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1.
Community Dent Health ; 38(3): 158-160, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34473431

RESUMO

Since the discovery of the caries preventive benefits of fluoride, it has been the cornerstone of preventive programs for children and adults. Water fluoridation, the controlled addition of a precise amount of fluoride to community water systems to the level beneficial for dental health, is one of the most effective and safe means to deliver fluoride (McDonagh et al., 2000; National Health and Medical Research Council, 2017). In 1999, the US Centers for Disease Control and Prevention (CDC) named fluoridation of drinking water as one of ten great public health achievements in the 20th Century, alongside vaccination, control of infectious diseases, a decline in death from coronary heart disease and other accomplishments (CDC, 2011). This is a remarkable recognition of the impact of dental conditions and the importance of a dental preventive program.


Assuntos
Cárie Dentária , Fluoretação , Adulto , Criança , Cárie Dentária/prevenção & controle , Fluoretos , Humanos , Saúde Pública
2.
JDR Clin Trans Res ; : 23800844211027489, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315314

RESUMO

OBJECTIVE: Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults. METHODS: Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity. RESULTS: A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income. CONCLUSION: The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.

3.
J Infect Dis ; 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33974708

RESUMO

BACKGROUND: No studies have explored the association between pneumococcal nasopharyngeal density and severe pneumonia using the WHO 2013 definition. In Lao People's Democratic Republic (Lao PDR), we determine the association between nasopharyngeal pneumococcal density and severe pneumonia in children. METHOD: A prospective observational study was undertaken at Mahosot Hospital, Vientiane from 2014 to mid-2018. Children <5 years admitted with acute respiratory infections (ARIs) were included. Clinical and demographic data were collected alongside nasopharyngeal swabs for pneumococcal quantification by lytA qPCR. Severe pneumonia was defined using the 2013 WHO definition. For pneumococcal carriers, a logistic regression model examined the association between pneumococcal density and severe pneumonia, after adjusting for potential confounders including demographic and household factors, 13-valent pneumococcal conjugate vaccine status, respiratory syncytial virus co-detection and pre-admission antibiotics. RESULTS: Of 1,268 participants with ARI, 32.3% (n=410) had severe pneumonia and 36.9% (n=468) had pneumococcal carriage. For pneumococcal carriers, pneumococcal density was positively associated with severe pneumonia (adjusted odds ratio 1.4; 95% CI 1.1-1.8; p=0.020). CONCLUSIONS: Among children with ARIs and pneumococcal carriage, pneumococcal carriage density was positively associated with severe pneumonia in Lao PDR. Further studies may determine if pneumococcal density is a useful marker for pneumococcal conjugate vaccine impact on childhood pneumonia.

4.
J Dent Res ; 100(11): 1243-1250, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33899569

RESUMO

The study aimed to quantify the excess risk of interaction between high free sugars (sugars) intake and lack of exposure to water fluoridation on child dental caries. Data from the Australian National Child Oral Health Study, a population-based survey of 24,664 children aged 5 to 14 y, were collected using parental questionnaires and oral epidemiological examinations by trained examiners. Information on socioeconomic status, dental health behaviors, and dental service use was used as covariates. The number of servings of sugars-containing foods and drinks consumed in a usual day was assessed as the main exposure, categorized into 5 groups. Residential history was used to calculate lifetime exposure to fluoridated water (LEFW), categorized as low (<25%), medium (25% to <75%), or high (75%-100%). Caries prevalence (dmfs/DMFS >0) and experience (dmfs/DMFS) in the primary (ages 5-10 y) and permanent (ages 8-14 y) dentitions were the main dependent variables. The association of sugars intake and LEFW with each outcome was estimated in multivariable log-Poisson regression models with robust standard error estimation, adjusted for covariates. The relative excess risk due to interaction (RERI) between sugars intake and LEFW was estimated. Strong positive gradients in all outcomes were observed across sugars intake groups. Relative to the lowest intake group, the 3 highest intake groups had significantly higher adjusted prevalence ratios for having caries and higher adjusted mean ratios of caries experience in both dentitions, after controlling for all covariates. LEFW strongly and consistently attenuated the effects of all levels of sugars intake on the outcomes. RERI estimates indicated that a combination of lack of exposure to fluoridated water and high sugars intake resulted in greater excess risk of primary and permanent caries than if there was no interaction. Evidently, children with high sugars intakes and low exposure to water fluoridation are at disproportionately higher risk of dental caries.

5.
Aust Dent J ; 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33899961

RESUMO

BACKGROUND: Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between the 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH). METHODS: Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15 years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences were calculated between the 2004-06 and 2017-18 NSAOHs. Ninety-five per cent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys. RESULTS: In 2004-06, 229 Indigenous and 13 882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15 392 non-Indigenous Australians provided self-report data, and 84 and 4937 of them had dental examinations respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of: inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%). CONCLUSIONS: The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.

6.
JDR Clin Trans Res ; 6(3): 317-323, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32731782

RESUMO

INTRODUCTION: Our ability to address child oral health inequalities would be greatly facilitated by a more nuanced understanding of whether underlying disease experience or treatment opportunities account for a larger share of differences between social groups. This is particularly relevant in the context of population subgroups who are socially marginalized, such as Australia's Indigenous population. The decayed, missing, and filled (dmf) surfaces index is at once a reflection of dental caries experience (d) and its management (m and f). OBJECTIVES: To 1) describe socioeconomic inequalities in dental caries experience and its management among Indigenous and non-Indigenous children and 2) compare these inequalities using absolute and relative measures. METHODS: Data were from the Australian National Child Oral Health Study 2012-2014. Absolute and relative income inequalities were assessed for overall dmfs and its individual components (ds, ms, fs) using adjusted means and health disparity indices (Slope Index of Inequality [SII] and Relative Index of Inequality [RII]). RESULTS: Mean dmfs among Indigenous children aged 5 to 10 y was 6.4 (95% confidence interval [CI], 5.4-7.4), ranging from 2.3 in the highest to 9.1 in the lowest income group. Mean dmfs among non-Indigenous children was 2.9 (95% CI, 2.8-3.1), ranging from 1.9 in the highest to 4.2 in the lowest income group. Age- and gender-adjusted social gradients for Indigenous children were evident across all dmfs components but were particularly notable for ds (SII = -4.6, RII = -1.7) and fs (SII = -3.2, RII = -1.5). The social gradients for non-Indigenous children were much lower in magnitude: ds (SII = -1.8, RII = -1.6) and fs (SII = -0.7, RII = -0.5). CONCLUSION: Our findings suggest that socioeconomic disadvantage may translate into both higher disease experience and increased use of dental services for both Indigenous and non-Indigenous groups, with the social gradients being much more amplified among Indigenous children. KNOWLEDGE TRANSFER STATEMENT: The findings of this study demonstrate the magnitude of disparities in dental caries among children by population groups in Australia. Our results suggest that the relationship between socioeconomic disadvantage and poor oral health is more deleterious among Indigenous than non-Indigenous children. Tackling upstream determinants of health might not only affect population patterns of health and disease but also mitigate the overwhelming racial inequalities in oral health between Indigenous and non-Indigenous Australians.

7.
JDR Clin Trans Res ; 6(1): 68-76, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32176558

RESUMO

INTRODUCTION: Many studies have investigated associations between demographic, socioeconomic status (SES), behavioral, and clinical factors and parental ratings of child oral health. Caries experience, pain, missing teeth, malocclusions, and conditions and treatments likely to negatively affect the child or family in the future have been consistently associated with poorer parental ratings. In contrast, effect sizes for associations between demographic and SES indicators (race/ethnicity, country of birth, family structure, household income, employment status, and parental education levels) and parental ratings vary greatly. OBJECTIVES: The primary objectives of this study were to estimate effect sizes for associations between demographic and SES variables and parental ratings of child oral health and then to consider possible causal implications. METHODS: This article uses a nationally representative data set from 24,664 Australian children aged 5 to 14 y, regression analyses guided by a directed acyclic graph causal model, and sensitivity analyses to investigate effects of demographic and SES factors on parental ratings of oral health. RESULTS: One in 8 children had oral health rated as fair or poor by a parent. Indigenous children, older boys, young children with a migrant parent, children from single-parent families, low-income households and families where no parent worked full-time, and children whose parents had lower education levels were much more likely to receive a fair or poor parental oral health rating in crude and adjusted models. CONCLUSION: This cross-sectional study helps to clarify inconsistent findings from previous research and shows many demographic and SES variables to be strong determinants of parental ratings of child oral health, consistent with the effects of these variables on other health outcomes. Sensitivity analyses and consideration of the potential for chance and bias to have affected these findings suggest that many of these associations may be causal. KNOWLEDGE TRANSFER STATEMENT: Based on regression analyses driven by a directed acyclic graph causal model, this research shows a strong impact of demographic and socioeconomic determinants on parental ratings of child oral health, consistent with associations between these variables and other oral and general health outcomes. Many of these associations may be causal. We demonstrate the value of causal models and causal thinking when analyzing complex multilevel observational data.


Assuntos
Saúde Bucal , Pais , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Demografia , Humanos , Masculino , Fatores Socioeconômicos
8.
JDR Clin Trans Res ; 6(2): 242-250, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32516023

RESUMO

INTRODUCTION: Oral health affects quality of life. Many studies have investigated the factors associated with oral health-related quality of life (OHRQoL). Little is known about OHRQoL of adults living in rural and remote areas of India, where many have lower levels of education and limited availability of oral health care services. OBJECTIVES: To determine the prevalence, extent, and severity of OHRQoL impacts associated with psychosocial factors, functional dentition, and patterns of dental visits among rural Indian adults between the ages of 35 and 54 y. METHODS: A cross-sectional study was conducted with a multistage stratified sampling strategy targeting 35- to 54-year-olds. Interviews and oral examinations were performed to collect data on sociodemographic variables, Oral Health Impact Profile-14 (OHIP-14), patterns of dental visits, stress, tobacco and alcohol use, and dentition status. Univariate, bivariate, and multivariable analyses were done to determine the factors associated with prevalence, extent, and severity of OHIP-14 using SAS version 9.3. RESULTS: There were 873 participants. Prevalence, extent, and severity of OHIP-14 were 13.4%, 0.5 (0.4-0.7), and 11.8 (11.2-12.5), respectively. The OHIP-14 impacts reported were not severe and mostly affected physical functioning. Levels of education, income, and number of functional teeth (FT) were inversely associated and last dental visit within the previous year was positively associated with prevalence, extent, and severity of OHIP-14. The prevalence of 1 or more oral health impacts was nearly 13% among rural middle-aged adults in India. CONCLUSIONS: Low socioeconomic conditions, dental visits, and FT ≤19 were positively associated with prevalence, extent, and severity of oral health impacts. KNOWLEDGE TRANSFER STATEMENT: This article provides data regarding OHRQoL of people in rural areas of a developing country. The study was intended to determine the factors associated with OHRQoL in rural people who are less educated and living in areas with minimal oral health care facilities. The findings of this study could potentially facilitate further research and health promotional activities for rural people of developing countries.


Assuntos
Saúde Bucal , Qualidade de Vida , Adulto , Estudos Transversais , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Prevalência
9.
J Dent Res ; 99(12): 1321-1331, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32680439

RESUMO

Birth cohorts are those among observational studies that provide understanding of the natural history and causality of diseases since early in life. Discussions during an International Association for Dental Research symposium in London, United Kingdom, in 2018, followed by a workshop in Bangkok, Thailand, in 2019, concluded that there are few birth cohort studies that consider oral health and that a broader discussion on similarities and differences among those studies would be valuable. This article aims to 1) bring together available long-term data of oral health birth cohort studies from the low, middle, and high-income countries worldwide and 2) describe similarities and differences among these studies. This work comprises 15 studies from all 5 continents. The most studied dental conditions and exposures are identified; findings are summarized; and methodological differences and similarities among studies are presented. Methodological strengths and weaknesses are also highlighted. Findings are summarized in 1) the negative impact of detrimental socioeconomic status on oral health changes over time, 2) the role of unfavorable patterns of dental visiting on oral health, 3) associations between general and oral health, 4) nutritional and dietary effects on oral health, and 5) intergenerational influences on oral health. Dental caries and dental visiting patterns have been recorded in all studies. Sources of fluoride exposure have been documented in most of the more recent studies. Despite some methodological differences in the way that the exposures and outcomes were measured, some findings are consistent. Predictive models have been used with caries risk tools, periodontitis occurrence, and permanent dentition orthodontic treatment need. The next steps of the group's work are as follows: 1) establishing a consortium of oral health birth cohort studies, 2) conducting a scoping review, 3) exploring opportunities for pooled data analyses to answer pressing research questions, and 4) promoting and enabling the development of the next generation of oral health researchers.


Assuntos
Cárie Dentária , Saúde Bucal , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Humanos , Londres , Tailândia/epidemiologia , Reino Unido
10.
Community Dent Health ; 37(2): 132-137, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32212435

RESUMO

OBJECTIVE: Improving the oral health of Aboriginal children is an Australian priority. Public policy recommends the development of evidence-based, culturally competent oral health promotion programs. Positive health outcomes are more likely for Aboriginal people when programs are co-designed with the community and tailored to local needs. This study aims to determine the impact of a community-led oral health promotion program for Aboriginal children in rural and remote communities. BASIC RESEARCH DESIGN: Consecutive surveys. Baseline data were collected on the oral health of Aboriginal children aged five-12 years in rural and remote communities in Central Northern New South Wales in 2014. Then, an evidence-based oral health promotion program was co-designed with local Aboriginal communities. It included daily toothbrushing, water bottle program, regular application of fluoride varnish, regular distribution of toothbrushes and fluoride toothpaste and dental health education and commenced in 2016 in three schools in the region. In 2018, oral health status and oral hygiene behaviours of participating children were compared against baseline data to evaluate the program. RESULTS: There was a significant reduction in tooth decay, plaque scores and gingivitis. The mean number of teeth affected by tooth decay was 4.13, compared to 5.31 in 2014. An increase was also seen in positive oral hygiene behaviour. CONCLUSIONS: The co-design elements of the program are critical to its success. Engaging local Aboriginal communities to co-design and deliver oral health promotion can reduce the burden of tooth decay experienced by Aboriginal children.


Assuntos
Promoção da Saúde , Saúde Bucal , Austrália , Criança , Pré-Escolar , Humanos , New South Wales , Grupo com Ancestrais Oceânicos
11.
Colloids Surf B Biointerfaces ; 189: 110852, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32062110

RESUMO

Nile tilapia skin, an abundant waste from fish processing, can be used for collagen extraction, which has a high aggregated value for biomedical applications. Collagen extraction was conducted under different reaction conditions (time, temperature, and concentration of acetic acid) in order to optimize the yield without compromising the integrity of the collagen. Temperature and time were responsible for increased yield. The extraction at 4 and 20 °C produced the acid-solubilized collagen (ASC) with the intact triple helix and was analysed by Fourier-transform infrared spectroscopy (FT-IR) and circular dichroism (CD). The optimized ASC (which used 0.35 mol/L of acetic acid at 20 °C) was consumed to obtain for the first-time fish-based hydrogels with hyaluronic acid (HA) crosslinked with 1-ethyl-3-(3-dimethylaminopropryl carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The hydrogel was characterized by FT-IR, rheology, swelling, and scanning electron microscopy (SEM), confirming that cross-linking was accomplished. It possesses a robust organized network, swells 255 % in PBS and bears interconnected pores with a diameter in the range of 10-100 µm. Until now, col-HA hydrogels crosslinked with EDC/NHS have not been reported in literature with collagen from Nile Tilapia skin. Fish collagen can be a better option than those from land-based animals (cow and pig).


Assuntos
Ácido Hialurônico/química , Hidrogéis/química , Pele/química , Animais , Ciclídeos , Colágeno/química , Colágeno/isolamento & purificação , Tamanho da Partícula , Propriedades de Superfície
12.
Aust Dent J ; 65(1): 30-38, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31868926

RESUMO

Fluoride use is the cornerstone of dental caries prevention. There are numerous sources of fluoride which might have different balance of risks and benefits. The first National Guidelines for Use of Fluorides in Australia were developed at a national Workshop in 2005, and updated in 2012. Since then, more evidence on the balance of risks and benefits of fluoride has become available. A third national Workshop was convened in 2019 to update the Guidelines for Use of Fluorides in Australia.


Assuntos
Cárie Dentária/prevenção & controle , Fluorose Dentária , Austrália , Cariostáticos , Fluoretação , Fluoretos , Humanos
13.
JDR Clin Trans Res ; 5(3): 244-253, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31661646

RESUMO

INTRODUCTION: Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. OBJECTIVE: This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. METHODS: Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. RESULTS: Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. CONCLUSION: Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. KNOWLEDGE TRANSFER STATEMENT: The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.


Assuntos
Assistência Odontológica , Austrália , Criança , Humanos
14.
J Dent Res ; 98(11): 1211-1218, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31379245

RESUMO

The aim of this article was to quantify socioeconomic inequalities in dental caries experience among Australian children and to identify factors that explain area-level socioeconomic inequalities in children's dental caries. We used data from the National Child Oral Health Survey conducted in Australia between 2012 and 2014 (n = 24,664). Absolute and relative indices of socioeconomic inequalities in the dental caries experience in primary and permanent dentition (decayed, missing, and filled surfaces [dmfs] and DMFS, respectively) were estimated. In the first stage, we conducted multilevel negative binomial regressions to test the association between area-level Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and dental caries experience (dmfs for 5- to 8-y-olds and DMFS for 9- to 14-y-olds) after adjustment for water fluoridation status, sociodemographics, oral health behaviors, pattern of dental visits, and sugar consumption. In the second stage, we performed Blinder-Oaxaca and Neumark decomposition analyses to identify factors that explain most of the area-level socioeconomic inequalities in dental caries. Children had a mean dmfs of 3.14 and a mean DMFS of 0.98 surfaces. Children living in the most disadvantaged and intermediately disadvantaged areas had 1.96 (95% confidence interval, 1.69-2.27) and 1.45 (1.26-1.68) times higher mean dmfs and 1.53 (1.36-1.72) and 1.43 (1.27-1.60) times higher mean DMFS than those living in the most advantaged areas, respectively. Water fluoridation status (33.6%), sugar consumption (22.1%), parental educational level (14.2%), and dental visit patterns (12.7%) were the main factors explaining area-level socioeconomic inequalities in dental caries in permanent dentition. Among all the factors considered, the factors that contributed most in explaining inequalities in primary dental caries were dental visits (30.3%), sugar consumption (20.7%), household income (20.0%), and water fluoridation status (15.9%). The inverse area-level socioeconomic inequality in dental caries was mainly explained by modifiable risk factors, such as lack of fluoridated water, high sugar consumption, and an unfavorable pattern of dental visits.


Assuntos
Cárie Dentária/epidemiologia , Fatores Socioeconômicos , Adolescente , Austrália/epidemiologia , Criança , Índice CPO , Açúcares da Dieta/efeitos adversos , Fluoretação , Humanos , Renda
15.
J Dent Res ; 98(8): 837-846, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31282846

RESUMO

Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.


Assuntos
Cárie Dentária/prevenção & controle , Fluoretação/legislação & jurisprudência , Fluorose Dentária/prevenção & controle , Fluoretos , Humanos , Cremes Dentais , Organização Mundial da Saúde
16.
Osteoarthritis Cartilage ; 27(9): 1347-1360, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31132406

RESUMO

OBJECTIVES: Wnt pathway upregulation contributes to knee osteoarthritis (OA) through osteoblast differentiation, increased catabolic enzymes, and inflammation. The small-molecule Wnt pathway inhibitor, lorecivivint (SM04690), which previously demonstrated chondrogenesis and cartilage protection in an animal OA model, was evaluated to elucidate its mechanism of action. DESIGN: Biochemical assays measured kinase activity. Western blots measured protein phosphorylation in human mesenchymal stem cells (hMSCs), chondrocytes, and synovial fibroblasts. siRNA knockdown effects in hMSCs and BEAS-2B cells on Wnt pathway, chondrogenic genes, and LPS-induced inflammatory cytokines was measured by qPCR. In vivo anti-inflammation, pain, and function were evaluated following single intra-articular (IA) lorecivivint or vehicle injection in the monosodium iodoacetate (MIA)-induced rat OA model. RESULTS: Lorecivivint inhibited intranuclear kinases CDC-like kinase 2 (CLK2) and dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). Lorecivivint inhibited CLK2-mediated phosphorylation of serine/arginine-rich (SR) splicing factors and DYRK1A-mediated phosphorylation of SIRT1 and FOXO1. siRNA knockdowns identified a role for CLK2 and DYRK1A in Wnt pathway modulation without affecting ß-catenin with CLK2 inhibition inducing early chondrogenesis and DYRK1A inhibition enhancing mature chondrocyte function. NF-κB and STAT3 inhibition by lorecivivint reduced inflammation. DYRK1A knockdown was sufficient for anti-inflammatory effects, while combined DYRK1A/CLK2 knockdown enhanced this effect. In the MIA model, lorecivivint inhibited production of inflammatory cytokines and cartilage degradative enzymes, resulting in increased joint cartilage, decreased pain, and improved weight-bearing function. CONCLUSIONS: Lorecivivint inhibition of CLK2 and DYRK1A suggested a novel mechanism for Wnt pathway inhibition, enhancing chondrogenesis, chondrocyte function, and anti-inflammation. Lorecivivint shows potential to modify structure and improve symptoms of knee OA.


Assuntos
Anti-Inflamatórios/uso terapêutico , Imidazóis/uso terapêutico , Indazóis/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Proteínas Tirosina Quinases/antagonistas & inibidores , Piridinas/uso terapêutico , Via de Sinalização Wnt/efeitos dos fármacos , Animais , Western Blotting , Células Cultivadas , Modelos Animais de Doenças , Humanos , Reação em Cadeia da Polimerase , Ratos
17.
J Dent Res ; 98(7): 755-762, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30974070

RESUMO

Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.


Assuntos
Aleitamento Materno , Cárie Dentária/prevenção & controle , Água Potável/química , Fluoretação , Adolescente , Austrália , Criança , Pré-Escolar , Índice CPO , Feminino , Humanos , Lactente , Masculino , Prevalência
18.
Aust Dent J ; 64(2): 175-180, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30883781

RESUMO

BACKGROUND: Silver fluoride 40% followed by 10% stannous fluoride (AgF) has been used in dental practice in some parts of Australia for many years. This study compared the effectiveness of application of AgF with atraumatic restorative technique (ART) in managing cavitated carious primary molars. METHODS: The study was a community effectiveness trial in two remote Aboriginal communities where AgF has been used for some time. Children between 4 and 8 years of age with caries on primary molars were randomized by birth date to receive AgF or ART. There were 210 children who were included in the study with 384 eligible teeth. Children were followed up for periods between 9 months and 4 years. Negative outcomes such as dental pain, extraction, use of antibiotics and more extensive restorative treatment were considered as the primary outcomes of the study. RESULTS: Those negative outcomes were infrequent in both treatment groups. The prevalence ratio of negative sequelae for children treated with AgF compared with those treated with ART was lower at 0.18. CONCLUSIONS: Silver fluoride was well accepted, easy to use and at least as effective a treatment as ART for dental caries in primary molars in young Aboriginal children in remote areas.


Assuntos
Cariostáticos/uso terapêutico , Cárie Dentária , Fluoretos Tópicos/uso terapêutico , Dente Decíduo , Austrália , Criança , Pré-Escolar , Tratamento Dentário Restaurador sem Trauma , Cárie Dentária/prevenção & controle , Cárie Dentária/terapia , Feminino , Fluoretos/uso terapêutico , Serviços de Saúde do Indígena , Humanos , Masculino , Compostos de Prata/uso terapêutico , Resultado do Tratamento
19.
BMC Public Health ; 19(1): 333, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898094

RESUMO

BACKGROUND: Streptococcus pneumoniae causes substantial morbidity and mortality among children. The introduction of pneumococcal conjugate vaccines (PCV) has the potential to dramatically reduce disease burden. As with any vaccine, it is important to evaluate PCV impact, to help guide decision-making and resource-allocation. Measuring PCV impact can be complex, particularly to measure impact on one of the most common and significant diseases caused by the pneumococcus, namely pneumonia. Here we outline the protocol developed to evaluate the impact of 13-valent PCV (PCV13) on childhood pneumonia in Mongolia, and a number of lessons learned in implementing the evaluation that may be helpful to other countries seeking to undertake pneumonia surveillance. METHODS: From 2016 PCV13 was introduced in a phased manner into the routine immunisation programme with some catch-up by the Government of Mongolia. We designed an evaluation to measure vaccine impact in children aged 2-59 months with hospitalised radiological pneumonia as a primary outcome, with secondary objectives to measure impact on clinically-defined pneumonia, nasopharyngeal carriage of S. pneumoniae among pneumonia patients and in the community, and severe respiratory infection associated with RSV and/or influenza. We enhanced an existing hospital-based pneumonia surveillance system by incorporating additional study components (nasopharyngeal swabbing using standard methods, C-reactive protein, risk factor assessment) and strengthening clinical practices, such as radiology as well as monitoring and training. We conducted cross-sectional community carriage surveys to provide data on impact on carriage among healthy children. DISCUSSION: Establishing a robust surveillance system is an important component of monitoring the impact of PCV within a country. The enhanced surveillance system in Mongolia will facilitate assessment of PCV13 impact on pneumonia, with radiological confirmed disease as the primary outcome. Key lessons arising from this evaluation have included the importance of establishing a core group of in-country staff to be responsible for surveillance activities and to work closely with this team; to be aware of external factors that could potentially influence disease burden estimates; to be flexible in data collection processes to respond to changing circumstances and lastly to ensure a consistent application of the pneumonia surveillance case definition throughout the study period.


Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Vacinas Pneumocócicas/administração & dosagem , Pneumonia/epidemiologia , Vigilância da População/métodos , Streptococcus pneumoniae/isolamento & purificação , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Programas de Imunização , Lactente , Masculino , Mongólia/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Vacinas Conjugadas
20.
Int J Dent Hyg ; 16(4): 492-502, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29911356

RESUMO

AIMS: This study aimed to identify risk indicators associated with periodontitis and the contribution of each of the indicators towards the prevalence, extent and severity of periodontitis in a rural Indian population. METHODS: A cross-sectional study design was used to collect data according to National Survey of Adult Oral Health Australia guidelines. A multistage stratified random sampling was followed to select 1401 participants, who were in the age group of 35-54 years. The participants were selected from 50 villages belonging to the 5 sub-provinces of 2 Indian districts. Data were collected through face-to-face interviews and oral examination. Statistical analysis was performed using SAS version 9.3. The univariate, bivariate and multivariate analyses were performed to determine the risk indicators of prevalence, extent and severity of periodontitis. Population attributable fraction was estimated for each of the significant risk indicators of prevalence and extent. RESULTS: In this study, factors such as age, education, tobacco chewing and plaque accumulation were significantly associated with the prevalence of periodontitis. Age, socioeconomic status, method of tooth cleaning, alcohol consumption and plaque accumulation were significant risk indicators for generalized periodontitis. Age, tobacco chewing and plaque were associated with severity of periodontitis in the population. CONCLUSION: The rural population had a high prevalence of periodontitis. Sociodemographic factors, poor oral hygiene, tobacco and alcohol were the main risk indicators attributable to periodontitis.


Assuntos
Periodontite/epidemiologia , Periodontite/etiologia , População Rural/estatística & dados numéricos , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Análise de Variância , Estudos Transversais , Placa Dentária/complicações , Escolaridade , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Índice de Higiene Oral , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Classe Social , Uso de Tabaco/efeitos adversos , Escovação Dentária/métodos
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