Food processing and its association with dental caries: Data from NHANES 2011-2014.

OBJECTIVE: To assess whether proportional contribution of unprocessed or minimally processed, processed or ultra-processed foods to daily energy intake is associated with dental caries in US adults. METHODS: This secondary cross-sectional analysis included adults aged 20 to 59 years old with complete oral examinations, using data gathered from cycles 2011-2012 and 2013-2014 of the continuous National Health and Nutrition Examination Survey (NHANES). Dietary recall data were categorized according to the NOVA classification into four groups: unprocessed or minimally processed foods (Group 1), processed culinary ingredients (Group 2), processed foods (Group 3) and ultra-processed foods (Group 4). The proportional contribution of each of these groups to mean daily energy intake was calculated and then cut into quartiles (Group 1, Group 3 and Group 4) or tertiles (Group 2). Two separate measures were used to assess dental caries: the decayed, missing, filled teeth (DMFT) index and, after exclusion of edentulous participants, prevalence of untreated caries. Poisson regression was used to model DMFT, while logistic regression was used to model the prevalence of untreated dental caries. Models were calculated for each NOVA group. All models were controlled for age, gender, race/ethnicity, level of education, income, access to oral health services, body mass index, smoking status and total energy intake. Analyses took into account NHANES sampling weights. RESULTS: We analysed data from 5720 individuals, of whom 123 (2.2%) were edentulous. Mean DMFT was 9.7 (± 0.2), while the prevalence of untreated dental caries was 26.0%. Mean daily energy intake was 2170 kcal (± 17). Mean contribution to overall daily energy intake was 28.6% (± 0.5) for G1 foods, 4.3% (± 0.1) for G2 foods, 10.1% (± 0.2) for G3 foods and 56.9% (± 0.5) for G4 foods. A higher intake of G3 was associated with lower DMFT at the fourth quartile (0.89; 95%: CI 0.81-0.96), while a higher intake of G4 was associated with a higher DMFT at the fourth quartile (1.10; 95% CI: 1.04-1.16). In the adjusted models for untreated dental caries, no statistically significant associations were found with any of the NOVA groups. CONCLUSION: Higher proportional intake of NOVA groups is only weakly associated with dental caries. Widespread exposure to a highly ultra-processed diet may explain these weak associations.

Trends of mortality due to oral and oropharyngeal cancers in Uruguay from 1997 to 2014

BACKGROUND: To analyze the trends of oral and oropharyngeal cancer mortality in Uruguay between 1997 and 2014 according to sex and age groups and its possible association with sociodemographic factors. MATERIAL AND METHODS: A time-series ecological study using secondary data was performed. The data about mortality due to oral and oropharyngeal cancers were obtained from the Statistics Vitals Department of the Public Health Ministry of Uruguay. To estimate the mortality trends of the historical series, by sex, anatomical site and age groups, linear regressions generated by the Prais-Winsten procedure were used. RESULTS: The analysis of mortality trends for oral cavity and oropharyngeal cancers in Uruguay indicated that the global mortality rate was stable over the studied period. The women's mortality rate increased from 0.51 per 100,000 in 1997 to 0.65 per 100,000 in 2014 while for men, rates per 100,000 went from 3.22 in 1997 to 2.20 per 100,000 in 2014. Mortality from oral cancer in men decreased between 1997 and 2014. Mortality by oropharyngeal cancer, irrespective of sex, remained stable. Analysis by cancer site revealed decreasing trends tumors situated in the base of the tongue and gum. Years of education, unemployment, smoking and Gini index were not associated with mortality trends. CONCLUSIONS: The overall mortality from oral and oropharyngeal cancer in Uruguay has remained constant in the period between 1997 and 2014. Oral cancer mortality decreased in men and increased in women and decreased at the base of the tongue. It's necessary to continue monitoring the behavior of these diseases

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High fluoride dentifrice for preventing and arresting root caries in community-dwelling older adults: A randomized controlled clinical trial.

OBJECTIVE: Self-administered non-invasive therapies with high-fluoride dentifrices are an attractive alternative to traditional restorative management of root carious lesions (RCLs), but the available evidence is still scarce, particularly in community-dwelling elders. The aim of this randomized controlled trial (RCT) was to compare the effectiveness of toothbrushing with 5,000 ppm versus 1,450 ppm fluoridated dentifrice (F- dentifrice) on preventing and arresting RCLs, in community-dwelling elders. METHODS: A two years double-blinded RCT was carried out with 345 independently-living older adults, with at least one tooth with RCL. Participants were instructed to brush twice per day with either high-fluoride (5,000 ppm F) or the control dentifrice (1,450 ppm F). Incidence of new and arrested existing RCLs was recorded at two years and compared with the baseline data. Linear mixed regression model with repeated measures were used to test differences between groups (p < 0.05). RESULTS: The percentage of teeth with active lesions varied significantly at two years, but in opposite directions for both groups. While the control group significantly increased the mean percentage of RCLs activity from baseline to two years, from 24.32% to 40.52%, the intervention decreased the percentage of activity from 29.74% to 3.72%. The incidence of RCL was 93.5% and 35.2% in participants of the 1,450 ppm and 5,000 ppm in the F- dentifrice groups, respectively, with a relative risk (RR) of 0.10 [CI: 0.05 - 0.19]. CONCLUSION: Non-invasive treatment with 5,000 ppm F dentifrice is more effective than conventional dentifrices in preventing and arresting RCLs in community dwelling elders. ClinicalTrials.gov NCT02647203. CLINICAL SIGNIFICANCE: RCLs can be effectively prevented and arrested with the use of 5,000 ppm F dentifrice. Oral health programs directed to community-dwelling older adults might benefit from the inclusion of high fluoride dentifrice in their portfolio.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly.

PURPOSE: Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices. METHODS: To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months. RESULTS: An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006). CONCLUSIONS: Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.

Decomposing early and adult life social position effects on oral health and chronic diseases in a cross-sectional study of Southern Brazil.

OBJECTIVES: As the socio-economic trajectory can influence on individual health during the life course, the aim of this study was to test a model of socio-economic life course effects on chronic diseases, tooth loss and on oral health-related quality of life using structural equation model (SEM) to decompose direct and indirect effects. METHODS: This cross-sectional study was performed in southern Brazil, within public healthcare users with 18 years old or more (n = 433). Latent variables were the Oral Health Impact Profile (OHIP), Childhood Socio-economic Status (SESC) and Adulthood (SESA), and Chronic Diseases (CD), and observed variables were sex, age, smoking status and tooth loss. The statistical analysis was performed using structural equation modelling (SEM) using WLSMV estimator. For the final model, we kept only plausible significant paths with P < 0.30. RESULTS: Final model presented an adequate fit: RMSA 0.03, Comparative Fit Index (CFI) 0.97, TLI 0.97, and Weighted Root Mean Square Residual (WRMR) 1.19. The direct effect from SESC to tooth loss was ß = -0.08 (P = 0.19) and the indirect was ß = -0.12 (P = 0.02). The indirect effect from SESC to OHIP was ß = -0.14 (P = 0.01) and there is no direct effect. The direct effect from SESA to tooth loss was ß = -0.21 (P < 0.01) and there is no indirect effect. The direct effect from SESA to OHIP was ß = -0.14 (P = 0.05). The association of SESA on SESC was ß = 0.59 (P < 0.01). CONCLUSIONS: SESC had indirect effects on OHIP and number of teeth via SESA, supporting the chain of effects theory, but not for chronic diseases.

Oral health of the Latin American elders: What we know and what we should do-Position paper of the Latin American Oral Geriatric Group of the International Association for Dental Research.

OBJECTIVE: The purpose of this review was to gather information and discuss oral health status of older people in the Latin American and Caribbean region (LAC). BACKGROUND: Scarce data are available to portrait the oral situation of older people in the region. MATERIAL AND METHODS: This review paper is the result of a meeting of the IADR's Latin American Geriatric Oral Research Group held in Porto Alegre, Brazil, in November of 2016, part of the activities of an IADR Regional Development Programme (RDP). A group of researchers from 8 countries of LAC held a discussion using 5 questions related to the oral health situation of older Latin Americans, the most appropriate strategies to face the problem and the challenges for the future, with an open discussion format. In a second step, a group of 6 experts refined the answers and reviewed the existent literature. RESULTS: The review of the evidence revealed that only a few LAC countries have information, which suggests the need for multinational efforts to understand the oral health status and programmes in place. Of the few studies available, it is possible to observe poor oral health as a common feature of older adults in the region. CONCLUSION: There is a need for the development of national surveys and standardised tools for the assessment of oral health in older adults. Also, intense advocacy to modify and influence public health policies in the different countries of the LAC is strongly recommended.

Four-year incidence rate and predictors of root caries among community-dwelling south Brazilian older adults.

OBJECTIVE: This study aimed to assess the incidence density (ID) of new root caries lesions and restorations among community-living south Brazilian older adults and to assess its association with predictor variables. METHODS: We conducted a prospective cohort with a random sample of elders from the municipality of Carlos Barbosa, in south Brazil. Trained dentists performed interviews and oral examinations in 388 individuals at baseline, of which 273 were retained at follow-up 4 years later. Our outcome was root caries ID, with 100 root-years as its unit of measure. Demographic, biological and lifestyle predictors were tested with Poisson regression. RESULTS: The mean number of roots at baseline among participants was 7.0 (SD ± 4.9) and the incidence rate per 100 root-year 4.9 (SD ± 8.9). Incidence of root caries among these older Brazilians was of 47.3%. The associated factors with the incidence of root caries were age, geographic location of residence, frequency of tooth brushing and stimulated saliva flow rate. CONCLUSION: Age, external environment, personal practices and oral status were predictors of the incidence of root caries. Preventive strategies including the use of fluorides and instruction to improve the attitude and behaviour towards oral hygiene are needed.

Impact of Bariatric Surgery on the Saliva of Patients with Morbid Obesity.

BACKGROUND: The oral condition of obese patients may change following bariatric surgery owing to adverse effects that cause alterations in the oral cavity. The aim of this study was to evaluate the impact of bariatric surgery on the saliva of patients with morbid obesity. METHODS: Whole saliva samples were collected from 27 patients with morbid obesity (BMI >40 kg/m(2)), prior to and 6 months after bariatric surgery. Stimulated salivary flow rate, pH, buffering capacity, and microbial levels of mutans streptococci, Lactobacillus spp., and Candida albicans were analyzed from saliva. RESULTS: Values of all salivary variables before and after bariatric surgery were within the normal range, except for the level of C. albicans, which was elevated at both times. An increase in the level of mutans streptococci was observed after bariatric surgery (p < 0.05). CONCLUSIONS: The results suggest that the salivary levels of mutans streptococci increase following bariatric surgery in morbidly obese patients.

Oral hygiene caregivers' educational programme improves oral health conditions in institutionalised independent and functional elderly.

OBJECTIVE: The goal of this study was to determine the impact of an oral hygiene education programme for caregivers on the oral health of institutionalised elderly and to examine the effect of disability and low muscle strength on programme outcomes. MATERIALS AND METHODS: The subjects of this study were geriatric patients (n = 80) from a nursing home. Katz Index for activities of daily living, handgrip strength and mucosal-plaque score (MPS) was evaluated at baseline and 1 year after intervention. The intervention consisted of an educational programme and specific guidelines for caregivers (to perform oral hygiene for dependent elderly and to supervise the independent elderly during oral hygiene practices). Differences on MPS were evaluated using a paired-sample t-test. A stratified analysis was carried out to identify differences in response to the programme according to the Katz Index and handgrip strength of elderly. RESULTS: The MPS was significantly reduced (p = 0.001) at follow-up; however, a separate analysis showed that only the independent elderly (p = 0.002) and those with normal muscle strength (p = 0.006) showed a reduction in MPS during the follow-up examination. CONCLUSION: The oral hygiene education programme for caregivers resulted in a positive impact on oral hygiene of the independent and functional elderly.

Added sugars and periodontal disease in young adults: an analysis of NHANES III data.

BACKGROUND: Added sugar consumption seems to trigger a hyperinflammatory state and may result in visceral adiposity, dyslipidemia, and insulin resistance. These conditions are risk factors for periodontal disease. However, the role of sugar intake in the cause of periodontal disease has not been adequately studied. OBJECTIVE: We evaluated the association between the frequency of added sugar consumption and periodontal disease in young adults by using NHANES III data. DESIGN: Data from 2437 young adults (aged 18-25 y) who participated in NHANES III (1988-1994) were analyzed. We estimated the frequency of added sugar consumption by using food-frequency questionnaire responses. We considered periodontal disease to be present in teeth with bleeding on probing and a probing depth ≥3 mm at one or more sites. We evaluated this outcome as a discrete variable in Poisson regression models and as a categorical variable in multinomial logistic regression models adjusted for sex, age, race-ethnicity, education, poverty-income ratio, tobacco exposure, previous diagnosis of diabetes, and body mass index. RESULTS: A high consumption of added sugars was associated with a greater prevalence of periodontal disease in middle [prevalence ratio (PR): 1.39; 95% CI: 1.02, 1.89] and upper (PR: 1.42; 95% CI: 1.08, 1.85) tertiles of consumption in the adjusted Poisson regression model. The upper tertile of added sugar intake was associated with periodontal disease in ≥2 teeth (PR: 1.73; 95% CI: 1.19, 2.52) but not with periodontal disease in only one tooth (PR: 0.85; 95% CI: 0.54, 1.34) in the adjusted multinomial logistic regression model. CONCLUSION: A high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated noncommunicable diseases.

Hand function and oral hygiene in older institutionalized Brazilians.

OBJECTIVES: To evaluate whether the oral hygiene of institutionalized older people differs significantly between groups of participants with different degrees of hand function. DESIGN: Cross-sectional study. SETTING: Residents of a long-term institution of Porto Alegre, Brazil. PARTICIPANTS: Forty-nine institutionalized older people. Subjects restricted to bed or with Mini-Mental State Examination (MMSE) scores less than 15 were excluded. MEASUREMENTS: Dental (Silness and Löe Index) and denture plaque (Modified Ambjornsen Plaque Index) scores were assessed as a measure of oral hygiene. Hand functions were assessed using the Jebsen-Taylor and the Purdue pegboard tests. Participants were grouped according to their levels of hand function (regarded as good if test values were at the median or higher in the case of Purdue pegboard test and below the median in the case of Jebsen-Taylor test). Existence of differences between groups was checked using univariate analysis of variance, adjusting for age, sex and cognitive status according to MMSE. RESULTS: Dentate participants with poor hand function according to the Dominant Hand Purdue test harbored significantly more dental plaque after adjustment for age, sex, and cognitive status. Complete denture wearers with poor hand function according to the Dominant Hand and Sum of Three Steps Purdue tests and the total Jebsen-Taylor test also had significantly more denture plaque after adjustment. CONCLUSION: The results support the notion that hand function plays a central role in oral hygiene, mainly removal of dental and denture plaque, in institutionalized older people.

Reproducibility of a hemi mandible positioning device and a method for measuring alveolar bone loss area in mice.

The objective of this study was to determine the reproducibility of a positioning device and a method for measuring the area of alveolar bone loss (ABL) in hemi mandibles of mice. Mucoperiosteal flaps were raised in CF1 Mus domesticus mice (n = 10) on the buccal aspects of the left side of the mandibles. Twenty-one days after surgery, the animals were sacrificed, and the mandibles were resected and stained with 1% toluidine blue. Two positioning devices, one for the buccal and the other for lingual aspect, were fabricated to keep the hemi mandibles in a standard position. The reliabilities of the positioning device and the method for measuring ABL area were analyzed using two series of pictures. The photographs were digitized and ABL measured as the exposed root area. Measurements were performed by two blinded examiners using image analysis software. Intra- and inter-examiner reproducibility of the positioning method ranged from -1.5 to +1.33 mm, while intra- and inter-examiner reproducibility of the measurement technique ranged from -3.37 to 14.70. Our results indicate that, due to the small variation observed in ABL area assessment, the positioning device and method for measuring ABL area represent useful techniques for evaluating ABL in mice.

Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older.

BACKGROUND: The role of psychoneuroimmunological factors in oral hygiene has been overlooked in the dental literature. Our objective was to evaluate the effects of stress, depression, and cortisol levels in dental plaque accumulation and gingivitis in a population of individuals aged >or=50 years. METHODS: In this cross-sectional study, 230 subjects, selected from caregivers of demented patient groups and from social activities groups of Porto Alegre, Brazil, were evaluated. Stress was evaluated with the Lipp stress inventory, whereas depressive symptoms were assessed using the Beck depression inventory. Three saliva samples (at 8, 12, and 20 hours) were collected for cortisol analysis by means of radioimmunoassay. Cortisol levels were expressed as the area under the curve of the three samples for each patient. Multivariate logistic regression was performed with the visible plaque index and gingival bleeding index as outcomes. RESULTS: The mean age of subjects was 61.6 +/- 8.2 years, mean monthly income in United States dollars (US dollars) was US 668 +/- 590, and mean cortisol level was 22.1 +/- 33.7 nmol/l. A total of 51.5% of the individuals were caregivers; 9.4% were smokers, and 25.5% used interdental floss/brush. Being a caregiver (odds ratio [OR] = 3.97; 95% confidence interval [95% CI] = 2.08 to 7.54), using an interdental brush (OR = 0.23; 95% CI = 0.11 to 0.47), cortisol (OR = 2.03; 95% CI = 1.09 to 3.81), and stress (OR = 1.45; 95% CI = 1.03 to 2.02) were all significantly associated with visible plaque index >mean (43%). Being a caregiver (OR = 2.35; 95% CI = 1.13 to 4.86), using an interdental brush (OR = 0.32; 95% CI = 0.13 to 0.77), smoking (OR = 0.26; 95% CI = 0.08 to 0.89), stress (OR = 1.78; 95% CI =1.31 to 2.38), and visible plaque index (mean) (OR = 12.87; 95% CI = 6.29 to 26.31) were significantly associated with a gingival bleeding index > mean (37%). CONCLUSION: Stress was a significant risk indicator of elevated levels of plaque and gingivitis, whereas cortisol was a risk indicator of plaque in the sample after controlling for confounders.

Alveolar bone loss and aging: a model for the study in mice.

BACKGROUND: Several animal studies have shown a positive correlation between aging and alveolar bone loss (ABL). The purpose of this study was to develop a model for the study of ABL in mice and aging. METHODS: Mucoperiosteal flap surgery (MFS) was performed on the buccal aspect of the left side of the mandible (BL) in 72 CF(1) Mus domesticus mice and divided into three groups as follows: males, breeding (non-virgin) females, and virgin females. The MFS was performed in 3-, 6-, 9-, and 12-month-old animals under anesthesia. The buccal aspects of right hemimandibles were used as controls (BR). Animals were sacrificed under anesthesia 21 days after surgery. Mandibles were removed, defleshed, stained with toluidine blue, and photographed in a microscope. The photographs were digitized, and ABL was measured as the exposed root surface area (mm(2)). Blinded measurements were performed using a computer-assisted image analysis system. RESULTS: In terms of alveolar bone loss, the BL (operated) area showed a significant difference (paired Student t test; P <0.001) when compared to the BR area in all three groups. Sex and breeding differences were not observed in this experiment. ABL in the left hemimandibles was significantly larger in 3- (mean: 0.70; 95% confidence interval [CI]: 0.59 to 0.80) and 12-month-old animals (mean: 0.58; 95% CI: 0.46 to 0.71) than in 6- (mean: 0.39; 95% CI: 0.33 to 0.46) and 9-month-old animals (mean: 0.42; 95% CI: 0.35 to 0.48); P <0.001. CONCLUSION: The results suggest that 3-month-old CF(1) mice, in a sex and breeding independent process, could be a useful model for provoked alveolar bone loss studies in aging.

Impacto da perda dentária na qualidade de vida de idosos independentes / The impact of tooth loss on quality of life in independent elderly people

O objetivo deste estudo foi avaliar o impacto da perda dentária na qualidade de vida em indivíduos idosos. Foram avaliados 28 idosos independentes do grupo de terceira idade do Centro Humanístico Vida, de Porto Alegre, RS. A amostra foi por conveniência e o protocolo foi aprovado pelo CEP-PUCPRS. Os indivíduos foram avaliados quanto ao número de dentes presentese, posteriormente, divididos em 2 grupos de acordo com o seguinte critério: grupo 1 = indivíduos com 0 a 7 dentes e grupo 2 = indivíduos com 8 ou mais dentes. Para determinar a qualidade de vida foi utilizado Inventário de qualidade de vida WHOQoL-breve. Diferenças entre grupos foram verificadas com o teste de Mann-Whiney, e a consistência interna do WHOQoL-breve com o teste Cronbach . O valor para regeição da hipótes nula foi p<0,05. O número médio de dentes dos indivíduos do grupo 1 foi 2,2 e do grupo 2 foi 10,7. O número de dentes naurais foi importante para determinar diferenças relacionadas à qualidade de vida(domínio meio ambiente), pois os idosos que possuiam 8 ou mais dentes apresentaram uma qualidade de vida melhor.