eliminate the association between amount of sugars intake and dental caries.

Relationship between family characteristics and children's regular toothbrushing with fluoride toothpaste.

OBJECTIVE: To examine the association between toothbrushing habits of 8-9 year-olds and maternal behaviours and attitudes towards oral health in a sample of Japanese population. METHODS: Cross-sectional data on mothers' behaviours and attitudes towards oral health and children's toothbrushing habits were collected from 378 mother-child pairs by self-administered questionnaires. Logistic regression examined the association of children's daily brushing with fluoride toothpaste with family characteristics, mother's behaviour (toothbrushing frequency, use of interdental aids and supervision of children's toothbrushing), and mother's attitudes towards oral health (priority for toothbrushing and dental fear). RESULTS: Children's favourable brushing habits were positively associated with child's gender (female) (OR 1.29; 95%CI:1.09,1.53), child's order of birth (first) (OR 1.53; 95%CI:1.05,2.23), maternal brushing habits (OR 2.42; 95%CI:1.73,3.40), and maternal dental fear (OR 1.45; 95%CI:1.10,1.90). None of the other examined factors were significantly associated with child toothbrushing behaviour. CONCLUSIONS: Matemal oral hygiene practice and attitude towards dentists appear to be important predictors of children's toothbrushing habits in this Japanese community sample.