Carbonated soft drinks and dental caries in the primary dentition.

We analyzed fluid intake data among children aged 2-10 years from a 24-hour dietary recall interview in the NHANES III (1988-94) to investigate the effect of high consumption of carbonated soft drinks on caries in the primary dentition. We used cluster analysis to determine fluid consumption patterns. Four distinct fluid consumption patterns were identified: high carbonated soft drinks, high juice, high milk, and high water. About 13% of children had a high carbonated soft drink consumption pattern; they also had a significantly higher dental caries experience in the primary dentition than did children with other fluid consumption patterns. A fluid intake pattern comprised mainly of milk, water, or juice was less likely to be associated with dental caries. Findings of this study suggest that high consumption of carbonated soft drinks by young children is a risk indicator for dental caries in the primary dentition and should be discouraged.

Prevalence and trends in periodontitis in the USA: the [corrected] NHANES, 1988 to 2000.

Trends in periodontal diseases in the USA have been documented for years. However, the results have been mixed, mostly due to different periodontal assessment protocols. This study examined change in the prevalence of periodontitis between the NHANES III and the NHANES 1999-2000, and differences in the prevalence of periodontitis among racial/ethnic groups in the USA. Analysis was limited to non-Hispanic black, non-Hispanic white, and Mexican-American adults aged 18+ yrs in the NHANES III (n=12,088) or the NHANES 1999-2000 (n=3214). The prevalences of periodontitis for the NHANES III and the NHANES 1999-2000 were 7.3% and 4.2%, respectively. In multivariable analyses, blacks were 1.88 times (95%CI: 1.42, 2.50) more likely to have periodontitis than whites surveyed in the NHANES III. However, the odds of periodontitis for blacks and Mexican-Americans did not differ from those for whites surveyed in the NHANES 1999-2000. Our findings indicate that the prevalence of periodontitis has decreased between the NHANES III and the NHANES 1999-2000 for all racial/ethnic groups in the USA.

The changing patterns of systemic fluoride intake.

Fluorosis prevalence has increased in North America since the 1930's-1940's. It may also have increased since 1970, though the evidence for that is less clear. Continued monitoring will help determine whether increased fluorosis prevalence in children in the United States is a cohort effect from the 1970's. This review considers the evidence for an increase in fluoride ingestion from all sources since the 1970's. If an increase has occurred, the most likely sources are fluoride dietary supplements, inadvertent swallowing of fluoride toothpastes, and increased fluoride in food and beverages. For adults, there is no evidence from dietary surveys to show that fluoride intake has increased over the last generation. Dietary surveys for children aged six months to two years are similarly inconclusive, though the great variation in fluoride content of various infant foods might be obscuring real effects. The data on fluoride intake by children from food and beverages, infant foods included, are not strong enough to conclude that an increase in fluoride ingestion has occurred since the 1970's. However, the suggested upper limit of fluoride intake is substantially being reached in many children by ingestion of fluoride from food and drink (0.2-0.3 mg per day) and from fluoride toothpaste (0.2-0.3 mg per day). Two public health issues that arise from this review are: (a) the need for a downward revision in the schedule for fluoride supplementation, and (b) education on the potential for high fluoride concentration of soft drinks and processed fruit juices.

Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren.

This study relates the prevalence of caries and fluorosis among Michigan children, residing in four different areas, to the various concentrations of F in the communities' water supplies. Demographic information, details of F history, and dental attendance data were collected by a questionnaire form filled out by parents. Children ages six to 12 were screened for caries by means of the NIDR criteria and for fluorosis by means of the TSIF index. Results pertain only to continuous residents and the permanent dentition. The prevalence of both caries and fluorosis was significantly associated with the F concentration in the community water supply. Approximately 65% of all children were caries-free, ranging from 55.1% in fluoride-deficient Cadillac to 73.7% in Redford (1.0 ppm F). About 36% of all children had dental fluorosis, ranging from 12.2 in Cadillac to 51.2 in Richmond (1.2 ppm). All of the fluorosis was very mild. From logistic regression, the prevalence of caries was significantly associated with age, dental attendance, and the use of a water supply fluoridated at 1.0 ppm. The odds of experiencing fluorosis increased at every F level above the baseline (Cadillac), with the use of topical F rinses, and with age. Results suggest that children in the four communities may be ingesting a similar level of F from sources such as dentifrices, dietary supplements, and professional applications, but the factor that differentiates them with respect to the prevalence of caries and fluorosis is the F concentration in the community water supply.

Water-borne fluoride and cortical bone mass: a comparison of two communities.

This study investigated the relationship between cortical bone mass in an older female population and their ingestion of fluoride from community water supplies. The study was conducted among lifelong female residents in Lordsburg (3.5 ppm fluoride) and Deming (0.7 ppm fluoride), NM. A total of 151 postmenopausal women ranging in age from 39 to 87 years took part; 69 were residents of the optimal-fluoride community, while the remaining 82 were residents of the high-fluoride community. Although bivariate analyses showed no difference in cortical bone mass between women in the two communities, with multiple regression analyses, significant predictors of bone mass (p less than 0.05) were weight, years since menopause, current estrogen supplementation, diabetes, and fluoride exposure status. Based on a model containing all of these variables, women living in the high-fluoride community had a bone mass ranging from 0.004 to 0.039 g/cm2 less than that of similar women living in the optimum-fluoride community. These results suggest that lifelong ingestion of water containing 3.5 ppm fluoride, compared with water containing 0.7 ppm fluoride, does not increase cortical bone mass in women of similar age, weight, and menopausal status. Under the conditions of this study, cortical bone mass might be reduced in a high-fluoride area.

An assessment of survival rates and within-patient clustering of failures for endosseous oral implants.

This study examined endosseous cylinder implant survival, defined as the unqualified presence of the implant in the mouth at the end of the observation period, in 598 consecutive VA patients, with a total of 2098 implants. Data were taken from the Department of Veterans Affairs (VA) Dental Implant Registry, which has maintained longitudinal data on the survival of individual dental implants in VA patients since 1987. The maximum time of observation in any one patient was 2040 days (5.6 yr). Survival analysis by use of life-table methods was carried out on both an implant- and a patient-specific basis. Implant cases were accrued randomly, and therefore a random censoring model was used. A correlated binomial model was used for assessment of the degree of within-patient clustering of implant removals. Results showed that the implant-specific survival rate during the longest time interval (5.6 yr) was 89.9%; the patient-specific implant survival rate during the same time was 78.2%. Among implants which were removed, the mean time to removal was 292 days. The hazard function, which describes the probability of implant loss as a function of time, decreased steadily throughout the observation period. The correlated binomial model suggested a clustering of removals within patients with multiple implants (rho = 0.11, p = 0.0001). The odds of having a second implant removed were 1.3 times greater if the patient had already had one implant removed. This study suggests that when implants fail, they do so soon after placement, and the likelihood of failure decreases steadily from implantation through the first five years post-surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

An epidemiological investigation into the relative importance of age and oral hygiene status as determinants of periodontitis.

The objective of this study was to assess the relative effects of age and oral hygiene on the progression of periodontitis by estimating incidence from age-specific prevalence. This study analyzed data from a representative national sample of 14,690 dentate Americans, aged from 15 to 74, seen in the first National Health and Nutrition Examination Survey (NHANES I) in 1971-1974. Results showed that the rate of increase in the estimated incidence of periodontitis with age, throughout all age groups, is much higher among subjects with poor oral hygiene than among those with good oral hygiene. Oral hygiene was confirmed as the most important predictor for periodontitis; in all age groups, more than 95% of those examined with good oral hygiene did not have periodontitis. It was concluded that the effect of age on the progression of periodontitis could therefore be considered negligible when good oral hygiene is maintained.

The effects of a break in water fluoridation on the development of dental caries and fluorosis.

Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study participants were continuously-resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696 children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded. Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5. Caries was assessed in the primary first and second molars according to the decayed-filled index; fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher education of the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3, 4, and 5 was 39.8%, 32.3%, 33.0%, 62.3%, and 57.1%, respectively. These cohort differences remained statistically significant in regression analysis. It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years.

Sugared soda consumption and dental caries in the United States.

Because of the complexity of the caries process, the potential cariogenicity of specific food items is difficult to assess. The purpose of this study was to investigate the associations between sugared soda consumption and caries. Dietary and dental examination data from the 1988-94 Third National Health and Nutrition Examination Survey (NHANES III) were used. From the food frequency questionnaire and 24-hour recall data, significant associations between DMFS and soda consumption were generally seen in persons over age 25. No differences in DMFS, relative to soda consumption, were seen in persons under age 25, or in analyses of dfs for children under age 12. The observed associations could be due to the cumulative effects of the long-term consumption of sugared soda. The absence of apparent effects of sugared soda consumption in younger people may also be related to the increased use of fluorides since the 1960s.

Fluorosis development in seven age cohorts after an 11-month break in water fluoridation.

This study used an 11-month break in water fluoridation to identify the time when developing incisors are most sensitive to fluorosis development. The study was based in Durham, NC, where an interruption to water fluoridation occurred between September, 1990, and August, 1991. A total of 1896 children was dentally examined. Fluorosis was measured by the TF index, and parents or guardians completed a questionnaire on demographics and fluoride history. Age cohorts ranged from those born 5 years before the break, to those born 1 year after the resumption of fluoridation. Fluorosis prevalence for seven age cohorts whose birth years ranged from 1985-86 to 1991-92 was 57.1, 62.3, 33.0, 32.3, 39.8, 30.2, and 36.8%, respectively. Children aged from birth to 3 years at the break, and those born 1 year after it, had less fluorosis than those aged 4-5 years at the break.

Root caries in an optimally fluoridated and a high-fluoride community.

The purpose of this study was to measure the prevalence and distribution of root caries in two New Mexico communities. One community, Deming, had a natural fluoride concentration of 0.7 mg/L in its drinking water, optimum for its climate. The other, Lordsburg, was naturally fluoridated at 3.5 mg/L, five times the optimum. Dental examinations were carried out on 151 adults in Deming (mean age, 39.8 years) and 164 in Lordsburg (mean age, 43.2 years); only persons born in the communities were included. Prevalence of root caries was 23.8% in Deming and 7.3% in Lordsburg; mean number of lesions was 0.69 in Deming and 0.08 in Lordsburg (p less than 0.0001). Although there was more gingival recession in Lordsburg, Root Caries Index scores were five times greater in Deming. Root caries was more prevalent in older age groups, and was correlated with coronal caries experience in both communities. Root caries was correlated with plaque and calculus scores in Deming only. Logistic regression showed that city of residence was the major predictor of root caries, with other significant predictors being age, education, gingival recession, and loss of periodontal attachment. When combined with previous research, these results confirm that root caries experience is directly related to the fluoride concentration in the drinking water.

Dental benefits of limited exposure to fluoridated water in childhood.

The effect of limited exposure to fluoridated water in childhood is of potential importance in highly-mobile modern society, but the subject has not been well-studied. This longitudinal study assessed caries experience and S. mutans proportions from fissure plaque in school-children who lived for at least the three years of the study in a non-fluoridated community (0.2 mg/L). Residence histories permitted division of the cohort into those who had lived all their lives in non-fluoridated communities, and those who had lived for some time previously in a fluoridated community. The children were aged 6-7 years at the beginning of the three-year study. Children with previous residence in the fluoridated communities developed 26.8% less caries in their permanent teeth during the study than did the children who had lived in non-fluoridated communities all their lives (p = 0.04), and had 29.8% less caries after three years (p = 0.02). Differences between the groups in S. mutans proportions from fissure plaque, sampled at six-monthly intervals throughout the study, could not be demonstrated. The dental benefits observed could not be attributed to socio-economic differences between the groups. Despite evidence that the benefits of limited ingestion of fluoridated water are topical in nature, the fact that many of the affected teeth in this study were unerupted at the time of the fluoride exposure means that pre-eruptive benefits cannot be ruled out.

Prevalence of total tooth loss, dental caries, and periodontal disease in Mexican-American adults: results from the southwestern HHANES.

The Southwestern portion of the Hispanic Health and Nutrition Examination Survey (HHANES) was conducted by the National Center for Health Statistics (NCHS) in 1982 and 1983. The survey population was Mexican-Americans residing in five Southwestern states. This report presents data on the prevalence of total tooth loss, dental caries, and periodontal diseases in 3860 Mexican-American adults aged from 18 to 74. Results show that 4.3% of this group was edentulous. Among the dentate, Mexican-Americans had lower overall DMF scores but higher numbers of untreated decayed teeth than did residents of the same region seen in the NHANES I survey in 1971-1974. Caries of the smooth surfaces in both posterior and anterior teeth was more pronounced in the older than in the younger age groups. Mexican-Americans had more gingivitis but fewer periodontal pockets than did the general population in the Western states during NHANES I. The caries pattern in the Mexican-Americans suggests that caries among adults may remain a problem in the future, with the possibility of increased involvement with the aging, although modest, of smooth tooth surfaces.

Risk factors for tooth loss over a 28-year period.

Over 500 residents of Tecumseh, Michigan, were dentially examined in 1959 as part of a community-wide health study. In 1987, the dental examinations were repeated, with use of the same criteria as in 1959, for 167 dentate persons from the original group. Another 28 reported by telephone that they had become edentulous since 1959. This report uses a historical cohort analysis for exploration of the risk factors for tooth loss, both total and partial, over the 28-year period. Over that time, the edentulous lost an average of 18.0 teeth (95% confidence interval 15.5, 20.7), whereas the age-matched 90 dentate persons lost only 3.2 (2.2, 4.2) teeth each. Descriptive data showed the edentulous to have higher baseline scores for plaque, calculus, and gingivitis, and a higher proportion of them smoked, though only loss of periodontal attachment (LPA) of 4 mm or more, early loss of first molars, and educational attainment were significant risk factors in regression analysis. Odds ratios for these three variables were 4.0 (1.2, 12.8), 2.0 (1.3, 3.1), and 0.6 (0.4, 0.9), respectively. The strongest risk factors for partial tooth loss among 116 dentate persons were baseline gingivitis (which was correlated with LPA of 4 mm or more) and the baseline number of teeth present, with odds ratios of 2.4 (1.2, 5.2) and 0.8 (0.7, 1.0), respectively. While the analysis had to be carried out without caries data, it was concluded that total tooth loss is a social-behavioral issue as much as it is disease-related. Social-behavioral factors were less clearly related to partial tooth loss in dentate persons; oral disease characteristics were the most prominent risk factors for partial tooth loss.

Natural history of periodontal disease in adults: findings from the Tecumseh Periodontal Disease Study, 1959-87.

The purpose of this epidemiological study was to estimate the degree of change in periodontal attachment level in a sample of adults examined in 1959 and 1987 in Tecumseh, Michigan. Out of 526 individuals between the ages of five and 60 years in 1959, a sample of 325 resided within an 80-km-radius area in 1987. Of those, 167 were re-examined. Loss of periodontal attachment (LPA) was determined with a Michigan #0 probe on four tooth sites (disto-buccal, mid-buccal, mesio-buccal, mid-lingual) for all teeth present. Of the individuals contacted, 28 had lost all their teeth during the 28 years. Of the 167 adults examined, two refused periodontal probing. Out of the 165 adults with LPA measurements in 1987, only 22 (13.3%) had an average increased loss of 2 mm or more per person between 1959 and 1987; five adults (3.0%) had an average LPA increase of 3 mm or more, and only two adults (1.2%) had an average LPA increase of 4 mm or more. The attachment level in 59.3% of all the tooth sites examined in 1959 in the 165 individuals either did not change or changed within +/- 1.0 mm. On the basis of bivariate analyses, the individuals with high LPA increase (greater than or equal to 2 mm) had the following characteristics significantly different from those with low LPA increase: They were older, smoked, had tooth mobility at baseline, higher gingivitis, plaque, calculus, and tooth mobility scores at follow-up, lower education level, and irregular dental attendance.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of sugars intake and frequency of ingestion on dental caries increment in a three-year longitudinal study.

A three-year longitudinal study was carried out with a group of children, initially aged 11-15, residing in non-fluoridated rural communities in south-central Michigan. This report analyzes the relation between caries increment and consumption of sugars from all sources to see if accepted relationships have changed with the caries decline in the United States. There were 499 children who provided three or more 24-hour dietary recall interviews, and who received dental examinations at baseline and after three years. Caries increment averaged 2.91 DMFS over the three years, with 81% of new lesions on pit-and-fissure surfaces. Consumption of sugars from all sources averaged 156 g per day for males and 127 g per day for females, an average of 52 kg per person per year. Sugars constituted one-quarter of total caloric intake for both boys and girls, and the average number of eating occasions per day was 4.3. Children who consumed a higher proportion of their total energy intake as sugars had a higher increment of approximal caries, though there was little relation to pit-and-fissure caries. The average number of daily eating occasions was not related to caries increment, nor was the average number of sugary snacks (defined as foods with 15% or more of sugars) consumed between meals, but the average consumption of between-meal sugars was related to the approximal caries increment. When children were categorized by high caries increment compared with no caries increment, a tendency toward more frequent snacks was seen in the high-caries children.(ABSTRACT TRUNCATED AT 250 WORDS)

A retrospective analysis of the cost-effectiveness of dental sealants in a children's health center.

A retrospective patient record analysis was conducted to study the cost-effectiveness of dental sealants placed under routine, unrestricted practice condition in a fluoridated community. The 26 dentists who provided care at the clinic over the period of the study used their own clinical judgement to determine sealant placement or alternative treatment. Dental services for 275 patients at a children's dental clinic for low-income families were evaluated. All children had at least 3 years between their first and last dental visit (mean = 5.8 years). A lifetable analysis was conducted to compare the probability of survival (restoration-free tooth years) and costs incurred to first molars of children who did not receive sealants, received any sealants, or received sealants on all first molars. Among the children with sealants, comparisons were also made between sealed and unsealed teeth in children who did and did not have a first molar restoration prior to sealant placement. Costs included the costs of sealants and restorative treatments for these teeth over time. Depending on the conditions under which sealants were placed, cost-savings or improving cost-effectiveness with time were found. A strategy of identifying children with prior restorations and sealing the remaining molars showed cost-savings within 4-6 years. For other comparisons, incremental cost-effectiveness ratios became more favorable over time.

Loss of periodontal attachment in HIV-seropositive military personnel.

The cross-sectional relationship between severe loss of periodontal attachment (LPA) and worsening immune status due to HIV infection was evaluated in 474 HIV-infected subjects (416 men, 58 women) aged 18 to 49 years who had been classified at stages 1 through 6 of the Walter Reed Army Institute of Research (WR) Staging Classification System. LPA was measured at four sites per tooth using a manual probe; severe LPA was defined as > or = 1 site/subject exhibiting > or = 5 mm LPA. Severe LPA was found in 94 (20%) of the subjects. Modeling with multiple logistic regression analysis revealed that WR stage and peripheral CD4+ lymphocyte cell counts were not significant independent predictors of severe LPA. Severe LPA was more common in subjects at WR stage 5 or 6 who exhibited oral candidiasis (OC), a marker of immune system damage, than in persons at those WR stages without OC (odds ratio = 7.85; 95% confidence interval (CI) = 1.94-31.81). After the analysis controlled for WR stage, younger subjects receiving AZT had greater odds of severe LPA than same-age subjects not taking the drug (e.g., odds ratio for subjects aged 30 years = 2.59; 95% CI = 1.22, 5.49). Other significant predictors in the model included male sex; retired military status; cigarette smoking; and presence of cratered, ulcerated, or necrotic interdental papillae. HIV-associated immune deficiency may be associated with localized severe LPA, but this may be an indirect association due to medication use, opportunistic infection, or other factors not captured by the WR staging system or peripheral CD4+ cell counts.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-insulin dependent diabetes mellitus and alveolar bone loss progression over 2 years.

This study tested the hypothesis that persons with non-insulin dependent diabetes mellitus (NIDDM) have greater risk of more severe alveolar bone loss progression over a 2-year period than those without NIDDM. Data from the longitudinal study of the oral health of residents of the Gila River Indian Community were analyzed for 362 subjects, aged 15 to 57, 338 of whom had less than 25% radiographic bone loss at baseline, and who did not develop NIDDM nor lose any teeth during the 2-year study period. The other 24 subjects had NIDDM at baseline, but met the other selection criteria. Bone scores (scale 0-4) from panoramic radiographs corresponded to bone loss of 0%, 1%-24%, 25%-49%, 50%-74%, or 75% and greater. Change in bone score category was computed as the change in worst bone score (WBS) reading after 2 years. Age, calculus, NIDDM status, time to follow-up examination, and baseline WBS were explanatory variables in regression models for ordinal categorical response variables. NIDDM was positively associated with the probability of a change in bone score when the covariates were controlled. The cumulative odds ratio for NIDDM at each threshold of the ordered response was 4.23 (95% C.I. = 1.80, 9.92). In addition to being associated with the incidence of alveolar bone loss (as demonstrated in previous studies), these results suggest an NIDDM-associated increased rate of alveolar bone loss progression.

Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus.

This study tested the hypothesis that severe periodontitis in persons with non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of poor glycemic control. Data from the longitudinal study of residents of the Gila River Indian Community were analyzed for dentate subjects aged 18 to 67, comprising all those: 1) diagnosed at baseline with NIDDM (at least 200 mg/dL plasma glucose after a 2-hour oral glucose tolerance test); 2) with baseline glycosylated hemoglobin (HbA1) less than 9%; and 3) who remained dentate during the 2-year follow-up period. Medical and dental examinations were conducted at 2-year intervals. Severe periodontitis was specified two ways for separate analyses: 1) as baseline periodontal attachment loss of 6 mm or more on at least one index tooth; and 2) baseline radiographic bone loss of 50% or more on at least one tooth. Clinical data for loss of periodontal attachment were available for 80 subjects who had at least one follow-up examination, 9 of whom had two follow-up examinations at 2-year intervals after baseline. Radiographic bone loss data were available for 88 subjects who had at least one follow-up examination, 17 of whom had two follow-up examinations. Poor glycemic control was specified as the presence of HbA, of 9% or more at follow-up. To increase the sample size, observations from baseline to second examination and from second to third examinations were combined. To control for non-independence of observations, generalized estimating equations (GEE) were used for regression modeling. Severe periodontitis at baseline was associated with increased risk of poor glycemic control at follow-up. Other statistically significant covariates in the GEE models were: 1) baseline age; 2) level of glycemic control at baseline; 3) having more severe NIDDM at baseline; 4) duration of NIDDM; and 5) smoking at baseline. These results support considering severe periodontitis as a risk factor for poor glycemic control and suggest that physicians treating patients with NIDDM should be alert to the signs of severe periodontitis in managing NIDDM.