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Context The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. Objectives (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. Data sources Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. Results In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 μmol/L (standardized mean difference [SMD], −0.83; 95%CI, −1.16 to −0.49; P  < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48  μmol/L or unknown (respective standardized mean differences: −0.23, 95%CI, −0.45 to −0.01, P  < 0.05; and −0.56; 95%CI: −1.19 to 0.06, P  < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11–28 μmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22–1.77; and 1.64; 95%CI: 1.32–2.03; P < 0.001 for both). Conclusion Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake. [ABSTRACT FROM AUTHOR]

Objectives: Birth season has been inconsistently associated with anthropometrics, bone fractures, and malocclusion. Our aim was to assess the association between birth season and anthropometrics (height, weight, birth weight), bone fractures and dental malocclusion in the United States. Methods: US surveys conducted between 1963‐1973 assessed 16 152 6‐to‐21‐year‐old participants. Prevalence ratios and mean differences were estimated using linear models using fall as reference. Results: Participants born in spring, when compared to fall, were of similar height (mean difference (MD) in height‐adjusted Z score 0.03, 95% Confidence Interval (CI): −0.01 to 0.08; P‐value =.17), weight (MD for weight‐adjusted Z‐score 0.00, 95% CI: −0.05 to 0.04; P‐value =0.83), had similar rates of bone fractures (Prevalence Rate [PR] 1.07; 95% CI: 0.94 to 1.22; P‐value =.28) and similar rates of dental malocclusion (MD of malocclusion index HLD −0.16; 95% confidence interval − 0.39 to 0.07; P =.18). Conclusion: We did not find an impact of birth season on anthropometrics, bone fractures, and dental malocclusions. [ABSTRACT FROM AUTHOR]

This study aims to determine whether breastfeeding duration affects the prevalence of nonrighthandedness in later life. A systematic search for studies on this topic was completed in 2018, and risk of bias was assessed by means of the Newcastle-Ottawa scale. Seven national surveys in five countries with Individual Participant Data (IPD) were identified (n = 62,129 mother-child dyads). These surveys had low risk of bias. An IPD meta-analysis showed that breastfeeding for < 1 month, 1 to 6 months, and > 6 months, when compared to bottle feeding, was associated with a 9%, 15% and 22% decreased prevalence of nonrighthandedness, respectively (Prevalence Ratio (PR) = 0.91, 95% confidence interval (ci): 0.83, 1.00; p-value = 0.05, PR = 0.85, 95% CI: 0.79, 0.92; p-value < 0.0001 and PR = 0.78; 95% CI: 0.71, 0.85; p-value < 0.0001). This dose-response relationship was significant (p < 0.001). No significant heterogeneity across surveys was detected (p-value > 0.54). Breastfeeding for longer than 9 months was not associated with further reductions in the prevalence for nonrighthandedness (p > 0.58). It is concluded that the critical age window for establishing hemispheric dominance in handedness includes the first 9 months of infancy and is in part determined by nurture. [ABSTRACT FROM AUTHOR]

Lower face variability in modern humans has been associated with a series of phenotypic characteristics including body architecture and handedness. The aim of this study was to provide a systematic review of lower face variability and handedness in national health surveys conducted in the United States. Three informative surveys with a total of 13,663 participants were identified. Lower face variability was described as one of six facial phenotypes and related to handedness using logistic regression models while adjusting for sex, ancestry, geography, and income. The results on 13,536 participants with complete information showed that bilateral retrognathism—a marker for a lower face phenotype characterized by a convex facial profile and slender jaws—was associated with a 25% increased odds for non-right-handedness (odds ratio, 1.250; 95% confidence interval: 1.076–1.453,p-value < .004). This association between non-right-handedness and a convex facial profile may unexpectedly find its origin in the genetic polymorphisms which determine tuberculosis susceptibility. [ABSTRACT FROM AUTHOR]

Objectives Fluctuating asymmetries in the craniofacial skeleton have been shown to be predictive for mortality from degenerative diseases. We investigate whether lower face asymmetries are a potential marker for the developmental origins of health and disease. Methods The lower face of a representative sample of 6654 12- to 17-year old United States (US) adolescents (1966-1970, National Health Examination Survey III) was classified as asymmetric when the mandibular teeth occluded prognathically (forward) or retrognathically (backward) on one side of the face only. It was investigated whether these lower face asymmetries were directional (preferentially to the left or the right) or fluctuating (random left-right distribution) in the US population. Results Lower face asymmetries affected 1 in 4 of the US adolescents. Unilateral retrognathic dental occlusions were fluctuating asymmetries, had a US prevalence of 17.0% (95% confidence interval: 15.5-18.4) and were associated with race/ethnicity ( P < .0001), not with handedness ( P < .7607). Unilateral prognathic dental occlusions were directional asymmetries ( P < .0001), had a US prevalence of 7.6% (95% confidence interval: 6.4-8.7) and were associated with large household size ( P < .001) and handedness ( P < .0223). Lower face asymmetries were not associated with distinct heritable traits such as color blindness. Conclusions The findings suggest that lower face asymmetries are a marker for environmental stress and cerebral lateralization during early development. [ABSTRACT FROM AUTHOR]

Aim To provide a narrative review of the role of macro- and micronutrients in relation to dental caries, gingival bleeding and destructive periodontal disease. Materials & Methods This review is based on systematic reviews (when available) and comparative human studies. Results Dental caries cannot develop without the presence of dietary fermentable carbohydrates, in particular sugar. The susceptibility to develop caries in the presence of carbohydrates may be influenced by genetics and micronutrients such as vitamin D. Gingival bleeding and destructive periodontal disease are sensitive markers to both abnormalities in macronutrient content (excessive carbohydrates or poly-unsaturated fat intake, deficient protein intake) and micronutrient intake (e.g. vitamin C and B12). Conclusion Dental caries and periodontal diseases are a sensitive alarm bell for an unhealthy diet, which predicts the future onset of the diseases of civilizations. [ABSTRACT FROM AUTHOR]

Vitamin D has been used to prevent and treat dental caries. The objective of this study was to conduct a systematic review of controlled clinical trials ( CCTs) assessing the impact of vitamin D on dental caries prevention. Random-effects and meta-regression models were used to evaluate overall and subgroup-specific relative-rate estimates. Twenty-four CCTs encompassing 2,827 children met the inclusion criteria. Twenty-two of the 24 CCTs predated modern clinical trial design, some of which nonetheless reported characteristics such as pseudo-randomization ( n = 2), blinding ( n = 4), or use of placebos ( n = 8). The relative-rate estimates of the 24 CCTs exhibited significant heterogeneity ( P < 0.0001), and there was evidence of significant publication bias ( P < 0.001). The pooled relative-rate estimate of supplemental vitamin D was 0.53 (95% CI, 0.43-0.65). No robust differences were identified between the caries-preventive effects of vitamin D2, vitamin D3, and ultraviolet radiation ( Prob > F = 0.22). The analysis of CCT data identified vitamin D as a promising caries-preventive agent, leading to a low-certainty conclusion that vitamin D may reduce the incidence of caries. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether statin use was associated with decreased tooth loss among patients with chronic periodontitis. Material and Methods: We evaluated administrative health plan data from 1996 to 2002 covering dental and periodontal treatment utilization, dental extractions, and prescription medication fills of 12,631 adults aged 48–64 in 2002. With tooth loss as the outcome, we evaluated a number of different patterns of statin prescription across time in multivariate generalized linear models. Results: Unadjusted, statin use was associated with increased tooth loss. After adjustment for potential confounders, there was no suggestion of either increased or decreased tooth loss associated with statin use. Conclusions: Statin use was not associated with either a decreased or an increased risk of tooth loss. [ABSTRACT FROM AUTHOR]

The goal of this study was to assess whether interruption of care for chronic periodontitis during pregnancy increased the risk of low-birthweight infants. A population-based case-control study was designed with 793 cases (infants < 2,500 g) and a random sample of 3,172 controls (infants ≥ 2,500 g). Generalized estimating equation models were used to relate periodontal treatment history to low birthweight risk and to common risk factors. The results indicate that periodontal care utilization was associated with a 2.35-fold increased odds of self-reported smoking during pregnancy (95% confidence interval: 1.48–3.71), a 2.19-fold increased odds for diabetes (95% confidence interval: 1.21–3.98), a 3.90-fold increased odds for black race (95% confidence interval: 2.31–6.61), and higher maternal age. After adjustment for these factors, interruption of periodontal care during pregnancy did not lead to an increased risk for a low-birthweight infant when compared to women with no history of periodontal care (odds ratio, 0.96; 95% confidence interval, 0.60–1.52). In conclusion, women receiving periodontal care had genetic and environmental characteristics, such as smoking, diabetes and race, that were associated with an increased risk for low-birthweight infants. Periodontal care patterns, in and of themselves, were unrelated to low-birthweight risk. [ABSTRACT FROM AUTHOR]

Compares destructive periodontal disease and periodontal atrophy. Clinical conditions of alveolar bone loss; Differences between the treatments and the economics of periodontal atrophy and destructive periodontal disease; Medical features of destructive periodontal disease and periodontal atrophy; Diagnosis of abnormal pocket depth in destructive periodontal disease.

The lack of a rigorous scientific basis for the measurement of periodontitis has led to an apparent ability to identify beneficial effects for almost any periodontal treatment. Positive treatment effects have been identified for a wide variety of local and systemic antibiotics, regenerative procedures, anti-inflammatory medications, metalloproteinase inhibitors, antimicrobials, surgical and nonsurgical techniques, and occasionally exotic treatments such as gold salts or biphosphonates. A periodontal endpoint is any measurement that is thought to be related to the periodontal disease process and that is used to assess periodontal treatment efficacy.

Context Both high- and low-dose radiation exposures in women have been associated with low-birth-weight offspring. It is unclear if radiation affects the hypothalamus-pituitary-thyroid axis and thereby indirectly birth weight, or if the radiation directly affects the reproductive organs. Objective To investigate whether antepartum dental radiography is associated with low-birth-weight offspring. Design A population-based case-control study. Participants and Setting Enrollees of a dental insurance plan with live singleton births in Washington State between January 1993 and December 2000. Cases were 1117 women with low-birth-weight infants (<2500 g), of whom 336 were term low-birth-weight infants (1501-2499 g and gestation ≥37 weeks). Four control pregnancies resulting in normal-birth-weight infants (≥2500 g) were randomly selected for each case (n = 4468). Main Outcome Measures Odds of low birth weight and term low birth weight by dental radiographic dose during gestation. Results An exposure higher than 0.4 milligray (mGy) during gestation occurred in 21 (1.9%) mothers of low-birth-weight infants and, when compared with women who had no known dental radiography, was associated with an adjusted odds ratio (OR) for a low-birth-weight infant of 2.27 (95% confidence interval [CI], 1.11-4.66, P = .03). Exposure higher than 0.4 mGy occurred in 10 (3%) term low-birth-weight pregnancies and was associated with an adjusted OR for a term low-birth-weight infant of 3.61 (95% CI, 1.46-8.92, P = .005). Conclusion Dental radiography during pregnancy is associated with low birth weight, specifically with term low birth weight. [ABSTRACT FROM AUTHOR]

PURPOSE: Periodontitis has been linked to the occurrence of various systemic diseases. The goal of this study was to explore the periodontitis–cancer association in the NHANES I Epidemiologic Follow-up Study.METHODS: Data were available on 11,328 adults, age 25 to 74 years, who were diagnosed as dentate individuals with either periodontitis (n = 2092), gingivitis (n = 2603), a healthy periodontium (n = 2,671), or as individuals without teeth (edentulous n = 3,962) at the beginning of the follow-up. The main outcome measure was fatal cancer, as ascertained from death certificates.RESULTS: Compared with individuals with a healthy periodontium, fatal cancer occurrence was positively associated with periodontitis at baseline (age and gender adjusted odds ratio = 1.55, 95% confidence interval: 1.25–1.92). Of the different cancer types, lung cancer demonstrated the strongest association. After adjustment for known risk factors for lung cancer, the magnitude of the association between periodontitis and lung cancer ranged between 1.48 (95% confidence interval: 0.88–2.50) and 1.73 (95% confidence interval: 1.01–2.97).CONCLUSIONS: Associations between periodontitis and lung cancer mortality can be identified above and beyond adjustment for known risk factors for lung cancer. Despite these apparent unconfounded associations, there are reasons to believe that the periodontitis-cancer associations may be spurious. [Copyright &y& Elsevier]

The article discusses the purpose of nonexperimental observational study designs while also explaining their strengths and weaknesses. These investigations are shown to be useful for the documentation of distribution of diseases in different populations. Despite of being extremely beneficial for developing critical appraisal skills and for guiding clinical research, such studies cannot be relied upon for clinical decision making.

OBJECTIVE-- To assess the hypothesis that retinopathies are indicative of systemic microvascular injury. RESEARCH DESIGN AND METHODS-- The only U.S. national survey assessing microvascular hemorrhaging at two distinct anatomical sites was the National Health and Nutrition Examination Survey (1988-1994). The systemic microvascular injury hypothesis was assessed by modeling the association of retinal and gingival hemorrhaging and the factors that explain this association. RESULTS-- Individuals in whom one or more in five gingival sites was hemorrhaging had a 57% increased odds for retinal hemorrhaging (95% CI: 1.26 -1.94). This association between retinal and gingival hemorrhaging was 51% explained by A1C concentrations. Retinal and gingival hemorrhaging exhibited the signature J-shaped prevalence patterns when plotted as a function of A1C concentrations. CONCLUSIONS-- Gingival hemorrhaging reflected on retinal hemorrhaging, and both shared chronic hyperglycemia as an explanatory marker. These epidemiological findings support the hypothesis that retinopathies are reflective of systemic microvascular injury. [ABSTRACT FROM AUTHOR]

The article discusses the link between destructive periodontal disease (DPD) and cannabis and tobacco smoking. One study involving 903 participants revealed that both cannabis and tobacco smoking were associated with a greater incidence of DPD prior to the age of 32, with tobacco use being perhaps the chief risk factor. The study adds to a growing body of evidence that DPD detected in early childhood can be a harbinger of unhealthy lifestyles. Consequently, the capacity for early detection by the dental profession is considerable.

Presents a letter to the editor about antepartum dental radiography and low birth weight.

Previous designs in split mouth caries clinical trials were found inefficient, as the response to treatments within individuals were weekly correlated. Four issues have been considered when contemplating the use of a split mouth design: bias, recruitment, efficiency, and statistical analysis. The split mouth design may lead to biased treatment efficacy estimates. Randomizing individuals, rather than split mouths, to treatments facilitates the recruitment process. The statistical analysis of a split mouth designs is complex. The essential feature of a split mouth is that treatment responses within an individual are correlated.

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p<0.0001) and smoking (p<0.0001). There was a dose-effect of smoking on the number of teeth. In the regression model, the variables that had a significantly-significant on residual ridge height (n=95 edentulous subjects) were age and gender. Our conclusion was that in elderly dental-school patients the number of teeth and residual ridge height were not influenced by fracture status. Age and smoking had the most influence ; there was no effect from HRT. The clinical implication is that a history of osteoporotic fractures is not an important cause for tooth loss and residual ridge resorption in an elderly dental-school population. [ABSTRACT FROM AUTHOR]

Objectives. We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy. Methods. We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System. Results. Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems. Conclusions. There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy. (Am J Public Health. 2004; 94:765-771). [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Bioarchaeological findings have linked defective enamel formation in preadulthood with adult mortality. We investigated how defective enamel formation in infancy and childhood is associated with risk factors for adult morbidity and mortality in adolescents. Methods: This cohort study of 349 Amerindian adolescents (10‐17 years of age) related extent of enamel defects on the central maxillary incisors (none, less than 1/3, 1/3 to 2/3, more than 2/3) to adolescent anthropometrics (height, weight) and biomarkers (hemoglobin, glycated hemoglobin, white blood cell count, and blood pressure). Risk differences and 95% confidence intervals were estimated using multiple linear regression. Enamel defects and stunted growth were compared in their ability to predict adolescent health indicators using log‐binomial regression and receiver operating characteristics (ROCs). Results: Greater extent of defective enamel formation on the tooth surface was associated with shorter height (–1.35 cm, 95% CI: −2.17, −0.53), lower weight (−0.98 kg, 95% CI: −1.70, −0.26), lower hemoglobin (−0.36 g/dL, 95% CI: −0.59, −0.13), lower glycated hemoglobin (−0.04 %A1c, 95% CI: −0.08, −0.00008), and higher white blood cell count (0.74 109/L, 95% CI: 0.35, 1.14) in adolescence. Extent of enamel defects and stunted growth independently performed similarly as risk factors for adverse adolescent outcomes, including anemia, prediabetes/type II diabetes, elevated WBC count, prehypertension/hypertension, and metabolic health. Conclusions: Defective enamel formation in infancy and childhood predicted adolescent health outcomes and may be primarily associated with infection. Extent of enamel defects and stunted growth may be equally predictive of adverse adolescent health outcomes. [ABSTRACT FROM AUTHOR]

Objectives We investigated the relationship between early childhood malnutrition-related measures and subsequent enamel defects in the permanent dentition. Materials and Methods This cohort study included 349 Amerindian adolescents (10-17 years, 52% male) from the Bolivian Amazon. Exposures included: stunted growth (height-for-age z-scores), underweight (weight-for-age z-scores), anemia (hemoglobin), acute inflammation (C-reactive protein) and parasitic infection (hookworm). We measured the occurrence (no/yes) and extent (<1/3, 1/3-2/3, >2/3) of enamel defects. We estimated associations between childhood exposures and enamel defect measures using log-binomial and multinomial logistic regression. Results The prevalence of an enamel defect characterized by an orange peel texture on a large central depression on the labial surface of the central maxillary incisors was 92.3%. During childhood (1-4 years), participants had a high prevalence of stunted growth (75.2%), anemia (56.9%), acute inflammation (39.1%), and hookworm infection (49.6%). We observed associations between childhood height-for-age (OR = 0.65; P = 0.028 for >2/3 extent vs. no EH) and gastrointestinal hookworm infection (OR = 3.43; P = 0.035 for >2/3 extent vs. no defects or <1/3 extent) with enamel defects. Discussion The study describes a possibly novel form of enamel hypoplasia and provides evidence for associations of malnutrition-related measures in early childhood, including stunted growth and parasitic helminth infection, with the observed enamel defects. [ABSTRACT FROM AUTHOR]

Background. A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Methods. The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. Practical Implications and Conclusions. For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak-, chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low. [ABSTRACT FROM AUTHOR]

Background. Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Methods. A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. Results. The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline micro-spheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). Conclusions and Practical Implications. With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline. [ABSTRACT FROM AUTHOR]

Background. A panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention. These recommendations are an update of the 2006 ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies. Types of Studies Reviewed. The authors conducted a search of MEDLINE and the Cochrane Library for clinical trials of professionally applied and prescription-strength topical fluoride agents-including mouthrinses, varnishes, gels, foams and pastes-with caries increment outcomes published in English through October 2012. Results. The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries- preventive agents. The panel makes recommendations for further research. Practical Implications. The panel recommends the following for people at risk of developing dental caries: 2.26 percent fluoride varnish or 1.23 percent fluoride (acidulated phosphate fluoride) gel, or a prescription-strength, home-use 0.05 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse for patients 6 years or older. Only 2.26 percent fluoride varnish is recommended for children younger than 6 years. The strengths of the recommendations for the recommended products varied from "in favor" to "expert opinion for." As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to provide an evidence-based clinical recommendations on the use of nonfluoride caries-preventive agents. It states that expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs present recommendations developed through a MEDLINE search. The panel of experts found and reviewed 50 randomized controlled trials and 15 nonrandomized studies to assess the efficacy of nonfluoride caries-preventive agents.

Purpose: Periodontitis has been linked to the occurrence of various systemic diseases. The goal of this study was to explore the periodontitis-cancer association in the NHANES I Epidemiologic Follow-up Study.Methods: Data were available on 11,328 adults, age 25 to 74 years, who were diagnosed as dentate individuals with either periodontitis (n = 2092), gingivitis (n = 2603), a healthy periodontium (n = 2,671), or as individuals without teeth (edentulous n = 3,962) at the beginning of the follow-up. The main outcome measure was fatal cancer, as ascertained from death certificates.Results: Compared with individuals with a healthy periodontium, fatal cancer occurrence was positively associated with periodontitis at baseline (age and gender adjusted odds ratio = 1.55, 95% confidence interval: 1.25-1.92). Of the different cancer types, lung cancer demonstrated the strongest association. After adjustment for known risk factors for lung cancer, the magnitude of the association between periodontitis and lung cancer ranged between 1.48 (95% confidence interval: 0.88-2.50) and 1.73 (95% confidence interval: 1.01-2.97).Conclusions: Associations between periodontitis and lung cancer mortality can be identified above and beyond adjustment for known risk factors for lung cancer. Despite these apparent unconfounded associations, there are reasons to believe that the periodontitis-cancer associations may be spurious. [ABSTRACT FROM AUTHOR]

Objectives: Recruitment for randomised clinical trials and community-based studies has received little attention in the dental literature. The goal of this study was to report on our experiences with direct and indirect recruitment methods for a trial to prevent tooth loss in elders. Methods: A direct approach, consisting of an introductory lecture with the help of a local contact person in each of the nine community centres, resulted in 208 recruits mostly from minority non-English speaking communities (52%), whereas the other 192 recruits who responded to newspaper announcements (48%) were, in large part, from the English-speaking community. Results: The response suggests that a more direct and culturally specific approach is more productive when recruiting elders from ethnic minority groups, whereas elders from the dominant culture can be recruited indirectly and for about half the financial cost through newspaper announcements. Conclusion: We conclude, therefore, that both direct and indirect methods are needed to recruit a multiethnic sample of subjects for a trial. [ABSTRACT FROM AUTHOR]

Presents several letters to the editor concerning medical issues. Questions concerning an article which assessed the risk of breast cancer in women with a family history of breast cancer from oral contraceptives; Rebuttal of an article which found a lack of connection between periodontal disease and risk of coronary heart disease; Criticism of an article which prescribed garlic consumption as a tick repellent; Others.

Caries examination and collection of paraffin wax-stimulated Saliva samples were performed in 37 children, 3-6 years old, in a child-care facility at the Vidigal slum. Rio de Janeiro, Brazil. The levels of mutans streptococci and lactobacilli in saliva were estimated by the Cariescreen and by the Dentocult tests and the saliva secretion rate was determined. Statistical analysis was performed on surface-based and patient-based caries prevalence rates (SBCPR and PBCPR ), and related to bacteria and salivary parameters. The results show that 31 of the 37 children were caries active. The SBCPR for the primary dentition was 6.7% ± 1.0%). Occlusal surfaces were the most affected by decay, Regression analysis revealed that mutans Streptococci salivary levels were significantly associated with the SBCPR (P = 0.0001). Similarly, lactobacilli salivary levels were significantly associated with the SBCPR (P = 0.0001). No significant association could be found between the saliva secretion rate and the SBCPR. When regression analysis was used to model dependence of the SBCPR on both organisms, the mutans streptococci and lactobacilli salivary levels were significantly associated with the SBCPRs (P = 0.0021 and 0.0118, respectively), and salivary levels of these organisms accounted for 57% of the SBCPR variability. These findings indicate that the levels of mutans streptococci and lactobacilli in saliva are significantly related to the SBCPRs on the primary dentition of these children. [ABSTRACT FROM AUTHOR]