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2.
Int Dent J ; 70(1): 3-4, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985821
3.
Int Dent J ; 69 Suppl 2: 1-2, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31478574
4.
J Periodontol ; 90(10): 1125-1132, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31152556

RESUMO

BACKGROUND: Population studies of the prevalence of oral disease rely upon indices that summarize disease status. There is no universally accepted index that summarizes the burden of periodontal diseases, considering the number of teeth remaining in the mouth. METHODS: A new conceptual index was developed that includes consideration of the extent and severity of the periodontal diseases, the distribution of affected teeth, and tooth loss as a function of age. The index is referred to as the burden of periodontal diseases and tooth loss (BPT). RESULTS: A cohort of 1,097 individuals originally seen as new patients in a dental school clinic, and evaluated for undiagnosed dysglycemia, were studied. The BPT index was applied to this data set. A modifying effect of considering the number of lost teeth was observed. The distribution of scores w skewed to the left, which gradually shifted to the right when the most involved teeth (periodontal pathology, tooth loss) were weighted more heavily. This shift was not observed when missing teeth were not considered. CONCLUSIONS: This conceptual study illustrates that the extent and severity of periodontal pathology, and number and distribution of missing teeth, are important considerations when summarizing the condition of the mouth. The BPT provides a measure of the oral disease burden, as both periodontal pathology and tooth loss are associated with both functional impairment and reduced quality of life. The dental profession and dental research community must continually seek to develop new approaches to defining and summarizing the oral disease burden.

5.
J Health Care Poor Underserved ; 29(4): 1509-1528, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449760

RESUMO

Understanding the relationships among diabetes, teeth present, and dental insurance is essential to improving primary and oral health care. Participants were older adults who attended senior centers in northern Manhattan (New York, N.Y.). Sociodemographic, health, and health care information were obtained via intake interviews, number of teeth present via clinical dental examinations, and glycemic status via measurement of glycosylated hemoglobin (HbA1c). Complete data on dental insurance coverage status for 785 participants were available for analysis (1,015 after multiple imputation). For participants with no dental insurance and any private/other dental insurance, number of teeth present is less for participants with diabetes than for participants without diabetes; however, for participants with Medicaid coverage only, the relationship is reversed. Potential explanations include the limited range of dental services covered under the Medicaid program, inadequate diabetes screening and monitoring of Medicaid recipients, and the poor oral and general health of Medicaid recipients.


Assuntos
Diabetes Mellitus/epidemiologia , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Perda de Dente/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Assistência Odontológica , Feminino , Hemoglobina A Glicada , Nível de Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos
7.
J Clin Periodontol ; 45(7): 780-790, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29779261

RESUMO

AIM: We investigated the cross-sectional association between diet quality and severe periodontitis in a sample of diverse Hispanics from the Hispanic Community Health Study/Study of Latinos. MATERIALS AND METHODS: A total of 13,920 Hispanic/Latinos aged 18-74 years of different heritages underwent a full-mouth oral examination and completed two 24-hr dietary recalls during 2008-2011. Severe periodontitis was defined as having ≥30% tooth sites with clinical attachment loss ≥5 mm. Diet quality was assessed using the Alternative Healthy Eating Index (AHEI-2010). We evaluated the association of diet quality with severe periodontitis adjusting for age, sex, nativity status, income, education, last dental visit, current insurance, cigarette smoking, diabetes, and energy intake. RESULTS: Relative to those at the lowest quartile of diet quality, individuals at the highest quartile had significantly lower odds of severe periodontitis (adjusted OR = 0.57, 95% CI: 0.39-0.82), with evidence of a dose-response relationship across AHEI quartiles. Among AHEI-2010 components, higher consumption of whole grains and fruits, and lower consumption of red/processed meats were associated with lower odds of severe periodontitis. CONCLUSION: Better-quality diet was associated with lower prevalence of severe periodontitis although the causal pathways need to be clarified in future work.


Assuntos
Dieta , Periodontite , Adolescente , Adulto , Idoso , Estudos Transversais , Ingestão de Energia , Hispano-Americanos , Humanos , Pessoa de Meia-Idade , Adulto Jovem
8.
Int Dent J ; 68(6): 428-432, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29696638

RESUMO

BACKGROUND: One approach to addressing oral health disparities for at-risk populations has been to increase discussion of oral health by non-dental healthcare providers. This study examined the accuracy of a simple instrument to detect individuals with a history of dental disease, which would then allow referral for an oral health evaluation. MATERIALS AND METHODS: A two-question instrument was evaluated for the relationship to oral diseases, periodontal disease, and decayed, missing and filled teeth in 391 individuals seen in a dental school clinic for non-emergent dental care over a 3-month period. Clinical dental findings were used as outcome variables. The oral health parameters were dichotomised, using different levels of disease severity. The criteria were increased and decreased in an effort to test the robustness of our method. RESULTS: While the sensitivity outcomes with one question alone showed significant ability to predict oral disease (59-71%), the addition of a second self-assessment question increased the sensitivity (76-91%) for all oral health parameters studied. As the criteria for oral disease increased so did the sensitivity of this instrument. CONCLUSION: The results presented here offer evidence that a simple two-item questionnaire is an efficient and effective method of detecting populations at-risk for oral diseases.


Assuntos
Inquéritos de Saúde Bucal , Autoavaliação Diagnóstica , Doenças da Boca/diagnóstico , Saúde Bucal , Autorrelato , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice CPO , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Higiene Bucal , Sensibilidade e Especificidade , Inquéritos e Questionários , Adulto Jovem
11.
Community Dent Oral Epidemiol ; 46(1): 102-108, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29023928

RESUMO

OBJECTIVE: The identification of persons with or at risk for chronic diseases is a new practice paradigm for oral healthcare. Diabetes mellitus (DM) is a chronic disease of particular importance to oral health providers. This study sought to understand healthcare utilization patterns that would support the introduction of this new practice paradigm. METHODS: The primary and oral healthcare utilization patterns of New York City (NYC) adults were assessed using data collected from the 2013 NYC Community Health Survey. We stratified healthcare utilization patterns by type of provider, insurance, DM diagnosis and DM modifiable risk factors. RESULTS: Of 6.4 million NYC adults, an estimated 676 000 (10.5%) reported a previous diagnosis of DM, and 3.9 million (69.5%) were identified with one or more modifiable risk factor for DM. Of these at risk individuals, 2.2 million (58.9%) received dental services in the past 12 months, and 545 000 (14.3%) did not see a primary care provider during the same period. Of the approximately 1.16 million adults without health insurance, an estimated 338 000 (26.2%) had a dental visit only. CONCLUSION: Healthcare utilization patterns in this urban setting suggest that oral healthcare providers can support the identification of patients with and at risk for DM who may otherwise not have the opportunity for screening.


Assuntos
Assistência Odontológica , Diabetes Mellitus/diagnóstico , Visita a Consultório Médico , Adolescente , Adulto , Fatores Etários , Idoso , Assistência Odontológica/métodos , Assistência Odontológica/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Adulto Jovem
12.
J Dent Educ ; 81(9): eS83-eS90, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28864808

RESUMO

The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21st Century."


Assuntos
Assistência à Saúde/tendências , Odontologia/tendências , Saúde Bucal , Prestação Integrada de Cuidados de Saúde , Previsões , Promoção da Saúde , Humanos , Atenção Primária à Saúde , Estados Unidos
14.
Community Dent Oral Epidemiol ; 45(3): 275-280, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28145564

RESUMO

OBJECTIVE: To analyse the cost-effectiveness of a screening programme and follow-up interventions for persons with dysglycemia who are identified during a dental visit. METHODS: This study is a secondary analysis utilizing data from two relevant publications. Those studies identified persons with dysglycemia who were seen in a dental school clinic for routine dental care and determined compliance with a recommendation to seek medical care. The response site was 59.4%. The Archimedes disease simulation model was utilized to simulate the effect of a weight loss programme for identified subjects on several outcomes. RESULTS: Two scenarios for weight loss programmes were considered: a 10% permanent loss in body weight and a 10% loss that decays over time. Both diabetes and prediabetes were analysed. The decay path costs $21 243 per quality adjusted life year (QALY) with 3 years required to achieve the weight reduction. This cost decreases to $6655 if only 1 year is needed to achieve the weight goal. Without decay, the cost per QALY is $15 873 with 20 years of intervention, vs $647 per QALY with 10 years of intervention. For individuals with type 2 diabetes mellitus, the cost per QALY is $48 604 to $56 207 depending on adherence. With the addition of oral medication (a sulfonylurea), the cost is three times higher. CONCLUSIONS: Under the conditions described here, identification of persons with dysglycemia in the dental office for initiating prediabetic care is a cost-effective means of identifying and treating affected individuals.


Assuntos
Glicemia/análise , Assistência Odontológica/métodos , Diabetes Mellitus Tipo 2/diagnóstico , Programas de Rastreamento/métodos , Adulto , Análise Custo-Benefício , Assistência Odontológica/economia , Assistência Odontológica/estatística & dados numéricos , Humanos , Programas de Rastreamento/economia , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/terapia , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos
15.
Int Dent J ; 67(2): 67-77, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27861820

RESUMO

The metabolic syndrome (MetS) is a spectrum of conditions that increase the risk of cardiovascular disease and diabetes mellitus. The components of MetS include dysglycemia, visceral obesity, atherogenic dyslipidemia (elevated triglycerides and low levels of high-density lipoprotein) and hypertension. An association of periodontal disease and MetS has been suggested. This association is believed to be the result of systemic oxidative stress and an exuberant inflammatory response. When examined individually, the components of the MetS that are most closely related to the risk of periodontitis are dysglycemia and obesity, with lesser contributions by atherogenic dyslipidemia and hypertension. Data suggest that the odds of periodontitis increase with the number of MetS components present in an individual. The direction of the relationship between MetS and periodontal disease cannot currently be determined because the majority of studies are cross-sectional. The association between MetS and periodontitis, however, suggests that improved understanding of this association could promote interprofessional practice. Evidence suggests that periodontal therapy can reduce the levels of inflammatory mediators in serum. If this finding is confirmed, periodontal treatment could become part of therapy for MetS. Oral health providers who identify patients at risk for MetS could refer them to a medical provider, and physicians could refer patients to dentists to ensure that patients with MetS receive a dental evaluation and any necessary treatment. These clinical activities would improve both oral and general health outcomes.


Assuntos
Síndrome Metabólica/complicações , Doenças Periodontais/complicações , Gengivite/complicações , Humanos , Hiperglicemia/complicações , Periodontite/complicações , Fatores de Risco
16.
Int Dent J ; 66(6): 321, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27885672
17.
Periodontol 2000 ; 72(1): 7-12, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27501487

RESUMO

The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population will be affected by noncommunicable chronic diseases, including diabetes mellitus, cardiovascular disease and cognitive impairment. This important demographic shift includes a reduction in tooth loss/edentulism, particularly in older adults of the developed countries in North America, western Europe and north-east Asia. Therefore, in the future, dental providers will be required to care for an expanded number of older adults who have retained teeth and are medically complex. As the linkage of oral disease and systemic disease has focused on the relationship of periodontitis and noncommunicable chronic diseases, a broad review of 'geriatric periodontology' is both timely and important. This volume of Periodontology 2000 covers a range of subjects under this heading. Included are the demographics of an aging world; the effect of aging on stem cell function in the periodontium; the periodontal microbiota associated with aging; the host response in the periodontium of aging individuals; an analysis of the prevalence of periodontitis in the USA on a national, state-wide and community basis; differentiation of physiologic oral aging from disease; treatment of periodontal disease in older adults; implant therapy for older patients; oral disease and the frailty syndrome; the relationship of tooth loss to longevity and life expectancy; and the relationship of periodontal disease to noncommunicable chronic diseases. Although 'geriatric dentistry' is not a recognized specialty in dentistry, and 'geriatric periodontology' is a descriptive title, the subject of this volume of Periodontology 2000 is critical to the future of clinical dentistry, dental public health and dental research. Any comprehensive focus on older patients can only be accomplished with an emphasis on interprofessional education and practice. If embraced, this shift will allow the dental profession to be more closely aligned with the larger health-care environment, and can improve both oral health and health outcomes for patients seen in the dental office.


Assuntos
Envelhecimento/fisiologia , Periodontia , Periodontite , Idoso , Doenças Cardiovasculares/complicações , Disfunção Cognitiva/complicações , Cárie Dentária , Pesquisa em Odontologia , Complicações do Diabetes , Diabetes Mellitus , Humanos , Saúde Bucal , Doenças Periodontais/terapia , Periodontite/epidemiologia , Periodontite/terapia , Fatores de Risco , Células-Tronco , Perda de Dente/epidemiologia , Perda de Dente/prevenção & controle
18.
Periodontol 2000 ; 72(1): 96-107, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27501493

RESUMO

Aging is the physiologic change that occurs over time. In humans, this change occurs at different rates and are related to lifestyle, environment and genetics. It can be challenging to differentiate normal aging from disease. In the oral cavity, with increasing age the teeth demonstrate wearing of the enamel, chipping and fracture lines, and a darker color. The pulp chamber and canals are reduced in size as a result of the deposition of secondary dentin. Coronal or root caries, however, represent disease. A limited amount of periodontal attachment loss occurs in association with aging, usually manifesting as recession on the buccal surface of teeth. Severe periodontitis occurs in 10.5-12% of the population, with the peak incidence being observed at 35-40 years of age. Changes to the mucosal tissue that occur with age include reduced wound-healing capacity. However, environmental factors, such as smoking, dramatically increase the risk of mucosal pathology. Reduced salivary gland function is often seen in association with medication usage, as well as with disorders such as diabetes mellitus. Both medication use and chronic disorders are more common in older adults. Masticatory function is of particular importance for older adults. Maintenance of a nutritionally complete diet is important for avoiding sarcopenia and the frailty syndrome. Successful oral aging is associated with adequate function and comfort. A reduced, but functional, dentition of 20 teeth in occlusion has been proposed as a measure of successful oral aging. Healthy oral aging is important to healthy aging from both biological and social perspectives.


Assuntos
Envelhecimento/fisiologia , Doenças da Boca , Saúde Bucal , Idoso , Doença Crônica , Assistência Odontológica para Idosos , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Dentição , Complicações do Diabetes , Dieta , Feminino , Humanos , Masculino , Mastigação/fisiologia , Boca , Doenças da Boca/prevenção & controle , Mucosa Bucal/fisiologia , Perda da Inserção Periodontal , Doenças Periodontais/complicações , Doenças Periodontais/epidemiologia , Periodonto/fisiologia , Cárie Radicular , Glândulas Salivares/metabolismo , Glândulas Salivares/fisiologia , Fumar/efeitos adversos , Articulação Temporomandibular/fisiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Desgaste dos Dentes , Cicatrização/fisiologia
19.
Periodontol 2000 ; 72(1): 142-52, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27501497

RESUMO

Many factors contribute to human tooth loss, including oral hygiene practices, trauma, smoking, health status, socio-economic status and individual preferences. Loss of teeth impairs quality-of-life measures, including the eating of most foods that require full masticatory function. A recent study of centenarians found that at age 65-74 years, those who lived to be 100 had a lower rate of edentulism than did younger members of their birth cohort at ages 65-74 years. Oral health was consistent with compression of morbidity toward the end of life. This article explores the hypothesis that factors associated with oral disease and noncommunicable diseases may increase the risk of tooth loss and lead to diminished longevity as a result of multifactorial interactions. It specifically addresses two critical questions. The first is: 'Can we conclude that the number of teeth in aging humans can affect longevity and life expectancy?' The answer is yes. The second is: 'Is tooth loss a predictor of shortened longevity?' Again, the answer is yes. Edentulism and partial edentulism are discussed as a disability, and how the philosophy/belief systems of dental providers and patients toward retaining teeth influences the outcome of tooth loss is also examined. Osteoporosis and cognitive impairment provide examples of modifying risk factors.


Assuntos
Envelhecimento , Longevidade , Fatores de Risco , Perda de Dente , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva , Feminino , Nível de Saúde , Humanos , Masculino , Higiene Bucal , Osteoporose , Qualidade de Vida , Fumar , Fatores Socioeconômicos , Ferimentos e Lesões
20.
J Evid Based Dent Pract ; 16 Suppl: 43-51, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27236995

RESUMO

UNLABELLED: The oral health care paradigm presented here would broaden oral health services to include primary health care activities focusing on risk reduction and chronic disease screening. BACKGROUND AND PURPOSE: Changes in our nation's health care delivery system, shifting patient demographics, and availability of new health insurance programs have resulted in exploration of new practice models of health care delivery. Chronic diseases require coordinated care efforts over decades of a patient's life. Oral health professionals will be part of that care. METHODS: The practice model for this article was developed in the context of an academic medical center that promotes oral health care professionals as health care providers through interprofessional education. The combined experiences of the authors, including a diabetes predictive model for oral health settings, the efficacy and effectiveness of human immunodeficiency virus screening in a dental setting, the feasibility of using a decision support tool for tobacco cessation, and the effectiveness of integrating oral health education with comprehensive health services for people living with human immunodeficiency virus, have contributed to this concept. CONCLUSIONS: Prevention is increasingly recognized as a cost-effective means of reducing chronic disease burdens. To be effective, health promotion activities that encourage healthy living and early detection need to occur in a variety of health care settings. Oral health professionals represent an underutilized group of health care providers that can contribute to improved health of populations living with chronic diseases by broadening their scope of practice to include primary health screenings and tailored health promotion activities.


Assuntos
Assistência à Saúde , Promoção da Saúde , Saúde Bucal , Pessoal de Saúde , Humanos , Atenção Primária à Saúde , Comportamento de Redução do Risco
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